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We previously developed 2 complementary surveys to measure coordination of care as experienced by the specialist and the primary care provider (PCP). These Coordination of Specialty Care (CSC) surveys were developed in the Veterans Health Administration (VA), under an integrated organizational umbrella that includes a shared electronic health record (EHR).To develop an augmented version of the CSC-Specialist in the private sector and use that version (CSC-Specialist 2.0) to examine the effect of a shared EHR on coordination.We administered the survey online to a national sample of clinicians from 10 internal medicine subspecialties. We used multitrait analysis and confirmatory factor analysis to evaluate the psychometric properties of the original VA-based survey and develop an augmented private sector survey (CSC-Specialist 2.0). We tested construct validity by regressing a single-item measure of overall coordination onto the 4 scales. We used analysis of variance to examine the relationship of a shared EHR to coordination.Psychometric assessment supported the 13-item, 4-scale structure of the original VA measure and the augmented 18-item, 4-scale structure of the CSC-Specialist 2.0. The CSC-Specialist 2.0 scales together explained 45% of the variance in overall coordination. A shared EHR was associated with significantly better scores for the Roles and Responsibilities and Data Transfer scales, and for overall coordination.The CSC-Specialist 2.0 is a unique survey that demonstrates adequate psychometric performance and is sensitive to use of a shared EHR. It can be used alone or with the CSC-PCP to identify coordination problems, guide interventions, and measure improvements.

Introduction: Coordination of care between primary care physicians (PCPs) and specialists is crucial in providing safe, efficient specialty care for referred patients, but shortcomings in coordination are common. Objective: Examine endocrinologists’ experience of coordination with PCPs and examine the relationship of a shared EHR to coordination. Methods: We surveyed a national sample of US endocrinologist members of the Endocrine Society (ES) or American Association of Clinical Endocrinologists (AACE), using a previously-developed online survey for specialists about care coordination1. ES and AACE included a link in a web-based newsletter and dedicated email. Four multi-item scales included 18 items measuring aspects of coordination with PCPs in the past 3 months: Communication (timeliness and helpfulness), Data Transfer (timeliness and usability), Relationships (mutually respectful), and Roles and Responsibilities (referral clarity, sufficiency, and appropriateness). Item responses and scale scores were on a 7-point frequency scale. A single-item measure of overall coordination with PCPs was measured on a 10-point scale (0 worst possible to 10 best possible). We asked “With about how many referring PCPs do you share an EHR?”. We examined frequencies of individual item responses (≤30%, about 50%, or ≥ 70% of the time) and extent of shared EHR with PCPs (None, Some, All), calculated mean scale scores (range 1-7) and used ANOVA to examine the relationship of a shared EHR to coordination scales and overall coordination. Results: Of 236 respondents: 35% age ≥ 60, 44% female, 80% ≥ 75% clinical effort. The highest frequency of good coordination (≥70% of the time) was reported for: aligned expectations of roles (84%), feeling valued by PCPs (80%) and clear division of responsibilities (70%). The lowest frequency of good coordination was for: kept informed by PCP about relevant issues (14%), and PCPs adequately evaluated prior to referring (18%). Mean (SD) for scale scores were: Communication 4.2 (1.0), Data Transfer 4.2 (1.1), Relationships 4.9 (0.8), Roles and Responsibilities 4.2 (0.9). The score for overall coordination with PCPs was 6.0 (1.9). Sharing an EHR with more PCPs was associated with higher Data Transfer scores (None, N=59, 3.9 (1.0), Some, N=126, 4.1 (0.9), All, N=26, 5.4 (0.8), P for trend Conclusions: There are opportunities for improvement across all aspects of inter-clinician coordination for endocrinology referrals. Use of a shared EHR improves data transfer, but not other aspects of coordination. 1. Vimalananda VG, Fincke BG, Qian S, et al. Development and psychometric assessment of a novel survey to measure care coordination from the specialist’s perspective. Health Serv Res. 2019;54(3):689-699.

During 2013–2015, an outbreak of dolphin morbillivirus (DMV) occurred in the western North Atlantic, which resulted in the stranding of over 1,600 common bottlenose dolphins (Tursiops truncatus). There are currently five coastal and 10 bay, sound, and estuary dolphin stocks along the U.S. Atlantic coast, yet there is very limited understanding of which stocks were exposed to DMV during the recent outbreak, or how DMV was transmitted across stocks. In order to address these questions, information is needed on spatial overlap and stock interactions. The goals of this project were to determine ranging patterns, prevalence of DMV, and spatial overlap of the South Carolina‐Georgia (SC‐GA) Coastal Stock, and adjacent Southern Georgia Estuarine System (SGES) Stock. During September 2015, a health assessment and telemetry study was conducted in which 19 dolphins were captured, tested for antibodies to DMV, and satellite tagged. Dolphins were classified into one of three ranging patterns (Coastal, Sound, or Estuary) based upon telemetry data. Coastal dolphins (likely members of the SC‐GA Coastal Stock) had a significantly higher prevalence of positive DMV antibody titers (0.67; N = 2/3), than Sound and Estuary dolphins (likely members of the SGES Stock) (0.13; N = 2/16). These results suggest that the SC‐GA Coastal Stock may have experienced greater exposure to DMV as compared to the SGES Stock. However, due to the small size of the SGES Stock and its exposure to high levels of persistent contaminants, this stock may be particularly vulnerable to DMV infection in the future.

