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Online education materials are widely used by patients and caregivers to understand the management of complex chronic diseases such as heart failure (HF). Organizations such as the American Medical Association and National Institutes of Health recommend that materials be written at a 6th-grade reading level. The current study examined the readability and accessibility of online education materials for patients with HF. Whole page texts from each included website were entered into an online readability calculator. Five validated readability indices (Flesch-Kincaid Grade Level, Flesch Reading Ease Scale, Gunning Fog Index, Coleman-Liau Index, and Simple Measure of Gobbledygook (SMOG Index)) were used to evaluate each source. Websites were categorized by source (government, public and private). The availability of audiovisual accessibility features and content in non-English languages were assessed for each website. Of the 36 online resources analyzed, the median readability level was 9th-10th grade according to the Flesch-Kincaid Grade Level and college level, according to the Flesch Reading Ease Scale. The Gunning Fog Index and Coleman-Liau Index both showed median readability scores corresponding to a 12th grade reading level, whereas the SMOG Index showed a median score corresponding to that of the 9th grade. Only 10 websites (28%) offered information in languages other than English, and none provided comprehensive accessibility features for users with disabilities. Common online educational materials for patients with HF are characterized by higher readability levels than those recommended by the National Institutes of Health and the American Medical Association, and there were limited multilingual and accessibility options, potentially limiting the accessibility of resources to patients and caregivers., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Financial considerations continue to impact access to heart transplantation. Transplant recipients face various costs, including, but not limited to, the index hospitalization, immunosuppressive medications, and lodging and travel to appointments. In this study, we sought to describe the state of crowdfunding for individuals being evaluated for heart transplantation. Using the search term heart transplant, 1000 GoFundMe campaigns were reviewed. After exclusions, 634 (63.4%) campaigns were included. Most campaigns were in support of white individuals (57.8%), males (63.1%) and adults (76.7%). Approximately 15% of campaigns had not raised any funds. The remaining campaigns fundraised a median of $53.24 dollars per day. Of the patients, 44% were admitted at the time of the fundraising. Within the campaigns in the United States, the greatest proportions were in the Southeast United States in non-Medicaid expansion states. These findings highlight the significant financial toxicities associated with heart transplantation and the need for advocacy at the governmental and payer levels to improve equitable access and coverage for all., Competing Interests: Disclosures EMD and JL are on the Board of Directors for The Equity in Heart Transplant Project. NI is the founder and executive director of The Equity in Heart Transplant Project. All remaining authors have no conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose of Review: To discuss the prevailing racial and ethnic disparities in heart failure (HF) care by identifying barriers to equitable care and proposing solutions for achieving equitable outcomes., Recent Findings: Throughout the entire spectrum of HF care, from prevention to implementation of guideline-directed medical therapy and advanced interventions, racial and ethnic disparities exist. Factors such as differential distribution of risk factors, poor access to care, inadequate representation in clinical trials, and discrimination from healthcare clinicians, among others, contribute to these disparities. Recent data suggests that despite improvements, disparities prevail in several aspects of HF care, hindering our progress towards equity in HF care. This review highlights the urgent need to address racial and ethnic disparities in HF care, emphasizing the importance of a multifaceted approach involving policy changes, quality improvement strategies, targeted interventions, and intentional community engagement. Our proposed framework was derived from existing research and emphasizes integrating equity into routine quality improvement efforts, tailoring interventions to specific populations, and advocating for policy transformation. By acknowledging these disparities, implementing evidence-based strategies, and fostering collaborative efforts, the HF community can strive to reduce disparities and achieve