Advancing preconception health in the United States: strategies for change

In January 2015, the US Preconception Health and Health Care Initiative (PCHHC) established a new national vision that all women and men of reproductive age will achieve optimal health and wellness, fostering a healthy life course for them and any children they may have. Achieving this vision presents both challenges and opportunities. This manuscript describes the reasons why the US needs to prioritize preconception health as well as its efforts historically to advance change. The authors share lessons from past work and current strategies in the US to reach this ambitious goal

Postpartum Health Services Requested by Mothers with Newborns Receiving Intensive Care

Objectives Our pilot study aimed to build knowledge of the postpartum health needs of mothers with infants in a newborn intensive care unit (NICU). Methods Between May 2008 and December 2009, a Certified Nurse Midwife was available during workday hours to provide health care services to mothers visiting their infants in the NICU at a large tertiary care center. Results A total of 424 health service encounters were recorded. Maternal requests for services covered a wide variety of needs, with primary care being the most common. Key health concerns included blood pressure monitoring, colds, coughs, sore throats, insomnia and migraines. Mothers also expressed a need for mental health assessment and support, obstetric care, treatment for sexually transmitted infections, tobacco cessation, breastfeeding assistance, postpartum visits, and provision of contraception. Conclusions Our study suggests that mothers with babies in the NICU have a host of health needs. We also found that women were receptive to receiving health services in a critical care pediatric setting. Intensive care nurseries could feasibly partner with in-patient mother-baby units and/or on-site obstetric clinics to increase access to health care for the mothers of the high-risk newborns in their units. Modifications should be made within health care systems that serve high-risk infants to better address the many needs of the mother/baby dyad in the postpartum period

Tobacco Use: Prevention, Cessation, and Control

Practice Center (RTI-UNC EPC) systematically reviewed the evidence on (a) the effectiveness of community- and population-based interventions to prevent tobacco use and to increase consumer demand for and implementation of effective cessation interventions; (b) the impacts of smokeless tobacco marketing on smoking, use of those products, and population harm; and (c) the directions for future research. Data Sources: We searched MEDLINE®, Cumulative Index to Nursing and Applied Health (CINAHL), Cochrane libraries, Cochrane Clinical Trials Register, Psychological Abstracts, and Sociological Abstracts from January 1980 through June 10, 2005. We included English-language randomized controlled trials, other trials, and observational studies, with sample size and followup restrictions. We used 15 Cochrane Collaboration systematic reviews, 5 prior systematic reviews, and 2 meta-analyses as the foundation for this report. Review Methods: Trained reviewers abstracted detailed data from included articles into evidence tables and completed quality assessments; other senior reviewers confirmed accuracy and resolved disagreements. Results: We identified 1,288 unique abstracts; 642 did not meet inclusion criteria, 156 overlapped with prior reviews, and 2 were not published articles. Of 488 full-text articles retrieved and reviewed, we excluded 298 for several reasons, marked 88 as background, and retained 102. Evidence (consistent with previous reviews) showed that (a) school-based prevention interventions have short-term (but not long-term) effects on adolescents; (b) multicomponent approaches, including telephone counseling, increase the number of users who attempt to quit; (c) self-help strategies alone are ineffective, but counseling and pharmacotherapy used either alone or in combination can improve success rates of quit attempts; and (d) provide training and academic detailing improve provider delivery of cessation treatments, but evidence is insufficient to show that these approaches yield higher quit rates. Recent evidence on the following topics was insufficient to change prior review findings: (a) effectiveness of population-based prevention interventions; (b) effectiveness of providerbased interventions to reduce tobacco initiation; (c) effectiveness of community- and providerbased interventions to increase use of proven cessation strategies; (d) effectiveness of marketing campaigns to switch tobacco users from smoking to smokeless tobacco products; and (e) effectiveness of interventions in populations with comorbidities and risk behaviors (e.g., depression, substance and alcohol abuse). No evidence was available on the way in which smokeless tobacco product marketing affects population harm. Conclusions: The evidence base has notable gaps and numerous study deficiencies. We found little information to address some of the issues that previous authoritative reviews had not covered, some information to substantiate earlier conclusions and recommendations from those reviews, and no evidence that would overturn any previous recommendations