The Mouse Genome Database (MGD; http://www.informatics.jax.org) is the community model organism genetic and genome resource for the laboratory mouse. MGD is the authoritative source for biological reference data sets related to mouse genes, gene functions, phenotypes, and mouse models of human disease. MGD is the primary outlet for official gene, allele and mouse strain nomenclature based on the guidelines set by the International Committee on Standardized Nomenclature for Mice. In this report we describe significant enhancements to MGD, including two new graphical user interfaces: (i) the Multi Genome Viewer for exploring the genomes of multiple mouse strains and (ii) the Phenotype-Gene Expression matrix which was developed in collaboration with the Gene Expression Database (GXD) and allows researchers to compare gene expression and phenotype annotations for mouse genes. Other recent improvements include enhanced efficiency of our literature curation processes and the incorporation of Transcriptional Start Site (TSS) annotations from RIKEN’s FANTOM 5 initiative.

The mouse Gene Expression Database (GXD) is an extensive, well-curated community resource freely available at www.informatics.jax.org/expression.shtml. Covering all developmental stages, GXD includes data from RNA in situ hybridization, immunohistochemistry, RT-PCR, northern blot and western blot experiments in wild-type and mutant mice. GXD’s gene expression information is integrated with the other data in Mouse Genome Informatics and interconnected with other databases, placing these data in the larger biological and biomedical context. Since the last report, the ability of GXD to provide insights into the molecular mechanisms of development and disease has been greatly enhanced by the addition of new data and by the implementation of new web features. These include: improvements to the Differential Gene Expression Data Search, facilitating searches for genes that have been shown to be exclusively expressed in a specified structure and/or developmental stage; an enhanced anatomy browser that now provides access to expression data and phenotype data for a given anatomical structure; direct access to the wild-type gene expression data for the tissues affected in a specific mutant; and a comparison matrix that juxtaposes tissues where a gene is normally expressed against tissues, where mutations in that gene cause abnormalities.

Older adults with multiple chronic conditions (MCCs) receive care that is fragmented and burdensome, lacks evidence, and most importantly is not focused on what matters most to them. An implementation feasibility study of Patient Priorities Care (PPC), a new approach to care that is based on health outcome goals and healthcare preferences, was conducted. This study took place at 1 primary care and 1 cardiology practice in Connecticut and involved 9 primary care providers (PCPs), 5 cardiologists, and 119 older adults with MCCs. PPC was implemented using methods based on a practice change framework and continuous plan-do-study-act (PDSA) cycles. Core elements included leadership support, clinical champions, priorities facilitators, training, electronic health record (EHR) support, workflow development and continuous modification, and collaborative learning. PPC processes for clinic workflow and decision-making were developed, and clinicians were trained. After 10 months, 119 older adults enrolled and had priorities identified; 92 (77%) returned to their PCP after priorities identification. In 56 (46%) of these visits, clinicians documented patient priorities discussions. Workflow challenges identified and solved included patient enrollment lags, EHR documentation of priorities discussions, and interprofessional communication. Time for clinicians to provide PPC remains a challenge, as does decision-making, including clinicians' perceptions that they are already doing so; clinicians' concerns about guidelines, metrics, and unrealistic priorities; and differences between PCPs and patients and between PCPs and cardiologists about treatment decisions. PDSA cycles and continuing collaborative learning with national experts and peers are taking place to address workflow and clinical decision-making challenges. Translating disease-based to priorities-aligned decision-making appears challenging but feasible to implement in a clinical setting.

PURPOSE: To measure the association between institutional investment in high-value care (HVC) performance improvement and resident HVC experiences. METHOD: The authors analyzed data from two 2014 surveys assessing institutions’ investments in HVC performance improvement as reported by program directors (PDs) and residents’ perceptions of the frequency of HVC teaching, participation in HVC-focused quality improvement (QI), and views on HVC topics. The authors measured the association between institutional investment and resident-reported experiences using logistic regression, controlling for program and resident characteristics. RESULTS: The sample included 214 programs and 9,854 residents (59.3% of 361 programs, 55.2% of 17,851 residents surveyed). Most PDs (158/209; 75.6%) reported some support. Residents were more likely to report HVC discussions with faculty at least a few times weekly if they trained in programs that offered HVC-focused faculty development (odds ratio [OR] = 1.19; 95% confidence interval [CI] 1.04–1.37; P = .01), that supported such faculty development (OR = 1.21; 95% CI 1.04–1.41; P = .02), or that provided physician cost-of-care performance data (OR = 1.19; 95% CI 1.03–1.39; P = .02). Residents were more likely to report participation in HVC QI if they trained in programs with a formal HVC curriculum (OR = 1.83; 95% CI 1.48–2.27; P < .001) or with HVC-focused faculty development (OR = 1.46; 95% CI 1.15–1.85; P = .002). CONCLUSIONS: Institutional investment in HVC-related faculty development and physician feedback on costs of care may increase the frequency of HVC teaching and resident participation in HVC-related QI.

