Silvery Gray Hair Syndrome With Hemophagocytic Lymphohistiocytosis: A Case Report.

Griscelli syndrome (GS) is a rare autosomal recessive disorder, which has been classified into three subtypes based on clinical and genetic differences. GS subtype 2 is commonly associated with hemophagocytic lymphohistiocytosis (HLH) and recurrent infections due to immunodeficiency. In this study, we describe a four-month-old boy with genetically proven GS2, with neurological and immunological manifestations. He presented with fever, refusal of feeds, drowsiness, and multiple episodes of seizures. Examination revealed hypopigmented skin, silvery gray hair, and organomegaly. The child developed features of HLH, fulfilling clinical and laboratory criteria. Neuroimaging findings were in concordance with HLH of the central nervous system. Microscopic examination of the hair showed clumps of melanin pigment along the hair shaft. All findings were in favor of GS type 2, complicated with HLH, which was later confirmed with a homozygous deletion of the RAB27A gene on exome sequencing. Unfortunately, the baby succumbed to death due to severe sepsis and multiorgan dysfunction. The silvery gray hair, with typical hair microscopic findings, and association with HLH are strong indicators for this potentially fatal condition and aid in prompt diagnosis and initiation of treatment. Hematopoietic stem cell transplantation is the only lifesaving treatment option.

Impact of SARS-CoV-2 infection and mitigation strategy during pregnancy on prenatal outcome, growth and development in early childhood in India: a UKRI GCRF Action Against Stunting Hub protocol paper.

INTRODUCTION: The COVID-19 pandemic has offset some of the gains achieved in global health, particularly in relation to maternal, child health and nutrition. As pregnancy is a period of plasticity where insults acting on maternal environment have far-reaching consequences, the pandemic has had a significant impact on prenatal outcomes, intrauterine and postnatal development of infants. This research will investigate both the direct and indirect impacts of the COVID-19 pandemic during pregnancy on prenatal outcomes, growth and development in early childhood. METHODS AND ANALYSIS: Community and hospital data in Hyderabad and Gujarat, India will be used to recruit women who were pregnant during the COVID-19 pandemic and contracted SARS-CoV-2 infection. In comparison with women who were pregnant around the same time and did not contract the virus, the study will investigate the impact of the pandemic on access to healthcare, diet, nutrition, mental health and prenatal outcomes in 712 women (356 per study arm). Children born to the women will be followed prospectively for an 18-month period to investigate the impact of the pandemic on nutrition, health, growth and neurocognition in early childhood. ETHICS AND DISSEMINATION: Ethics approval was granted from the institutional ethics committees of the Indian Institute of Public Health Gandhinagar (SHSRC/2021/2185), Indian Council of Medical Research-National Institute of Nutrition (EC/NEW/INST/2021/1206), and London School of Hygiene and Tropical Medicine (72848). The findings of the study will be disseminated to policy and research communities through engagements, scientific conferences, seminars, and open-access, peer-reviewed publication.

Green synthesis of silver nanoparticles using Adhatoda vasica leaf extract and its application in photocatalytic degradation of dyes.

The paper describes biogenic synthesis of silver nanoparticles (AgNPs) using Adhatoda vasica leaf extracts at room temperature. The prepared AgNPs were characterized by UV-visible spectroscopy, Fourier-transform infrared spectroscopy, powder X-ray diffraction, Energy dispersive X-ray (EDX), High Resolution Transmission Electron Microscope, Scanning Electron Microscopy and Thermogravimetric analyser. The bio reduction method is devoid of any toxic chemicals, organic solvents, and external reducing, capping and stabilizing agent. The synthesized AgNPs had spherical shape with particle size ranging between 3.88 and 23.97 nm and had face centered cubic structure. UV-visible spectral analysis confirmed the formation of AgNPs with a characteristic surface plasmon resonance band at 419 nm. The EDX pattern revealed the presence of elemental Ag in AgNPs. The prepared AgNPs were used for degradation of Amaranth, Allura red and Fast green in aqueous medium, with ≥ 92.6% efficiency within 15 min using 5 mg of AgNPs. The optical bandgap, Eg value of 2.26 eV for AgNPs was found to be effective for rapid photocatalytic degradation of all the three dyes. The degradation process was observed to follow pseudo first order kinetics.

Awareness and Perceptions of "Age-Friendly": Analyzing Survey Results from Voices in the United States.

