Association between maternal closeness with parents and mother-toddler relationship quality

Objective

Understanding how positive parenting is conveyed across generations informs early childhood policy.

Background

The extant literature has focused on how a mother's relationship with her own mother sets the stage for her parenting of her own children, yet less understood is how a mother's relationship with her father supports her responsive parenting and potentially informs her child's attachment security.

Method

We analyzed data from 6,400 mothers of singleton infants participating in the Early Childhood Longitudinal Study, Birth Cohort. We examined whether a mother's closeness with her own mother and father (Generation 1) related to her responsiveness and child attachment security (Generation 3) at age 24 months.

Results

Most mothers reported being extremely (25.7%) or at least quite close (25.1%) with both their mother and father. How close mothers felt to their own parents was not associated with their observed level of responsiveness to their toddler or their toddler's attachment security, adjusting for sociodemographic covariates. Maternal education was the strongest predictor of responsiveness and attachment security.

Conclusion

Maternal education is strongly related to responsiveness, and to a lesser extent, child attachment security, in toddlerhood.

Implications

Programs aimed at addressing the challenges of caregiving may overcome the limitations of lower education status.

Household chaos, child temperament, and structure-related feeding practices in toddlerhood: A moderation analysis

Structure-related feeding practices may promote intuitive child eating behaviors and foster responsiveness to internal cues of hunger and satiety. Caregivers' ability to engage in structure-related feeding practices likely depends on a complex ecology of factors, including household- and child-characteristics. This study examined associations between household chaos and structure-related feeding practices, and the moderating effect of child temperament. Data were from 275 caregiver-toddler dyads from central Ohio. Child temperament was reported by caregivers when children were 18 months of age, whereas household chaos and structure-related feeding practices were reported by caregivers when children were 36 months of age. Multivariable linear regression models were constructed to assess the relationship between chaos and structure-related feeding practices. Interaction terms between household chaos and three dimensions of child temperament were tested to determine whether temperament moderated the relationship between chaos and structure-related feeding practices. Household chaos was not independently associated with structure-related feeding practices, but higher levels of child effortful control were associated with greater mealtime structure. There was a statistically significant interaction between household chaos and child temperamental surgency, such that greater levels of chaos were associated with less structured mealtimes, but only when children had low-surgency. Findings suggest household chaos and child temperament inform caregiver feeding practices, but the influence of chaos may depend on more proximal factors, like child temperament. Recommendations to improve caregiver-child feeding interactions should be sensitive to characteristics of the broader family home environment.

The transcription factor DksA exerts opposing effects on cell division depending on the presence of ppGpp

Bacterial cell size is a multifactorial trait that is influenced by variables including nutritional availability and the timing of cell division. Prior work revealed a negative correlation between concentration of the alarmone (p)ppGpp (ppGpp) and cell length in Escherichia coli, suggesting that ppGpp may promote assembly of the division machinery (divisome) and cytokinesis in this organism. To clarify this counterintuitive connection between a starvation-induced stress response effector and cell proliferation, we undertook a systematic analysis of growth and division in E. coli cells defective in ppGpp synthesis and/or engineered to overproduce the alarmone. Our data indicate that ppGpp acts indirectly on divisome assembly through its role as a global mediator of transcription. Loss of either ppGpp (ppGpp0) or the ppGpp-associated transcription factor DksA led to increased average length, with ppGpp0 mutants also exhibiting a high frequency of extremely long filamentous cells. Using heat-sensitive division mutants and fluorescently labeled division proteins, we confirmed that ppGpp and DksA are cell division activators. We found that ppGpp and DksA regulate division through their effects on transcription, although the lack of known division genes or regulators in available transcriptomics data strongly suggests that this regulation is indirect. We also found that DksA inhibits division in ppGpp0 cells, contrary to its role in a wild-type background. We propose that the ability of ppGpp to switch DksA from a division inhibitor to a division activator helps tune cell length across different concentrations of ppGpp. IMPORTANCE Cell division is a key step in the bacterial lifecycle that must be appropriately regulated to ensure survival. This work identifies the alarmone (p)ppGpp (ppGpp) as a general regulator of cell division, extending our understanding of the role of ppGpp beyond a signal for starvation and other stress. Even in nutrient-replete conditions, basal levels of ppGpp are essential for division to occur appropriately and for cell size to be maintained. This study establishes ppGpp as a "switch" that controls whether the transcription factor DksA behaves as a division activator or inhibitor. This unexpected finding enhances our understanding of the complex regulatory mechanisms employed by bacteria to coordinate division with diverse aspects of cell growth and stress response. Because division is an essential process, a better understanding of the mechanisms governing the assembly and activation of the division machinery could contribute to the development of novel therapeutics to treat bacterial infections.

Self-Compassion and Depressive Symptoms as Determinants of Sensitive Parenting: Associations with Sociodemographic Characteristics in a Sample of Mothers and Toddlers

Parenting that is sensitive and responsive to children's needs has been shown to support children's optimal growth and development in many cultural contexts. Numerous studies suggest that self-compassion is positively related to sensitive parenting. Despite growing research interest linking self-compassion to responsive parenting, there are considerable gaps in the literature. The current study examined the associations between self-compassion, depressive symptoms, socioeconomic status, and sensitive parenting. Data was obtained from a cohort study of 300 families in central Ohio enrolled when children were a mean (SD) calendar age of 18.2 (0.7) months. Children of all gestational ages at birth are included, and 37% were born preterm (<37 weeks' gestation). Observational protocols were used to determine maternal sensitivity in a semi-structured play setting. Self-compassion was assessed with the Self-Compassion Scale when children were 24 months old. Self-compassion was not associated with sociodemographic characteristics including maternal education, household income, child sex and gestational age. In unadjusted regression models, depressive symptoms were related to sensitive parenting (B = -0.036, SE = 0.016, p = 0.03), but self-compassion was not a statistically significant predictor (p = 0.35) of sensitivity, and neither self-compassion nor depressive symptoms were statistically significant predictors of sensitive parenting after adjustment for covariates. Considerations for future studies are discussed.

The transcription factor DksA exerts opposing effects on cell division depending on the presence of ppGpp

Bacterial cell size is a multifactorial trait that is influenced by variables including nutritional availability and the timing of cell division. Prior work revealed a negative correlation between the alarmone (p)ppGpp (ppGpp) and cell length in Escherichia coli , suggesting that ppGpp may promote assembly of the division machinery (divisome) and cytokinesis in this organism. To clarify this counterintuitive connection between a starvation induced stress response effector and cell proliferation, we undertook a systematic analysis of growth and division in E. coli cells defective in ppGpp synthesis and/or engineered to overproduce the alarmone. Our data indicate that ppGpp acts indirectly on divisome assembly through its role as a global mediator of transcription. Loss of either ppGpp (ppGpp 0 ) or the ppGpp-associated transcription factor DksA led to increased average length, with ppGpp 0 mutants also exhibiting a high frequency of extremely long filamentous cells. Using heat-sensitive division mutants and fluorescently labeled division proteins, we confirmed that ppGpp and DksA are cell division activators. We found that ppGpp and DksA regulate division through their effects on transcription, although the lack of known division genes or regulators in available transcriptomics data strongly suggests that this regulation is indirect. Surprisingly, we also found that DksA inhibits division in ppGpp 0 cells, contrary to its role in a wild-type background. We propose that the ability of ppGpp to switch DksA from a division inhibitor to a division activator helps tune cell length across different concentrations of ppGpp.

Importance

Cell division is a key step in the bacterial lifecycle that must be appropriately regulated to ensure survival. This work identifies the alarmone ppGpp as a general regulator of cell division, extending our understanding of the role of ppGpp beyond a signal for starvation and other stress. Even in nutrient replete conditions, basal levels of ppGpp are essential for division to occur appropriately and for cell size to be maintained. This study establishes ppGpp as a "switch" that controls whether the transcription factor DksA behaves as a division activator or inhibitor. This unexpected finding enhances our understanding of the complex regulatory mechanisms employed by bacteria to coordinate division with diverse aspects of cell growth and stress response. Because division is an essential process, a better understanding the mechanisms governing assembly and activation of the division machinery could contribute to the development of novel therapeutics to treat bacterial infections.

