INTEGRATING BEHAVIORAL HEALTH INTO PEDIATRIC DEPARTMENTS AT A PRIMARY CARE ORGANIZATION, AND RESPONDING TO NEW NEEDS DURING THE COVID-19 PANDEMIC: A PROGRAM EVALUATION AND ITS CHALLENGES

It is estimated that 14 million, or 21% of children residing in the United States meet diagnostic criteria for a mental health and/or substance use disorder (American Academy of Pediatrics, 2016) } id= 2086950881 \u3e(American Academy of Pediatrics, 2016). Additionally, 16% of children and adolescents have impaired mental health functioning that does not meet criteria for a mental health disorder. Unfortunately, approximately 75% to 85% of children with behavioral health concerns do not receive mental health specialty services, and many of them do not receive any treatment at all. Limited resources and long wait times for services are among the many barriers to Behavioral Health care for this population. In addition to quality of life issues, untreated child mental health disorders have profound societal economic consequences. This study set out to evaluate a pilot project that integrates Behavioral Health (BH) care into pediatric departments at a large multi-site, multispecialty primary care organization as a strategy for reducing wait times for child BH services and improving patient outcomes. Data started to be collected and some preliminary findings were obtained but the program did not reach its planned endpoint. In March of 2020 operations at the primary care organization were severely disrupted by an organizational and financial crisis caused by the necessary safety precautions designed to reduce the spread of infection during the onset of the Covid-19 pandemic. Behavioral Health care at the organization subsequently shifted to a telehealth platform. The in-person pilot program was terminated and reorganized into two new telehealth programs with the same goal of increasing access to BH care by reducing wait times for services. The first of these programs called the Pediatric Behavioral Health Covid Response (PBHCR) team was designed to address the emerging urgent child mental health needs caused by the pandemic. The second program called The Virtual Integration Program was designed to provide general BH care to children. Data for the new pilot program is incomplete, but preliminary results indicate that wait times and no show rates were reduced, and pediatric providers and their patients generally found the program helpful. The Virtual Integration Program was not evaluated. An exploration of operational data for the PBHCR program found that the use of a single session and psychoeducation in the form of Tip Sheets may be an effective strategy for increasing access to child behavioral health care

Identification of quantitative trait loci associated with cell wall components and resistance to the European corn borer (Ostrinia nubilalis (Hübner)) in maize (Zea mays L.)

The European corn borer is a significant pest of maize in temperate regions. Resistance to stalk tunneling damage from the second-generation larvae appears to be quantitatively inherited, and may be related to cell wall components (CWCs) in the leaf sheath and stalk. In order to identify quantitative trait loci (QTL) that affect resistance to stalk tunneling and clarify their association with QTL affecting cell wall components in the leaf sheath and stalk, two populations of B73 (susceptible to tunneling by ECB, low to intermediate concentrations of CWCs) x De811 (resistant, high CWCs) were developed, one consisting of 147 F3 lines and the other of 191 recombinant inbred lines (RILs). Both populations were artificially infested with ECB larvae at pollen shed, and stalks were split at 60 days after infestation and the amount of tunneling was recorded. These populations were also analyzed for concentrations of neutral detergent fiber (NDF), acid detergent fiber (ADF), and acid detergent lignin (ADL) in the leaf sheaths and stalks. The samples were scanned using near infrared spectroscopy and prediction equations were developed using data collected from a subset of samples analyzed using the van Soest detergent method. Composite interval mapping (CIM) was used to detect QTL for each trait, and the relationships between the QTL detected for the same traits in different generations and among different traits in the same generation were examined. Seven and fourteen QTL for stalk tunneling were observed in the mean environments for the F3 and RI lines of B73 x De811, four and twelve of which, respectively, are linked to QTL for CWCs. The previously reported genetic correlations for ECB stalk tunneling with CWCs in the F3 lines (rg = -0.11 to -0.33) indicate that a genetic association may exist between the two traits. However, the genetic correlations for the RIL were -0.03 to 0.08, raising the possibility that the correlations observed in the F 3 lines were either due to environmental factors or the result of linkage disequilibrium. Factors other than concentrations of CWCs appear to be associated with the expression of resistance to stalk tunneling in this population

Leonard Covello: A Study of Progressive Leadership and Community Empowerment

Describes Leonard Covello\u27s progressive work at and around Benjamin Franklin High School in East Harlem, NY

Impact of nutrition on non-coding RNA epigenetics in breast and gynecological cancer

Cancer is the second leading cause of death in females. According to the American Cancer Society, there are 327,660 new cases in breast and gynecological cancers estimated in 2014, placing emphasis on the need for cancer prevention and new cancer treatment strategies. One important approach to cancer prevention involves phytochemicals, biologically active compounds derived from plants. A variety of studies on the impact of dietary compounds found in cruciferous vegetables, green tea, and spices like curry and black pepper have revealed epigenetic changes in female cancers. Thus, an important emerging topic comprises epigenetic changes due to the modulation of noncoding RNA levels. Since it has been shown that non-coding RNAs such as microRNAs and long non-coding RNAs are aberrantly expressed in cancer, and furthermore are linked to distinct cancer phenotypes, understanding the effects of dietary compounds and supplements on the epigenetic modulator non-coding RNA is of great interest. This article reviews the current findings on nutrition-induced changes in breast and gynecological cancers at the non-coding RNA level

The Impact of Bariatric Surgery on Urinary Incontinence: A Systematic Review and Meta-Analysis

