Adolescent Depression Screening in Primary Care Practice

Purpose: The purpose of this DNP quality improvement project was to increase primary care provider knowledge about indications for adolescent depression screening. Background: Approximately 13.3% of adolescents experienced depression in the past year. In Oklahoma alone, rates are increasing, with depression totaling 60% of all mental health illness among adolescents. Primary care providers see approximately 75% of adolescents; however, mental health conditions are missed 84% of the time. Current clinical guidelines recommend screening for adolescent depression during wellness visits or when risk factors are present. Methods: The providers of interest were nurse practitioners, physicians, and physician assistants providing primary care to children between the ages of 12 and 17 in a private pediatric practice group consisting of three clinics. The Model for Improvement guided the process of developing, implementing, and evaluating an educational intervention through use of a pre-test/post-test quantitative design. An email invited participants to complete an anonymous pre-test survey to evaluate knowledge and beliefs surrounding adolescent depression, then view an educational presentation on adolescent depression and screening guidelines, then complete a post-survey to evaluate any changes in knowledge and intention to screen. Results were shared with clinic representatives to help refine the education for future testing cycles and other clinic sites. Results: Data collection took place over one week. Five providers completed both the pre-test and post-test surveys. Provider knowledge scores significantly increased 29% after participating in the education and self-reported knowledge on screening increased. Conclusions: DNP quality improvement projects like this help develop strategies to increase best practices, leading to improved patient outcomes. Nurse-led improvement programs like this contribute to healthcare literature and the advancement of the nursing profession by developing patient-centered interventions applicable to a wide variety of providers. Results may be used to develop strategies to increase and align provider practices with best standards to help promote early identification and treatment of adolescents with depression

Making and Breaking Trust in Forest Collaborative Groups

There has been a recent increase in use of an organized, forest ‘collaborative’ group approach for multi-stakeholder input on federal forestlands in the U.S. West. This approach relies on the creation of shared trust to achieve social agreement. Yet growing critiques suggest a lack of trust in the U.S. Forest Service [Forest Service], between stakeholders, and the collaborative process itself. We conducted three comparative case studies of established forest collaborative groups in Oregon, Washington, and Idaho to ask how trust is created and damaged or broken in this context. We found multiple, interlinked dimensions to trust, including significant reliance on procedural trust, trust of ‘in-groups’ who shared norms for conduct, and distrust of new participants. We also found that trust or distrust in the Forest Service affected other trust and process dynamics within groups. Our research offers new insights into the functions and limitations of a collaborative approach that is increasingly central to federal forest governance; and new empirical knowledge toward recent theoretical developments about trust in natural resource collaboration

SafeTeens Think First: A Driver's Education Program Evaluation

Background: In the United States (US), motor vehicle crashes (MVCs) represent the leading cause of death among youth 16-19 years of age. Although adolescents comprise only 14% of the US population, they are responsible for 30% ($19 billion) of motor vehicle crash (MVC) related injury costs incurred by hospitals and 28$7 billion) of MVC-related injury costs incurred by emergency departments. The number of teen MVC-related fatalities and the economic impact of teen MVCs demonstrate the need for effective programs aimed at reducing risky teen driving behaviors. SafeTeens Think First (SafeTeens) is a one time, three-hour safe driving educational program delivered to Cleveland County, North Carolina high school students that provides information on the risks and consequences of unsafe driving. Through a yearlong Capstone experience, a team of students from the UNC Gillings School of Global Public Health partnered with the UNC Department of Surgery and Cleveland Country Regional Medical Center to conduct the first process and outcome evaluation of the SafeTeens program. The purpose of the evaluations was to determine whether the SafeTeens program was being delivered as intended and whether it was reducing the number of adolescent MVCs and MVC-related deaths occurring in Cleveland County. Methods: Throughout the academic year, Capstone team members emphasized community engagement and incorporated feedback from stakeholders and experts. First, the Capstone team created an evidence table in order to explore the literature base on teen driving program evaluations that focus on long-term outcomes. Next, the Capstone team developed a process and outcome evaluation plan. Three process evaluation instruments were developed to measure implementation fidelity, dose delivered, dose received, and participant satisfaction, and a process evaluation user guide was created to standardize measurement across evaluators. Quantitative and qualitative methods were used to analyze primary data and conduct the process evaluation of the SafeTeens program. For the outcome evaluation, study design and secondary data sources were carefully considered when developing the outcome evaluation plan. MVC rates were calculated for Cleveland County and each of three comparison groups at pre- and post-implementation of SafeTeens. MVC rate differences computations with 95% confidence intervals were calculated for each group to determine if the decrease in teen MVCs in Cleveland County was significantly lower than the decrease observed in the comparison groups. A program evaluation report and PowerPoint presentation were created to present evaluation findings to stakeholders in April 2014, along with a comprehensive report sharing program recommendations. Results: Results suggested that the SafeTeens program was implemented with fidelity and students reported being satisfied with the program. However, student engagement with the program activities was low. Students reported interactive activities as program components that they like best, yet the majority of students recommended increasing the number of engaging activities in which they can participate. Statistical analysis of the long-term impact of SafeTeens suggested that the program did not lower the number of teen MVCs that occurred in Cleveland County since the program's implementation in 2005 (p = 0.05). Sample size was too small to evaluate impact of SafeTeens on teen driver fatalities. Discussion: This Capstone project not only provided Cleveland Regional Medical Center with a user-friendly toolkit to conduct future evaluations of the SafeTeens program, but it also included recommendations for improving the program's effectiveness. This evaluation contributed to the current body of knowledge surrounding evaluated drivers' education programs. The UNC Department of Surgery Capstone experience provided a setting in which parties engaged in a reciprocal relationship to foster a positive learning environment, enhance and develop skills, evaluate and present program findings, and promote principles of community engagement.Master of Public Healt

