Attention Deficit HyperactivityDisorder (ADHD): Survey Report

In the spring of 2016, the New Hampshire Pediatric Improvement Partnership (NHPIP) conducted an online survey of NH pediatric and family practice clinicians to understand practice patterns, comfort level, and support needs relative to caring for pediatric patients with Attention Deficit Hyperactivity Disorder (ADHD). Of the clinicians surveyed, 138 responded yielding a 13% response rate

A microRNA signature in circulating exosomes is superior to exosomal glypican-1 levels for diagnosing pancreatic cancer

Pancreatic ductal adenocarcinoma (PDAC) is a deadly malignancy that often presents clinically at an advanced stage and that may be confused with chronic pancreatitis (CP). Conversely, CP may be misdiagnosed as PDAC leading to unwarranted pancreas resection. Therefore, early PDAC diagnosis and clear differentiation between PDAC and CP are crucial for improved care. Exosomes are circulating microvesicles whose components can serve as cancer biomarkers. We compared exosomal glypican-1 (GPC1) and microRNA levels in normal control subjects and in patients with PDAC and CP. We report that exosomal GPC1 is not diagnostic for PDAC, whereas high exosomal levels of microRNA-10b, (miR-10b), miR-21, miR-30c, and miR-181a and low miR-let7a readily differentiate PDAC from normal control and CP samples. By contrast with GPC1, elevated exosomal miR levels decreased to normal values within 24 h following PDAC resection. All 29 PDAC cases exhibited significantly elevated exosomal miR-10b and miR-30c levels, whereas 8 cases had normal or slightly increased CA 19-9 levels. Thus, our exosomal miR signature is superior to exosomal GPC1 or plasma CA 19-9 levels in establishing a diagnosis of PDAC and differentiating between PDAC and CP

Extensive carbon isotopic heterogeneity among methane seep microbiota

To assess and study the heterogeneity of δ^(13)C values for seep microorganisms of the Eel River Basin, we studied two principally different sample sets: sediments from push cores and artificial surfaces colonized over a 14 month in situ incubation. In a single sediment core, the δ^(13)C compositions of methane seep-associated microorganisms were measured and the relative activity of several metabolisms was determined using radiotracers. We observed a large range of archaeal δ^(13)C values (> 50‰) in this microbial community. The δ^(13)C of ANME-1 rods ranged from −24‰ to −87‰. The δ^(13)C of ANME-2 sarcina ranged from −18‰ to −75‰. Initial measurements of shell aggregates were as heavy as −19.5‰ with none observed to be lighter than −57‰. Subsequent measurements on shell aggregates trended lighter reaching values as ^(13)C-depleted as −73‰. The observed isotopic trends found for mixed aggregates were similar to those found for shell aggregates in that the initial measurements were often enriched and the subsequent analyses were more ^(13)C-depleted (with values as light as −56‰). The isotopic heterogeneity and trends observed within taxonomic groups suggest that ANME-1 and ANME-2 sarcina are capable of both methanogenesis and methanotrophy. In situ microbial growth was investigated by incubating a series of slides and silicon (Si) wafers for 14 months in seep sediment. The experiment showed ubiquitous growth of bacterial filaments (mean δ^(13)C = −38 ± 3‰), suggesting that this bacterial morphotype was capable of rapid colonization and growth

MicroRNA Expression in a Readily Accessible Common Hepatic Artery Lymph Node Predicts Time to Pancreatic Cancer Recurrence Postresection

Lymph node involvement in pancreatic adenocarcinoma (PAC) predicts postresection survival, but early lymph node metastasis detection is not easily accomplished. We assessed a panel of microRNAs (miRNAs) in a common hepatic artery lymph node (station 8) that is readily accessible during pancreatoduodenectomy (PD) to determine if increased miRNA levels correlate with postresection recurrence. Station 8 lymph nodes overlying the common hepatic artery collected during PD were assayed for miRNA-10b, miRNA-30c, miRNA-21, and miRNA-155 and cytokeratin-19 (CK19), an epithelial cell marker, using quantitative PCR. Expression was correlated with disease recurrence, recurrence-free survival (RFS), and overall survival (OS). Station 8 lymph nodes from 37 patients (30 periampullary carcinomas (PCs), 2 chronic pancreatitis, 5 other cancers) exhibited increased miRNA-10b levels in 14/30 PCs, and in 10 of these 14 patients, cancer recurred during the study period (2012–2015). High miRNA-10b was also associated with shorter RFS (42.5 vs. 92.4 weeks, p < 0.05) but not OS, whereas miRNA-30c, miRNA-21, and miRNA-155 levels and CK19 mRNA levels in station 8 nodes were variable and did not correlate with RFS or OS. We conclude that elevated miRNA-10b levels in station 8 lymph nodes could be utilized to assess risk for early disease progression in patients with periampullary tumors

