Impact of a dissemination strategy on family day care educators' intentions to adopt outdoor free play guidelines introduced in response to COVID-19: a randomized controlled trial

In 2021, guidelines for early childhood education and care were released recommending children are provided access to outdoor areas during all free play sessions to reduce the risk of coronavirus disease of 2019 transmission, aligning with the existing recommendations to increase children's physical activity. There is a need to understand how to disseminate guidelines in this setting as dissemination is a prerequisite of adoption and implementation. This randomized controlled trial explored the impact of a video-based strategy to disseminate guidelines on family day care educators' intentions to adopt outdoor free play guidelines. Educators (N = 255) were randomized to receive a video (intervention) or text-based (usual care) resource via email describing recommendations. Educators were invited to participate in a post-intervention survey at 5-week follow-up assessing intentions to adopt guidelines. The secondary outcomes included knowledge, beliefs about capabilities, beliefs about consequences, social/professional role and identity, goals, implementation of guidelines, acceptability of resource and intervention reach. There was no statistically significant difference between groups in intentions to adopt guidelines [ß = 0.01 (95% confidence interval -0.50 to 0.52), P = 0.97], nor for any secondary outcomes. Further investigation is needed to identify effective dissemination strategies in the family day care setting to increase the adoption of public health guidelines.

Coronary Atherosclerotic Plaque Regression: JACC State-of-the-Art Review

Over the last 3 decades there have been substantial improvements in treatments aimed at reducing cardiovascular (CV) events. As these treatments have been developed, there have been parallel improvements in coronary imaging modalities that can assess plaque volumes and composition, using both invasive and noninvasive techniques. Plaque progression can be seen to precede CV events, and therefore, many studies have longitudinally assessed changes in plaque characteristics in response to various treatments, aiming to demonstrate plaque regression and improvements in high-risk features, with the rationale being that this will reduce CV events. In the past, decisions surrounding treatments for atherosclerosis have been informed by population-based risk scores for initiation in primary prevention and low-density lipoprotein cholesterol levels for titration in secondary prevention. If outcome data linking plaque regression to reduced CV events emerge, it may become possible to directly image plaque treatment response to guide management decisions.

MRI safety considerations during pregnancy

The use of magnetic resonance imaging (MRI) during pregnancy is on the rise due its ability to provide detailed cross-sectional anatomy without ionizing radiation. Despite the favorable radiation profile, theoretically concerns regarding the safety of MRI and gadolinium-based contrast agent (GBCA) administration have been raised. Currently there are no studies that have shown any attributable harms of MRI during any trimester of pregnancy although prospective and longitudinal studies are lacking. GBCA administration may be associated with a slightly higher rate of neonatal death, although this is based on a single, large cohort study. Understanding the available evidence regarding MRI safety during pregnancy in the context of current society guidelines will help the radiologist serve as a valuable resource to patients and referring providers.

Can pre-hospital administration reduce time to initial antibiotic therapy in septic patients?

OBJECTIVE

To quantify the potential time saved with pre-hospital antibiotic therapy in sepsis.

METHODS

Study data for adult patients transported by Ambulance Victoria (AV), and enrolled into the Australasian Resuscitation In Sepsis Evaluation (ARISE), were linked with pre-hospital electronic records.

RESULTS

An AV record was identified for 240 of 341 ARISE patients. The pre-hospital case notes referred to potential infection in 165 patients. The median time to first antibiotic administration from loading the patient into the ambulance was 107 (74-160) min.

CONCLUSIONS

ARISE patients in Victoria were frequently identified pre-hospital. An opportunity exists to study the feasibility of pre-hospital antibiotic therapy.

MRI Features Associated with TERT Promoter Mutation Status in Glioblastoma

BACKGROUND AND PURPOSE

Telomerase reverse transcriptase (TERT) promoter mutations are associated with worse prognosis in glioblastoma. The purpose of this study was to evaluate whether TERT mutation status was associated with specific morphologic and quantitative imaging features.