equity in HF care., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Non-US citizens/non-US residents (NCNR) are a unique and growing population. Patterns of heart donation and heart transplantation (HT) within this subgroup have not been described fully. The purpose of this study was to evaluate the use of organs from NCNR donors and the characteristics and outcomes of NCNR HT recipients., Methods: All adult donors whose hearts were recovered for HT and all primary adult HT recipients from 2013 to 2020 were identified using the United Network for Organ Sharing. Donors and recipients were categorized as citizens, residents, or NCNR. NCNR were further categorized by reason for travel to the United States. Outcomes included mortality, infection, and rejection at 1-year after transplantation., Results: NCNR accounted for 0.4% (n = 77) of heart donors. Most NCNR donors identified as Hispanic (61%), were predominately recovered from the South and Southwest United States, and were less likely to express written documentation to be a donor compared with citizens and residents. NCNR accounted for 0.7% (n = 147) of all HT recipients. The majority identified as non-Hispanic White individuals (57.1%). Compared with citizens and residents, NCNR recipients seemed to be sicker, as evidenced by higher intra-aortic balloon pump use before HT and higher priority United Network for Organ Sharing status. Of NCNR recipients, 63% traveled to the United States for HT, predominately from Kuwait (29.9%) and Saudi Arabia (20%). At 1-year after transplant, there were no differences in mortality, infection, or rejection between the groups., Conclusions: A growing subgroup of NCNR travel from countries with low HT rates to the United States for HT. This finding highlights the need for strategies to improve equitable access to HT domestically and abroad., Competing Interests: Disclosures The authors have no relevant disclosures., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Accurately counting analog events requires constructing an electronics chain that produces one count for each input pulse. In this work we review the use of Nuclear Instrumentation Module electronic units for counting neutron capture events in a 3 He tube. We identify two unique types of false trigger events in a leading-edge discriminator and show how a dual timer module can be used to produce a veto window to exclude these events. We use the constructed electronics chain to build an apparatus to measure neutron pulses from a 252 Cf neutron source. We compare the measurements with a Monte Carlo N-Particle (MCNP) model to determine the activity of the neutron source. Furthermore, by making additional measurements with borated polyethylene attenuators between the source and detector, we are able to determine the boron concentration of the polyethylene. This technique provides accurate determination of the source activity to a precision of 2.8% at the k = 1 level. The method used is simple, inexpensive, and requires no additional calibrated instruments., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background A parental history of cardiovascular disease (CVD) confers greater risk of future CVD among offspring. Whether the presence of parental modifiable risk factors contribute to or modify CVD risk in offspring is unclear. Methods and Results We studied 6278 parent-child trios in the multigenerational longitudinal Framingham Heart Study. We assessed parental history of CVD and modifiable risk factors (smoking, hypertension, diabetes, obesity, and hyperlipidemia). Multivariable Cox models were used to evaluate the association of parental history and future CVD among offspring. Among 6278 individuals (mean age 45±11 years), 44% had at least 1 parent with history of CVD. Over a median follow-up of 15 years, 353 major CVD events occurred among offspring. Parental history of CVD conferred 1.7-fold increased hazard of future CVD (hazard ratio [HR], 1.71 [95% CI, 1.33-2.21]). Parental obesity and smoking status were associated with higher hazard of future CVD (obesity: HR, 1.32 [95% CI, 1.06-1.64]; smoking: HR, 1.34 [95% CI, 1.07-1.68], attenuated after adjusting for offspring smoking status). By contrast, parental history of hypertension, diabetes, and hypercholesterolemia were not associated with future CVD in offspring ( P >0.05 for all). Furthermore, parental risk factors did not modify the association of parental CVD history on future offspring CVD risk. Conclusions Parental history of obesity and smoking were associated with a higher hazard of future CVD in offspring. By contrast, other parental modifiable risk factors did not alter offspring CVD risk. In addition to parental CVD, the presence of parental obesity should prompt a focus on disease prevention.

