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BackgroundParent training programs are traditionally delivered in face-to-face formats and require trained facilitators and weekly parent attendance. Implementing face-to-face sessions is challenging in busy primary care settings and many barriers exist for parents to attend these sessions. Tablet-based delivery of parent training offers an alternative to face-to-face delivery to make parent training programs easier to deliver in primary care settings and more convenient and accessible to parents. We adapted the group-based Chicago Parent Program (CPP) to be delivered as a self-administered, tablet-based program called the ezParent program. ObjectiveThe purpose of this study was to (1) assess the feasibility of the ezParent program by examining parent satisfaction with the program and the percent of modules completed, (2) test the efficacy of the ezParent program by examining the effects compared with a control condition for improving parenting and child behavior in a sample of low-income ethnic minority parents of young children recruited from a primary care setting, and (3) compare program completion and efficacy with prior studies of the group-based CPP. MethodsThe study used a two-group randomized controlled trial (RCT) design with repeated measures follow up. Subjects (n=79) were randomly assigned to an intervention or attention control condition. Data collection was at baseline and 12 and 24 weeks post baseline. Parents were recruited from a large, urban, primary care pediatric clinic. ezParent module completion was calculated as the percentage of the six modules completed by the intervention group parents. Attendance in the group-based CPP was calculated as the percentage of attendance at sessions 1 through 10. Satisfaction data were summarized using item frequencies. Parent and child data were analyzed using a repeated measures analysis of variance (RM-ANOVA) with simple contrasts to determine if there were significant intervention effects on the outcome measures. Effect sizes for between group comparisons were calculated for all outcome variables and compared with CPP group based archival data. ResultsezParent module completion rate was 85.4% (34.2/40; 95% confidence interval [CI] = 78.4%-93.7%) and was significantly greater (P

Providing equitable informal science, technology, engineering, and mathematics (STEM) learning opportunities to young children from diverse backgrounds may be a way to increase access and interest in STEM and can help to address the broader goal of increasing representation. Importantly, these learning experiences must be meaningful and engage everyday cultural practices. Guided by a strengths-based approach, the current study examines how oral stories as a cultural resource can be harnessed to support Latine children's engagement in a tinkering activity. The project explores whether and how setting an at-home tinkering activity within a story context engenders rich parent--child conversations that provide engineering learning opportunities for young children. Fifty-two Latine parents and children (M[subscript age] = 7.69 years; 23 girls; 90.4% Mexican heritage) were randomly assigned to either hear a story as a frame for a hands-on tinkering activity or to engage in the same tinkering activity without the story. After families finished tinkering, a researcher elicited the children's reflections about their tinkering experience. Approximately 2 weeks after the activity, children were asked to share their tinkering reflections with a second researcher. Parents and children in the story condition talked more about engineering during tinkering, and these children also talked more about engineering during both reflections than did children in the no-story condition. These findings suggest that integrating oral storytelling into tinkering activities is a promising future direction for the creation of more equitable informal engineering learning opportunities for Latine children and families.

This study is a collaborative project between university researchers and museum practitioners investigating ways to advance STEM learning opportunities for young children and their families in museums. The focus of the work is on how the knowledge resources that are available to families (e.g., prior knowledge, information provided by the museum staff) can support talk about STEM during and after hands-on problem-solving activities in a museum exhibit. More specifically, we asked whether and how associations between parent-child talk about STEM during tinkering, and the STEM content of the children's reflections on their learning afterward, might vary based on the knowledge that is available to families to make sense of their experiences. One hundred and eleven families with 5- to 10-year-old children (M = 7.23 years) were observed in a tinkering exhibit in a children's museum. Results indicated that the more parents and children talked about STEM during tinkering, the more the children talked about STEM in their reflections. This association was moderated by children's knowledge based on prior tinkering experiences, and knowledge that was acquired through a pre-tinkering, facilitated orientation by museum staff about engineering, but not by children's age or parents' educational attainment. Implications for museum research and practice are discussed.