The term "age-friendly" is widely used to describe cities, communities, health systems, and other environments. However, little is known about how this is interpreted or what the term means to the public. To investigate the public's familiarity with the term and gain insights into its relevance to older adults, we utilized data generated by a survey of 1000+ adults aged 40 and above. We employed a 10-question survey, distributed online in the US from 8 to 17 March 2023 via a third-party vendor, that captured awareness and perceptions of age-friendly designations by exploring awareness of the term, contextual understanding, and influence on decision making. The resultant aggregate data was analyzed using Microsoft Excel and straightforward summary statistical analyses. The majority of respondents (81%) were aware of the term "age-friendly." Older adults (ages 65+) lagged in the self-described extreme or moderate level of awareness compared to adults aged 40-64. In the surveyed population, the term "age-friendly" was most often understood to apply to communities (57%), followed by health systems (41%) and cities (25%). Most people believed "age-friendly" refers to all ages, even though age-friendly health systems are designed to meet the unique needs of older adults. These survey results provide the age-friendly ecosystem field with insights into the awareness and perceptions of the term "age-friendly," highlighting opportunities to bolster understanding.

Active sampling of volatile chemicals for non-invasive classification of chicken eggs by sex early in incubation.

According to industry estimates, approximately 7 billion day-old male chicks are disposed of annually worldwide because they are not of use to the layer industry. A practical process to identify the sex of the egg early in incubation without penetrating the egg would improve animal welfare, reduce food waste and mitigate environmental impact. We implemented a moderate vacuum pressure system through commercial egg-handling suction cups to collect volatile organic compounds (VOCs). Three separate experiments were set up to determine optimal conditions to collect eggs VOCs to discriminate male from female embryos. Optimal extraction time (2 min), storage conditions (short period of incubation during egg storage (SPIDES) at days 8-10 of incubation), and sampling temperature (37.5°C) were determined. Our VOC-based method could correctly differentiate male from female embryos with more than 80% accuracy. These specifications are compatible with the design of specialized automation equipment capable of high-throughput, in-ovo sexing based on chemical sensor microchips.

The Validity and Reliability of the Reflux Finding Score.

Laryngopharyngeal reflux (LPR) disease is common. The incidence of newly diagnosed cases has increased substantially due to awareness and development of new diagnostic measurements. The reflux finding score (RFS) and reflux symptom index (RSI) are believed to be useful in the assessment process, including after the initiation of therapy. However, many authors have suggested concerns about the reliability and validity of the RFS. OBJECTIVE: To evaluate the validity and reliability of the RFS. METHODS: Ninety-two patients diagnosed with LPR who had undergone 24-hour pH-Impedance tests were included. All patients underwent stroboscopy and 24-Hour pH-Impedance monitoring within thirty days. Fifty-nine patients filled out a RSI prior to stroboscopic exam. The RFS was determined by four blinded observers: one otolaryngology resident, two laryngology fellows, and one laryngologist. Stroboscopic images were reviewed again one year later to assess intrarater reliability. RFS and RSI were correlated with 24-hour pH Impedance testing. RESULTS: The Kappa value between reviewers was 0.479. The percent agreement of the four observers for total RFS was 74.04%.The percent agreement between reviewers for subglottic edema was 78.77%; for ventricular obliteration was 65.55%; for erythema/hyperemia was 69.62%, for vocal fold edema was 68.32%; for diffuse laryngeal edema was 66.86%, for posterior commissure hypertrophy was 73.54%; for granuloma/granulation was 96.80%; for thick endolaryngeal mucus was 72.81%. The intrarater reliability of the four observers for total RFS was 67.5% with an intrarater reliability range of 50%-90%. The intrarater reliability for subglottic edema was 85% with a range of 70%-100%; for ventricular obliteration was 77.50% with a range of 70%-90%; for erythema/hyperemia was 65.00% with a range of 50%-90%; for vocal fold edema was 52.50% with a range of 30%-70%; for diffuse laryngeal edema was 62.50% with a range of 20%-80%; for posterior commissure hypertrophy was 52.50% with a range of 10%-80%; for granuloma/granulation was 100%; for thick endolaryngeal mucus was 55.00% with a range of 10%-90%. There was no correlation between RFS and any parameter of the 24-Hr pH-Impedance Test. RSI had a significant correlation with number of upright events (r value of 0.271, R2 of 0.0733 and P-value of 0.037), total symptoms experienced (r value of 0.0.267, R2 of 0.0715 and P-value of 0.041), and symptom correlation score (r value of -0.297, R2 of 0.0884 and P-value of 0.022). CONCLUSION: Many authors have expressed concerns about the reliability and validity of the RFS. In our study we found a fair/substantial interrater reliability, and a modest intra-rater reliability. We found no correlation between the RFS and 24-Hr pH Impedance testing. This study suggests that the concerns about the validity and reliability of the RFS may be warranted. This widely used clinical score should be interpreted with caution and further research and refinement should be considered.