Silver Nanoparticle Surface Chemistry Determines Interactions with Human Serum Albumin and Cytotoxic Responses in Human Liver Cells

Engineered nanomaterials (ENMs) are synthesized with a diversity of surface chemistries that mediate biochemical interactions and physiological response to the particles. In this work, silver engineered nanomaterials (AgENMs) are used to evaluate the role of surface charge in protein interactions and cellular cytotoxicity. The most abundant protein in blood, human serum albumin (HSA), was interacted with 40 nm AgENMs with a range of surface-charged coatings: positively charged branched polyethyleneimine (bPEI), negatively charged citrate (CIT), and circumneutral poly(ethylene glycol) (PEG). HSA adsorption to AgENMs was monitored by UV-vis spectroscopy and dynamic light scattering, while changes to the protein structure were evaluated with circular dichroism spectroscopy. Binding affinity for citrate-coated AgENMs and HSA is largest among the three AgENM coatings; yet, HSA lost the most secondary structure upon interaction with bPEI-coated AgENMs compared to the other two coatings. HSA increased AgENM oxidative dissolution across all particle types, with the greatest dissolution for citrate-coated AgENMs. Results indicate that surface coating is an important consideration in transformation of both the particle and protein upon interaction. To connect results to cellular outcomes, we also performed cytotoxicity experiments with HepG2 cells across all three AgENM types with and without HSA. Results show that bPEI-coated AgENMs cause the greatest loss of cell viability, both with and without inclusion of HSA with the AgENMs. Thus, surface coatings on AgENMs alter both biophysical interactions with proteins and particle cytotoxicity. Within this study set, positively charged bPEI-coated AgENMs cause the greatest disruption to HSA structure and cell viability.

Stochastic activation of a family of TetR type transcriptional regulators controls phenotypic heterogeneity in Acinetobacter baumannii

Phenotypic heterogeneity is an important mechanism for regulating bacterial virulence, where a single regulatory switch is typically activated to generate virulent and avirulent subpopulations. The opportunistic pathogen Acinetobacter baumannii can transition at high frequency between virulent opaque (VIR-O) and avirulent translucent subpopulations, distinguished by cells that form opaque or translucent colonies. We demonstrate that expression of 11 TetR-type transcriptional regulators (TTTRs) can drive cells from the VIR-O opaque subpopulation to cells that form translucent colonies. Remarkably, in a subpopulation of VIR-O cells, four of these TTTRs were stochastically activated in different combinations to drive cells to the translucent state. The resulting translucent subvariants exhibited unique phenotypic differences and the majority were avirulent. Due to their functional redundancy, a quadruple mutant with all four of these TTTRs inactivated was required to observe a loss of switching from the VIR-O state. Further, we demonstrate a small RNA, SrvS, acts as a "rheostat," where the levels of SrvS expression influences both the VIR-O to translucent switching frequency, and which TTTR is activated when VIR-O cells switch. In summary, this work has revealed a new paradigm for phenotypic switching in bacteria, where an unprecedented number of related transcriptional regulators are activated in different combinations to control virulence and generate unique translucent subvariants with distinct phenotypic properties.

Eating Competence Among Caregivers of Toddlers: Associations With Caregiver and Child Overweight/Obesity

OBJECTIVE

To examine the association between caregiver eating competence and child overweight/obesity and caregiver obesity.

DESIGN

Longitudinal cohort.

SETTING

A large US children's hospital.

PARTICIPANTS

Caregiver-child dyads (n = 288 with complete data at 2 time points) were sampled in 2017-2019 from those who received care at Nationwide Children's Hospital.

MAIN OUTCOME MEASURE(S)

Child overweight/obesity at 24 months of age (body mass index [BMI]) z-score >2 per World Health Organization standards and caregiver weight status (underweight/healthy [BMI < 25 kg/m2], overweight [BMI ≥ 25 and < 30 kg/m2], or obese [BMI ≥ 30 kg/m2]).

ANALYSIS

Log-binomial models examined the relationship between caregiver eating competence (ecSatter Inventory) at 18 months and child overweight/obesity at 24 months of age. Proportional odds models investigated the relationship between caregivers' eating competence and weight status.

RESULTS

Eating competent caregivers had more than twice the odds (odds ratio, 2.11; 95% confidence interval, 1.30-3.42) of having a lower BMI category and had lower average BMI than noneating competent caregivers. Child overweight/obesity at 24 months did not differ by caregiver eating competence.

CONCLUSIONS AND IMPLICATIONS

Although child overweight/obesity did not vary by caregiver eating competence, caregiver eating competence was related to their weight status. Longer-term studies are needed to clarify the role of caregiver eating competence as children develop. Promoting caregivers' eating competence may translate into healthier behaviors and skills for caregivers and their children long term.

Factors associated with parenting stress in parents of 18-month-old children: Parenting stress in parents of toddlers

AIM

Parenting stress is associated with less optimal outcomes for children. Risk factors contributing to parenting stress in healthy toddlers have received little empirical attention. This study sought to determine the factors that are associated with parenting stress in parents of 18-month-old children.

METHODS

We analysed cross-sectional survey data from a prospective cohort study focused on parent-child mealtime interactions. Families with an 18-month-old child were recruited in Columbus, Ohio, USA, between December 2017 and May 2019. Adjusted stepwise linear regression models estimated associations between child factors (e.g., temperament), parental factors (e.g., depressive symptoms), quality of romantic relationship factors (e.g., adult attachment style) and home environment factors (e.g., household income) and parenting stress (Parental Distress subscale of the Parenting Stress Index-4 Short Form).

RESULTS

The 299 children included 129 (43%) females. Parents were on average 30.6 (SD 6.1) years old and included a diverse racial/ethnic cohort. Mean Parental Distress score was 24.3 (SD 6.8; score range 12-60). Higher Parental Distress scores were associated with greater parental depressive symptoms (B = 5.1 [95% CI: 2.4, 7.7]) and avoidant (B = 2.8 [95% CI: 0.9, 4.6]) attachment style. Other child, parental and home environment factors did not demonstrate statistically significant relationships with parental distress in the final model.

CONCLUSION

Our findings align with recommendations for paediatric providers to screen for parenting stress and mental health.

Play & Grow: prospective observational cohort of toddlers to inform obesity prevention, Columbus, Ohio, USA

PURPOSE

Obesity prevention is increasingly focused on early childhood, but toddlers have not been well-studied, and children born preterm are frequently excluded. The Play & Grow Cohort was established to investigate child growth in relation to parent-child interactions in mealtime and non-mealtime settings.

PARTICIPANTS

Between December 2017 and May 2019, 300 toddlers and primary caregivers were recruited from records of a large paediatric care provider in Columbus, Ohio, USA. This report describes recruitment of the cohort and outlines the data collection protocols for two toddler and two preschool-age visits. The first study visit coincided with enrolment and occurred when children (57% boys) were a mean (SD) calendar age of 18.2 (0.7) months.

FINDINGS TO DATE

Children in the cohort are diverse relative to gestational age at birth (16%, 28-31 completed weeks' gestation; 21%, 32-36 weeks' gestation; 63%, ≥37 weeks' gestation) and race/ethnicity (8%, Hispanic; 35%, non-Hispanic black; 46%, non-Hispanic white). Caregivers enrolled in the cohort are primarily the child's biological mother (93%) and are diverse in age (range 18-54 years), education (23%, high school or less; 20% graduate degree) and annual household income (27%, <US$20 000 24%, ≥US$90 000). Parent-child interactions were video-recorded during play in the laboratory at 18 months (n=299) and during play, reading and mealtime in the home (n=284) at 24 months. The preschool phase of the study was impacted by COVID-19. Parent-child interactions were video-recorded during play and mealtime at home at 36 months (n=141) and during a standardised buffet meal in the laboratory at 42 months (n=50). Caregivers unable to participate in face-to-face visits due to COVID-19 completed questionnaires.