Respiratory failure secondary to rib fractures is a major source of morbidity and mortality in trauma patients, particularly in older populations. Management of pain in these patients is complex due to the nature of the injuries. We present 3 patients who underwent a video-assisted thoracoscopic cryoablation of intercostal nerves for pain control after chest trauma. None of the patients developed post-operative complications related to poor respiratory status such as pneumonia or atelectasis. At one-month clinic follow-up, all patients reported no chest pain and were not using opiate analgesics. In patients for whom there is a contraindication to rib fixation in the setting of unstable rib fractures, cryoablation may be a method by which to improve respiratory status and decrease ventilator dependency due to pain. Cryoablation of intercostal nerves may provide a more durable and clinically feasible solution to aid in the healing process of these patients.

Background: There is growing recognition that reproductive factors are associated with increased risk of future cardiovascular disease. Infertility has been less well studied, although emerging data support its association with increased risk of cardiovascular disease. Whether infertility is associated with future risk of heart failure (HF) is not known., Objectives: This study sought to examine the development of HF and HF subtypes in women with and without history of infertility., Methods: We followed postmenopausal women from the Women's Health Initiative prospectively for the development of HF. Infertility was self-reported at study baseline. Multivariable cause-specific Cox models were used to evaluate the association of infertility with incident overall HF and HF subtypes (heart failure with preserved ejection fraction [HFpEF]: left ventricular ejection fraction of ≥50% vs heart failure with reduced ejection fraction [HFrEF]: left ventricular ejection fraction of <50%])., Results: Among 38,528 postmenopausal women (mean age: 63 ± 7 years), 5,399 (14%) participants reported a history of infertility. Over a median follow-up of 15 years, 2,373 developed incident HF, including 807 with HFrEF and 1,133 with HFpEF. Infertility was independently associated with future risk of overall HF (HR: 1.16; 95% CI: 1.04-1.30; P = 0.006). Notably, when examining HF subtypes, infertility was associated with future risk of HFpEF (HR: 1.27; 95% CI: 1.09-1.48; P = 0.002) but not HFrEF (HR: 0.97; 95% CI: 0.80-1.18)., Conclusions: Infertility was significantly associated with incident HF. This was driven by increased risk of HFpEF, but not HFrEF, and appeared independent of traditional cardiovascular risk factors and other infertility-related conditions. Future research should investigate mechanisms that underlie the link between infertility and HFpEF., Competing Interests: Funding Support and Author Disclosures The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts 75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, and 75N92021D00005. Dr Lau is supported by the American Heart Association (853922). Dr Ho is supported by the National Institutes of Health (R01-HL134893, R01-HL140224, and K24-HL153669). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Patients admitted with decompensated heart failure (HF) are at risk for hospital readmission and poor quality of life during the discharge period. Lifestyle behavior modifications that promote the self-management of chronic cardiac diseases have been associated with an improved quality of life. However, whether a mobile health (mHealth) program can assist patients in the self-management of HF during the acute posthospital discharge period is unknown., Objective: We aimed to develop an mHealth program designed to enhance patients' self-management of HF by increasing knowledge, self-efficacy, and symptom detection. We hypothesized that patients hospitalized with HF would be willing to use a feasibly deployed mHealth program after their hospital discharge., Methods: We employed a patient-centered outcomes research methodology to design a stakeholder-informed mHealth program. Adult patients with HF admitted to a large academic hospital were enrolled and randomized to receive the mHealth intervention versus usual care. Our feasibility outcomes included ease of program deployment, use of the clinical escalation process, duration of participant recruitment, and participant attrition. Surveys assessing the demographics and clinical characteristics of HF were measured at baseline and at 30 and 90 days after discharge., Results: The study period was between July 1, 2019, and April 7, 2020. The mean cohort (N=31) age was 60.4 (range 22-85) years. Over half of the participants were men (n=18, 58%) and 77% (n=24) were White. There were no significant differences in baseline measures. We determined that an educational mHealth program tailored for patients with HF is feasibly deployed and acceptable by patients. Though not significant, we found notable trends including a higher mean quality of life at 30 days posthospitalization among program users and a longer duration before rehospitalization, which are suggestive of better HF prognosis., Conclusions: Our mHealth tool should be further assessed in a larger comparative effectiveness trial. Our pilot intervention offers promise as an innovative means to help HF patients lead healthy, independent lives. These preliminary data suggest that patient-centered mHealth tools can enable high-risk patients to play a role in the management of their HF after discharge., Trial Registration: ClinicalTrials.gov NCT03982017; https://clinicaltrials.gov/ct2/show/NCT03982017., (©Amber E Johnson, Shuvodra Routh, Christy N Taylor, Meagan Leopold, Kathryn Beatty, Dennis M McNamara, Esa M Davis. Originally published in JMIR Cardio (https://cardio.jmir.org), 21.03.2022.)

Background: Treatment of elevated intracranial pressure (ICP) in traumatic brain injury (TBI) is controversial. Hyperosmolar therapy is used to prevent cerebral edema in these patients. Many intensivists measure direct correlates of these agents-serum sodium and osmolality. We seek to provide context on the utility of using these measures to estimate ICP in TBI patients., Materials and Methods: Patients admitted with TBI who required ICP monitoring from 2008 to 2012 were included. Intracranial pressure, serum sodium, and serum osmolality were assessed prior to hyperosmotic therapy then at 6, 12, 18, 24, 48, and 72 hours after admission. A linear regression was performed on sodium, osmolality, and ICP at baseline and serum sodium and osmolality that corresponded with ICP for 6-72-hour time points., Results: 136 patients were identified. Patients with initial measures were included in the baseline analysis (n = 29). Patients who underwent a craniectomy were excluded from the 6-72-hour analysis (n = 53). Initial ICP and serum sodium were not significantly correlated (R2 .00367, P = .696). Initial ICP and serum osmolality were not significantly correlated (R2 .00734, P = .665). Intracranial pressure and serum sodium 6-72 hours after presentation were poorly correlated (R2 .104, P < .0001), as were ICP and serum osmolality at 6-72 hours after presentation (R2 .116, P < .0001)., Discussion: Our results indicate initial ICP is not correlated with serum sodium or osmolality suggesting these are not useful initial clinical markers for ICP estimation. The association between ICP and serum sodium and osmolality after hyperosmolar therapy was poor, thus may not be useful as surrogates for direct ICP measurements.

Racism has significantly impacted communities of color for centuries. The year 2020 is a reminder that racism is an ongoing public health crisis. Healthcare institutions have an important role in dismantling racism because of their ability to implement innovative solutions that advance diversity, address social determinants of health, and promote health equity. Healthcare professionals have the unique opportunity to support patients by discussing patients' experiences of bias and racism. Asking about discrimination, however, can be difficult because of the sensitive nature of the topic and lack of appropriate education. This review highlights the importance of addressing patients' experiences of racism, utilizing the frameworks of trauma-informed care, structural competency, provider bias, and intersectionality. Furthermore, this review provides ways to engage in meaningful dialogue around discrimination and includes important patient-centric resources., (© 2021. The Author(s).)