Model organism databases (MODs) have been collecting and integrating biomedical research data for 30 years and were designed to meet specific needs of each model organism research community. The contributions of model organism research to understanding biological systems would be hard to overstate. Modern molecular biology methods and cost reductions in nucleotide sequencing have opened avenues for direct application of model organism research to elucidating mechanisms of human diseases. Thus, the mandate for model organism research and databases has now grown to include facilitating use of these data in translational applications. Challenges in meeting this opportunity include the distribution of research data across many databases and websites, a lack of data format standards for some data types, and sustainability of scale and cost for genomic database resources like MODs. The issues of widely distributed data and application of data standards are some of the challenges addressed by FAIR (Findable, Accessible, Interoperable, and Re-usable) data principles. The Alliance of Genome Resources is now moving to address these challenges by bringing together expertly curated research data from fly, mouse, rat, worm, yeast, zebrafish, and the Gene Ontology consortium. Centralized multi-species data access, integration, and format standardization will lower the data utilization barrier in comparative genomics and translational applications and will provide a framework in which sustainable scale and cost can be addressed. This article presents a brief historical perspective on how the Alliance model organisms are complementary and how they have already contributed to understanding the etiology of human diseases. In addition, we discuss four challenges for using data from MODs in translational applications and how the Alliance is working to address them, in part by applying FAIR data principles. Ultimately, combined data from these animal models are more powerful than the sum of the parts.

Dietary and urinary risk factors have been implicated in conditions favoring ammonium urate nephrolithiasis in managed dolphins compared with free-ranging dolphins. In this study, urine samples were collected from 16 dolphins (8 cases, 8 controls) from the U.S. Navy Marine Mammal Program for the purposes of assessing changes in urinary biomarkers after a large meal. Urinary biomarkers and nephrolithiasis presence were assessed opportunistically in 15 long-term resident free-ranging dolphins living in Sarasota Bay, Florida. Additionally, the total purine contents of fish commonly consumed by each dolphin population were measured to evaluate potential dietary risk factors. Populations were compared for total dietary purine composition, recently fed status, nephrolithiasis presence, and differences in urinary biochemical, acid-base, and physicochemical parameters via Wilcoxon rank sum analysis and least square means. Managed dolphins had higher urinary pH and ammonium ([Formula: see text]) in both pre- and postprandial conditions and higher urinary uric acid and saturation indices of NH4U in the postprandial condition compared with free-ranging dolphins ( P < 0.05). The purine content was greater ( P < 0.0001) in the diet consumed by managed dolphins [7 mmol/Mcal metabolizable energy (ME)] than in the free-ranging dolphin diet (4 mmol/Mcal ME). Free-ranging dolphins did not show evidence of nephrolithiasis. Observed differences in urinary biomarkers and dietary purine content in these two dolphin populations suggest a pathophysiologic basis for the role of fish types on the risk of NH4U stone formation. Future research should investigate fish type and feeding frequency, inhibitors and promoters, and alkalinizing therapy for reducing NH4U nephrolithiasis in dolphins.

As the importance of socioemotional development for educational outcomes is increasingly recognized as a crucial aspect of children’s success in the classroom, the role of temperament in children’s...

SYNOPSISObjective. Stress felt by parents is often negatively related to their ability to engage in optimal parenting; however, research on relations of parenting stress to parenting behaviors typically examines negative associations instead of taking a strengths-based approach. The current study examines longitudinally the role of positive affect as a moderator of the relation of parenting stress to later maternal sensitivity, controlling for prior levels of sensitivity. Design. Maternal positive affect and maternal sensitivity were observed for 93 mother–child dyads during free-play sessions when children were 4- to 5-years-old (T1) and 8- to 9-years-old (T2), respectively. Mothers reported on parenting stress felt from dysfunctional parent–child interactions (T1). Results. Maternal positive affect moderated the association of parenting stress to sensitivity at T2, after controlling for prior levels of sensitivity at T1. Mothers who exhibited low positive affect were less likely to respond sensitively a...

In summer 2020, researchers conducted a Quality Assurance and Quality Improvement (QA/QI) assessment of the NYU Langone Alzheimer’s Disease and Related Dementias Family Support Program’s adaptations in response to COVID by interviewing 10 participating spouse caregivers of persons with dementia (PWD). The primary adaptations were shifting from in-person to online services, changing support groups from biweekly to weekly, and offering an arts-based group for PWD daily rather than weekly. In the course of these interviews, all respondents described their adaptation to remote teleconferencing programming, and five also contrasted their experiences with those of the PWD. Methods: After transcription and de-identification, a codebook was created from the transcript content that included a priori topics of interest as well as emergent themes using framework analysis. These transcripts were then coded by two independent coders through an iterative process and consultation with the codebook creator, who also resolved any discrepancies between coders. Results: Respondents reported largely successful transitions to teleconferencing for themselves, though missing the physical contact afforded by meeting in-person. However, they also described some interactional challenges related to participants talking over one another, and suggested more active moderating to facilitate greater turn-taking. The respondents’ descriptions of the PWD’s response suggested a much less successful transition to teleconferencing. Challenges and barriers included lack of interest, difficulty following or participating in conversation, and teleconferencing creating confusion, such making it “hard for her to separate out when everybody's in the same place or not."

