Early Adolescent Critical Consciousness Development in the Age of Trump

Political elections have been shown to influence youth civic development. The election of Donald Trump is historic and has elevated precarity for people of color and immigrants, yet we know little about how young people with these identities experienced this potentially catalytic event. Using ethnographic methods, we examined youth and adult discussions that occurred during youth participatory action research in four sites of one after-school program between October 2016 and May 2017, to investigate how the development of critical consciousness occurs among early adolescent youth of color in the context of catalyzing political events. We identified emergent patterns in how young people (a) engaged in critical reflection, (b) weighed political efficacy, and (c) considered engagement in critical action in the wake of Trump’s election. The data revealed that young people’s critical consciousness development ranged from basic to advanced levels. This research highlights the ways that politically catalytic events shape critical consciousness development among early adolescents of color.

More than Data Collectors: A Systematic Review of the Environmental Outcomes of Youth Inquiry Approaches in the United States

Over the last twenty years, research on the impact of engaging children and adolescents in the generation of new knowledge about their lives, schools, and communities, has grown tremendously. This systematic review summarizes the findings from empirical studies of youth inquiry approaches in the United States, with a focus on their environmental outcomes. Searches of four interdisciplinary databases retrieved a total of 3,724 relevant articles published between 1995 and 2015. Sixty-three distinct studies met the systematic review inclusion criteria, of which, 36 (57.1%) reported that the youth inquiry approach contributed to positive changes among adults, peers, organizations, and/or institutions. These environmental outcomes were qualitatively recorded, inductively categorized, and then organized into Bronfenbrenner's ecological framework. Youth inquiry approaches led to practitioner growth and changes in peer group norms at the micro-system level, program development or improvement and research benefits at the meso-system level, and school, city, and state level policy adoption at the exo-system level. Qualitative methods, especially case studies, were most commonly used to evaluate the impact of youth inquiry approaches on environmental outcomes. Studies of approaches that utilized advocacy to create change, targeted decision-makers as the audience for the youth's work and convened for a longer duration were more likely to report improved environmental outcomes. This systematic review suggests that youth inquiry approaches are a promising strategy for ecological systems change.

"Be creative and you will reach more people": youth's experiences participating in an arts-based social action group aimed at mental health stigma reduction

Background: Starting in 2013, the Mental Health Youth Action Board, made up of 15 teens ages 15-18, was created to advise a large children's hospital on improvements in mental health care and produce social action projects to impact community perceptions of mental health.Methods: This participatory qualitative case study explored the experiences of 14 young people who participated in the Mental Health Youth Action Board between 2013 and 2016.Results: There were two higher order themes: process and outcomes. Process-related themes included how this was a unique leadership experience, the importance of the arts-based approach, and value of the intentionally constructed storytelling process. These processes led to youth growing as advocates for mental health.Conclusions: Arts-based approaches to social action that allow youth to share personal experiences of stigmatized topics can promote healing and support their growth as leaders.

A Systematic Review of Youth Participatory Action Research (YPAR) in the United States: Methodologies, Youth Outcomes, and Future Directions

OBJECTIVES

To use a systematic review methodology to describe the state of the youth participatory action research (YPAR) literature and synthesize findings about the youth outcomes reported in these studies.

METHODS

We screened and coded studies using a process consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Of the 3,724 articles found in the database search, 67 reports of 63 distinct studies were included in the final sample. These reports were coded for reports of YPAR principles and project characteristics, study methods, and reported youth outcomes.

RESULTS

The YPAR literature comprises predominantly qualitative studies, with only two randomized trials. The most common outcomes associated with participation in YPAR were those related to agency and leadership (75.0%), followed by academic or career (55.8%), social (36.5%), interpersonal (34.6%), and cognitive (23.1%) outcomes.

CONCLUSIONS

This systematic review provides emerging evidence of the skills and competencies youth may develop through YPAR and offers methodological recommendations for future research that can provide greater evidence of causality.