Summary: Background: Ustekinumab is approved for ulcerative colitis (UC). Aims: To assess the durability of ustekinumab in patients with UC and its short‐term effectiveness, durability and tolerability in clinical practice. Methods: Retrospective, multicentre study of patients who had received their first ustekinumab dose at least 16 weeks before inclusion. Patients were followed until treatment discontinuation or last visit. Only patients with active disease at the start of ustekinumab treatment were considered in the effectiveness analysis. Patients who stopped ustekinumab before their last visit were considered not to be in subsequent remission. Results: We included 620 patients; 155 (25%) discontinued ustekinumab during follow‐up (median 12 months). Rate of discontinuation was 20% per patient‐year of follow‐up. Anaemia at baseline (hazard ratio, HR 1.5; 95% confidence interval [CI] 1.1–2.1), steroids at baseline (HR 1.5; 95% CI 1.06–2.08) and more severe clinical activity at baseline (HR 1.5; 95% CI 1.09–2.06) were associated with higher risk of discontinuation. At the end of induction, 226 (40%) patients were in steroid‐free clinical remission. Moderate–severe vs mild disease activity at baseline (odds ratio [OR] 0.3; 95% CI 0.2–0.5), male sex (OR 0.5; 95% CI 0.4–0.8), and increased number of previous biologics (OR 0.6; 95% CI 0.6–0.8) were associated with lower likelihood of steroid‐free clinical remission at week 16. One hundred and seventy‐six patients (28%) had at least one adverse event. We observed no negative impact of ustekinumab on extraintestinal manifestations and/or immune‐mediated diseases. Conclusions: Ustekinumab durability in UC was relatively high, and treatment was effective in highly refractory patients. The safety profile was consistent with previous studies. [ABSTRACT FROM AUTHOR]

IntroductionThe stereotypical progression of Alzheimer's disease (AD) pathology is not fully understood. The selective impact of AD on distinct regions has led the field to question if innate vulnerability exists. This study aims to determine if the causative factors of regional vulnerability are dependent on cell-autonomous or transneuronal (non-cell autonomous) processes.MethodsUsing mathematical and statistical models, we analyzed the contribution of cell-autonomous and non-cell autonomous factors to predictive linear models of AD pathology.ResultsResults indicate gene expression as a weak contributor to predictive linear models of AD. Instead, the network diffusion model acts as a strong predictor of observed AD atrophy and hypometabolism.DiscussionWe propose a convenient methodology for identifying genes and their role in determining AD topography, in comparison with network spread. Results reinforce the role of transneuronal network spread on disease progression and suggest that innate gene expression plays a secondary role in seeding and subsequent disease progression.

Multiple genes have been implicated in Parkinson disease pathogenesis, but the relationship between regional expression of these genes and regional dysfunction across the brain is unknown. We address this question by joint analysis of high resolution magnetic resonance imaging data from the Parkinson's Progression Markers Initiative and regional genetic microarray expression data from the Allen Brain Atlas. Regional brain atrophy and genetic expression was co-registered to a common 86 region brain atlas and robust multivariable regression analysis was performed to identify genetic predictors of regional brain atrophy. Top candidate genes from GWAS analysis, as well as genes implicated in trans-synaptic alpha-synuclein transfer and autosomal recessive PD were included in our analysis. We identify three genes with expression patterns that are highly significant predictors of regional brain atrophy. The two most significant predictors are LAG3 and RAB5A, genes implicated in trans-synaptic synuclein transfer. Other well-validated PD-related genes do not have expression patterns that predict regional atrophy, suggesting that they may serve other roles such as disease initiation factors.

Current hypotheses stipulate core symptoms of schizophrenia (SZ) result from the brain's incapacity to integrate neural processes. Converging diffusion magnetic resonance imaging and graph theory studies provide evidence of macrostructural alterations in SZ. However, age-related topological changes within and between white matter (WM) networks and its relationship to gene expression with disease progression remain incompletely understood. This cross-sectional study uses network modeling to investigate changes in WM network organization with disease progression in chronic SZ as well its relationship with gene expression in healthy brains. First, we replicate prior findings demonstrating altered global WM network topology in SZ. Novel results show significantly altered age-related network degradation patterns in patients compared with controls. Specifically, controls show stereotyped, linear global network decline with age. In contrast, patients show nonlinear network decline with age. Further analysis reveals lack of significant topological decline in younger adult patients, which is subsequently followed by stereotyped linear decline in older adult patients. Node-specific analyses show significant topological differences in frontal and limbic regions of younger adult patients compared with age-matched controls, which become less pronounced with age in older adult patients compared with age-matched controls. Lastly, we show several gene expression profiles, including DISC1, are associated with age-related changes in WM disconnectivity. Together, these findings provide novel WM topological and genetic evidence supporting neurodevelopmental models of SZ, suggesting that network remodeling continues throughout the third decade of life before stabilizing.

