Third-party virus-specific T cells for the treatment of double-stranded DNA viral reactivation and posttransplant lymphoproliferative disease after solid organ transplant

Reactivation or primary infection with double-stranded DNA viruses is common in recipients of solid organ transplants (SOTs) and is associated with significant morbidity and mortality. Treatment with conventional antiviral medications is limited by toxicities, resistance, and a lack of effective options for adenovirus (ADV) and BK polyomavirus (BKPyV). Virus-specific T cells (VSTs) have been shown to be an effective treatment for infections with ADV, BKPyV, cytomegalovirus (CMV), and Epstein-Barr virus (EBV). Most of these studies have been conducted in stem cell recipients, and no large studies have been published in the SOT population to date. In this study, we report on the outcome of quadrivalent third-party VST infusions in 98 recipients of SOTs in the context of an open-label phase 2 trial. The 98 patients received a total of 181 infusions, with a median of 2 infusions per patient. The overall response rate was 45% for BKPyV, 65% for cytomegalovirus, 68% for ADV, and 61% for Epstein-Barr virus. Twenty percent of patients with posttransplant lymphoproliferative disorder had a complete response and 40% of patients had a partial response. All the VST infusions were well tolerated. We conclude that VSTs are safe and effective in the treatment of viral infections in SOT recipients.

Genomic Insights for Personalized Care: Motivating At-Risk Individuals Toward Evidence-Based Health Practices

Lung cancer and tobacco use pose significant global health challenges and require a comprehensive translational roadmap for improved prevention strategies. We propose the GREAT care paradigm ( G enomic Informed Care for Motivating High R isk Individuals E ligible for Evidence-b a sed Prevention), which employs polygenic risk scores (PRSs) to stratify disease risk and personalize interventions, such as lung cancer screening and tobacco treatment. We developed PRSs using large-scale multi-ancestry genome-wide association studies and adjusted for genetic ancestry for standardized risk stratification across diverse populations. We applied our PRSs to over 340,000 individuals of diverse ethnic background and found significant odds ratios for lung cancer and difficulty quitting smoking. These findings enable the evaluation of PRS-based interventions in ongoing trials aimed at motivating health behavior changes in high-risk patients. This pioneering approach enhances primary care with genomic insights, promising improved outcomes in cancer prevention and tobacco treatment, and is currently under assessment in clinical trials.

Circulating Tumor Reactive KIR+CD8+ T cells Suppress Anti-Tumor Immunity in Patients with Melanoma

Effective anti-tumor immunity is largely driven by cytotoxic CD8+ T cells that can specifically recognize tumor antigens. However, the factors which ultimately dictate successful tumor rejection remain poorly understood. Here we identify a subpopulation of CD8+ T cells which are tumor antigen-specific in patients with melanoma but resemble KIR+CD8+ T cells with a regulatory function (Tregs). These tumor antigen-specific KIR+CD8+ T cells are detectable in both the tumor and the blood, and higher levels of this population are associated with worse overall survival. Our findings therefore suggest that KIR+CD8+ Tregs are tumor antigen-specific but uniquely suppress anti-tumor immunity in patients with melanoma.

THE USE OF CLASSIFIERS IN VIETNAMESE IN TYPICAL AND ATYPICAL LANGUAGE DEVELOPMENT

The acquisition of numeral classifiers and their associated syntactic structures has been documented and studied in a broad range of East and Southeast Asian languages among typically-developing (TD) young speakers. However, little research has considered how classifiers are acquired by children with developmental language disorder (DLD). The current paper compares and analyzes the development of numeral classifier patterns among a set of Vietnamese speakers, TD and DLD, studied over three years, from kindergarten to second grade. The investigation highlights differences in the performance of children with TD and DLD and describes the areas of classifier use that seem to be most challenging. Children with DLD produced more errors of classifier omission in kindergarten, showed more random alternations in representational forms, and delays in the development of three element classifier structures. Findings are discussed in terms of future directions in the study of classifier use in Vietnamese speakers with DLD.

Kruppel-like factor 2+ CD4 T cells avert microbiota-induced intestinal inflammation

Intestinal colonization by antigenically foreign microbes necessitates expanded peripheral immune tolerance. Here we show commensal microbiota prime expansion of CD4 T cells unified by the Kruppel-like factor 2 (KLF2) transcriptional regulator and an essential role for KLF2+ CD4 cells in averting microbiota-driven intestinal inflammation. CD4 cells with commensal specificity in secondary lymphoid organs and intestinal tissues are enriched for KLF2 expression, and distinct from FOXP3+ regulatory T cells or other differentiation lineages. Mice with conditional KLF2 deficiency in T cells develop spontaneous rectal prolapse and intestinal inflammation, phenotypes overturned by eliminating microbiota or reconstituting with donor KLF2+ cells. Activated KLF2+ cells selectively produce IL-10, and eliminating IL-10 overrides their suppressive function in vitro and protection against intestinal inflammation in vivo. Together with reduced KLF2+ CD4 cell accumulation in Crohn's disease, a necessity for the KLF2+ subpopulation of T regulatory type 1 (Tr1) cells in sustaining commensal tolerance is demonstrated.

Reproductive outcomes after pregnancy-induced displacement of preexisting microchimeric cells

Pregnancy confers partner-specific protection against complications in future pregnancy that parallel persistence of fetal microchimeric cells (FMcs) in mothers after parturition. We show that preexisting FMcs become displaced by new FMcs during pregnancy and that FMc tonic stimulation is essential for expansion of protective fetal-specific forkhead box P3 (FOXP3)-positive regulatory T cells (Treg cells). Maternal microchimeric cells and accumulation of Treg cells with noninherited maternal antigen (NIMA) specificity are similarly overturned in daughters after pregnancy, highlighting a fixed microchimeric cell niche. Whereas NIMA-specific tolerance is functionally erased by pregnancy, partner-specific resiliency against pregnancy complications persists in mothers despite paternity changes in intervening pregnancy. Persistent fetal tolerance reflects FOXP3 expression plasticity, which allows mothers to more durably remember their babies, whereas daughters forget their mothers with new pregnancy-imprinted immunological memories.

Vietnamese children with and without DLD: Classifier use and grammaticality over time

INTRODUCTION

One way to identify Developmental Language Disorder (DLD) is to establish clinical markers in a language to serve as reliable indicators of the disorder. This study embarks on the search for clinical markers for Vietnamese using longitudinal data from children with and without DLD.

METHODS

We matched ten children previously classified with DLD to ten with typical development (TD) by age and gender. Participants completed a story generation task at three time points: kindergarten, first, and second grade. Overall grammatical development was measured using mean length of utterance, MLU, and proportion of grammatical utterances, PGU. We examined a language-specific feature, classifiers, in terms of accuracy (omission errors), diversity (number of different classifiers), and productivity, or the use of classifiers in constructions of two-to-three elements (classifier+noun, numeral+classifier+noun). Longitudinal change and group differences were examined using linear mixed modeling, supplemented by linguistic analysis.

RESULTS

Both groups increased in MLU and PGU over time. The DLD group performed lower in kindergarten and continued to show lower performance over time on these measures. Classifier omission errors decreased over time with no group differences. Classifier diversity increased across groups, with lower performance by the DLD group in kindergarten and over time. For classifier productivity, TD children used classifiers in multiple constructions in kindergarten and maintained the same level over time. In contrast, children with DLD had minimal use of three-element constructions in kindergarten but increased in productivity over time.

CONCLUSIONS

Children with DLD produce shorter utterances with relatively more grammatical errors compared to their TD peers in the early school years. Though no longer committing classifier omission errors, children with DLD showed more restricted use of classifiers in terms of the number of different classifiers and constructions produced. Findings inform the search for Vietnamese clinical markers of DLD.

Understanding (un)grammaticality in context: Evidence from young Spanish-English bilinguals over time

PURPOSE

Percent grammatical utterances (PGU) provides clinicians and researchers with meaningful information on young children's grammatical abilities (Eisenberg & Guo, 2016). However, work is still needed to place PGU within the context of conventional language sample measures and understand how PGU reflects grammatical development in bilingual populations. The current study focuses on Spanish-English bilingual preschoolers to examine: 1) change in Spanish and English PGU over one year of preschool English instruction, 2) associations between PGU and other language sample measures within each language and across time, and 3) the types and frequency of error patterns in each language.

