Changes in fecal elastase-1 following initiation of CFTR modulator therapy in pediatric patients with cystic fibrosis.

BACKGROUND: Improvement in exocrine pancreatic function in persons with CF (pwCF) on cystic fibrosis transmembrane conductance regulator (CFTR) modulators has been documented in clinical trials using fecal pancreatic elastase-1 (FE-1). Our group endeavored to evaluate real-world data on FE-1 in children on CFTR modulator therapy at three pediatric cystic fibrosis (CF) centers. METHODS: Pediatric pwCF were offered FE-1 testing if they were on pancreatic enzyme replacement therapy (PERT) and on CFTR modulator therapy according to their center's guideline. FE-1 data were collected retrospectively. The primary outcome was absolute change in FE-1. RESULTS: 70 pwCF were included for analysis. 53 had baseline and post-modulator FE-1 values. There was a significant increase in FE-1 from median 25 mcg/g (IQR 25-60) at baseline to 57 mcg/g (IQR 20-228) post-modulator (p<0.001 by Wilcoxon matched pairs), with an absolute change in FE-1 of median 28 mcg/g (IQR -5-161) and mean 93.5 ± 146.8 mcg/g. Age was negatively correlated with change in FE-1 (Spearman r=-0.48, p<0.001). 15 pwCF (21%) had post-modulator FE-1 values ≥200 mcg/g, consistent with pancreatic sufficiency (PS). The PS group was significant for younger age at initiation of first CFTR modulator and a higher baseline FE-1. CONCLUSIONS: Most pwCF experienced an increase in FE-1 while receiving CFTR modulator treatment and a small percentage demonstrated values reflective of PS. These data suggest that PS may be attained in those that initiated modulator therapy at a younger age or had a higher baseline FE-1. FE-1 testing is suggested for children on any CFTR modulator therapy.

Insect Infestation Increases Viscosity of Biogenic Secondary Organic Aerosol.

Plant stress alters emissions of volatile organic compounds. However, little is known about how this could influence climate-relevant properties of secondary organic aerosol (SOA), particularly from complex mixtures such as real plant emissions. In this study, the chemical composition and viscosity were examined for SOA generated from real healthy and aphid-stressed Canary Island pine (Pinus canariensis) trees, which are commonly used for landscaping in Southern California. Healthy Canary Island pine (HCIP) and stressed Canary Island pine (SCIP) aerosols were generated in a 5 m3 environmental chamber at 35-84% relative humidity and room temperature via OH-initiated oxidation. Viscosities of the collected particles were measured using an offline poke-flow method, after conditioning the particles in a humidified air flow. SCIP particles were consistently more viscous than HCIP particles. The largest differences in particle viscosity were observed in particles conditioned at 50% relative humidity where the viscosity of SCIP particles was an order of magnitude larger than that of HCIP particles. The increased viscosity for the aphid-stressed pine tree SOA was attributed to the increased fraction of sesquiterpenes in the emission profile. The real pine SOA particles, both healthy and aphid-stressed, were more viscous than α-pinene SOA particles, demonstrating the limitation of using a single monoterpene as a model compound to predict the physicochemical properties of real biogenic SOA. However, synthetic mixtures composed of only a few major compounds present in emissions (<10 compounds) can reproduce the viscosities of SOA observed from the more complex real plant emissions.

Conceptualization, Operationalization, and Utilization of Race and Ethnicity in Major Epidemiology Journals, 1995-2018: A Systematic Review.

Despite repeated calls by scholars to critically engage with the concepts of race and ethnicity in US epidemiologic research, the incorporation of these social constructs in scholarship may be suboptimal. This study characterizes the conceptualization, operationalization, and utilization of race and ethnicity in US research published in leading journals whose publications shape discourse and norms around race, ethnicity, and health within the field of epidemiology. We systematically reviewed randomly selected articles from prominent epidemiology journals across 5 periods: 1995-1999, 2000-2004, 2005-2009, 2010-2014, and 2015-2018. All original human-subjects research conducted in the United States was eligible for review. Information on definitions, measurement, coding, and use in analysis was extracted. We reviewed 1,050 articles, including 414 (39%) in our analyses. Four studies explicitly defined race and/or ethnicity. Authors rarely made clear delineations between race and ethnicity, often adopting an ethnoracial construct. In the majority of studies across time periods, authors did not state how race and/or ethnicity was measured. Top coding schemes included "Black, White" (race), "Hispanic, non-Hispanic" (ethnicity), and "Black, White, Hispanic" (ethnoracial). Most often, race and ethnicity were deemed "not of interest" in analyses (e.g., control variables). Broadly, disciplinary practices have remained largely the same between 1995 and 2018 and are in need of improvement.

