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Autistic university students face stigma. Online trainings have been used to improve explicit autism stigma (social distance) and knowledge among university students in different countries. However, autistic university students have not typically been involved in developing such trainings. We developed two autism trainings: a participatory training (developed in collaboration with autistic university students) and a non-participatory training. We evaluated these trainings with undergraduate students in the United States and Lebanon. A pilot study revealed improvements in implicit biases (measured with an Implicit Association Test) and knowledge following both trainings, but no clear benefit of the participatory training in particular. Feedback revealed that participants found the Implicit Association Test tedious, suggesting that it might have dampened effects by boring participants. To increase engagement, we removed the Implicit Association Test and conducted a cross-university training comparison which revealed evidence that the participatory training was more effective than the non-participatory training at improving autism knowledge, explicit stigma, and attitudes toward inclusion. Autistic co-authors coded participant feedback and identified three key themes to guide future training development and adaptation: an (inter)personal element, accessibility, and clarity of information. These studies provide empirical support for the oft-cited, but rarely directed tested, benefits of involving autistic people in research about autism. [ABSTRACT FROM AUTHOR]

Background: Sensory peripheral neuropathy (PN) is associated with gait, balance problems and high fall risk. The walk2Wellness trial investigates effects of long-term, home-based daily use of a wearable sensory prosthesis on gait function, balance, quality of life and fall rates in PN patients. The device (Walkasins®, RxFunction Inc., MN, United States) partially substitutes lost nerve function related to plantar sensation providing directional tactile cues reflecting plantar pressure measurements during standing and walking. We tested the null hypothesis that the Functional Gait Assessment (FGA) score would remain unchanged after 10 weeks of use. Methods: Participants had PN with lost plantar sensation, gait and balance problems, an FGA score < 23 (high fall risk), and ability to sense tactile stimuli above the ankle. Clinical outcomes included FGA, Gait Speed, Timed Up&Go (TUG) and 4-Stage Balance Test. Patient-reported outcomes included Activities-Specific Balance Confidence (ABC) scale, Vestibular Disorders Activities of Daily Living Scale, PROMIS participation and satisfaction scores, pain rating, and falls. Evaluations were performed at baseline and after 2, 6, and 10 weeks. Subjects were not made aware of changes in outcomes. No additional balance interventions were allowed. Results: Forty-five participants of 52 enrolled across four sites completed in-clinic assessments. FGA scores improved from 15.0 to 19.1 (p < 0.0001), normal and fast gait speed from 0.86 m/s to 0.95 m/s (p < 0.0001) and 1.24 m/s to 1.33 m/s (p = 0.002), respectively, and TUG from 13.8 s to 12.5 s (p = 0.012). Four-Stage Balance Test did not improve. Several patient-reported outcomes were normal at baseline and remained largely unchanged. Interestingly, subjects with baseline ABC scores lower than 67% (high fall risk cut-off) increased their ABC scores (49.9% to 59.3%, p = 0.01), whereas subjects with ABC scores above 67% showed a decrease (76.6% to 71.8%, p = 0.019). Subjects who reported falls in the prior 6 months (n = 25) showed a decrease in the number of fall-risk factors (5.1 to 4.3, p = 0.023) and a decrease in fall rate (13.8 to 7.4 falls/1000 days, p = 0.014). Four pre-study non-fallers (n = 20) fell during the 10 weeks. Conclusion: A wearable sensory prosthesis presents a new way to treat gait and balance problems and manage falls in high fall-risk patients with PN. Trial registration: ClinicalTrials.gov (#NCT03538756). [ABSTRACT FROM AUTHOR]

Copyright of Journal of Traumatic Stress 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.)