Funding for this work was provided by the National Fish and Wildlife Foundation Gulf Environmental Benefit Fund (https://www.nfwf.org/gulf-environmental-benefit-fund; contract number 57223) to CS under subcontracts to Abt Associates Inc. More than 2,000 common bottlenose dolphins (Tursiops truncatus) inhabit the Barataria Bay Estuarine System in Louisiana, USA, a highly productive estuary with variable salinity driven by natural and man-made processes. It was unclear whether dolphins that are long-term residents to specific areas within the basin move in response to fluctuations in salinity, which at times can decline to 0 parts per thousand in portions of the basin. In June 2017, we conducted health assessments and deployed satellite telemetry tags on dolphins in the northern portions of the Barataria Bay Estuarine System Stock area (9 females; 4 males). We analyzed their fine-scale movements relative to modeled salinity trends compared to dolphins tagged near the barrier islands (higher salinity environments) from 2011 to 2017 (37 females; 21 males). Even though we observed different movement patterns among individual dolphins, we found no evidence that tagged dolphins moved coincident with changes in salinity. One tagged dolphin spent at least 35 consecutive days, and 75 days in total, in salinity under 5 parts per thousand. Health assessments took place early in a seasonal period of decreased salinity. Nonetheless, we found an increased prevalence of skin lesions, as well as abnormalities in serum biochemical markers and urine:serum osmolality ratios for dolphins sampled in lower salinity areas. This study provides essential information on the likely behavioral responses of dolphins to changes in salinity (e.g., severe storms or from the proposed Mid-Barataria Sediment Diversion project) and on physiological markers to inform the timing and severity of impacts from low salinity exposure. Publisher PDF

Considering child characteristics may be an important piece to understanding parental decision-making for children’s screen use. The current cross-sectional study examined the mediating role of maternal parenting stress in the relation of child temperament to young children’s screen use. Recognizing the multidimensional aspects of temperament, three mediated pathways for three temperament domains (i.e., negative affectivity, surgency, and effortful control) were tested. Mothers of toddlers, 18–36 months (N = 296), completed an online survey, reporting on child temperament, total parenting stress, and child screen use. The results showed that mother-child dynamics were related to toddlers’ screen use. Toddlers’ negative affectivity and effortful control were each associated with toddlers’ screen use through maternal parenting stress. Higher negative affectivity was associated with higher maternal parenting stress, which in turn, was related to greater screen use in toddlers. Toddlers’ lower effortful control was related to higher maternal parenting stress, which in turn, was associated with greater screen use. Toddlers’ surgency was not related to either maternal parenting stress or toddlers’ screen use. The findings from this study contribute to an understanding of media-related parenting in toddlerhood and may help with the development of strategies for supporting healthy media habits in families with young children.

Motivation Biomedical research findings are typically disseminated through publications. To simplify access to domain-specific knowledge while supporting the research community, several biomedical databases devote significant effort to manual curation of the literature—a labor intensive process. The first step toward biocuration requires identifying articles relevant to the specific area on which the database focuses. Thus, automatically identifying publications relevant to a specific topic within a large volume of publications is an important task toward expediting the biocuration process and, in turn, biomedical research. Current methods focus on textual contents, typically extracted from the title-and-abstract. Notably, images and captions are often used in publications to convey pivotal evidence about processes, experiments and results. Results We present a new document classification scheme, using both image and caption information, in addition to titles-and-abstracts. To use the image information, we introduce a new image representation, namely Figure-word, based on class labels of subfigures. We use word embeddings for representing captions and titles-and-abstracts. To utilize all three types of information, we introduce two information integration methods. The first combines Figure-words and textual features obtained from captions and titles-and-abstracts into a single larger vector for document representation; the second employs a meta-classification scheme. Our experiments and results demonstrate the usefulness of the newly proposed Figure-words for representing images. Moreover, the results showcase the value of Figure-words, captions and titles-and-abstracts in providing complementary information for document classification; these three sources of information when combined, lead to an overall improved classification performance. Availability and implementation Source code and the list of PMIDs of the publications in our datasets are available upon request.

Research Findings: In addition to being a regulatory strategy, children’s private speech may enhance or interfere with their effortful control used to regulate emotion. The goal of the current stud...

Following the Deepwater Horizon (DWH) oil spill, the Natural Resource Damage Assessment conducted comprehensive health assessments on common bottlenose dolphins Tursiops truncatus in Barataria Bay (BB), Louisiana, in 2011, 2013 and 2014, as well as in Mississippi Sound (MS) in 2013, to assess potential health effects from exposure to oil compared to Sarasota Bay (SB), Florida dolphins not exposed to DWH oil. Immune functions demonstrated a consistent increase in T (BB 2011) and B (BB 2011 and 2013) lymphocyte proliferation compared to SB. Cytokine concentrations varied considerably in wild dolphin populations, and no significant differences were found; however, interesting trends were observed. The Th1 cytokines IL-2, IL-12, and IFNγ, and the Th2 cytokines IL-5, IL-10, and IL-13, were 2- to 50-fold lower, and IL-4 was 3-fold higher, in BB 2011 compared to SB. Overall, the changes observed were compatible with those documented in other species following exposure to oil or PAHs and were most pronounced in BB 2011, at the place and time most affected by oil. The changes in T cell functions, and the trend towards a cytokine balance tilted towards a Th2, rather than a Th1 response, are compatible with intra-cellular bacterial infections such as Brucella, which has been identified as one of the potential contributory factors to perinatal dolphin mortalities, and changes in B cell functions are compatible with an increase in extra-cellular bacterial infections and primary bacterial pneumonia.