What do dental students expect from oral and maxillofacial surgery externships?

INTRODUCTION: Limited information exists on the goals and expectations of dental students from oral and maxillofacial surgery (OMS) externships. This information is valuable to OMS residency programs. Dental students use externships to gain insight into various OMS residency programs.  The purpose of this project was to answer the following question: "what do dental students expect from OMS externships?" PURPOSE: The aim of this study was to report the expectations of dental students from OMS externships. MATERIALS AND METHODS: This cross-sectional study took place from June 2015 to September 2019. Every student completing an Emory OMS externship completed an anonymous survey. The survey consisted of questions regarding (1) demographics, (2) previous OMS experience, and (3) open-ended questions regarding expectations and sources of anxiety. Answers were grouped into categories with similar answers. Descriptive statistics summarized data. RESULTS: Of 116 externs who completed the survey, the majority were males (n = 80, 68.9%) with a mean age of 25 (range 21-30) years old in the 3rd/4th year of dental school. Most had previous OMS experience (n = 103, 89.6%) and plan to apply to OMS residency (n = 104, 90.4%). Most externs hoped to learn about life as a resident and the scope and culture of the program. Externs expressed the highest level of anxiety regarding their own experience and/or knowledge level. CONCLUSIONS: This project demonstrated that during the externship, externs expect to gain insight into the daily activities, scope, and culture of the OMS program they are visiting.

Opportunities to improve policy dissemination by tailoring communication materials to the research priorities of legislators.

BACKGROUND: Communicating research to policymakers is a complex and difficult process. Ensuring that communication materials have information or design aspects that appeal to groups of policymakers with different priorities could be a substantive improvement over current dissemination approaches. To facilitate a more nuanced design of policy communication materials and message framing, we identified and characterized groups of state legislators based on how they prioritize different characteristics of research. METHODS: We used deidentified data collected in 2012 on 862 state legislators belonging to the US liberal-moderate-conservative ideological spectrum and from all 50 US states. Legislators were grouped using latent class analysis based on how they prioritized 12 different characteristics of research (e.g., research is unbiased, presents data on cost-effectiveness, policy options are feasible). We fit initial models using 1-6 group solutions and chose the final model based on identification, information criteria, and substantive interpretation. RESULTS: Most legislators placed a high priority on research that was understandable (61%), unbiased (61%), available at the time that decisions are made (58%), and brief and concise (55%). The best model identified four groups of state legislators. Pragmatic consumers (36%) prioritized research that was brief and concise, provided cost-effectiveness analyses, and was understandably written. Uninterested skeptics (30%) generally did not place a high priority on any of the research characteristics. Conversely, one-quarter of legislators (25%) belonged to the Highly Informed Supporters group that placed a high priority on most characteristics of research. Finally, Constituent-Oriented Decision Makers (9%) prioritized research that was relevant to their constituents, delivered by someone they knew or trusted, available at the time decisions were made, and dealt with an issue that they felt was a priority for state legislative action. CONCLUSIONS: To maximize the impact of dissemination efforts, researchers should consider how to communicate with legislators who have distinct preferences, values, and priorities. The groups identified in this study could be used to develop communication materials that appeal to a wide range of legislators with distinct needs and preferences, potentially improving the uptake of research into the policymaking process. Future work should investigate how to engage skeptical legislators.

A Guide for Choosing Community Detection Algorithms in Social Network Studies: The Question Alignment Approach.

