Health disparities between Appalachia and the rest of the country are widening. To address this, the Appalachian Translational Research Network (ATRN) organizes an annual ATRN Health Summit. The most recent Summit was held online September 22–23, 2020, and hosted by Wake Forest Clinical and Translational Science Institute in partnership with the Northwest Area Health Education Center. The Summit, titled “Community-Engaged Research in Translational Science: Innovations to Improve Health in Appalachia,” brought together a diverse group of 141 stakeholders from communities, academic institutions, and the National Center for Advancing Translational Science (NCATS) to highlight current research, identify innovative approaches to translational science and community-engaged research, develop cross-regional research partnerships, and establish and disseminate priorities for future Appalachian-focused research. The Summit included three plenary presentations and 39 presentations within 12 concurrent breakout sessions. Here, we describe the Summit planning process and implementation, highlight some of the research presented, and outline nine emergent themes to guide future Appalachian-focused research.

Introduction: Needle-related procedures are considered the most important source of pain and distress in children in hospital settings. Time constraints, heavy workload, busy and noisy environment represent barriers to the use of available interventions for pain management during needle-related procedures. Therefore, the use of a rapid, easy-to-use intervention could improve procedural pain management practices. The objective was to determine if a device combining cold and vibration (Buzzy) is non-inferior (no worse) to a topical anesthetic (Maxilene) for pain management in children undergoing needle-related procedures in the Emergency Department (ED). Methods: This study was a randomized, controlled, non-inferiority trial. We enrolled children aged between 4-17 years presenting to the ED and requiring a needle-related procedure. Participants were randomly assigned to the Buzzy or Maxilene group. The primary outcome was the mean difference in pain intensity during the procedure, as measured with the CAS (0-10). Secondary outcomes were procedural distress, success of the procedure at first-attempt and satisfaction of parents. Results: A total of 352 participants were enrolled and 346 were randomized (Buzzy = 172; Maxilene = 174). Mean difference in procedural pain scores between groups was 0.64 (95%CI -0.1 to 1.3), showing that the Buzzy device was not non-inferior to Maxilene according to a non-inferiority margin of 0.70. No significant differences were observed for procedural distress (p = .370) and success of the procedure at first attempt (p = .602). Parents of both groups were very satisfied with both interventions (Buzzy = 7.8 ±2.66; Maxilene = 8.1 ±2.4), but there was no significant difference between groups (p = .236). Conclusion: Non-inferiority of the Buzzy device over a topical anesthetic was not demonstrated for pain management of children during a needle-related procedure in the ED. However, considering that topical anesthetics are underused in the ED setting and require time, the Buzzy device seems to be a promising alternative as it is a rapid, low-cost, easy-to-use and reusable intervention.

Eggs attenuate postprandial hyperglycaemia (PPH), which transiently impairs vascular endothelial function (VEF). We hypothesised that co-ingestion of a glucose challenge with egg-based meals would protect against glucose-induced impairments in VEF by attenuating PPH and oxidative stress. A randomised, cross-over study was conducted in prediabetic men (n 20) who ingested isoenegertic meals (1674 kJ (400 kcal)) containing 100 g glucose (GLU), or 75 g glucose with 1·5 whole eggs (EGG), seven egg whites (WHITE) or two egg yolks (YOLK). At 30 min intervals for 3 h, brachial artery flow-mediated dilation (FMD), plasma glucose, insulin, cholecystokinin (CCK), lipids (total, LDL- and HDL-cholesterol; TAG), F2-isoprostanes normalised to arachidonic acid (F2-IsoPs/AA), and methylglyoxal were assessed. In GLU, FMD decreased at 30–60 min and returned to baseline levels by 90 min. GLU-mediated decreases in FMD were attenuated at 30–60 min in EGG and WHITE. Compared with GLU, FMDAUC was higher in EGG and WHITE only. Relative to baseline, glucose increased at 30–120 min in GLU and YOLK but only at 30–90 min in EGG and WHITE. GlucoseAUC and insulinAUC were also lower in EGG and WHITE only. However, CCKAUC was higher in EGG and WHITE compared with GLU. Compared with GLU, F2-IsoPs/AAAUC was lower in EGG and WHITE but unaffected by YOLK. Postprandial lipids and methylglyoxal did not differ between treatments. Thus, replacing a portion of a glucose challenge with whole eggs or egg whites, but not yolks, limits postprandial impairments in VEF by attenuating increases in glycaemia and lipid peroxidation.

A consideration of possible expressions for the number and size of bonds intersected by a potential failure surface leads to the following expression for the strength of snow, σ f, which is age-hardening at a constant porosity n:

where σ i is the strength of ice, t f is the time at failure, α is a parameter specifically related to the mechanism of bonding, and ω is a temperature-dependent parameter. Allowing t f to become infinite provides the envelope of maximum strength for fully age-hardened snow at any porosity n.

A consolidation theory is developed for an age-hardened snow under uniaxial stress in the porosity range of 35 to 55 per cent by considering one mechanism, viz. viscous flow of interparticle bonds. For a uniaxial stress σ the differential equation for porosity n in terms of time t is shown to be

where a and ν are structural parameters and η is the coefficient of viscosity of ice. Comparison of this equation and the integrated form with existing data predicts consistent and reasonable values for a. The predicted values of η/ν range from 10−2 to 102 times the published values for, η which may indicate that ν, and hence the consolidation rate, is greatly affected by the diagenetic history of the snow and the conditions of experimentation.

