Exploring the role of motivational interviewing in adolescent patient-provider communication about type 1 diabetes

Type 1 diabetes (T1D) is one of the most common pediatric chronic illnesses. Glycemic control among patients with T1D often deteriorates during adolescence; yet little is known about the most effective way for providers to communicate with adolescents to prevent this decline. Given the importance of effective communication, examination of effective patient-provider communication strategies is needed. The current investigation used Motivational Interviewing (MI) as a framework to help characterize naturally-occurring adolescent patient-provider communication in medical encounters and examined the relations between provider communication and T1D self-management and control. Participants were five pediatric endocrine providers and 55 adolescents with T1D (49% female; 76% White; M age= 14.8 years, SD= 1.6). Mean T1D duration was 7.9 years (SD= 3.9) and mean baseline HbA1c was 8.58% (SD= 1.4). Adolescents and caregivers completed surveys related to diabetes self-management and psychosocial functioning at a routine endocrinology visit and again at one and three months post-baseline. Medical encounters were audio-recorded and coded. HbA1c was obtained via medical chart review at baseline, three, and six month appointments. Hierarchical multiple regressions revealed that, after controlling for prior MI training (providers) and adolescent baseline HbA1c, age, and race, use of MI non-adherent behavior (e.g., confronting, persuading) was associated with 1) poorer three month HbA1c, F(5,45)= 11.19, p \u3c .001; R2 = .554 and 2) worse adolescent diabetes adherence, F(5, 46)= 9.86, p \u3c .001; R2= .517. MI non-adherent behavior emerged as a significant predictor in each model, t(45)= 2.13,p = .038, β = .242 and t(46) = -2.39, p= .021, β= -.300, respectively. A mediation analysis determined that patient self-efficacy for diabetes self-management mediated the relation between the use of these MI non-adherent behaviors and lower diabetes adherence. In TalkT1me, providers’ overreliance on persuasion and confronting adolescents about the risks of non-adherence was paradoxically associated with poorer glycemic control and adherence. Certain communication techniques that are inconsistent with MI, like confronting or persuading, appear to have a negative impact on diabetes self-care and HbA1c. Results from this evaluation of naturally occurring communication can help guide targeted training efforts to enhance communication and improve diabetes self-care with these vulnerable patients

Trends in Correctional Control by Race and Sex

American prison populations have long been characterized by racial and ethnic disparities. U.S. Census Bureau data on incarcerated persons from 1870 through 1980 show that black incarceration rates ranged from three to nine times those of whites, depending upon the decade and region of the country.In recent years, racial disparities in imprisonment have decreased. This Council on Criminal Justice report updates and advances earlier presentations of data on disparities

ERAP1 and ERAP2 Haplotypes Influence Suboptimal HLA-B*27:05-Restricted Anti-Viral CD8+ T Cell Responses Cross-Reactive to Self-Epitopes

The human leukocyte antigen (HLA)-B*27 family of alleles is strongly associated with ankylosing spondylitis (AS), a chronic inflammatory disorder affecting the axial and peripheral joints, yet some HLA-B*27 variants not associated with AS have been shown. Since no major differences in the ligandome of associated compared to not-associated alleles have emerged, a plausible hypothesis is that the quantity rather than the quality of the presented epitopes makes the difference. In addition, the Endoplasmic Reticulum AminoPeptidases (ERAPs) 1 and 2, playing a crucial role in shaping the HLA class I epitopes, act as strong AS susceptibility factors, suggesting that an altered peptidome might be responsible for the activation of pathogenic CD8+ T cells. In this context, we have previously singled out a B*27:05-restricted CD8+ T cell response against pEBNA3A (RPPIFIRRL), an EBV peptide lacking the B*27 classic binding motif. Here, we show that a specific ERAP1/2 haplotype negatively correlates with such response in B*27:05 subjects. Moreover, we prove that the B*27:05 allele successfully presents peptides with the same suboptimal N-terminal RP motif, including the self-peptide, pDYNEIN (RPPIFGDFL). Overall, this study underscores the cooperation between the HLA-B*27 and ERAP1/2 allelic variants in defining CD8+ T cell reactivity to suboptimal viral and self-B*27 peptides and prompts further investigation of the B*27:05 peptidome composition

Combination of chemotherapy and PD-1 blockade induces T cell responses to tumor non-mutated neoantigens

Grimaldi and Cammarata et al. develop a proteomics-based, target discovery platform to identify immunogenic proteins specific to apoptotic tumor cells. This study highlights the importance of protein modifications in apoptotic tumor cells as a mechanism of generating immunogenic neoantigens that can be targeted for T cell-based immunotherapy.Here, we developed an unbiased, functional target-discovery platform to identify immunogenic proteins from primary non-small cell lung cancer (NSCLC) cells that had been induced to apoptosis by cisplatin (CDDP) treatment in vitro, as compared with their live counterparts. Among the multitude of proteins identified, some of them were represented as fragmented proteins in apoptotic tumor cells, and acted as non-mutated neoantigens (NM-neoAgs). Indeed, only the fragmented proteins elicited effective multi-specific CD4(+) and CD8(+) T cell responses, upon a chemotherapy protocol including CDDP. Importantly, these responses further increased upon anti-PD-1 therapy, and correlated with patients' survival and decreased PD-1 expression. Cross-presentation assays showed that NM-neoAgs were unveiled in apoptotic tumor cells as the result of caspase-dependent proteolytic activity of cellular proteins. Our study demonstrates that apoptotic tumor cells generate a repertoire of immunogenic NM-neoAgs that could be potentially used for developing effective T cell-based immunotherapy across multiple cancer patients

An Overview of Kinematic and Calibration Models Using Internal/External Sensors or Constraints to Improve the Behavior of Spatial Parallel Mechanisms

This paper presents an overview of the literature on kinematic and calibration models of parallel mechanisms, the influence of sensors in the mechanism accuracy and parallel mechanisms used as sensors. The most relevant classifications to obtain and solve kinematic models and to identify geometric and non-geometric parameters in the calibration of parallel robots are discussed, examining the advantages and disadvantages of each method, presenting new trends and identifying unsolved problems. This overview tries to answer and show the solutions developed by the most up-to-date research to some of the most frequent questions that appear in the modelling of a parallel mechanism, such as how to measure, the number of sensors and necessary configurations, the type and influence of errors or the number of necessary parameters

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening