An Extension Educator Perspective on Adverse Childhood Experiences

Research on adverse childhood experiences (ACEs) has garnered a great deal of attention and is increasingly used to demonstrate the negative impact of stressful and traumatic childhood experiences on psychological and physical health. ACEs have become a focus of local and state organizations and coalitions concerned about the well-being of children and their families, resulting in a growing number of Extension professionals becoming involved in these initiatives. In this article we provide an overview and analysis of seminal and more recent ACEs research and offer suggestions about where an understanding of and response to ACEs might fit into the work of Extension educators

A Revisitation of Kernel Synchronization Schemes

In an operating system kernel, critical sections of code must be protected from interruption. This is traditionally accomplished by masking the set of interrupts whose handlers interfere with the correct operation of the critical section. Because it can be expensive to communicate with an off-chip interrupt controller, more complex optimistic techniques for masking interrupts have been pro-posed. In this paper we present measurements of the behavior of the NetBSD 1.2 kernel, and use the measurements to explore the space of kernel synchronization schemes. We show that (a) most critical sections are very short, (b) very few are ever interrupted, (c) using the traditional synchronization technique, the synchronization cost is often higher than the time spent in the body of the critical section, and (d) under heavy load NetBSD 1.2 can spend 9% to 12% of its time in synchronization primitives. The simplest scheme we examined, disabling all interrupts while in a critical section or interrupt handler, can lead to loss of data under heavy load. A more complex optimistic scheme functions correctly under the heavy workloads we tested and has very low overhead (at most 0.3%). Based on our measurements, we present a new model that offers the simplicity of the traditional scheme with the performance of the optimistic schemes. Given the relative CPU, memory, and device performance of today’s hardware, the newer techniques we examined have a much lower synchronization cost than the traditional technique. Under heavy load, such as that incurred by a web server, a system using these newer techniques will have noticeably better performance.Engineering and Applied Science

Activated lymphocyte recruitment into the tumor microenvironment following preoperative sipuleucel-T for localized prostate cancer.

BackgroundSipuleucel-T is a US Food and Drug Administration-approved immunotherapy for asymptomatic or minimally symptomatic metastatic castration-resistant prostate cancer (mCRPC). Its mechanism of action is not fully understood. This prospective trial evaluated the direct immune effects of systemically administered sipuleucel-T on prostatic cancer tissue in the preoperative setting.MethodsPatients with untreated localized prostate cancer were treated on an open-label Phase II study of sipuleucel-T prior to planned radical prostatectomy (RP). Immune infiltrates in RP specimens (posttreatment) and in paired pretreatment biopsies were evaluated by immunohistochemistry (IHC). Correlations between circulating immune response and IHC were assessed using Spearman rank order.ResultsOf the 42 enrolled patients, 37 were evaluable. Adverse events were primarily transient, mild-to-moderate and infusion related. Patients developed T cell proliferation and interferon-γ responses detectable in the blood following treatment. Furthermore, a greater-than-three-fold increase in infiltrating CD3(+), CD4(+) FOXP3(-), and CD8(+) T cells was observed in the RP tissues compared with the pretreatment biopsy (binomial proportions: all P < .001). This level of T cell infiltration was observed at the tumor interface, and was not seen in a control group consisting of 12 concurrent patients who did not receive any neoadjuvant treatment prior to RP. The majority of infiltrating T cells were PD-1(+) and Ki-67(+), consistent with activated T cells. Importantly, the magnitude of the circulating immune response did not directly correlate with T cell infiltration within the prostate based upon Spearman's rank order correlation.ConclusionsThis study is the first to demonstrate a local immune effect from the administration of sipuleucel-T. Neoadjuvant sipuleucel-T elicits both a systemic antigen-specific T cell response and the recruitment of activated effector T cells into the prostate tumor microenvironment

SHRiMP: Accurate Mapping of Short Color-space Reads

The development of Next Generation Sequencing technologies, capable of sequencing hundreds of millions of short reads (25–70 bp each) in a single run, is opening the door to population genomic studies of non-model species. In this paper we present SHRiMP - the SHort Read Mapping Package: a set of algorithms and methods to map short reads to a genome, even in the presence of a large amount of polymorphism. Our method is based upon a fast read mapping technique, separate thorough alignment methods for regular letter-space as well as AB SOLiD (color-space) reads, and a statistical model for false positive hits. We use SHRiMP to map reads from a newly sequenced Ciona savignyi individual to the reference genome. We demonstrate that SHRiMP can accurately map reads to this highly polymorphic genome, while confirming high heterozygosity of C. savignyi in this second individual. SHRiMP is freely available at http://compbio.cs.toronto.edu/shrimp

