Health of Post-Institutionalized Haitian Children Adopted to the United States

OBJECTIVES

Haiti remains a principal placement country for intercountry adoptees to the United States. This project reports the health status of children adopted from Haiti arriving to the U.S. and compares them to intercountry adoptees from other regions.

METHODS

A retrospective chart review was conducted of adoptees placed in the U.S. from Haiti (n=87), age and sex matched with intercountry adoptees placed in the U.S. from Asia (n=87) and Latin America (n=87) between January 2010 and November 2019. Data on immunization status, contagious diseases, and nutrition and growth were analyzed via linear, logistic, and multinomial regression.

RESULTS

After adjusting for age, sex, and standardized height, children adopted from Haiti, compared to adoptees from Latin America and Asia, demonstrated a lack of immunity to hepatitis B (OR=5.89;6.87), increased immunity to hepatitis A (OR=0.38;0.30), infection by two or more parasites (OR=8.43;38.48), high lead levels (OR=23.79;7.04), and anemia (OR=15.25;9.18). Unexpectedly, children adopted from Haiti had greater standardized height (-1.28 vs. -1.82 and -2.13) and standardized weight (-0.32 vs. -0.57 and -1.57) than their counterparts from Latin America and Asia.

CONCLUSIONS

Children adopted from Haiti face complex medical challenges undoubtedly related to the country's low socioeconomic status (SES) and the impact of recurrent natural disasters and governmental neglect on public health infrastructure. Appropriate care is critical in preventing and avoiding transmission of infectious diseases in adoptees and family members. The high incidence of anemia and elevated lead levels may further exacerbate the developmental effects of early institutional deprivation.

Pilonidal sinus laser-assisted closure (PiLAC) - a low-morbidity alternative to excision with excellent long-term outcomes

INTRODUCTION

Recurrence after surgery for pilonidal sinus disease is a recognised problem and patients often re-present months after discharge. We routinely treat primary and recurrent pilonidal sinus disease with Pilonidal sinus Laser-Assisted Closure (PiLAC). Long-term outcomes following PiLAC surgery was examined following clinical and telephone review.

METHODS

All patients undergoing PiLAC as a day-case between April 2016 and July 2019 were included. Patients were followed up in a nurse-led clinic until complete healing or recurrence. A prospective database and retrospective audit of notes combined with longer-term follow-up by telephone were used.

RESULTS

A total of 35 patients underwent PiLAC, median age 28 (18-53 years), 28 males:7 females. A total of 28 patients had long-term (>60 days) follow-up, mean 407 days (range 67-887 days); 25/28 patients (89.3%) had healed with no recurrence on long-term follow-up. Of these 28 patients, 11 were first presentation of pilonidal disease and underwent PiLAC as their first treatment, with a 91% heal rate long term. A total of 15 patients had seton drainage prior to PiLAC, with a 93% heal rate versus no seton (83%). Fisher's exact test showed no significant difference between sex, new/recurrent pilonidal disease and seton placement (p>0.05).

CONCLUSIONS

Healing after PiLAC for the treatment of primary and recurrent pilonidal sinus disease is preserved with excellent long-term outcomes. We recommend it as an alternative to surgical excision.

Determination of Cyclamates (Sodium and Calcium Salts) in Canned Fruits

A method for determining calcium or sodium cyclaniate in canned fruits and fruit products has been developed. The cyclamate salt in a homogenized portion of fruit is hydrolyzed to cyclohexylamine in the presence of hydrochloric acid at 125°C and 15 psi. The cyclohexylamine is extracted into chloroform and reacts with ethanolic p-quinone to produce 2-(cyclohexylamine)-l,4-benzoquinone, which is determined spectrophotometrically at 493 mµ. Sucrose and saccharin do not interfere. Eleven collaborators tested the method on canned pears, peaches, pineapple, and grapefruit. Each fruit was fortified at two different levels with sodium cyclamate. The average recovery of both levels of cyclamate salt in all four fruits was 98.7%. Each collaborator also tested the method on a can of commercially canned dietary peach pie filling. The results were good, and the method is recommended for adoption as official, first action.

Caregiving Disruptions Affect Growth and Pubertal Development in Early Adolescence in Institutionalized and Fostered Romanian Children: A Randomized Clinical Trial

OBJECTIVES

To determine the effects of foster care vs institutional care, as well as disruptions in the caregiving environment on physical development through early adolescence.