Enhanced Transcriptome Maps from Multiple Mouse Tissues Reveal Evolutionary Constraint in Gene Expression for Thousands of Genes

We characterized by RNA-seq the transcriptional profiles of a large and heterogeneous collection of mouse tissues, augmenting the mouse transcriptome with thousands of novel transcript candidates. Comparison with transcriptome profiles obtained in human cell lines reveals substantial conservation of transcriptional programs, and uncovers a distinct class of genes with levels of expression across cell types and species, that have been constrained early in vertebrate evolution. This core set of genes capture a substantial and constant fraction of the transcriptional output of mammalian cells, and participates in basic functional and structural housekeeping processes common to all cell types. Perturbation of these constrained genes is associated with significant phenotypes including embryonic lethality and cancer. Evolutionary constraint in gene expression levels is not reflected in the conservation of the genomic sequences, but is associated with strong and conserved epigenetic marking, as well as to a characteristic post-transcriptional regulatory program in which sub-cellular localization and alternative splicing play comparatively large roles

Effect of Subcutaneous Casirivimab and Imdevimab Antibody Combination vs Placebo on Development of Symptomatic COVID-19 in Early Asymptomatic SARS-CoV-2 Infection: A Randomized Clinical Trial

Importance: Easy-to-administer anti-SARS-CoV-2 treatments may be used to prevent progression from asymptomatic infection to symptomatic disease and to reduce viral carriage. Objective: To evaluate the effect of combination subcutaneous casirivimab and imdevimab on progression from early asymptomatic SARS-CoV-2 infection to symptomatic COVID-19. Design, Setting, and Participants: Randomized, double-blind, placebo-controlled, phase 3 trial of close household contacts of a SARS-CoV-2-infected index case at 112 sites in the US, Romania, and Moldova enrolled July 13, 2020-January 28, 2021; follow-up ended March 11, 2021. Asymptomatic individuals (aged ≥12 years) were eligible if identified within 96 hours of index case positive test collection. Results from 314 individuals positive on SARS-CoV-2 reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR) testing are reported. Interventions: Individuals were randomized 1:1 to receive 1 dose of subcutaneous casirivimab and imdevimab, 1200 mg (600 mg of each; n = 158), or placebo (n = 156). Main Outcomes and Measures: The primary end point was the proportion of seronegative participants who developed symptomatic COVID-19 during the 28-day efficacy assessment period. The key secondary efficacy end points were the number of weeks of symptomatic SARS-CoV-2 infection and the number of weeks of high viral load (>4 log10copies/mL). Results: Among 314 randomized participants (mean age, 41.0 years; 51.6% women), 310 (99.7%) completed the efficacy assessment period; 204 were asymptomatic and seronegative at baseline and included in the primary efficacy analysis. Subcutaneous casirivimab and imdevimab, 1200 mg, significantly prevented progression to symptomatic disease (29/100 [29.0%] vs 44/104 [42.3%] with placebo; odds ratio, 0.54 [95% CI, 0.30-0.97]; P =.04; absolute risk difference, -13.3% [95% CI, -26.3% to -0.3%]). Casirivimab and imdevimab reduced the number of symptomatic weeks per 1000 participants (895.7 weeks vs 1637.4 weeks with placebo; P =.03), an approximately 5.6-day reduction in symptom duration per symptomatic participant. Treatment with casirivimab and imdevimab also reduced the number of high viral load weeks per 1000 participants (489.8 weeks vs 811.9 weeks with placebo; P =.001). The proportion of participants receiving casirivimab and imdevimab who had 1 or more treatment-emergent adverse event was 33.5% vs 48.1% for placebo, including events related (25.8% vs 39.7%) or not related (11.0% vs 16.0%) to COVID-19. Conclusions and Relevance: Among asymptomatic SARS-CoV-2 RT-qPCR-positive individuals living with an infected household contact, treatment with subcutaneous casirivimab and imdevimab antibody combination vs placebo significantly reduced the incidence of symptomatic COVID-19 over 28 days. Trial Registration: ClinicalTrials.gov Identifier: NCT04452318

