Dilated cardiomyopathy (DCM) is a leading cause of heart failure and the most common indication for a heart transplant. Guidelines are regularly based on studies of adults and applied to the young. Children and adolescents diagnosed with DCM face different lifestyle challenges from individuals diagnosed in adulthood that include medical trauma and are influenced by maturity levels and confidence with advocacy to adults.

Using a UK patient-scientist’s perspective, we reviewed the age-specific challenges faced by the young with DCM, evaluated current guidelines and evidence, and identified areas requiring further recommendations and research. We highlight the importance of (i) the transition clinic from paediatric to adult services, (ii) repeated signposting to mental health services, (iii) standardised guidance on physical activity, (iv) caution surrounding alcohol and smoking, (v) the dangers of illegal drugs, and (vi) reproductive options and health.

Further research is needed to address the many uncertainties in these areas with respect to young age, particularly for physical activity, and such guidance would be welcomed by the young with DCM who must come to terms with being different and more limited amongst healthy peers.

Traditional approaches for evaluating the impact of scientific research – mainly scholarship (i.e., publications, presentations) and grant funding – fail to capture the full extent of contributions that come from larger scientific initiatives. The Translational Science Benefits Model (TSBM) was developed to support more comprehensive evaluations of scientific endeavors, especially research designed to translate scientific discoveries into innovations in clinical or public health practice and policy-level changes. Here, we present the domains of the TSBM, including how it was expanded by researchers within the Implementation Science Centers in Cancer Control (ISC3) program supported by the National Cancer Institute. Next, we describe five studies supported by the Penn ISC3, each focused on testing implementation strategies informed by behavioral economics to reduce key practice gaps in the context of cancer care and identify how each study yields broader impacts consistent with TSBM domains. These indicators include Capacity Building, Methods Development (within the Implementation Field) and Rapid Cycle Approaches, implementing Software Technologies, and improving Health Care Delivery and Health Care Accessibility. The examples highlighted here can help guide other similar scientific initiatives to conceive and measure broader scientific impact to fully articulate the translation and effects of their work at the population level.

Background: Travel screening can facilitate the identification of patients at risk for emerging infectious diseases, such as Middle East respiratory syndrome (MERS). A travel navigator with associated decision support through a best practice advisory (BPA) was implemented in an electronic health record to build upon the CDC identify-isolate-inform framework. Compliance with documentation of travel history, symptom screening when appropriate, and isolation of suspect MERS patients were assessed. Methods: Adult and pediatric emergency department encounters at the Massachusetts General Hospital, a 1,035-bed, tertiary-care, academic health center in Boston, Massachusetts, from August 2018 to October 2019, were included. We categorized an encounter as adherent to initial travel screening if providers answered foreign, domestic, or no travel to the screen. Encounters were defined as nonadherent if they were recorded as unknown or if an answer was not selected. Adherence to completion of data entry for the subgroup of patients with documented foreign travel was further assessed for region- and country-level specification, completion of symptom screen, and response to the MERS BPA (Fig. 1). Results: In total, 127,866 encounters were included, of which 105,593 (83%) were adherent to initial travel screening. Among 4,498 encounters with documented foreign travel, 2,970 (66%) specified the region of travel, and 710 (16%) selected a country of travel from the listing. Moreover, 214 encounters had documented travel to the Middle East. Selection of Middle East or 1 of the 13 countries identified by the CDC as at risk for MERS triggered symptom screening for fever and cough, which was performed in 139 encounters (65%). Of these, 95 encounters documented absence of fever and cough, 15 documented fever and cough, 12 documented a cough alone, and 17 documented a fever alone through reporting or obtaining vitals. The MERS BPA was triggered in 37 encounters; 10 patients were ordered for isolation using the BPA. Of these, 4 patients met CDC criteria for a MERS patient under investigation and were tested; all were negative. Conclusions: Initial screening to document foreign travel is completed at a high rate; however, use of the travel navigator to specify region and country, key components necessary to prompt clinicians for symptom screening, are documented in a minority of encounters. Future interventions are needed to improve region and country capture and appropriate symptom screening, with isolation when appropriate.

Funding: None

Disclosures: None

The early phase of the coronavirus disease 2019 (COVID-19) pandemic and ongoing efforts for mitigation underscore the importance of universal travel and symptom screening. We analyzed adherence to documentation of travel and symptom screening through a travel navigator tool with clinical decision support to identify patients at risk for Middle East Respiratory Syndrome.

