Engaging with African American youth following gunshot wound trauma: The Calhoun Cultural Competency Course

African American youth comprise one-third of the 17,300 victims annually impacted by gun violence (National Center for Injury Prevention and Control, CDC, 2016). Injuries they sustain lead to extensive rehabilitation processes often overshadowed by the youths’ perceptions of discrimination and mistrust in medical staff, exacerbated by limitations in patient–provider communication and collaboration (Alston, Gayles, Rucker, &Hobson, 2007; Liebschutz et al., 2010). Healthcare staff often misinterpret youth gunshot survivors’ behavior and engagement efforts, labeling them noncompliant and implying they overexaggerate their pain. Overall, research suggests that African American patients do not have positive rehabilitation outcomes comparable to those of White patients (Suarez-Balcazar et al., 2009). Studies identify cultural competence, considered a best practice in healthcare professions, as a mitigating factor in this health disparity. The central aim of this doctoral project is to enhance patient–provider relationships to support optimal rehabilitation processes and outcomes and reduce this disparity. The Calhoun Cultural Competency Course (4C) was designed to address this urgent and profound problem according to a sound theoretical foundation and best evidence in cultural competency training. It is an online training on best practices for treating young African American gunshot-wound survivors. Course content and instruction methods were developed based on in-depth review of theories and evidence-based literature (Liebschutz et al., 2010; Teal, Gill, Green, & Crandall, 2012). Upon course completion, participants master skills necessary to provide care that is culturally sensitive, responsive, and appropriately tailored to these individuals’ needs, leading to more successful outcomes and community reintegration. The 4C program pilot is anticipated within 1 year of content completion. The program’s effectiveness in fostering change in participants’ cultural competency will be measured using a mixed-methods pre–post program evaluation design. First-year expenses include funding to support personnel during program-module development, create the online platform, and launch and evaluate the course pilot. The course moves forward in Year 3 with modifications and publishing pilot study results. Dissemination efforts will be written, electronic, and person-to-person methods with hopes of inspiring others to instill cultural competence training in their settings. Cultural competency training has potential to mitigate health disparities. The program described in this doctoral project aims to promote engagement of African American youth in rehabilitation following gunshot assault for better health and participation outcomes for them and their caretakers.

Genetic architecture of subcortical brain structures in 38,851 individuals

Subcortical brain structures are integral to motion, consciousness, emotions and learning. We identified common genetic variation related to the volumes of the nucleus accumbens, amygdala, brainstem, caudate nucleus, globus pallidus, putamen and thalamus, using genome-wide association analyses in almost 40,000 individuals from CHARGE, ENIGMA and UK Biobank. We show that variability in subcortical volumes is heritable, and identify 48 significantly associated loci (40 novel at the time of analysis). Annotation of these loci by utilizing gene expression, methylation and neuropathological data identified 199 genes putatively implicated in neurodevelopment, synaptic signaling, axonal transport, apoptosis, inflammation/infection and susceptibility to neurological disorders. This set of genes is significantly enriched for Drosophila orthologs associated with neurodevelopmental phenotypes, suggesting evolutionarily conserved mechanisms. Our findings uncover novel biology and potential drug targets underlying brain development and disease

Genetic architecture of subcortical brain structures in 38,851 individuals

Subcortical brain structures are integral to motion, consciousness, emotions and learning. We identified common genetic variation related to the volumes of the nucleus accumbens, amygdala, brainstem, caudate nucleus, globus pallidus, putamen and thalamus, using genome-wide association analyses in almost 40,000 individuals from CHARGE, ENIGMA and UK Biobank. We show that variability in subcortical volumes is heritable, and identify 48 significantly associated loci (40 novel at the time of analysis). Annotation of these loci by utilizing gene expression, methylation and neuropathological data identified 199 genes putatively implicated in neurodevelopment, synaptic signaling, axonal transport, apoptosis, inflammation/infection and susceptibility to neurological disorders. This set of genes is significantly enriched for Drosophila orthologs associated with neurodevelopmental phenotypes, suggesting evolutionarily conserved mechanisms. Our findings uncover novel biology and potential drug targets underlying brain development and disease

Addressing global environmental challenges to mental health using population neuroscience: A review

