Quality Child Care Supports the Achievement of Low-Income Children: Direct and Indirect Pathways Through Caregiving and the Home Environment

Existing studies of child care have not been able to determine whether higher quality child care protects children from the effects of poverty, whether poverty and lower quality child care operate as dual risk factors, or whether both are true. The objective of the current study was to test two pathways through which child care may serve as a naturally occurring intervention for low-income children: a direct pathway through child care quality to child outcomes, and an indirect pathway through improvements in the home environment. Children were observed in their homes and child care settings at 6, 15, 24, and 36 months. An interaction between family income-to-needs ratio and child care quality predicted School Readiness, Receptive Language, and Expressive Language, as well as improvements in the home environment. Children from low-income families profited from observed learning supports in the form of sensitive care and stimulation of cognitive development, and their parents profited from unobserved informal and formal parent supports. Policy implications are discussed

Eating As Treatment (EAT): A Stepped-Wedge, Randomized Controlled Trial of a Health Behavior Change Intervention Provided by Dietitians to Improve Nutrition in Patients With Head and Neck Cancer Undergoing Radiation Therapy (TROG 12.03)

Purpose: Malnutrition in head and neck cancer (HNC) treatment is common and associated with poorer morbidity and mortality outcomes. This trial aimed to improve nutritional status during radiation therapy (RT) using a novel method of training dietitians to deliver psychological techniques to improve nutritional behaviors in patients with HNC. Methods and Materials: This trial used a stepped-wedge, randomized controlled design to assess the efficacy of the Eating As Treatment (EAT) program. Based on motivational interviewing and cognitive behavioral therapy, EAT was designed to be delivered by oncology dietitians and integrated into their clinical practice. During control steps, dietitians provided treatment as usual, before being trained in EAT and moving into the intervention phase. The training was principles based and sought to improve behavior-change skills rather than provide specific scripts. Patients recruited to the trial (151 controls, 156 intervention) were assessed at 4 time points (the first and the final weeks of RT, and 4 and 12 weeks afterward). The primary outcome was nutritional status at the end of RT as measured by the Patient-Generated Subjective Global Assessment. Results: Patients who received the EAT intervention had significantly better scores on the primary outcome of nutritional status at the critical end-of-treatment time point (β = −1.53 [−2.93 to −.13], P =.03). Intervention patients were also significantly more likely than control patients to be assessed as well-nourished at each time point, lose a smaller percentage of weight, have fewer treatment interruptions, present lower depression scores, and report a higher quality of life. Although results were not statistically significant, patients who received the intervention had fewer and shorter unplanned hospital admissions. Conclusions: This trial is the first of its kind to demonstrate the effectiveness of a psychological intervention to improve nutrition in patients with HNC who are receiving RT. The intervention provides a means to ameliorate malnutrition and the important related outcomes and consequently should be incorporated into standard care for patients receiving RT for HNC

MaxCorrMGNN: A Multi-Graph Neural Network Framework for Generalized Multimodal Fusion of Medical Data for Outcome Prediction

With the emergence of multimodal electronic health records, the evidence for an outcome may be captured across multiple modalities ranging from clinical to imaging and genomic data. Predicting outcomes effectively requires fusion frameworks capable of modeling fine-grained and multi-faceted complex interactions between modality features within and across patients. We develop an innovative fusion approach called MaxCorr MGNN that models non-linear modality correlations within and across patients through Hirschfeld-Gebelein-Renyi maximal correlation (MaxCorr) embeddings, resulting in a multi-layered graph that preserves the identities of the modalities and patients. We then design, for the first time, a generalized multi-layered graph neural network (MGNN) for task-informed reasoning in multi-layered graphs, that learns the parameters defining patient-modality graph connectivity and message passing in an end-to-end fashion. We evaluate our model an outcome prediction task on a Tuberculosis (TB) dataset consistently outperforming several state-of-the-art neural, graph-based and traditional fusion techniques.Comment: To appear in ML4MHD workshop at ICML 202

Variance and Rate-of-Change as Early Warning Signals for a Critical Transition in an Aquatic Ecosystem State: A Test Case From Tasmania, Australia

