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Childcare services are widely used by families and thereby exert an important influence on many young children. Yet, little research has examined whether childcare may impact the development of child executive functioning (EF), one of the pillars of cognitive development in early childhood. Furthermore, despite persisting hypotheses that childcare may be particularly beneficial for children who have less access to optimal developmental resources at home, research has yet to address the possibility that putative associations between childcare and EF may vary as a function of family factors. Among a sample of 180 mostly White middle-class families (91 girls), we examined if childcare participation in infancy was related to two aspects of EF (Delay and Conflict) at 3 years, and whether two aspects of maternal parenting behavior (sensitivity and autonomy support) moderated these associations. The results showed positive associations between participation in group-based childcare and Delay EF specifically among children of relatively less autonomy-supportive mothers. These findings suggest that out-of-home childcare services may play a protective role for children exposed to parenting that is less conducive to their executive development.

We aimed to identify unique constellations of sensory phenotypes for genetic etiologies associated with diagnoses of autism spectrum disorder (ASD) and intellectual disability (ID). Caregivers reported on sensory behaviors via the Sensory Profile for 290 participants (younger than 25 years of age) with ASD and/or ID diagnoses, of which [approximately] 70% have a known pathogenic genetic etiology. Caregivers endorsed poor registration (i.e., high sensory threshold, passive behaviors) for all genetic subgroups relative to an "idiopathic" comparison group with an ASD diagnosis and without a known genetic etiology. Genetic profiles indicated prominent sensory seeking in "ADNP," "CHD8," and "DYRK1A," prominent sensory sensitivities in "SCN2A," and fewer sensation avoidance behaviors in "GRIN2B" (relative to the idiopathic ASD comparison group).

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death worldwide. It has been known for some considerable time that radiation is associated with excess risk of CVD. A recent systematic review of radiation and CVD highlighted substantial inter-study heterogeneity in effect, possibly a result of confounding or modifications of radiation effect by non-radiation factors, in particular by the major lifestyle/environmental/medical risk factors and latent period. METHODS: We assessed effects of confounding by lifestyle/environmental/medical risk factors on radiation-associated CVD and investigated evidence for modifying effects of these variables on CVD radiation dose-response, using data assembled for a recent systematic review. RESULTS: There are 43 epidemiologic studies which are informative on effects of adjustment for confounding or risk modifying factors on radiation-associated CVD. Of these 22 were studies of groups exposed to substantial doses of medical radiation for therapy or diagnosis. The remaining 21 studies were of groups exposed at much lower levels of dose and/or dose rate. Only four studies suggest substantial effects of adjustment for lifestyle/environmental/medical risk factors on radiation risk of CVD; however, there were also substantial uncertainties in the estimates in all of these studies. There are fewer suggestions of effects that modify the radiation dose response; only two studies, both at lower levels of dose, report the most serious level of modifying effect. CONCLUSIONS: There are still large uncertainties about confounding factors or lifestyle/environmental/medical variables that may influence radiation-associated CVD, although indications are that there are not many studies in which there are substantial confounding effects of these risk factors.

While there has been a recent focus on developing programs to support educational research by community college anatomy and physiology instructors, there is not yet an established long-term community of practice (CoPs) in this particular area. Studies of long-term CoPs, particularly in STEM education, are few and far between. This study examines College in the Schools (CIS), a long-term community of practice for high school anatomy and physiology (A&P) educators in Minnesota and Wisconsin. In addition, this study highlights the factors that attract high school A&P teachers to CIS and the possibility of creating a similar CoP for community college (CC) A&P instructors focused on educational research. It was discovered that despite their varying reasons for joining, members of CIS and CC instructors tend to participate in CoPs similarly. As a result, A&P instructors from CC who are interested in educational research could benefit from a CoP structure similar to CIS over a longer period of time.