METHOD

Play-based language samples were elicited in English and Spanish from bilingual children (n = 19) at the beginning and end of an instructional preschool year in English. PGU was derived from each sample along with other language sample measures (e.g., mean length of utterance). We examined change in PGU from Time 1 to Time 2, and correlations between Time 1 PGU and Time 2 PGU for each language. Specific grammatical errors were described in terms of their frequency in each language and stability across time.

RESULTS

Average English PGU increased from Time 1 to Time 2, and correlated with other language sample measures. Conversely, average Spanish PGU did not increase from Time 1 to Time 2, nor did PGU correlate with any other Spanish measure. Error patterns in each language reflected grammatical differences across English and Spanish.

CONCLUSIONS

Our results revealed distinct developmental patterns in bilingual children's first and second languages. Associations between time points and measures in English contrasted with disassociations in Spanish. Error patterns revealed more detailed information as to how bilingual children begin to acquire grammatical structures in each of their languages. We provide a case example to illustrate how grammaticality and error patterns can be used to characterize children's language abilities. We conclude with clinical implications of grammaticality in Spanish-English bilingual children.

Assessment of formal tobacco treatment and smoking cessation in dual users of cigarettes and e-cigarettes

BACKGROUND

The utility of electronic cigarettes ('e-cigarettes') as a smoking cessation adjunct remains unclear. Similarly, it is unclear if formal tobacco treatment (pharmacotherapy and/or behavioural support) augments smoking cessation in individuals who use both cigarettes and e-cigarettes.

METHODS

We performed a longitudinal cohort study of adult outpatients evaluated in our tertiary care medical centre (6/2018-6/2020). E-cigarette use, smoking status and formal tobacco treatment (deterrent pharmacotherapy and/or behavioural support) were assessed in 6-month blocks (eg, cohort 1 (C1)=6/2018-12/2018, C2=1/2019-6/2019 and so on) using our electronic health record. We assessed the relationship between e-cigarette use (either with or without formal tobacco treatment) and point prevalence of smoking cessation at 6 and 12 months.

RESULTS

111 823 unique patients were included in the study. The prevalence of dual use of cigarettes and e-cigarettes increased significantly over the study period (C1=0.8%; C2=1.1%; C3=1.8%; C4=2.3%; p<0.001). The prevalence of smoking cessation at 12 months was higher among e-cigarette users (20.8%) compared with non-users (16.8%) (risk difference, 4.0% (95% CI 2.5% to 5.5%); adjusted relative risk (aRR) 1.354, 95% CI 1.252 to 1.464, p<0.0001). Further, among dual users of cigarettes and e-cigarettes, the prevalence of smoking cessation at 12 months was higher among individuals who received tobacco treatment (29.1%) compared with individuals who did not receive tobacco treatment (19.6%) (risk difference, 9.5% (95% CI, 4.6% to 14.4%); aRR 1.238, 95% CI 1.071 to 1.432, p=0.004).

INTERPRETATION

These results suggest that dual users of cigarettes and e-cigarettes benefit from formal tobacco treatment. Clinicians should consider offering formal tobacco treatment to such patients, though future trials are needed.

Ran-GTP/-GDP-dependent nuclear accumulation of NONEXPRESSOR OF PATHOGENESIS-RELATED GENES1 and TGACG-BINDING FACTOR2 controls salicylic acid-induced leaf senescence

Leaf senescence is the final stage of leaf development and can be triggered by various external factors, such as hormones and light deprivation. In this study, we demonstrate that the overexpression of the GTP-bound form of Arabidopsis (Arabidopsis thaliana) Ran1 (a Ras-related nuclear small G-protein, AtRan1) efficiently promotes age-dependent and dark-triggered leaf senescence, while Ran-GDP has the opposite effect. Transcriptome analysis comparing AtRan1-GDP- and AtRan1-GTP-overexpressing transgenic plants (Ran1T27Nox and Ran1G22Vox, respectively) revealed that differentially expressed genes (DEGs) related to the senescence-promoting hormones salicylic acid (SA), jasmonic acid, abscisic acid, and ethylene (ET) were significantly upregulated in dark-triggered senescing leaves of Ran1G22Vox, indicating that these hormones are actively involved in Ran-GTP/-GDP-dependent, dark-triggered leaf senescence. Bioinformatic analysis of the promoter regions of DEGs identified diverse consensus motifs, including the bZIP motif, a common binding site for TGACG-BINDING FACTOR (TGA) transcription factors. Interestingly, TGA2 and its interactor, NONEXPRESSOR OF PATHOGENESIS-RELATED GENES1 (NPR1), which are two positive transcriptional regulators of SA signaling, differed in their extent of accumulation in the nucleus versus cytoplasm of Ran1T27Nox and Ran1G22Vox plants. Moreover, SA-induced, Ran-GTP-/-GDP-dependent functions of NPR1 included genome-wide global transcriptional reprogramming of genes involved in cell death, aging, and chloroplast organization. Furthermore, the expression of AtRan1-GTP in SA signaling-defective npr1 and SA biosynthesis-deficient SA-induction deficient2 genetic backgrounds abolished the effects of AtRan1-GTP, thus retarding age-promoted leaf senescence. However, ET-induced leaf senescence was not mediated by Ran machinery-dependent nuclear shuttling of ETHYLENE-INSENSITIVE3 and ETHYLENE-INSENSITIVE3-LIKE1 proteins. We conclude that Ran-GTP/-GDP-dependent nuclear accumulation of NPR1 and TGA2 represents another regulatory node for SA-induced leaf senescence.

Maternal-fetal conflict averted by progesterone- induced FOXP3+ regulatory T cells

Pregnancy stimulates an intricately coordinated assortment of physiological changes to accommodate growth of the developing fetus, while simultaneously averting rejection of genetically foreign fetal cells and tissues. Despite increasing evidence that expansion of immune-suppressive maternal regulatory T cells enforces fetal tolerance and protects against pregnancy complications, the pregnancy-associated signals driving this essential adaptation remain poorly understood. Here we show that the female reproductive hormone, progesterone, coordinates immune tolerance by stimulating expansion of FOXP3+ regulatory T cells. Conditional loss of the canonical nuclear progesterone receptor in maternal FOXP3+ regulatory T cells blunts their proliferation and accumulation, which is associated with fetal wastage and decidual infiltration of activated CD8+ T cells. Reciprocally, the synthetic progestin 17α-hydroxyprogesterone caproate (17-OHPC) administered to pregnant mice reinforces fetal tolerance and protects against fetal wastage. These immune modulatory effects of progesterone that promote fetal tolerance establish a molecular link between immunological and other physiological adaptions during pregnancy.

Pregnancy enables antibody protection against intracellular infection

Adaptive immune components are thought to exert non-overlapping roles in antimicrobial host defence, with antibodies targeting pathogens in the extracellular environment and T cells eliminating infection inside cells1,2. Reliance on antibodies for vertically transferred immunity from mothers to babies may explain neonatal susceptibility to intracellular infections3,4. Here we show that pregnancy-induced post-translational antibody modification enables protection against the prototypical intracellular pathogen Listeria monocytogenes. Infection susceptibility was reversed in neonatal mice born to preconceptually primed mothers possessing L. monocytogenes-specific IgG or after passive transfer of antibodies from primed pregnant, but not virgin, mice. Although maternal B cells were essential for producing IgGs that mediate vertically transferred protection, they were dispensable for antibody acquisition of protective function, which instead required sialic acid acetyl esterase5 to deacetylate terminal sialic acid residues on IgG variable-region N-linked glycans. Deacetylated L. monocytogenes-specific IgG protected neonates through the sialic acid receptor CD226,7, which suppressed IL-10 production by B cells leading to antibody-mediated protection. Consideration of the maternal-fetal dyad as a joined immunological unit reveals protective roles for antibodies against intracellular infection and fine-tuned adaptations to enhance host defence during pregnancy and early life.

Point of care tobacco treatment sustains during COVID-19, a global pandemic

BACKGROUND

Tobacco cessation treatment for cancer patients is essential to providing comprehensive oncologic care. We have implemented a point of care tobacco treatment care model enabled by electronic health record (EHR) modifications in a comprehensive cancer center. Data are needed on the sustainability of both reach of treatment and effectiveness over time, including the COVID-19 pandemic.