Critical transitions in ecosystem states are often sudden and unpredictable. Consequently, there is a concerted effort to identify measurable early warning signals (EWS) for these important events. Aquatic ecosystems provide an opportunity to observe critical transitions due to their high sensitivity and rapid response times. Using palaeoecological techniques, we can measure properties of time series data to determine if critical transitions are preceded by any measurable ecosystem metrics, that is, identify EWS. Using a suite of palaeoenvironmental data spanning the last 2,400 years (diatoms, pollen, geochemistry, and charcoal influx), we assess whether a critical transition in diatom community structure was preceded by measurable EWS. Lake Vera, in the temperate rain forest of western Tasmania, Australia, has a diatom community dominated by Discostella stelligera and undergoes an abrupt compositional shift at ca. 820 cal yr BP that is concomitant with increased fire disturbance of the local vegetation. This shift is manifest as a transition from less oligotrophic acidic diatom flora (Achnanthidium minutissimum, Brachysira styriaca, and Fragilaria capucina) to more oligotrophic acidic taxa (Frustulia elongatissima, Eunotia diodon, and Gomphonema multiforme). We observe a marked increase in compositional variance and rate-of-change prior to this critical transition, revealing these metrics are useful EWS in this system. Interestingly, vegetation remains complacent to fire disturbance until after the shift in the diatom community. Disturbance taxa invade and the vegetation system experiences an increase in both compositional variance and rate-of-change. These trends imply an approaching critical transition in the vegetation and the probable collapse of the local rain forest system

Effect of Metformin Added to Insulin on Glycemic Control Among Overweight/Obese Adolescents With Type 1 Diabetes: A Randomized Clinical Trial

Importance Previous studies assessing the effect of metformin on glycemic control in adolescents with type 1 diabetes have produced inconclusive results. Objective To assess the efficacy and safety of metformin as an adjunct to insulin in treating overweight adolescents with type 1 diabetes. Design, Setting, and Participants Multicenter (26 pediatric endocrinology clinics), double-blind, placebo-controlled randomized clinical trial involving 140 adolescents aged 12.1 to 19.6 years (mean [SD] 15.3 [1.7] years) with mean type 1 diabetes duration 7.0 (3.3) years, mean body mass index (BMI) 94th (4) percentile, mean total daily insulin 1.1 (0.2) U/kg, and mean HbA1c 8.8% (0.7%). Interventions Randomization to receive metformin (n = 71) (≤2000 mg/d) or placebo (n = 69). Main Outcomes and Measures Primary outcome was change in HbA1c from baseline to 26 weeks adjusted for baseline HbA1c. Secondary outcomes included change in blinded continuous glucose monitor indices, total daily insulin, BMI, waist circumference, body composition, blood pressure, and lipids. Results Between October 2013 and February 2014, 140 participants were enrolled. Baseline HbA1c was 8.8% in each group. At 13-week follow-up, reduction in HbA1c was greater with metformin (−0.2%) than placebo (0.1%; mean difference, −0.3% [95% CI, −0.6% to 0.0%]; P = .02). However, this differential effect was not sustained at 26-week follow up when mean change in HbA1c from baseline was 0.2% in each group (mean difference, 0% [95% CI, −0.3% to 0.3%]; P = .92). At 26-week follow-up, total daily insulin per kg of body weight was reduced by at least 25% from baseline among 23% (16) of participants in the metformin group vs 1% (1) of participants in the placebo group (mean difference, 21% [95% CI, 11% to 32%]; P = .003), and 24% (17) of participants in the metformin group and 7% (5) of participants in the placebo group had a reduction in BMI z score of 10% or greater from baseline to 26 weeks (mean difference, 17% [95% CI, 5% to 29%]; P = .01). Gastrointestinal adverse events were reported by more participants in the metformin group than in the placebo group (mean difference, 36% [95% CI, 19% to 51%]; P < .001). Conclusions and Relevance Among overweight adolescents with type 1 diabetes, the addition of metformin to insulin did not improve glycemic control after 6 months. Of multiple secondary end points, findings favored metformin only for insulin dose and measures of adiposity; conversely, use of metformin resulted in an increased risk for gastrointestinal adverse events. These results do not support prescribing metformin to overweight adolescents with type 1 diabetes to improve glycemic control