Telehealth and Mobile Health Applied To IntegratedBehavioral Care: OpportunitiesFor Progress In New Hampshire

This paper is an accompanying document to a webinar delivered on May 16, 2017, for the New Hampshire Citizens Health Initiative (Initiative). As integrated behavioral health efforts in New Hampshire gain traction, clinicians, administrators, payers, and policy makers are looking for additional efficiencies in delivering high quality healthcare. Telehealth and mobile health (mHealth) have the opportunity to help achieve this while delivering a robust, empowered patient experience. The promise of video-based technology was first made in 1964 as Bell Telephone shared its Picturephone® with the world. This was the first device with audio and video delivered in an integrated technology platform. Fast-forward to today with Skype, FaceTime, and webinar tools being ubiquitous in our personal and business lives, but often slow to be adopted in the delivery of medicine. Combining technology-savvy consumers with New Hampshire’s high rate of electronic health record (EHR) technology adoption, a fairly robust telecommunications infrastructure, and a predominately rural setting, there is strong foundation for telehealth and mHealth expansion in New Hampshire’s integrated health continuum

Participatory Planning for the Creation of a Coastal Protected Area: Middle Basin from Arroyo Solís Grande, Canelones – Uruguay

Se presentan resultados de un caso de estudio perteneciente a un proyecto de investigación internacional, que estudia la gestión de procesos deliberativos que incorporan conocimientos locales y tradicionales, articulan diversos intereses y valoraciones asociadas a servicios ecosistémicos y la biodiversidad. El caso de estudio se centra en el proceso de creación de la primera área en integrar el SDAPA (Sistema Departamental de Áreas de Protección Ambiental) de Canelones: “Cuenca Media del Arroyo Solís Grande”. El estudio se realizó con un enfoque de Manejo Costero Integrado, y se centró en la realización de entrevistas semiestructuradas a integrantes de la Comisión Administradora del área que fueron prota- gonistas del proceso de planificación. Se presenta una sistematización del proceso deliberativo que condujo a la creación del área y su Comisión Administradora, identificando las razones que motivaron el proceso y el método empleado para ello. Los principales resultados se centran en la identificación de barreras y facilitadores del proceso de implementación que el área tiene por delante. Por tratarse de un proceso pionero, se sistematizaron lecciones aprendidas que fueran rele- vantes también para futuros procesos de creación de áreas dentro del SDAPA u otros procesos en áreas costeras similares. A partir de este caso de estudio, se proponen ideas y alternativas en torno a importantes desafíos del Manejo Costero Integrado: la integración de diferentes cuerpos de conocimiento, la participación efectiva de actores clave, la facilitación o mediación ante conflictos de intereses y el involucramiento de privados en iniciativas de conservación.This work displays the results of a case study included in an international research project, which studies delibera- tive processes of management that incorporate local and traditional knowledge, and articulate diverse interests and values associated with ecosystem services and biodiversity. The case study focuses on the creation process of the first area to integrate the SDAPA (Departmental System of Environmental Protection Areas) of Canelones: “Cuenca Media del Arroyo Solís Grande”. The study was carried out with an Integrated Coastal Management approach. Data collection was done through semi-structured inter- views with members of the administrative commission of the area who were protagonists of the planning process. This work displays a systematization of the deliberative processes that led to the creation of the area and its ad- ministrative commission, identifying the reasons that motivated the process and the methods used to achieve this goal. The results show the barriers and facilitators of the imple- mentation process that may shape upcoming developments in the area. Since this was a pioneering process, this work systematized the lessons learned that are relevant for future SDAPA area creation processes or similar processes in other coastal areas. Based on this case study, ideas and alternatives are proposed regarding important challenges of Integrated Coastal Management: the integration of different bodies of knowledge, the effective participation of key stakeholders, the facilitation or mediation of conflicts of interest, and the involvement of the private sector in conservation initiatives

