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Curiosity is associated with increased learning, and developing curious individuals is an educational goal in its own right. This review uses Bioecological Systems Theory to examine how students’ curiosity can be supported in educational contexts. Understanding the nature of curiosity as a biopsychosocial characteristic that can change over time and its relation to other characteristics such as knowledge and epistemic beliefs provides insight into why some students may be more curious than others, or more curious in certain subject areas than others. Scaffolding uncertainty and other practices that instigate curiosity are an important means of increasing curiosity for learning. Overall, the development of students’ curiosity should account for the complex, nested structure of learning environments, including the culture of high-stakes testing.

Objective The quality of cancer-related information on social media (SM) is mixed, and exposure to inaccurate information may negatively affect knowledge, attitudes, and behaviors. This study examines SM users’ attention to simulated Facebook posts related to cancer and identifies message features associated with increased attention. Methods SM users (N = 53) participated in a mixed methods experimental study using eye-tracking technology, whereby participants’ dwell time on message components was measured. Stimuli conditions included message format (narrative/non-narrative), information veracity, source (organization/individual), and cancer topic (HPV vaccine and sunscreen safety). Results Pixel-size adjusted analyses revealed that average dwell time was longer on posts attributed to individuals and on narrative-based posts. The source of the message received nearly the same amount of dwell time as the text. Dwell time on other message components did not significantly differ by condition. Conclusion This study found that the source of a message attracted substantial attention, whereas other features were not associated with attention. The study illustrates how communication research can help us understand the processing of ubiquitous cancer-related messages on SM. Practical Implications Health communication practitioners should consider message features that garner attention when developing efforts to facilitate the exchange of evidence-based information and to mitigate the harms of misinformation.

Background Information avoidance tendencies have been found to be associated with lower intentions to pursue medically actionable genomic sequencing results, but less so among individuals who engage more in spontaneous self-affirmation. Yet these results were obtained with a largely non-Hispanic White, high-SES cohort. Purpose To assess these variables, their magnitude, and their associations in an African-descent cohort as part of the same ClinSeq® exome sequencing program. Methods Participants reported levels of spontaneous self-affirmation, information avoidance, and intentions to receive three types of results – medically actionable, non-medically actionable, and carrier status as part of a baseline survey. Results Relative to the original, non-Hispanic White cohort, those in the African-descent cohort had higher levels of spontaneous self-affirmation and lower intentions of learning about carrier genomic results; they reported comparable levels of information avoidance and intentions to receive other results. Information avoidance was negatively associated with intention to receive non-actionable results in the African-descent cohort, as found in the initial cohort, with no moderating effect of spontaneous self-affirmation. Information avoidance, spontaneous self-affirmation, and their interaction were not associated with intentions to receive actionable results (contrary to findings in the initial cohort), or carrier results. Conclusions Individuals of African descent may engage in relatively more spontaneous self-affirmation, and do not appear to engage in more information avoidance. Their information avoidance tendencies were associated with pursuit of non-actionable sequencing results, with no moderating effect of self-affirmation, and were not associated with pursuit of actionable results or carrier results.

Public trust in traditional sources of health information is essential for public health agencies and organizations to perform necessary public health functions. Little research has examined levels and predictors of trust in government health agencies and national health organizations. Additionally, few studies have simultaneously analyzed trust in multiple health topics. The major aim of this study was to compare levels and factors associated with trust in national health sources across three health topics: information about tobacco, electronic cigarettes, and general health. Data from two cycles of the National Cancer Institute’s Health Information National Trends Survey collected in 2015 and 2017 were merged and analyzed for this study (n = 5,474). A series of weighted multivariable logistic regression models calculated odds of high trust in government health agencies and health organizations for each health topic. More respondents reported high trust in health organizations than for government health agencies across all topics. More participants reported high trust in these sources tobacco information, as compared to general health or e-cigarette information. Logistic models found that those higher in information seeking confidence were more likely to report high trust across all models. Other demographic variables were inconsistent predictors of trust across topics. This study highlights inconsistent sociodemographic predictors of trust across multiple health topics and national health sources. Researchers, practitioners, and policymakers should consider the unique context of specific health topics in health promotion campaigns, partner with existing community-based organizations, and encourage and enable health information seeking.

