Health Status of Children Entering Kindergarten: Results of the 2010-2011 (Year Three) Nevada Kindergarten Health Survey

Academic achievement for children is vital to their success in life. Those that do well in school have greater opportunities for post-secondary education, and later have better prospects for employment. One of the major factors that can affect a child’s academic achievement is his or her health status. Academic outcomes and health conditions are consistently linked in the literature (Taras & Potts-Datema, 2005). Children with poor health status, and especially those with common chronic health conditions, have increased numbers of school absences and more academic deficiencies (Taras & Potts-Datema, 2005). In a study concerning excused versus unexcused absences, children with greater absenteeism had lower academic performance, and those with excused absences performed better than those with unexcused absences (Gottfried, 2009). Therefore, to increase the likelihood for academic success in children, we need address their health concerns. Preventative care is crucial to a child’s ability to succeed in school.According to data from the KIDS COUNT Data Center at the Annie E. Casey Foundation (2009), 11 percent of Nevada’s teens are high school dropouts, compared to 7 percent nationally. The national dropout prevention center lists poor attendance and low achievement as two of the significant risk factors for school dropout (Hammond et al., 2007). Additionally studies examining school dropout rates indicate that early intervention is necessary to prevent students from dropping out of school. Middle and high school students that drop out likely stopped being engaged in school much earlier in their academic career. Therefore, early prevention and intervention is crucial to improving graduation rates. Ensuring that children have their basic needs met, including receiving adequate health care, can directly impact a child’s academic achievement as well as increase their likelihood for high school graduation.To gain baseline information on the health status of children entering the school system and better track student health status, the Nevada Institute for Children’s Research and Policy (NICRP), in partnership with the state’s 17 school districts, the Southern Nevada Health District (SNHD), and the Nevada State Health Division (NSHD), conducted a health survey examining the health status as well health insurance status of Nevada’s children entering kindergarten. This study was conducted with the goal of quantifying the health status of children as they enter school to be able to identify specific areas for improvement to eventually increase academic success among Nevada’s students

Compensatory Development and Costs of Plasticity: Larval Responses to Desiccated Conspecifics

Understanding constraints on phenotypic plasticity is central to explaining its evolution and the evolution of phenotypes in general, yet there is an ongoing debate on the classification and relationships among types of constraints. Since plasticity is often a developmental process, studies that consider the ontogeny of traits and their developmental mechanisms are beneficial. We manipulated the timing and reliability of cues perceived by fire salamander larvae for the future desiccation of their ephemeral pools to determine whether flexibility in developmental rates is constrained to early ontogeny. We hypothesized that higher rates of development, and particularly compensation for contradictory cues, would incur greater endogenous costs. We found that larvae respond early in ontogeny to dried conspecifics as a cue for future desiccation, but can fully compensate for this response in case more reliable but contradictory cues are later perceived. Patterns of mortality suggested that endogenous costs may depend on instantaneous rates of development, and revealed asymmetrical costs of compensatory development between false positive and false negative early information. Based on the results, we suggest a simple model of costs of development that implies a tradeoff between production costs of plasticity and phenotype-environment mismatch costs, which may potentially underlie the phenomenon of ontogenetic windows constraining plasticity

Planck 2015 results: XXV. Diffuse low-frequency Galactic foregrounds

We discuss the Galactic foreground emission between 20 and 100 GHz based on observations by Planck and WMAP. The total intensity in this part of the spectrum is dominated by free-free and spinning dust emission, whereas the polarized intensity is dominated by synchrotron emission. The Commander component-separation tool has been used to separate the various astrophysical processes in total intensity. Comparison with radio recombination line templates verifies the recovery of the free-free emission along the Galactic plane. Comparison of the high-latitude H\u3b1 emission with our free-free map shows residuals that correlate with dust optical depth, consistent with a fraction (\ue2\u2030 30%) of H\u3b1 having been scattered by high-latitude dust. We highlight a number of diffuse spinning dust morphological features at high latitude. There is substantial spatial variation in the spinning dust spectrum, with the emission peak (in I\u3bd) ranging from below 20 GHz to more than 50 GHz. There is a strong tendency for the spinning dust component near many prominent H ii regions to have a higher peak frequency, suggesting that this increase in peak frequency is associated with dust in the photo-dissociation regions around the nebulae. The emissivity of spinning dust in these diffuse regions is of the same order as previous detections in the literature. Over the entire sky, the Commander solution finds more anomalous microwave emission (AME) than the WMAP component maps, at the expense of synchrotron and free-free emission. This can be explained by the difficulty in separating multiple broadband components with a limited number of frequency maps. Future surveys, particularly at 5-20 GHz, will greatly improve the separation by constraining the synchrotron spectrum. We combine Planck and WMAP data to make the highest signal-to-noise ratio maps yet of the intensity of the all-sky polarized synchrotron emission at frequencies above a few GHz. Most of the high-latitude polarized emission is associated with distinct large-scale loops and spurs, and we re-discuss their structure. We argue that nearly all the emission at 40deg > l >-90deg is part of the Loop I structure, and show that the emission extends much further in to the southern Galactic hemisphere than previously recognised, giving Loop I an ovoid rather than circular outline. However, it does not continue as far as the "Fermi bubble/microwave haze", making it less probable that these are part of the same structure. We identify a number of new faint features in the polarized sky, including a dearth of polarized synchrotron emission directly correlated with a narrow, roughly 20deg long filament seen in H\u3b1 at high Galactic latitude. Finally, we look for evidence of polarized AME, however many AME regions are significantly contaminated by polarized synchrotron emission, and we find a 2\u3c3 upper limit of 1.6% in the Perseus region