Ecological characteristics of core-use areas used by Bering–Chukchi–Beaufort (BCB) bowhead whales, 2006–2012

© The Author(s), 2014]. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Progress in Oceanography 136 (2015): 201-222, doi:10.1016/j.pocean.2014.08.012.The Bering–Chukchi–Beaufort (BCB) population of bowhead whales (Balaena mysticetus) ranges across the seasonally ice-covered waters of the Bering, Chukchi, and Beaufort seas. We used locations from 54 bowhead whales, obtained by satellite telemetry between 2006 and 2012, to define areas of concentrated use, termed “core-use areas”. We identified six primary core-use areas and describe the timing of use and physical characteristics (oceanography, sea ice, and winds) associated with these areas. In spring, most whales migrated from wintering grounds in the Bering Sea to the Cape Bathurst polynya, Canada (Area 1), and spent the most time in the vicinity of the halocline at depths <75 m, which are within the euphotic zone, where calanoid copepods ascend following winter diapause. Peak use of the polynya occurred between 7 May and 5 July; whales generally left in July, when copepods are expected to descend to deeper depths. Between 12 July and 25 September, most tagged whales were located in shallow shelf waters adjacent to the Tuktoyaktuk Peninsula, Canada (Area 2), where wind-driven upwelling promotes the concentration of calanoid copepods. Between 22 August and 2 November, whales also congregated near Point Barrow, Alaska (Area 3), where east winds promote upwelling that moves zooplankton onto the Beaufort shelf, and subsequent relaxation of these winds promoted zooplankton aggregations. Between 27 October and 8 January, whales congregated along the northern shore of Chukotka, Russia (Area 4), where zooplankton likely concentrated along a coastal front between the southeastward-flowing Siberian Coastal Current and northward-flowing Bering Sea waters. The two remaining core-use areas occurred in the Bering Sea: Anadyr Strait (Area 5), where peak use occurred between 29 November and 20 April, and the Gulf of Anadyr (Area 6), where peak use occurred between 4 December and 1 April; both areas exhibited highly fractured sea ice. Whales near the Gulf of Anadyr spent almost half of their time at depths between 75 and 100 m, usually near the seafloor, where a subsurface front between cold Anadyr Water and warmer Bering Shelf Water presumably aggregates zooplankton. The amount of time whales spent near the seafloor in the Gulf of Anadyr, where copepods (in diapause) and, possibly, euphausiids are expected to aggregate provides strong evidence that bowhead whales are feeding in winter. The timing of bowhead spring migration corresponds with when zooplankton are expected to begin their spring ascent in April. The core-use areas we identified are also generally known from other studies to have high densities of whales and we are confident these areas represent the majority of important feeding areas during the study (2006–2012). Other feeding areas, that we did not detect, likely existed during the study and we expect core-use area boundaries to shift in response to changing hydrographic conditions.This study is part of the Synthesis of Arctic Research (SOAR) and was funded in part by the U.S. Department of the Interior, Bureau of Ocean Energy Management, Environmental Studies Program through Interagency Agreement No. M11PG00034 with the U.S. Department of Commerce, National Oceanic and Atmospheric Administration (NOAA), Office of Oceanic and Atmospheric Research (OAR), Pacific Marine Environmental Laboratory (PMEL). Funding for this research was mainly provided by U.S. Minerals Management Service (now Bureau of Ocean Energy Management) under contracts M12PC00005, M10PS00192, and 01-05-CT39268, with the support and assistance from Charles Monnett and Jeffery Denton, and under Interagency Agreement No. M08PG20021 with NOAA-NMFS and Contract No. M10PC00085 with ADF&G. Work in Canada was also funded by the Fisheries Joint Management Committee, Ecosystem Research Initiative (DFO), and Panel for Energy Research and Development

Magnetic Resonance Guided Radiation Therapy for Pancreatic Adenocarcinoma, Advantages, Challenges, Current Approaches, and Future Directions