Objectives A systematic review to analyze communication rates of complementary and integrative health (CIH) and analyze how communication terms, such as “disclosure,” are measured and operationalized. Methods We searched seven databases for studies published between 2010 and 2018 with quantitative measurements of patients’ communication of CIH to a biomedical clinician. We analyzed communication terms used to describe patients reporting CIH usage. We also examined the conceptual and operational definitions of CIH provided and whether those terms were explicitly operationalized. We aggregated the percentage, rate, or ratio of CIH users that communicated about CIH with their clinicians by disease type and geographical region. Results 7882 studies were screened and 89 included in the review. Studies used a wide range of conceptual and operational definitions for CIH, as well as 23 different terms to report communication related to reporting CIH usage. Usage varied by disease type and geographical region. Conclusions Studies of CIH and CIH communication may measure different kinds of social and communicative phenomena, which makes comparison across international studies challenging. Practice Implications Future studies should employ standardized, replicable measures for defining CIH and for reporting CIH communication. Clinicians can incorporate questions about prior, current, and future CIH use during the medical visit.

Highlights • Risk communication for viruses can be efficacious. • Results highlight the complexities of risk communication. • Risk communication for HIV/AIDS was more consistently efficacious as compared to influenza. • Various risk communication approaches were effective. • Tailoring risk communication to a population may be more efficacious., Objective In response to COVID-19, we conducted a rapid review of risk communication interventions to mitigate risk from viruses to determine if such interventions are efficacious. Methods We searched for risk communication interventions in four databases: Medline, PsycInfo, the ProQuest Coronavirus Research Database, and CENTRAL. The search produced 1572 articles. Thirty-one articles were included in the final review. Results Results showed risk communication interventions can produce cognitive and behavior changes around viruses. Results were more consistently positive for interventions focused on HIV/AIDS as compared to influenza. There was no consistent best intervention approach when comparing peer health, audio/visual, and intensive multi-media interventions. Tailoring risk communication toward a target population, in comparison to not tailoring, was related to better outcomes. Conclusion The results suggest that risk communication interventions can be efficacious at reducing risk from viruses. They also highlight the complexity of risk communication interventions. Additional research is needed to understand the mechanisms that lead risk communication to reduce risk from viruses. Practical value Results support risk communication interventions to reduce risk from viruses.

Background Effective communication of cancer-related genetic and genomic testing (CGT) with patients and the public is paramount to transforming and managing cancer prevention, detection, and care. Behavioral and social science theories could improve communication effectiveness and, in turn, health outcomes. Methods In this study, we characterized the use of theory in recent research on communication about CGT from 2010 to 2017. Results Of 513 empirical papers focusing on communication about CGT, only 119 (23%) utilized any theory in the study design. Behavior change and health psychology/cognitive representation theories (24.2% and 21.9%, respectively) were the most commonly used with minimal use of communication theories (3%). Theories were primarily used to guide hypotheses or research question development (73.9%), and for selecting measures or codes (68.9%). Approximately half of the papers (48.3%) related their study findings to the referenced theory. Fewer papers (14.3%) discussed implications of the findings for the theory. Conclusions While theories are being utilized to inform study design, few discuss their results in the context of theoretical implications and thus decrease potential generalizability. Greater use of theory could help scholars to identify and develop theories suited to this clinical context and inform our understanding of related communication processes more broadly.