Although much of what we know about political advertising comes from the study of television advertising alone, online advertising is an increasingly prominent part of political campaigning. Research on other online political communication—especially candidate websites, blogs, and social media—tends to conclude that these communications are aimed primarily at turning existing supporters into campaign donors, activists, and volunteers. Is a similar communication strategy found in online display ads—those ads placed adjacent to website content? In one of the first systematic analyses of the nature, content, and targets of online display advertising, we examined 840 unique online display ads from the 2012 presidential campaign. We show that the policy content, ad location, and interactive elements of the ads varied based on the audience, with persuasive appeals aimed at undecided or persuadable voters and engagement appeals aimed at existing supporters. Comparing ad content across candidates also found that each side focused on those issues for which the candidate had a strategic advantage. As a consequence, and in contrast to the conclusions of previous research that examines television advertising, we found minimal issue engagement in online advertising.

This paper suggests ways in which videotape modelling strategies may be used in behaviour therapy. Clients can acquire new responses through observational learning, while the consequences accruing to a model from different actions can be planned to effect inhibition or disinhibition of specific client behaviours. Modelling may facilitate the performance of previously learned behaviour by identifying for the observer appropriate contexts and discriminative stimuli. Also, models can be used to present cultural norms or standards for performance. The effective and ethical use of videotape modelling strategies requires that therapists understand the theoretical dimensions of this intervention format and justify the content of modelling presentations from empirical research on the behaviours targeted for change. Particular cautions are noted in the areas of social skills training and desensitization to anxiety provoking situations.

Data on rate and qualitative features of social interactions and on peer social involvement in play were obtained from repeated observation measures taken across 14 to 23 weeks on two children randomly selected from each of 6 kindergartens. Session-by-session variability was found to be a feature of the social interaction and social play data, and there was evidence that social behaviours may vary systematically across different kindergarten settings. A case is made for obtaining normative data in each setting of interest in order to identify atypical behaviour and to evaluate the social validity of intervention outcomes.

Whey protein intake reduces CVD risk, but little is known whether whey-derived bioactive peptides regulate vascular endothelial function (VEF). We determined the impact of a whey-derived extract (NOP-47) on VEF in individuals with an increased cardiovascular risk profile. Men and women with impaired brachial artery flow-mediated dilation (FMD) (n 21, age 55 (sem 1·3) years, BMI 27·8 (sem 0·6) kg/m2, FMD 3·7 (sem 0·4) %) completed a randomised, cross-over study to examine whether ingestion of NOP-47 (5 g) improves postprandial VEF. Brachial artery FMD, plasma amino acids, insulin, and endothelium-derived vasodilators and vasoconstrictors were measured for 2 h after ingestion of NOP-47 or placebo. Acute NOP-47 ingestion increased FMD at 30 min (4·6 (sem 0·5) %) and 120 min (5·1 (sem 0·5) %) post-ingestion (P< 0·05, time × trial interaction), and FMD responses at 120 min were significantly greater in the NOP-47 trial compared with placebo (4·3 (sem 0·5) %). Plasma amino acids increased at 30 min following NOP-47 ingestion (P< 0·05). Serum insulin increased at 15, 30 and 60 min (P< 0·001) following NOP-47 ingestion. No changes were observed between the trials for plasma NO∙ and prostacyclin metabolites or endothelin-1. Ingestion of a rapidly absorbed extract derived from whey protein improved endothelium-dependent dilation in older adults by a mechanism independent of changes in circulating vasoactive compounds. Future investigation is warranted in individuals at an increased CVD risk to further elucidate potential health benefits and the underlying mechanisms of extracts derived from whey.

A microbiological investigation of Black infants suffering from severe acute summer gastroenteritis revealed enteropathogenic agents in 30 out of 37 patients (81%). Enterotoxigenic bacteria were isolated from 15 patients (41%). A total of 16 enterotoxigenic strains were isolated, comprising 9 enterotoxigenic Escherichia coli strains secreting labile and stable toxin on their own and in combination, and labile-toxin secreting strains of Klebsiella pneumoniae (4), Enterobacter cloacae (2) and Proteus vulgaris (1). In the case of the latter three species, however, 6 out of the 7 strains were isolated from patients who were excreting other enteric pathogens, whereas only 2 out of 9 enterotoxigenic E. coli patients had concomitant infections with other pathogens. No invasive bacteria were isolated except for 2 shigella strains. Salmonella and shigella strains were found in four patients. No correlation was found between the enteropathogenicity of E. coli and its serotype. Rotavirus was observed by negative staining electron microscopy in only two patients (6%) but using a reverse complement fixation test rotavirus antigen was detected in the stool of 17 out of 35 patients (49%). The low EM detection rate may well be due to the patients being admitted for treatment late in the course of their illness when the degree of viral shedding has decreased below EM detectability. No significant difference in clinical presentation was noted between the various aetiological agents. Only one patient was being solely breast-fed compared to 16% of control non-diarrhoeic infants. Evidence of malnutrition was noted in over half of our patients.

The ability to detect and measure water stress accurately is critical for optimizing crop production. The Crop Water Stress Index (CWSI), the linear relationship of the difference between foliage and air temperatures as a function of the air vapour pressure deficit, is one widely used method. Under well-watered conditions, a ‘baseline’ is derived that is crop specific and presumed fairly constant, despite differences in development and physiology. This study reports changes in the baseline of the CWSI for lucerne crops not subjected to water shortage over 3 years. Studies of lucerne in California from April 1986 to October 1988 used the CWSI to plan irrigations. It was necessary to re-establish the baseline periodically throughout the experiment. In the first year it was similar to that reported in the literature, but in the second year it had a statistically significant steeper slope and higher intercept. In the third year, the regression equation was similar to that in the first year. The changes in the baseline are thought to be a result of crop age rather than year-to-year weather fluctuations. The baseline needs to be determined periodically as the crop matures, to ensure accurate interpretation of plant water stress.