FUTURE PLANS

Assessment during middle childhood is being planned. Future visits will include anthropometric measurements and parent-child interactions at mealtime. School-based outcomes are additionally being considered.

Fully kinetic simulations of strong steady-state collisional planar plasma shocks

We report on simulations of strong, steady-state collisional planar plasma shocks with fully kinetic ions and electrons, independently confirmed by two fully kinetic codes (an Eulerian continuum and a Lagrangian particle-in-cell). While kinetic electrons do not fundamentally change the shock structure as compared with fluid electrons, we find an appreciable rearrangement of the preheat layer, associated with nonlocal electron heat transport effects. The electron heat-flux profile qualitatively agrees between kinetic- and fluid-electron models, suggesting a certain level of "stiffness," though substantial nonlocality is observed in the kinetic heat flux. We also find good agreement with nonlocal electron heat-flux closures proposed in the literature. Finally, in contrast to the classical hydrodynamic picture, we find a significant collapse in the "precursor" electric-field shock at the preheat layer leading edge, which correlates with the electron-temperature gradient relaxation.

Knowledge of Infant Development and Parent Well-Being: Cross-Sectional Analysis of Toddlers

OBJECTIVE

Knowledge about child development is associated with parenting and children's outcomes. Parents with less accurate knowledge about developmental milestones may have unrealistic expectations for their child's behavior, which may affect parent well-being. Limited research has examined this topic relative to depression, but other aspects of parent well-being (e.g., parenting stress) are unexplored.

METHODS

Cross-sectional analysis of an ongoing prospective cohort study of 300 families in central Ohio enrolled when children were a mean (SD) calendar age of 18.2 (0.7) months. Children of all gestational ages at birth are included, and 37% were born preterm (<37 weeks' gestation.) Primary caregivers (93% mothers) completed the 20-item Knowledge of Infant Development Index (KIDI) and questionnaires for child temperament and 3 aspects of parent well-being (depressive and anxious symptoms, parenting stress, and general health). Covariate-adjusted regression models assessed relationships between the KIDI score and each well-being outcome. We hypothesized that parents with less knowledge would have more symptoms of depression and anxiety, greater parenting stress, and poorer health. Whether associations were stronger for parents of children born preterm or who had high negative affect was explored.

RESULTS

Knowledge of Infant Development Index scores were associated with sociodemographic characteristics, child temperament, and gestational age (more knowledge: higher socioeconomic position, less child negative affect, and full-term birth). KIDI scores did not predict any aspect of parent well-being, and there was no evidence that child temperament or preterm birth altered these findings.

CONCLUSION

In this sample of parents of toddlers assessed in 2018/19, greater knowledge of infant development was not associated with parent well-being.

Benefit of the Wayfinder System for Individuals With Cognitive Disabilities and Their Caregivers

Date Presented 04/13/21

The MAPCD project uses the WayFinder3 GPS app and comprehensive trainings to improve community mobility for individuals with cognitive disabilities and their caregivers. Participants used the app in their daily lives, and preliminary findings demonstrate unique and substantial benefits including increased autonomy and improved quality of life. This research advances the field of OT through the implementation of innovative assistive technology to improve independence in community mobility.

Primary Author and Speaker: Kaetlyn E. Culter

Associations between sleep, stress, and cardiovascular health in emergency medical services personnel

OBJECTIVE

Our objective was to quantify the associations between sleep duration and perceived and chronic stress with ideal cardiovascular health (CVH) among emergency medical services (EMS) personnel from county-based EMS agencies.

METHODS

We conducted a cross-sectional survey of cardiovascular disease (CVD)-free EMS personnel from 4 US EMS agencies. The questionnaire consisted of the Pittsburgh Sleep Quality Index (PSQI), Perceived Stress Scale (PSS), Chronic Burden Scale, and the CVH components (smoking, body mass index, physical activity, diet, blood glucose, blood pressure, cholesterol, each scored 0-2 points). The components were summed and ideal CVH considered 11-14 points. Mixed effects logistic regression models with a random intercept for agency were used to estimate the odds of ideal CVH for good sleep quality (PSQI < 5 points), recommended sleep duration (7 to < 9h), low perceived stress (PSS < 26 points), and low chronic stress (0 recent stressful events).

RESULTS

We received 379 responses (response rate = 32%). There was low prevalence of good sleep quality (23%) and recommended sleep duration (25%), but 95% reported low perceived stress, and 33% had low chronic stress. Ideal CVH was reported by 30%. No significant associations between ideal CVH and sleep quality, perceived stress, or chronic stress were found. There was a nearly 2-fold increase in the odds of ideal CVH with recommended sleep duration (odds ratio: 1.83, 95% confidence interval: 1.08-3.10).

CONCLUSION

In this sample of EMS personnel, only recommended sleep duration was associated with ideal CVH. Future longitudinal studies are needed to understand the relationship between sleep, stress, and CVD in this understudied occupational group.

Mobility Assistance for People With Cognitive Disabilities: Identifying Implementation Outcomes and Strategies of Innovative Technology

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

The Mobility Assistance for People with Cognitive Disabilities (MAPCD) program, including the WayFinder 3 assistive smartphone navigation app and training program, addresses barriers to community mobility and provides supports to both individuals with cognitive deficits and their caregivers. We describe the MAPCD program and examine strategies that facilitated the adoption of the WayFinder 3 app designed to optimize independent community mobility.

Primary Author and Speaker: Sarah E. Anderson

Additional Authors and Speakers: Lisa Juckett

Contributing Authors: Carmen DiGiovine, Sandra A. Metzler, Ashley Stojkov, Bethany Frick, Kaetlyn E. Culter, and Elizabeth Mance

OT Interventions for Anxiety and Depressive Symptoms in Physical Inpatient Rehabilitation: A Systematic Review

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

This systematic review examined interventions for anxiety and depressive symptoms among inpatient physical rehabilitation patients. Results were framed by intervention type, context, and concentration of current literature among patient groups. Setting specific analyses does not seem to be common, because patient groups are often considered regardless of therapeutic setting and therefore regardless of recovery stage. Setting-specific information can aid resource development and literature navigation.

Primary Author and Speaker: Janell Pisegna

Additional Authors and Speakers: Sarah E. Anderson

Contributing Authors: Jessica L. Krok-Schoen

Cationic Homopolymers Inhibit Spore and Vegetative Cell Growth of Clostridioides difficile

A wide range of synthetic polymers have been explored for antimicrobial activity. These materials usually contain both cationic and hydrophobic subunits because these two characteristics are prominent among host-defense peptides. Here, we describe a series of nylon-3 polymers containing only cationic subunits and their evaluation against the gastrointestinal, spore-forming pathogen Clostridioides difficile. Despite their highly hydrophilic nature, these homopolymers showed efficacy against both the vegetative and spore forms of the bacterium, including an impact on C. difficile spore germination. The polymer designated P34 demonstrated the greatest efficacy against C. difficile strains, along with low propensities to lyse human red blood cells or intestinal epithelial cells. To gain insight into the mechanism of P34 action, we evaluated several cell-surface mutant strains of C. difficile to determine the impacts on growth, viability, and cell morphology. The results suggest that P34 interacts with the cell wall, resulting in severe cell bending and death in a concentration-dependent manner. The unexpected finding that nylon-3 polymers composed entirely of cationic subunits display significant activities toward C. difficile should expand the range of other polymers considered for antibacterial applications.