Protocol for the adolescent hayfever trial: cluster randomised controlled trial of an educational intervention for healthcare professionals for the management of school-age children with hayfever

<p>Abstract</p> <p>Background</p> <p>Seasonal allergic rhinitis (hayfever) is common and can contribute to a considerable reduction in the quality of life of adolescents. This study aims to examine the effectiveness of standardised allergy training for healthcare professionals in improving disease-specific quality of life in adolescents with hayfever.</p> <p>Methods/Design</p> <p>Adolescents with a history of hayfever registered in general practices in Scotland and England were invited to participate in a cluster randomised controlled trial. The unit of randomisation is general practices.</p> <p>The educational intervention for healthcare professionals consists of a short standardised educational course, which focuses on the management of allergic rhinitis. Patients in the intervention arm of this cluster randomised controlled trial will have a clinic appointment with their healthcare professional who has attended the training course. Patients in the control arm will have a clinic appointment with their healthcare professional and will receive usual care.</p> <p>The primary outcome measure is the change in the Rhinoconjunctivitis Quality of Life Questionnaire with Standardised Activities (RQLQ(S)) score between baseline and six weeks post-intervention in the patient intervention and control groups.</p> <p>Secondary outcome measures relate to healthcare professionals' understanding and confidence in managing allergic rhinitis, changes in clinical practice, numbers of consultations for hayfever and adolescent exam performance.</p> <p>A minimum of 11 practices in each arm of the trial (10 patients per cluster) will provide at least 80% power to demonstrate a minimal clinically important difference of 0.5 in RQLQ(S) score at a significance level of 5% based on an Intraclass Correlation Coefficient (ICC) of 0.02.</p> <p>Discussion</p> <p>At the time of submission, 24 general practices have been recruited (12 in each arm of the trial) and the interventions have been delivered. Follow-up data collection is complete. 230 children consented to take part in the trial; however complete primary outcome data are only available for 160. Further recruitment of general practices and patients will therefore take place in the summer of 2010.</p> <p>Trial Registration</p> <p>Current Controlled Trials ISRCTN95538067</p

Internal capsule microstructure mediates the relationship between childhood maltreatment and PTSD following adulthood trauma exposure.

Childhood trauma is a known risk factor for trauma and stress-related disorders in adulthood. However, limited research has investigated the impact of childhood trauma on brain structure linked to later posttraumatic dysfunction. We investigated the effect of childhood trauma on white matter microstructure after recent trauma and its relationship with future posttraumatic dysfunction among trauma-exposed adult participants (n = 202) recruited from emergency departments as part of the AURORA Study. Participants completed self-report scales assessing prior childhood maltreatment within 2-weeks in addition to assessments of PTSD, depression, anxiety, and dissociation symptoms within 6-months of their traumatic event. Fractional anisotropy (FA) obtained from diffusion tensor imaging (DTI) collected at 2-weeks and 6-months was used to index white matter microstructure. Childhood maltreatment load predicted 6-month PTSD symptoms (b = 1.75, SE = 0.78, 95% CI = [0.20, 3.29]) and inversely varied with FA in the bilateral internal capsule (IC) at 2-weeks (p = 0.0294, FDR corrected) and 6-months (p = 0.0238, FDR corrected). We observed a significant indirect effect of childhood maltreatment load on 6-month PTSD symptoms through 2-week IC microstructure (b = 0.37, Boot SE = 0.18, 95% CI = [0.05, 0.76]) that fully mediated the effect of childhood maltreatment load on PCL-5 scores (b = 1.37, SE = 0.79, 95% CI = [-0.18, 2.93]). IC microstructure did not mediate relationships between childhood maltreatment and depressive, anxiety, or dissociative symptomatology. Our findings suggest a unique role for IC microstructure as a stable neural pathway between childhood trauma and future PTSD symptoms following recent trauma. Notably, our work did not support roles of white matter tracts previously found to vary with PTSD symptoms and childhood trauma exposure, including the cingulum bundle, uncinate fasciculus, and corpus callosum. Given the IC contains sensory fibers linked to perception and motor control, childhood maltreatment might impact the neural circuits that relay and process threat-related inputs and responses to trauma