INTRODUCTION: Community detection, the process of identifying subgroups of highly connected individuals within a network, is an aspect of social network analysis that is relevant but potentially underutilized in prevention research. Guidance on using community detection methods stresses aligning methods with specific research questions but lacks clear operationalization. The Question Alignment approach was developed to help address this gap and promote the high-quality use of community detection methods. METHODS: A total of 6 community detection methods are discussed: Walktrap, Edge-Betweenness, Infomap, Louvain, Label Propagation, and Spinglass. The Question Alignment approach is described and demonstrated using real-world data collected in 2013. This hypothetical case study was conducted in 2019 and focused on targeting a hand hygiene intervention to high-risk communities to prevent influenza transmission. RESULTS: Community detection using the Walktrap method best fit the hypothetical case study. The communities derived using the Walktrap method were quite different from communities derived through the other 5 methods in both the number of communities and individuals within communities. There was evidence to support that the Question Alignment approach can help researchers produce more useful community detection results. Compared to other methods of selecting high-risk groups, the Walktrap produced the most communities that met the hypothetical intervention requirements. CONCLUSIONS: As prevention research incorporating social networks increases, researchers can use the Question Alignment approach to produce more theoretically meaningful results and potentially more useful results for practice. Future research should focus on assessing whether the Question Alignment approach translates into improved intervention results.

Demographic Groups Likely Affected by Regulating Sugar-Sweetened Beverage Portion Sizes.

INTRODUCTION: Sugar-sweetened beverages are a key driver of obesity. Portion-size regulations typically limit the volume of unsealed sugar-sweetened beverage containers to 16 fluid ounces. These regulations could reduce sugar-sweetened beverage consumption, but whom these policies would affect remains unknown. This study evaluates demographic groups likely affected by hypothetical national portion-size regulations modeled on policy language and scopes from New York City and California. METHODS: Data from adults (aged 18-65 years, n=6,594) in the National Health and Nutrition Examination Survey (2013‒2016) were used to classify individuals as likely affected if they consumed a sugar-sweetened beverage larger than 16 fluid ounces from a potentially regulated food source during at least 1 eating occasion. Two classifications of affected food sources were evaluated: (1) excluding convenience stores (New York City scope) and (2) including convenience stores (California scope). In 2020, analyses were conducted using logistic regression to examine associations between affected status and age (<35 and ≥35 years), sex, race/ethnicity (white, non-Hispanic, black, non-Hispanic, andHispanic), education (without college degree and with college degree), and income (≤185% and >185% of the federal poverty line). RESULTS: Portion-size regulations would affect 8.87% of adults (New York City scope) and 14.71% of adults (California scope). Regulations had a greater potential effect on adults who were aged <35 years, male, and without a college degree (all p<0.05). Differences between demographic groups would be larger in magnitude using California's policy scope. CONCLUSIONS: Portion-size regulations would likely have a greater effect on younger, male, and less-educated adults. Policy effects would likely be larger if these regulations are written to encompass more food sources.

Social Influences on Obesity: Current Knowledge, Emerging Methods, and Directions for Future Research and Practice.

PURPOSE OF REVIEW: Individuals tend to be socially connected with those of similar weight and obesity status. To inform future research and intervention development, we reviewed recent literature examining social influences on weight with a focus on mechanisms of social influence, populations studied, and emerging analytical methods. RECENT FINDINGS: Social networks appear to influence weight gain and weight loss. It remains unclear what underlying mechanisms (e.g., social norms, social comparison, behavioral modeling) drive this relationship. Stochastic actor-oriented modeling is an important method in the field, but other work has leveraged natural experiment or randomized designs to study social influence. Future networks and obesity research should examine social influence mechanisms, focus on diverse populations across the life course, and carefully consider how to adequately control for competing factors of social selection and physical environments.

Weight-related quality of life and temperament as predictors and moderators of outcomes among treatment-seeking, low-income, ethnically diverse children with obesity.