Chronic rheumatic diseases often occur in women of reproductive age and the impact pregnancy has on rheumatic disease often varies depending on the condition. Medical management of rheumatic diseases during pregnancy may prevent joint or organ damage and minimize the adverse effects of the disease itself on pregnancy outcomes. Each patient requires individual assessment to control disease activity, while minimizing or avoiding medications with potential maternal or fetal toxicity. An open discussion with shared decision-making between patients, obstetricians, rheumatologists, and pharmacists is imperative to create an individualized treatment plan that meets patient’s goals. This paper will review the current literature available for use of disease modifying anti-rheumatic drugs and biologics during pregnancy and lactation, providing healthcare professionals with the most up-to-date information available.

Objective Pharmacogenomic testing (PGx) is expanding into psychiatric care. PGx could potentially offer a unique benefit to psychiatric patients, providing information about patients’ reaction to medications that could reduce the time and financial burdens of drug optimization. The aims of this study were to: (1) examine psychiatry patients’ familiarity and interest in PGx, and (2) explore how Uncertainty Management Theory relates to PGx testing in psychiatry. Method We surveyed psychiatric patients, measuring their PGx familiarity and interest, attitudes toward PGx testing, and preference for managing illness uncertainty. Results We analyzed data from 598 patients. Patients’ familiarity of PGx was low, but interest was high. Thirty percent of patients were familiar with the test from communication with their healthcare provider or their own online health information seeking. A preference for seeking information was a significant positive predictor of testing interest (p Conclusion Psychiatric patients were interested in PGx testing, regardless of their uncertainty management preferences. Practice implications This study is one of the first to examine psychiatric patients’ perspectives on PGx testing in mental health care. Our findings show that psychiatric patients are interested in the test and are familiar enough with PGx to be included in future research on the topic.

Growing evidence points to the significant amount of health misinformation on social media platforms, requiring users to assess the believability of messages and trustworthiness of message sources. This mixed methods experimental study fills this gap in research by examining social media users' (n = 53) trust assessment of simulated cancer-related messages using eye-tracking, surveys, and cognitive interviews. Posts varied by information veracity (evidence-based vs. non-evidence-based) and source type (government agency, health organization, lay individual); topics included HPV vaccination and sun safety. Among sources, participants reported trusting the government more than individuals, regardless of veracity. When viewing non-evidence-based messages, participants reported higher trust in health organizations than individuals. Participants with high trust in message source tended to report high message believability. Furthermore, attention (measured by total fixation duration) spent on viewing the source of the post was not associated with the amount of trust in the source of message, which suggests that participants may have utilized other cognitive heuristics when processing the posts. Through post-experiment interviews, participants described higher trust in government due to reputation and familiarity. Further verification of the quality of information is needed to combat the spread of misinformation on Facebook. Future research should consider messaging strategies that include sources that are already trusted and begin to build trust among other credible sources.

Introduction Emerging tobacco products have become increasingly popular, and the US Food and Drug Administration extended its authority to all products meeting the definition of a tobacco product in 2016. These changes may lead to shifts in public perceptions about tobacco products and regulation, and national surveys are attempting to assess these perceptions at the population level. This article describes the item development and cognitive interviewing of the tobacco product and regulation perception items included in two tobacco-focused cycles of the Health Information National Trends Survey (HINTS-FDA), referred to as HINTS-FDA. Methods Cognitive interviewing was used to investigate how respondents comprehended and responded to tobacco product and regulation perception items. Adult participants (n = 20) were selected purposively to oversample current tobacco users and were interviewed in two iterative rounds. Weighted descriptive statistics from the fielded HINTS-FDA surveys (N = 5474) were also calculated. Results Items were generally interpreted as intended, and participants meaningfully discriminated between tobacco products when assessing addiction perceptions. Response selection issues involved inconsistent reporting among participants with little knowledge or ambivalent opinions about either government regulation or tobacco products and ingredients, which resolved when a “don’t know” response option was included in the survey. The fielded survey found that a non-negligible proportion of the population do not have clear perceptions of emerging tobacco products or government regulation. Conclusions A “don’t know” response option is helpful for items assessing many emerging tobacco products but presents several analytic challenges that should be carefully considered. Multiple items assessing specific tobacco product and regulation perception items are warranted in future surveys. Implications The findings from this study can serve as a foundation for future surveys that assess constructs related to emerging tobacco products, harm perceptions across multiple tobacco products, and tobacco-related government regulatory activities. The data provide unique insight into item-specific motivation for selecting a “don’t know” response option for tobacco survey items.