Background: Rib fractures are a major problem characterized by pain, increased length of stay, and respiratory complications. Treatments include fixation, management with opiates, paraspinous local anesthetic pumps, and intercostal nerve blocks. The aim of this study was to evaluate the use of treatment options and compare clinically relevant outcomes., Methods: Patients admitted to a Level 1 trauma center with multiple rib fractures between 2015 and 2019 were screened. We included all participants treated with surgical fixation and/or intercostal nerve block or local anesthetic pump. Patients were case-matched 1:2 by Injury Severity Score (ISS), Abbreviated Injury Scale (AIS) Chest and Head, age, and number of rib fractures. Outcomes assessed were hospital length of stay (LOS), intensive care unit (ICU) LOS, ventilator days, pneumonia, and tracheostomy rates., Results: We identified 25 patients who received rib fixation and intercostal analgesia. Of these, 14 cases were treated with liposomal bupivaicaine nerve block and 11 by paraspinous catheter block. Fifty control cases treated with opiates were identified. All patients survived to discharge. Cases and controls were approximately equivalent in age, ISS, number of fractured ribs, chest AIS, and head AIS. Rib-plated patients had a lower rate of pneumonia (OR 0.2029, 95% CI 0.0242, 0.09718), decreased average ICU LOS (10.62 vs 6.64, P = .018), and decreased average ventilator days (5.44 vs 1.68, P = .003)., Discussion: Findings suggest more aggressive treatment of rib fractures may decrease ICU LOS, ventilator days, and pneumonia in patients with multiple rib fractures. These findings are in line with current literature; however, more research is needed in this area.

Competing Interests: Conflict of Interest None of the authors has a relevant conflict of interest.

The purpose of this study was to evaluate the reliability, validity, and accuracy of scores from the Intervention Selection Profile-Function (ISP-Function): a brief functional assessment tool founded upon Direct Behavior Rating (DBR) methodology. Participants included 34 teacher-student dyads. Using the ISP-Function, teachers rated the extent to which students exhibited disruptive behavior, as well as the frequency with which disruptions were met with four consequences. Ratings were completed across three 10-min sessions, during which a research assistant also collected systematic direct observation (SDO) data regarding the same behavior and consequences. Results indicated adequate temporal reliability (≥.70) was attained for the adult attention and peer attention targets across the three ratings; in contrast, up to 8-18 data points would be needed to achieve adequate reliability across the remaining targets. Findings further suggested that while ISP-Function ratings of disruptive behavior, adult attention, and peer attention were moderately to highly correlated with SDO data, correlations were in the low range for the access to items/activities and escape/avoidance targets. Finally, analysis of difference scores showed that on average, mean ISP-Function scores fell within only 0.33 to 1.81 points of mean SDO scores (on the 0-10 DBR scale). Agreement coefficients indicative of exact score agreement were less consistent, suggesting accuracy ranged from poor to substantial. Results are promising, but future research is necessary to support applied ISP-Function use. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The purpose of this study was to examine the effects of Incremental Rehearsal (IR) and traditional drill (TD) on retention of multiplication facts with 29 students in third and fourth grades with low mathematical skills. Results indicated that IR led to significantly more facts being retained, and was essentially equal to TD for efficiency as measured by number of facts retained per instructional minute. Memory scores accounted for 34% of the variance beyond mathematics calculation scores in retention of multiplication facts for the TD condition, but only 2% of the variance for the IR condition. Thus, retention of multiplication facts seems largely influenced by a student's memory skills when using less effective instructional techniques such as TD, while approaches like IR are likely effective regardless of memory skills. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The purposes of this study were twofold. The first was to use latent class analysis to identify groupings of students defined by the presence or absence of academic or behavioral risk. The second was to determine whether these groups differed across various dichotomous academic and behavioral outcomes (e.g., suspensions, office discipline referrals, statewide achievement test failure). Students (N = 1,488) were sampled from Grades 3-5. All students were screened for academic risk using AIMSweb Reading Curriculum-Based Measure and AIMSweb Mathematics Computation, and behavioral risk using the Social, Academic, and Emotional Behavior Risk Screener (SAEBRS). Latent class analyses supported the fit of a three-class model, with resulting student classes defined as low-risk academic and behavior (Class 1), at-risk academic and high-risk behavior (Class 2), and at-risk math and behavior (Class 3). Logistic regression analyses indicated the classes demonstrated statistically significant differences statewide achievement scores, as well as suspensions. Further analysis indicated that the odds of all considered negative outcomes were higher for both groups characterized by risk (i.e., Classes 2 and 3). Negative outcomes were particularly likely for Class 2, with the odds of negative behavioral and academic outcomes being 6-15 and 112-169 times more likely, respectively. Results were taken to support an integrated approach to universal screening in schools, defined by the evaluation of both academic and behavioral risk. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background: To see which socioeconomic and demographic variables associate with the nutritional status of under five-year old Nepalese children. This nationwide study provides a comprehensive analysis on of risk factors for childhood acute and chronic undernutrion. Methods: The Nepal Demographic and Health Survey 2006 was used as a cross sectional data source. A total of 3630 children were analysed. Standard Z-score were used for children. Anaemia was also defined using international norms. The statistical analysis used was binary logistic regression, which was performed using SPSS software package for Windows. The cut-off for a significant result was <0.05. Results: The results showed that 1680 (46.3%) of children were stunted, 1384 (38.1%) were underweight, 513 (14.1%) were wasted and 1631 (44.9%) were anaemic. Underweight and stunting showed significant association with mother's education and ethnicity. All nutritional factors were associated with ecological zone and standard of living. Also, underweight and wasting showed a significant relationship with religion. Conclusion: Maternal education, ecological zone, ethnicity and standard of living were the main predictors of child nutritional status.