METHODS

Using EHR data from the pre-implementation (P: 5 months) and post-implementation periods (6 month-blocks, T1-T5 for a total of 30 months), we compared two primary outcomes: 1) reach of treatment among those smoking and 2) effectiveness assessed by smoking cessation among those smoking in the subsequent 6 month period. We analyzed the data using generalized estimation equation regression models.

RESULTS

With the point of care tobacco treatment care model, reach of treatment increased from pre to post T5 (3.2 % vs. 48.4 %, RR 15.50, 95 % CI 10.56-22.74, p < 0.0001). Reach of treatment in all post periods (T1-T5 including the COVID-19 pandemic time) remained significantly higher than the pre period. Effectiveness, defined by smoking cessation among those smoking, increased from pre to post T2 before the pandemic (12.4 % vs. 21.4 %, RR 1.57, 95 % CI 1.31-1.87, p < 0.0001). However, effectiveness, while higher in later post periods (T3, T4), was no longer significantly increased compared with the pre period.

CONCLUSION

A point of care EHR-enabled tobacco treatment care model demonstrates sustained reach up to 30 months following implementation, even during the COVID-19 pandemic and changes in healthcare prioritization. Effectiveness was sustained for 12 months, but did not sustain through the subsequent 12 months.

Scheduled administration of virus-specific T cells for viral prophylaxis after pediatric allogeneic stem cell transplant

Infections with double-stranded DNA viruses are a significant cause of morbidity and mortality in pediatric patients following allogeneic hematopoietic stem cell transplantation (HSCT). Virus-specific T-cell therapies (VSTs) have been shown to be an effective treatment for infections with adenovirus, BK virus, cytomegalovirus (CMV), and Epstein-Barr virus (EBV). To date, prophylactic regimens to prevent or mitigate these infections using conventional antiviral medications provide suboptimal response rates. Here we report on a clinical trial (NCT03883906) performed to assess the feasibility of rapid manufacturing and early infusion of quadrivalent VSTs generated from stem cell donors ("donor-derived VSTs") into allogeneic HSCT recipients with minimal or absent viremia. Patients were eligible to receive scheduled VSTs as early as 21 days after stem cell infusion. Twenty-three patients received scheduled VSTs. Twenty of 23 patients had no viremia at the time of infusion, while 3 patients had very low-level BK viremia. Two developed clinically significant graft-versus-host disease (GVHD), although this incidence was not outside of expected incidence early after HSCT, and both were successfully treated with systemic corticosteroids (n = 2). Five patients were deemed treatment failures. Three developed subsequent significant viremia/viral disease (n = 3). Eighteen patients did not fail treatment, 7 of whom did not develop any viremia, while 11 developed low-level, self-limited viremia that resolved without further intervention. No infusion reactions occurred. In conclusion, scheduled VSTs appear to be safe and potentially effective at limiting serious complications from viral infections after allogeneic transplantation. A randomized study comparing this scheduled approach to the use of VSTs to treat active viremia is ongoing.

Increased Reach and Effectiveness With a Low-Burden Point-of-Care Tobacco Treatment Program in Cancer Clinics

BACKGROUND

Tobacco cessation after a cancer diagnosis can extend patient survival by improving outcomes for primary cancer and preventing secondary cancers. However, smoking is often unaddressed in cancer care, highlighting the need for strategies to increase treatment reach and cessation. This study examined a low-burden, point-of-care tobacco treatment program (ELEVATE) featuring an electronic health record-enabled smoking module and decision support tools to increase the reach and effectiveness of evidence-based smoking cessation treatment.

METHODS

This study included adult outpatient tobacco smokers (n=13,651) in medical oncology, internal medicine, and surgical oncology clinics from a large midwestern healthcare system. We examined reach and effectiveness of ELEVATE with 2 comparisons: (1) preimplementation versus postimplementation of ELEVATE and (2) ELEVATE versus usual care. Data were evaluated during 2 time periods: preimplementation (January through May 2018) and postimplementation (June through December 2018), with smoking cessation assessed at the last follow-up outpatient encounter during the 6 months after these periods.

RESULTS

The proportion of current tobacco smokers receiving cessation treatment increased from pre-ELEVATE to post-ELEVATE (1.6%-27.9%; difference, 26.3%; relative risk, 16.9 [95% CI, 9.8-29.2]; P<.001). Compared with 27.9% treatment reach with ELEVATE in the postimplementation time period, reach within usual care clinics ranged from 11.8% to 12.0% during this same period. The proportion of tobacco smokers who subsequently achieved cessation increased significantly from pre-ELEVATE to post-ELEVATE (12.0% vs 17.2%; difference, 5.2%; relative risk, 1.3 [95% CI, 1.1-1.5]; P=.002). Compared with 17.2% smoking cessation with ELEVATE in the postimplementation time period, achievement of cessation within usual care clinics ranged from 8.2% to 9.9% during this same period.

CONCLUSIONS

A low-burden, point-of-care tobacco treatment strategy increased tobacco treatment and cessation, thereby improving access to and the impact of evidence-based cessation treatment. Using implementation strategies to embed tobacco treatment in every healthcare encounter promises to engage more smokers in evidence-based treatment and facilitate smoking cessation, thereby improving care cancer for patients who smoke.

From a Distance: Comparison of In-Person and Virtual Assessments With Adult-Child Dyads From Linguistically Diverse Backgrounds

PURPOSE

Our proof-of-concept study tested the feasibility of virtual testing using child assessments that were originally validated for in-person testing only.

METHOD

Ten adult-child dyads were assigned to complete both in-person and virtual tests of language, cognition, and narratives. Child participants fell between the ages of 4 and 8 years; adult participants were speech-language clinicians or researchers with experience in administering child assessments. Half of child participants were Spanish-English bilinguals, and half were monolingual English speakers.

RESULTS

Results showed similar performance across in-person and virtual modalities on all assessments. Recommendations for adapting, administering, and scoring virtual measures with linguistically diverse children are discussed.

CONCLUSIONS

Although additional research on virtual assessment is needed, our results open opportunities for appropriate remote assessment, particularly for bilingual children, who may not have in-person access to speech-language pathology services.

Quantifying rural disparity in healthcare utilization in the United States: Analysis of a large midwestern healthcare system

PURPOSE

The objective of this study is to identify how predisposing characteristics, enabling factors, and health needs are jointly and individually associated with epidemiological patterns of outpatient healthcare utilization for patients who already interact and engage with a large healthcare system.

METHODS

We retrospectively analyzed electronic medical record data from 1,423,166 outpatient clinic visits from 474,674 patients in a large healthcare system from June 2018-March 2019. We evaluated patients who exclusively visited rural clinics versus patients who exclusively visited urban clinics using Chi-square tests and the generalized estimating equation Poisson regression methodology. The outcome was healthcare use defined by the number of outpatient visits to clinics within the healthcare system and independent variables included age, gender, race, ethnicity, smoking status, health status, and rural or urban clinic location. Supplementary analyses were conducted observing healthcare use patterns within rural and urban clinics separately and within primary care and specialty clinics separately.

FINDINGS

Patients in rural clinics vs. urban clinics had worse health status [χ2 = 935.1, df = 3, p<0.0001]. Additionally, patients in rural clinics had lower healthcare utilization than patients in urban clinics, adjusting for age, race, ethnicity, gender, smoking, and health status [2.49 vs. 3.18 visits, RR = 0.61, 95%CI = (0.55,0.68), p<0.0001]. Further, patients in rural clinics had lower utilization for both primary care and specialty care visits.

CONCLUSIONS

Within the large healthcare system, patients in rural clinics had lower outpatient healthcare utilization compared to their urban counterparts despite having potentially elevated health needs reflected by a higher number of unique health diagnoses documented in their electronic health records after adjusting for multiple factors. This work can inform future studies exploring the roots and ramifications of rural-urban healthcare utilization differences and rural healthcare disparities.

The Promise of Polygenic Risk Prediction in Smoking Cessation: Evidence From Two Treatment Trials

INTRODUCTION

Tobacco use disorder is a complex behavior with a strong genetic component. Genome-wide association studies (GWAS) on smoking behaviors allow for the creation of polygenic risk scores (PRSs) to approximate genetic vulnerability. However, the utility of smoking-related PRSs in predicting smoking cessation in clinical trials remains unknown.