Recently, the identification of several classes of aryl sulfonamides and acyl sulfonamides that potently inhibit NaV1.7 and demonstrate high levels of selectivity over other NaV isoforms have been reported. The fully ionizable nature of these inhibitors has been shown to be an important part of the pharmacophore for the observed potency and isoform selectivity. The requirement of this functionality, however, has presented challenges associated with optimization toward inhibitors with drug-like properties and minimal off-target activity. In an effort to obviate these challenges, we set out to develop an orally bioavailable, selective NaV1.7 inhibitor, lacking these acidic functional groups. Herein, we report the discovery of a novel series of inhibitors wherein a triazolesulfone has been designed to serve as a bioisostere for the acyl sulfonamide. This work culminated in the delivery of a potent series of inhibitors which demonstrated good levels of selectivity over NaV1.5 and favorable pharmacokinetics in rodents.

Introduction: Our aim is to investigate pediatric primary healthcare providers' (PPCPs) perceptions about e-cigarettes and current e-cigarette-related clinical practices with adolescents.Methods: I...

The voltage-gated sodium channel NaV1.7 has received much attention from the scientific community due to compelling human genetic data linking gain- and loss-of-function mutations to pain phenotypes. Despite this genetic validation of NaV1.7 as a target for pain, high quality pharmacological tools facilitate further understanding of target biology, establishment of target coverage requirements and subsequent progression into the clinic. Within the sulfonamide class of inhibitors, reduced potency on rat NaV1.7 versus human NaV1.7 was observed, rendering in vivo rat pharmacology studies challenging. Herein, we report the discovery and optimization of novel benzoxazine sulfonamide inhibitors of human, rat and mouse NaV1.7 which enabled pharmacological assessment in traditional behavioral rodent models of pain and in turn, established a connection between formalin-induced pain and histamine-induced pruritus in mice. The latter represents a simple and efficient means of measuring target engagement.

Background/Aims: Cancer clinical trials give patients access to state-of-the-art treatments and facilitate the translation of findings into mainstream clinical care. However, patients from racial and ethnic minority groups remain underrepresented in clinical trials. Primary care physicians are a trusted source of information for patients, yet their role in decision-making about cancer treatment and referrals to trial participation has received little attention. The aim of this study was to determine physicians’ knowledge, attitudes, and beliefs about cancer clinical trials, their experience with trials, and their interest in appropriate training about trials. Methods: A total of 613 physicians in the New York City area primarily serving patients from ethnic and racial minority groups were invited via email to participate in a 20-min online survey. Physicians were asked about their patient population, trial knowledge and attitudes, interest in training, and personal demographics. Using calculated scale variables, we used descriptive statistical analyses to better understand physicians’ knowledge, attitudes, and beliefs about trials. Results: A total of 127 physicians completed the survey. Overall, they had low knowledge about and little experience with trials. However, they generally had positive attitudes toward trials, with 41.4% indicating a strong interest in learning more about their role in trials, and 35.7% indicating that they might be interested. Results suggest that Black and Latino physicians and those with more positive attitudes and beliefs were more likely to be interested in future training opportunities. Conclusion: Primary care physicians may be an important group to target in trying to improve cancer clinical trial participation among minority patients. Future work should explore methods of educational intervention for such interested providers.