The purpose of this diagnostic accuracy study was to evaluate the sensitivity and specificity (among other indicators) of three universal screening approaches, including the Social, Academic, and Emotional Behavior Risk Screener (SAEBRS), a SAEBRS-based teacher nomination tool, and a multiple gating procedure (MGP). Each screening approach was compared to the BASC-2 Behavioral and Emotional Screening System (BESS), which served as a criterion indicator of student social-emotional and behavioral risk. All data were collected in a concurrent fashion. Participants included 704 students (47.7% female) from four elementary schools within the Midwestern United States (21.6% were at risk per the BESS). Findings yielded support for the SAEBRS, with sensitivity = .93 (95% confidence interval [.89-.97]), specificity = .91 (.89-.93), and correct classification = .92. Findings further supported the MGP, which yielded sensitivity = .81 (.74-.87), specificity = .93 (.91-.95), and correct classification = .91. In contrast, the teacher nomination tool yielded questionable levels of diagnostic accuracy (sensitivity = .86 [.80-.91], specificity = .74 [.70-.78], and correct classification = .76). Overall, findings were particularly supportive of SAEBRS diagnostic accuracy, suggesting the MGP might also serve as an acceptable approach to universal screening. Other implications for practice and directions for future research are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The purpose of this study was to support the identification of Social, Academic, and Emotional Behavior Risk Screener (SAEBRS) cut scores that could be used to detect high-risk students. Teachers rated students across two time points (Time 1 n = 1,242 students; Time 2 n = 704) using the SAEBRS and the Behavioral and Emotional Screening System (BESS), the latter of which served as the criterion measure. Exploratory receiver operating characteristic (ROC) curve analyses of Time 1 data detected cut scores evidencing optimal levels of specificity and borderline-to-optimal levels of sensitivity. Cross-validation analyses of Time 2 data confirmed the performance of these cut scores, with all but one scale evidencing similar performance. Findings are considered particularly promising for the SAEBRS Total Behavior scale in detecting high-risk students. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

The unique ability of grain boundaries to act as effective sinks for radiation damage plays a significant role in nanocrystalline materials due to their large interfacial area per unit volume. Leveraging this mechanism in the design of tungsten as a plasma-facing material provides a potential pathway for enhancing its radiation tolerance under fusion-relevant conditions. In this study, we explore the impact of defect microstructures on the mechanical behavior of helium ion implanted nanocrystalline tungsten through nanoindentation. Softening was apparent across all implantation temperatures and attributed to bubble/cavity loaded grain boundaries suppressing the activation barrier for the onset of plasticity via grain boundary mediated dislocation nucleation. An increase in fluence placed cavity induced grain boundary softening in competition with hardening from intragranular defect loop damage, thus signaling a new transition in the mechanical behavior of helium implanted nanocrystalline tungsten.