AIMS AND METHODS

We evaluated the association between polygenic risk scores and bioverified smoking abstinence in a meta-analysis of two randomized, placebo-controlled smoking cessation trials. PRSs of smoking behaviors were created using the GWAS and Sequencing Consortium of Alcohol and Nicotine use (GSCAN) consortium summary statistics. We evaluated the utility of using individual PRS of specific smoking behavior versus a combined genetic risk that combines PRS of all four smoking behaviors. Study participants came from the Transdisciplinary Tobacco Use Research Centers (TTURCs) Study (1091 smokers of European descent), and the Genetically Informed Smoking Cessation Trial (GISC) Study (501 smokers of European descent).

RESULTS

PRS of later age of smoking initiation (OR [95% CI]: 1.20, [1.04-1.37], p = .0097) was significantly associated with bioverified smoking abstinence at end of treatment. In addition, the combined PRS of smoking behaviors also significantly predicted bioverified smoking abstinence (OR [95% CI] 0.71 [0.51-0.99], p = .045).

CONCLUSIONS

PRS of later age at smoking initiation may be useful in predicting smoking cessation at the end of treatment. A combined PRS may be a useful predictor for smoking abstinence by capturing the genetic propensity for multiple smoking behaviors.

IMPLICATIONS

There is a potential for polygenic risk scores to inform future clinical medicine, and a great need for evidence on whether these scores predict clinically meaningful outcomes. Our meta-analysis provides early evidence for potential utility of using polygenic risk scores to predict smoking cessation amongst smokers undergoing quit attempts, informing further work to optimize the use of polygenic risk scores in clinical care.

Systematic reconstruction of an effector-gene network reveals determinants of Salmonella cellular and tissue tropism

The minimal genetic requirements for microbes to survive within multiorganism communities, including host-pathogen interactions, remain poorly understood. Here, we combined targeted gene mutagenesis with phenotype-guided genetic reassembly to identify a cooperative network of SPI-2 T3SS effector genes that are sufficient for Salmonella Typhimurium (STm) to cause disease in a natural host organism. Five SPI-2 effector genes support pathogen survival within the host cell cytoplasm by coordinating bacterial replication with Salmonella-containing vacuole (SCV) division. Unexpectedly, this minimal genetic repertoire does not support STm systemic infection of mice. In vivo screening revealed a second effector-gene network, encoded by the spv operon, that expands the life cycle of STm from growth in cells to deep-tissue colonization in a murine model of typhoid fever. Comparison between Salmonella infection models suggests how cooperation between effector genes drives tissue tropism in a pathogen group.

CD8+ T Cell Functional Exhaustion Overrides Pregnancy-Induced Fetal Antigen Alloimmunization

Pregnancy necessitates physiological exposure, and often re-exposure, to foreign fetal alloantigens. The consequences after pregnancy are highly varied, with evidence of both alloimmunization and expanded tolerance phenotypes. We show that pregnancy primes the accumulation of fetal-specific maternal CD8⁺ T cells and their persistence as an activated memory pool after parturition. Cytolysis and the potential for robust secondary expansion occurs with antigen re-encounter in non-reproductive contexts. Comparatively, CDS⁺ T cell functional exhaustion associated with increased PD-1 and LAG-3 expression occurs with fetal antigen re-stimulation during subsequent pregnancy. PD-L1/LAG-3 neutralization unleashes the activation of fetal-specific CD8⁺ T cells, causing fetal wastage selectively during secondary but not primary pregnancy. Thus, CD8⁺ T cells with fetal alloantigen specificity persist in mothers after pregnancy, and protection against fetal wastage in subsequent pregnancies is maintained by their unique susceptibility to functional exhaustion. Together, distinct mechanisms whereby fetal tolerance is maintained during primary compared with subsequent pregnancies are demonstrated.

Expecting mothers are immunologically aware of, but do not reject, genetically foreign tissues of the developing fetus. Comparing tolerance occuring during first and subsequent pregnancies, Kinder et al. show that activated memory CD8⁺ T cells primed by prior pregnancy are uniquely prone to functional exhaustion with fetal antigen re-stimulation.

International, Transdisciplinary, and Ecohealth Action for Sustainable Agriculture in Asia

Sustainably intensifying agriculture to secure food for people, while minimizing the human, animal, and environmental health impacts is an unprecedented global food security challenge. Action research is needed to understand and mitigate impacts, with Ecosystem approaches to health (Ecohealth) emerging as a promising framework to support such efforts. Yet, few have critically examined the application of Ecohealth principles in an agricultural context, particularly in Southeast Asia where agricultural intensification is rapidly expanding. In this paper, we evaluate the strengths, challenges, and opportunities of agriculture-related Ecohealth projects in low-resource settings of Vietnam, Thailand, Indonesia, and China, drawing on a case study of the Field Building Leadership Initiative (FBLI). To do this, we used a developmental evaluation framework involving several iterative cycles of document reviews, interviews, focus groups, and outcome harvesting with researchers, partners, and community members involved in FBLI. Results highlight the importance of transdisciplinarity, participation, and knowledge-to-action principles in co-generating knowledge and co-developing practical solutions. Implementing such principles presents challenges in terms of coordinating regional collaborations, managing high workloads, meaningfully engaging communities, and ensuring ongoing monitoring and evaluation. To address these challenges, there is a need to strengthen capacity in integrated approaches to health, improve institutionalization of Ecohealth, foster community engagement, and systematically monitor and evaluate efforts. Ecohealth holds significant promise in improving food security, but only when considerable time is spent developing and implementing projects with communities.

In situ mapping identifies distinct vascular niches for myelopoiesis

In contrast to nearly all other tissues, the anatomy of cell differentiation in the bone marrow remains unknown. This is owing to a lack of strategies for examining myelopoiesis-the differentiation of myeloid progenitors into a large variety of innate immune cells-in situ in the bone marrow. Such strategies are required to understand differentiation and lineage-commitment decisions, and to define how spatial organizing cues inform tissue function. Here we develop approaches for imaging myelopoiesis in mice, and generate atlases showing the differentiation of granulocytes, monocytes and dendritic cells. The generation of granulocytes and dendritic cells-monocytes localizes to different blood-vessel structures known as sinusoids, and displays lineage-specific spatial and clonal architectures. Acute systemic infection with Listeria monocytogenes induces lineage-specific progenitor clusters to undergo increased self-renewal of progenitors, but the different lineages remain spatially separated. Monocyte-dendritic cell progenitors (MDPs) map with nonclassical monocytes and conventional dendritic cells; these localize to a subset of blood vessels expressing a major regulator of myelopoiesis, colony-stimulating factor 1 (CSF1, also known as M-CSF)¹. Specific deletion of Csf1 in endothelium disrupts the architecture around MDPs and their localization to sinusoids. Subsequently, there are fewer MDPs and their ability to differentiate is reduced, leading to a loss of nonclassical monocytes and dendritic cells during both homeostasis and infection. These data indicate that local cues produced by distinct blood vessels are responsible for the spatial organization of definitive blood cell differentiation.

Beginning to Read in Vietnamese: Kindergarten Precursors to First Grade Fluency and Reading Comprehension

Measures of decoding and oral language have been shown to predict early reading comprehension across a wide variety of languages, though the timeframe and strength of the predictions vary by orthographic depth. This study is the first to examine predictors of early reading in Vietnamese, a transparent orthography of Romanized letters and diacritics. Eighty-two children in Hanoi, Vietnam, completed measures of decoding and oral language in kindergarten (phonological awareness, PA; rapid automatized naming, RAN; receptive and expressive vocabulary) and measures of decoding and reading comprehension in first grade. Average performance at the end of first grade, after just one year of formal instruction, was near ceiling on word reading but more variable on nonword and text reading. Kindergarten PA and RAN (but not vocabulary) predicted first-grade decoding after controlling for maternal education and kindergarten decoding, and PA was a stronger predictor than RAN (10% vs 4% of unique variance). The best predictors of first grade reading comprehension were first-grade decoding (47% of unique variance) and kindergarten expressive vocabulary (4% of unique variance) after controlling for maternal education. Overall, Vietnamese children became accurate and efficient decoders after one year of instruction. Findings from RAN and PA suggest their utility in guiding differentiated instruction on decoding. Kindergarten vocabulary, which differed as a function of maternal education, significantly predicted first-grade comprehension.