The contemporary healthcare system can help improve health literacy outcomes in two ways: first, by nurturing the skills and motivations needed for patients to be actively engaged in their own health and healthcare decisions; and, second, by creating a prepared and proactive healthcare system that adapts to patients' capacities and needs in efficacious ways. In 2001, the National Cancer Institute launched the Health Information National Trends Survey (HINTS) as a way for researchers and planners to understand how the public is interacting with a rapidly changing health information environment. Original iterations of the HINTS national probability sampling strategies took place on a biennial basis, but in subsequent years the protocol moved to a yearly administration. This yields a rich resource of cross-sectional, national surveillance data to evaluate for trends across and within vulnerable populations. Sixteen studies are presented from the published literature to illustrate how HINTS data were used to explore constructs of direct interest to health literacy researchers. Suggestions are given for how this ongoing public surveillance mechanism can be used: (a) to provide a sentinel view of how the public is interacting with information in the environment to address their health needs; (b) to generate research questions and hypotheses for further exploration using complementary methodologies; and

Because of its strong genetic validation, NaV1.7 has attracted significant interest as a target for the treatment of pain. We have previously reported on a number of structurally distinct bicyclic heteroarylsulfonamides as NaV1.7 inhibitors that demonstrate high levels of selectivity over other NaV isoforms. Herein, we report the discovery and optimization of a series of atropisomeric quinolinone sulfonamide inhibitors [Bicyclic sulfonamide compounds as sodium channel inhibitors and their preparation. WO 2014201206, 2014] of NaV1.7, which demonstrate nanomolar inhibition of NaV1.7 and exhibit high levels of selectivity over other sodium channel isoforms. After optimization of metabolic and pharmacokinetic properties, including PXR activation, CYP2C9 inhibition, and CYP3A4 TDI, several compounds were advanced into in vivo target engagement and efficacy models. When tested in mice, compound 39 (AM-0466) demonstrated robust pharmacodynamic activity in a NaV1.7-dependent model of histamine-induced pruritus (i...

Several reports have recently emerged regarding the identification of heteroarylsulfonamides as NaV1.7 inhibitors that demonstrate high levels of selectivity over other NaV isoforms. The optimization of a series of internal NaV1.7 leads that address a number of metabolic liabilities including bioactivation, PXR activation, as well as CYP3A4 induction and inhibition led to the identification of potent and selective inhibitors that demonstrated favorable pharmacokinetic profiles and were devoid of the aforementioned liabilities. The key to achieving this within a series prone to transporter-mediated clearance was the identification of a small range of optimal cLogD values and the discovery of subtle PXR SAR that was not lipophilicity dependent. This enabled the identification of compound 20, which was advanced into a target engagement pharmacodynamic model where it exhibited robust reversal of histamine-induced scratching bouts in mice.

Cancer screening is critical for early detection and a lack of screening is associated with late-stage diagnosis and lower survival rates. The goal of this review was to analyze studies that focused on the role of provider-patient communication in screening behavior for cervical, breast, and colorectal cancer. A comprehensive search was conducted in four online databases between 1992 and 2016. Studies were included when the provider being studied was a primary care provider and the communication was face-to-face. The search resulted in 3252 records for review and 35 articles were included in the review. Studies were divided into three categories: studies comparing recommendation status to screening compliance; studies examining the relationship between communication quality and screening behavior; and intervention studies that used provider communication to improve screening behavior. There is overwhelming evidence that provider recommendation significantly improves screening rates. Studies examining quality of communication are heterogeneous in method, operationalization and results, but suggest giving information and shared decision making had a significant relationship with screening behavior. Intervention studies were similarly heterogeneous and showed positive results of communication interventions on screening behavior. Overall, results suggest that provider recommendation is necessary but not sufficient for optimal adherence to cancer screening guidelines. Quality studies suggest that provider-patient communication is more nuanced than just a simple recommendation. Discussions surrounding the recommendation may have an important bearing on a person's decision to get screened. Research needs to move beyond studies examining recommendations and adherence and focus more on the relationship between communication quality and screening adherence.