METHODS

Twenty-nine patients with isocitrate dehydrogenase 1/2-wildtype glioblastoma (13 TERT-wildtype, 16 TERT-mutated), who underwent preoperative magnetic resonance (MR) imaging were included in this retrospective study. Qualitative imaging phenotypes were evaluated using the Visually Accessible Rembrandt Images (VASARIs) feature set. Histogram analysis of apparent diffusion coefficient (ADC) and dynamic contrast-enhanced MR perfusion values were performed on enhancing tumor volumes-of-interest, and differences between TERT-wildtype and TERT-mutated tumors were assessed.

RESULTS

VASARI analysis demonstrated that the majority of morphologic features were not significantly different between TERT-wildtype and TERT-mutated tumors, although a higher proportion of TERT-wildtype tumors featured nonenhancing tumor crossing midline (P = .014). TERT-mutated tumors demonstrated lower median rate constant k_ep (.38 vs. .76, P = .03) and lower median volume transfer coefficient K^trans (.13 vs. .31, P = .02). There was no significant difference in median plasma volume v_p (P = .92) or ADC values (P = .66) between the two groups. We further found a significant interaction between median k_ep and K^trans and TERT status, respectively, suggesting greater risk of death with increasing blood-brain barrier dysfunction in TERT-mutated but not in TERT-wildtype tumors.

CONCLUSION

Our study demonstrates evidence of altered permeability metrics associated with TERT mutation in glioblastoma, laying the foundation for future prospective studies assessing implications for therapeutic management and clinical outcomes.

Sex differences in the long-term neuropsychological outcome of mild traumatic brain injury

PRIMARY OBJECTIVE

To investigate possible sex differences in neuropsychological functioning among patients following mild traumatic brain injury (TBI).

METHODS AND PROCEDURES

Retrospective records analysis of the neuropsychological test results of 102 participants with head injury, including 62 males and 40 females.

MAIN OUTCOME AND RESULTS

A multivariate analysis of variance indicated that females and males performed similarly on neuropsychological tests, on average, approximately 2 years after minor head trauma. A sex-by-age interaction effect was found on the Category and Trail Making A Tests, with a pattern similar to those obtained in a previous research.

CONCLUSIONS

Although past research has found that females develop more TBI-related neuropsychological deficits than males in the immediate post-injury period, the present study found that, overall, sex differences in the performance of patients with mild TBI on a variety of neuropsychological tests were insignificant. More investigation into the sex-by-age interaction effect appears warranted.

Inhibition of neurosphere proliferation by IFNgamma but not IFNbeta is coupled to neuronal differentiation

Interferons are produced following neural damage as part of the inflammatory response and may thus affect neural stem cell function. We compared the effects of interferon-gamma and interferon-beta on the proliferation and differentiation of adult murine neural progenitors. Both interferons inhibited neurosphere proliferation due to cell cycle arrest in G1 but only interferon-gamma induced neuronal differentiation. Both interferons induced differential phosphorylation of STAT proteins and a modest and late upregulation of the cell cycle regulator p27 but not several other likely cell cycle regulators. Thus in neural progenitor cells, anti-proliferative effects of interferons are not necessarily linked to differentiation.

A National Institute for Occupational Safety and Health Alert sent to hospitals and the intentions of hospital decision makers to advocate for latex allergy control measures

This study evaluated a National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, Alert concerning the risk and prevention of latex allergy among health care workers. It has been estimated that 8-12% of health care workers are sensitized to latex. NIOSH Alerts are publications that are intended to educate stakeholders about risks in the workplace; this Alert contained four recommendations for administrative control measures that hospital decision makers could adopt to reduce the risk of latex allergy to employees. The Alert was mailed to a random selection of Directors of Infection Control and Directors of Nursing in hospitals in the US. A random sample of these targeted recipients and a control group were surveyed by telephone (N = 298). Although nearly all of the respondents were concerned about latex allergy (96%), those reporting having seen the Alert were significantly more likely to report an intention to advocate for one or more of the control measures.