Technological Advances to Address Current Issues in Entomology: 2020 Student Debates

The 2020 Student Debates of the Entomological Society of America (ESA) were live-streamed during the Virtual Annual Meeting to debate current, prominent entomological issues of interest to members. The Student Debates Subcommittee of the National ESA Student Affairs Committee coordinated the student efforts throughout the year and hosted the live event. This year, four unbiased introductory speakers provided background for each debate topic while four multi-university teams were each assigned a debate topic under the theme 'Technological Advances to Address Current Issues in Entomology'. The two debate topics selected were as follows: 1) What is the best taxonomic approach to identify and classify insects? and 2) What is the best current technology to address the locust swarms worldwide? Unbiased introduction speakers and debate teams began preparing approximately six months before the live event. During the live event, teams shared their critical thinking and practiced communication skills by defending their positions on either taxonomical identification and classification of insects or managing the damaging outbreaks of locusts in crops.

Exploring the Ligand Preferences of the PHD1 Domain of Histone Demethylase KDM5A Reveals Tolerance for Modifications of the Q5 Residue of Histone 3

Understanding the ligand preferences of epigenetic reader domains enables identification of modification states of chromatin with which these domains associate and can yield insight into recruitment and catalysis of chromatin-acting complexes. However, thorough exploration of the ligand preferences of reader domains is hindered by the limitations of traditional protein-ligand binding assays. Here, we evaluate the binding preferences of the PHD1 domain of histone demethylase KDM5A using the protein interaction by SAMDI (PI-SAMDI) assay, which measures protein-ligand binding in a high-throughput and sensitive manner via binding-induced enhancement in the activity of a reporter enzyme, in combination with fluorescence polarization. The PI-SAMDI assay was validated by confirming its ability to accurately profile the relative binding affinity of a set of well-characterized histone 3 (H3) ligands of PHD1. The assay was then used to assess the affinity of PHD1 for 361 H3 mutant ligands, a select number of which were further characterized by fluorescence polarization. Together, these experiments revealed PHD1's tolerance for H3Q5 mutations, including an unexpected tolerance for aromatic residues in this position. Motivated by this finding, we further demonstrate a high-affinity interaction between PHD1 and recently identified Q5-serotonylated H3. This work yields interesting insights into permissible PHD1-H3 interactions and demonstrates the value of interfacing PI-SAMDI and fluorescence polarization in investigations of protein-ligand binding.

Evaluation of the skin-sensitizing potential of gold nanoparticles and the impact of established dermal sensitivity on the pulmonary immune response to various forms of gold

Gold nanoparticles (AuNP) are largely biocompatible; however, many studies have demonstrated their potential to modulate various immune cell functions. The potential allergenicity of AuNP remains unclear despite the recognition of gold as a common contact allergen. In these studies, AuNP (29 nm) dermal sensitization potential was assessed via Local Lymph Node Assay (LLNA). Soluble gold (III) chloride (AuCl₃) caused lymph node (LN) expansion (SI 10.9), whereas bulk particles (Au, 942 nm) and AuNP did not. Next, the pulmonary immune effects of AuNP (10, 30, 90 µg) were assessed 1, 4, and 8 days post-aspiration. All markers of lung injury and inflammation remained unaltered, but a dose-responsive increase in LN size was observed. Finally, mice were dermally-sensitized to AuCl₃ then aspirated once, twice, or three times with Au or AuNP in doses normalized for mass or surface area (SA) to assess the impact of existing contact sensitivity to gold on lung immune responses. Sensitized animals exhibited enhanced responsivity to the metal, wherein subsequent immune alterations were largely conserved with respect to dose SA. The greatest increase in bronchoalveolar lavage (BAL) lymphocyte number was observed in the high dose group - simultaneous to preferential expansion of BAL/LN CD8+ T-cells. Comparatively, the lower SA-based doses of Au/AuNP caused more modest elevations in BAL lymphocyte influx (predominantly CD4+ phenotype), exposure-dependent increases in serum IgE, and selective expansion/activation of LN CD4+ T-cells and B-cells. Overall, these findings suggest that AuNP are unlikely to cause sensitization; however, established contact sensitivity to gold may increase immune responsivity following pulmonary AuNP exposure.

A high-throughput SAMDI-mass spectrometry assay for isocitrate dehydrogenase 1

The enzyme isocitrate dehydrogenase 1 (IDH1) catalyzes the conversion of isocitrate to alpha-ketoglutarate (αKG) and has emerged as an important therapeutic target for glioblastoma multiforme (GBM). Current methods for assaying IDH1 remain poorly suited for high-throughput screening of IDH1 antagonists. This paper describes a high-throughput and quantitative assay for IDH1 that is based on the self-assembled monolayers for matrix-assisted laser desorption/ionization-mass spectrometry (SAMDI-MS) method. The assay uses a self-assembled monolayer presenting a hydrazide group that covalently captures the αKG product of IDH1, where it can then be detected by MALDI-TOF mass spectrometry. Co-capture of an isotopically-labeled αKG internal standard allows the αKG concentration to be quantitated. The assay was used to analyze a series of standard αKG solutions and produced minimal error in measured αKG concentration values. The suitability of the assay for high-throughput analysis was evaluated in a 384-sample biochemical IDH1 screen. Cells expressing IDH1 were lysed and the lysate was applied to the monolayer to capture αKG, which was then quantitated using the SAMDI-MS assay. Cells in which IDH1 expression was reduced by small-interfering RNA exhibited a corresponding decrease in αKG concentration as measured by the assay. Application of the assay toward the high-throughput screening of IDH1 inhibitors or knockdown agents may facilitate the discovery of treatments for GBM.

0895 Pediatric Positive Pressure Therapy: Enhancing Education And Parent/guardian Confidence To Implement Therapy

Introduction

Pediatric positive airway pressure (PAP) therapy can be challenging for children and their parent/guardian (PG). These challenges are complicated by the need to facilitate behavioral competency in the management of both device equipment and therapy.

Methods

As part of a larger quality management project aimed to improve PG and patient satisfaction we developed a targeted education visit provided by registered nurses prior to PAP trial initiation. Principle aims were to measure satisfaction with education and increase PG confidence in ability to manage therapy. The nurse session included: education on Obstructive Sleep Apnea (OSA) and PAP therapy, development of plan for first month of therapy, concepts of desensitization, regular practice, discussion and identification of concerns (assessment of barriers to implementation). A survey was administered pre-intervention to assess PG confidence in ability to manage therapy. Post-intervention, PG rated the interventions impact on baseline confidence, as well as an assessment of satisfaction with the education and content. Descriptive statistics were utilized to summarize the Likert survey questions.

Results

A total of 21of 25 (84%) participants completed surveys. 100% of PG that responded was either extremely satisfied or very satisfied with the educational intervention. Prior to the intervention, 19% (N4) indicated little to no confidence, 19% (N4) indicated some confidence and 62% (N13) indicated being very confident. 62% (N13) of PG’s indicated the information covered was new to them, while 24% (N5) indicated some information was new and 14% (N3) indicated none of the information was new. Regardless of baseline confidence, 100% (N21) responded that the intervention further improved confidence to a great degree.

Conclusion

The nurse visit resulted in high satisfaction with care and education and impacted PG confidence in ability to implement treatment. Future studies are needed to determine the impact on patient compliance.

Support

 

Analogies for a No-Analog World: Tackling Uncertainties in Reintroduction Planning

Species reintroductions involve considerable uncertainty, especially in highly altered landscapes. Historical, geographic, and taxonomic analogies can help reduce this uncertainty by enabling conservationists to better assess habitat suitability in proposed reintroduction sites. We illustrate this approach using the example of the California grizzly, an iconic species proposed for reintroduction.