Hepatitis and HIV in Northern Ireland prisons: a cross-sectional study

A study was undertaken in Northern Ireland (NI) prisons to (i) determine prevalence of bloodborne viruses among inmates, (ii) estimate the extent of self-reported risk behaviours. All three prisons in NI were included in the study. Outcome measures included (i) antibodies to hepatitis C (HCV), hepatitis B (HBV) core antigen, HIV, (ii) self-reported risk behaviour. Five prisoners (0.75%) tested positive for HBV, seven (1.1%) for HCV and none for HIV. Eleven per cent reported ever having injected drugs. Of these, 20% had started injecting while in prison, and 12% shared injecting equipment in prison. Two per cent had completed HBV immunisation. Injecting drugs was associated with HCV (adjusted prevalence ratio=5.2; 95% CI 0.9-16) and HBV infection (adjusted prevalence ratio=4.1; 95% CI 0.7-23). The low prevalence of bloodborne viruses within NI prisons is not consistent with findings of studies in other countries, possibly reflecting the unique sociopolitical situation in NI. In spite of knowledge of the risks of transmission of bloodborne viruses in prison, high-risk practices are occurring. Preventing risk behaviours and transmission of infection in prisons now poses a challenge for health services in the United Kingdom.

“You Just Give them what they Want and Pray they don't Kill You”

Using both qualitative (in-depth, personal interviews) and quantitative (self-report survey indices) techniques, data were collected from 43 women involved in streetwalking prostitution. The purpose of the investigation was to examine exposure to violence and victimization among a particularly vulnerable female population across the life span. A secondary goal was to apply stress theory as an organizing framework for examining personal resources (e.g., social support, locus of control) and coping behavior. Results from both data collection strategies are presented, and implications for intervention are described.

Growth and hormone profiling in children with congenital melanocytic naevi

Background

Multiple congenital melanocytic naevi (CMN) is a rare mosaic RASopathy, caused by postzygotic activating mutations in NRAS. Growth and hormonal disturbances are described in germline RASopathies, but growth and hormone status have not previously been investigated in individuals with CMN.

Objectives

To explore premature thelarche, undescended testes, and a clinically abnormal fat distribution with CMN through prospective endocrinological assessment of a cohort of subjects with CMN, and a retrospective review of longitudinal growth of a larger group of patients with CMN from outpatient clinics (which included all subjects in the endocrinological assessment group).

Patients and methods

Longitudinal growth in a cohort of 202 patients with single or multiple CMN was compared with the U.K. National Child Measurement Programme 2010. Forty‐seven children had hormonal profiling including measurement of circulating luteinizing hormone, follicle‐stimulating hormone, thyroid stimulating hormone, adrenocorticotrophic hormone, growth hormone, prolactin, pro‐opiomelanocortin, estradiol, testosterone, cortisol, thyroxine, insulin‐like growth factor‐1 and leptin; 10 had oral glucose tolerance testing 25 had dual‐energy X‐ray absorptiometry scans for body composition.

Results

Body mass index increased markedly with age (coefficient 0·119, SE 0·016 standard deviation scores per year), at twice the rate of the U.K. population, due to increased adiposity. Three per cent of girls had premature thelarche variant and 6% of boys had persistent undescended testes. Both fat and muscle mass were reduced in areas underlying large naevi, resulting in limb asymmetry and abnormal truncal fat distribution. Anterior pituitary hormone profiling revealed subtle and variable abnormalities. Oral glucose tolerance tests revealed moderate–severe insulin insensitivity in five of 10, and impaired glucose tolerance in one.

Conclusions

Interpersonal variation may reflect the mosaic nature of this disease and patients should be considered individually. Postnatal weight gain is potentially related to the underlying genetic defect; however, environmental reasons cannot be excluded. Naevus‐related reduction of fat and muscle mass suggests local hormonal or metabolic effects on development or growth of adjacent tissues, or mosaic involvement of these tissues at the genetic level. Premature thelarche and undescended testes should be looked for, and investigated, as for any child.

What's already known about this topic?

CMN are caused by postzygotic mutations in the gene NRAS in the majority of cases, classifying it within the group of mosaic RASopathies.

Other germline and mosaic RASopathies are known to have growth and hormonal abnormalities.

No studies have been done on growth or endocrinology in children with CMN.

What does this study add?

Average body mass index increases markedly with age compared with the normal population; this is due to increased adiposity, and can be associated with insulin insensitivity.

Premature thelarche variant and persistent undescended testes are not infrequent findings, but puberty appears to develop normally.

Both fat and muscle mass can be reduced in areas underlying large naevi, resulting in asymmetry.

Linked Comment:Millington, Br J Dermatol 2015; 173: 1366–67.