Importance Climate change, pollution, urbanization, socioeconomic inequality, and psychosocial effects of the COVID-19 pandemic have caused massive changes in environmental conditions that affect brain health during the life span, both on a population level as well as on the level of the individual. How these environmental factors influence the brain, behavior, and mental illness is not well known. Observations A research strategy enabling population neuroscience to contribute to identify brain mechanisms underlying environment-related mental illness by leveraging innovative enrichment tools for data federation, geospatial observation, climate and pollution measures, digital health, and novel data integration techniques is described. This strategy can inform innovative treatments that target causal cognitive and molecular mechanisms of mental illness related to the environment. An example is presented of the environMENTAL Project that is leveraging federated cohort data of over 1.5 million European citizens and patients enriched with deep phenotyping data from large-scale behavioral neuroimaging cohorts to identify brain mechanisms related to environmental adversity underlying symptoms of depression, anxiety, stress, and substance misuse. Conclusions and Relevance This research will lead to the development of objective biomarkers and evidence-based interventions that will significantly improve outcomes of environment-related mental illness

Young Adulthood as a Factor in Social Change in the United States

This essay compares family change during two periods of social and historical upheaval in the United States: the industrial revolution of the late nineteenth century and the more recent family changes of the late twentieth century. Despite the manifest social and demographic changes brought about by the industrial revolution, some aspects of family life remained unchanged. Almost all new families formed in the United States before and during the industrial revolution were same-race heterosexual marriages. In the past half-century, however, family diversity has become the new rule; interracial marriages and extramarital cohabitation have both risen sharply. A key to understanding the lack of family diversity in the past and the recent rise in diversity is the changing nature of young adulthood. Copyright 2006 The Population Council, Inc..

Dual endothelin antagonist aprocitentan for resistant hypertension (PRECISION): a multicentre, blinded, randomised, parallel-group, phase 3 trial

Auteurs : the PRECISION investigatorsInternational audienceBackground Resistant hypertension is associated with increased cardiovascular risk. The endothelin pathway has been implicated in the pathogenesis of hypertension, but it is currently not targeted therapeutically, thereby leaving this relevant pathophysiological pathway unopposed with currently available drugs. The aim of the study was to assess the blood pressure lowering efficacy of the dual endothelin antagonist aprocitentan in patients with resistant hypertension. Methods PRECISION was a multicentre, blinded, randomised, parallel-group, phase 3 study, which was done in hospitals or research centres in Europe, North America, Asia, and Australia. Patients were eligible for randomisation if their sitting systolic blood pressure was 140 mm Hg or higher despite taking standardised background therapy consisting of three antihypertensive drugs, including a diuretic. The study consisted of three sequential parts: part 1 was the 4-week double-blind, randomised, and placebo-controlled part, in which patients received aprocitentan 12•5 mg, aprocitentan 25 mg, or placebo in a 1:1:1 ratio; part 2 was a 32-week single (patient)-blind part, in which all patients received aprocitentan 25 mg; and part 3 was a 12-week double-blind, randomised, and placebo-controlled withdrawal part, in which patients were re-randomised to aprocitentan 25 mg or placebo in a 1:1 ratio. The primary and key secondary endpoints were changes in unattended office systolic blood pressure from baseline to week 4 and from withdrawal baseline to week 40, respectively. Secondary endpoints included 24-h ambulatory blood pressure changes. The study is registered on ClinicalTrials.gov, NCT03541174. Findings The PRECISION study was done from June 18, 2018, to April 25, 2022. 1965 individuals were screened and 730 were randomly assigned. Of these 730 patients, 704 (96%) completed part 1 of the study; of these, 613 (87%) completed part 2 and, of these, 577 (94%) completed part 3 of the study. The least square mean (SE) change in office systolic blood pressure at 4 weeks was-15•3 (SE 0•9) mm Hg for aprocitentan 12•5 mg,-15•2 (0•9) mm Hg for aprocitentan 25 mg, and-11•5 (0•9) mm Hg for placebo, for a difference versus placebo of-3•8 (1•3) mm Hg (97•5% CI-6•8 to-0•8, p=0•0042) and-3•7 (1•3) mm Hg (-6•7 to-0•8; p=0•0046), respectively. The respective difference for 24 h ambulatory systolic blood pressure was-4•2 mm Hg (95% CI-6•2 to-2•1) and-5•9 mm Hg (-7•9 to-3•8). After 4 weeks of withdrawal, office systolic blood pressure significantly increased with placebo versus aprocitentan (5•8 mm Hg, 95% CI 3•7 to 7•9, p<0•0001). The most frequent adverse event was mild-to-moderate oedema or fluid retention, occurring in 9%, 18%, and 2% for patients receiving aprocitentan 12•5 mg, 25 mg, and placebo, during the 4-week double-blind part, respectively. This event led to discontinuation in seven patients treated with aprocitentan. During the trial, a total of 11 treatment-emergent deaths occurred, none of which were regarded by the investigators to be related to study treatment. Interpretation In patients with resistant hypertension, aprocitentan was well tolerated and superior to placebo in lowering blood pressure at week 4 with a sustained effect at week 40