46. Tacrolimus Increases Susceptibility to Secondary Infection in a Mouse Model

Background

Transplant acceptance requires life-long pharmacological intervention that broadly suppresses recipients’ immunity in order to prevent rejection of foreign graft. In turn, non-specific immune-suppression in these patients is also associated with increased risk of infection from opportunistic pathogens. Currently our knowledge on the effects immune suppressive therapies on adaptive immune components response in patients is limited

Methods

To investigate this we established a mouse model of post-transplant immune suppression therapy, using tacrolimus. To dissect the effects of tacrolimus on infection susceptibility, tacrolimus-treated mice were infected with a virulent strain of recombinant Listeria monocytogenes (Lm) expressing model antigens. Infection with this transgenic strain of Lm transforms these model antigens into surrogate Lm antigens and allows tracking of pathogen-specific T-cells using MHC tetramer staining.

Results

Here we show, tacrolimus treatment triggered increased susceptibility to secondary, but not primary Lm infection with increased bacterial burden in the liver and spleen tissues. Increased susceptibility during secondary infection paralleled dampened functional activation of Lm-specific CD8+ T cells as indicated by diminished in vivo cytolytic activity. Interestingly, when tacrolimus treatment was initiated only during primary or during secondary infection susceptibility to infection was overturned as both groups of mice had lower bacterial burden in target tissues. This suggests that while tacrolimus treatment does not negatively impact primary immune response, it may dampen the formation of CD8+ T cell memory.

Conclusion

Further studies will investigate the long-term durability of blunted pathogen-specific memory and CTL activity triggered by tacrolimus treatment after cessation of therapy. These findings will allow more defined prediction of patient risk of infection allowing for a personalized prophylaxis regimen.

Disclosures

All Authors: No reported disclosures

Grammatical Characteristics of Vietnamese and English in Developing Bilingual Children

Purpose Defining parameters for typical development in bilingual children's first and second languages can serve as the basis for accurate language assessment. This is the first study to characterize Vietnamese and English grammatical development in a sample of bilingual children. Method Participants were 89 Vietnamese-English bilingual children, aged 3-8 years. Children completed story retell tasks in Vietnamese and English. Stories were transcribed and analyzed for grammaticality, error patterns, subordination index, and types of subordinating clauses. Of key interest were associations with age and identifying developmental patterns that were shared across languages or unique to a given language. Results Age correlated with more measures in English than in Vietnamese, suggesting that older children had higher grammaticality and greater syntactic complexity in English than younger children. Children also produced greater syntactic complexity with age in Vietnamese, but not higher grammaticality. There were a set of error patterns shared across languages (e.g., object omission) and patterns specific to each language (e.g., classifier errors in Vietnamese, tense errors in English). While children produced nominal, adverbial, and relative clauses in Vietnamese and English, the proportion of each clause type differed by language. Conclusions Results from this typically developing sample provide a reference point to improve clinical practice. Characterizing developmental patterns in sentence structure in Vietnamese and English lays the groundwork for investigations of language disorders in this bilingual population.

Persistent Zika Virus Clinical Susceptibility despite Reduced Viral Burden in Mice with Expanded Virus-Specific CD8+ T Cells Primed by Recombinant Listeria monocytogenes

Vaccines against Zika virus (ZIKV) infection that target CD8⁺ T cells are of considerable interest because Abs may enhance infection susceptibility. However, whether CD8⁺ T cells are protective or promote susceptibility to clinical infection symptoms remains uncertain. To more precisely investigate ZIKV-specific CD8⁺ T cells in isolation, we engineered a Listeria monocytogenes-based vector to express a single MHC class I-restricted immune dominant peptide, E294-302, from ZIKV envelope protein. We show accumulation of activated ZIKV-specific CD8⁺ T cells primed by recombinant L. monocytogenes is associated with reductions in circulating virus levels after ZIKV challenge in type I IFN receptor-deficient mice and wildtype mice administered neutralizing Abs against type I IFN receptor. Interestingly, susceptibility to ZIKV clinical infection including weight loss and mortality each persists and is neither significantly improved nor worsened compared with isogenic L. monocytogenes-primed control mice. These data demonstrating persistent ZIKV clinical susceptibility despite reduced viral burden in mice with expanded virus-specific CD8⁺ T cells highlights the need for targeting other adaptive immune components in developing vaccines against ZIKV infection.

Diagnostic Accuracy of Sentence Repetition and Nonword Repetition for Developmental Language Disorder in Vietnamese

Purpose Sentence repetition and nonword repetition assess different aspects of the linguistic system, but both have been proposed as potential tools to identify children with developmental language disorder (DLD). Cross-linguistic investigation of diagnostic tools for DLD contributes to an understanding of the core features of the disorder. This study evaluated the effectiveness of these tools for the Vietnamese language. Method A total of 104 kindergartners (aged 5;2-6;2 [years;months]) living in Vietnam participated, of which 94 were classified as typically developing and 10 with DLD. Vietnamese sentence repetition and nonword repetition tasks were administered and scored using multiple scoring systems. Sensitivity, specificity, and likelihood ratios were calculated to assess the ability of these tasks to identify DLD. Results All scoring systems on both tasks achieved adequate to excellent sensitivity or specificity, but not both. Binary scoring of sentence repetition achieved a perfect negative likelihood ratio, and binary scoring of nonword repetition approached a highly informative positive likelihood ratio. More detailed scoring systems for both tasks achieved moderately informative values for both negative and positive likelihood ratios. Conclusions Both sentence repetition and nonword repetition are valuable tools for identifying DLD in monolingual speakers of Vietnamese. Scoring systems that consider number of errors and are relatively simple (i.e., error scoring of sentence repetition and syllables scoring of nonword repetition) may be the most efficient and effective for identifying DLD. Further work to develop and refine these tasks can contribute to cross-linguistic knowledge of DLD as well as to clinical practice.

IL-17-producing γδ T cells protect against Clostridium difficile infection

Colitis caused by Clostridium difficile infection is a growing cause of human morbidity and mortality, especially after antibiotic use in health care settings. The natural immunity of newborn infants and protective host immune mediators against C. difficile infection are not fully understood, with data suggesting that inflammation can be either protective or pathogenic. Here, we show an essential role for IL-17A produced by γδ T cells in host defense against C. difficile infection. Fecal extracts from children with C. difficile infection showed increased IL-17A and T cell receptor γ chain expression, and IL-17 production by intestinal γδ T cells was efficiently induced after infection in mice. C. difficile-induced tissue inflammation and mortality were markedly increased in mice deficient in IL-17A or γδ T cells. Neonatal mice, with naturally expanded RORγt+ γδ T cells poised for IL-17 production were resistant to C. difficile infection, whereas elimination of γδ T cells or IL-17A each efficiently overturned neonatal resistance against infection. These results reveal an expanded role for IL-17-producing γδ T cells in neonatal host defense against infection and provide a mechanistic explanation for the clinically observed resistance of infants to C. difficile colitis.

Low Burden Strategies Are Needed to Reduce Smoking in Rural Healthcare Settings: A Lesson from Cancer Clinics

Rural populations face significant smoking-related health disparities, such as a higher prevalence of lung cancer and cancer mortality, higher prevalence of smoking, and lower likelihood of receiving cessation treatment than urban counterparts. A significant proportion of health disparities in rural populations could be eliminated with low-barrier, easy-access treatment delivery methods for smoking cessation. In this study, we assessed treatment engagement among patients in rural and urban settings. Then, we examined the effect of an electronic health record-based smoking cessation module on patient receipt of evidence-based cessation care. As part of a quality improvement project, we retrospectively observed 479,798 unique patients accounting for 1,426,089 outpatient clinical encounters from June 2018-March 2019 across 766 clinics in the greater St. Louis, southern Illinois, and mid-Missouri regions. Smoking prevalence was higher in rural versus urban clinics (20.7% vs. 13.9%, 6.7% [6.3, 7.1], odds ratio = 1.6 [1.6, 1.6], p < 0.0001), and yet rural smokers were nearly three times less likely than their urban counterparts to receive any smoking cessation treatment after adjusting for patients clustering within clinics (9.6% vs. 25.8%, -16.2% [-16.9, -15.5], odds ratio = 0.304 [0.28, 0.33], p < 0.0001). Although not yet scaled up in the rural setting, we examined the effects of a low-burden, point-of-care smoking module currently implemented in cancer clinics. After adjusting for patient clustering within clinics, patients were more likely to receive smoking treatment in clinics that implemented the module versus clinics that did not implement the module (31.2% vs. 17.5%, 13.7% [10.8, 16.6], odds ratio = 2.1 [1.8, 2.6], p < 0.0001). The point-of-care treatment approach offers a promising solution for rural settings, both in and outside the context of cancer care.