The crisis intervention team (CIT) is a tool that can be used to foster pre-booking diversion of individuals with mental illness from the criminal justice system and into community treatment services. Although CIT is often implemented solely as the training of law enforcement officers, the model stipulates that CIT is a vehicle for collaboration with community stakeholders who share a similar philosophy, as well as expanded mental health services offering a 24 hour-seven days per week drop-off option for law enforcement officers. This case study presents the countywide implementation of CIT and expands previous findings on the prevalence of officer interaction with persons with mental health issues and CIT training outcomes, including changes in officer perception of individuals with mental health issues. Furthermore, analysis of the disposition of calls for officer assistance coded as mental health or suicide found significant increases in officer drop-offs to the mental health crisis center post-CIT training. Interrupted time series analysis determined that this change has been sustained over time, perhaps owing to the unique communication between county law enforcement and mental health staff. Implications for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND: The current single-chemical-as-carcinogen risk assessment paradigm might underestimate or miss the cumulative effects of exposure to chemical mixtures, as highlighted in recent work from the Halifax Project. This is particularly important for chemical exposures in the low-dose range that may be affecting crucial cancer hallmark mechanisms that serve to enable carcinogenesis. OBJECTIVE: Could ongoing low-dose exposures to a mixture of commonly encountered environmental chemicals produce effects in concert that lead to carcinogenesis? A workshop held at the NIEHS in August 2015 evaluated the scientific support for the low-dose mixture hypothesis of carcinogenesis and developed a research agenda. Here we describe the science that supports this novel theory, identify knowledge gaps, recommend future methodologies, and explore preventative risk assessment and policy decision-making that incorporates cancer biology, environmental health science, translational toxicology, and clinical epidemiology. DISCUSSION AND CONCLUSIONS: The theoretical merits of the low-dose carcinogenesis hypothesis are well founded with clear biological relevance, and therefore, the premise warrants further investigation. Expert recommendations include the need for better insights into the ways in which noncarcinogenic constituents might combine to uniquely affect the process of cellular transformation (in vitro) and environmental carcinogenesis (in vivo), including investigations of the role of key defense mechanisms in maintaining transformed cells in a dormant state. The scientific community will need to acknowledge limitations of animal-based models in predicting human responses; evaluate biological events leading to carcinogenesis both spatially and temporally; examine the overlap between measurable cancer hallmarks and characteristics of carcinogens; incorporate epigenetic biomarkers, in silico modelling, high-performance computing and high-resolution imaging, microbiome, metabolomics, and transcriptomics into future research efforts; and build molecular annotations of network perturbations. The restructuring of many existing regulatory frameworks will require adequate testing of relevant environmental mixtures to build a critical mass of evidence on which to base policy decisions. CITATION: Miller MF, Goodson WH III, Manjili MH, Kleinstreuer N, Bisson WH, Lowe L. 2017. Low-Dose Mixture Hypothesis of Carcinogenesis Workshop: scientific underpinnings and research recommendations. Environ Health Perspect 125:163-169; http://dx.doi.org/10.1289/EHP411 [ABSTRACT FROM AUTHOR]

Background: There is a lack of evidence to manage veterans with service-related mental health problems. This research aimed to develop an optimally effective, feasible, and acceptable integrated care pathway (ICP).Methods: A prototype ICP was developed through an initial modeling phase. Systematic reviews informed a portfolio of information for key stakeholders to discuss in a series of focus groups and semistructured interviews. They included 16 mental health professionals with expertise in the fields of mental health provision for military personnel, and 6 veterans with a history of mental illness. Data were analyzed through Inductive Thematic Analysis and used to inform the content, delivery, and guidance of an ICP. The prototype was piloted with 20 veterans in two pilot studies and refined on the basis of their quantitative and qualitative feedback.Results: The final ICP was agreed with additional guidance notes. It included three pathways covering referral, intervention, and management of veterans. Qualitative and quantitative results supported its efficacy in terms of reducing mental health symptoms and its acceptability to veterans.Conclusions: A specific veteran ICP shows promise as an effective and acceptable way of treating veterans with service related mental health problems. [ABSTRACT FROM AUTHOR]

To determine patient characteristics associated with isoniazid resistance in cases of tuberculous meningitis, we conducted a cross-sectional study by using data from the US National Tuberculosis Surveillance System during 1993-2005. Foreign-born patients were more likely to be infected with an isoniazid-resistant strain. [ABSTRACT FROM AUTHOR]

Billions of songbirds migrate several thousand kilometers from breeding to wintering grounds and are challenged with crossing ecological barriers and facing displacement by winds along the route. A satisfactory explanation of long-distance animal navigation is still lacking, partly because of limitations on field-based study. The navigational tasks faced by adults and juveniles differ fundamentally, because only adults migrate toward wintering grounds known from the previous year. Here, we show by radio tracking from small aircraft that only adult, and not juvenile, long-distance migrating white-crowned sparrows rapidly recognize and correct for a continent-wide displacement of 3,700 km from the west coast of North America to previously unvisited areas on the east coast. These results show that the learned navigational map used by adult long-distance migratory songbirds extends at least on a continental scale. The juveniles with less experience rely on their innate program to find their distant wintering areas and continue to migrate in the innate direction without correcting for displacement. [ABSTRACT FROM AUTHOR]