CYP3A7*1C allele: linking premenopausal oestrone and progesterone levels with risk of hormone receptor-positive breast cancers

Funder: Breast Cancer Now (BCN); doi: https://doi.org/10.13039/100009794Funder: Cancer Research UK (CRUK); doi: https://doi.org/10.13039/501100000289Funder: RCUK | Medical Research Council (MRC); doi: https://doi.org/10.13039/501100000265Funder: U.S. Department of Health & Human Services | National Institutes of Health (NIH)Funder: Wellcome Trust (Wellcome); doi: https://doi.org/10.13039/100004440Funder: EC | EC Seventh Framework Programm | FP7 Ideas: European Research Council (FP7-IDEAS-ERC - Specific Programme: "Ideas" Implementing the Seventh Framework Programme of the European Community for Research, Technological Development and Demonstration Activities (2007 to 2013)); doi: https://doi.org/10.13039/100011199; Grant(s): HEALTH-F2-2009-223175, HEALTH-F2-2009-223175Funder: Genome Canada (Génome Canada); doi: https://doi.org/10.13039/100008762Funder: Gouvernement du Canada | Canadian Institutes of Health Research (Instituts de Recherche en Santé du Canada); doi: https://doi.org/10.13039/501100000024Funder: Quebec Breast cancer Foundation Genome QuebecFunder: U.S. Department of Health & Human Services | NIH | U.S. National Library of Medicine (NLM); doi: https://doi.org/10.13039/100000092Funder: EC | EC Seventh Framework Programm | FP7 Ideas: European Research Council (FP7-IDEAS-ERC - Specific Programme: "Ideas" Implementing the Seventh Framework Programme of the European Community for Research, Technological Development and Demonstration Activities (2007 to 2013))Funder: European Union’s Horizon 2020Funder: Deutsche Krebshilfe (German Cancer Aid); doi: https://doi.org/10.13039/501100005972Funder: BCAST - European Union’s Horizon 2020Funder: Breast Cancer Now; doi: https://doi.org/10.13039/501100007913Abstract: Background: Epidemiological studies provide strong evidence for a role of endogenous sex hormones in the aetiology of breast cancer. The aim of this analysis was to identify genetic variants that are associated with urinary sex-hormone levels and breast cancer risk. Methods: We carried out a genome-wide association study of urinary oestrone-3-glucuronide and pregnanediol-3-glucuronide levels in 560 premenopausal women, with additional analysis of progesterone levels in 298 premenopausal women. To test for the association with breast cancer risk, we carried out follow-up genotyping in 90,916 cases and 89,893 controls from the Breast Cancer Association Consortium. All women were of European ancestry. Results: For pregnanediol-3-glucuronide, there were no genome-wide significant associations; for oestrone-3-glucuronide, we identified a single peak mapping to the CYP3A locus, annotated by rs45446698. The minor rs45446698-C allele was associated with lower oestrone-3-glucuronide (−49.2%, 95% CI −56.1% to −41.1%, P = 3.1 × 10–18); in follow-up analyses, rs45446698-C was also associated with lower progesterone (−26.7%, 95% CI −39.4% to −11.6%, P = 0.001) and reduced risk of oestrogen and progesterone receptor-positive breast cancer (OR = 0.86, 95% CI 0.82–0.91, P = 6.9 × 10–8). Conclusions: The CYP3A7*1C allele is associated with reduced risk of hormone receptor-positive breast cancer possibly mediated via an effect on the metabolism of endogenous sex hormones in premenopausal women