STUDY DESIGN

This was a randomized controlled trial of 114 institutionalized, though otherwise healthy, children from 6 orphanages and 51 never institutionalized control children living in birth families (family care group) in Bucharest, Romania. Children were followed from baseline (21 months, range 5-31) through age 12 years for caregiving disruptions and growth trajectories and through age 14 years for pubertal development.

RESULTS

Children randomized to the foster care group showed greater rates of growth in height, weight, and body mass index (BMI) through age 12 years than institutionalized group. Tanner development was delayed in institutionalized group boys compared with foster care group and family care group boys at 12 but not 14 years. There were no differences in Tanner development and age of menarche among foster care group, institutionalized group, and family care group girls at ages 12 and 14 years. More disruptions in caregiving between 30 months and 12 years moderated decreases in growth rates of height in foster care group and weight in foster care group and institutionalized group across age. institutionalized group boys with ≥2 disruptions showed lower Tanner scores at age 12 vs institutionalized group and foster care group boys with <2 disruptions. foster care group girls with ≥2 disruptions had higher Tanner scores at age 14 vs foster care group girls with <2 disruptions. Age of menarche was not affected by caregiving disruptions.

CONCLUSIONS

For children who experienced early institutionalization, stable placement within family care is essential to ensuring the best outcomes for physical developmental.

TRIAL REGISTRATION

clinicaltrials.gov: NCT00747396.

Squamous cell carcinoma antigen in genitourinary tumors

We have evaluated the serum levels of squamous cell carcinoma (SCC) antigen in patients with adenocarcinoma of the kidney, adenocarcinoma of the prostate, germ cell tumors of the testis, transitional cell carcinoma of the bladder, and SCC of the penis, urethra, and bladder. Serum SCC antigen levels were elevated in 5 of 11 patients (45%) with metastatic SCC of the penis, and in the 3 patients for whom serial determinations were made, the serum levels correlated correctly with the progression of disease or response to treatment. The antigen was elevated in 1 of 3 patients with SCC of the urethra, and 1 apparent false-positive value was observed in a patient with adenocarcinoma of the prostate. Otherwise, no SCC antigen elevations were noted among 10 patients with metastatic adenocarcinoma of the prostate, 8 with metastatic adenocarcinoma of the kidney, 11 with metastatic transitional cell carcinoma of the bladder, 8 with metastatic nonseminomatous germ cell tumors of the testis, and 2 patients with metastatic SCC of the bladder

Leveraging Genomics for Head and Neck Cancer Treatment

The genomic landscape of head and neck squamous cell carcinoma (HNSCC) has been recently elucidated. Key epigenetic and genetic characteristics of this cancer have been reported and substantiated in multiple data sets, including those distinctive to the growing subset of human papilloma virus (HPV)-associated tumors. This increased understanding of the molecular underpinnings of HNSCC has not resulted in new approaches to treatment. Three Food and Drug Administration-approved molecular targeting agents are currently available to treat recurrent/metastatic disease, but these have exhibited efficacy only in subsets of HNSCC patients, and thus surgery, chemotherapy, and/or radiation remain as standard approaches. The lack of predictive biomarkers to any therapy represents an obstacle to achieving the promise of precision medicine. This review aims to familiarize the reader with current insights into the HNSCC genomic landscape, discuss the currently approved and promising molecular targeting agents under exploration in laboratories and clinics, and consider precision medicine approaches to HNSCC.

IMPACT OF JOINT ATTENTION ON SOCIAL-COMMUNICATION SKILLS IN INTERNATIONALLY ADOPTED CHILDREN

Internationally adopted (IA) children have often experienced early adversity and are at risk for long-term deficiencies in multiple developmental domains. This study examined the association between IA children's joint attention (JA) soon after arrival and later cognitive, communicative, and socioemotional competency 6 months' postadoption. We expected a child's initial JA would positively predict later cognitive, communication, and social ability. IA children (n = 63) adopted from Eastern Europe were seen soon after their arrival into the United States to assess their JA. Their socioemotional competency, social communication, and cognitive abilities were measured at a follow-up session 6 months' postadoption. We found that higher order JA was positively associated with measures of social relatedness. Furthermore, individual hierarchical regressions of each measure of JA (higher order JA, initiating JA, responding to JA, and initiating behavior requests [BR]) considered with age-at-adoption showed that each measure was an independent and positive predictor of Mullen outcomes in the receptive and expressive language domains. These results suggest that JA may be a sensitive predictor of subsequent functioning in the social, communicative, and cognitive domains. Thus, assessing JA soon after arrival has the potential to identify at-risk IA children, and interventions targeting JA may support those children in overcoming the negative impacts of early adversity.