COVID-19: Impact on the Musician and Returning to Singing; A Literature Review.

OBJECTIVE: The purpose of this study was to review current literature of the impact of COVID-19 on musicians and returning to singing. METHODS: A comprehensive search of peer-review articles was completed using PubMed, GoogleScholar, Scopus, and Web of Science. The search was completed using many key terms including voice, hoarseness, dysphonia, aphonia, cough, singers, and public speakers. The bibliography from each article found was searched to find additional articles. The search process revealed 56 peer-reviewed articles, 18 primary articles, ranging from the years 2019 to 2020. CONCLUSION: COVID-19 has had a major impact on singers and other musicians worldwide. It can affect the voice and can lead to paresis/paralysis of laryngeal nerves to long-term changes in respiratory function. There is a risk from aerosolization/droplet formation transmission with singing, and with playing wind and brass instruments that can be mitigated by following COVID-19 guidelines. Ways to reduce possible transmission during singing and instrument play include virtual rehearsals or performances, mask-wearing, instrument covers, smaller choirs, performing outside, excellent ventilation being socially distanced, shorter rehearsals, regularly cleaning commonly touched surfaces and washing hands, avoiding contact with others, and temperature screening.

Calixarene Functionalized Supramolecular Liquid Crystals and Their Diverse Applications.

Liquid crystals are considered to be the fourth state of matter with an intermediate order and fluidity in comparison to solids and liquids. Calixarenes are among one of the most versatile families of building blocks for supramolecular chemistry due to their unique vaselike structure that can be chemically engineered to have different shapes and sizes. During the last few decades, calixarenes have drawn much attention in the field of supramolecular chemistry due to their diverse applications in the fields of ion and molecular recognition, ion-selective electrodes for catalysis, drug delivery, gelation, organic electronics and sensors, etc. Imbuing liquid crystallinity to the calixarene framework leads to functionalized calixarene derivatives with fluidity and order. Columnar self-assembly of such derivatives in particular enhance the charge migration along the column due to the 1D stacking due to the enhanced π-π overlap. Considering limited reports and reviews on this new class of calixarene based liquid crystals, a comprehensive account of the synthesis of calixarene liquid crystals along with their mesomorphic behavior and potential applications are presented in this review.

Prevalence of anemia in pre-school tribal children with reference to parasitic infections and nutritional impact.

Objectives: Anemia is a global health problem and has very high prevalence in developing as well as developed countries, particularly in children and women. The present study evaluates hematological predictors, nutrition deficiency, parasitic infections and their association with the prevalence of anemia. This analysis will help to identify the anemic status of tribal preschool children. Methods: This was a cross-sectional study conducted in 300 children (age: 6 months to 5 years) in Santrampur village, Gujarat. Blood was collected and used to determine complete blood count (CBC); we also performed ELISA (enzyme-linked immunoassay) for the estimation of ferritin, transferrin, sTfR (soluble transferrin receptor), vitamin B12 and vitamin B9 (folate). Stool samples were also collected and assessed by ELISA for Entamoeba histolytica, Giardia lamblia and Cryptosporidium parvum. Microscopy was used to screen samples for malaria. Results: Of the 300 children analyzed, 87.7% were anemic, 239 children were mildly anemic, 20 were moderately anemic and 4 were severely anemic. Mean Hb level was 9.49 ± 1.47 g/dL; males and females had an Hb level of 9.39 ± 1.59 g/dL and 9.58 ± 1.34 g/dL, respectively. Twenty-six children had sickle cell anemia and five had thalassemia. Over 50% of the children had vitamin B12 and B9 deficiency and 16% had abnormalities in CRP (C-reactive protein) levels. Parasitic infection by C. parvum was positively associated the anemia followed by the prevalence of G. lamblia and E. histolytica. Conclusion: An increased awareness of parents in the improvement of sanitary facilities and nutritional counselling with regards to iron-rich food consumption is recommended to if we are to prevent anemia among pre-school children. To reduce parasitic infestation, effective periodic deworming measures are also recommended.

