Engaging with a Prevention Approach: System Supports Needed in Child Abuse and Neglect Prevention

Public policy has been shifting from child abuse and neglect (CAN) intervention toward prevention, using public health style frameworks, which emphasize shared community and legislative responsibilities to support families (Browne, 2014; CDC, 2014). Analysis of qualitative data from statewide focus groups held in 2019 in Alabama with 99 community-based CAN prevention workers shows strengths in community collaboration, but also, struggles to help families meet basic needs because of lack of community resources, such as transportation and quality child care, and other barriers, including stigma. The results demonstrate confusion between prevention, which is intended to build family resilience to avert crisis, and intervention, meant to reunite families after child protection services involvement. We recommend researchers consistently link CAN research to prevention frameworks so as to build meaningful understanding how to create better prevention programs. Future practitioners should understand prevention, and be prepared to document their work so as to demonstrate need

Association of IL4R single-nucleotide polymorphisms with rheumatoid nodules in African Americans with rheumatoid arthritis

Abstract Introduction To determine whether IL4R single-nucleotide polymorphisms (SNPs) rs1805010 (I50V) and rs1801275 (Q551R), which have been associated with disease severity in rheumatoid arthritis (RA) patients of European ancestry, relate to the presence of rheumatoid nodules and radiographic erosions in African Americans. Methods Two IL4R SNPs, rs1805010 and rs1801275, were genotyped in 749 patients from the Consortium for Longitudinal Evaluation of African-Americans with Early Rheumatoid Arthritis (CLEAR) registries. End points were rheumatoid nodules defined as present either by physical examination or by chest radiography and radiographic erosions (radiographs of hands/wrists and feet were scored using the modified Sharp/van der Heijde system). Statistical analyses were performed by using logistic regression modeling adjusted for confounding factors. Results Of the 749 patients with RA, 156 (20.8%) had rheumatoid nodules, with a mean age of 47.0 years, 84.6% female gender, and median disease duration of 1.9 years. Of the 461 patients with available radiographic data, 185 (40.1%) had erosions (score >0); their mean age was 46.7 years; 83.3% were women; and median disease duration was 1.5 years. Patients positive for HLA-DRB1 shared epitope (SE) and autoantibodies (rheumatoid factor (RF) or anti-cyclic citrullinated peptide (CCP)) had a higher risk of developing rheumatoid nodules in the presence of the AA and AG alleles of rs1801275 (odds ratio (OR)adj = 8.08 (95% confidence interval (CI): 1.60-40.89), P = 0.01 and ORadj = 2.97 (95% CI, 1.08 to 8.17), P = 0.04, respectively). Likewise, patients positive for the HLA-DRB1 SE and RF alone had a higher risk of developing rheumatoid nodules in presence of the AA and AG alleles of rs1801275 (ORadj = 8.45 (95% CI, 1.57 to 45.44), P = 0.01, and ORadj = 3.57 (95% CI, 1.18 to 10.76), P = 0.02, respectively) and in the presence of AA allele of rs1805010 (ORadj = 4.52 (95% CI, 1.20 to 17.03), P = 0.03). No significant association was found between IL4R and radiographic erosions or disease susceptibility, although our statistical power was limited by relatively small numbers of cases and controls. Conclusions We found that IL4R SNPs, rs1801275 and rs1805010, are associated with rheumatoid nodules in autoantibody-positive African-American RA patients with at least one HLA-DRB1 allele encoding the SE. These findings highlight the need for analysis of genetic factors associated with clinical RA phenotypes in different racial/ethnic populations

Bioavailability of Macro and Micronutrients Across Global Topsoils: Main Drivers and Global Change Impacts