ATBS1-INTERACTING FACTOR 2 negatively regulates dark- and brassinosteroid-induced leaf senescence through interactions with INDUCER OF CBF EXPRESSION 1

ATBS1-INTERACTING FACTOR 2 (AIF2) is a non-DNA-binding basic helix-loop-helix (bHLH) transcription factor. We demonstrated that AIF2 retards dark-triggered and brassinosteroid (BR)-induced leaf senescence in Arabidopsis thaliana. Dark-triggered BR synthesis and the subsequent activation of BRASSINAZOLE RESISTANT 1 (BZR1), a BR signaling positive regulator, result in BZR1 binding to the AIF2 promoter in a dark-dependent manner, reducing AIF2 transcript levels and accelerating senescence. BR-induced down-regulation of AIF2 protein stability partly contributes to the progression of dark-induced leaf senescence. Furthermore, AIF2 interacts with INDUCER OF CBF EXPRESSION 1 (ICE1) via their C-termini. Formation of the AIF2-ICE1 complex and subsequent up-regulation of C-REPEAT BINDING FACTORs (CBFs) negatively regulates dark-triggered, BR-induced leaf senescence. This involves antagonistic down-regulation of PHYTOCHROME INTERACTING FACTOR 4 (PIF4), modulated through AIF2-dependent inhibition of ICE1's binding to the promoter. PIF4-dependent activities respond to dark-induced early senescence and may promote BR synthesis and BZR1 activation to suppress AIF2 and accelerate dark-induced senescence. Taken together, these findings suggest a coordination of AIF2 and ICE1 functions in maintaining stay-green traits.

Commensal Candida albicans Positively Calibrates Systemic Th17 Immunological Responses

Mucosal barriers are densely colonized by pathobiont microbes such as Candida albicans, capable of invasive disseminated infection. However, systemic infections occur infrequently in healthy individuals, suggesting that pathobiont commensalism may elicit host benefits. We show that intestinal colonization with C. albicans drives systemic expansion of fungal-specific Th17 CD4⁺ T cells and IL-17 responsiveness by circulating neutrophils, which synergistically protect against C. albicans invasive infection. Protection conferred by commensal C. albicans requires persistent fungal colonization and extends to other extracellular invasive pathogens such as Staphylococcus aureus. However, commensal C. albicans does not protect against intracellular influenza virus infection and exacerbates allergic airway inflammation susceptibility, indicating that positively calibrating systemic Th17 responses is not uniformly beneficial. Thus, systemic Th17 inflammation driven by CD4⁺ T cells responsive to tonic stimulation by commensal C. albicans improves host defense against extracellular pathogens, but with potentially harmful immunological consequences.

Including Nonlinguistic Processing Tasks in the Identification of Developmental Language Disorder

Purpose Accurate identification of developmental language disorder (DLD) remains challenging, particularly for children who speak different dialects, languages, or more than 1 language. Children with DLD, on average, have shown subtle deficits on nonlinguistic cognitive processing tasks, and performance on such tasks may be minimally influenced by language experience. This study explores whether nonlinguistic cognitive processing tasks can contribute to the identification of DLD in children from diverse linguistic backgrounds. Method Study 1 combined data from 4 U.S.-based investigations to yield a sample of 395 children, ages 6-10 years, who spoke only English or both Spanish and English. Study 2 consisted of an international sample of 55 kindergarten children living in Vietnam. Each study included children with DLD and children with typical development. Participants completed nonlinguistic cognitive tasks of processing speed, auditory working memory, and attentional control. Data analysis compared typically developing to DLD groups by age and language background. Then, we empirically derived cut-points to report diagnostic accuracy (sensitivity, specificity, and positive and negative likelihood ratios). Results For all 3 tasks, adequate sensitivity or specificity (but not both in most cases) was achieved in nearly all age groups. Likelihood ratios reached moderately to very informative levels in several instances. Diagnostic results were maintained when monolingual and bilingual samples were combined into a single group. Conclusions Nonlinguistic cognitive processing tasks may contribute to accurate identification of DLD in combination with other measures. Further research is needed to refine tasks, confirm cut-points established here, and extend findings to children from additional language backgrounds.

Internal and External Factors That Support Children's Minority First Language and English

Purpose

Sequential bilingual children in the United States often speak 2 languages that have different social statuses (minority-majority) and separate contexts for learning (home-school). Thus, distinct factors may support the development of each language. This study examined which child internal and external factors were related to vocabulary skills in a minority language versus English.

Method

Participants included 69 children, aged 5-8 years, who lived in Southern California, spoke Vietnamese as the home language, and received school instruction in English. All participants had at least 1 foreign-born parent, and most mothers reported limited English proficiency. Parents completed a telephone survey, and children completed measures of receptive and expressive vocabulary in each language. Using correlations and stepwise regression, we examined predictors of vocabulary skills in each language that were internal to the child (age, gender, analytical reasoning, phonological memory) or that pertained to the surrounding environment (cumulative exposure, quantity and quality of input/output).

Results

Vietnamese vocabulary outcomes were related to multiple external factors, of which input and enrichment activities were the best predictors. In contrast, English vocabulary outcomes were related to internal factors, of which age and phonological memory were the best predictors. Parental use of Vietnamese contributed to children's Vietnamese vocabulary outcomes but was not related to children's English vocabulary outcomes.

Conclusions

Vietnamese exposure does not hinder English development. Children from immigrant families are learning English with or without familial support. Rich and frequent exposure and opportunities for practice are essential for the continued development of a minority first language.

Learning Words and Definitions in Two Languages: What Promotes Cross-Language Transfer?

This study used a brief vocabulary training paradigm to examine two factors for cross-language transfer: how similar the first language (L1) is to the second language (L2) and L1-L2 proficiency levels. Fifty-four sequential bilingual children (aged 6-8) with similar L2 English proficiency levels were assigned to three equal groups: a Vietnamese-English group with low L1 proficiency, a Spanish-English group with low L1 proficiency, and a Spanish-English group with high L1 proficiency. Individual training consisted of two mediated learning experiences conducted in the L1 targeting eight vocabulary items using narrative-based activities. Four of eight target words were cognates between Spanish and English. Pre- and posttesting measured definition quality in the L1 and L2. All groups showed improvement in the L1 following training, but only the Spanish-English group with high L1 proficiency improved in L2 English, revealing a degree of spontaneous cross-language transfer among children with high L1-L2 proficiency.

Commensal Fungi Recapitulate the Protective Benefits of Intestinal Bacteria

Commensal intestinal microbes are collectively beneficial in preventing local tissue injury and augmenting systemic antimicrobial immunity. However, given the near-exclusive focus on bacterial species in establishing these protective benefits, the contributions of other types of commensal microbes remain poorly defined. Here, we show that commensal fungi can functionally replace intestinal bacteria by conferring protection against injury to mucosal tissues and positively calibrating the responsiveness of circulating immune cells. Susceptibility to colitis and influenza A virus infection occurring upon commensal bacteria eradication is efficiently overturned by mono-colonization with either Candida albicans or Saccharomyces cerevisiae. The protective benefits of commensal fungi are mediated by mannans, a highly conserved component of fungal cell walls, since intestinal stimulation with this moiety alone overrides disease susceptibility in mice depleted of commensal bacteria. Thus, commensal enteric fungi safeguard local and systemic immunity by providing tonic microbial stimulation that can functionally replace intestinal bacteria.