Food Consumption Pattern and Dietary Diversity Among Pregnant and Lactating Women, Children, and Adolescent Girls in Devbhumi Dwarka District, Gujarat: A Cross-Sectional Study.

Background Food consumption patterns and dietary diversity are vital sources for the nutrition status of pregnant women (PW) and lactating women (LW), children, and adolescent girls. Undernutrition, food consumption pattern, and poor dietary diversity are interlinked; however, not much is known in the context of rural Gujarat. This study aims to assess the regional pattern of food consumption and dietary diversity among pregnant and lactating women, children, and adolescent girls from Devbhumi Dwarka District in the state of Gujarat. Methods A cross-sectional study was conducted in four blocks of Devbhumi Dwarka District of Gujarat. A cluster sampling method was used for a better representation. A total of 632 pregnant women, 562 lactating mothers, 855 children aged 7-24 months, and 1,252 adolescent girls were assessed for food consumption patterns. Results Consumption of cereals (98%) was found to be highest among pregnant women, whereas consumption of pulses and fruits, which are rich in proteins and vitamins, was inadequate. Overall, the consumption of fruits was inadequate among adolescent girls (56.5%). Moreover, inadequate consumption of green leafy vegetables (36.4%) was noted among children. The dietary diversity score (DDS) for the study population ranges between 4.5 and 4.8, indicating medium diversity in food. Conclusion Cereal consumption is higher, which indicates a major part of the energy consumed by vulnerable groups. In contrast, low consumption of pulses, fruits, milk, and green leafy vegetables suggests the possibility of one or more micronutrient deficiencies. There is a need for innovative intervention to change food habits and promote locally available nutrient-rich food and awareness of the importance of various food groups to improve food patterns and the health of vulnerable groups.

Hybrid solid-phase extraction to overcome interference due to phospholipids for determination of neratinib in human plasma using UPLC-MS/MS.

A reliable and robust bioanalytical method was developed to quantify neratinib, a tyrosine kinase inhibitor in human plasma, using UPLC-MS/MS. The extraction of neratinib and its deuterated internal standard, neratinib-d6, was successfully performed on hybrid solid-phase extraction ultra-cartridges to remove the interference of phospholipids and proteins. Chromatographic analysis was performed on a UPLC BEH C18 (50 × 2.1 mm, 1.7 µm) column using 0.1% formic acid and acetonitrile under gradient conditions. The total analysis time was 1.5 min. Neratinib was quantified using electrospray ionization source operated in the positive-ion multiple reaction monitoring mode. The mass transitions of neratinib and neratinib-d6 were m/z 557.3/112.1 and m/z 563.1/118.2, respectively. The linear concentration range for neratinib was 0.5-500 ng/mL, which adequately covers concentration levels expected in real subject samples. The assay was extensively validated for various validation parameters following standard guidelines for a bioanalytical assay. The intra- and inter-batch precision was ≤4.6%, and neratinib was found to be stable under various stability conditions. The mean internal standard-normalized matrix factor and recovery were 0.997 and 95.4%, respectively. The validated method was successfully applied to a pharmacokinetic study in healthy subjects with different doses.

Psychoactive Substance Use among Second-Year and Third-Year Medical Students of a Medical College: A Descriptive Cross-sectional Study.

INTRODUCTION: Psychoactive substance use among medical students is common. This may not only pose a threat to their health and academic performance but may have medico-legal and ethical ramifications. The aim of this study was to find out the prevalence of six psychoactive substances (alcohol, tobacco, cannabis, cocaine, benzodiazepines, opioids) among second year and third year medical students. METHODS: A descriptive cross-sectional study was done in a medical college. Whole sampling was done and ethical approval was taken from the Institutional Review Committee (Reference Number: 54-074/075). The study was conducted from May 2018 to June 2018. A semi-structured self-administered questionnaire modified and adapted from World Health Organization's guidelines for student substance use survey was used to collect data from second year and third year medical students. Statistical Package for Social Sciences version 16.0 was used for analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 226 total respondents, 95 (42.0%) (35.55- 48.45 at 95% Confidence Interval) reported current use of one or more psychoactive substances. Most frequently used substance was alcohol with current use prevalence of 87 (38.5%), followed by smoking 39 (17.3%) and cannabis 27 (11.9%). Cocaine, benzodiazepines and opioids were the least consumed substances with current use prevalence of 2 (0.9%) each. CONCLUSIONS: Almost half of the students were currently using one or more psychoactive substances which is concerning, and therefore strategies must be adopted to alleviate such use.