Craniofacial phenotyping is critical for both syndrome delineation and diagnosis because craniofacial abnormalities occur in 30% of characterized genetic syndromes. Clinical reports, textbooks, and available software tools typically provide two-dimensional, static images and illustrations of the characteristic phenotypes of genetic syndromes. In this work, we provide an interactive web application that provides three-dimensional, dynamic visualizations for the characteristic craniofacial effects of 95 syndromes. Users can visualize syndrome facial appearance estimates quantified from data and easily compare craniofacial phenotypes of different syndromes. Our application also provides a map of morphological similarity between a target syndrome and other syndromes. Finally, users can upload 3D facial scans of individuals and compare them to our syndrome atlas estimates. In summary, we provide an interactive reference for the craniofacial phenotypes of syndromes that allows for precise, individual-specific comparisons of dysmorphology.

Differential diagnosis of young children with suspected autism spectrum disorder (ASD) is challenging, and clinician uncertainty about a child's diagnosis may contribute to misdiagnosis and subsequent delays in access to early treatment. The current study was designed to replicate and expand a recent report in this Journal (McDonnell et al. in "J Autism Dev Disord," v49:1391-1401, https://doi.org/10.1080/15374416.2020.1823850, 2019), in which only 60% of diagnoses were made with complete certainty by clinicians evaluating 478 toddlers and preschool children referred for possible ASD to specialized clinics. In this study, secondary analyses were performed on diagnostic, demographic and clinical data for 496 16-30-month-old children who were consecutive referrals to a 6-site clinical trial executed by specialized centers with experienced clinicians following best-practice procedures for the diagnosis of ASD. Overall, 70.2% of diagnoses were made with complete certainty. The most important factor associated with clinician uncertainty was mid-level autism-related symptomatology. Mid-level verbal age equivalents were also associated with clinician uncertainty, but measures of symptomatology were stronger predictors. None of the socio-demographic variables, including sex of the child, was significantly associated with clinician certainty. Close to one third of early diagnoses of ASD are made with a degree of uncertainty. The delineation of specific ranges on the ADOS-2 most likely to result in clinician uncertainty identified in this study may provide an opportunity to reduce random subjectivity in diagnostic decision-making via calibration of young-child diagnostic thresholds based on later-age longitudinal diagnostic outcome data, and via standardization of decision-making in regard to clinical scenarios frequently encountered by clinicians.

Abstract Binding-activated optical sensors are powerful tools for imaging, diagnostics, and biomolecular sensing. However, biosensor discovery is slow and requires tedious steps in rational design, screening, and characterization. Here we report on a platform that streamlines biosensor discovery and unlocks directed nanosensor evolution through genetically encodable fluorogenic amino acids (FgAAs). Building on the classical knowledge-based semisynthetic approach, we engineer ~15 kDa nanosensors that recognize specific proteins, peptides, and small molecules with up to 100-fold fluorescence increases and subsecond kinetics, allowing real-time and wash-free target sensing and live-cell bioimaging. An optimized genetic code expansion chemistry with FgAAs further enables rapid (~3 h) ribosomal nanosensor discovery via the cell-free translation of hundreds of candidates in parallel and directed nanosensor evolution with improved variant-specific sensitivities (up to ~250-fold) for SARS-CoV-2 antigens. Altogether, this platform could accelerate the discovery of fluorogenic nanosensors and pave the way to modify proteins with other non-standard functionalities for diverse applications.

Abstract Background Unhealthy alcohol use represents a significant risk for morbidity and mortality among people living with HIV (PLWH), in part through its impact on HIV management. Chronic pain, a common comorbidity, exacerbates suboptimal engagement in the HIV care continuum and has reciprocal detrimental effects on alcohol outcomes. There are no integrated, accessible approaches that address these comorbid conditions among PLWH to date. This paper describes a research study protocol of an integrated telehealth intervention to reduce unhealthy drinking and chronic pain among PLWH (Motivational and Cognitive-Behavioral Management for Alcohol and Pain [INTV]). Methods Two-hundred and fifty PLWH with unhealthy drinking and chronic pain will be recruited nationally via online advertisement. Informed consent and baseline assessments occur remotely, followed by 15 days of ecological momentary assessment to assess alcohol use, chronic pain, functioning, and mechanisms of behavior change. Next, participants will be randomized to either the INTV or Control (CTL) condition. Individuals in both conditions will meet with a health counselor through videoconferencing following randomization, and those in the INTV condition will receive 6 additional sessions. At 3- and 6-months post-baseline, participants will complete outcome assessments. It is hypothesized that the INTV condition will result in reduced unhealthy alcohol use and pain ratings compared to the CTL condition. Conclusion This protocol paper describes a randomized controlled trial which tests the efficacy of a novel, integrated telehealth approach to reduce unhealthy alcohol use and chronic pain for PLWH, two common comorbid conditions that influence the HIV treatment cascade. ClinicalTrials.gov identifier NCT05503173.

