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Long-term birth cohorts are essential for studying health and disease over the life course. The retention of participants remains a challenge in study design. Previous research works on attrition are limited in length of follow-up time and lack of racial/ethnic diversity. Using data from the Wayne County Health, Environment, Allergy, and Asthma Longitudinal Study (WHEALS; United States cohort born between 2004 and 2007, n = 1258), we first performed longitudinal latent class analyses to identify patterns of participation spanning the prenatal period and six follow-up timepoints: 1, 6, 12, and 24 months; 3–6 years; and 10–12 years. Data collection included a combination of in-person visits, home visits, home specimen kits, and staff-administered questionnaires. We examined associations between baseline factors and participation class using multinomial logistic regression modeling, and with conditional inference modeling to identify variables most strongly associated with class. We identified four participation classes: high early participation with gradual loss-to-follow-up, sporadic participation, consistently high participation, and consistently low participation. Multiple baseline characteristics were associated with participation class. The “consistently high participation” class was disproportionately composed of participants who were older, were of higher education, had private insurance, had suburban residence, and were with higher income. Conditional inference trees identified maternal education, insurance, and income as most strongly associated with participation class. Through latent class modeling, we show that participants who were lost to follow-up fell into distinct groupings of participation. In the future, preparatory communications with those who are at the highest risk of study discontinuation may improve long-term retention.
Interprofessional teams in the pediatric cardiac ICU consolidate their management plans in pre-family meeting huddles, a process that affects the course of family meetings but often lacks optimal communication and teamwork.
Methods:
Cardiac ICU clinicians participated in an interprofessional intervention to improve how they prepared for and conducted family meetings. We conducted a pretest–posttest study with clinicians participating in huddles before family meetings. We assessed feasibility of clinician enrollment, assessed clinician perception of acceptability of the intervention via questionnaire and semi-structured interviews, and impact on team performance using a validated tool. Wilcoxon rank sum test assessed intervention impact on team performance at meeting level comparing pre- and post-intervention data.
Results:
Totally, 24 clinicians enrolled in the intervention (92% retention) with 100% completion of training. All participants recommend cardiac ICU Teams and Loved ones Communicating to others and 96% believe it improved their participation in family meetings. We exceeded an acceptable level of protocol fidelity (>75%). Team performance was significantly (p < 0.001) higher in post-intervention huddles (n = 30) than in pre-intervention (n = 28) in all domains. Median comparisons: Team structure [2 vs. 5], Leadership [3 vs. 5], Situation Monitoring [3 vs. 5], Mutual Support [ 3 vs. 5], and Communication [3 vs. 5].
Conclusion:
Implementing an interprofessional team intervention to improve team performance in pre-family meeting huddles is feasible, acceptable, and improves team function. Future research should further assess impact on clinicians, patients, and families.
Technology is central in supporting older people with their daily tasks and independence at home. This project aimed to identify technologies that can be built into residential environments (e.g., appliances, fixtures, or fittings) to support older people in activities of daily living (ADL) through a horizon scan (HS) informed by public insights on unmet needs and priorities.
Methods
A survey of members of the public was conducted to prioritize outcomes included within an evidence and gap map (EGM) framework. The EGM aimed to illustrate the current landscape of technologies supporting ADL in residential settings (e.g., care homes) and innovation gaps. The EGM results were shared with end users in a workshop discussion on the current range of technologies aimed at supporting ADL in residential settings. This was facilitated using vignettes to elicit views on unmet needs and priorities for technology development. The workshop informed the scope of the HS to identify and prioritize emerging technologies that could address unmet needs.
Results
This project successfully embedded public involvement throughout to identify innovation gaps in technologies supporting ADL, unmet needs among end users, and potential solutions to these needs. The HS identified 190 technologies that were ready to market. All the technologies had potential to address identified unmet needs and could be built into the residential environment to support older people with ADL and to improve their quality of life, independence, and safety at home. Horizon scanning research can meaningfully involve stakeholders and take direction from their insights to enable voices less often heard to drive innovation in areas where it is needed.
Conclusions
Involving stakeholders in research using evidence synthesis and qualitative methods helps to gain a better understanding of gaps in innovation, the related unmet needs, and the technologies that might address these needs. Public involvement in the survey and workshop influenced the conduct and interpretation of the EGM, the scope of the HS, and the interpretation of the findings.
