Early-Life Air Pollution Exposure, Neighborhood Poverty, and Childhood Asthma in the United States, 1990⁻2014.

Ambient air pollution is a well-known risk factor of various asthma-related outcomes, however, past research has often focused on acute exacerbations rather than asthma development. This study draws on a population-based, multigenerational panel dataset from the United States to assess the association of childhood asthma risk with census block-level, annual-average air pollution exposure measured during the prenatal and early postnatal periods, as well as effect modification by neighborhood poverty. Findings suggest that early-life exposures to nitrogen dioxide (NO₂), a marker of traffic-related pollution, and fine particulate matter (PM2.5), a mixture of industrial and other pollutants, are positively associated with subsequent childhood asthma diagnosis (OR = 1.25, 95% CI = 1.10⁻1.41 and OR = 1.25, 95% CI = 1.06⁻1.46, respectively, per interquartile range (IQR) increase in each pollutant (NO₂ IQR = 8.51 ppb and PM2.5 IQR = 4.43 µ/m³)). These effects are modified by early-life neighborhood poverty exposure, with no or weaker effects in moderate- and low- (versus high-) poverty areas. This work underscores the importance of a holistic, developmental approach to elucidating the interplay of social and environmental contexts that may create conditions for racial-ethnic and socioeconomic disparities in childhood asthma risk

DO HOLISTIC PRACTICES AS AN ADJUNCT TO TRADITIONAL PSYCHOTHERAPY AFFECT GENERALIZED ANXIETY DISORDER-7 (GAD-7) SCORES?

ABSTRACT This study examined the effect of holistic practices on anxiety. The study used a pre-experimental design and measured any differences in outcomes in Generalized Anxiety Disorder clients as measured by General Anxiety Disorder-7 (GAD-7) between the two following groups: 1) the experimental group who received holistic services in addition to traditional treatment such as psychotherapy and/or medication as compared to 2) the control group who received psychotherapy and/or medication alone. Pretest of GAD-7 at intake and post-tests at about 4 months into treatment were measured along with a holistic practice survey and analyzed post-hoc through SPSS data analysis. This study found that GAD-7 scores were improved, with majority of the participants involved in some sort of holistic supplemental practices. However there was no statistical correlation between the two phenomena in this small sample. More research is recommended with larger samples, as well as improved instrumentation that could vet out other possible effects on the GAD scores

Investigating Developing Attachment Relationships: Infants with Hearing Loss and Complex Needs

A key part of any child’s development is forming a secure attachment relationship. Yet there is a scarcity in the research investigating attachment development in infants with hearing loss and complex needs (HL-CN). Such infants often receive varied services to support their learning and development. Parents of infants with HL-CN often experience higher amounts of stress, anxiety, depression, prolonged grief and trauma in comparison to parents of typically-developing infants. The current study proposed that an accumulation of risk factors may have an adverse impact on the attachment process, and that hearing loss alone was not a determinant for attachment insecurity. The study thus aimed to better understand how attachment develops in infants with HL-CN and their caregivers. It also asked whether the infant’s early childhood intervention service provider could facilitate the development of attachment relationships. The study took a mixed-methods approach to a multiple-case study embedded design to explore these questions. It utilised interviews, self-report psychometric questionnaires, documentation, videotaped mother-infant interactions and service provider-infant interactions, during early childhood intervention therapy sessions. The CARE-Index and an original video-coding scheme were used to analyse the videotaped observations. Findings from the study revealed that in infants with HL-CN, the attachment process takes much longer, with an accumulation of risk and protective factors, including the presence of the service provider, influencing the likelihood of secure attachments. The implications of these findings are discussed, as well as future directions for attachment in infants with HL-CN

Gen-Z ambassadors: students supporting persons with Alzheimer’s disease and their caregivers in the Rio Grande Valley