We reviewed the behavior of wildfire in riparian zones, primarily in the western United States, and the potential ecological consequences of postfire logging. Fire behavior in riparian zones is complex, but many aquatic and riparian organisms exhibit a suite of adaptations that allow relatively rapid recovery after fire. Unless constrained by other factors, fish tend to rebound relatively quickly, usually within a decade after a wildfire. Additionally, fire and subsequent erosion events contribute wood and coarse sediment that can create and maintain productive aquatic habitats over time. The potential effects of postfire logging in riparian areas depend on the landscape context and disturbance history of a site; however, available evidence suggests two key management implications: (1) fire in riparian areas creates conditions that may not require intervention to sustain the long-term productivity of the aquatic network and (2) protection of burned riparian areas gives priority to what is left rather than what is removed. Research is needed to determine how postfire logging in riparian areas has affected the spread of invasive species and the vulnerability of upland forests to insect and disease outbreaks and how postfire logging will affect the frequency and behavior of future fires. The effectiveness of using postfire logging to restore desired riparian structure and function is therefore unproven, but such projects are gaining interest with the departure of forest conditions from those that existed prior to timber harvest, fire suppression, and climate change. In the absence of reliable information about the potential consequence of postfire timber harvest, we conclude that providing postfire riparian zones with the same environmental protections they received before they burned is justified ecologically. Without a commitment to monitor management experiments, the effects of postfire riparian logging will remain unknown and highly contentious. [ABSTRACT FROM AUTHOR]

Presents a radio commentator's conversation with the chief spokesperson of the administration of U.S. President George W. Bush concerning war on terrorism.

Copyright of Canadian Bar Review is the property of Canadian Bar Association 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.)

Since 1985, the prevalence of Autism Spectrum Disorder (ASD) has been increasing, and few theories account for a true increase in prevalence rates. Elevated cerebrospinal fluid (CSF) in the extra axial region of the brain is an early biomarker of ASD, and the side sleeping position allows for more efficient CSF filtration. Therefore, we proposed that infants who slept on their sides during the first 6 months of life would exhibit less severe ASD symptoms. Parents/guardians of 53 children with a confirmed ASD diagnosis and 47 parents/guardians of typically developing children ages 2 to 4 in the United States. Parents were asked to recall the percentage of time their child spent in various sleeping positions during the first six months of life. Additionally, the severity of ASD symptoms were measured using a modified version of Baby and Infant Screen for Children with Autism Traits. In children diagnosed with ASD, increased side sleeping was associated with lowered severity in ASD symptoms, and increased back sleeping was associated with increased severity in ASD symptoms. Results provide evidence of a relationship between increased time in side-sleeping positions and lower ASD severity in children with ASD. Additional research is needed to further explore the relation between sleeping position and ASD symptom severity. [ABSTRACT FROM AUTHOR]

Assesses the impact of HIV epidemic in emergency department patients at the Johns Hopkins Hospital Emergency Department in Baltimore, Maryland. Factors influencing the quality of emergency services; Need for the development of strategies for appropriate use of emergency resources and for maximizing health care provider protection; Implications for medical care.

Airlift crews were exposed to extended work periods, reduced sleep periods, night work, and circadian dysrhythmia caused by shift work and time-zone crossings during Operations Desert Shield and Desert Storm. This research reveals the extent to which severe subjective fatigue was experienced by the crews during Operation Desert Storm. In addition, through the evaluation of long-term and short-term work and sleep histories, this research shows that recent sleep and flight histories are correlated with high fatigue levels. Furthermore, we found a tendency for fatigue to correspond with pilot error. We recommend that the training of personnel involved in long-duration operations include fatigue management strategies and, further, that work policies and environments be designed to take into account the importance of regular and restorative sleep when unusual duty hours are required. [ABSTRACT FROM AUTHOR]

The author comments on the study concerning the President's Emergency Plan for AIDS Relief (PEPFAR) in the U.S. He mentions that researchers provide limited but valuable evidence that PEPFAR is achieving some of its goals. He stresses that the limited scope of the study highlights the importance of bringing program implementers to determine the best metrics for evaluating the effects of the program. Moreover, he states that detailed program evaluation is political necessity.