Similar to adults with posttraumatic stress disorder, children with early life adversity show bias in memory for negative emotional stimuli. However, it is not well understood how childhood adversity impacts mechanisms underlying emotional memory. N = 56 children (8–14 years, 48% female) reported on adverse experiences including potentially traumatic events and underwent fMRI while attending to emotionally pleasant, neutral, or negative images. Post-scan, participants completed a cued recall test to assess memory for these images. Emotional difference-in-memory (DM) scores were computed by subtracting negative or positive from neutral recall performance. All children showed enhancing effects of emotion on recall, with no effect of trauma load. However, children with less trauma showed a larger emotional DM for both positive and negative stimuli when amygdala or anterior hippocampal activity was higher. In contrast, highly trauma-exposed children demonstrated a lower emotional DM with greater amygdala or hippocampal activity. This suggested that alternative neural mechanisms might support emotional enhancement of encoding in children with greater trauma load. Whole-brain analyses revealed that right fusiform activity during encoding positively correlated with both trauma load and successful later recall of positive images. Therefore, highly trauma-exposed children may use alternative, potentially adaptive neural pathways via the ventral visual stream to encode positive emotional events.
COVID-19 misinformation proliferating online has led to adverse health and societal consequences. Older adults are a particularly vulnerable population due to increased risk for both COVID-19 related complications and susceptibility to, as well as sharing of, misinformation on social networking sites. The present study aimed to: 1) investigate differences in COVID-19 headline accuracy discernment and online sharing of COVID-19 misinformation in older and younger adults; and 2) examine individual differences in global cognition, health literacy and verbal IQ in online sharing of COVID-19 misinformation.
Participants and Methods:
Fifty-two younger (age 18 to 35 years) and fifty older adults (age 50 and older) completed a telephone neurocognitive battery, health literacy and numeracy measures and self-report questionnaires. Participants also completed a social media headline-sharing experiment (Pennycook et al.,2020) in which they were presented true and false COVID-19 headlines and asked to indicate: 1) the likelihood that they would share the story on social media; and 2) the factual accuracy of the story.
Results:
A repeated measures multivariate analysis of variance controlling for gender and race/ethnicity showed no effects of age (p=.099), but a significant interaction between actual COVID-19 headline accuracy and likelihood of sharing (p<.001), such that accuracy is more strongly related to sharing false headlines (r=-.64) versus true headlines (r=-.43). Moreover, higher likelihood of sharing false COVID-19 headlines was associated with lower verbal IQ and numeracy skills in older adults (rs=-.51--.40; ps<.01) and with lower verbal IQ, numeracy, and global cognition in younger adults (rs=-.66--.60; ps<.01).
Conclusions:
Findings indicate that headline accuracy judgements are an important predictor of sharing COVID-19 misinformation in both older and younger adults. Further, individual differences in cognition, IQ, and numeracy may predict the likelihood of misinformation sharing in younger adults, while IQ and numeracy skills may act as important antecedents of misinformation sharing in older adults. Future work might leverage modern, neuropsychologically-based psychoeducation approaches to improving health and science literacy related to COVID-19.
Physical activity and social interaction among rural older adults are important, particularly during the COVID-19 pandemic when restrictions on physical gatherings were placed. The purpose of this qualitative study was to gain a deeper understanding of rural older adults’ experience with physical activity and social interaction during the COVID-19 pandemic. An interpretative phenomenological approach was used to explore the experience of 10 older adults, 67–82 years of age, from rural communities throughout Saskatchewan. Findings revealed that many rural older adults acknowledged the health benefits of physical and social activities and experienced loneliness when COVID-19 restrictions were placed, even when living with a partner. For some, the restrictions placed on physical and social activity provided a welcome break from daily responsibilities. Rural communities, often at a disadvantage, were also perceived by participants as being protected against COVID-19. The resilience demonstrated among rural participants to persevere and adapt to their changing environment during the pandemic was evident in the findings.
This collection profiles understudied figures in the book and print trades of the seventeenth century. With an equal balance between women and men, it intervenes in the history of the trades, emphasising the broad range of material, cultural, and ideological work these people undertook. It offers a biographical introduction to each figure, placing them in their social, professional, and institutional settings. The collection considers varied print trade roles including that of the printer, publisher, paper-maker, and bookseller, as well as several specific trade networks and numerous textual forms. The biographies draw on extensive new archival research, with details of key sources for further study on each figure. Chronologically organised, this Element offers a primer both on numerous individual figures, and on the tribulations and innovations of the print trade in the century of revolution.