Objectives: Fluency is a major problem for individuals with neurodevelopmental disorders, including fluency deficits for academic skills. The aim of this study was to determine neurocognitive predictors of academic fluency within and across domains of reading, writing, and math, in children and adults, with and without spina bifida. In addition to group differences, we expected some neurocognitive predictors (reaction time, inattention) to have similar effects for each academic fluency outcome, and others (dexterity, vocabulary, nonverbal reasoning) to have differential effects across outcomes. Methods: Neurocognitive predictors were reaction time, inattention, dexterity, vocabulary, and nonverbal reasoning; other factors included group (individuals with spina bifida, n=180; and without, n=81), age, and demographic and untimed academic content skill covariates. Univariate and multivariate regressions evaluated hypotheses. Results: Univariate regressions were significant and robust (R2=.78, .70, .73, for reading, writing, and math fluency, respectively), with consistent effects of covariates, age, reaction time, and vocabulary; group and group moderation showed small effect sizes (<2%). Multivariate contrasts showed differential prediction across academic fluency outcomes for reaction time and vocabulary. Conclusions: The novelty of the present work is determining neurocognitive predictors for an important outcome (academic fluency), within and across fluency domains, across population (spina bifida versus typical), over a large developmental span, in the context of well-known covariates. Results offer insight into similarities and differences regarding prediction of different domains of academic fluency, with implications for addressing academic weakness in spina bifida, and for evaluating similar questions in other neurodevelopmental disorders. (JINS, 2019, 25, 249–265)

The main objective of our target article was to sketch the empirical case for the importance of selection at the level of groups on cultural variation. Such variation is massive in humans, but modest or absent in other species. Group selection processes acting on this variation is a framework for developing explanations of the unusual level of cooperation between non-relatives found in our species. Our case for cultural group selection (CGS) followed Darwin's classic syllogism regarding natural selection: If variation exists at the level of groups, if this variation is heritable, and if it plays a role in the success or failure of competing groups, then selection will operate at the level of groups. We outlined the relevant domains where such evidence can be sought and characterized the main conclusions of work in those domains. Most commentators agree that CGS plays some role in human evolution, although some were considerably more skeptical. Some contributed additional empirical cases. Some raised issues of the scope of CGS explanations versus competing ones.

Human cooperation is highly unusual. We live in large groups composed mostly of non-relatives. Evolutionists have proposed a number of explanations for this pattern, including cultural group selection and extensions of more general processes such as reciprocity, kin selection, and multi-level selection acting on genes. Evolutionary processes are consilient; they affect several different empirical domains, such as patterns of behavior and the proximal drivers of that behavior. In this target article, we sketch the evidence from five domains that bear on the explanatory adequacy of cultural group selection and competing hypotheses to explain human cooperation. Does cultural transmission constitute an inheritance system that can evolve in a Darwinian fashion? Are the norms that underpin institutions among the cultural traits so transmitted? Do we observe sufficient variation at the level of groups of considerable size for group selection to be a plausible process? Do human groups compete, and do success and failure in competition depend upon cultural variation? Do we observe adaptations for cooperation in humans that most plausibly arose by cultural group selection? If the answer to one of these questions is “no,” then we must look to other hypotheses. We present evidence, including quantitative evidence, that the answer to all of the questions is “yes” and argue that we must take the cultural group selection hypothesis seriously. If culturally transmitted systems of rules (institutions) that limit individual deviance organize cooperation in human societies, then it is not clear that any extant alternative to cultural group selection can be a complete explanation.

We agree that evolutionary perspectives may help us organize many divergent realms of the science of human behavior. Nevertheless, an imperative to unite all social science under an evolutionary framework risks turning off researchers who have their own theoretical perspectives that can be informed by evolutionary theory without being exclusively defined by it. We propose a few considerations for scholars interested in joining the evolutionary and social sciences.

In a randomized 6-week trial comparing fluoxetine with placebo, the Medical Outcomes Study 36-Item Short-Form Health Status Survey (SF-36) scales were used to measure the effects of treatment on functional health and well-being among elderly (age ≥ 60 years) outpatients with major depression. In the fluoxetine and placebo groups, 261 and 271 patients, respectively, completed the SF-36 before treatment and at Weeks 3 and 6. Compared with national norms for individuals over age 60, study patients before treatment exhibited baseline decrements on the following SF-36 scales: mental health, role limitations due to emotional problems, social functioning, vitality, role limitations due to physical problems, and bodily pain. Analyses of SF-36 changed scores from baseline to Week 6 revealed that the fluoxetine group improved more than the placebo group across all scales. Differences in changes of scores between groups were significant (p < .05), favoring the fluoxetine group for the scales of mental health, role limitations due to emotional problems, physical functioning, and bodily pain. Improvements observed in the fluoxetine group were both clinically and socially significant.

This line has long been a crux in the interpretation of Pindar, and there is still no consensus on its syntax or meaning. The conclusions reached by Stefan Radt (Mnem. n.s 19 (1966), 148–74) and Richard Stoneman (Quad. Urb. 31 (1979), 65–70) in the most recent studies of the problem are in all respects at variance. The cardinal difficulty of0 the line is the sense of , which must be elucidated before one can attempt to disentangle the syntax. I believe that previous commentators have overlooked or misapplied crucial parallel passages because of their preconceptions about the nature of the metaphor here.