Within any childhood obesity treatment program, some children have better outcomes than others. Little is known about predictors or moderators of more positive outcomes. We aimed to identify whether child temperament and weight-related quality of life predict or moderate childhood obesity treatment outcomes at 6 months. From 2015 to 2016, children (n = 97) ages 5-11 years old with obesity were randomized to a clinic-community (Bull City Fit) or a clinic-only treatment program. Linear regression was used to explore whether dimensions of child temperament and weight-related quality of life predicted or moderated 6-month anthropometric and physical activity outcomes. Children who had more social avoidance due to their weight at baseline had significantly better improvements in body fat percent in the clinic-community model compared with the clinic-only model at 6 months. Across programs, better baseline social quality of life predicted greater increases in waist circumference; conversely, better physical quality of life predicted a decrease in percent of the 95th percentile. Also, children with longer attention spans had greater increases in physical activity. Our findings suggest that children who have social avoidance due to their weight may benefit most from comprehensive clinic-community treatment. Weight-related quality of life may influence outcomes across all treatments, and practitioners need to carefully counsel children experiencing weight negatively.

Health Warnings on Sugar-Sweetened Beverages: Simulation of Impacts on Diet and Obesity Among U.S. Adults.

INTRODUCTION: Overconsumption of sugar-sweetened beverage (SSB) is a significant contributor to obesity. Policymakers have proposed requiring health warnings on SSBs to reduce SSB consumption. Randomized trials indicate that SSB warnings reduce SSB purchases, but uncertainty remains about how warnings affect population-level dietary and health outcomes. METHODS: This study developed a stochastic microsimulation model of dietary behaviors and body weight using the 2005-2014 National Health and Nutrition Examination Surveys, research on SSB health warnings, and a validated model of weight change. In 2019, the model simulated a national SSB health warning policy's impact on SSB intake, total energy intake, BMI, and obesity among U.S. adults over 5 years. Sensitivity analyses varied assumptions about: (1) how warning efficacy changes over time, (2) the magnitude of warnings' impact on SSB intake, and (3) caloric compensation. RESULTS: A national SSB health warning policy would reduce average SSB intake by 25.3 calories/day (95% uncertainty interval [UI]= -27.0, -23.6) and total energy intake by 31.2 calories/day (95% UI= -32.2, -30.1). These dietary changes would reduce average BMI by 0.64 kg/m2 (95% UI= -0.67, -0.62) and obesity prevalence by 3.1 percentage points (95% UI= -3.3%, -2.8%). Obesity reductions persisted when assuming warning efficacy wanes over time and when using conservative estimates of warning impact and caloric compensation. Benefits were larger for black and Hispanic adults than for white adults, and for adults with lower SES than for those with higher SES. CONCLUSIONS: A national SSB health warning policy could reduce adults' SSB consumption and obesity prevalence. Warnings could also narrow sociodemographic disparities in these outcomes.

A scoping review of simulation modeling in built environment and physical activity research: Current status, gaps, and future directions for improving translation.

Existing reviews have suggested that simulation studies of physical activity and environments are an emerging area, but none have explored findings in this area systematically. We used a scoping review framework to assess the use of simulation modeling to inform decision-making about built environment influences on physical activity. A systematic literature search was conducted in multiple databases in January 2018. Sixteen articles met the inclusion criteria. The studies evaluated interventions and features that were related to neighborhood safety (crime or traffic), active transportation, land use design, and walking and biking infrastructure. All of the studies focused on urban areas and most considered heterogeneity of outcomes based on local context. The majority of studies (70%) did not appear to have engaged or been used by practitioners or policy-makers to inform real-world decisions. There has been a growth of simulation modeling studies, but there remain gaps. The studies evaluated built environment interventions that have been recommended by expert panels, but more were of interventions related to active transportation; few considered recommended interventions to support recreational activity. Furthermore, studies have all focused on urban settings and there is a need to consider non-urban settings and how heterogeneity could reduce or exacerbate health disparities. More work to involve and evaluate practices for engaging stakeholders in model development and interpretation is also needed to overcome the translation of simulation research to practice gap, and realize its potential impact on the built environment and physical activity.

Childhood Misfortune and Handgrip Strength Among Black, White, and Hispanic Americans.