Viruses are the most numerically abundant biological entities on Earth. As ubiquitous replicators of molecular information and agents of community change, viruses have potent effects on the life on Earth, and may play a critical role in human spaceflight, for life-detection missions to other planetary bodies and planetary protection. However, major knowledge gaps constrain our understanding of the Earth's virosphere: (1) the role viruses play in biogeochemical cycles, (2) the origin(s) of viruses and (3) the involvement of viruses in the evolution, distribution and persistence of life. As viruses are the only replicators that span all known types of nucleic acids, an expanded experimental and theoretical toolbox built for Earth's viruses will be pivotal for detecting and understanding life on Earth and beyond. Only by filling in these knowledge and technical gaps we will obtain an inclusive assessment of how to distinguish and detect life on other planetary surfaces. Meanwhile, space exploration requires life-support systems for the needs of humans, plants and their microbial inhabitants. Viral effects on microbes and plants are essential for Earth's biosphere and human health, but virus–host interactions in spaceflight are poorly understood. Viral relationships with their hosts respond to environmental changes in complex ways which are difficult to predict by extrapolating from Earth-based proxies. These relationships should be studied in space to fully understand how spaceflight will modulate viral impacts on human health and life-support systems, including microbiomes. In this review, we address key questions that must be examined to incorporate viruses into Earth system models, life-support systems and life detection. Tackling these questions will benefit our efforts to develop planetary protection protocols and further our understanding of viruses in astrobiology.
Background: Long-term care facility (LTCF) employees pose potential risk for COVID-19 outbreaks. Association between employee infection prevention (IP) adherence with facility COVID-19 outbreaks remains a knowledge gap. Methods: From April through December 2020, prior to COVID-19 vaccination, we tested asymptomatic Veterans’ Affairs (VA) community living center (CLC) residents twice weekly and employees monthly, which increased to weekly with known exposure, for SARS-CoV-2 via nasopharyngeal PCR. Employees voluntarily completed multiple choice questionnaires assessing self-reported IP adherence at and outside work. Surveys were longitudinally administered in April, June, July, and October 2020. Changes in paired employee responses for each period were analyzed using the McNemar test. We obtained COVID-19 community rates from surrounding Davidson and Rutherford counties from the Tennessee Department of Health public data set. CLC resident COVID-19 cases were obtained from VA IP data. Incidence rate and number of positive tests were calculated. Results: Between April and December 2020, 444 employees completed at least 1 survey; 177 completed surveys in both April and June, 179 completed surveys in both June and July, and 140 completed surveys in both July and October (Fig. 1). Across periods, employee surveys demonstrated an increase in masking at work and outside work between April and June (63% to 95% [P < .01] and 36% to 63% [P < .01], respectively), and June to July (95% to 99% [P < .05] and 71% to 84% [P < .01], respectively) that were both maintained between July and October (Fig. 2). Distancing at work and limiting social contacts outside work significantly decreased from April to June but increased in subsequent periods, although not significantly. COVID-19 community incidence peaked in July and again in December, but CLC resident COVID-19 cases peaked in August, declined, and remained low through December (Fig. 3). Discussion: Wearing a mask at work, which was mandatory, increased, and voluntary employee masking outside work also increased. CLC COVID-19 cases mirrored community increases in July and August; however, community cases increased again later in 2020 while CLC cases remained low. Employees reporting distancing at work and limiting social contacts outside work decreased preceding the initial rise in CLC cases but increased and remained high after July. Conclusions: These data from the pre–COVID-19 vaccination era suggest that widespread, increased support for and emphasis on LTCF IP adherence, especially masking, may have effectively prevented COVID-19 outbreaks in the vulnerable LTCF population.
The Trial Innovation Network has established an infrastructure for single IRB review in response to federal policies. The Network’s single IRB (sIRBs) have successfully supported over 70 multisite studies via more than 800 reliance arrangements. This has generated several lessons learned that can benefit the national clinical research enterprise, as we work to improve the conduct of clinical trials. These lessons include distinguishing the roles of the single IRB from institutional Human Research Protections programs, establishing a consistent sIRB review model, standardizing collection of local context and supplemental, study-specific information, and educating and empowering lead study teams to support their sites.
Anorexia nervosa (AN) is a psychiatric disorder with complex etiology, with a significant portion of disease risk imparted by genetics. Traditional genome-wide association studies (GWAS) produce principal evidence for the association of genetic variants with disease. Transcriptomic imputation (TI) allows for the translation of those variants into regulatory mechanisms, which can then be used to assess the functional outcome of genetically regulated gene expression (GReX) in a broader setting through the use of phenome-wide association studies (pheWASs) in large and diverse clinical biobank populations with electronic health record phenotypes.