Overuse of medical services is an increasingly recognized driver of poor-quality care and high cost. A practical framework is needed to guide clinical decisions and facilitate concrete actions that can reduce overuse and improve care. We used an iterative, expert-informed, evidence-based process to develop a framework for conceptualizing interventions to reduce medical overuse. Given the complexity of defining and identifying overused care in nuanced clinical situations and the need to define care appropriateness in the context of an individual patient, this framework conceptualizes the patient-clinician interaction as the nexus of decisions regarding inappropriate care. This interaction is influenced by other utilization drivers, including healthcare system factors, the practice environment, the culture of professional medicine, the culture of healthcare consumption, and individual patient and clinician factors. The variable strength of the evidence supporting these domains highlights important areas for further investigation. Journal of Hospital Medicine 2017;12:346-351.

Externalizing behaviors observed in early childhood have been found to be stable, particularly for boys, but little research has investigated the antecedents of these behaviors, especially how the antecedents may differentially relate to externalizing behaviors in boys and girls. The goal of this study was to explore predictors of externalizing behaviors concurrently in toddlerhood and longitudinally to preschool. When children ( n = 140) were 30–36 months old, maternal supportive and controlling behaviors were observed, and children’s effortful control and anger were measured through observations and maternal report. Mothers reported on children’s externalizing behavior during toddlerhood and approximately 2 years later ( n = 116). Although mean level differences were not found between boys and girls, effortful control was differentially related to externalizing behaviors in toddlerhood. Higher levels of effortful control were associated with less externalizing behaviors for boys but not for girls. Additionally, anger was positively related to externalizing behaviors. Few associations were found for maternal behaviors, which emphasizes the importance of child characteristics in externalizing behaviors. Our findings emphasize how future research should continue to examine relations of early antecedents to concurrent and later externalizing behaviors even if mean level sex differences are not found.

Following the Deepwater Horizon (DWH) oil spill, reproductive success rates in 2 northern Gulf of Mexico (GoM) bottlenose dolphin stocks exposed to oil were evaluated for 4 yr during and after the spill (2010 to 2015) in efforts to assess population-level reproductive health. Pregnancy was determined from either (1) ultrasound examinations of the reproductive tract during capture-release health assessments, or (2) endocrine evaluations of blubber tissue collected from dart biopsies of free-ranging dolphins. Follow-up photo-identification was then used to track the status of pregnant females and any associated neonatal calves for a minimum of 1 yr after the initial pregnancy detection (IPD). For all pregnant females observed following IPD, individuals seen with a calf (reproductive success) and without one (reproductive failure) were recorded. The resulting estimated reproductive success rates for both GoM stocks (19.4%; 7/36) were less than a third of those previously reported in other areas not impacted by the spill (i.e. Sarasota Bay, FL; Indian River Lagoon, FL; and Charleston Harbor, SC) using similar techniques (64.7%; 22/34). We also evaluated the relationships between reproductive success and 13 potential covariates, including stock, ordinal date, progesterone, cortisol, thyroid hormone concentrations, leukocyte count, lung health score, and total body length. Among these, the results only provide strong evidence (Bayes factor >20) of a relationship between reproductive failure and the total leukocyte count covariate. The high reproductive failure rates measured in both GoM stocks following the DWH oil spill are consistent with mammalian literature that shows a link between petroleum exposure and reproductive abnormalities and failures.

The potential role of morbillivirus was evaluated in the deaths of >1100 bottlenose dolphins Tursiops truncatus and other small cetaceans that stranded from February 2010 through July 2014, during the northern Gulf of Mexico (GoM) unusual mortality event (UME). Morbillivirus analysis was carried out on 142 live or freshly dead cetaceans and results were combined with samples from 102 live, free-ranging bottlenose dolphins sampled during capture-release health assessments conducted from 2011 to 2014. Polymerase chain reaction (PCR) testing for morbillivirus showed that 9.9% (14/142) of the stranded cetaceans and 1% (1/83) of the free-ranging live dolphins were positive for dolphin morbilliviral (DMV) RNA. In contrast, previous DMV dolphin die-offs had DMV detectable by PCR in 61 to 97% of animals tested. Histologic findings consistent with morbillivirus infection, including lymphoid depletion, bronchointerstitial pneumonia, syncytial cell formation, or meningoencephalitis, were found in 6.6% (9/136) of the cetaceans that underwent histologic examinations. Serological analysis using a virus neutralization assay found that 29% (5/17) of live stranded and 23% (23/102) of live free-ranging bottlenose dolphins had titers of 64 or greater for cetacean morbillivirus, indicating prior but not necessarily recent exposure to morbillivirus. Current findings suggest that DMV infection, although present in the northern GoM, was sporadic and occurred at low levels and therefore was not the primary cause of the northern GoM UME. Confirmation of DMV infections and existing DMV titers demonstrate continued exposure to morbillivirus among northern GoM cetaceans since the first detection of this virus in the early 1990s.