Carbonic anhydrase IX is a pH-stat that sets an acidic tumour extracellular pH in vivo

Background Tumour Carbonic Anhydrase IX (CAIX), a hypoxia-inducible tumour-associated cell surface enzyme, is thought to acidify the tumour microenvironment by hydrating CO2 to form protons and bicarbonate, but there is no definitive evidence for this in solid tumours in vivo. Methods We used 1H magnetic resonance spectroscopic imaging (MRSI) of the extracellular pH probe imidazolyl succinic acid (ISUCA) to measure and spatially map extracellular pH in HCT116 tumours transfected to express CAIX and empty vector controls in SCID mice. We also measured intracellular pH in situ with 31P MRS and measured lactate in freeze-clamped tumours. Results CAIX expressing tumours had 0.15 pH-unit lower median extracellular pH than control tumours (pH 6.71 tumour vs pH 6.86 control, P = 0.01). Importantly, CAIX expression imposed an upper limit for tumour extracellular pH at 6.93. Despite the increased lactate concentration in CAIX-expressing tumours, 31P MRS showed no difference in intracellular pH, suggesting that CAIX acidifies only the tumour extracellular space. Conclusions CAIX acidifies the tumour microenvironment, and also provides an extracellular pH control mechanism. We propose that CAIX thus acts as an extracellular pH-stat, maintaining an acidic tumour extracellular pH that is tolerated by cancer cells and favours invasion and metastasis.We are grateful for the support of CRUK [grant number C14303/A17197], the Breast Cancer Research Foundation, the Royal Society, Worldwide Cancer Research and the European Research Council [SURVIVE: 723397]. JP-T and SC received support from the Spanish Ministry of Economy and Competitiveness SAF2014-23622

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Outcomes of Wraparound Care Coordination for Youth with Complex Behavioral Health Needs

Thesis (Master's)--University of Washington, 2019Background. Approximately 10% of youth in the US are estimated to experience “serious emotional disorder,” or SED. Wraparound is a commonly implemented care coordination process for youth with SED and complex needs, but effectiveness research is sparse, and results have been mixed. RCTs have found favorable effects of Wraparound on child welfare placements and service utilization in their samples, but only two RCTs have measured youth emotional and behavioral functioning outcomes directly, and they have found null results. Thus, the need for more evidence about the effectiveness of Wraparound on youth functioning remains. This study uses a propensity-score-matched comparison group to measure the effectiveness of Wraparound on youth functioning across multiple areas of need. Methods. Data from this study come from a large 501(c)(3) non-profit behavioral health provider agency with multiple locations in California. All youth who received services through this agency between October 1, 2015 and December 17, 2018 and who completed assessments of emotional and behavioral functioning at intake and six-months after enrollment were eligible for inclusion in the study. A total of 129 Wraparound-enrolled youth were included. These youth were propensity-score-matched on 13 relevant demographic and clinical acuity variables to youth who received services other than Wraparound (N = 1,154 youth). After matching, 122 Wraparound-enrolled and 122 comparison youth were included for analyses. Youth functioning was measured using the Child and Adolescent Needs and Strengths (CANS), an assessment that rates youth functioning with respect to the “actionability” of discrete needs. We measured change in three ways: the net change in number of needs considered “actionable,” the number of needs resolved after six months, and the number of new needs after six months. Matching successfully balanced youth with respect to baseline functioning. Linear regressions and negative binomial regressions were used to compare change scores between the Wraparound-enrolled and comparison youth. Results. Wraparound youth experienced a greater net reduction in actionable needs after six months (Mean Difference: -0.36, 95%CI: -2.03, +1.32), though confidence intervals were wide such that this difference was non-significant. Similarly, Wraparound youth experienced both a greater reduction in actionable needs (IRR: 1.32, 95%CI: 0.98, 1.79) and had new needs discovered more often than non-Wraparound youth (IRR: 1.23, 95%CI: 0.92, 1.65), though neither of these outcomes differed significantly between the two groups. Conclusions. Our results contribute to the growing effectiveness research base on the behavioral, emotional, and functional impacts of Wraparound. Although the estimated effects of Wraparound in this study only approached significance, between-group differences were clinically meaningful as per conventions for interpreting results from the CANS. The resolution and discovery of more needs after six months may be explained by the additional and intensive time spent with families by Wraparound provider staff

Cytokine modulation correlates with severity of monkeypox disease in humans.

BackgroundHuman monkeypox is a zoonotic disease endemic to parts of Africa. Similar to other orthopoxviruses, virus and host have considerable interactions through immunomodulation. These interactions likely drive the establishment of a productive infection and disease progression, resulting in the range of disease presentations and case fatality rates observed for members of the Orthopoxvirus genus.ObjectivesMuch of our understanding about the immune response to orthopoxvirus infection comes from either in vitro or in vivo studies performed in small animals or non-human primates. Here, we conducted a detailed assessment of cytokine responses to monkeypox virus using serum from acutely ill humans collected during monkeypox active disease surveillance (2005-2007) in the Democratic Republic of the Congo.Study designNineteen serum samples that were from patients with confirmed monkeypox virus infections were selected for cytokine profiling. Cytokine profiling was performed on the Bio-Rad Bioplex 100 system using a 30-plex human cytokine panel.ResultsCytokine profiling revealed elevated cytokine concentrations in all samples. Overproduction of certain cytokines (interleukin [IL]-2R, IL-10, and granulocyte macrophage-colony stimulating factor were observed in patients with serious disease (defined as >250 lesions based on the World Health Organization scoring system).ConclusionsThe data suggest that cytokine modulation affects monkeypox disease severity in humans