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Background: The impact of the National Diabetes Prevention Program (N-DPP) for Latinos "post-program" participation is uncertain. Purpose: We examine the experiences of Latinos who participated in the N-DPP in continuing the dietary and physical activity changes learned in the program. Methods: This is a qualitative descriptive interview study. We recruited 19 Latino adults who participated in a culturally and linguistically adapted N-DPP. Thematic analysis was used to analyze the data and report emerging themes. Results: Participants discussed how the program improved their knowledge about healthier lifestyles, and shared specific tools and strategies that they used to maintain learned program behaviors. Factors related to discontinuation of behaviors included missing the group social support, losing commitment over time, and avoiding family conflict. Maintenance of behaviors was mainly facilitated by family support. Discussion: Our study suggests that Latinos who participated in the N-DPP gained useful knowledge on healthier behaviors and learning strategies for implementation into their lifestyle, but barriers remain. Translation to Health Education Practice: Adaptations of the program for Latinos should consider the important roles of family and social support to improve N-DPP outcomes for this group and better support Latinos in preventing diabetes.

PurposeTo organize a multi-institute knee MRI segmentation challenge for characterizing the semantic and clinical efficacy of automatic segmentation methods relevant for monitoring osteoarthritis progression.Materials and methodsA dataset partition consisting of three-dimensional knee MRI from 88 retrospective patients at two time points (baseline and 1-year follow-up) with ground truth articular (femoral, tibial, and patellar) cartilage and meniscus segmentations was standardized. Challenge submissions and a majority-vote ensemble were evaluated against ground truth segmentations using Dice score, average symmetric surface distance, volumetric overlap error, and coefficient of variation on a holdout test set. Similarities in automated segmentations were measured using pairwise Dice coefficient correlations. Articular cartilage thickness was computed longitudinally and with scans. Correlation between thickness error and segmentation metrics was measured using the Pearson correlation coefficient. Two empirical upper bounds for ensemble performance were computed using combinations of model outputs that consolidated true positives and true negatives.ResultsSix teams (T 1-T 6) submitted entries for the challenge. No differences were observed across any segmentation metrics for any tissues (P = .99) among the four top-performing networks (T 2, T 3, T 4, T 6). Dice coefficient correlations between network pairs were high (> 0.85). Per-scan thickness errors were negligible among networks T 1-T 4 (P = .99), and longitudinal changes showed minimal bias (< 0.03 mm). Low correlations (ρ < 0.41) were observed between segmentation metrics and thickness error. The majority-vote ensemble was comparable to top-performing networks (P = .99). Empirical upper-bound performances were similar for both combinations (P = .99).ConclusionDiverse networks learned to segment the knee similarly, where high segmentation accuracy did not correlate with cartilage thickness accuracy and voting ensembles did not exceed individual network performance.See also the commentary by Elhalawani and Mak in this issue.Keywords: Cartilage, Knee, MR-Imaging, Segmentation © RSNA, 2020Supplemental material is available for this article.

In this article, we provide a case example of how telehealth can be used by care providers in their homes to access empirically validated procedures such as functional communication training. As shown in the case example, complex assessment and intervention procedures were implemented successfully by care providers in their homes while receiving real-time coaching by behavior analysts who were located in a hospital in a different city. This case example is representative of the results we obtained thus far; substantial improvements in challenging and adaptive behavior occurred. Given these results obtained to date with telehealth, in terms of both outcomes of interventions and rated acceptability of the procedures by care providers, further and more widespread application of telehealth is warranted.

AimsInsulin resistance (IR) adversely impacts memory and executive functioning in non-Hispanic whites without diabetes. Less is known in Hispanics/Latinos, despite the fact that Hispanics/Latinos have higher rates of insulin resistance than non-Hispanic whites. We investigated the association between IR and cognition and its variation by age.MethodsData from 5987 participants 45-74 years old without diabetes from the Hispanic Community Health Study/Study of Latinos. IR was considered continuously using homeostasis model assessment for insulin resistance (HOMA-IR) and also dichotomized based on clinically relevant thresholds for hyperinsulinemia (fasting insulin > 84.73 pmol/L or HOMA-IR > 2.6) and sample-based norms (75th percentile of fasting insulin or HOMA-IR). Cognitive testing included the Brief Spanish English Verbal Learning Test (B-SEVLT), Verbal Fluency, and Digit Symbol Substitution.ResultsThere was 90% overlap in participant categorization comparing clinically relevant and sample-based thresholds. In separate fully-adjusted linear regression models, age modified the association between HOMA-IR and Digit Symbol Substitution (p = 0.02); advancing age combined with higher HOMA-IR levels resulted in higher scores. Age also modified the association between clinically relevant hyperinsulinemia and B-SEVLT recall (p = 0.03); with increasing age came worse performance for individuals with hyperinsulinemia.ConclusionThe relationship of IR with cognition in Hispanics/Latinos without diabetes may reflect an age- and test-dependent state.

Many children with autism spectrum disorder (ASD) have problem behaviors that interfere with learning and social interaction. This randomized controlled trial compared treatment with functional communication training (FCT) to "treatment as usual" for young children with ASD (n=38, ages 21-84 months). FCT was conducted by parents with training and real-time coaching provided by behavioral consultants using telehealth. FCT treatment via telehealth achieved a mean reduction in problem behavior of 98% compared to limited behavioral improvement in children receiving "treatment as usual" during a 12-week period. Social communication and task completion also improved. For children with ASD and moderate to severe behavior problems, parent-implemented FCT using telehealth significantly reduced problem behavior while ongoing interventions typically did not.