The 2010 Deepwater Horizon (DWH) disaster resulted in large-scale oil contamination of the northern Gulf of Mexico. As part of the Natural Resource Damage Assessment designed to investigate the potential impacts of the DWH oil spill, comprehensive health assessments were conducted on bottlenose dolphins Tursiops truncatus living in oiled bays (Barataria Bay [BB], Louisiana, and Mississippi Sound [MS], Mississippi/Alabama) and a reference bay with no evidence of DWH oil contamination (Sarasota Bay [SB], Florida). As previously reported, multiple health issues were detected in BB dolphins during 2011. In the present study, follow-on capture-release health assessments of BB dolphins were performed (2013, 2014) and indicated an overall improvement in population health, but demonstrated that pulmonary abnormalities and impaired stress response persisted for at least 4 yr after the DWH disaster. Specifically, moderate to severe lung disease remained elevated, and BB dolphins continued to release low levels of cortisol in the face of capture stress. The proportion of guarded or worse prognoses in BB improved over time, but 4 yr post-spill, they were still above the proportion seen in SB. Health assessments performed in MS in 2013 showed similar findings to BB, characterized by an elevated prevalence of low serum cortisol and moderate to severe lung disease. Prognosis scores for dolphins examined in MS in 2013 were similar to BB in 2013. Data from these follow-on studies confirmed that dolphins living in areas affected by the DWH spill were more likely to be ill; however, some improvement in population health has occurred over time.

Host genetics, housing conditions, and antibiotic treatments impact microbiota diversity and composition, but microbes that inhabit the mouse gut and skin can also influence severity and penetrance of host mutant phenotypes.

There’s growing evidence that sex-based differences can influence phenotypes beyond those directly related to the reproductive system; to fully understand a gene’s function, researchers should consider both male and female subjects.

Creating a null mutation of a gene is a powerful way to examine gene function, but knocking out part of a gene does not always result in a null allele.

To identify difficult to see ureteral orifices (UOs), urologists need a method to stain the urine. Phenazopyridine, a urinary analgesic which discolors the urine orange, can be administered orally preoperatively. We evaluated the usefulness of phenazopyridine in identifying the UOs and optimal timing of administration.Adult patients undergoing endoscopic procedures at the Stratton VA were prospectively enrolled. Preoperative metabolic panels were reviewed. Exclusion criteria were renal insufficiency (creatinine clearance 50 mL/min), severe hepatitis or severe liver disease, glucose-6-phosphate dehydrogenase deficiency, previous hypersensitivity to phenazopyridine, or pregnancy. In phase 1, patients undergoing office flexible cystoscopy were administered 200 mg phenazopyridine the morning of the procedure. Because of the robust orange color of the urine, phase 2 was implemented. In phase 2, patients undergoing rigid cystoscopy in the operating room took 200 mg phenazopyridine at 7 PM the night before surgery. Upon entry into the bladder, UOs were identified and urine color was graded (0 = no dye, 1 = weak, 2 = moderate, and 3 = strong). Patients were assessed postoperatively for side effects.Five patients were included in phase 1. The mean time from medication to cystoscopy was 153 minutes (range 17-304 minutes). One-third of patients had excretion of grade 3 orange urine that obscured inspection of the bladder mucosa. The study design was adjusted and we transitioned to phase 2. Twenty-three patients were enrolled in phase 2. The mean time from phenazopyridine dose to cystoscopy was 14 hours (range 13-17 hours). Seventy-three percent of patients had grade 2 efflux from the UOs.Phenazopyridine can successfully identify UOs and can be administered as early as the evening before the procedure.

When children transition to school between the ages of 4 and 6 years, they must learn to control their attention and behavior to be successful. Concurrently, executive function (EF) is an important skill undergoing significant development in childhood. To understand changes occurring during this period, we examined the role of parenting in the development of children’s EF from 4 to 6 years old. Participants were mother and child dyads (N = 151). Children completed cognitive tasks to assess overall EF at age 4 and age 6. At both time points, mothers and children completed interaction tasks which were videotaped and coded to assess various parenting dimensions. Results indicated that children with high EF at age 4 were more likely to have high EF at age 6. In addition, results suggested that higher levels of positive parenting across the transition to school promote stability of individual differences in EF.

The common bottlenose dolphin (Tursiops truncatus) is a global marine mammal species for which some populations, due to their coastal accessibility, have been monitored diligently by scientists for decades. Health assessment examinations have developed a comprehensive knowledge base of dolphin biology, population structure, and environmental or anthropogenic stressors affecting their dynamics. Bottlenose dolphin health assessments initially started as stock assessments prior to acquisition. Over the last four decades, health assessments have evolved into essential conservation management tools of free-ranging dolphin populations. Baseline data enable comparison of stressors between geographic locations and associated changes in individual and population health status. In addition, long-term monitoring provides opportunities for insights into population shifts over time, with retrospective application of novel diagnostic tests on archived samples. Expanding scientific knowledge enables effective long-term conservation management strategies by facilitating informed decision making and improving social understanding of the anthropogenic effects. The ability to use bottlenose dolphins as a model for studying marine mammal health has been pivotal in our understanding of anthropogenic effects on multiple marine mammal species. Future studies aim to build on current knowledge to influence management decisions and species conservation. This paper reviews the historical approaches to dolphin health assessments, present day achievements, and development of future conservation goals.