Introduction: Pancreatic adenocarcinoma (PAC) has some of the worst treatment outcomes for any solid tumor. PAC creates substantial difficulty for effective treatment with traditional RT delivery strategies primarily secondary to its location and limited visualization using CT. Several of these challenges are uniquely addressed with MR-guided RT. We sought to summarize and place into context the currently available literature on MR-guided RT specifically for PAC. Methods: A literature search was conducted to identify manuscript publications since September 2014 that specifically used MR-guided RT for the treatment of PAC. Clinical outcomes of these series are summarized, discussed, and placed into the context of the existing pancreatic literature. Multiple international experts were involved to optimally contextualize these publications. Results: Over 300 manuscripts were reviewed. A total of 6 clinical outcomes publications were identified that have treated patients with PAC using MR guidance. Successes, challenges, and future directions for this technology are evident in these publications. MR-guided RT holds theoretical promise for the treatment of patients with PAC. As with any new technology, immediate or dramatic clinical improvements associated with its use will take time and experience. There remain no prospective trials, currently publications are limited to small retrospective experiences. The current level of evidence for MR guidance in PAC is low and requires significant expansion. Future directions and ongoing studies that are currently open and accruing are identified and reviewed. Conclusions: The potential promise of MR-guided RT for PAC is highlighted, the challenges associated with this novel therapeutic intervention are also reviewed. Outcomes are very early, and will require continued and long term follow up. MR-guided RT should not be viewed in the same fashion as a novel chemotherapeutic agent for which dosing, administration, and toxicity has been established in earlier phase studies. Instead, it should be viewed as a novel procedural intervention which must be robustly tested, refined and practiced before definitive conclusions on the potential benefits or detriments can be determined. The future of MR-guided RT for PAC is highly promising and the potential implications on PAC are substantial

Transplantation in Remission Improves the Disease-Free Survival of Patients with Advanced Myelodysplastic Syndromes Treated with Myeloablative T Cell-Depleted Stem Cell Transplants from HLA-Identical Siblings

AbstractFrom 1985 to 2004, 49 patients with advanced myelodysplastic syndromes (MDS) (≥5% blasts) or acute myeloid leukemia (AML) transformed from MDS underwent T cell depleted bone marrow or peripheral blood hematopoietic stem cell transplantation (HSCT) from HLA-identical siblings following conditioning with a myeloablative regimen that included total body irradiation (44 patients) or busulfan (5 patients). Thirty-six patients received chemotherapy (3 low dose and 33 induction doses) before conditioning, and 13 patients did not receive any chemotherapy. Prior to transplantation, 22 of the 36 treated patients were in hematologic remission; 4 were in a second refractory cytopenia phase (26 responders); 8 had failed to achieve remission; and 2 of the responders had progression or relapse of their MDS (10 failures). No post-transplantation pharmacologic prophylaxis for graft-versus-host disease (GVHD) was given. The median age was 48 yrs (range 13-61). Forty-five of the 49 patients engrafted; 2 had primary graft failure; and 2 died before engraftment. Only 3 patients developed acute GVHD (aGVHD) (grades I and III) and 1 chronic GVHD (cGVHD). At 3 yrs post-transplantation, the overall survival (OS) was 54% in the responders; 31% in the untreated group; and 0% in the failure group (P=.0004). The disease free survival (DFS) was 50%, 15% and 0% in each group respectively (P=.0008). In multivariate analysis, disease status before cytoreduction remained highly correlated with DFS (P<.001). The cumulative incidence (CI) of relapse at 2-yrs post-transplantation for the responders was 23%; for the untreated group was 38%; and for the failures was 50%. The CI of non-relapse mortality at 2-yrs post-transplantation, for the responders was 23%; for the untreated group was 38%; and for the failures was 40%. All survivors achieved a Karnofsky Performance Status (KPS) of ≥90. These results indicate that patients with advanced MDS who achieve and remain in remission or a second refractory cytopenia phase with chemotherapy before conditioning can achieve successful long-term remissions following a myeloablative T cell depleted allogeneic HSCT

Multiple interactions between the alpha2C- and beta1-adrenergic receptors influence heart failure survival