Neonatal Respiratory Failure Caused by Congenital Diffuse Intrinsic Pontine Glioma

The authors present a case of diffuse intrinsic pontine glioma presenting in a newborn with stridor and respiratory distress that progressed to respiratory failure. Magnetic resonance imaging (MRI) of the brain revealed findings compatible with the diagnosis of diffuse intrinsic pontine glioma. The family pursued palliative care and postmortem examination confirmed WHO grade III astrocytoma.

Micronutrient status and neurodevelopment in internationally adopted children

AIM

To assess the status of nutrients relevant for brain development in internationally adoptees from disparate global regions and determine whether identified deficiencies are associated with neurodevelopment.

METHODS

Participants included children adopted from Post-Soviet States (n = 15), Ethiopia (n = 26) or China (n = 17), ages 8-18 months. A comprehensive nutritional battery and a neurodevelopmental assessment were completed at baseline (within one month of arrival) and follow-up (six months later).

RESULTS

At baseline, 35% were stunted, and 68% had at least one abnormal nutritional biochemical marker. The most common were low retinol-binding protein (33%), zinc deficiency (29%), vitamin D insufficiency/deficiency (21%), and iron deficiency (15%). There was significant catch-up growth in height and weight at follow-up, but little improvement in micronutrient deficiencies. Iron deficiency was associated with lower cognitive scores on the Bayley Scales of Infant Development-III, p = 0.027, and slower speed of processing, p = 0.012. Zinc deficiency was associated with compromised memory functioning, p = 0.001.

CONCLUSION

Nutrient deficiencies were common during the early adoption period in internationally adoptees from three global regions, and iron and zinc deficiencies were associated with poorer neurodevelopmental outcomes. Results emphasise the importance of monitoring micronutrient status at arrival and during the early adoption period, irrespective of country of origin.

Associations between physical growth and general cognitive functioning in international adoptees from Eastern Europe at 30 months post-arrival

Background

Internationally adopted children have often experienced early adversity and growth suppression as a consequence of institutional care. Furthermore, these children are at risk for impaired cognitive development due to their early adverse experiences. This study examined the association between physical growth, the growth hormone (GH) system, and general cognitive functioning post-adoption. Based on previous research, we expected to find that a child’s initial physical growth status and normalization of the growth hormone-insulin-like growth factor 1 (GH-IGF-1) axis would be positive predictors of general cognitive functioning.

Methods

Post-institutionalized children (n = 46) adopted from Eastern Europe were seen approximately 1 month after their arrival into the USA to determine baseline measurements. They were seen again 6 and 30 months later for two follow-up sessions. Measures included anthropometry, insulin-like growth factor-1 (IGF-1), IGF binding protein-3 (IGFBP-3), Mullen Scales of Early Learning, and Stanford-Binet Intelligence Scales. Information about parental education was also collected.

Results

We found that a child’s general cognitive functioning at 30 months post-adoption was predicted by their general developmental scores at 6 months post-adoption, their initial height status, and markers of the growth hormone system. Children with lower initial IGFBP-3 standard deviation (SD) scores had higher verbal IQ scores at 30 months. Furthermore, a child’s initial height was found to be a significant positive predictor of non-verbal IQ.

Conclusions

These results suggest an association between a child’s suppressed physical growth in response to early adversity and alterations in GH system functioning and subsequent recovery in cognitive functioning.

Growth, nutritional, and developmental status of young children living in orphanages in Kazakhstan

This article describes the nutritional and developmental status of young children living in Baby Houses (orphanages for children ages 0-3 years) in Kazakhstan. In 2009/2010, 308 children under age 3 years living in 10 Baby Houses were measured for height/length and weight. The Bayley Scales of Infant Development (N. Bayley, 2006) were used to assess mental and motor development. Blood was collected on a subsample to assess key nutritional factors. The World Health Organization growth charts were used to calculate Z-scores. Cut points for wasting (moderate to severe low weight for length/height growth), underweight (low weight for age), stunting (low length/height for age), development, and biomarkers used established guidelines. Most (n = 286) children had complete data on z-scores. Of these, 22.1% were experiencing wasting, 31.5% were underweight, and 36.7% had stunting. The nutritional status of the children, based on blood biomarkers, revealed that 37.1% of the children were anemic, 21.4% had low albumin, 38.1% had low vitamin D, 5.5% were iodine-deficient, and 2% had low serum zinc. One half had mild to significant mental and motor delays. Children living at these Baby Houses in Kazakhstan have substantial nutritional deficits and developmental delays. Focused attention is needed to provide a nutritionally enhanced diet and improved developmental opportunities to improve the long-term outcomes for these children.