The relation between maternal behavior and neurocognitive development is complex and may depend on the task context. We examined 5-month-old infant frontal EEG, maternal intrusiveness (MI) evaluated during two play contexts at 5 and 10 months, and a battery of executive function (EF) tasks completed at 48 months to evaluate if MI during infancy and infant neural function interacted to predict later cognition. Infant frontal EEG was a predictor of 4-year EF. MI during structured play at both 5 and 10 months predicted preschool EF, and MI during unstructured did not have a main effect on EF but showed a potential moderating effect of infant EEG on later EF. The pattern changed between ages, with MI during structured play at 5 months showing a positive association with age 4 EF, whereas MI during structured play at 10 months had a negative association with age 4 EF. We demonstrate differences in the context of maternal behavior used to predict childhood EF, highlighting the importance of considering parenting context in EF development.

The physiological demands of pregnancy inevitably result in changes of both biochemical and hematological parameters as the fetus develops. Alterations in blood parameters have been observed to shift according to both trimester and species, to support fetal physiological needs and maternal basal requirements. Establishing normal reference ranges for each stage in gestation is important to facilitate diagnosis of underlying health concerns and prevent over-diagnosing abnormalities. Despite bottlenose dolphins (Tursiops truncatus) being one of the most highly studied cetaceans, the blood profile changes occurring as a result of pregnancy have not been previously described. A retrospective analysis was performed from blood samples obtained from 42 successful pregnancies from 20 bottlenose dolphins in a managed population over 30 years. Samples were compared to non-pregnant states and among trimesters of pregnancy. Blood profile fluctuations occurred throughout gestation, however significant alterations predominantly occurred between the 2nd and 3rd trimester. Hematological changes from the 2nd to the 3rd trimester included a decrease in lymphocytes, decrease in platelet count, and hemoconcentration with increased hematocrit and hemoglobin. Biochemical changes in the 3rd trimester included significant reductions in ALKP (alkaline phosphatase), ALT (alanine aminotransferase) and AST (aspartate aminotransferase) with significant increases observed in albumin, globulins, total protein, cholesterol, triglycerides and CO2. It's important to note that despite significant shifts occurring between the 2nd and 3rd trimester, there was no significant change in platelets, hematocrit, hemoglobin, lymphocytes or CO2 between non-pregnant and 3rd trimester blood samples. The normal reference ranges for each trimester established herein, will enable future identification of abnormalities occurring during pregnancy and help improve our understanding of factors potentially influencing a failed or successful pregnancy outcome.

Background Rising out-of-pocket costs are creating a need for cost conversations between patients and physicians. Objective To understand the factors that influence physicians to discuss and consider cost during a patient encounter. Design Mixed-methods study using semistructured interviews and a survey. Setting United States. Participants 20 internal medicine physicians were interviewed; 621 internal medicine physician members of the American College of Physicians completed the survey. Measurements Interviews were analyzed by using thematic analysis, and surveys were analyzed by using descriptive statistics. Results From the interviews, 4 themes were identified: Physicians are 1) aware that patients are struggling to afford medical care; 2) relying on clues from patients that hint at their cost sensitivity; 3) relying on experience to anticipate potentially high-cost treatments; and 4) aware that patients are making financial trade-offs to afford their care. Three quarters (n = 466) of survey respondents stated that they consider out-of-pocket costs when making most clinical decisions. For 31% (n = 191) of participants, there were times in the past year that they wanted to discuss out-of-pocket prescription drug costs with patients but did not. The most influential factors for ordering a test are the desire to be as thorough as possible (71% [n = 422]) and insurance coverage for the test (68% [n = 422]). Limitation Findings are self-reported, the sample is limited to a single specialty, the survey response rate was low, information on the patient population was limited, and the survey instrument is not validated. Conclusion Physicians are attuned to the burden of health care costs and are willing to consider alternative options based on a patient's cost sensitivity. Primary funding source Robert Wood Johnson Foundation.

Background: The performance of U.S. Food and Drug Administration (FDA) Elemental Analysis Manual (EAM) 4.13 method (Inductively Coupled Plasma-Mass Spectrometric Determination of Iodine in Food Using Tetramethyl Ammonium Hydroxide Extraction) was tested in an interlaboratory study. Objective: The aim of the study is to demonstrate that the FDA EAM method 4.13 is applicable for the analysis of food and multivitamins. Methods: Six collaborators participated in the study using four different models of inductively coupled plasma-mass spectrometry instruments. The method evaluation included determination of the limits of detection and quantification, analysis of National Institute of Standards and Technology standard reference materials (SRMs), unknown samples, blinded SRMs, and fortified analytical portions by all six collaborators. The samples were chosen to represent all sectors of the AOAC food triangle and additionally included pet food and multivitamin tablets. Results: The repeatability and reproducibility ranges were 1.8–11.4% and 3.6–13.7%, respectively; the calculated HorRat values were in the 0.17–1.18 range; and 174 of 175 SRM analyses had z-scores