Purpose: To assess the public’s trust in health information sources (ie, government health agencies, doctors, family/friends, charitable organizations, and religious leaders/organizations) from 2005 to 2015 and identify sociodemographics factors associated with high trust. Design: Cross-sectional. Setting: Health Information National Trends Survey, a US nationally representative publicly available data on health-related knowledge, behaviors, and attitudes. Participants: Data included 5 iterations (2005-2015) of US adults (2005: N = 5586, 2008: N = 7764, 2011: N = 3959, 2013: N = 3185, and 2015: N = 3738). Measures: Outcome variables were high trust in health information sources and independent variables were sociodemographics. Analysis: A descriptive analysis was conducted to track changes in trust over the past decade. The χ2 and multivariable logistic regression were conducted to assess sociodemographic associations in 2015. Results: Trust in health information across all sources remained stable from 2005 to 2015. Doctors were the most trusted source, followed by government health agencies. Sociodemographics were independently associated with trust. For example, non-Hispanic blacks were more likely to trust charitable organizations (odds ratio [OR] = 2.32, confidence interval [CI] = 1.42-3.79) and religious leaders/organizations (OR = 3.57, CI = 1.20-10.57) compared to non-Hispanic whites. In addition, those with less than high school education (OR = 2.44, CI = 1.32-4.52) were more likely than college graduates to report trust in religious leaders/organizations. Conclusion: Although there are analytic limitations to the specific time periods, the findings demonstrate that public health communication practitioners must consider the role of source credibility among priority populations when disseminating and promoting information.

Deregulation of the receptor tyrosine kinase mesenchymal epithelial transition factor (MET) has been implicated in several human cancers and is an attractive target for small molecule drug discovery. Herein, we report the discovery of compound 23 (AMG 337), which demonstrates nanomolar inhibition of MET kinase activity, desirable preclinical pharmacokinetics, significant inhibition of MET phosphorylation in mice, and robust tumor growth inhibition in a MET-dependent mouse efficacy model.

Purpose: The public health burden caused by tobacco is heavy among first-generation Chinese immigrant men whose home country has significantly higher smoking rates than the United States. The current study is part of a larger effort to pilot an mHealth tobacco cessation intervention using MMS (graphic) mobile phone technologies to target East Asian immigrant populations. Grounded in the Extended Parallel Process Model (EPPM), our specific aims were to determine what message themes, level of graphic intensity, and types of efficacy information are most appropriate and useful for mHealth interventions targeting this population. Methodology/Approach: A qualitative study utilizing a series of focus groups (k = 5) was conducted with male adult smokers who were born in China and currently reside in the United States. The primary aim of the focus groups was to solicit reactions to a series of preliminary messages developed by the research team. A secondary aim was to gauge receptivity to the use of MMS as a vehicle for smoking cessation intervention. Participants (n = 32) were recruited from local Chinese communities in a large Mid-Atlantic metropolitan area. Findings: Opinions about different message strategies were mixed. However, participants tended to rate messages more positively when they focused on the impact of smoking on family and loved ones, particularly children. Messages with fear-arousing images were also perceived to be effective at low frequency of exposure, but there were concerns that they may backfire at high exposure. Awareness of and interest in Quitline were low, and concrete quitting tips were perceived as more effective. Participants reported a preference for receiving messages a few times a week, and an MMS message platform was generally preferred to WeChat (a Chinese social media platform). Implications: Our results suggest that graphic MMS messaging holds promise as an effective intervention method for this population and that EPPM is an appropriate framework to develop, test, and analyze mHealth intervention messages. While messages that focused primarily on impact on children, health, and specific quitting tips were generally found to be more effective, a mix of different types of messages that address a wide range of issues may be most appropriate for this population. Originality/Value: This study is the first to explore the utility of graphic text messaging as an intervention method to promote smoking cessation among male Chinese immigrants. Findings from the study provide important insights for future intervention work targeting this underserved population.