<p>Abstract</p> <p>Background</p> <p>Persistent stimulation of cardiac β₁-adrenergic receptors by endogenous norepinephrine promotes heart failure progression. Polymorphisms of this gene are known to alter receptor function or expression, as are polymorphisms of the α_2C-adrenergic receptor, which regulates norepinephrine release from cardiac presynaptic nerves. The purpose of this study was to investigate possible synergistic effects of polymorphisms of these two intronless genes (<it>ADRB1 </it>and <it>ADRA2C</it>, respectively) on the risk of death/transplant in heart failure patients.</p> <p>Methods</p> <p>Sixteen sequence variations in <it>ADRA2C </it>and 17 sequence variations in <it>ADRB1 </it>were genotyped in a longitudinal study of 655 white heart failure patients. Eleven sequence variations in each gene were polymorphic in the heart failure cohort. Cox proportional hazards modeling was used to identify polymorphisms and potential intra- or intergenic interactions that influenced risk of death or cardiac transplant. A leave-one-out cross-validation method was utilized for internal validation.</p> <p>Results</p> <p>Three polymorphisms in <it>ADRA2C </it>and five polymorphisms in <it>ADRB1 </it>were involved in eight cross-validated epistatic interactions identifying several two-locus genotype classes with significant relative risks ranging from 3.02 to 9.23. There was no evidence of intragenic epistasis. Combining high risk genotype classes across epistatic pairs to take into account linkage disequilibrium, the relative risk of death or transplant was 3.35 (1.82, 6.18) relative to all other genotype classes.</p> <p>Conclusion</p> <p>Multiple polymorphisms act synergistically between the <it>ADRA2C </it>and <it>ADRB1 </it>genes to increase risk of death or cardiac transplant in heart failure patients.</p

Microbiological, histological, immunological, and toxin response to antibiotic treatment in the mouse model of Mycobacterium ulcerans disease.

Mycobacterium ulcerans infection causes a neglected tropical disease known as Buruli ulcer that is now found in poor rural areas of West Africa in numbers that sometimes exceed those reported for another significant mycobacterial disease, leprosy, caused by M. leprae. Unique among mycobacterial diseases, M. ulcerans produces a plasmid-encoded toxin called mycolactone (ML), which is the principal virulence factor and destroys fat cells in subcutaneous tissue. Disease is typically first manifested by the appearance of a nodule that eventually ulcerates and the lesions may continue to spread over limbs or occasionally the trunk. The current standard treatment is 8 weeks of daily rifampin and injections of streptomycin (RS). The treatment kills bacilli and wounds gradually heal. Whether RS treatment actually stops mycolactone production before killing bacilli has been suggested by histopathological analyses of patient lesions. Using a mouse footpad model of M. ulcerans infection where the time of infection and development of lesions can be followed in a controlled manner before and after antibiotic treatment, we have evaluated the progress of infection by assessing bacterial numbers, mycolactone production, the immune response, and lesion histopathology at regular intervals after infection and after antibiotic therapy. We found that RS treatment rapidly reduced gross lesions, bacterial numbers, and ML production as assessed by cytotoxicity assays and mass spectrometric analysis. Histopathological analysis revealed that RS treatment maintained the association of the bacilli with (or within) host cells where they were destroyed whereas lack of treatment resulted in extracellular infection, destruction of host cells, and ultimately lesion ulceration. We propose that RS treatment promotes healing in the host by blocking mycolactone production, which favors the survival of host cells, and by killing M. ulcerans bacilli

Rift Valley Fever Risk Map Model and Seroprevalence in Selected Wild Ungulates and Camels from Kenya

Since the first isolation of Rift Valley fever virus (RVFV) in the 1930s, there have been multiple epizootics and epidemics in animals and humans in sub-Saharan Africa. Prospective climate-based models have recently been developed that flag areas at risk of RVFV transmission in endemic regions based on key environmental indicators that precede Rift Valley fever (RVF) epizootics and epidemics. Although the timing and locations of human case data from the 2006-2007 RVF outbreak in Kenya have been compared to risk zones flagged by the model, seroprevalence of RVF antibodies in wildlife has not yet been analyzed in light of temporal and spatial predictions of RVF activity. Primarily wild ungulate serum samples from periods before, during, and after the 2006-2007 RVF epizootic were analyzed for the presence of RVFV IgM and/or IgG antibody. Results show an increase in RVF seropositivity from samples collected in 2007 (31.8%), compared to antibody prevalence observed from 2000-2006 (3.3%). After the epizootic, average RVF seropositivity diminished to 5% in samples collected from 2008-2009. Overlaying maps of modeled RVF risk assessments with sampling locations indicated positive RVF serology in several species of wild ungulate in or near areas flagged as being at risk for RVF. Our results establish the need to continue and expand sero-surveillance of wildlife species Kenya and elsewhere in the Horn of Africa to further calibrate and improve the RVF risk model, and better understand the dynamics of RVFV transmission