OBJECTIVE: Although early-life insults may affect health, few studies use objective physical measures of adult health. This study investigated whether experiencing misfortune during childhood is associated with handgrip strength (HGS) in later life. METHOD: Data on childhood misfortune and adult characteristics from the Health and Retirement Study were used to predict baseline and longitudinal change in HGS among White, Black, and Hispanic American men and women. RESULTS: Regression analyses revealed that multiple indicators of childhood misfortune were related to HGS at baseline, but the relationships were distinct for men and women. Over the study, having one childhood impairment predicted steeper declines in HGS for men, but childhood misfortune was unrelated to HGS change among women. Hispanic Americans had lower baseline HGS than their non-Hispanic counterparts and manifested steeper declines in HGS. DISCUSSION: The relationship between childhood exposures and adult HGS varied by the type of misfortune, but there was no evidence that the relationship varied by race/ethnicity. The significant and enduring Hispanic disadvantage in HGS warrants greater attention in gerontology.

Associations between birth weight and colon and rectal cancer risk in adulthood.

BACKGROUND: Birth weight has inconsistent associations with colorectal cancer, possibly due to different anatomic features of the colon versus the rectum. The aim of this study was to investigate the association between birth weight and colon and rectal cancers separately. METHODS: 193,306 children, born from 1936 to 1972, from the Copenhagen School Health Record Register were followed prospectively in Danish health registers. Colon and rectal cancer cases were defined using the International Classification of Disease version 10 (colon: C18.0-18.9, rectal: 19.9 and 20.9). Only cancers classified as adenocarcinomas were included in the analyses. Cox regressions were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Analyses were stratified by birth cohort and sex. RESULTS: During 3.8 million person-years of follow-up, 1465 colon and 961 rectal adenocarcinomas were identified. No significant sex differences were observed; therefore combined results are presented. Birth weight was positively associated with colon cancers with a HR of 1.14 (95% CI, 1.04-1.26) per kilogram of birth weight. For rectal cancer a significant association was not observed for birth weights below 3.5kg. Above 3.5kg an inverse association was observed (at 4.5kg, HR=0.77 [95% CI, 0.61-0.96]). Further, the associations between birth weight and colon and rectal cancer differed significantly from each other (p=0.006). CONCLUSIONS: Birth weight is positively associated with the risk of adult colon cancer, whereas the results for rectal cancer were inverse only above values of 3.5kg. The results underline the importance of investigating colon and rectal cancer as two different entities.

Use of existing water, sediment, and tissue data to screen ecological risks to the endangered Rio Grande silvery minnow.

A screening-level ecological risk assessment was applied to two extensive, but previously unanalyzed datasets from the middle Rio Grande (MRG) in New Mexico. The assessment evaluated how adverse water-quality effects from aquatic toxicants may have influenced the population decline of the endangered Rio Grande silvery minnow (Hybognathus amarus; silvery minnow). Standardized US Environmental Protection Agency (USEPA) screening-level ecological risk assessment procedures were applied to chemicals assessed in samples collected from the MRG between 1985 and 2003. Since more chemicals have established risk-screening criteria, relative to water-quality criteria, this approach produces more complete assessments. Chemical concentrations at some locations and times were potentially sufficient to affect fish health or produce localized mortalities. Many constituents displaying the highest risks have substantial natural sources within the watershed; native species likely would have adapted to natural instream concentrations such that actual risks might be markedly less than projected by a risk screening based on generic aquatic-life criteria. Also, highest risks found for individual and combinations of contaminants were very inconsistent both within and across the sites. As such, this risk assessment does not support the conclusion that toxicants were a primary factor causing the silvery minnow population to decline in the MRG between 1985 and 2003. The assessment indicates that sediment-borne, relative to water-borne, contaminants appeared to present the greatest risks to the silvery minnow and thus should have increased focus during future assessments of potential contaminant effects in the MRG. Contaminants of greatest concern are identified. This study presents approaches to cost-effectively assess and reduce uncertainties associated with potential water quality effects, and to help direct future assessments of water quality onto those contaminants likely to produce potentially significant effects. The techniques presented and criteria compiled are suitable for aiding similar assessments in other aquatic habitats.