Social workers collaborate with a wide range of healthcare providers in clinical trial teams, yet their roles may not always be understood or supported by team members. It is currently unknown how social workers and multidisciplinary team members perceive social workers' roles in the clinical trial context.Using a group case-study approach, social workers, core medical team members, and allied healthcare workers (n = 19) completed in-depth interviews to discuss the roles of social workers in a cancer clinical trial setting.Social workers discussed their role as primarily patient-centered, perceiving themselves to be a counselor, patient advocate, and conduit. They also described areas of perceived limited role contribution. Other members of the multidisciplinary teams viewed the roles of social workers to be focused on being a conduit and coordinator.We found discordance in the way that social workers and their team members view the roles of social workers in clinical trials. Our data suggest that structural and interpersonal barriers may prevent social workers from working to the full extent of their license in a clinical trial context. Implications, future research, and suggestions for interventions to more fully integrate social workers into clinical trial settings are discussed.

Cancer-related genetic and genomic testing (CGT) is changing cancer care by personalizing care options, leading to an era of precision medicine. Advances in and increased use of CGT add complexity to clinical communication. This landscape analysis assessed published reviews of communication issues related to CGT and discusses implications for practice and behavioral research. A comprehensive electronic literature search was conducted of peer-reviewed literature reviews on studies related to CGT communication published between January 2010 and January 2017, resulting in a final sample of 24 reviews. Reviews were categorized, with overlaps, into four domains across the genetic testing communication continuum. Reviews on CGT-related knowledge, attitudes, and perceptions (n = 8) found that despite substantial public interest, their knowledge and awareness remains low. Providers also reported insufficient knowledge and overall caution, particularly regarding direct-to-consumer (DTC) genetic testing. Reviews of decision-making about CGT and test uptake (n = 8) identified individual, interpersonal, and systems-level barriers to uptake. Reviews of patient-provider CGT communication (n = 8) revealed limited communication and little empirical research on outcomes of communication or efforts at improving clinical and family communication. There were mixed findings in reviews (n = 15) on the psychological and behavioral impact of CGT, and DTC testing particularly had little effect on behaviors. Taken together, there is very little extant research in CGT in minority and underserved communities. In order for scientific advances in CGT to translate into equitable, patient-centered care, behavioral research, including health literacy and communication, plays critical roles.

Background Angiotensin II (ANG II) stimulates fetal heart growth, though little is known regarding changes in cardiomyocyte endowment or the molecular pathways mediating the response. We measured cardiomyocyte proliferation and morphology in ANG II treated fetal sheep and assessed transcriptional pathway responses in ANG II and losartan (an ANG II type 1 receptor antagonist) treated fetuses. Methods In twin gestation pregnant sheep, one fetus received ANG II (50 μg/kg/min iv) or losartan (20 mg/kg/d iv) for 7 days; non-instrumented twins served as controls. Results ANG II produced increases in heart mass, cardiomyocyte area (left ventricle (LV) and right ventricle mononucleated and LV binucleated cells) and the percentage of Ki-67-positive mononucleated cells in the LV (all p< 0.05). ANG II and losartan produced generally opposing changes in gene expression, affecting an estimated 55% of the represented transcriptome. The most prominent significantly effected biological pathways included those involved in cytoskeletal remodeling and cell cycle activity. Conclusion ANG II produces an increase in fetal cardiac mass via cardiomyocyte hypertrophy and likely hyperplasia, involving transcriptional responses in cytoskeletal remodeling and cell cycle pathways.