Development and testing of the BONES physical activity survey for young children

<p>Abstract</p> <p>Background</p> <p>Weight-bearing and high intensity physical activities are particularly beneficial for stimulating bone growth in children given that bone responds favorably to mechanical load. While it is important to assess the contribution and impact of weight-bearing physical activity on health outcomes, measurement tools that quantify and provide information on these activities separately from overall physical activity are limited. This study describes the development and evaluation of a pictorial physical activity survey (PAS) that measures children's participation and knowledge of high-intensity, weight-bearing ("bone smart") physical activity.</p> <p>Methods</p> <p>To test reliability, two identical sets of the PAS were administered on the same day to 41 children (mean age 7.1 ± 0.8 years; 63% female) and compared. To test validity, accelerometry data from 40 children (mean age 7.7 ± 0.8 years; 50% female) were compared to data provided by the PAS. Agreements between categorical and ordinal items were assessed with Kappa statistics; agreements between continuous indices were assessed with Spearman's correlation tests.</p> <p>Results</p> <p>The subjects produced reliable results in all 10 physical activity participation items (κ range: 0.36-0.73, all p < 0.05), but less reliable in answering if the physical activities were "bone smart" (κ range: -0.04-0.66). Physical activity indices, including metabolic equivalent time and weight-bearing factors, were significant in test-retest analyses (Spearman's <it>r </it>range: 0.57-0.74, all p < 0.001). Minutes of very vigorous activity from the accelerometer were associated with the self-reported weight-bearing activity, moderate-high, and high activity scores from the PAS (Spearman's <it>r </it>range: 0.47-0.48, all p < 0.01). However, accelerometer counts, counts per minute, and minutes of moderate-vigorous and vigorous activity were not associated with the PAS scores.</p> <p>Conclusions</p> <p>Together, the results of these studies suggest that the PAS has acceptable test-retest reliability, but limited validity for early elementary school children. This survey demonstrates a first step towards developing a questionnaire that measures high intensity, weight-bearing activity in schoolchildren.</p

Genetic errors of immunity distinguish pediatric non-malignant lymphoproliferative disorders

Background Pediatric non-malignant lymphoproliferative disorders (PLPD) are clinically and genetically heterogeneous. Long-standing immune dysregulation and lymphoproliferation in children may be life-threatening, and a paucity of data exists to guide evaluation and treatment of children with PLPD. Objective The primary objective of this study was to ascertain the spectrum of genomic immunologic defects in PLPD. Secondary objectives included characterization of clinical outcomes and associations between genetic diagnoses and those outcomes. Methods PLPD was defined by persistent lymphadenopathy, lymph organ involvement, or lymphocytic infiltration for more than 3 months, with or without chronic or significant EBV infection. Fifty-one subjects from 47 different families with PLPD were analyzed using whole exome sequencing (WES). Results WES identified likely genetic errors of immunity in 51% to 62% of families (53% to 65% of affected children). Presence of a genetic etiology was associated with younger age and hemophagocytic lymphohistiocytosis. Ten-year survival for the cohort was 72.4%, and patients with viable genetic diagnoses had a higher survival rate (82%) compared to children without a genetic explanation (48%, p = 0.03). Survival outcomes for individuals with EBV-associated disease and no genetic explanation were particularly worse than outcomes for subjects with EBV-associated disease and a genetic explanation (17% vs. 90%; p = 0.002). Ascertainment of a molecular diagnosis provided targetable treatment options for up to 18 individuals and led to active management changes for 12 patients. Conclusion PLPD therefore defines children with high risk for mortality, and WES informs clinical risks and therapeutic opportunities for this diagnosis

Frequency and Success of Larval Clone Production in the Daisy Brittle Star Ophiopholis aculeata

Marine community structure is dependent on the recruitment of new individuals; an incomplete understanding of life histories, however, hinders the accuracy of recruitment estimates. For example, the assumption that one zygote yields one offspring is violated for many phyla under various conditions. Polyembryony, and specifically larval cloning, is one mechanism by which echinoderms actively refute this assumption. The daisy brittle star, Ophiopholis aculeata, exhibits three different modes of larval cloning. First, as an 8-arm pluteus, the larva autotomizes the distal portion of its posterolateral arm. The second and third modes are related and both occur during metamorphosis and settlement. In the second mode, one half of the posterolateral arm pair is released and the other half is reabsorbed into the juvenile. In the third mode, the full posterolateral arm pair is released from the juvenile body following settlement. I describe these three modes of cloning and provide details of each. First, I tracked the frequency of cloning and regeneration success in a population of O. aculeata from Maine. Larvae of O. aculeata cloned via the first mode 7% of the time and were least likely to regenerate at only 4%. The second mode occurred 6% of the time and 5% of half arm pairs regenerated. Full arm pairs were released 79% of the time and 15% of those regenerated. Only the third mode of cloning via full arm pair release has been reported previously in the literature, but I compare my results to an unpublished data set from a population of the same species in Washington that exhibits the same three cloning modes. Second, I tested whether larvae that were starved had delayed cloning compared to those that were fed. Third, I tested whether the second and third modes of cloning had costs associated with them: a reduction in disc area and decreased time to death from starvation. Lastly, I confirmed that primary larvae that produced clones were asymmetrical and that secondary larvae, which were the products of cloning events were uniquely pigmented. Both of these observations may allow researchers to identify and analyze polyembryony in the field and to estimate cloning frequency in nature