The puma (Puma concolor Linnaeus, 1771) is the top predator with the widest distribution in America. Since the establishment of European settlers on the American continent, puma populations have experienced significant contractions and reductions in their original distribution. In Argentina, the management of the conflict between humans and pumas (direct persecution and habitat modification) focused on reduction or elimination methods, leading to a drastic contraction, even total eradication, of puma populations as seen in Patagonia and the eastern part of the country. Despite the lack of knowledge about puma population demographic trends, there are taxonomic issues that remain controversial and need to be resolved to implement appropriate management and conservation measures. Therefore, the aim of this study was to genetically characterize puma populations in the central-southern region of Argentina using two mitochondrial markers, evaluate their demographic history, compare our results at a macro-regional level, and discuss our findings in a conservation and management context. A total of 203 individuals were used, and a fragment of the control region and another of ND5 were sequenced. The genetic variability obtained was moderate. Substitution rates for each locus and the tMRCA were calculated from calibrated trees. In a concatenated tree, two main phylogenetic clades were identified (posterior probability = 1), although a reciprocal monophyly was not observed, with a divergence time of 228 thousand years and a 95% CI [117-363 thousand years]. When evaluating population structuring, three genetic clusters were found, one characteristic of the Patagonian region and the others in the central part of the country. Calculating the ФST values for pairs resulted in significant structuring between Patagonia and the rest of the populations, suggesting the arid diagonal as a possible barrier to gene flow. When evaluating the demographic history, neutrality tests would support a recent expansion in Patagonia. These findings are crucial in defining two distinct Management Units (MUs) in the southern part of puma distribution and providing valuable information for management and conservation measures for the species. [ABSTRACT FROM AUTHOR]

In 2020, Bhutan pioneered a school-based gender-neutral human papillomavirus (HPV) vaccination program, achieving an impressive 96% vaccination coverage rate by 2021. This study, conducted through 49 in-depth interviews with community leaders, policymakers, parents, teachers, and health workers, and 12 focus group discussions with boys who received HPV vaccination. We used conventional content analysis to analyze the data. Enablers of the extension of gender-neutral HPV vaccination included social mobilization and advocacy efforts, which encompassed community engagement and leadership and collaborations with schools. Equally crucial were proficient program management and the strategic use of digital interventions. Challenges included tracking and reaching eligible adolescents. Vaccinated boys perceived school-based vaccination to be a key enabler of vaccine update. The study concludes that extending a girls-only HPV vaccination program to gender-neutral is feasible and acceptable in Bhutan. Findings related to challenges and ways for overcoming them can support other countries interested in gender-neutral HPV vaccination program. [ABSTRACT FROM AUTHOR]

Introduction: Double vena cava is the most common thoracic abnormality and is mainly caused by persistence of the left superior vena cava and are usually described incidentally after placement of central venous accesses. Objective: Presentation of a clinical case where a double superior vena cava was identified after the placement of a Mahurkar-type catheter. Clinical case: A 54-year-old man was admitted to the nephrology department with a diagnosis of angioaccess-associated infection. Mahurkar catheter was placed without complications, atypical location was observed by chest X-ray, so CT angiography was requested suggestive images of left superior vena cava persistence with a central venous catheter inside are reported. Discussion: The identification of superior double vena cava in most cases occurs incidentally after the placement of a central venous access, after taking a plain chest x-ray where a persistent left superior vena cava can be observed, and it may be accompanied by other abnormalities. Conclusions: Knowing the possible vascular alterations helps prevent complications during procedures such as central venous catheter placement. [ABSTRACT FROM AUTHOR]

Objective: Adrenal myelolipoma is an infrequent benign tumor. Myelolipoma represents 2,6-3 % of all adrenal incidentalomas. This tumor is more frequent in aged individuals. Our aim was to evaluate the prevalence of myelolipoma in patients with adrenal incidentaloma detected by abdominal computed tomography (CT) during 1 year at a university tertiary care hospital. Methods: Retrospective study. All abdominal CT done at the Hospital Universitario San Vicente Fundación, Medellín, Colombia, with or without contrast, were reviewed from 2014 to 2015. Of all adrenal incidentalomas, those with diagnosis of adrenal mielolipoma were further evaluated. The clinical and laboratory data were extracted. Results: 4288 abdominal CT were reviewed in 3709 patients. 108 adrenal incidentalomas were found. Of those, two cases were adrenal myelolipomas. The frequency of mielolipoma presenting as adrenal incidentalomas was 1.85 % with a prevalence in abdominal CT of 0.05 %. The mean age at presentation was 57 years. Both cases were unilateral right masses; the mean size was 31 mm and a mean of -84.5 Hounsfield units. Hormonal studies or surgical management was no performed.Discussion: This study report the prevalence and clinical characteristics of adrenal myelolipoma presenting as adrenal incidentalomas. 1.85 % of adrenal incidentalomas are myelolipomas. To our knowledge, there are no studies in Colombia evaluating the prevalence of this disease in abdominal CT scans. In conclusion, myelolipoma is an infrequent adrenal tumor.