Racial disparities exist in health care, even when controlling for relevant sociodemographic variables. Recent data suggest disparities in patient-physician communication may also contribute to racial disparities in health care. This study aimed to systematically review studies examining the effect of black race and racial concordance on patient-physician communication.A comprehensive search using the PRISMA guidelines was conducted across seven online databases between 1995 and 2016. The search resulted in 4672 records for review and 40 articles for final inclusion in the review. Studies were included when the sample consisted of black patients in healthcare contexts and the communication measure was observational or patient-reported. Data were extracted by pairs of authors who independently coded articles and reconciled discrepancies. Results were synthesized according to predictor (race or racial concordance) and communication domain.Studies were heterogeneous in health contexts and communication measures. Results indicated that black patients consistently experienced poorer communication quality, information-giving, patient participation, and participatory decision-making than white patients. Results were mixed for satisfaction, partnership building, length of visit, and talk-time ratio. Racial concordance was more clearly associated with better communication across all domains except quality, for which there was no effect.Despite mixed results due to measurement heterogeneity, results of the present review highlight the importance of training physicians and patients to engage in higher quality communication with black and racially discordant patients by focusing on improving patient-centeredness, information-giving, partnership building, and patient engagement in communication processes.

The number of pregnancies complicated by diabetes mellitus continues to increase throughout the developed world, a figure that will rise with the increasing prevalence of type 2 diabetes among young adult women 1,2. Infants of diabetic mothers represent a group of patients with an increased risk of perinatal mortality and morbidity, including cardiomyopathy, macrosomia, hypoglycemia, hypocalcemia, and respiratory distress syndrome 3. Recently, long-term complications in offspring of diabetic mothers have been recognized, including development of type 2 diabetes, dyslipidemia and obesity independently of the genetic background of the offspring 4–8. While considerable attention is focused on the increased metabolic abnormalities in adult offspring of diabetic mothers, cardiovascular alterations, including hypertension, are also lifelong consequences of in-utero exposure to maternal diabetes. In a Pima Indian population, offspring of mothers who suffered diabetes during pregnancy had higher systolic arterial blood pressure in adolescence compared with offspring of mothers who developed type 2 diabetes mellitus after the index pregnancy, independent of obesity 9. In a separate population enrolled in the Diabetes in Pregnancy follow-up study, 10–14 year old offspring of diabetic mothers had significantly higher systolic and mean arterial blood pressures than offspring of nondiabetic mothers 10. The etiology of hypertension in offspring of diabetic mothers (ODM) has not been extensively explored. The majority of studies examining cardiovascular dysfunction in ODM have used animals made diabetic either prior to pregnancy or early in pregnancy by injection of streptozotocin, an alkylating agent with selective toxicity to the beta cells of pancreatic islets 11. Studies in rats demonstrate that male but not female offspring of dams made diabetic prior to mating or on the 7th day of pregnancy are hypertensive by 2–3 months of age 12–14. Findings of these studies and others suggest changes in baroreflex sensitivity, vascular responsiveness, activity of the renin-angiotensin and NO systems and arachidonic acid metabolism may contribute to the development of hypertension in ODM 15,16. Because gestational onset diabetes, characterized by maternal hyperglycemia during the last third of gestation, is the most common form of diabetes to affect pregnancy, our laboratory has focused on a rat model whereby maternal hyperglycemia is induced by streptozotocin at the beginning of the third and final week of gestation. Using this model of maternal diabetes, with hyperglycemia moderated by twice daily insulin, we previously described significantly enhanced aortic contractility and endothelial dysfunction in female but not male offspring 17. We therefore sought to extend studies in this model to determine whether offspring exposed to short-term (7-day) maternal hyperglycemia in utero would display sex-specific increased blood pressure. As studies in animal models suggest abnormalities in autonomic function may precede overt hypertension, we also analyzed baroreflex control of heart rate 18. Finally, we chose to further our previously reported findings of altered ex vivo aortic vascular responsiveness and endothelial dysfunction in offspring of hyperglycemic mothers and explore potential mechanisms contributing to our previous observations. Diabetes during pregnancy is associated with increased markers of oxidative injury in the offspring 19,20. Thus, the isolated vessels studies focused on the contribution of reactive oxygen species to ex vivo aortic vascular dysfunction. Importantly, we cross-fostered all pups to non-diabetic mothers to insure that any identified pathophysiology would be related to the in utero environment and not alterations in postnatal nutritional intake or behavioral patterns associated with maternal diabetes.