Frequent promoter hypermethylation of PTPRT increases STAT3 activation and sensitivity to STAT3 inhibition in head and neck cancer

STAT3 overactivation is a common event in many cancers, including head and neck squamous cell carcinoma (HNSCC), where STAT3 represents a promising therapeutic target. HNSCC is not characterized by frequent kinase mutations, in contrast to some malignancies where mutational activation of kinases upstream of STAT3 is common. Instead, STAT3 may be activated by loss-of-function (LOF) of negative regulators of STAT3, including by promoter hypermethylation of PTPRT. Here we first analyzed The Cancer Genome Atlas (TCGA) data and determined that the PTPRT promoter is frequently hypermethylated in several cancers, including HNSCC (60.1% of tumors analyzed) in association with downregulation of PTPRT mRNA expression and upregulation of pSTAT3 expression. These findings were confirmed in an independent cohort of HNSCC tumors by methylation-specific PCR (MSP) and immunohistochemistry. We demonstrate that PTPRT promoter methylation and gene silencing is reversible in HNSCC cells, leading to PTPRT-specific downregulation of pSTAT3 expression. We further show that PTPRT promoter methylation is significantly associated with sensitivity to STAT3 inhibition in HNSCC cells, suggesting that PTPRT promoter methylation may serve as a predictive biomarker for responsiveness to STAT3 inhibitors in clinical development.

Vision and hearing deficits and associations with parent-reported behavioral and developmental problems in international adoptees

To determine the occurrence of vision and hearing deficits in international adoptees and their associations with emotional, behavioral and cognitive problems. The Minnesota International Adoption Project (MnIAP) was a 556-item survey that was mailed to 2,969 parents who finalized an international adoption in Minnesota (MN) between January 1990 and December 1998 and whose children were between 4 and 18 years-old at the time of the survey. Families returned surveys for 1,906 children (64%); 1,005 had complete data for analyses. The survey included questions about the child's pre-adoption experiences and post-placement medical diagnoses, and the Child Behavior Checklist (CBCL). Multivariate logistic regression assessed associations between hearing and vision problems and problems identified by the CBCL. Information on hearing and vision screening and specific vision and hearing problems was also collected via a telephone survey (HVS) from 96/184 children (52%) seen between June 1999 and December 2000 at the University of Minnesota International Adoption Clinic. In both cohorts, 61% of children had been screened for vision problems and 59% for hearing problems. Among those children screened, vision (MnIAP = 25%, HVS = 31%) and hearing (MnIAP = 12%, HVS = 13%) problems were common. For MnIAP children, such problems were significant independent predictors for T scores >67 for the CBCL social problems and attention subscales and parent-reported, practitioner-diagnosed developmental delay, learning and speech/language problems, and cognitive impairment. Hearing and vision problems are common in international adoptees and screening and correction are available in the immediate post-arrival period. The importance of identifying vision and hearing problems cannot be overstated as they are risk factors for development and behavior problems.

DNMT3A and IDH mutations in acute myeloid leukemia and other myeloid malignancies: associations with prognosis and potential treatment strategies

The development of effective treatment strategies for most forms of acute myeloid leukemia (AML) has languished for the past several decades. There are a number of reasons for this, but key among them is the considerable heterogeneity of this disease and the paucity of molecular markers that can be used to predict clinical outcomes and responsiveness to different therapies. The recent large-scale sequencing of AML genomes is now providing opportunities for patient stratification and personalized approaches to treatment that are based on individual mutational profiles. It is particularly notable that studies by The Cancer Genome Atlas and others have determined that 44% of patients with AML exhibit mutations in genes that regulate methylation of genomic DNA. In particular, frequent mutation has been observed in the genes encoding DNA methyltransferase 3A (DNMT3A), isocitrate dehydrogenase 1 (IDH1) and isocitrate dehydrogenase 2 (IDH2), as well as Tet oncogene family member 2. This review will summarize the incidence of these mutations, their impact on biochemical functions including epigenetic modification of genomic DNA and their potential usefulness as prognostic indicators. Importantly, the presence of DNMT3A, IDH1 or IDH2 mutations may confer sensitivity to novel therapeutic approaches, including the use of demethylating agents. Therefore, the clinical experience with decitabine and azacitidine in the treatment of patients harboring these mutations will be reviewed. Overall, we propose that understanding the role of these mutations in AML biology will lead to more rational therapeutic approaches targeting molecularly defined subtypes of the disease.