The current study examined the effect of academic interventions and modifications on behavioral outcomes in a meta-analysis of 32 single-case design studies. Academic interventions included modifying task difficulty, providing instruction in reading, mathematics, or writing, and contingent reinforcement for academic performance. There was an overall small to moderate effect (ϕ = .56) on behavioral outcomes, with a stronger effect on increasing time on task (ϕ = .64) than on decreasing disruptive behavior (ϕ = .42). There was a small effect for using a performance-based contingent reinforcer (ϕ = .48). Interventions completed in an individual setting resulted in a moderate to large effects on behavior outcomes. Results of the current meta-analysis suggest that academic interventions can offer both positive academic and behavioral outcomes. Practical implications and suggestions for future research are included. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Cardiac progenitor cells (CPCs) have been shown to promote cardiac regeneration and improve heart function. However, evidence suggests that their regenerative capacity may be limited in conditions of severe hypoxia. Elucidating the mechanisms involved in CPC protection against hypoxic stress is essential to maximize their cardioprotective and therapeutic potential. We investigated the effects of hypoxic stress on CPCs and found significant reduction in proliferation and impairment of vasculogenesis, which were associated with induction of quiescence, as indicated by accumulation of cells in the G0-phase of the cell cycle and growth recovery when cells were returned to normoxia. Induction of quiescence was associated with a decrease in the expression of c-Myc through mechanisms involving protein degradation and upregulation of p21. Inhibition of c-Myc mimicked the effects of severe hypoxia on CPC proliferation, also triggering quiescence. Surprisingly, these effects did not involve changes in p21 expression, indicating that other hypoxia-activated factors may induce p21 in CPCs. Our results suggest that hypoxic stress compromises CPC function by inducing quiescence in part through downregulation of c-Myc. In addition, we found that c-Myc is required to preserve CPC growth, suggesting that modulation of pathways downstream of it may re-activate CPC regenerative potential under ischemic conditions.

The purpose of this investigation was to evaluate the utility of Direct Behavior Rating Single Item Scale (DBR-SIS) methodology in collecting functional behavior assessment data. Specific questions of interest pertained to the evaluation of the accuracy of brief DBR-SIS ratings of behavioral consequences and determination of the type of training necessary to support such accuracy. Undergraduate student participants (N = 213; 62.0% male; 62.4% White) viewed video clips of students in a classroom setting, and then rated both disruptive behavior and 4 consequences of that behavior (i.e., adult attention, peer attention, escape/avoidance, and access to tangibles/activities). Results indicated training with performance feedback was necessary to support the generation of accurate disruptive behavior and consequence ratings. Participants receiving such support outperformed students in training-only, pretest-posttest, and posttest-only groups for disruptive behavior and all 4 DBR-SIS consequence targets. Future directions for research and implications for practice are discussed, including how teacher ratings may be collected along with other forms of assessment (e.g., progress monitoring) within an efficient Tier 2 assessment model. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

The primary purposes of this investigation were to (a) continue a line of research examining the psychometric defensibility of the Social, Academic, and Emotional Behavior Risk Screener - Teacher Rating Scale (SAEBRS-TRS), and (b) develop and preliminarily evaluate the diagnostic accuracy of a novel multiple gating procedure based on teacher nomination and the SAEBRS-TRS. Two studies were conducted with elementary and middle school student samples across two separate geographic locations. Study 1 (n=864 students) results supported SAEBRS-TRS defensibility, revealing acceptable to optimal levels of internal consistency reliability, concurrent validity, and diagnostic accuracy. Findings were promising for a combined multiple gating procedure, which demonstrated acceptable levels of sensitivity and specificity. Study 2 (n=1534 students), which replicated Study 1 procedures, further supported the SAEBRS-TRS' psychometric defensibility in terms of reliability, validity, and diagnostic accuracy. Despite the incorporation of revisions intended to promote sensitivity levels, the combined multiple gating procedure's diagnostic accuracy was similar to that found in Study 1. Taken together, results build upon prior research in support of the applied use of the SAEBRS-TRS, as well as justify future research regarding a SAEBRS-based multiple gating procedure. Implications for practice and study limitations are discussed., (Copyright © 2016 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.)

Objective: To analyse trends in maternal nutritional status in Bangladesh over a 12-year period and to examine the associations between nutritional status and socio-economic variables., Design: Maternal nutritional status indicators were height, weight and BMI. Socio-economic variables used were region, residency, education and occupation of the mothers and their husbands, house type, and possession score in the household., Setting: Bangladesh Demographic and Health Surveys (1996, 2000, 2004 and 2007) were the source of data., Subjects: A total of 16 278 mothers were included., Results: All of the socio-economic variables showed significant associations with maternal nutritional status indicators. Regional variation was found to be present; all three indicators were found to be lowest in the Sylhet division. Upward trends in maternal height, weight and BMI were evident from no possessions to four possessions in households, and for no education to higher education of women and their husbands. Bangladeshi mothers measured in 2007 were found to be on average 0·34 cm taller and 3·36 kg heavier than mothers measured in 1996. Between 1996 and 2007 maternal underweight fell from nearly 50 % to just over 30 % while overweight and obesity increased from about 3 % to over 9 % (WHO cut-offs) or from 7 % to nearly 18 % (Asian cut-offs)., Conclusions: The study reveals that over the 12-year period in Bangladesh there has been a substantial reduction in maternal underweight accompanied by a considerable increase in obesity. It is also evident that malnutrition in Bangladesh is a multidimensional problem that warrants a proper policy mix and programme intervention.