Depression, Anxiety, and Stress among First-year Medical Students in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Medical students are prone to develop stress, anxiety and depression owing to vastness of curriculum, hectic lifestyle, economic burden, and competitiveness of medical field. The study aims to find out the prevalence of depression, anxiety, and stress among first-year medical students. METHODS: A descriptive cross-sectional study was conducted among 91 first-year students of Bachelor of Medicine and Bachelor of Surgery enrolled in a tertiary care hospital using depression, anxiety, and stress-42 scale along with a questionnaire regarding sociodemographic and stressors for their problems. Whole sampling was done and the study was conducted between June and July 2018 after taking ethical approval from the Research and Institutional Review Committee (Reference Number: 57-074/075). RESULTS: The highest prevalence among undergraduate medical students was found to be anxiety 54 (59.3%), followed by stress 41 (45.1%) and depression 40 (44%). CONCLUSIONS: Almost half of the first-year medical students reported some level of depression, anxiety, or stress. It is important to implement programs in the early years of the medical school from the administrative level to help and identify students suffering from depression, anxiety, and stress.

Amino acid divergence in the ligand-binding pocket of Vibrio LuxR/HapR proteins determines the efficacy of thiophenesulfonamide inhibitors.

The quorum-sensing signaling systems in Vibrio bacteria converge to control levels of the master transcription factors LuxR/HapR, a family of highly conserved proteins that regulate gene expression for bacterial behaviors. A compound library screen identified 2-thiophenesulfonamide compounds that specifically inhibit Vibrio campbellii LuxR but do not affect cell growth. We synthesized a panel of 50 thiophenesulfonamide compounds to examine the structure-activity relationship effects on Vibrio quorum sensing. The most potent molecule identified, PTSP (3-phenyl-1-(thiophen-2-ylsulfonyl)-1H-pyrazole), inhibits quorum sensing in multiple strains of V. vulnificus, V. parahaemolyticus, and V. campbellii at nanomolar concentrations. However, thiophenesulfonamide inhibition efficacy varies significantly among Vibrio species: PTSP is most inhibitory against V. vulnificus SmcR, but V. cholerae HapR is completely resistant to all thiophenesulfonamides tested. Reverse genetics experiments show that PTSP efficacy is dictated by amino acid sequence in the putative ligand-binding pocket: F75Y and C170F SmcR substitutions are each sufficient to eliminate PTSP inhibition. Further, in silico modeling distinguished the most potent thiophenesulfonamides from less-effective derivatives. Our results revealed the previously unknown differences in LuxR/HapR proteins that control quorum sensing in Vibrio species and underscore the potential for developing thiophenesulfonamides as specific quorum sensing-directed treatments for Vibrio infections.

Clinical Mortality Review of COVID-19 Patients at Sukraraj Tropical and Infectious Disease Hospital, Nepal; A Retrospective Study.

Coronavirus Disease 2019 (COVID-19) has challenged the health system worldwide, including the low and middle income countries like Nepal. In view of the rising number of infections and prediction of multiple waves of this disease, mortalities due to COVID-19 need to be critically analyzed so that every possible effort could be made to prevent COVID-19 related mortalities in future. Main aim of this research was to study about the mortalities due to COVID-19 at a tertiary level hospital, in Nepal. This was a retrospective, observational study that included all inpatients from Sukraraj Tropical and Infectious Disease Hospital, who were reverse transcriptase polymerase chain reaction positive for SARS-COV-2 and died during hospital stay from January 2020 till January 2021. Medical records of the patients were evaluated. Out of 860 total admissions in a year, there were 50 mortalities in the study center. Out of 50 mortalities, majority were males (76%) with male to female ratio of 3.17:1. Most were above 65 years of age (72%) and had two or more comorbidities (64%). The most common comorbidities among the patients who had died during hospital stay were hypertension (58%) followed by diabetes mellitus (50%) and chronic obstructive airway disease (24%). The median duration from the symptom onset to death was 18 days, ranged from the minimum of 2 days till maximum of 39 days. D-dimer was found to be >1 mg/L in 58% cases and ferritin was >500 ng/ml in 42% patients at presentation. A total of 42% patients had thrombocytopenia, 80% patients had lymphocytopenia and 60% had Neutrophil to Lymphocyte ratio >11.75 with the mean NLR of 18.38. Of total mortalities, 16% patients also showed microbiological evidence of secondary infection; Male gender, age more than 65 years, multiple comorbidities with lymphocytopenia, elevated Neutrophil lymphocyte ratio and elevated inflammatory markers were risk factors found in majority of mortalities in our study. These findings could be utilized for early triage and risk assessment in COVID-19 patients so that aggressive treatment strategies could be employed at the earliest to reduce mortalities due to COVID-19 in future.