Effects of Exergaming on Balance of Healthy Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Balance is critical for older adults to perform daily activities. However, age-related declines in balance increase the risk of falls and severe injuries, such as bone fractures and head injuries. Exergames have been widely applied to improve health-related outcomes in older adults. This meta-analysis aims to quantify the effects of exergaming interventions on balance performance in healthy older adults. A literature search was performed using PubMed, ScienceDirect, SPORTDiscus, COCHRANE, EBSCO, and EMBASE. A total of 16 experimental studies met inclusion criteria for a full-text review. Data synthesis examined balance functions, including static, dynamic, proactive, and perceived balance abilities when performing daily activities. Intervention protocols of the reviewed studies included an average of two to three 40-minute exergaming sessions per week for 8 weeks. A random effects model identified significant effects in favor of the exergaming group, with moderate effect size in dynamic balance (Hedges' g = 0.36, 95% CI = 0.26-1.30, P < 0.001), and perceived balance (Hedges' g = 0.31, 95% CI = 0.04-0.58, P = 0.02); and considerable effect size in Chair Stand Test (Hedges' g = 0.78, 95% CI = 0.26-1.30, P = 0.003), and balance test batteries (Hedges' g = 0.72, 95% CI = 0.42-1.02, P < 0.001). No significant effect was found in the static balance (Hedges' g = 0.22, 95% CI = -0.31 to 0.76, P = 0.42), or proactive balance (Hedges' g = 0.54, 95% CI = -0.12 to 1.20, P = 0.11). Meta-analysis identified exergaming-associated benefits in older adults' balance function and confidence. This finding supports the feasibility of exergaming as a supplementary approach to improve balance for healthy older adults. Health professionals may optimize treatment effect by integrating exergaming sessions into a traditional balance exercise program.

Impact of Life Events on Short-Term Change in BMI in Early and Middle Childhood

OBJECTIVE

The accumulation of adverse events in childhood is linked to obesity, although the short-term (1 to 2 years) dynamics of weight change during life events has not been investigated.

METHODS

In the Eunice Kennedy Shriver National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, mothers reported life events in the past year when their children were 54 months, 9 years, and 11 years old. Children's height and weight were measured, and BMI-for-age z scores were calculated at 36 and 54 months and at 7, 9, 10, and 11 years. The estimated 1- and 2-year change in BMI z score of being in the highest quartile of negative and total life events was modeled using linear regression accounting for repeated measures.

RESULTS

Analyses included 1,074 children. The highest quartile of negative life events was not statistically associated with BMI z score change at 2 years compared with those below the highest quartile (estimate: 0.069, 95% CI: -0.006, 0.144). Similarly, the highest quartile of total events was not related to BMI z score change (estimate: 0.029, 95% CI: -0.054, 0.114). The developmental period of the child did not moderate the association.

CONCLUSIONS

No significant change in BMI z score was observed in 1 to 2 years for children experiencing many life events.

Residential mobility in early childhood and obesity at kindergarten age among children from the United States

BACKGROUND

Children who frequently move have poorer behavioural, emotional, and overall health. For similar reasons, the experience of changing home may contextualize children's risk for obesity. Few studies have assessed the relationship between residential mobility and obesity; even fewer explore this relationship with assessment of obesity before school age.

METHODS

We analysed data from the Early Childhood Longitudinal Study-Birth Cohort. Obesity at kindergarten age was determined from measured height and weight. Early childhood residential mobility was categorized as not moving or having moved once, twice, or three or more times. Analyses are weighted to be representative of children from the United States and variance estimates account for the complex survey design.

RESULTS

The prevalence of obesity at kindergarten age was 17.5%, and most children (71%) moved in early childhood. Compared with children who did not move, the adjusted odd ratios for obesity at kindergarten age were 0.72 (95% CI, 0.57-0.92), 0.70 (95% CI, 0.55-0.89), and 0.64 (95% CI, 0.50-0.84) for children who experienced 1, 2, or 3+ moves.

CONCLUSIONS

Our study suggests that obesity and mobility in early life are associated, but not in the way we might expect. Residential mobility may fit into a broader picture of instability and, on its own, may not elevate a child's risk for obesity.

The association of job demands and resources with burnout among emergency medical services professionals

OBJECTIVE

Although burnout has been linked to negative workplace-level effects, prior studies have primarily focused on individuals rather than job-related characteristics. This study sought to evaluate variation in burnout between agencies and to quantify the relationship between burnout and job-related demands/resources among emergency medical services (EMS) professionals.

METHODS

An electronic questionnaire was sent to all licensed, practicing EMS professionals in South Carolina. Work-related burnout was measured using the Copenhagen Burnout Inventory. Multivariable generalized estimating equations were used to estimate odds ratios (ORs) for specific job demands and resources while adjusting for confounding variables. Composite scores were used to simultaneously assess the relationship between burnout and job-related demands and resources.

RESULTS

Among 1271 EMS professionals working at 248 EMS agencies, the median agency-level burnout was 35% (interquartile range [IQR]: 13% to 50%). Job-related demands, including time pressure, were associated with increased burnout. Traditional job-related resources, including pay and benefits, were associated with reduced burnout. Less tangible job resources, including autonomy, clinical performance feedback, social support, and adequate training demonstrated strong associations with reduced burnout. EMS professionals facing high job demands and low job resources demonstrated nearly a 10-fold increase in odds of burnout compared with those exposed to low demands and high resources (adjusted OR [aOR]: 9.50, 95% confidence interval [CI]: 6.39-14.10). High job resources attenuated the impact of high job demands.

CONCLUSION

The proportion of EMS professionals experiencing burnout varied substantially across EMS agencies. Job resources, including those reflective of organizational culture, were associated with reduced burnout. Collectively, these findings suggest an opportunity to address burnout at the EMS agency level.

Responsiveness of a Balance Assessment Using a Mobile Application

BACKGROUND

Balance assessment is used by clinicians as part of athlete concussion screening. The King-Devick (K-D) Balance app is designed to provide an objective balance assessment value. The purpose of this study was to investigate the responsiveness of a balance assessment using the K-D Balance app.

HYPOTHESIS

The K-D Balance app will demonstrate acceptable responsiveness for balance assessment.

STUDY DESIGN

Repeated-measures study.

LEVEL OF EVIDENCE

Level 5.

METHODS

A convenience sample of 25 participants between the ages of 20 and 25 years completed testing procedures. A battery of balance tests using the K-D Balance app on an iPhone were conducted 1 week apart. After a 5-minute warm-up, 3 stances were assessed: double leg, tandem right, and tandem left. The K-D Balance app guided the test positions and test times. A value representing movement was generated by the app algorithm. Analysis included descriptive statistics along with intraclass correlation coefficient and minimal detectable change (MDC).

RESULTS

The median score of the K-D test was 0.5 for session 1 and 0.4 for session 2. The ICC was 0.42 (95% CI, 0.04-0.70), and the MDC was 1.58.

CONCLUSION

The MDC value of 1.58 represents the threshold of meaningful change in balance, as measured with the K-D Balance app.

CLINICAL RELEVANCE

Clinicians can use the results of this study to objectively assess changes in balance over time using the K-D Balance app.

Child diet and health outcomes of the simple suppers program: a 10-week, 2-group quasi-experimental family meals trial

BACKGROUND

Racial minority children, particularly from low-income households, are at risk for obesity. Family meals have a protective effect on child nutritional health. However, the current evidence is limited in racial and socioeconomic diversity. The objective of this study was to evaluate the impact of a family meals intervention, Simple Suppers, on improvements in diet and health outcomes from baseline (T0) to post-intervention (T1) in intervention compared to waitlist control participants, and determine retention of change in outcomes among intervention participants at 10-week follow-up (T2).

METHODS

Simple Suppers was a 10-week family meals intervention implemented as a 2-group quasi-experimental trial. Ten 90-min lessons were delivered weekly. Data were collected at T0 and T1, and from intervention participants at T2. Participants were racially diverse 4-10 year-old children from low-income households. Setting was a faith-based community center. Main outcomes were daily servings of fruit, vegetables, and sugar-sweetened beverages and diet quality; z-scores for body mass index (BMI), waist circumference, systolic and diastolic blood pressure (BP); weight status categories; food preparation skills; and family meals (frequency of dinner, breakfast, TV viewing during meals, meals in dining area). Generalized linear mixed models (GLMMs) and mixed-effects ordinal regression models were used to assess intervention impact (T0:T1). Paired t-tests examined retention of change among intervention participants (T1:T2).