Study Design: A retrospective database review.Objective: The aim of this study was to examine whether patient characteristics, distribution of care, and patient outcomes for spinal cord injury (SCI) in the United States have changed between 2001 and 2012.Summary Of Background Data: Although patient outcomes after cranial injury are better at high-volume centers with specialized, multidisciplinary teams, similar assessments have not been done for spinal injuries.Methods: We retrospectively reviewed the National and Nationwide Inpatient Samples for the years 2001, 2002, 2011, and 2012 to identify patients with spinal fracture with or without SCI. The demographic characteristics of the patient cohort, clinical course, hospital characteristics, interhospital transfer, and disposition were statistically analyzed relative to patient mortality, total hospital costs, and length of stay. How these data changed over this 11-year period was also evaluated.Results: A total of 159,875 cases were identified, with 141,737 fractures without SCI and 18,138 SCIs with or without fracture. There was a statistically significant decrease in the percentage of patients transferred with spine injury from 4.2% to 3.4% (P < 0.001) from the early years to the later years and in patient transfers for SCIs (8.1% vs. 6.5%, P < 0.001). Interestingly, the overall mortality rate (3.5% vs. 3.6%) remained unchanged (P = 0.679), but mortality from SCI increased (6.6-7.4%, P = 0.021).Conclusion: From 2002 to 2012, the rate of interhospital transfer of spinal injury patients declined, while the mortality rate for patients with SCI increased. Interestingly, there was an increase in transfers after spinal surgery at the index hospital. The decentralization of spine care may be responsible for the increase in mortality.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

The article offers updates on the developments of the nonprofit organization New England Water Environment Association (NEWEA) which continued to provide an exceptional service relevant to water and wastewater treatment across the U.S. It mentions its various activities to influence public policy including its Congressional Briefing. The move to create an updated brand identity for consistent, clear and effective communications between its constituents and audiences is also unveiled.

Background: The economic impact of intra-articular hyaluronic acid (IAHA) for the treatment of knee pain associated with osteoarthritis (OA) has been evaluated in the United States, but not systematically summarized. Objective: We reviewed the literature to determine the economic impact of IAHA for pain associated with knee OA in the United States. Methods: A literature review was performed in PubMed (including MEDLINE and MEDLINE In-Process), Embase, the Cochrane Database of Systematic Reviews, and National Health Service Economic Evaluation Database and was limited to English language human studies published from January 2000 to October 2020. Results: The literature search identified 215 unique abstracts; of these, 47 were selected for full-text review and 21 studies met the inclusion criteria. Intra-articular hyaluronic acid injections delayed progression to total knee arthroplasty (TKA), and repeated courses of treatment successfully delayed TKA by more than 5 years. Intra-articular hyaluronic acid was found to reduce the use of pain medications overall and reduce the number of patients receiving opioid prescriptions by 6% (P <.001). Several studies showed that IAHA is more cost-effective in treating pain associated with knee OA compared with conventional care with nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, and corticosteroids, and several authors concluded that IAHA should be the dominant treatment strategy. Conclusions: Current studies suggest that IAHA may reduce the use of pain medications, such as NSAIDs and opioids, and impact time to TKA procedures, thus potentially decreasing overall treatment costs of knee OA over time. Furthermore, IAHA was determined to be cost-effective against NSAIDs, corticosteroids, analgesics, and conservative treatment. As the safety and efficacy of IAHA for knee OA have been well established, the findings from our literature review may be used to inform future economic evaluations. [ABSTRACT FROM AUTHOR]