In this article, we propose a silvicultural approach that takes soil health into account. Using a biblical metaphor, the first chapter highlights the forest’s critical role in the planet’s future, emphasizing that forest biodiversity is essential for sustaining a planet inhabited by complex life forms like humans. The second chapter focuses to the soil, explaining how the biological dynamics of the soil are interconnected with the forest cycle, demonstrating that vegetation and soil form a continuous, co-evolving system. The third chapter explores the possibility of extending the forest cycle to restore soil functionality, illustrating how the recycling of the forest’s biological past facilitates the emergence of a new, evolving soil-vegetation system. Examples of forest management practices in France, Italy, and Switzerland are presented, including graphs and mathematical models depicting the evolution of organic carbon in the soil and the distribution of tree stems by diameter, age, and stature. The description of uneven-aged Swiss forests, featuring fir and beech, is sourced from the Helvetica Pro-Silva website.

Introduction : La maladie hématologique-oncologique pédiatrique implique de nombreux défis adaptatifs. Conséquemment, des problèmes de santé mentale font parfois surface durant ou après les traitements, et ce, tant chez les jeunes que chez leurs parents. La prise en charge actuelle de ces problèmes ne semblait pas correspondre aux besoins soulevés par certains jeunes. Le rôle infirmier au Québec permet l’évaluation et la prise en charge de personnes souffrant d’un trouble de la santé physique et mentale (Ordre des infirmières et infirmiers du Québec, 2016). Ainsi, un infirmier clinicien en santé mentale possédant également de l’expérience en hématologie-oncologie pourrait offrir des soins complémentaires aux soins des psychologues, travailleurs sociaux et autres intervenants psychosociaux présents dans le service d’hématologie-oncologie et possiblement répondre à des besoins non comblés chez certains jeunes. Le projet lié au rôle de l’ICSM se fera en trois étapes : 1) le développement du rôle, 2) l’implantation, et 3) l’évaluation réalisée un an après l’implantation. L’objectif de cette première partie est de présenter la méthode utilisée pour développer le rôle de l’ICSM. Méthodologie : Le modèle a été fait en respectant la structure proposée par le cadre PEPPA (Participatory, Evidence-based, Patient-focused Process for APN role development, implementation and evaluation; Bryant-Lukosius et Dicenso, 2004). Les cinq premières étapes de ce cadre ont été utilisé pour cette première partie du projet en lien avec le développement du rôle de l’ICSM. Celles-ci sont : 1) définir la population cible; 2) définir les acteurs-clés à impliquer; 3) cibler les besoins; 4) cerner et prioriser les problèmes ainsi que fixer les objectifs; 5) définir le nouveau modèle de rôle. Résultats : Au terme de plusieurs rencontres impliquant de nombreux professionnels de la santé et des gestionnaires, un rôle d’ICSM a été développé avec une perspective flexible et transdisciplinaire afin de mieux répondre aux besoins des jeunes atteints de cancer et de leur famille (notamment des adolescents). Ce rôle a été définit selon quatre axes de pratique : 1) l’intervention auprès du patient-famille; 2) l’intervention auprès des équipes; 3) la consultation-liaison psychiatrique; 4) la formation, l’enseignement et la recherche. Conclusion : Les prochaines étapes consisteront en la mise en application d’un plan stratégique d’implantation et l’évaluation des retombées après un d’implantation.

