Individualized decision aid for diverse women with lupus nephritis (IDEA-WON): A randomized controlled trial.

BackgroundTreatment decision-making regarding immunosuppressive therapy is challenging for individuals with lupus. We assessed the effectiveness of a decision aid for immunosuppressive therapy in lupus nephritis.Methods and findingsIn a United States multicenter, open-label, randomized controlled trial (RCT), adult women with lupus nephritis, mostly from racial/ethnic minority backgrounds with low socioeconomic status (SES), seen in in- or outpatient settings, were randomized to an individualized, culturally tailored, computerized decision aid versus American College of Rheumatology (ACR) lupus pamphlet (1:1 ratio), using computer-generated randomization. We hypothesized that the co-primary outcomes of decisional conflict and informed choice regarding immunosuppressive medications would improve more in the decision aid group. Of 301 randomized women, 298 were analyzed; 47% were African-American, 26% Hispanic, and 15% white. Mean age (standard deviation [SD]) was 37 (12) years, 57% had annual income of <$40,000, and 36% had a high school education or less. Compared with the provision of the ACR lupus pamphlet (n = 147), participants randomized to the decision aid (n = 151) had (1) a clinically meaningful and statistically significant reduction in decisional conflict, 21.8 (standard error [SE], 2.5) versus 12.7 (SE, 2.0; p = 0.005) and (2) no difference in informed choice in the main analysis, 41% versus 31% (p = 0.08), but clinically meaningful and statistically significant difference in sensitivity analysis (net values for immunosuppressives positive [in favor] versus negative [against]), 50% versus 35% (p = 0.006). Unresolved decisional conflict was lower in the decision aid versus pamphlet groups, 22% versus 44% (p < 0.001). Significantly more patients in the decision aid versus pamphlet group rated information to be excellent for understanding lupus nephritis (49% versus 33%), risk factors (43% versus 27%), medication options (50% versus 33%; p ≤ 0.003 for all); and the ease of use of materials was higher in the decision aid versus pamphlet groups (51% versus 38%; p = 0.006). Key study limitations were the exclusion of men, short follow-up, and the lack of clinical outcomes, including medication adherence.ConclusionsAn individualized decision aid was more effective than usual care in reducing decisional conflict for choice of immunosuppressive medications in women with lupus nephritis.Trial registrationClinicaltrials.gov, NCT02319525

Getting ready to use control:Advances in the measurement of young children's use of proactive control

A key developmental transition in executive function is in the temporal dynamics of its engagement: children shift from reactively calling to mind task-relevant information as needed, to being able to proactively maintain information across time in anticipation of upcoming demands. This transition is important for understanding individual differences and developmental changes in executive function; however, methods targeting its assessment are limited. We tested the possibility that Track-It, a paradigm developed to measure selective sustained attention, also indexes proactive control. In this task children must track a target shape as it moves unpredictably among moving distractors, and identify where it disappears, which may require proactively maintaining information about the target or goal. In two experiments (5-6 year-olds, Ns = 33, 64), children's performance on Track-It predicted proactive control across two established paradigms. These findings suggest Track-It measures proactive control in children. Theoretical possibilities regarding how proactive control and selective sustained attention may be related are also discussed

Phytochemical diversity and genetics of purple corn

Color strongly influences the perception of food and beverage quality and plays an important role in the marketing, desirability, and consumption of food and beverage products. Increasing demand for more natural products has spurred interest in natural colorants, especially from sources rich in anthocyanins, red to purple plant pigments. Anthocyanin-rich purple corn is being explored as a potential economical source of natural colorant. Our recent survey of colored corn maize germplasm identified a purple corn landrace, Apache Red (AR), with great pigment variability and intensity. Further breeding and investigation of this line resulted in the identification of AR lines with mostly pelargonidin-derived anthocyanins (orange-red) as opposed to the traditional cyanidin-dominant (red-pink) anthocyanin content of other available purple corn varieties. This unique anthocyanin profile may be attractive to the food and beverage industry looking for orange or red natural colorants. Examination of AR lines also resulted in the identification of new flavanol-anthocyanin condensed pigments not previously reported in maize. Further analysis of AR phytochemistry identified abundant apigenin-derived flavones that were found to copigment with anthocyanins, resulting in darker and bluer extracts and improved anthocyanin stability in a model beverage. Given the unique phytochemical diversity present in AR, a large-scale AR mapping population was created and genotyped using genotyping-by-sequencing, and phenotyped for flavonoid content using HPLC. GWAS (genome-wide association studies) revealed several candidate genes associated with anthocyanin concentration and type as well as flux through the flavonoid pathway. Of interest were candidates found for an O-methyltransferase involved in peonidin biosynthesis, an anthocyanidin reductase (ANR) associated with flavonol synthesis, and MATE transporters that may function in more efficient vacuolar sequestration of acylated anthocyanins. In addition to GWAS, GS was used to predict anthocyanin content in AR. Five-fold cross validation resulted in high prediction accuracies, suggesting GS will be useful in landrace development and may be useful for other purple corn breeding programs. Results from these studies have helped inform breeding goals and provide a foundation for future research into anthocyanin and flavonoid biosynthesis in maize pericarp.LimitedAuthor requested closed access (OA after 2yrs) in Vireo ETD syste

Severe Monkeypox in Hospitalized Patients - United States, August 10-October 10, 2022.

As of October 21, 2022, a total of 27,884 monkeypox cases (confirmed and probable) have been reported in the United States.§ Gay, bisexual, and other men who have sex with men have constituted a majority of cases, and persons with HIV infection and those from racial and ethnic minority groups have been disproportionately affected (1,2). During previous monkeypox outbreaks, severe manifestations of disease and poor outcomes have been reported among persons with HIV infection, particularly those with AIDS (3-5). This report summarizes findings from CDC clinical consultations provided for 57 patients aged ≥18 years who were hospitalized with severe manifestations of monkeypox¶ during August 10-October 10, 2022, and highlights three clinically representative cases. Overall, 47 (82%) patients had HIV infection, four (9%) of whom were receiving antiretroviral therapy (ART) before monkeypox diagnosis. Most patients were male (95%) and 68% were non-Hispanic Black (Black). Overall, 17 (30%) patients received intensive care unit (ICU)-level care, and 12 (21%) have died. As of this report, monkeypox was a cause of death or contributing factor in five of these deaths; six deaths remain under investigation to determine whether monkeypox was a causal or contributing factor; and in one death, monkeypox was not a cause or contributing factor.** Health care providers and public health professionals should be aware that severe morbidity and mortality associated with monkeypox have been observed during the current outbreak in the United States (6,7), particularly among highly immunocompromised persons. Providers should test all sexually active patients with suspected monkeypox for HIV at the time of monkeypox testing unless a patient is already known to have HIV infection. Providers should consider early commencement and extended duration of monkeypox-directed therapy†† in highly immunocompromised patients with suspected or laboratory-diagnosed monkeypox.§§ Engaging all persons with HIV in sustained care remains a critical public health priority