Conditional Deletion of NF-κB-Inducing Kinase (NIK) in Adult Mice Disrupts Mature B Cell Survival and Activation

NF-κB-inducing kinase (NIK) is a primary regulator of the noncanonical NF-κB signaling pathway, which plays a vital role downstream of BAFF, CD40L, lymphotoxin, and other inflammatory mediators. Germline deletion or inactivation of NIK in mice results in the defective development of B cells and secondary lymphoid organs, but the role of NIK in adult animals has not been studied. To address this, we generated mice containing a conditional allele of NIK. Deletion of NIK in adult mice results in decreases in B cell populations in lymph nodes and spleen, similar to what is observed upon blockade of BAFF. Consistent with this, B cells from mice in which NIK is acutely deleted fail to respond to BAFF stimulation in vitro and in vivo. In addition, mice with induced NIK deletion exhibit a significant decrease in germinal center B cells and serum IgA, which is indicative of roles for NIK in additional pathways beyond BAFF signaling. Our conditional NIK-knockout mice may be broadly useful for assessing the postdevelopmental and cell-specific roles of NIK and the noncanonical NF-κB pathway in mice.

A quality improvement project to decrease emergency department and medical intensive care unit transfer times

OBJECTIVE

To reduce transfer time of critically ill patients from the emergency department (ED) to the medical intensive care unit (MICU).

DESIGN

A prospective, observational study assessing preimplementation and postimplementation of quality improvement interventions in a tertiary academic medical center.

INTERVENTIONS

A team of frontline health care professional including ED, MICU, and supporting services using the clinical microsystems approach mapped out existing practice patterns, determined causes for delays, and used the Plan-Do-Study-Act to test changes. Measurements and Main Results The team identified multiple issues that contributed to delays. These included poor coordination between transport services, respiratory therapy, and nursing in transferring patients from the ED as well delays in identification and transfer of stable MICU patients. These interventions reduced transfer time from 4.2 (3.4-5.7) hours to 2.2 (1.4-3.1) hours (median [interquartile range]; P<.001). Hospital length of stay decreased from 9.9±9 to 8.3±7 days (P<.03).

CONCLUSION

A team made up of frontline health care professionals using a structured quality improvement process and implementing multifaceted, multistage interventions, reduced transfer delays, and length of stay. Added benefits included engagement among members of the 2 microsystems and a more cohesive approach to patient care.

Regulation of alternative VEGF-A mRNA splicing is a therapeutic target for analgesia

Vascular endothelial growth factor-A (VEGF-A) is best known as a key regulator of the formation of new blood vessels. Neutralization of VEGF-A with anti-VEGF therapy e.g. bevacizumab, can be painful, and this is hypothesized to result from a loss of VEGF-A-mediated neuroprotection. The multiple vegf-a gene products consist of two alternatively spliced families, typified by VEGF-A₁₆₅a and VEGF-A₁₆₅b (both contain 165 amino acids), both of which are neuroprotective. Under pathological conditions, such as in inflammation and cancer, the pro-angiogenic VEGF-A₁₆₅a is upregulated and predominates over the VEGF-A₁₆₅b isoform.

We show here that in rats and mice VEGF-A₁₆₅a and VEGF-A₁₆₅b have opposing effects on pain, and that blocking the proximal splicing event – leading to the preferential expression of VEGF-A₁₆₅b over VEGF₁₆₅a – prevents pain in vivo. VEGF-A₁₆₅a sensitizes peripheral nociceptive neurons through actions on VEGFR2 and a TRPV1-dependent mechanism, thus enhancing nociceptive signaling. VEGF-A₁₆₅b blocks the effect of VEGF-A₁₆₅a.

After nerve injury, the endogenous balance of VEGF-A isoforms switches to greater expression of VEGF-A_xxxa compared to VEGF-A_xxxb, through an SRPK1-dependent pre-mRNA splicing mechanism. Pharmacological inhibition of SRPK1 after traumatic nerve injury selectively reduced VEGF-A_xxxa expression and reversed associated neuropathic pain. Exogenous VEGF-A₁₆₅b also ameliorated neuropathic pain.

We conclude that the relative levels of alternatively spliced VEGF-A isoforms are critical for pain modulation under both normal conditions and in sensory neuropathy. Altering VEGF-A_xxxa/VEGF-A_xxxb balance by targeting alternative RNA splicing may be a new analgesic strategy.

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The different vegf-a splice variants, VEGF-A₁₆₅a and VEGF-A₁₆₅b have pro- and anti-nociceptive actions respectively.

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Pro-nociceptive actions of VEGF-A₁₆₅a are dependent on TRPV1.

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Alternative pre-mRNA splicing underpins peripheral sensitization by VEGF-A isoforms in normal and neuropathic animals.