Preconceptual Zika virus asymptomatic infection protects against secondary prenatal infection

Pregnant women, and their fetal offspring, are uniquely susceptible to Zika virus and other microbial pathogens capable of congenital fetal infection. Unavoidable exposure to Zika virus in endemic areas underscores the need for identifying at-risk individuals, and protecting expecting mothers and their fetal offspring against prenatal infection. Here we show that primary Zika virus asymptomatic infection in mice confers protection against re-infection, and that these protective benefits are maintained during pregnancy. Zika virus recovery was sharply reduced in maternal tissues and amongst fetal concepti after prenatal challenge in mothers with resolved subclinical infection prior to pregnancy compared with mice undergoing primary prenatal infection. These benefits coincide with expanded accumulation of viral-specific antibodies in maternal serum and fetal tissues that protect against infection by the identical or heterologous Zika virus genotype strains. Thus, preconceptual infection primes Zika virus-specific antibodies that confer cross-genotype protection against re-infection during pregnancy.

Emerging health risks from agricultural intensification in Southeast Asia: a systematic review

Background Agricultural intensification is having profound impacts on food security and rural livelihoods; however, concerns remain about the potential implications on public health. Objectives We aim to examine and synthesize the evidence for human health risks of agricultural intensification in Southeast Asia. Methods We conducted a systematic review of peer-reviewed articles published between January 2000 and December 2015 from two electronic databases (PubMed, CAB Direct). Results A total of 73 relevant studies were included and evaluated. More than half of the studies used epidemiological methods while others applied alternative methods to quantify or estimate risks. Studies mainly focused on occupational and consumer exposure to pesticides, without often specifying the actual health risk. Conclusion Overall, the current knowledge on health risks appears to be limited. More research on long-term health implications and a wider range of contaminants are needed if sustainable benefits are to be obtained from agricultural intensification.

Synthesizing Information From Language Samples and Standardized Tests in School-Age Bilingual Assessment

Purpose

Although language samples and standardized tests are regularly used in assessment, few studies provide clinical guidance on how to synthesize information from these testing tools. This study extends previous work on the relations between tests and language samples to a new population-school-age bilingual speakers with primary language impairment-and considers the clinical implications for bilingual assessment.

Method

Fifty-one bilingual children with primary language impairment completed narrative language samples and standardized language tests in English and Spanish. Children were separated into younger (ages 5;6 [years;months]-8;11) and older (ages 9;0-11;2) groups. Analysis included correlations with age and partial correlations between language sample measures and test scores in each language.

Results

Within the younger group, positive correlations with large effect sizes indicated convergence between test scores and microstructural language sample measures in both Spanish and English. There were minimal correlations in the older group for either language. Age related to English but not Spanish measures.

Conclusions

Tests and language samples complement each other in assessment. Wordless picture-book narratives may be more appropriate for ages 5-8 than for older children. We discuss clinical implications, including a case example of a bilingual child with primary language impairment, to illustrate how to synthesize information from these tools in assessment.

Ex vivo antigen-pulsed PBMCs generate potent and long lasting immunity to infection when administered as a vaccine

Numerous studies have demonstrated that administration of antigen (Ag)-pulsed dendritic cells (DCs) is an effective strategy for enhancing immunity to tumors and infectious disease organisms. However, the generation and/or isolation of DCs can require substantial time and expense. Therefore, using inactivated F. tularensis (iFt) Ag as a model immunogen, we first sought to determine if DCs could be replaced with peripheral blood mononuclear cells (PBMCs) during the ex-vivo pulse phase and still provide protection against Ft infection. Follow up studies were then conducted using the S. pneumoniae (Sp) vaccine Prevnar ®13 as the Ag in the pulse phase followed by immunization and Sp challenge. In both cases, we demonstrate that PBMCs can be used in place of DCs when pulsing with iFt and/or Prevnar ®13 ex vivo and re-administering the Ag-pulsed PBMCs as a vaccine. In addition, utilization of the i.n. route for Ag-pulsed PBMC administration is superior to use of the i.v. route in the case of Sp immunization, as well as when compared to direct injection of Prevnar ®13 vaccine i.m. or i.n. Furthermore, this PBMC-based vaccine strategy provides a more marked and enduring protective immune response and is also capable of serving as a multi-organism vaccine platform. The potential for this ex-vivo vaccine strategy to provide a simpler, less time consuming, and less expensive approach to DC-based vaccines and vaccination in general is also discussed.

Differential Cultivation of Francisella tularensis Induces Changes in the Immune Response to and Protective Efficacy of Whole Cell-Based Inactivated Vaccines

Francisella tularensis (Ft) is a category A biothreat agent for which there is no Food and Drug Administration-approved vaccine. Ft can survive in a variety of habitats with a remarkable ability to adapt to changing environmental conditions. Furthermore, Ft expresses distinct sets of antigens (Ags) when inside of macrophages (its in vivo host) as compared to those grown in vitro with Mueller Hinton Broth (MHB). However, in contrast to MHB-grown Ft, Ft grown in Brain-Heart Infusion (BHI) more closely mimics the antigenic profile of macrophage-grown Ft. Thus, we anticipated that when used as a vaccine, BHI-grown Ft would provide better protection compared to MHB-grown Ft, primarily due to its greater antigenic similarity to Ft circulating inside the host (macrophages) during natural infection. Our investigation, however, revealed that inactivated Ft (iFt) grown in MHB (iFt-MHB) exhibited superior protective activity when used as a vaccine, as compared to iFt grown in BHI (iFt-BHI). The superior protection afforded by iFt-MHB compared to that of iFt-BHI was associated with significantly lower bacterial burden and inflammation in the lungs and spleens of vaccinated mice. Moreover, iFt-MHB also induced increased levels of Ft-specific IgG. Further evaluation of early immunological cues also revealed that iFt-MHB exhibits increased engagement of Ag-presenting cells including increased iFt binding to dendritic cells, increased expression of costimulatory markers, and increased secretion of pro-inflammatory cytokines. Importantly, these studies directly demonstrate that Ft growth conditions strongly impact Ft vaccine efficacy and that the growth medium used to produce whole cell vaccines to Ft must be a key consideration in the development of a tularemia vaccine.

Pathways for learning two languages: lexical and grammatical associations within and across languages in sequential bilingual children

This study examines the strength and direction of lexical-grammatical associations within and between first and second languages (L1 and L2) in a longitudinal sample of sequential bilinguals. Thirty-three children who spoke Vietnamese (L1) and English (L2) completed picture-naming and story-telling tasks in each language at four yearly intervals. Hierarchical linear modeling across Years 1-4 revealed bidirectional within-language associations and a unidirectional cross-language association from the L1 to L2. Results suggest a conditional relationship between languages in which the L1 supports L2 growth, but not vice versa. Findings contribute to defining pathways for L1 and L2 learning across domains and languages.

Modulation of Protective Efficacy of Fracisella tularensis Immunogens by Differential Cultivation in Mueler Hinton Broth Versus Brain Heart Infusion Medium

Francisella tularensis (Ft) can survive in a variety of habitats with a remarkable ability to adapt to changing environmental conditions. For example, Ft expresses a distinct set of antigens (Ags) in the macrophage, which are not expressed in Ft grown in vitro with Mueler Hinton Broth (MHB) medium. In contrast, Ft grown in Brain Heart Infusion (BHI) medium exhibits an antigenic profile more closely resembling that of in vivo growth conditions. In addition, studies also suggest an alteration in immunological properties of Ft when grown in BHI versus MHB medium. Thus, we investigated the protective efficacy of BHI and MHB-grown Ft, when inactivated and used as an immunogen to protect against Ft LVS challenge. Inactivated Ft (iFt) generated in MHB (iFt-MHB) was found to have superior protective efficacy as compared to that of the iFt generated in BHI (iFt-BHI). The enhanced protection generated by iFt- MHB-immunized mice was also associated with lower bacterial burden and sepsis-like conditions in the lungs and spleens of iFt-MHB versus iFt-BHI-immunized mice. Further evaluation of early immunological events revealed, in the case of iFt-MHB immunogen, superior Ag binding to Ag-presenting dendritic cells (DCs), increased MHC class II expression by DCs, and enhanced Ag presentation by DCs, as apposed to the use of iFt-BHI. Also, iFt-MHB induced increased levels of Ft-specific IgG as well as IFNg and IL17 production versus that of iFt-BHI. These studies thus demonstrate the critical importance of considering bacterial growth medium in Ft vaccine development.