Methods
Here, we applied TI using S-PrediXcan to translate the most recent PGC-ED AN GWAS findings into AN-GReX. For significant genes, we imputed AN-GReX in the Mount Sinai BioMe™ Biobank and performed pheWASs on over 2000 outcomes to test the clinical consequences of aberrant expression of these genes. We performed a secondary analysis to assess the impact of body mass index (BMI) and sex on AN-GReX clinical associations.
Results
Our S-PrediXcan analysis identified 53 genes associated with AN, including what is, to our knowledge, the first-genetic association of AN with the major histocompatibility complex. AN-GReX was associated with autoimmune, metabolic, and gastrointestinal diagnoses in our biobank cohort, as well as measures of cholesterol, medications, substance use, and pain. Additionally, our analyses showed moderation of AN-GReX associations with measures of cholesterol and substance use by BMI, and moderation of AN-GReX associations with celiac disease by sex.
Conclusions
Our BMI-stratified results provide potential avenues of functional mechanism for AN-genes to investigate further.
To evaluate the fatty acid profiles and relevant vitamin and mineral compositions of margarine/margarine-like products and butter blend products available in the US marketplace and to compare with butter.
Design:
Analysis of the food and nutrient composition information available for margarine/margarine-like products, butter blend products and butter in the 2021 version of the University of Minnesota Nutrition Coordinating Center (NCC) Food and Nutrient Database.
Setting:
The US retail food marketplace in 2020.
Participants:
A selection of eighty-three margarine/margarine-like or butter blend products available in the USA in 2020 and regular and whipped butter (both salted and unsalted).
Results:
All products contained no or negligible amounts of trans fat. Mean daily values (DV) for SFA per 1 tablespoon ranged from 11 % for margarine/margarine-like tub and squeeze products to 18 % for margarine/margarine-like stick products and butter blend products. In contrast, one tablespoon butter provides 36 % of the DV for SFA. Results from ANOVA comparing the percent of total fat from SFA, PUFA and MUFA by product type indicated significant differences for SFA (P < 0·01) and PUFA (P < 0·01), but not MUFA (P = 0·07).
Conclusions:
Leading brands of margarine/margarine-like and butter blend products examined in this study were found to be in greater alignment with current dietary recommendations for fatty acids and cholesterol than butter. Margarine/margarine-like tub and squeeze products were found to be optimal over margarine/margarine-like stick products and butter blend products. Future research should include an examination of private label products.
Increased frequency and occurrence of herbicide-resistant biotypes heightens the need for alternative wild oat management strategies. This study aimed to exploit the height differential between wild oat and crops by targeting wild oat between panicle emergence and seed shed timing. Two field studies were conducted either in Lacombe, AB, or Lacombe, AB and Saskatoon, SK, from 2015 to 2017. In the first study, we compared panicle removal methods: hand clipping, use of a hedge trimmer, and a selective herbicide crop topping application to a weedy check and an industry standard in-crop herbicide application in wheat. These treatments were tested early (at panicle emergence), late (at initiation of seed shed), or in combination at one location over 3 yr. In the second study, we investigated optimal timing of panicle removal via a hedge trimmer with weekly removals in comparison to a weedy check in wheat and lentil. This study was conducted at two locations, Lacombe, AB, and Saskatoon, SK, over 3 yr. Among all the tested methods, the early crop topping treatment consistently had the largest impact on wild oat density, dockage, seedbank, and subsequent year crop yield. The early (at panicle emergence) or combination of early and late (at initiation of seed shed) treatments tended to reduce wild oat populations the following season the most compared to the late treatments. Subsequent wild oat populations were not influenced by panicle removal timing, but only by crop and location interactions. Panicle removal timing did significantly affect wild oat dockage in the year of treatment, but no consistent optimal timing could be identified. However, the two studies together highlight additional questions to be investigated, as well as the opportunity to manage wild oat seedbank inputs at the panicle emergence stage of the wild oat lifecycle.
To prioritise and refine a set of evidence-informed statements into advice messages to promote vegetable liking in early childhood, and to determine applicability for dissemination of advice to relevant audiences.
Design:
A nominal group technique (NGT) workshop and a Delphi survey were conducted to prioritise and achieve consensus (≥70 % agreement) on thirty evidence-informed maternal (perinatal and lactation stage), infant (complementary feeding stage) and early years (family diet stage) vegetable-related advice messages. Messages were validated via triangulation analysis against the strength of evidence from an Umbrella review of strategies to increase children’s vegetable liking, and gaps in advice from a Desktop review of vegetable feeding advice.