Efficient computation of Faith's phylogenetic diversity with applications in characterizing microbiomes

The number of publicly available microbiome samples is continually growing. As data set size increases, bottlenecks arise in standard analytical pipelines. Faith's phylogenetic diversity (Faith's PD) is a highly utilized phylogenetic alpha diversity metric that has thus far failed to effectively scale to trees with millions of vertices. Stacked Faith's phylogenetic diversity (SFPhD) enables calculation of this widely adopted diversity metric at a much larger scale by implementing a computationally efficient algorithm. The algorithm reduces the amount of computational resources required, resulting in more accessible software with a reduced carbon footprint, as compared to previous approaches. The new algorithm produces identical results to the previous method. We further demonstrate that the phylogenetic aspect of Faith's PD provides increased power in detecting diversity differences between younger and older populations in the FINRISK study's metagenomic data.Peer reviewe

Acute Cardiovascular and Metabolic Responses to Three Modes of Treadmill Exercise in Older Adults with Parkinson’s Disease

Parkinson’s disease (PD) is a neurodegenerative condition characterized by muscle tremors, rigidity and dyskinesis leading to balance and gait abnormalities that could alter physiologic responses during exercise. Locomotion on an aquatic treadmill (ATM) or anti-gravity treadmill (AGTM) may be a safe alternative to exercise on a traditional land treadmill (LTM) in those with PD. PUPROSE: To determine the acute cardiovascular and metabolic responses to three different modes of treadmill exercise in older adults diagnosed with Parkinson’s disease. METHODS: Eight adults diagnosed with PD (68 ± 3 years of age) completed one exercise session on an LTM, one session on an ATM, and one session on an AGTM at 50% body weight. Participants walked from 1 to 3 mph in 0.5 mph increments at 0% grade during each exercise session. Heart rate (HR), energy expenditure (EE), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured at rest and during steady-state exercise at each speed on each treadmill. Rate of perceived exertion was also measured during steady-state exercise. Rate pressure product (RPP) was calculated. RESULTS: All variables, with the exception of DBP, increased as speed increased across all treadmill modes (p \u3c 0.001). Between treadmill modes across all speeds, EE was statistically different (p = 0.025). There was a significant interaction effect for mode and speed for HR (p \u3c 0.001) and RPP (p = 0.003). At all speeds except 1.5 mph, HR was higher on the LTM versus the AGTM (p \u3c 0.05). CONCLUSION: Exercising on an ATM or an AGTM elicits similar physiologic responses to exercise on an LTM in adults with P

Changes in Balance, Gait and Motor Skills Following Treadmill Exercise in Adults with Parkinson’s Disease

Locomotion on an aquatic treadmill or anti-gravity treadmill may be a safe and effective alternative to exercise on a traditional land treadmill in those with Parkinson’s disease as the removal of body weight in these environments may allow the participant to exercise with less concern of falling at higher speeds before reaching volitional fatigue. PURPOSE: To determine the training effects of three different treadmill modalities on dynamic balance, gait, and fine motor control in older adults diagnosed with Parkinson’s disease. METHODS: Ten adults diagnosed with Parkinson’s disease (70 ± 5 years of age) completed 8 exercise sessions (4 weeks, 2x/week) each separately on a land treadmill, aquatic treadmill, and anti-gravity treadmill at 50% body weight. Two weeks separated each intervention and the order was randomized. A 4-week control period occurred at the start of the study in which no treadmill exercise was performed. Each exercise session included a 2-minute warm-up and 30 minutes at a moderate intensity. Before and after each intervention, balance, gait and fine motor control were measured. Dynamic balance and gait were assessed using a Timed-Up-and-Go test and Performance Oriented Mobility Assessment (POMA). Fine motor control was assessed with the Purdue Pegboard Test. RESULTS: The gait assessment of the POMA was significant across all time points (p = 0.028). All other variables were statistically similar (p \u3e 0.05) across all time points. CONCLUSION: Exercising on a traditional land treadmill, aquatic treadmill, or anti-gravity treadmill for 60 min/week for 4 weeks at a moderate intensity did not alter balance, gait or fine motor control in adults with Parkinson’s disease