Characterization of multiple isoforms of protein 4.1R expressed during erythroid terminal differentiation

In erythrocytes, 80-kD protein 4.1R regulates critical membrane properties of deformability and mechanical strength. However, previously obtained data suggest that multiple isoforms of protein 4. 1, generated by alternative pre-mRNA splicing, are expressed during erythroid differentiation. Erythroid precursors use two splice acceptor sites at the 5' end of exon 2, thereby generating two populations of 4.1 RNA: one that includes an upstream AUG-1 in exon 2' and encodes high molecular weight isoforms, and another that skips AUG-1 in exon 2' and encodes 4.1 by initiation at a downstream AUG-2 in exon 4. To begin an analysis of the complex picture of protein 4.1R expression and function during erythropoiesis, we determined the number and primary structure of 4.1R isoforms expressed in erythroblasts. We used reverse-transcription polymerase chain reaction to amplify and clone full-length coding domains from the population of 4.1R cDNA containing AUG-1 and the population excluding AUG-1. We observed an impressive repertoire of 4.1R isoforms that included 7 major and 11 minor splice variants, thus providing the first definitive characterization of 4.1R primary structures in a single-cell lineage. 4.1R isoforms, transfected into COS-7 cells, distributed to the nucleus, cytoplasm, plasma membrane, and apparent centrosome. We confirmed previous studies showing that inclusion of exon 16 was essential for efficient nuclear localization. Unexpectedly, immunochemical analysis of COS-7 cells transfected with an isoform lacking both AUG-1 and AUG-2 documented that a previously unidentified downstream translation initiation codon located in exon 8 can regulate expression of 4.1R. We speculate that the repertoire of primary structure of 4.1R dictates its distinct binding partners and functions during erythropoiesis.

Expression of early nodulin genes in alfalfa mycorrhizae indicates that signal transduction pathways used in forming arbuscular mycorrhizae and Rhizobium-induced nodules may be conserved

Transcripts for two genes expressed early in alfalfa nodule development (MsENOD40 and MsENOD2) are found in mycorrhizal roots, but not in noncolonized roots or in roots infected with the fungal pathogen Rhizoctonia solani. These same two early nodulin genes are expressed in uninoculated roots upon application of the cytokinin 6-benzylaminopurine. Correlated with the expression of the two early nodulin genes, we found that mycorrhizal roots contain higher levels of trans-zeatin riboside than nonmycorrhizal roots. These data suggest that there may be conservation of signal transduction pathways between the two symbioses-nitrogen-fixing nodules and phosphate-acquiring mycorrhizae.

Fluid balance charts: do they measure up?

Many current nursing activities are performed without regular reviews of their usefulness. The recording of fluid gains and losses on a fluid balance chart is one such activity. This article explores the practice of fluid monitoring on the wards of a university teaching hospital.

Probable interaction of sodium divalproex with benzodiazepines

1. After drug discontinuation and 1 week placebo washout, 12 patients with panic disorders received, for 6 weeks, either placebo or sodium divalproex. During 6 consecutive weeks, alternate medication was given. 2. Severity of panic and anxiety attacks was improved only in patients receiving sodium divalproex as a first medication. 3. Protracted benzodiazepine effects may occur in the dichotomous antipanic activity of sodium divalproex.

Toxicology information and computer sources for the medical practitioner

This paper addresses the importance of toxicology information in medical practice. It begins by describing the role of clinical toxicology in dealing with health hazards that result from exposure to hazardous chemicals. This is followed by an overview of reference sources of practical value to physicians. Among the types of information considered are books, journals, fact sheets, abstracting/indexing tools, computer services, and organizations. Training resources are also presented. An appendix provides full details on accessing the toxicology resources cited in the body of the paper.

Haemophilus influenzae type b anticapsular antibody responses to PRP-pertussis and PRP-D vaccines in Alaska native infants

To evaluate immune responses in Alaska Native infants at high risk for invasive Haemophilus influenzae type b (Hib) disease, we studied PRP-pertussis and PRP-D conjugate vaccines in this population relative to responses in white infants in California and New York. Infants were immunized at two, four, and six months of age (both vaccines). In the PRP-pertussis trial, there were no significant differences in antibody levels at any age between Alaska Native infants and infants from California. Only 50% of the infants had a twofold or greater antibody rise after three doses. In the PRP-D trial, antibody levels at two months of age (presumably maternally acquired) were significantly higher for Alaska Native infants compared with infants from New York (P = .002). There were no significant differences in antibody levels after any of the three doses. Among Alaska Native infants there was no significant difference in antibody response based upon degree of ethnic purity.