Setting:
Australia.
Participants:
A purposeful sample of key stakeholders (NGT workshop, n 8 experts; Delphi survey, n 23 end users).
Results:
Participant consensus identified the most highly ranked priority messages associated with the strategies of: ‘in-utero exposure’ (perinatal and lactation, n 56 points) and ‘vegetable variety’ (complementary feeding, n 97 points; family diet, n 139 points). Triangulation revealed two strategies (‘repeated exposure’ and ‘variety’) and their associated advice messages suitable for policy and practice, twelve for research and four for food industry.
Conclusions:
Supported by national and state feeding guideline documents and resources, the advice messages relating to ‘repeated exposure’ and ‘variety’ to increase vegetable liking can be communicated to families and caregivers by healthcare practitioners. The food industry provides a vehicle for advice promotion and product development. Further research, where stronger evidence is needed, could further inform strategies for policy and practice, and food industry application.
ABSTRACT IMPACT: Mobile app may help improve the depression symptoms among underserved patients OBJECTIVES/GOALS: Depression is one of most common mental health conditions and the leading cause of disability worldwide, affecting about one in 10 adults in the US. The aim of this study was to explore the factors that affect feasibility of incorporating mobile app self-management tools for depression in integrated primary care settings. METHODS/STUDY POPULATION: This was a cross-sectional questionnaire study of depressed patients at two primary care clinics in a Midwest academic medical center. Adult patients (≥19 years) who had an active or previous diagnosis of depression were included in the study. A self-administered survey collected information pertaining to demographics, smartphone ownership, data plan type, smartphone application usage, mobile app self-management interest, health literacy, and patient activation. Chi-square analysis was conducted to compare the patient demographic characteristics, the smartphone ownership, phone plan, smartphone use for health information between two clinics. Multinominal logistic regression analysis was conducted to examine the association between the patient activation and patient characteristics. RESULTS/ANTICIPATED RESULTS: Over 80% of patients owned a smartphone, 80.5% were willing to use data for depression management, and 68.9% believe an app can help in depression management. A higher literacy level was significantly associated with higher level of patient activation (Chi-square=8.5453; p=0.0360). These results suggest that planning interventions that use mobile apps within this patient population is likely feasible and the intended underserved patients at these clinics have an interest in using depression related apps which is similar to findings found by other studies exploring app interest. DISCUSSION/SIGNIFICANCE OF FINDINGS: Understanding patient activation levels within a given population can help to shape corresponding needs. The use of depression related self-management mobile apps will likely require the development of educational materials to facilitate patient use and engagement which means understanding the literacy needs of this population as well.
OBJECTIVES/GOALS: To characterize the oncogenic potential of HNSCC cell lines harboring 17 non-canonical PIK3CA mutations. METHODS/STUDY POPULATION: Non-canonical PIK3CA mutant constructs generated via site-directed mutagenesis are subcloned into doxycycline-inducible vector pLVX-Puro. Serum-dependent HNSCC cell line (PCI-52-SD1) is then stably transfected with vectors and undergo doxycycline-induction. Cell survival is determined by depriving cells of fetal bovine serum for 72 hours and quantifying remaining cells with 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays. Cell proliferation and migration is evaluated with colony formation assays and transwell assays respectively. RESULTS/ANTICIPATED RESULTS: To date, the survival behavior of eight non-canonical mutants was assessed. Three mutants – Q75E, V71I, and E970K – exhibited 18.7-26.7% greater survival rate relative to cells transfected with wild-type. Five mutants – R519G, Y606C, W328S, C905S, and M1040I – demonstrated survival rates that differed only by −4.3% to +6.6% relative to wild-type. We hypothesize the three activating mutants that exhibited increased survival will also demonstrate increased cell proliferation and migratory behavior whereas the three neutral mutants will not differ from control. DISCUSSION/SIGNIFICANCE OF IMPACT: Ongoing HNSCC PI3K inhibitor trials could be more effective if all PIK3CA hyperactivation mutations are known. Identifying non-canonical mutation effects could result in greater efficacy if drugs are restricted only to those with activating mutations. CONFLICT OF INTEREST DESCRIPTION: JRG and DEJ are co-inventors of cyclic STAT3 decoy and have financial interests in STAT3 Therapeutics, Inc. STAT3 Therapeutics, Inc. holds an interest in a cyclic STAT3 decoy oligonucleotide. The remaining authors declare no conflicts.