But : Le but de cette étude est de définir le processus d’implantation et d’évaluation préliminaire d’une pratique infirmière novatrice en santé mentale dans un programme d’hématologie-oncologie pédiatrique. Cette approche permettra par le fait même d’évaluer de façon préliminaire si la stratégie d’implantation était appropriée. Contexte : Le cancer pédiatrique implique de nombreux défis adaptatifs pour les patients et leur famille. Pour plusieurs, des problèmes de santé mentale font surface pendant ou après les traitements. Un infirmier clinicien en santé mentale possédant également une expertise en hémato-oncologie contribuera à la prise en charge des patients et de leur famille en offrant une vision complémentaire aux approches psychosociales. Comme les changements de pratique sont souvent difficiles et que l’introduction d’un rôle sans plan d’implantation clairement défini mène parfois à un échec, une structure d’implantation s’avérait nécessaire. La création du rôle d’infirmier clinicien en santé mentale au programme d’hématologie-oncologie pédiatrique (ICSM) comprend trois phases : 1) le développement du rôle; 2) la stratégie d’implantation; 3) l’évaluation de la faisabilité, de l’acceptabilité et de l’appréciation, à réaliser un an après l’implantation. Cet article explicite la deuxième partie du projet. Or, les objectifs du présent article sont : 1) présenter la stratégie d’implantation du rôle de l’ICSM employée; et 2) une évaluation préliminaire exploratoire de la faisabilité, de l’acceptabilité et de l’appréciation trois mois suivant l’implantation. Méthode : La stratégie d’implantation utilisée est tirée de l’approche proposée parFry et Rogers (2009), approche que nous avons adaptée au contexte de la présente étude. Les cinq étapes de l’approche sont : 1) les stratégies de communication; 2) le processus de consultation pour définir le rôle et l’étendue de la pratique; 3) l’éducation; 4) la définition des structures de support; 5) l’évaluation et les mécanismes de rétroaction. Cette dernière étape en est une d’évaluation préliminaire exploratoire réalisée trois mois après l’implantation du rôle d’ICSM à l’aide d’un sondage destiné aux infirmières, aux infirmières praticiennes spécialisées et aux médecins. Résultats : Les résultats présentent de façon détaillée les cinq éléments du plan d’implantation. Les résultats préliminaires du sondage effectué trois mois après l’implantation indiquent que l’ICSM a travaillé en moyenne 150 h/mois, a réalisé 22,7 consultations et 52,3 suivis par mois lesquels étaient d’une durée moyenne de 53,1 minutes. Au final, 96 % des soignants ont indiqués qu’il s’agit d’une expertise nécessaire en hématologie-oncologie pédiatrique, 95 % que le rôle améliore les soins psychosociaux et les soins psychiatriques. Par ailleurs, seulement 28 % des répondants considèrent avoir les connaissances/compétences nécessaires pour gérer efficacemnent la psychopharmacothérapie. Conclusion : Ces résultats semblent démontrer que la stratégie proposée par Fry et Rogers (2009) est appropriée pour le développement d’une pratique infirmière en santé mentale au programme d’hématologie-oncologie pédiatrique, en raison de la faisabilité, de l’acceptabilité et de l’appréciation du rôle de l’ICSM. La troisième partie de ce projet permettra une évaluation structurée et rigoureuse de la faisabilité, de l’acceptabilité et de l’appréciation qui sera réalisée auprès des patients rencontrés, de leurs parents et des soignants un an après l’implantation.