Caring for older adults with multiple chronic conditions (MCCs) is challenging. The American Geriatrics Society (AGS) previously developed The AGS Guiding Principles for the Care of Older Adults With Multimorbidity using a systematic review of the literature and consensus. The objective of the current work was to translate these principles into a framework of Actions and accompanying Action Steps for decision making for clinicians who provide both primary and specialty care to older people with MCCs. A work group of geriatricians, cardiologists, and generalists: (1) articulated the core MCC Actions and the Action Steps needed to carry out the Actions; (2) provided decisional tips and communication scripts for implementing the Actions and Action Steps, using commonly encountered situations: (3) performed a scoping review to identify evidence-based, validated tools for carrying out the MCC Actions and Action Steps; and (4) identified potential barriers to, and mitigating factors for, implementing the MCC Actions. The recommended MCC Actions include: (1) identify and communicate patients' health priorities and health trajectory; (2) stop, start, or continue care based on health priorities, potential benefit vs harm and burden, and health trajectory; and (3) align decisions and care among patients, caregivers, and other clinicians with patients' health priorities and health trajectory. The tips and scripts for carrying out these Actions are included in the full MCC Action Framework available in the supplement (www.GeriatricsCareOnline.org). J Am Geriatr Soc 67:665-673, 2019.

In 2017 an emergency field effort was undertaken in an attempt to prevent the extinction of the world's most endangered marine mammal, the vaquita Phocoena sinus. The rescue effort involved 90 experts from 9 countries and cost US$ 5 million. Following a long decline due to entanglement in legal gillnet fisheries, the vaquita population had fallen from more than 200 to fewer than 30 individuals from 2008 to 2016, due to entanglement in an illegal gillnet fishery that supplies swim bladders of the endangered totoaba Totoaba macdonaldi to Chinese black markets. An emergency ban of gillnets and increased enforcement failed to slow the decline, triggering an emergency effort to catch vaquitas and place them under protection in captivity. Two animals were targeted and captured using light gill nets; a juvenile was released 4 h later because it appeared stressed, and an adult female died of capture myopathy. The program was suspended because of the risk of additional mortalities to the population. The lack of success in capturing vaquitas for temporary protection emphasizes the need to improve our understanding of the effects of chase, capture, handling and enclosure on cetaceans, and to consider intervention before populations reach critically low levels, when there is sufficient time to use phased, precautionary approaches. Furthermore, conservation approaches focused on single species must be integrated into broader efforts to conserve ecosystems and involve the human communities that depend on them.

National Institutes of Health (NIH), Monarch Initiative [OD #5R24OD011883]; Forums for Integrative Phenomics [U13 CA221044-01]; NCATS Data Translator [1OT3TR002019]; NCATS National Center for Digital Health Informatics Innovation [U24 TR002306];NIH Data Commons [1 OT3 OD02464-01 UNCCH]; Cost Action CA 16118 Neuro-MIG; British Heart Foundation Programme Grant [RG/13/5/30112]; Division of Intramural Research; NIAID; NIH; E-RARE project Hipbi-RD [01GM1608]; European Union's Horizon 2020 Research and Innovation Programme [779257]. Funding for open access charge: NIH; Donald A. Roux Family Fund (to P.N.R.). The Human Phenotype Ontology (HPO) - a standardized vocabulary of phenotypic abnormalities associated with 7000+ diseases - is used by thousands of researchers, clinicians, informaticians and electronic health record systems around the world. Its detailed descriptions of clinical abnormalities and computable disease definitions have made HPO the de facto standard for deep phenotyping in the field of rare disease. The HPO's interoperability with other ontologies has enabled it to be used to improve diagnostic accuracy by incorporating model organism data. It also plays a key role in the popular Exomiser tool, which identifies potential disease-causing variants from whole-exome or whole-genome sequencing data. Since the HPO was first introduced in 2008, its users have become both more numerous and more diverse. To meet these emerging needs, the project has added new content, language translations, mappings and computational tooling, as well as integrations with external community data. The HPO continues to collaborate with clinical adopters to improve specific areas of the ontology and extend standardized disease descriptions. The newly redesigned HPO website (www.human-phenotype-ontology.org) simplifies browsing terms and exploring clinical features, diseases, and human genes.

Objective To conduct a systematic review of the available literature for primary research articles identifying potential gene mutations, polymorphisms and other molecular regulatory mechanisms related to trigeminal neuralgia in order to identify the genetic and molecular models of primary trigeminal neuralgia currently being investigated. Methods PubMed and Web of Science were systematically searched to identify primary research articles discussing genetic predictors of trigeminal neuralgia and neuropathic pain that were published prior to July 2020. This review was conducted according to PRISMA guidelines. Results Out of the 333 articles originally identified, a total of 14 papers were selected for study inclusion. These articles included 5 human studies, 6 mouse studies and 3 rat studies. Four articles investigated sodium channels, 1 investigated a sodium channel and nerve growth factor receptor, 2 investigated potassium channels, 1 investigated calcium channels, 1 investigated the downstream regulatory element antagonist modulator protein, 1 investigated the dynorphin-kappa opioid receptor system, 1 investigated TRPA1, 1 investigated the Nrg1/ErbB3/ErbB2 signaling complex, 1 investigated a serotonin transporter and 1 investigated potassium channels, sodium channels, calcium channels, chloride channels, TRP channels and gap junctions. Conclusion Researchers have identified multiple genetic and molecular targets involved with potential pathophysiologies that have a relationship to the creation of trigeminal neuralgia. At this time, there does not seem to be clear causal frontrunner, demonstrating the possibility that genetic predisposition to trigeminal neuralgia may involve multiple genes and/or downstream products, such as ion channels.