From institutional care to family support: development of an effective early intervention network in the Nizhny Novgorod Region, Russian Federation, to support family care for children at risk for institutionalization

Despite efforts of the government to reform child protection, Russia continues to rely on institutional care due to the lack of support services for families in crisis, children with disabilities, and foster and adoptive parents.The project goal was to establish a replicable professional model that would direct the child welfare system in the Nizhny Novgorod Region away from institutional care and toward services for young children and their families that reduce the risk of institutionalization. The program was carried out over a 3-year period through a public-private partnership, which included the Ministries of Social Policy and Health of the Nizhny Novgorod Region, Firefly, and KPMG with partial funding by the United States Agency for International Development (USAID). Participation of professionals was excellent, attitudinal changes were extensive, and there were significant improvements in the understanding and utilization of early intervention concepts. The number of visits to program sites increased from essentially none to almost 1,000/month during the course of the project. Difficulties employing standardized child-based measures of success and developing ministry data-collection systems were encountered. Changes within the child welfare system in Russia are possible, but require a knowledgeable and adequately funded and supported program within regions receptive to change.

Iron deficiency after arrival is associated with general cognitive and behavioral impairment in post-institutionalized children adopted from Eastern Europe

To investigate the role of iron deficiency in general cognitive and behavioral development in post-institutionalized (PI) children during the early post-adoption period. PI children (N = 57) adopted from Eastern Europe or Central Asia (9-46 months of age) were seen at baseline around 1 month after arrival into the US and at follow-up 6 months later. Measures included anthropometry, iron status, the Toddler Behavior Assessment Questionnaire-R (TBAQ-R), the Mullen Scales of Early Learning, and examiner-rated behaviors during testing. 26 % were iron deficient at baseline; 18 % were iron deficient at follow-up. There was a trend for those with iron deficiency at baseline to be more fearful on the TBAQ-R. Those with iron deficiency at follow-up displayed more hyperactivity on both the TBAQ-R and the examiner-rated behaviors. Those with iron deficiency at follow-up were more likely to score below average on the Mullen Early Learning Composite (iron deficient: 80 %; good iron status: 32 %). The association between iron status at follow-up and the Mullen Early Learning Composite was mediated by inattention and hyperactivity behaviors during testing. Iron deficiency is associated with neurobehavioral alterations months after arrival, mediated by the effect on attention and activity levels. Iron status needs to be monitored at least through the first half-year post-adoption, particularly in children exhibiting rapid catch-up growth. Additionally, developmental evaluation is recommended in those with iron deficiency, even in children with good iron status at arrival.

STAT transcription factors in hematopoiesis and leukemogenesis: opportunities for therapeutic intervention

Signal transducer and activator of transcription (STAT) proteins comprise a family of transcription factors that are activated by cytokines, hormones and growth factors. The activation of STAT proteins plays a key role in the production of mature hematopoietic cells via effects on cellular proliferation, survival and lineage-specific differentiation. Emerging evidence also demonstrates frequent, constitutive activation of STATs in primary leukemia specimens. Moreover, roles for STATs in promoting leukemia development have been delineated in numerous preclinical studies. This review summarizes our current understanding of STAT protein involvement in normal hematopoiesis and leukemogenesis, as well as recent advances in the development and testing of novel STAT inhibitors.

Terrestrial vegetation and aquatic chemistry influence larval mosquito abundance in catch basins, Chicago, USA

Background

An important determinant of mosquito-borne pathogen transmission is the spatial distribution of vectors. The primary vectors of West Nile virus (WNV) in Illinois are Culex pipiens Linnaeus (Diptera: Culicidae) and Culex restuans Theobald. In urban environments, these mosquitoes commonly oviposit in roadside storm water catch basins. However, use of this habitat is inconsistent, with abundance of larvae varying significantly across catch basins at a fine spatial scale.