RESULTS

One hundred forty children enrolled and 126 completed T1 (90% retention); 71 of 87 intervention participants completed T2(79% retention). Mean (SD) age was 6.9(1.9) yr, 62% female, 60% Black, and 42% low-income. Intervention vs waitlist controls had higher food preparation skills (p < 0.001) and lower TV viewing during meals (p = 0.04) at T1.There were no group differences in dietary intake or quality or z-scores for BMI, waist circumference, or BP, however intervention versus waitlist controls experienced a greater change toward healthy weight (p = 0.04) At T2, intervention participants demonstrated a retention of improved food preparation skills.

CONCLUSIONS

Simple Suppers led to improvements in children's weight status, food preparation skills, and TV viewing during meals, but not diet or z-scores for BMI, waist circumference, or BP. Future research should examine the preventive effects of healthy family mealtime routines in children at greatest risk for obesity.

TRIAL REGISTRATION

NCT02923050; Simple Suppers Scale-up (S3); Retrospectively registered on Oct 2016; First participant enrolled on Jan 2015.

Early mother-child dyadic pathways to childhood obesity risk: A conceptual model

Understanding the emotional quality of the mother-child dyadic relationship and parent-child feeding interactions may further clarify early developmental pathways to eating behaviours and obesity risk. The quality of parent-child relationships fosters all aspects of child development but has not yet been extensively examined in relation to childhood weight gain. The aim of this paper is to propose a conceptual model, which outlines early mother-child dyadic pathways linking parent-child feeding interactions to child body mass index, where parent-child relationships have a central role. It maps out individual and dyadic mother-child factors (i.e., attachment, child temperament and maternal mental health) that influence the nature and quality of parent-child feeding interactions from infancy to toddlerhood. Our model bridges the gap between research fields by bringing together key maternal and child factors implicated in child development. Understanding early parent-child feeding interactional patterns and their influence on child self-regulation and eating behaviours may be relevant to multidisciplinary approaches toward preventing childhood obesity. High quality quantitative and observational data capturing meaningful parent, child and dyadic level interactions around food contexts, attachment security, maternal mental health, child temperament and self-regulation will help to inform new, aetiologically important, targets for preventative intervention.

Associations between parenting behavior and executive function among preschool-aged children born very preterm

The objective of the current study was to determine whether three domains of observed parenting behavior were associated with executive function in preschool-aged children born very preterm (<30 completed weeks' gestation). Executive function of 41 preschool-aged (3.5 to 4.5 years) children was assessed using a standardized protocol (gift delay) and by parent-report (Behavior Rating Inventory of Executive Function-Preschool, BRIEF-P). Observational protocols were used to determine parental sensitivity, harsh intrusiveness, and dyadic mutuality in a semi-structured play task. Parental sensitivity and mutuality were rated as higher, and harsh intrusiveness was rated as lower for children high in executive function on the gift delay task. Similarly, correlations between the three parenting scales and the BRIEF-P Global Executive Composite t-score were in the expected direction though not always statistically significant. Findings suggest that very preterm children who experienced sensitive parenting and were rated as having greater mutuality in their interactions with their caregivers scored higher on executive function tasks. These findings add to the growing literature on the key role that sensitive parenting and mutually responsive, harmonious interactions between caregivers and children may play in the development of executive function in very preterm children.

Nutrition Counseling for Hypertension Within a Grocery Store: An Example of the Patient-Centered Medical Neighborhood Model

OBJECTIVE

To evaluate the effectiveness of nutrition counseling for patients with hypertension, provided in a grocery store setting.

DESIGN

Single-arm pretest-posttest design implementing a 12-week dietary intervention.

SETTING

Grocery store.

PARTICIPANTS

Thirty adults with hypertension recruited from a primary care practice.

INTERVENTION

Registered dietitian nutritionists provided counseling based on the Dietary Approaches to Stop Hypertension diet.

MAIN OUTCOME MEASURES

Dietary intake patterns and Healthy Eating Index-2010 (HEI-2010) scores measured via food-frequency questionnaire. Change in systolic blood pressure (SBP) was a secondary outcome.

ANALYSIS

Paired t tests were used to test for differences between HEI-2010 scores, intake of key food pattern components, and SBP at baseline compared with follow-up. Statistical significance was established at P ≤ .05.

RESULTS

Eight HEI-2010 component scores increased significantly from baseline to follow-up (a change toward a more desirable eating pattern): total fruit, whole fruit, greens and beans, whole grains, fatty acids, refined grains, and empty calories. Sodium (P < .001), saturated fat (P < .001), discretionary solid fat (P < .001), added sugars (P = .01), and total fat (P < .001) all decreased significantly. The change in SBP was not significant.

CONCLUSIONS AND IMPLICATIONS

Grocery store-based counseling for patients with hypertension may be an effective strategy to provide lifestyle counseling that is not typically available within primary care.

Exploring Lactation Consultant Views on Infant Safe Sleep

Objectives The purpose of this qualitative study was to explore the infant safe sleep beliefs and occupational practices of lactation consultants and to determine if lactation consultants give advice to clients that is consistent with the American Academy of Pediatrics' recommendations on this topic. Methods Focus groups were conducted with certified lactation consultants in two cities in Ohio. Participants discussed the role of lactation consultants, the infant sleep advice they provide to women, their views on the American Academy of Pediatrics' infant safe sleep recommendations and related policies, and perceived benefits and barriers associated with providing infant safe sleep education as part of their work. A member-checking session was held to ensure the credibility of the findings. Results Four focus groups were conducted with 22 certified lactation consultants between September and November 2015. Major themes that emerged included: lactation consultants' beliefs regarding the importance of bedsharing for supporting breastfeeding success; their disagreement with the infant safe sleep recommendations of the American Academy of Pediatrics; their frustration with policies that restrict consultants' ability to discuss bedsharing; and the impact of infant safe sleep policies on their work and the advice they provide. Conclusions for Practice Lactation consultants interact with mothers of newborns at a critical time for infant safe sleep decision-making and may influence a woman's choices related to this topic. Women may not be receiving messages from lactation consultants that are consistent with the infant safe sleep recommendations of the American Academy of Pediatrics.

Association of Self-regulation With Obesity in Boys vs Girls in a US National Sample

IMPORTANCE

Poor self-regulation in childhood is associated with increased risk of obesity. However, studies have assumed that greater self-regulation is associated with a lower obesity risk and have rarely examined differences in the association by sex.

OBJECTIVES

To examine how different levels of toddler self-regulation are associated with the prevalence of obesity at kindergarten age and whether the pattern of association is different between boys and girls.

DESIGN, SETTING, AND PARTICIPANTS

This was a prospective cohort study using data from the Early Childhood Longitudinal Study, Birth Cohort, a nationally representative sample of 10 700 US children born in 2001 and followed up through kindergarten entry (2006-2007). The analytic sample included 6400 children with observed toddler self-regulation. Data collection occurred in children's homes and consisted of a parent interview and direct assessment of the child. Data analysis took place between May 2016 and March 2018.

EXPOSURES

During a standardized, in-home, developmental assessment at 24 months of age, observers scored 4 dimensions of children's self-regulation: adaptability, attention, persistence, and frustration tolerance. Self-regulation scores ranging from a low of 4 to a high of 20 were grouped into quartiles.

MAIN OUTCOMES AND MEASURES

With use of measured heights and weights at 5.5 years, obesity was defined as a body mass index for age in the 95th percentile or greater.