A weighted and directed interareal connectivity matrix for macaque cerebral cortex

Retrograde tracer injections in 29 of the 91 areas of the macaque cerebral cortex revealed 1,615 interareal pathways, a third of which have not previously been reported. A weight index (extrinsic fraction of labeled neurons [FLNe]) was determined for each area-to-area pathway. Newly found projections were weaker on average compared with the known projections; nevertheless, the 2 sets of pathways had extensively overlapping weight distributions. Repeat injections across individuals revealed modest FLNe variability given the range of FLNe values (standard deviation <1 log unit, range 5 log units). The connectivity profile for each area conformed to a lognormal distribution, where a majority of projections are moderate or weak in strength. In the G_{29 × 29} interareal subgraph, two-thirds of the connections that can exist do exist. Analysis of the smallest set of areas that collects links from all 91 nodes of the G_{29 × 91} subgraph (dominating set analysis) confirms the dense (66%) structure of the cortical matrix. The G_{29 × 29} subgraph suggests an unexpectedly high incidence of unidirectional links. The directed and weighted G_{29 × 91} connectivity matrix for the macaque will be valuable for comparison with connectivity analyses in other species, including humans. It will also inform future modeling studies that explore the regularities of cortical networks.

Aspirin in the aetiology of Crohn's disease and ulcerative colitis: a European prospective cohort study

BACKGROUND

Aspirin has detrimental effects on the gastrointestinal tract mucosa and may play a role in the aetiology of inflammatory bowel disease.

AIM

To investigate if the regular use of aspirin is associated with the development of Crohn's disease (CD) and ulcerative colitis (UC) using, for the first time, a prospective cohort study design.

METHODS

A total of 135,780 men and women in Europe, aged 30-74years, were recruited into the European Prospective Investigation into Cancer and Nutrition study. Participants completed questionnaires at baseline detailing their regular aspirin use and were then followed up to identify those who developed either incident CD or UC. Each case was matched with four controls and odds ratios (OR) were calculated, adjusting for cigarette smoking. Potential interactions between aspirin and smoking were assessed.

RESULTS

A total of 35 participants developed CD and a further 84 were diagnosed with UC. Regular aspirin intake was positively associated with the risk of developing CD (OR=6.14, 95% CI=1.76-21.35). In those who took aspirin and smoked there was no detectable increased risk of CD (OR=0.30, 95% CI=0.03-3.08). No association was found between regular aspirin use and UC (OR=1.29, 95% CI=0.67-2.46).

CONCLUSIONS

A strong positive association between regular aspirin use and CD, but not UC, was observed. The data suggest that regular aspirin use should be measured in epidemiological work on CD. If such findings are consistent in other work then aspirin may affect the development of CD in a middle-aged to elderly population.

Long-term clinical outcome of oestrogen receptor-positive operable primary breast cancer in older women: a large series from a single centre

INTRODUCTION

A Cochrane review of seven randomised trials (N=1571) comparing surgery and primary endocrine therapy (PET) (oestrogen receptor (ER) unselected) shows no difference in overall survival (OS). We report outcome of a large series with ER-positive (ER+) early invasive primary breast cancer.

METHODS

Between 1973 and 2009, 1065 older (≥ 70 years) women (median age 78 years (70-99)) had either surgery (N=449) or PET (N=616) as initial treatment.

RESULTS

At 49-month median follow-up (longest 230 months), the 5-year breast cancer-specific survival (BCSS) and OS were 90 and 62%, respectively. Majority (74.2%) died from causes other than breast cancer. The rates (per annum) of local/regional recurrence (<1%) (following surgery), contralateral tumour (<1%) and metastases (<3%) were low. For patients on PET, 97.9% achieved clinical benefit (CB) at 6 months, with median time to progression of 49 months (longest 132 months) and significantly longer BCSS when compared with those who progressed (P<0.001). All patients with strongly ER+ (H-score >250) tumours achieved CB and had better BCSS (P<0.01). Patients with tumours having an H-score >250 were found to have equivalent BCSS regardless of treatment (surgery or PET; P=0.175), whereas for those with H-score ≤ 250, surgery produced better outcome (P<0.001).

CONCLUSION

Older women with ER+ breast cancer appear to have excellent long-term outcome regardless of initial treatment. Majority also die from non-breast cancer causes. Although surgery remains the treatment of choice, patients with ER-rich (H-score >250) tumours tend to do equally well when treated by PET. This should be taken into account when therapies are considered.