Purpose: The factors affecting frequency discrimination in school-age children are poorly understood. The goal of the present study was to evaluate developmental effects related to memory for pitch and the utilization of temporal fine structure., Method: Listeners were 5.1- to 13.6-year-olds and adults, all with normal hearing. A subgroup of children had musical training. The task was a 3-alternative forced choice in which listeners identified the interval with the higher frequency tone or the tone characterized by frequency modulation (FM). The standard was 500 or 5000 Hz, and the FM rate was either 2 or 20 Hz., Results: Thresholds tended to be higher for younger children than for older children and adults for all conditions, although this age effect was smaller for FM detection than for pure-tone frequency discrimination. Neither standard frequency nor modulation rate affected the child/adult difference FM thresholds. Children with musical training performed better than their peers on pure-tone frequency discrimination at 500 Hz., Conclusions: Testing frequency discrimination using a low-rate FM detection task may minimize effects related to cognitive factors like memory for pitch or training effects. Maturation of frequency discrimination does not appear to differ across conditions in which listeners are hypothesized to rely on temporal cues and place cues.

We compared current Centers for Disease Control and Prevention surveillance criteria with the newer adult screening criteria (ASC) for identifying pediatric ventilator-associated pneumonia (VAP). Possible cases of VAP identified by ASC (n = 17) and cases of VAP identified by the older current surveillance criteria (n = 15) are comparable, but only 9 were identified by both. Positive end expiratory pressure was inferior to fraction of inspired oxygen in identifying ventilator-associated conditions by ASC., (Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)

Lithium wall conditioning has lowered hydrogenic recycling and dramatically improved plasma performance in many magnetic-fusion devices. In this Letter, we report quantum-classical atomistic simulations and laboratory experiments that elucidate the roles of lithium and oxygen in the uptake of hydrogen in amorphous carbon. Surprisingly, we show that lithium creates a high oxygen concentration on a carbon surface when bombarded by deuterium. Furthermore, surface oxygen, rather than lithium, plays the key role in trapping hydrogen.

The objective of the materials analysis particle probe (MAPP) in NSTX is to enable prompt and direct analysis of plasma-facing components exposed to plasma discharges. MAPP allows multiple samples to be introduced to the level of the plasma-facing surface without breaking vacuum and analyzed using X-ray photoelectron spectroscopy (XPS), ion-scattering and direct recoil spectroscopy, and thermal desorption spectroscopy (TDS) immediately following the plasma discharge. MAPP is designed to operate as a diagnostic within the ∼12 min NSTX minimum between-shot time window to reveal fundamental plasma-surface interactions. Initial calibration demonstrates MAPP's XPS and TDS capabilities.

Diisopropylsilyl bis-enol ethers are shown to be powerful intermediates for the diastereoselective dimerization and cross-coupling of cyclic ketones. The trends observed for the oxidative coupling of a range of different dialkylsilyl bis-enol ethers derived from cyclohexanone are rationalized by invoking a stereochemical model based on a Thorpe-Ingold effect.

Unsymmetrical silyl bis-enol ethers have been developed as effective substrates for synthesizing quaternary centers from tetralone derivatives through oxidative carbon-carbon bond formation. The derived products are shown to be highly versatile intermediates that may be used to generate diverse structures such as cyclopentenones, 2H-pyrroles, and spirocyclic pyrrolidines.

This contribution moves in the direction of answering some general questions about the most effective and useful ways of modelling bioprocesses. We investigate the characteristics of models that are good at extrapolating. We trained three fully predictive models with different representational structures (differential equations, differential equations with inheritance of rates and a network of reactions) on Saccharopolyspora erythraea shake flask fermentation data using genetic programming. The models were then tested on unseen data outside the range of the training data and the resulting performances were compared. It was found that constrained models with mathematical forms analogous to internal mass balancing and stoichiometric relations were superior to flexible unconstrained models, even though no a priori knowledge of this fermentation was used.

Background: The effect of helminth infestation on the nutrition, growth, and physiology of the host is still poorly understood. Anthelmintic treatment of children in developing countries has had varying success in terms of growth improvements., Objective: The objective of this study was to assess the effect of regular deworming on child growth, physiology, and biochemical status., Design: The study was a 12-mo longitudinal intervention in 123 Bangladeshi children aged 2-5 y. Treatment (mebendazole) or placebo tablets were administered every 2 mo for 8 mo and again at 12 mo. Weight, height, midupper arm circumference, intestinal permeability, plasma albumin, alpha(1)-antichymotrypsin, and total protein concentration were assessed every 2 mo., Results: Treatment with mebendazole reduced the prevalence of Ascaris lumbricoides from 78% to 8%, of Trichuris trichiura from 65% to 9%, and of hookworm from 4% to 0%. There was no significant difference in the growth of treated children compared with those given placebo tablets. No changes in intestinal permeability or plasma albumin were observed after deworming. Significant decreases in total protein (P<0.001) and alpha(1)-antichymotrypsin (P<0.001) were observed in the treatment group, indicating possible reductions in inflammation and immunoglobulin concentration after deworming. A significant increase in the prevalence of Giardia intestinalis (from 4% to 49%) in the treatment group was associated with a short-term reduction in weight (P = 0.02) and higher intestinal permeability (P <0.001) in infected subjects. No long-term effects of G. intestinalis on growth were observed., Conclusion: Low-intensity helminth infections, predominantly of A. lumbricoides and T. trichiura, do not contribute significantly to the poor growth and biochemical status of rural Bangladeshi children.