RESULTS

The analytic sample consisted of 6400 children (3250 boys [50.6%, weighted]), with a median age of 24.1 months (interquartile range, 23.4-24.7 months) and 64.5 months (interquartile range, 61.7-67.6 months) at the self-regulation and body mass index assessments, respectively. Self-regulation scores were lower for boys than for girls (mean, 13.7 [95% CI, 13.4-13.9] vs 14.9 [95% CI, 14.7-15.1]), and the lowest self-regulation quartile comprised more boys than girls (weighted percentages, 66.5% vs 33.5%). The prevalence of obesity at 5.5 years was 19.2% among boys and 16.5% among girls. The pattern of association between toddler self-regulation and obesity at 5.5 years was different for boys and girls (P = .008 for interaction). Among boys, the adjusted prevalence of obesity was 19.7%, 18.3%, 20.3%, and 15.9% from lowest to highest quartile of self-regulation. In contrast, among girls, there was a U-shaped association (adjusted prevalence of obesity from lowest to highest self-regulation quartile, 17.0%, 10.3%, 10.7%, and 15.0%).

CONCLUSIONS AND RELEVANCE

In a large national cohort of US children, there were differences between boys and girls in the pattern of the association between self-regulation at 24 months and obesity at 5.5 years of age. Obesity prevention efforts aimed at improving self-regulation may have different results for girls and boys.

Certified Nurse-Midwives' Knowledge, Attitudes, and Behaviors About Infant Safe Sleep

INTRODUCTION

Little is known about the knowledge, attitudes, and behaviors of certified nurse-midwives related to sudden infant death syndrome and infant safe sleep. However, this population is an important and trusted source of information for pregnant women and may provide guidance on infant care. We explored these topics with certified nurse-midwives to identify potential barriers as well as enabling and reinforcing factors associated with providing infant safe sleep education in the prenatal health care environment.

METHODS

Participants in this cross-sectional survey study were certified nurse-midwives who provide prenatal health care to women in Ohio. Surveys were mailed to all certified nurse-midwives listed with the licensing registry of the Ohio Board of Nursing (N = 333).

RESULTS

A total of 153 eligible respondents completed the survey for a response rate of 55%. Most participants had at least some knowledge of the infant safe sleep recommendations from the American Academy of Pediatrics, and two-thirds had positive attitudes about providing infant safe sleep education in the prenatal environment. Many participants (61%) perceived that there were barriers to providing prenatal infant safe sleep education, but nearly all (94%) indicated that they were interested in providing this education to their patients. Positive attitudes about providing infant safe sleep education were predictive of whether they discussed this topic with their patients.

DISCUSSION

Certified nurse-midwives routinely provide guidance on infant care, and it is important that they are familiar with current evidence-based recommendations on infant safe sleep. They should be supported in their desire to provide infant safe sleep education to their prenatal patients. In addition, efforts should be made to improve attitudes and social norms related to providing infant safe sleep education in the prenatal environment.

Changes in Food Selectivity in Children with Autism Spectrum Disorder

Food selectivity is a common problem in children with autism spectrum disorder (ASD) and has an adverse impact on nutrient adequacy and family mealtimes. Despite recent research in this area, few studies have addressed whether food selectivity present in children with ASD persists into adolescence. In this study, we assessed food selectivity in 18 children with ASD at two time points (mean age = 6.8 and 13.2 years), and examined changes in food selectivity. While food refusal improved overall, we did not observe an increase in food repertoire (number of unique foods eaten). These findings support the need for interventions early in childhood to increase variety and promote healthy eating among children with ASD.

The cardiac glycoside convallatoxin inhibits the growth of colorectal cancer cells in a p53-independent manner

Cardiac glycosides are plant-derived molecules that have shown antiproliferative properties against cancer cells, though the mechanism of action is not completely understood. We show that one cardiac glycoside, convallatoxin, presents antiproliferative effects against colorectal cancer cells in culture and that the resulting cell death is independent of the p53 tumor suppressor. Our data suggest that convallatoxin may be useful in the treatment of cancers that harbor inactivating mutations in the p53 signaling pathway.

Self-regulation and household routines at age three and obesity at age eleven: longitudinal analysis of the UK Millennium Cohort Study

Objective

To examine, in a population-based cohort of three-year-old children, the association between self-regulation and exposure to the household routines of regular bedtime, regular mealtime, and limits on watching television/video; and to determine whether self-regulation and these routines predict the risk of obesity at age 11.

Methods

Analyses included 10 955 children in the nationally-representative UK Millennium Cohort Study. When children were age 3, parents reported whether children had a regular bedtime and mealtime and the amount of television/video watched. Emotional and cognitive self-regulation at age 3 were assessed by parent-report with the Child Social Behaviour Questionnaire. Children’s height and weight were measured at age 11 and obesity was defined using the International Obesity Task Force (IOTF) criteria.

Results

At age 3, 41% of children always had a regular bedtime, 47% always had a regular mealtime, and 23% were limited to ≤1 hour television/video daily. At age 11, 6.2% of children were obese. All three household routines were significantly associated with better emotional self-regulation, but not better cognitive self-regulation. In a multi-variable logistic regression model including emotional and cognitive self-regulation, all routines, and controlling for sociodemographic covariates, a 1 unit difference in emotional self-regulation at age 3 was associated with an OR (95% CI) for obesity of 1.38 (1.11, 1.71) at age 11, and inconsistent bedtimes with an OR (95% CI) for obesity of 1.87 (1.39, 2.51) at age 11. There was no evidence that emotional self-regulation mediated the relationship between regular bedtimes and later obesity. Cognitive self-regulation was not associated with later obesity.

Conclusions

Three-year-old children who had regular bedtimes, mealtimes, and limits on their television/video time had better emotional self-regulation. Lack of a regular bedtime and poorer emotional self-regulation at age 3 were independent predictors of obesity at age 11.

External Arrhythmia Ablation Using Photon Beams

Background—

This study sought to investigate external photon beam radiation for catheter-free ablation of the atrioventricular junction in intact pigs.

Methods and Results—

Ten pigs were randomized to either sham irradiation or irradiation of the atrioventricular junction (55, 50, 40, and 25 Gy). Animals underwent baseline electrophysiological evaluation, cardiac gated multi-row computed tomographic imaging for beam delivery planning, and intensity-modulated radiation therapy. Doses to the coronary arteries were optimized. Invasive follow-up was conducted ≤4 months after the irradiation. A mean volume of 2.5±0.5 mL was irradiated with target dose. The mean follow-up length after irradiation was 124.8±30.8 days. Out of 7 irradiated animals, complete atrioventricular block was achieved in 6 animals of all 4 dose groups (86%). Using the same targeting margins, ablation lesion size notably increased with the delivered dose because of volumetric effects of isodose lines around the target volume. The mean macroscopically calculated atrial lesion volume for all 4 dose groups was 3.8±1.1 mL, lesions extended anteriorly into the interventricular septum. No short-term side effects were observed. No damage was observed in the tissues of the esophagus, phrenic nerves, or trachea. However, histology revealed in-field beam effects outside of the target volume.

Conclusions—

Single-fraction doses as low as 25 Gy caused a lesion with interruption of cardiac impulse propagation using this respective target volume. With doses of ≤55 Gy, maximal point-doses to coronary arteries could be kept <7Gy, but target conformity of lesions was not fully achieved using this approach.

Television, Home-Cooked Meals, and Family Meal Frequency: Associations with Adult Obesity

BACKGROUND

Adults, regardless of whether they are parents, regularly eat meals with family at home, but few studies have analyzed large, population-based samples to examine how mealtime practices or family meal frequency are associated with health.

OBJECTIVE

The aim of this study was to evaluate associations between the frequency of family meals eaten at home, watching television or videos during family meals, and consumption of meals that were cooked and eaten at home and the odds of being obese in adults.

DESIGN

This was an analysis of the cross-sectional 2012 Ohio Medicaid Assessment Survey (OMAS), a telephone survey of Ohio's population.

PARTICIPANTS/SETTING

The study sample was adult Ohio residents responding to the 2012 OMAS who ate at least one family meal in the past week (n=12,842).

MAIN OUTCOME MEASURES

Obesity (body mass index [BMI] ≥30), calculated from self-reported height and weight, was the outcome.