Regional differences in outcomes after spine surgery are poorly understood. We assessed disability and quality-of-life outcomes by geographic region in the United States using the NeuroPoint Alliance Quality Outcomes Database. We queried the prospective Quality Outcomes Database patient registry to identify patients who underwent elective 1- or 2-level lumbar surgery for grade I degenerative spondylolisthesis from July 2014 through June 2016. Primary outcome measures included Oswestry Disability Index (ODI) and EuroQOL-5D (EQ-5D) reported at 24 months postoperatively. Differences in EQ-5D and ODI were compared across geographic regions of the United States (Northeast, Midwest, South, West). We identified 608 patients from 12 centers who underwent surgery. Of these, 517 (85.0%) had ODI data and 492 (80.9%) had EQ-5D data at 24 months. Southern states had the largest representation (304 patients; 5 centers), followed by Northeastern (114 patients; 3 centers), Midwestern (96 patients; 2 centers), and Western (94 patients; 2 centers) states. Baseline ODI scores were significantly different among regions, with the South having the greatest baseline disability burden (Northeast: 40.9 ± 16.9, South: 51.2 ± 15.8, Midwest: 40.9 ± 17.8, West: 45.0 ± 17.1, P < 0.001). The change in ODI at 24 months postoperatively was significantly different among regions, with the South showing the greatest ODI improvement (Northeast: −21.1 ± 18.2, South: −26.5 ± 20.2, Midwest: −18.2 ± 22.9, West: −21.7 ± 19.6, P < 0.001). All regions had ≥60% achievement of the minimum clinically important difference in ODI at 24 months postoperatively. No regional differences were observed for EQ-5D. Significant regional variation exists for disability outcomes, but not quality of life, at 24 months after spinal surgery for grade I degenerative spondylolisthesis. [ABSTRACT FROM AUTHOR]

Spine fractures, including associated spinal cord injury, account for 3%–6% of all skeletal fractures annually in the United States. Patients who undergo interhospital transfer after injury may have a greater likelihood of nonroutine disposition, longer hospital stay, and higher cost. We evaluated the effects of patient transfer on functional outcomes after spine trauma. Patients were treated after acute traumatic spine injury at a rehabilitation hospital in 2011–2017. Compared patients were those directly admitted to the tertiary hospital or transferred from a community hospital. A total of 188 patients (mean age 46.1 ± 18.6 years, 77.1% men) were evaluated, including 130 (69.1%) directly admitted and 58 (30.9%) transferred patients. The most common levels of injury were at C5 (19.1%) and C6 (12.2%), and most injuries were American Spinal Injury Association injury severity score grade D (33.2%) or grade A (32.1%). No statistical difference in age, injury pattern, timing from injury to surgery, or rehabilitation length of stay was seen between admitted and transferred patients. A significant improvement in ambulation distances was seen at discharge for directly admitted compared with transferred patients (447.7 ± 724.9 vs. 159.9 ± 359.5 feet; P = 0.005). However, no significant difference primary outcomes, namely American Spinal Injury Association injury severity score distribution (P = 0.2) or Functional Independence Measures (Δ30.9 ± 15.9 vs. 30.1 ± 17.1; P = 0.7), were seen between admitted and transferred patients at time of rehabilitation discharge. Interhospital transfer status did not diminish time to rehabilitation after injury or reduce functional recovery, suggesting early surgical treatment in community settings may have merit prior to transfer. [ABSTRACT FROM AUTHOR]

Background Prescription opioid medications negatively affect postoperative outcomes after lumbar spine surgery. Furthermore, opioid-related overdose death rates in the United States increased by 200% between 2000 and 2014. Thus, alternatives are imperative. Mindfulness-based stress reduction (MBSR), a mind-body therapy, has been associated with improved activity and mood in opioid-using patients with chronic pain. This study assessed whether preoperative MBSR is an effective adjunct to standard postoperative care in adult patients undergoing lumbar spine surgery for degenerative disease. Methods The intervention group underwent a preoperative online MBSR course. The comparison group was matched retrospectively in a 1:1 ratio by age, sex, type of surgery, and preoperative opioid use. Prescription opioid use during hospital admission and at 30 days postoperatively were compared with preoperative use. Thirty-day postoperative patient-reported outcomes for pain, disability, and quality of life were compared with preoperative patient-reported outcomes. Dose-response effect of mindfulness courses was assessed using Mindful Attention Awareness Scale scores. Results In this pilot study, 24 participants were included in each group. Most intervention patients (70.83%) completed 1 session, and the mean Mindful Attention Awareness Scale score was 4.28 ± 0.71 during hospital admission. At 30 days, mean visual analog scale back pain score was lower in the intervention group (P = 0.004) but other patient-reported outcomes did not differ. Conclusions During hospital admission, no significant dose-response effect of mindfulness techniques was found. At 30 days postoperatively, MBSR use was associated with less back pain. Further research is needed to assess the effectiveness of preoperative MBSR on postoperative outcomes in lumbar spine surgery for degenerative disease. Highlights • During admission, there was no dose-response effect of mindfulness on opioid intake. • At 30 days, MBSR participants had lower mean VAS-BP scores. • There was no difference in morphine-equivalent dosing at 30-day follow-up. [ABSTRACT FROM AUTHOR]