Background: Youth participation in policy, research, education and community development initiatives is a right embedded in the United Nations Convention on the Rights of the Child (UNCRC, General Assembly, 1989). However, avenues for youth participation in health promotion and care remains limited. Our Ambassadors program prepares high-school students on the Texas-Mexico border to understand and empathize with persons with Alzheimer’s disease (PwAD) and to empower their family and caregivers, consummating the UNCRC in the service of transformative community change actions. Methods: Our long-term objective is youth participation, defined as practices that involve collaboration between students and various community stakeholders in AD. The initial phase of the program is the design of a curriculum for early high school students to develop the knowledge, skills and attitudes required for that participation. We used a cooperative strategy (a high school students-faculty collaborative), guided by empowerment and ecological theories to achieve optimal youth advancement in the context of the UNCRC social, health and cultural rights of children. Results: The GenZ Ambassadors curricular units were identified through an iterative process in which faculty documented their activities with youth and tested sessions ranging from the biological basis and clinical presentations of AD to family impact, principles of caregiving, youth as change agents, building intergenerational partnerships, and self-reflection exercises. Ambassadors selected settings and strategies designed to empower their peers and to transform communities by skill and confidence building. Discussion: The process implemented and content analysis revealed a variety of themes that benefited persons with AD and their caregivers in the Rio Grande Valley. Several strategies will be tested to generate interactive training materials and culturally and age-competent as well as delivery strategies, including peer-to-peer delivery

Northern Orange Latino community, Orange County, North Carolina : an action-oriented community diagnosis : findings and next steps of action

From September 2004 – April 2005, a six-member graduate student team from the Department of Health Behavior and Health Education at the University of North Carolina at Chapel Hill conducted an Action Oriented Community Diagnosis (AOCD) with the Latino Community (LC) of Northern Orange County (NOC). An AOCD examines the quality of life, community capacity, and strengths and needs of a community. Two preceptors from the Orange County Public Health Department mentored the student team throughout this process. The students interviewed 67 community members and service providers in both individual and group interview settings. Additional information was collected using secondary data sources and participant observations by the student team. The students presented the results at a community forum held in Hillsborough, North Carolina on April 9, 2005. Major topics that were discussed and addressed at the forum include transportation, adult education, linguistically and culturally competent service providers, a central location for information, and dental care. Below, a summary of the themes and the key action steps that were laid out at the community forum are listed (note Appendix F): There is a lack of public transportation in Northern Orange County. 1. Develop bilingual pamphlets about existing public transportation in Northern Orange County and distribute them to churches and social service agencies serving Latinos. 2. The Department of Transportation will hold a forum to inform Latinos of the extended bus routes that are scheduled to take effect in January 2006. 3. A bilingual community member will attend the Department of Transportation (DOT) board meetings. The Latino community needs more dental services that are affordable. 1. Hold dental screening and cleaning for preschoolers. 2. Publicize this and other events through a network of Promotores de Salud (community members who have received training in health education) as well as churches serving Latinos. 3. Latino community members will help the dental clinic to demonstrate the need for more dental services that are affordable. There is a need for a central location in Northern Orange County that provides the Latino community with information about existing social and health services. 1. Establish a planning committee. 2. Speak to libraries, schools, churches, and county commissioners about office space. 3. Coordinate a petition from the community and service providers. There is a need for more service providers in Northern Orange County with linguistic and cultural competency. 1. Invite the following agencies to learn how to recruit bilingual service providers: Orange County Health Department Medical Clinic in Hillsborough. Orange County Health Department Dental Clinic in Hillsborough. Orange County Department of Social Services. Day cares. Schools (parent/teacher conferences). Police. Courts. 2. Plan and hold job fairs. 3. Share resources and bilingual personnel between towns and counties. 4. Increase English as a Second Language (ESL) educational opportunities. 5. Offer free Spanish classes to personnel in agencies serving a large number of Latinos. There is a need for more adult education in Northern Orange County, such as ESL classes and job skills training. 1. Ask about possible locations for ESL classes. 2. Ask the following people and places for information and help: Teachers and schools. Social service agencies. Day cares. County politiciansMaster of Public Healt

Rituximab-containing reduced-intensity conditioning improves progression-free survival following allogeneic transplantation in B cell non-Hodgkin lymphoma