Methods

We tested the hypothesis that attributes of the biotic and abiotic environment contribute to spatial and temporal variation in production of mosquito vectors, characterizing the relationship between terrestrial vegetation and aquatic chemistry and Culex abundance in Chicago, Illinois. Larvae were sampled from 60 catch basins from June 14 to October 3, 2009. Density of shrubs and 14 tree genera surrounding the basins were quantified, as well as aquatic chemistry content of each basin.

Results

We demonstrate that the spatial pattern of Culex abundance in catch basins is strongly influenced by environmental characteristics, resulting in significant variation across the urban landscape. Using regression and machine learning techniques, we described landscape features and microhabitat characteristics of four Chicago neighborhoods and examined the implications of these measures for larval abundance in adjacent catch basins. The important positive predictors of high larval abundance were aquatic ammonia, nitrates, and area of shrubs of height <1 m surrounding the catch basins, whereas pH and area of flowering shrub were negatively correlated with larval abundance. Tree density, particularly of arborvitae, maple, and pear, also positively influenced the distribution of Culex during the fruit-bearing periods and early senescent periods in August and September.

Conclusions

This study identifies environmental predictors of mosquito production in urban environments. Because an abundance of adult Culex is integral to efficient WNV transmission and mosquitoes are found in especially high densities near larval habitats, identifying aquatic sites for Culex and landscape features that promote larval production are important in predicting the spatial pattern of cases of human and veterinary illness. Thus, these data enable accurate assessment of regions at risk for exposure to WNV and aid in the prevention of vector-borne disease transmission.

Adoption as an intervention for institutionally reared children: HPA functioning and developmental status

Institutional care, particularly when experienced early in life, is associated with delays in social and emotional development that often persist years after adoption. It has been hypothesized that compromise of the hypothalamic-pituitary-adrenocortical (HPA) axis due to adverse condition in institutions is a mediator of later emotional and behavioral problems. The first goal of our project was to investigate whether improvements in the social and emotional environment are associated with changes in HPA axis function. The second goal was to explore whether HPA alterations related to early social adversity were associated with more compromised general development and social and emotional functioning post adoption. Children adopted from Eastern European orphanages (N = 76, mean age was 17 months, SD = 5) were followed as part of an ongoing longitudinal study. Data, including diurnal cortisol patterns, were collected at two time points: baseline (within one month of adoption) and follow-up (six months later). Cortisol values were averaged over two days of saliva sampling after wake-up and before bedtime. We found that morning cortisol values increased between the baseline assessment (M = 0.27 μg/dl, SD = 0.13) and follow-up (M = 0.33 μg/dl, SD = 0.20), t(76) = -2.1, p<0.05. HPA functioning was not associated with general developmental level at either the initial or six months post-adoption assessments. However, dysregulation of the HPA axis (i.e., flatter diurnal pattern) at follow-up was associated with more behavioral and emotional problems. Overall, these results suggest that investigating specific physiological mechanisms is important in identifying children at risk for persistent social and emotional problems and in understanding the long-term consequences of early adversity. Future work should investigate whether disturbance in the HPA system is a heightened risk for long-term negative developmental outcomes.

Haptic Edge Sharpness Perception with a Contact Location Display

The effect of contact location information on virtual edge perception was investigated in two experiments. In Experiment 1, participants discriminated edge sharpness under force-alone and force-plus-contact-location conditions using a 4.8 mm radius contact roller. Virtual objects were 2D profiles of edges with two adjoining surfaces. For both conditions, the Just Noticeable Difference (JND) in change of edge radius increased from 2.3 to 7.4 mm as edge radii increased from 2.5 to 20.0 mm; there was no significant difference between the two conditions. A follow-up experiment with contact location alone resulted in higher edge sharpness JNDs. In Experiment 2, the same edge sharpness discrimination task was performed using a smaller contact roller (R = 1.5 mm) to investigate the effect of roller size. The JNDs for the smaller roller were not statistically significant from those of the larger roller. Our results suggest that 1) contact location cues alone are capable of conveying edge sharpness information, but that force cues are dominant when both types of cues are available; and 2) the radius of the contact roller does not significantly affect the user's ability to discriminate edge sharpness, indicating that the participants could use the changes in contact location to judge curvature.