STATISTICAL ANALYSES PERFORMED

Logistic regression models were used to examine the association between obesity and family meal practices, adjusted for respondents' employment status, marital status, race/ethnicity, educational attainment, and age.

RESULTS

Family meal frequency was not associated with odds of obesity: those who ate family meals most (6-7) days were as likely as those who ate family meals few (1-2) days to be obese (adjusted odds ratio [OR_adj]=1.01, 95% CI=0.86, 1.18). Thirty-six percent of adults never watched television or videos while eating family meals, and 62% ate family meals that were all home-cooked. Adults who never watched television or videos during family meals had 37% lower odds of obesity compared with those who always did (95% CI=0.54, 0.73), regardless of family meal frequency. Adults whose family meals were all home-cooked had 26% lower odds of obesity than those who ate some or no home-cooked family meals (95% CI=0.62, 0.88). This association was more pronounced among adults who ate few family meals.

CONCLUSIONS

Family meal practices may be associated with obesity in adults, even if they eat few family meals per week. Future research should examine more aspects of shared meals and investigate which specific practices may impact obesity risk.

Methods and design of a 10-week multi-component family meals intervention: a two group quasi-experimental effectiveness trial

Background

Given the ongoing childhood obesity public health crisis and potential protective effect of family meals, there is need for additional family meals research, specifically experimental studies with expanded health outcomes that focus on the at-risk populations in highest need of intervention. Future research, specifically intervention work, would also benefit from an expansion of the target age range to include younger children, who are laying the foundation of their eating patterns and capable of participating in family meal preparations. The purpose of this paper is to address this research gap by presenting the objectives and research methods of a 10-week multi-component family meals intervention study aimed at eliciting positive changes in child diet and weight status.

Methods

This will be a group quasi-experimental trial with staggered cohort design. Data will be collected via direct measure and questionnaires at baseline, intervention completion (or waiting period for controls), and 10-weeks post-intervention. Setting will be faith-based community center. Participants will be 60 underserved families with at least 1, 4–10 year old child will be recruited and enrolled in the intervention (n = 30) or waitlist control group (n = 30). The intervention (Simple Suppers) is a 10-week family meals program designed for underserved families from racial/ethnic diverse backgrounds. The 10, 90-min program lessons will be delivered weekly over the dinner hour. Session components include: a) interactive group discussion of strategies to overcome family meal barriers, plus weekly goal setting for caregivers; b) engagement in age-appropriate food preparation activities for children; and c) group family meal for caregivers and children. Main outcome measures are change in: child diet quality; child standardized body mass index; and frequency of family meals. Regression models will be used to compare response variables results of intervention to control group, controlling for confounders. Analyses will account for clustering by family and cohort. Significance will be set at p < 0.05.

Discussion

This is the first experimentally designed family meals intervention that targets underserved families with elementary school age children and includes an examination of health outcomes beyond weight status. Results will provide researchers and practitioners with insight on evidence-based programming to aid in childhood obesity prevention.

Trial registration

NCT02923050. Registered 03 October 2016. Retrospectively registered.

Chemical and Stress Resistances of Clostridium difficile Spores and Vegetative Cells

Clostridium difficile is a Gram-positive, sporogenic and anaerobic bacterium that causes a potentially fatal colitis. C. difficile enters the body as dormant spores that germinate in the colon to form vegetative cells that secrete toxins and cause the symptoms of infection. During transit through the intestine, some vegetative cells transform into spores, which are more resistant to killing by environmental insults than the vegetative cells. Understanding the inherent resistance properties of the vegetative and spore forms of C. difficile is imperative for the development of methods to target and destroy the bacterium. The objective of this study was to define the chemical and environmental resistance properties of C. difficile vegetative cells and spores. We examined vegetative cell and spore tolerances of three C. difficile strains, including 630Δerm, a 012 ribotype and a derivative of a past epidemic strain; R20291, a 027 ribotype and current epidemic strain; and 5325, a clinical isolate that is a 078 ribotype. All isolates were tested for tolerance to ethanol, oxygen, hydrogen peroxide, butanol, chloroform, heat and sodium hypochlorite (household bleach). Our results indicate that 630Δerm vegetative cells (630 spo0A) are more resistant to oxidative stress than those of R20291 (R20291 spo0A) and 5325 (5325 spo0A). In addition, 5325 spo0A vegetative cells exhibited greater resistance to organic solvents. In contrast, 630Δerm spores were more sensitive than R20291 or 5325 spores to butanol. Spores from all three strains exhibited high levels of resistance to ethanol, hydrogen peroxide, chloroform and heat, although R20291 spores were more resistant to temperatures in the range of 60-75°C. Finally, household bleach served as the only chemical reagent tested that consistently reduced C. difficile vegetative cells and spores of all tested strains. These findings establish conditions that result in vegetative cell and spore elimination and illustrate the resistance of C. difficile to common decontamination methods. These results further demonstrate that the vegetative cells and spores of various C. difficile strains have different resistance properties that may impact decontamination of surfaces and hands.

Acute haematoma of the latissimus dorsi with low-intensity exercise – An unusual diagnosis heralding an ageing population

The world’s population is ageing. A significant proportion of this ageing population will undertake exercise, to optimise their health and wellbeing. Age-related changes in muscle physiology and composition may increase susceptibility to muscle injury and reduce the ability for recovery post exercise, which may have public health implications in years to come. This is a case report of a 59-year-old man with an isolated intramuscular haematoma, with onset during non-impact exercise (surfing and subsequently cricket). Injury to the latissimus dorsi muscle and/or tendon is rare. The individual in this report suffered from rheumatoid arthritis, which was well-controlled with methotrexate but had no other relevant medical history, which may have predisposed him to this injury.

Bedtime in Preschool-Aged Children and Risk for Adolescent Obesity

OBJECTIVE

To determine whether preschool-aged children with earlier bedtimes have a lower risk for adolescent obesity and whether this risk reduction is modified by maternal sensitivity.

STUDY DESIGN

Data from 977 of 1364 participants in the Study of Early Child Care and Youth Development were analyzed. Healthy singleton-births at 10 US sites in 1991 were eligible for enrollment. In 1995-1996, mothers reported their preschool-aged (mean = 4.7 years) child's typical weekday bedtime, and mother-child interaction was observed to assess maternal sensitivity. At a mean age of 15 years, height and weight were measured and adolescent obesity defined as a sex-specific body-mass-index-for-age ≥95th percentile of the US reference.

RESULTS

One-quarter of preschool-aged children had early bedtimes (8:00 p.m. or earlier), one-half had bedtimes after 8:00 p.m. but by 9:00 p.m., and one-quarter had late bedtimes (after 9:00 p.m.). Children's bedtimes were similar regardless of maternal sensitivity (P = .2). The prevalence of adolescent obesity was 10%, 16%, and 23%, respectively, across early to late bedtime groups. The multivariable-adjusted relative risk (95% CI) for adolescent obesity was 0.48 (0.29, 0.82) for preschoolers with early bedtimes compared with preschoolers with late bedtimes. This risk was not modified by maternal sensitivity (P = .99).

CONCLUSIONS

Preschool-aged children with early weekday bedtimes were one-half as likely as children with late bedtimes to be obese as adolescents. Bedtimes are a modifiable routine that may help to prevent obesity.

Parent-Child Interaction, Self-Regulation, and Obesity Prevention in Early Childhood

This paper describes the epidemiologic evidence linking parent-child relationships, self-regulation, and weight status with a focus on early childhood. The emotional quality of parent-child interactions may influence children's risk for obesity through multiple pathways. Prospective studies linking observer ratings of young children's self-regulation, particularly inhibitory control, to future weight status are discussed. Although findings are preliminary, promoting positive relationships between parents/caregivers and young children holds promise as a component of efforts to prevent childhood obesity. Multi-disciplinary collaborations between researchers with training in developmental science and child health should be encouraged.