The use of telehealth technologies to provide clinical services to families of children with autism and other developmental disabilities is a rapidly growing area of research. In particular, remote training of caregivers via video conferencing appears to be a promising approach for disseminating behavior-analytic interventions (Neely et al. in "J Dev Phys Disabil" 29:849-874, 2017. 10.1007/s10882-017-9550-4; Tomlinson et al. in "J Behav Educ" 27:172-222, 2018. 10.1007/s10864-018-9292-0). Although remote training offers a number of advantages, it brings a variety of challenges that are unique to this modality. The field would benefit from information on problems that practitioners may encounter when providing these services and how to train caregivers effectively. In this paper, we report on the experiences of 18 practitioners who provided caregiver training via telehealth from four different sites across a 4-year period. We describe a variety of technical and clinical issues that arose during service delivery, suggest strategies for preventing and remediating problems, and include case descriptions and data to illustrate our experiences. This information may help prepare practitioners to deliver telehealth services and guide further research in this area.

ObjectivesWe examined the association between the size and growth of Latino populations and hospitals' uncompensated care in California.MethodsOur sample consisted of general acute care hospitals in California operating during 2000 and 2010 (n = 251). We merged California hospital data with US Census data for each hospital service area. We used spatial analysis, multivariate regression, and fixed-effect models.ResultsWe found a significant association between the growth of California's Latino population and hospitals' uncompensated care in the unadjusted regression. This association was still significant after we controlled for hospital and community population characteristics. After we added market characteristics into the final model, this relationship became nonsignificant.ConclusionsOur findings suggest that systematic support is needed in areas with rapid Latino population growth to control hospitals' uncompensated care, especially if Latinos are excluded from or do not respond to the insurance options made available through the Affordable Care Act. Improving availability of resources for hospitals and providers in areas with high Latino population growth could help alleviate financial pressures.

Up to 50% of patients with severe congenital heart disease (CHD) develop life-altering neurodevelopmental disability (NDD). It has been presumed that NDD arises in CHD cases because of hypoxia before, during, or after cardiac surgery. Recent studies detected an enrichment in de novo mutations in CHD and NDD, as well as significant overlap between CHD and NDD candidate genes. However, there is limited evidence demonstrating that genes causing CHD can produce NDD independent of hypoxia. A patient with hypoplastic left heart syndrome and gross motor delay presented with a de novo mutation in SMC5. Modeling mutation of smc5 in Xenopus tropicalis embryos resulted in reduced heart size, decreased brain length, and disrupted pax6 patterning. To evaluate the cardiac development, we induced the conditional knockout (cKO) of Smc5 in mouse cardiomyocytes, which led to the depletion of mature cardiomyocytes and abnormal contractility. To test a role for Smc5 specifically in the brain, we induced cKO in the mouse central nervous system, which resulted in decreased brain volume, and diminished connectivity between areas related to motor function but did not affect vascular or brain ventricular volume. We propose that genetic factors, rather than hypoxia alone, can contribute when NDD and CHD cases occur concurrently. [ABSTRACT FROM AUTHOR]

Background: Insufficient physical activity among urban youth increases risk of chronic disease.Purpose:This study assessed reported physical activity to determine when disparities in participation emerge and what ecologically guided factors are linked with high activity. Methods:We administered a cross-sectional survey to a diverse sample of 321 fourth-, sixth-, and eighth-graders measuring physical activity and a range of ecologically guided variables via self-report. Students who reported high versus low levels of physical activity were compared in bivariate and stepwise regression models stratified by gender and grade to elucidate factors associated with high physical activity. Results: The proportion of highly active students declined between fourth and sixth/eighth grade, driven largely by a decline in highly active girls. Unique factors were associated with high physical activity by grade or gender including self-efficacy among fourth-graders (adjusted odds ratio [aOR] ¼ 14.51, 95% confidence interval [CI], 1.60-131.84), social support among sixth- and eighth-graders (aOR ¼ 5.93, 95% CI, 2.04-17.29) and girls (aOR ¼ 9.03, 95% CI, 1.95-41.75), and perceived normal weight status among boys (aOR ¼ 6.62, 95% CI, 2.18-20.16). Discussion: Declines in physical activity among girls may initiate earlier than previously reported. Translation to Health Education Practice: School-based efforts to increase physical activity levels should be initiated as soon as fourth grade.

Drawing from role theory, this study sought to explore the effects of assuming a new role on Latina community health workers (CHW) participating in a cervical cancer prevention program in a new Latino immigrant community located on the East Coast of the United States. Through a series of in-depth, Spanish language interviews with the 4 participants, the researchers explored the process and effects of assuming and enacting the CHW role through a narrative analysis approach. Themes that emerged from the analysis included "Reasons for becoming a promotora," "Vision and reality of the role," "Structuring interactions: The hierarchy of knowledge transmission," and "Transforming identities." Findings showed that assuming the CHW role had transformative effects on the participants that, in the end, allowed them to reconcile disparate aspects of their own immigrant identities. The findings have multiple implications for designing prevention programs employing CHWs and immigrant community strengthening. (Contains 1 note.)