Background: In B cell non-Hodgkin lymphoma (B-NHL), rituximab-containing reduced-intensity conditioning regimens (R-RIC) have been shown to provide favorable outcomes in single-arm studies; however, large multicenter studies comparing R-RIC and non-rituximab-containing reduced-intensity conditioning regimens (nonR-RIC) have not been performed. Using the CIBMTR database, we report the outcomes of R-RIC versus nonR-RIC regimens in B-NHL. Methods: We evaluated 1401 adult B-NHL patients undergoing allogeneic hematopoietic cell transplantation (alloHCT) who received nonR-RIC (n = 1022) or R-RIC (n = 379) regimens. Graft-versus-host disease (GVHD) prophylaxis was limited to calcineurin inhibitor-based approaches. Results: Median follow-up of survivors in the R-RIC and nonR-RIC groups was 47 and 37 months, respectively. On multivariate analysis, no difference was seen between the R-RIC and nonR-RIC cohorts in terms of acute GVHD grade II-IV (RR = 1.14, 95% CI = 0.83-1.56, p = 0.43) or grade III-IV (RR = 1.16, 95% CI = 0.72-1.89, p = 0.54), chronic GVHD (RR = 1.15, 95% CI = 0.92-1.46, p = 0.22), non-relapse mortality (RR = 0.90; 95% CI = 0.67-1.22; p = 0.51), relapse/progression (RR = 0.79; 95% CI = 0.63-1.01; p = 0.055), and mortality (RR = 0.84, 95% CI = 0.69-1.02, p = 0.08) risk. However, R-RIC was associated with a significantly improved progression-free survival (RR = 0.76; 95% CI 0.62-0.92; p = 0.006). On subgroup analysis, mortality benefit was noted in the R-RIC group patients not receiving busulfanbased RIC (RR = 0.76; 95% CI = 0.60-0.96; p = 0.02) and with the use of a higher cumulative rituximab dose (RR = 0.43; 95% CI = 0.21-0.90; p = 0.02). Conclusion: Our analysis shows that inclusion of rituximab in RIC regimens improves progression-free survival in patients with B cell NHL. These data supports the use of R-RIC in B-NHL patients undergoing allo-HCT

Characterization of Cronobacter sakazakii Strains Originating from Plant-Origin Foods Using Comparative Genomic Analyses and Zebrafish Infectivity Studies

Cronobacter sakazakii continues to be isolated from ready-to-eat fresh and frozen produce, flours, dairy powders, cereals, nuts, and spices, in addition to the conventional sources of powdered infant formulae (PIF) and PIF production environments. To understand the sequence diversity, phylogenetic relationship, and virulence of C. sakazakii originating from plant-origin foods, comparative molecular and genomic analyses, and zebrafish infection (ZI) studies were applied to 88 strains. Whole genome sequences of the strains were generated for detailed bioinformatic analysis. PCR analysis showed that all strains possessed a pESA3-like virulence plasmid similar to reference C. sakazakii clinical strain BAA-894. Core genome analysis confirmed a shared genomic backbone with other C. sakazakii strains from food, clinical and environmental strains. Emerging nucleotide diversity in these plant-origin strains was highlighted using single nucleotide polymorphic alleles in 2000 core genes. DNA hybridization analyses using a pan-genomic microarray showed that these strains clustered according to sequence types (STs) identified by multi-locus sequence typing (MLST). PHASTER analysis identified 185 intact prophage gene clusters encompassing 22 different prophages, including three intact Cronobacter prophages: ENT47670, ENT39118, and phiES15. AMRFinderPlus analysis identified the CSA family class C β-lactamase gene in all strains and a plasmid-borne mcr-9.1 gene was identified in three strains. ZI studies showed that some plant-origin C. sakazakii display virulence comparable to clinical strains. Finding virulent plant-origin C. sakazakii possessing significant genomic features of clinically relevant STs suggests that these foods can serve as potential transmission vehicles and supports widening the scope of continued surveillance for this important foodborne pathogen

Reduced-intensity Transplantation For Lymphomas Using Haploidentical Related Donors Versus Hla-matched Sibling Donors: A Center For International Blood And Marrow Transplant Research Analysis