A longitudinal analysis of sentence interpretation in bilingual children

This longitudinal study used sentence interpretation tasks to consider growth in language processing among school-aged children learning Vietnamese and English. Thirty-two children participated yearly over three time points. Children were asked to identify the agent of sentences that manipulated linguistic cues relevant to Vietnamese (animacy) and English (word order). Hierarchical linear modeling was used to examine change in cue use over time as well as the relation between cue use and proficiency in each language. Findings include exclusive reliance on word order by the end point, nearly identical group-level cue-use patterns across languages with individual variation, and positive relationships between language proficiency and cue use. Findings are discussed within the unified competition model (MacWhinney, 2004) and the literature on sequential bilingualism.

Brassinazole resistant 1 (BZR1)-dependent brassinosteroid signalling pathway leads to ectopic activation of quiescent cell division and suppresses columella stem cell differentiation

Previous publications have shown that BRI1 EMS suppressor 1 (BES1), a positive regulator of the brassinosteroid (BR) signalling pathway, enhances cell divisions in the quiescent centre (QC) and stimulates columella stem cell differentiation. Here, it is demonstrated that BZR1, a BES1 homologue, also promotes cell divisions in the QC, but it suppresses columella stem cell differentiation, opposite to the action of BES1. In addition, BR and its BZR1-mediated signalling pathway are shown to alter the expression/subcellular distribution of pin-formed (PINs), which may result in changes in auxin movement. BR promotes intense nuclear accumulation of BZR1 in the root tip area, and the binding of BZR1 to the promoters of several root development-regulating genes, modulating their expression in the root stem cell niche area. These BZR1-mediated signalling cascades may account for both the ectopic activation of QC cell divisions as well as the suppression of the columella stem cell differentiation. They could also inhibit auxin-dependent distal stem cell differentiation by antagonizing the auxin/WOX5-dependent pathway. In conclusion, BZR1-/BES1-mediated BR signalling pathways show differential effects on the maintenance of root apical meristem activities: they stimulate ectopic QC division while they show opposite effects on the differentiation of distal columella stem cells in a BR concentration- and BZR1-/BES1-dependent manner.

Bilingual children with primary language impairment: 3 months after treatment

BACKGROUND

Evidence on the treatment effectiveness for bilingual children with primary language impairment (PLI) is needed to advance both theory and clinical practice. Of key interest is whether treatment effects are maintained following the completion of short-term intense treatments.

AIMS

To investigate change in select language and cognitive skills in Spanish-English bilingual children with PLI 3 months after children have completed one of three experimental treatment conditions. There are two main study aims. First, to determine if skills in Spanish, English and cognitive processing decline, improve or are maintained after treatment has been completed. Second, to determine if differential rates of change are a function of the type of treatment children received.

METHODS & PROCEDURES

Participants were 48 children, aged 5:6-11:3, who spoke Spanish and English and were diagnosed with moderate to severe PLI. Participants received 6 weeks of treatment focused on English only (EO), bilingual skills in Spanish and English (BI) or nonlinguistic cognitive processing (NCP). Treatment effects reported in a previous study were determined by comparing pre- and post-treatment performance on a variety of language and cognitive measures. Here we re-administered each measure 3 months after completion of the experimental treatments. Hierarchical linear models were calculated for each measure using pre-, post- and follow-up testing scores to estimate change trajectories and compare outcomes between treatment conditions.

OUTCOMES & RESULTS

Participants in all three treatment conditions either maintained skills or showed improvement even after treatment was discontinued for 3 months. Main findings included (1) comparable, positive rates of change on all English language outcomes for EO and BI conditions; (2) maintenance of Spanish language skills, and (3) modest improvements in NCP following the discontinuation of treatment.

CONCLUSIONS & IMPLICATIONS

This study is the first to examine longer-term treatment effects for bilingual school-age children with PLI. Differences in rates of change between languages and between treatment conditions are discussed in terms of social and cognitive processes that impact children's language systems. The main findings have at least two implications for clinical practice: (1) therapy that emphasizes focused practice in language and cognitive processing skills may promote gains in children's language learning abilities; and (2) bilingual treatment does not detract from outcomes in English, the language of the majority community for study participants.

Lexical profiles of bilingual children with primary language impairment

This study used lexical tasks to examine associations between languages, tasks, and age in bilingual children with primary language impairment. Participants (n = 41, mean age 8;8 years) lived in the United States, spoke primarily Spanish (L1) at home and English (L2) at school, and were identified with moderate to severe impairments in both languages. A total of eight tasks (four in each language) measured breadth of vocabulary knowledge (receptive and expressive vocabulary) and aspects of lexical processing (rapid automatic naming and nonword repetition). Correlational analyses revealed older children outperformed younger children on lexical tasks in L2 but not L1, as well as relative L2 dominance for most individuals and tasks. Positive associations were found between languages on processing-based tasks but not vocabulary measures. Findings were consistent with literature on typical bilingual learners, albeit with a notable increased risk of plateau in L1 growth. Results are interpreted within a Dynamic Systems framework.

A novel elastin gene mutation in a Vietnamese patient with cutis laxa

We report a 3-year-old girl from Vietnam with severe congenital cutis laxa; no cardiovascular, pulmonary, neurologic, or visceral involvement; and no family history of cutis laxa. Mutational analysis of the elastin gene identified heterozygosity for a previously unreported de novo c.2184delT mutation in exon 30 not present in either parent.

FcγRIIB limits protection against F. tularensis LVS challenge induced by inactivated F. tularensis (VAC7P.964)

We have previously demonstrated that intranasal (i.n.) immunization with inactivated Francisella tularensis (Ft) live vaccine strain (LVS) targeted to Fcγ receptors (FcγR) can induce partial protection against a lethal mucosal challenge with Ft SchuS4. This protection is antibody (Ab) and interferon gamma (IFNγ) dependent. FcγRIIB is the only inhibitory Fc receptor (FcR) in the FcγR family, and has been reported to regulate IgG production, which plays a significant role in protection against Ft LVS and Ft SchuS4 challenge. Thus, we sought to determine the impact of FcγRIIB on immune protection against Ft infection. We utilized inactivated Ft (iFt) as an immunogen. Naïve or iFt-immunized FcγRIIB knockout (KO) versus wildtype (WT) C57BL/6 mice were challenged with varying doses of Ft LVS. We observed no significant difference in survival between naïve KO versus WT mice or in basal levels of Ft-specific IgG or IgM. However, KO mice immunized with iFt showed significantly increased survival as compared to iFt-immunized WT mice. Furthermore, Ft-specific IgG and IgA production were elevated in the serum from iFt-immunized KO versus WT mice. IFNγ levels were also enhanced in iFt-immunized KO versus WT mice. In summary, our studies demonstrate that FcγRIIB influences the level of protection against Ft challenge generated by iFt immunization by limiting the production of Ft-specific Ab and IFNγ, which have been shown to play significant roles in protection against Ft infection.

Three treatments for bilingual children with primary language impairment: examining cross-linguistic and cross-domain effects

PURPOSE

This study examines the absolute and relative effects of 3 different treatment programs for school-age bilingual children with primary or specific language impairment (PLI). It serves to expand the evidence base on which service providers can base treatment decisions. It also explores hypothesized relations between languages and cognition in bilinguals with PLI.

METHOD

Fifty-nine school-age Spanish–English bilingual children with PLI were assigned to receive nonlinguistic cognitive processing, English, bilingual (Spanish–English), or deferred treatment. Participants in each of the 3 active treatments received treatment administered by nationally certified speech-language pathologists. Pre- and posttreatment assessments measured change in nonlinguistic cognitive processing, English, and Spanish skills, and analyses examined change within and across both treatment groups and skill domains.

RESULTS

All active treatment groups made significant pre- to post-treatment improvement on multiple outcome measures. There were fewer significant changes in Spanish than in English across groups. Between-group comparisons indicate that the active treatment groups generally outperformed the deferred treatment control, reaching statistical significance for 2 tasks.

CONCLUSION

Results provide insight into cross-language transfer in bilingual children and advance understanding of the general PLI profile with respect to relationships between basic cognitive processing and higher level language skills.