Abstract Objectives To systematically review and meta-analyze the impact of bariatric surgery on obese patients with urinary incontinence (UI). Methods A search of Medline, EMBASE, CENTRAL, and PubMed to June 2018 was performed using methods pre-published on PROSPERO. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Studies comparing UI status in obese patients before and after bariatric surgery were included. Primary outcomes were the improvement or complete resolution of any UI, stress urinary incontinence (SUI), and urgency urinary incontinence (UUI). Secondary outcomes were validated UI questionnaire scores. The GRADE approach assessed overall quality of evidence. Results 33 cohort studies (2,910 patients) were included (median follow-up 12 months). Bariatric surgery resulted in improvement or resolution of any UI in 56% (95% confidence interval [CI] 48?63%), SUI in 47% (95% CI 34?60%), and UUI in 53% (95% CI 32?73%) of patients. Moreover, bariatric surgery significantly decreased (PPeer reviewe

Challenges to access and provision of palliative care for people who are homeless : a systematic review of qualitative research

Background: People who are homeless or vulnerably housed are a marginalized group who often experience high rates of morbidity and die young as a result of complex problems. Access to health care and support can be challenging, with access to palliative care even more so. This review presents a synthesis of published qualitative research exploring from the perspective of homeless people and those working to support them, current challenges to palliative care access and provision, in addition to suggestions for what may improve palliative care for this population. Methods: Systematic review of qualitative research analysed using thematic synthesis. PsycINFO, Medline, Sociological Abstracts, Social Services Abstracts, Science citations index and CINAHL were searched up to September 2016. Thematic synthesis involved a three-step inductive process to develop a deeper understanding of the challenges to and suggestions for the access and provision of palliative care for homeless people. Results: Thirteen qualitative articles, reporting nine studies were identified. The challenges to access and provision to palliative care were drawn from the data covering three broad areas, namely “the chaotic lifestyles sometimes associated with being homeless”, “the delivery of palliative care within a hostel for homeless people” and provision within “mainstream health care systems”. Obstacles were related to homeless persons competing day-to-day priorities, their experience of stigma in mainstream settings, the high burden on hostel staff in supporting residents at the end of life and inflexibility in mainstream health care systems. Suggestions for improving access to palliative care include building trust between homeless persons and health professionals, increasing collaboration between and flexibility within services, and providing more training and support for all professionals. Conclusions: The provision of palliative care can be complicated for all populations, however delivering palliative care for people who are homeless is influenced by a potentially greater and more varied range of factors, on both individual and systemic levels, than providing palliative care for the housed population. Careful consideration and potentially great changes will be needed within health care systems to ensure homeless populations have equitable access to palliative care

Spatial Patterns of Aflatoxin Levels in Relation to Ear-Feeding Insect Damage in Pre-Harvest Corn

Key impediments to increased corn yield and quality in the southeastern US coastal plain region are damage by ear-feeding insects and aflatoxin contamination caused by infection of Aspergillus flavus. Key ear-feeding insects are corn earworm, Helicoverpa zea, fall armyworm, Spodoptera frugiperda, maize weevil, Sitophilus zeamais, and brown stink bug, Euschistus servus. In 2006 and 2007, aflatoxin contamination and insect damage were sampled before harvest in three 0.4-hectare corn fields using a grid sampling method. The feeding damage by each of ear/kernel-feeding insects (i.e., corn earworm/fall armyworm damage on the silk/cob, and discoloration of corn kernels by stink bugs), and maize weevil population were assessed at each grid point with five ears. The spatial distribution pattern of aflatoxin contamination was also assessed using the corn samples collected at each sampling point. Aflatoxin level was correlated to the number of maize weevils and stink bug-discolored kernels, but not closely correlated to either husk coverage or corn earworm damage. Contour maps of the maize weevil populations, stink bug-damaged kernels, and aflatoxin levels exhibited an aggregated distribution pattern with a strong edge effect on all three parameters. The separation of silk- and cob-feeding insects from kernel-feeding insects, as well as chewing (i.e., the corn earworm and maize weevil) and piercing-sucking insects (i.e., the stink bugs) and their damage in relation to aflatoxin accumulation is economically important. Both theoretic and applied ramifications of this study were discussed by proposing a hypothesis on the underlying mechanisms of the aggregated distribution patterns and strong edge effect of insect damage and aflatoxin contamination, and by discussing possible management tactics for aflatoxin reduction by proper management of kernel-feeding insects. Future directions on basic and applied research related to aflatoxin contamination are also discussed

Active Surveillance for Favorable-Risk Prostate Cancer: A Short Review

Active surveillance is becoming a more widely accepted management strategy in men with low-risk localized prostate cancer. This is in recognition of the knowledge that most men with such cancer are likely to die from other causes. The obvious benefits of active surveillance are reduced morbidity by delaying or avoiding radical gland therapy. These advantages should be balanced against appropriate selection criteria and triggers for moving to radical therapy while on active surveillance. The optimal method by which to identify the small number of men who will progress by use of clinical, biopsy, and imaging data is yet to be defined. Nevertheless, active surveillance is an appealing management option in selected men with prostate cancer and represents a solution to the significant problem of the overdiagnosis of clinically insignificant disease that accompanies prostate-specific antigen (PSA) screening

Conserved linkage of neurotrophin-3 and von Willebrand factor on mouse Chromosome 6

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47003/1/335_2004_Article_BF00357095.pd