Introduction: Pediatric hematological and oncological illnesses present many coping challenges. Mental health issues can arise during and after treatment, in both patients and their families. The current model of care does not always seem to meet the needs identified by some young patients. In Quebec, nurses are allowed to assess and care for patients experiencing physical and mental health difficulties (Ordre des infirmières et infirmiers du Québec, 2016). Therefore, a mental health nurse clinician (MHNC) with experience in pediatric hematology/oncology could provide care that is complementary to that offered by psychologists, social workers, and other psychosocial professionals in the pediatric hematology/oncology unit in order to meet any needs that remain unmet. The MHNC project has three stages: (1) role development, (2) role implementation, and (3) role assessment one year after implementation. In this first article, we explain how the MHNC role was developed. Methodology: We used the participatory, evidence-based, patient-focused process for advanced practice nursing (APN) role development, implementation, and evaluation (PEPPA Framework; Bryant-Lukosius & Dicenso, 2004) to develop this model. The first five steps in the PEPPA Framework were applied in the creation of the MHNC role to (1) select the target population, (2) identify the stakeholders to be involved, (3) ascertain needs, (4) determine and prioritize problems and set goals, and (5) define a new model of care. Results: After multiple meetings involving numerous health professionals and managers, the MHNC role was developed with a versatile, transdisciplinary perspective to address better the needs of young cancer patients (especially those in their teens) and their families. The role was developed around four main areas of practice: (1) interventions offered to patient-family, (2) interventions offered to health professionals, (3) psychiatric consultation-liaison, and (4) education and research. Conclusion: The next steps are to use a strategic plan to implement the role and then to evaluate the impact of the role one year after implementation.

But : Expliciter le processus utilisé pour le développement du rôle d’infirmier clinicien en santé mentale au sein d’un programme d’hématologie-oncologie pédiatrique au Québec Background : La maladie hématologique-oncologique pédiatrique implique de nombreux défis adaptatifs et parfois des enjeux de santé mentale font surface durant ou après les traitements, et ce tant chez les jeunes que leurs parents. La prise en charge actuelle de ces problèmes ne semblait pas correspondre aux besoins soulevés par certains jeunes. Le rôle infirmier au Québec permet l’évaluation et la prise en charge de personnes souffrant de trouble de la santé physique et mentale (Ordre des Infirmières et Infirmiers du Québec, 2016a). Ainsi, un infirmier possédant de l’expérience en hématologie-oncologie et possédant une expertise en santé mentale pourrait offrir une vision complémentaire aux approches traditionnelles. Méthodes & discussion : L’implantation de ce nouveau rôle se fera en 4 étapes. Le présent article présente le développement de ce modèle de rôle novateur dans le domaine de l’hématologie-oncologie pédiatrique au Québec. Le modèle a été fait en respectant la structure proposée par le modèle Participatory, Evidence-informed, Patient-centered Process for APN role development, implementation and evaluation (PEPPA Framework) (Bryant-Lukosius & Dicenso, 2004). Conclusion : Les prochaines étapes consisteront en la mise en application d’un plan stratégique d’implantation et de l’évaluation des retombées un an post-implantation.

Abstract Background Bile acids (BAs) are steroid-derived molecules with important roles in digestion, the maintenance of host metabolism, and immunomodulation. Primary BAs are synthesized by the host, while secondary BAs are produced by the gut microbiome through transformation of the former. The regulation of microbial production of secondary BAs is not well understood, particularly the production of 7-dehydroxylated BAs, which are the most potent agonists for host BA receptors. The 7-dehydroxylation of cholic acid (CA) is well established and is linked to the expression of a bile acid-inducible (bai) operon responsible for this process. However, little to no 7-dehydroxylation has been reported for other host-derived BAs (e.g., chenodeoxycholic acid, CDCA or ursodeoxycholic acid, UDCA). Results Here, we demonstrate that the 7-dehydroxylation of CDCA and UDCA by the human isolate Clostridium scindens is induced when CA is present, suggesting that CA-dependent transcriptional regulation is required for substantial 7-dehydroxylation of these primary BAs. This is supported by the finding that UDCA alone does not promote expression of bai genes. CDCA upregulates expression of the bai genes but the expression is greater when CA is present. In contrast, the murine isolate Extibacter muris exhibits a distinct response; CA did not induce significant 7-dehydroxylation of primary BAs, whereas BA 7-dehydroxylation was promoted upon addition of germ-free mouse cecal content in vitro. However, E. muris was found to 7-dehydroxylate in vivo. Conclusions The distinct expression responses amongst strains indicate that bai genes are regulated differently. CA promoted bai operon gene expression and the 7-dehydroxylating activity in C. scindens strains. Conversely, the in vitro activity of E. muris was promoted only after the addition of cecal content and the isolate did not alter bai gene expression in response to CA. The accessory gene baiJ was only upregulated in the C. scindens ATCC 35704 strain, implying mechanistic differences amongst isolates. Interestingly, the human-derived C. scindens strains were also capable of 7-dehydroxylating murine bile acids (muricholic acids) to a limited extent. This study shows novel 7-dehydroxylation activity in vitro resulting from the presence of CA and suggests distinct bai gene expression across bacterial species.

Abstract DNA hydroxymethylation (5hmC), the most abundant oxidative derivative of DNA methylation, is typically enriched at enhancers and gene bodies of transcriptionally active and tissue-specific genes. Although aberrant genomic 5hmC has been implicated in age-related diseases, its functional role in aging remains unknown. Here, using mouse liver and cerebellum as model organs, we show that 5hmC accumulates in gene bodies associated with tissue-specific function and restricts the magnitude of gene expression changes with age. Mechanistically, 5hmC decreases the binding of splicing associated factors and correlates with age-related alternative splicing events. We found that various age-related contexts, such as prolonged quiescence and senescence, drive the accumulation of 5hmC with age. We provide evidence that this age-related transcriptionally restrictive function is conserved in mouse and human tissues. Our findings reveal that 5hmC regulates tissue-specific function and may play a role in longevity.

Abstract Background Cardiovascular disease is the leading cause of death worldwide. Cardiac rehabilitation (CR) programs are recognized as effective in reducing the burden of cardiovascular disease. However, CR programs are offered inequitably across regions and are available in less than 15% of remote areas worldwide. The main goal of this study was to design a CR program adapted to the contexts of remote areas to improve the service offered to patients. Methods We used an iterative user-centered design approach to understand the user context and services offered in cardiac rehabilitation in remote areas. We conducted two co-design processes with knowledge users in two remote regions. Two advisory committees were created in each of these regions, comprising managers (n = 6), healthcare professionals (n = 12) and patients (n = 2). We utilized the BACPR guidelines and the Hautes Autorités de santé operational model to support data collection in coding sessions to develop the CR program. We conducted four cycles of co-design with each of the committees to develop the cardiac rehabilitation program. Qualitative data were analyzed iteratively after each cycle. Results The co-design process resulted in developing a prototype cardiac rehabilitation program similar in both regions. It is based on a contextualized six-phase pathway of care designed for remote regions. For each phase 0 to 6 of the care pathway, knowledge users were asked to describe how to offer these phases in remote areas. Participants made structural changes to phases 0, 2, 3 and 4 in order to overcome staffing shortages in remote areas. These changes make it possible to decentralize cardiac rehabilitation expertise away from specialized centers, to ensure equity of service across the territory. Therapeutic patient education was integrated into phase 4 to meet patients' needs. Participants suggested that three follow-up offerings could come from nursing services to increase access to the cardiac rehabilitation program (primary care, home care, special chronic disease programs) in patients' home communities. Conclusion The co-design process enables us to meet the needs of remote regions in program development. This final program can be the subject of future implementation research.

Advocacy has been a core function and expectation of school psychologists for over 50 years (Oyen et al., 2020; Skalski, 2012). It can take many forms, from staying up to date on critical issues in research to writing letters to elected officials to communicate support for proposed legislation. Given that school psychology state associations usually comprise students, graduate educators, and practitioners engaging as volunteers, they can easily become overextended. Yet advancement of the field is highly dependent upon their efforts. Grassroots initiatives offer a more accessible and feasible vehicle for change that, in conjunction with state organizations, can have a substantial cumulative impact (Oyen et al., 2020). The Minnesota Collective for Educational Equity (MnCEE) is one example of a grassroots agency that has created strong organizational ties to state school psychology associations, built relationships with key decision makers, and engaged membership within their organizations. This article details how and why MnCEE was created, describes the challenges the group has faced, and outlines actions to inspire grassroots efforts in other states.