Understanding the chemical composition of our planet\u27s crust was one of the biggest questions of the 20th century. More than 100 years later, we are still far from understanding the global patterns in the bioavailability and spatial coupling of elements in topsoils worldwide, despite their importance for the productivity and functioning of terrestrial ecosystems. Here, we measured the bioavailability and coupling of thirteen macro- and micronutrients and phytotoxic elements in topsoils (3–8 cm) from a range of terrestrial ecosystems across all continents (∼10,000 observations) and in response to global change manipulations (∼5,000 observations). For this, we incubated between 1 and 4 pairs of anionic and cationic exchange membranes per site for a mean period of 53 days. The most bioavailable elements (Ca, Mg, and K) were also amongst the most abundant in the crust. Patterns of bioavailability were biome-dependent and controlled by soil properties such as pH, organic matter content and texture, plant cover, and climate. However, global change simulations resulted in important alterations in the bioavailability of elements. Elements were highly coupled, and coupling was predictable by the atomic properties of elements, particularly mass, mass to charge ratio, and second ionization energy. Deviations from the predictable coupling-atomic mass relationship were attributed to global change and agriculture. Our work illustrates the tight links between the bioavailability and coupling of topsoil elements and environmental context, human activities, and atomic properties of elements, thus deeply enhancing our integrated understanding of the biogeochemical connections that underlie the productivity and functioning of terrestrial ecosystems in a changing world

Examination of the role of interprofessional teamwork in the implementation and maintenance of the ABCDE bundle in Jefferson intensive care units

Purpose: To evaluate the attitudes toward interprofessional collaboration (IPC) in Jefferson intensive care units (ICUs) following a workshop to facilitate a new protocol, the ABCDE (Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility) bundle. Examining the effects of this workshop on the success of ABCDE bundle implementation, as well as ICU staff’s attitudes about teamwork, will help us better understand the role of interprofessionalism in healthcare delivery and effective strategies for enhancing IPC. Background: An urban academic medical center introduced the ABCDE bundle in its ICUs and an interprofessional team training workshop was held in spring 2014. Team members from various ICUs and health professions worked together to identify potential barriers to bundle implementation and create strategies for overcoming them. Description of Program/Intervention: A survey asking respondents to reflect on the role interprofessionalism has played in their unit’s implementation and maintenance of the ABDCE bundle was administered. The survey link was distributed to ICU staff via email and collected for one month following IRB exemption. Preliminary Results: The top three barriers perceived were: coordinating team members and activities, fear/resistance to culture change, and timing activities appropriately. The top three strategies utilized were: focused huddle rounds, ongoing education and reinforcement, and clearly defining and documenting goals of care for each patient. Minor differences between professions were noted. Relevance to Interprofessional Practice: Balas, MC, et al. (2013) noted that IPC was a significant factor in the implementation of the ABCDE bundle in several ICUs. Understanding barriers and strategies for success by profession will further support implementation of the ABCDE bundle by characterizing the interprofessional communication and coordination needed. Recommendations for Future Investigation: Although this study primarily focuses on staff perceptions of interprofessional collaboration, it would be prudent to analyze patient outcomes and perceptions of interprofessional practice related to the protocol. Learning Objectives: Identify three overall barriers and strategies perceived by ICU staff in the implementation and maintenance of the ABCDE bundle. Compare and contrast the barriers and strategies identified by profession. Evaluate the role of interprofessional collaboration in the implementation and maintenance of the ABCDE bundle in the ICU setting

Ecogenomics and genome landscapes of marine Pseudoalteromonas phage H105/1

Marine phages have an astounding global abundance and ecological impact. However, little knowledge is derived from phage genomes, as most of the open reading frames in their small genomes are unknown, novel proteins. To infer potential functional and ecological relevance of sequenced marine Pseudoalteromonas phage H105/1, two strategies were used. First, similarity searches were extended to include six viral and bacterial metagenomes paired with their respective environmental contextual data. This approach revealed ‘ecogenomic' patterns of Pseudoalteromonas phage H105/1, such as its estuarine origin. Second, intrinsic genome signatures (phylogenetic, codon adaptation and tetranucleotide (tetra) frequencies) were evaluated on a resolved intra-genomic level to shed light on the evolution of phage functional modules. On the basis of differential codon adaptation of Phage H105/1 proteins to the sequenced Pseudoalteromonas spp., regions of the phage genome with the most ‘host'-adapted proteins also have the strongest bacterial tetra signature, whereas the least ‘host'-adapted proteins have the strongest phage tetra signature. Such a pattern may reflect the evolutionary history of the respective phage proteins and functional modules. Finally, analysis of the structural proteome identified seven proteins that make up the mature virion, four of which were previously unknown. This integrated approach combines both novel and classical strategies and serves as a model to elucidate ecological inferences and evolutionary relationships from phage genomes that typically abound with unknown gene content