Purpose: To review results from cross-sectional imaging studies performed to evaluate asymptomatic anterior chest wall lesions in children., Materials and Methods: All magnetic resonance (MR) images or computed tomographic (CT) scans of the chest obtained from 1989 to 1996 for evaluation of asymptomatic, palpable, focal, anterior chest wall lesions in otherwise healthy children were reviewed. Fifty-one children were considered for the study. Findings from 27 examinations in 27 children (13 underwent MR imaging, and 14 underwent CT) were included in the study. All children had normal radiographs of the region. Twenty-four patients did not meet the inclusion criteria and were excluded., Results: The cause of the lesion palpated at physical examination was identified in 26 of 27 patients: prominent anterior convex ribs in 10 patients; "tilted" sternum in six; prominent asymmetric costal cartilage in four; bifid rib in one; and well-defined, small (< 1-cm) subcutaneous nodule adjacent to costal cartilage in five. One examination demonstrated no abnormality. Of the 27 patients, none required treatment., Conclusion: All palpable, asymptomatic, anterior chest wall lesions were benign and usually related to normal variations in the bone or cartilage of the chest wall. The low yield of cross-sectional imaging performed for evaluation of these asymptomatic "bumps" should be considered when decisions are made with regard to imaging.

Study Objective: The UK National Case-Control Study was carried out to investigate the relationship between oral contraceptive use and breast cancer risk. This study investigates whether general practitioner notes could be used as the sole data source for epidemiological studies of young women and what the effect would be on non-response and recall bias., Design: Case-control study with data on gynaecological, obstetric, and contraceptive history collected at interview and from general practitioners' notes. Information from these two sources was compared., Setting: This was a population-based study., Participants: Altogether 755 women with breast cancer aged under 36 years at diagnosis, each with an age-matched control, participated in the study. Response rates at interview were 72% and 89% for cases and controls but GP data were available for 90% of the 1049 case and first-selected control pairs., Main Results: There was generally good agreement between the two data sources with respect to obstetric history and gynaecological procedures (hysterectomy, oophorectomy, and tubal ligation). The use of intra-uterine devices, or diaphragm, and partner's vasectomy were not reliably recorded in the GP's notes. The overall results of the UK study would have been qualitatively the same with respect to the relationship between oral contraceptive use and breast cancer risk if GP notes only had been used, in spite of the fact that only about half of all oral contraceptive usage was recorded in the notes. Response rates would have been higher, recall bias eliminated, and the cost of the study halved., Conclusions: When planning case-control studies in young women, the possibility of using GP notes as the primary data source should be considered. Lack of data on potential confounding factors is a possible drawback to such use. The practice of destroying GP's notes shortly after the death of patients seriously restricts the possibility of using these notes when studying rapidly fatal conditions.

A retrospective histopathological study of 300 women under 36 years of age was carried out to determine whether breast cancers occurring in oral contraceptive users showed any differences in pathological features compared with non-users. The patients belong to an age group in which an increased risk of cancer development has been reported following oral contraceptive usage. The incidence of non-neoplastic conditions in the residual breast was also studied in the two groups. There was little difference between breast cancers arising in pill users and non-users but in the residual non-neoplastic breast a decreased incidence of cysts and blunt duct adenosis was found in current users of the contraceptive pill. In contrast, lactational foci were found only in the breasts of pill users. The incidence of intraductal hyperplasia was not significantly different in the two groups.

A challenge to politicains and health administrators everywhere, and therefore to health education, is how to achieve a more equitable distribution of health care to the people. A new approach that may well be the answer is the use of primary health care, which is concerned with measures that will provide simple and effective health care to all people. The priniciples on which primary health care is based have much in common with those of health education, as spelled out over the past 20 years by WHO expert committees, namely: involving people in a working partnership respecting their values and beliefs, placing reliance on indigenous practitioners, etc. In both cases, "the focus is on people and action" and the primary health care context offers a challenging opportunity for health education to make a major contribution towards a fairer distribution of health services. Another area where health education has a particular challenge to meet concerns the education of politicians at all levels: health educators must do all they can to influence health and health-related policy away from those determined solely by political expediency and towards policies that benefit the people. They must also help bridge the gap between "deciding politicians" and the "consuming citizen" to help ensure that the decisions of the former meet the needs of the latter.