Purpose: Related donor haploidentical hematopoietic cell transplantation (Haplo-HCT) using post-transplantation cyclophosphamide (PT-Cy) is increasingly used in patients lacking HLA-matched sibling donors (MSD). We compared outcomes after Haplo-HCT using PT-Cy with MSD-HCT in patients with lymphoma, using the Center for International Blood and Marrow Transplant Research registry. Materials and Methods: We evaluated 987 adult patients undergoing either Haplo-HCT (n = 180) or MSD-HCT (n = 807) following reduced-intensity conditioning regimens. The haploidentical group received graft-versus-host disease (GVHD) prophylaxis with PT-Cy with or without a calcineurin inhibitor and mycophenolate. The MSD group received calcineurin inhibitor-based GVHD prophylaxis. Results: Median follow-up of survivors was 3 years. The 28-day neutrophil recovery was similar in the two groups (95% v 97%; P = .31). The 28-day platelet recovery was delayed in the haploidentical group compared with the MSD group (63% v 91%; P = .001). Cumulative incidence of grade II to IV acute GVHD at day 100 was similar between the two groups (27% v 25%; P = .84). Cumulative incidence of chronic GVHD at 1 year was significantly lower after Haplo-HCT (12% v 45%; P < .001), and this benefit was confirmed on multivariate analysis (relative risk, 0.21; 95% CI, 0.14 to 0.31; P < .001). For Haplo-HCT v MSD-HCT, 3-year rates of nonrelapse mortality (15% v 13%; P = .41), relapse/progression (37% v 40%; P = .51), progression-free survival (48% v 48%; P = .96), and overall survival (61% v 62%; P = .82) were similar. Multivariate analysis showed no significant difference between Haplo-HCT and MSD-HCT in terms of nonrelapse mortality (P = .06), progression/relapse (P = .10), progression-free survival (P = .83), and overall survival (P = .34). Conclusion: Haplo-HCT with PT-Cy provides survival outcomes comparable to MSD-HCT, with a significantly lower risk of chronic GVHD

Allogeneic Transplantation Provides Durable Remission in a Subset of DLBCL Patients Relapsing after Autologous Transplantation

For diffuse large B-cell lymphoma (DLBCL) patients progressing after autologous haematopoietic cell transplantation (autoHCT), allogeneic HCT (alloHCT) is often considered, although limited information is available to guide patient selection. Using the Center for International Blood and Marrow Transplant Research (CIBMTR) database, we identified 503 patients who underwent alloHCT after disease progression/relapse following a prior autoHCT. The 3-year probabilities of non-relapse mortality, progression/relapse, progression-free survival (PFS) and overall survival (OS) were 30, 38, 31 and 37% respectively. Factors associated with inferior PFS on multivariate analysis included Karnofsky performance status (KPS) <80, chemoresistance, autoHCT to alloHCT interval <1-year and myeloablative conditioning. Factors associated with worse OS on multivariate analysis included KPS<80, chemoresistance and myeloablative conditioning. Three adverse prognostic factors were used to construct a prognostic model for PFS, including KPS<80 (4 points), autoHCT to alloHCT interval <1-year (2 points) and chemoresistant disease at alloHCT (5 points). This CIBMTR prognostic model classified patients into four groups: low-risk (0 points), intermediate-risk (2-5 points), high-risk (6-9 points) or very high-risk (11 points), predicting 3-year PFS of 40, 32, 11 and 6%, respectively, with 3-year OS probabilities of 43, 39, 19 and 11% respectively. In conclusion, the CIBMTR prognostic model identifies a subgroup of DLBCL patients experiencing long-term survival with alloHCT after a failed prior autoHCT

Identification of Human Papillomavirus Type 58 Lineages and the Distribution Worldwide

Background. Human papillomavirus type 58 (HPV-58) accounts for a much higher proportion of cervical cancers in East Asia than other types. A classification system of HPV-58, which is essential for molecular epidemiological study, is lacking. Methods and results. This study analyzed the sequences of 401 isolates collected from 15 countries and cities. The 268 unique concatenated E6-E7-E2-E5-L1-LCR sequences that comprised 57% of the whole HPV-58 genome showed 4 distinct clusters. L1 and LCR produced tree topologies that best resembled the concatenated sequences and thus are the most appropriate surrogate regions for lineage classification. Moreover, short fragments from L1 (nucleotides 6014–6539) and LCR (nucleotides 7257–7429 and 7540–52) were found to contain sequence signatures informative for lineage identification. Lineage A was the most prevalent lineage across all regions. Lineage C was more frequent in Africa than elsewhere, whereas lineage D was more prevalent in Africa than in Asia. Among lineage A variants, sublineage A2 dominated in Africa, the Americas, and Europe, but not in Asia. Sublineage A1, which represents the prototype that originated from a patient with cancer, was rare worldwide except in Asia. Conclusions. HPV-58 can be classified into 4 lineages that show some degree of ethnogeographic predilection in distribution. The evolutionary, epidemiological, and pathological characteristics of these lineages warrant further study