Usability of Electronic Health Record-Generated Discharge Summaries: Heuristic Evaluation.

BACKGROUND: Obtaining accurate clinical information about recent acute care visits is extremely important for outpatient providers. However, documents used to communicate this information are often difficult to use. This puts patients at risk of adverse events. Elderly patients who are seen by more providers and have more care transitions are especially vulnerable. OBJECTIVE: This study aimed to (1) identify the information about elderly patients' recent acute care visits needed to coordinate their care, (2) use this information to assess discharge summaries, and (3) provide recommendations to help improve the quality of electronic health record (EHR)-generated discharge summaries, thereby increasing patient safety. METHODS: A literature review, clinician interviews, and a survey of outpatient providers were used to identify and categorize data needed to coordinate care for recently discharged elderly patients. Based upon those data, 2 guidelines for creating useful discharge summaries were created. The new guidelines, along with 17 previously developed medical documentation usability heuristics, were applied to assess 4 simulated elderly patient discharge summaries. RESULTS: The initial research effort yielded a list of 29 items that should always be included in elderly patient discharge summaries and a list of 7 "helpful, but not always necessary" items. Evaluation of 4 deidentified elderly patient discharge summaries revealed that none of the documents contained all 36 necessary items; between 14 and 18 were missing. The documents each had several other issues, and they differed significantly in organization, layout, and formatting. CONCLUSIONS: Variations in content and structure of discharge summaries in the United States make them unnecessarily difficult to use. Standardization would benefit both patients, by lowering the risk of care transition-related adverse events, and outpatient providers, by helping reduce frustration that can contribute to burnout. In the short term, acute care providers can help improve the quality of their discharge summaries by working with EHR vendors to follow recommendations based upon this study. Meanwhile, additional human factors work should determine the most effective way to organize and present information in discharge summaries, to facilitate effective standardization.

The Case for S2: The Potential Benefits of the S2 Subunit of the SARS-CoV-2 Spike Protein as an Immunogen in Fighting the COVID-19 Pandemic.

As COVID-19 cases continue to rise, it is imperative to learn more about antibodies and T-cells produced against the causative virus, SARS-CoV-2, in order to guide the rapid development of therapies and vaccines. While much of the current antibody and vaccine research focuses on the receptor-binding domain of S1, a less-recognized opportunity is to harness the potential benefits of the more conserved S2 subunit. Similarities between the spike proteins of both SARS-CoV-2 and HIV-1 warrant exploring S2. Possible benefits of employing S2 in therapies and vaccines include the structural conservation of S2, extant cross-reactive neutralizing antibodies in populations (due to prior exposure to common cold coronaviruses), the steric neutralization potential of antibodies against S2, and the stronger memory B-cell and T-cell responses. More research is necessary on the effect of glycans on the accessibility and stability of S2, SARS-CoV-2 mutants that may affect infectivity, the neutralization potential of antibodies produced by memory B-cells, cross-reactive T-cell responses, antibody-dependent enhancement, and antigen competition. This perspective aims to highlight the evidence for the potential advantages of using S2 as a target of therapy or vaccine design.

A Longitudinal Study of Parent Gestures, Infant Responsiveness, and Vocabulary Development in Infants at Risk for Autism Spectrum Disorder.

We investigated gestures that parents used with 12-, 18-, and 24-month-old infants at high or low risk for autism spectrum disorder (ASD; high-risk diagnosed with ASD: n = 21; high-risk classified as no ASD: n = 34; low-risk classified as no ASD: n = 34). We also examined infant responses to parent gestures and assessed the extent to which parent gesture relates to vocabulary development. Parents of three groups gestured in similar frequencies and proportions. Infants, in turn, responded similarly to parent gestures regardless of the infant's ASD risk and later diagnosis. Finally, parents who gestured more at 12 months had children with better vocabulary at 36 months than parents who gestured less. These findings highlight the importance of examining parent gestures when predicting language development.