Cultural refraction through transpacific material exchange : Chinese porcelain and early Colonial Spanish America

This thesis frames the cultural development of late Ming China and Colonial Spanish America within the scientific model of light refraction, arguing that the deliberate inclusion of Chinese ceramics into the visual culture of nascent New Spain influenced its emerging cultural identity, and that the influx of American silver catalyzed advancements in Chinese ceramic production. Examining the transpacific exchange of material culture, this thesis uses visual analysis, connoisseurship, and historical testimonies to address cultural intersections between 1600 and 1700. Chinese porcelain with cobalt blue under clear glaze is known to have been consumed in the Eastern Hemisphere, but its presence in the Americas is relatively underrepresented, though increasingly garnering recognition as a result of recent excavations and exhibitions. Imported by the galleon trade from the Philippine port of Manila, colonialists used and treasured Chinese ceramics and absorbed characteristics of these foreign goods into local production. As New Spain refracted from its European origins, the colony developed a unique cultural identity informed, in part, by Chinese influences. As early Spanish American society flourished, Ming rule destabilized and kilns faltered with the absence of commissions. Cultural convergence via the transpacific trade refracted the course of Chinese ceramic production; the influx of American silver advantageously financed kilns’ new creative pursuits. American silver fueled the coastal economy, facilitated the rise of a new merchant class, and converted coastal economy to a specie-based economy. Kilns’ newly obtained artistic freedom encouraged the production of innovative motifs and shapes based on domestic merchant demand and foreign export trade, diverting from the traditional ware types for imperial and scholar-official consumption, and inspiring a new visual language for the early Qing dynasty.Art Histor

Brazil: Determinants of Wheat Import Demand

Trade and marketing reforms are influencing wheat production and consumption in Brazil, and increasing wheat import demand. This report describes the relative importance of factors that influence wheat import decisions, with particular attention to the role of quality in the choice of import supplier. Net import price was found to be the most important determinant in the import decision, based on interviews with Brazilian importers and millers. Several quality factors were also identified as important, primarily protein, gluten, moisture, and nonmillable materials. Among wheat suppliers, Argentina ranked best for price, while Canada and the United States ranked highest for quality. The survey results also suggest that lower levels of dockage and nonmillable materials would expand U.S. exports to Brazil, but not as strongly as would the General Sales Manager Credit Guarantee program

132 Modernizing Onboarding for Clinical Research Professionals: An Interactive and Adoptable Approach

OBJECTIVES/GOALS: The Clinical Research Professionals (CRP) at Cincinnati Children’s Hospital Medical Center (CCHMC) identified and addressed gaps in a static on boarding material by transforming it into an interactive, centralized, and customizable REDCap checklist to better meet researcher needs across the institution. METHODS/STUDY POPULATION: The CRP On boarding Checklist is a tool designed to assist clinical researchers in their onboarding process at CCHMC. This tool helps CRPs determine the required/recommended trainings available to assist with skill-building and establishing job role competency. CRP supervisorsand subject matter experts were included incontent revisions, format, and transition to a RED Capsurvey. The new checklist is interactive, targets training requirements by job function, and clearly labels mandatory training. A companion document allows new CRPs to create and track their own individualized training plan. RESULTS/ANTICIPATED RESULTS: The revised CRP On boarding Checklist was launched in April 2022 and announced via email communication. Alive demonstration was presented to all CRPs during the May 2022 CRP Monthly Meeting. The checklist and companion document are linked to the internal CRP website, which is accessible institutionally. Sincelaunch, almost 100 new and internally transferring CRPs have utilized the online tool to guide their training needs. The checklist is intended to reflect real-time changes in educational offerings. In addition to feedback and change requests from the CRP community, the checklist is updated as necessary and routinely reviewed on a biannual basisby the CRP Education Committee. DISCUSSION/SIGNIFICANCE: The creation and maintenance of the CRP Onboarding Checklist is a modern and accessible way for CRPs and supervisors to explore role-applicable training and take active roles in the on boarding process. The RED Capformat allows easy sharing and adoptability to other institutions via data dictionary