The effect of the speed and range of motion of movement on the hyperemic response to passive leg movement

Abstract Passive leg movement (PLM)‐induced hyperemia is used to assess the function of the vascular endothelium. This study sought to determine the impact of movement speed and range of motion (ROM) on the hyperemic response to PLM and determine if the currently recommended protocol of moving the leg through a 90° ROM at 180°/sec provides a peak hyperemic response to PLM. 11 healthy adults underwent multiple bouts of PLM, in which either movement speed (60–240°/sec) or ROM (30–120° knee flexion) were varied. Femoral artery blood flow (Doppler Ultrasound) and mean arterial pressure (MAP; photoplethysmography) were measured throughout. Movement speed generally exhibited positive linear relationships with the hyperemic response to PLM, eliciting ~15–20% increase in hyperemia and conductance for each 30°/sec increase in speed (P < 0.05). However, increasing the movement speed above 180°/sec was physically difficult and seemingly impractical to implement. ROM exhibited curvilinear relationships (P<0.05) with hyperemia and conductance, which peaked at 90°, such that a 30° increase or decrease in ROM from 90° resulted in a 10–40% attenuation (P < 0.05) in the hyperemic response. Alterations in the balance of antegrade and retrograde flow appear to play a role in this attenuation. Movement speed and ROM have a profound impact on PLM‐induced hyperemia. When using PLM to assess vascular endothelial function, it is recommended to perform the test at the traditional 180°/sec with 90° ROM, which offers a near peak hyperemic response, while maintaining test feasibility

Design and participant characteristics of TX sprouts: A school-based cluster randomized gardening, nutrition, and cooking intervention.

AIMS: To outline the study design, outcome measures, protocol and baseline characteristics of enrolled participants of Texas (TX) Sprouts, a one-year school-based gardening, nutrition, and cooking cluster randomized trial. METHODS: Eight schools were randomly assigned to the TX Sprouts intervention and eight schools to the delayed intervention over three years (2016-2019). The intervention arm received: formation/training of Garden Leadership Committees; a 0.25-acre outdoor teaching garden; 18 student lessons including gardening, nutrition, and cooking activities, taught weekly during school hours by hired educators throughout one school year; and nine parent lessons taught monthly to families. The delayed intervention was implemented the following academic year and received the same protocol as the intervention arm. Primary outcomes included: dietary intake, dietary-related behaviors, obesity, and metabolic parameters. Child measures included: height, weight, waist circumference, body composition, blood pressure, and dietary psychosocial variables. A subsample of children were measured for glucose, hemoglobin-A1C, and 24-hour dietary recalls. Parent measures included: height and weight, dietary intake, and related dietary psychosocial variables. RESULTS: Of the 4239 eligible students, 3137 students consented and provided baseline clinical measures; 3132 students completed child surveys, with 92% of their parents completing parent surveys. The subsamples of blood draws and dietary recalls were 34% and 24%, respectively. Intervention arm baseline descriptives, clinical and dietary data for children and parents are reported. CONCLUSION: The TX Sprouts intervention targeted primarily low-income Hispanic children and their parents; utilized an interactive gardening, nutrition, and cooking program; and measured a battery of dietary behaviors, obesity and metabolic outcomes

ITMS CAPABILITIES IN ISOMER ANALYSIS .3. CHARACTERIZATION OF METHYL AND DIMETHYL DERIVATIVES OF 8-DESMETHYLSESELINE, POTENTIAL ANTIPROLIFERATIVE AGENTS, BY TANDEM MASS-SPECTROMETRY

Two sets of isomeric pyranocoumarins and pyranochromones have been studied by both electron impact and collision-induced dissociation. The daughter spectra were obtained by ion trap mass spectrometry experiments. Characteristic fragments were obtained in electron impact that allowed differentiation between the chromone and the coumarin systems. Distinction between isomers in each set was achieved by collision-induced daughter spectra of selected parent ions