GABAergic regulation of striatal spiny projection neurons depends upon their activity state.

Synaptic transmission mediated by GABAA receptors (GABAARs) in adult, principal striatal spiny projection neurons (SPNs) can suppress ongoing spiking, but its effect on synaptic integration at subthreshold membrane potentials is less well characterized, particularly those near the resting down-state. To fill this gap, a combination of molecular, optogenetic, optical, and electrophysiological approaches were used to study SPNs in mouse ex vivo brain slices, and computational tools were used to model somatodendritic synaptic integration. In perforated patch recordings, activation of GABAARs, either by uncaging of GABA or by optogenetic stimulation of GABAergic synapses, evoked currents with a reversal potential near -60 mV in both juvenile and adult SPNs. Transcriptomic analysis and pharmacological work suggested that this relatively positive GABAAR reversal potential was not attributable to NKCC1 expression, but rather to HCO3- permeability. Regardless, from down-state potentials, optogenetic activation of dendritic GABAergic synapses depolarized SPNs. This GABAAR-mediated depolarization summed with trailing ionotropic glutamate receptor (iGluR) stimulation, promoting dendritic spikes and increasing somatic depolarization. Simulations revealed that a diffuse dendritic GABAergic input to SPNs effectively enhanced the response to dendritic iGluR signaling and promoted dendritic spikes. Taken together, our results demonstrate that GABAARs can work in concert with iGluRs to excite adult SPNs when they are in the resting down-state, suggesting that their inhibitory role is limited to brief periods near spike threshold. This state-dependence calls for a reformulation for the role of intrastriatal GABAergic circuits.

Correction: GABAergic regulation of striatal spiny projection neurons depends upon their activity state.

[This corrects the article DOI: 10.1371/journal.pbio.3002483.].

Long-term frequent fire and cattle grazing alter dry forest understory vegetation.

Understanding fire and large herbivore interactions in interior western forests is critical, owing to the extensive and widespread co-occurrence of these two disturbance types and multiple present and future implications for forest resilience, conservation and restoration. However, manipulative studies focused on interactions and outcomes associated with these two disturbances are rare in forested rangelands. We investigated understory vegetation response to 5-year spring and fall prescribed fire and domestic cattle grazing exclusion in ponderosa pine stands and reported long-term responses, almost two decades after the first entry fires. In fall burn areas open to cattle grazing, total understory cover prior to utilization was about 12% lower compared with fall burn areas where cattle were experimentally excluded. This response was not strongly driven by a particular palatable or unpalatable plant functional group. Fire and grazing are likely interacting in a numerically mediated process, as we found little evidence to support a functionally moderated pathway. Post-fire green-up may equalize forage to a certain extent and concentrate herbivores in the smaller burned areas within pastures, constraining a positive understory response to burning. Fall fire and grazing also increased annual forbs and resprouting shrubs. The effects of spring burning were relatively minor, and we found no interaction with grazing. The nonnative annual grass Bromus tectorum (cheatgrass) remains a problematic invader linked to fall burning but not grazing in stands that had higher propagule pressure when the experiment was initiated. At these sites, exotic grass was a major component of the vegetation by 2015, and invasion was also increasing in spring burn and unburned areas. Information from our study suggests that frequent fall fires and cattle grazing combined may reduce understory resilience in similar dry ponderosa pine forests. Consideration of longer fire return intervals, resting areas after fire, virtual fencing, or burning entire pastures may help to mitigate the effects noted in this study.

A translational profiling approach for the molecular characterization of CNS cell types.

The cellular heterogeneity of the brain confounds efforts to elucidate the biological properties of distinct neuronal populations. Using bacterial artificial chromosome (BAC) transgenic mice that express EGFP-tagged ribosomal protein L10a in defined cell populations, we have developed a methodology for affinity purification of polysomal mRNAs from genetically defined cell populations in the brain. The utility of this approach is illustrated by the comparative analysis of four types of neurons, revealing hundreds of genes that distinguish these four cell populations. We find that even two morphologically indistinguishable, intermixed subclasses of medium spiny neurons display vastly different translational profiles and present examples of the physiological significance of such differences. This genetically targeted translating ribosome affinity purification (TRAP) methodology is a generalizable method useful for the identification of molecular changes in any genetically defined cell type in response to genetic alterations, disease, or pharmacological perturbations.

Does Narrative Quality Matter During Implementation of a School-Based Prevention Intervention? A Test of Narrative Engagement Theory.

Narratives play a powerful role in sharing meaning and making sense of experiences. Specifically, health narratives convey storylines, characters, and messages about health-related behaviors and provide audiences with models for healthy behaviors, prompting audiences' health-related reflections and decision-making. Narrative engagement theory (NET) explains how personal narratives can be integrated into interventions to promote health. This study utilizes NET to test direct and indirect effects of teachers' narrative quality on adolescent outcomes during a school-based substance use prevention intervention that includes narrative pedagogy and an implementation strategy. Observational coding of teacher narratives in video-recorded lessons along with self-report student surveys (N = 1,683) were subjected to path analysis. Findings showed significant direct effects of narrative quality on student engagement, norms (i.e. personal, best-friend injunctive, and descriptive norms), and substance use behavior. The analysis also yielded support for indirect effects of narrative quality on adolescent substance use behavior via student engagement, personal norms, and descriptive norms. Findings highlight important issues related to teacher-student interaction during implementation and contributes implications for adolescent substance use prevention research.

"This Isn't Just Busy, This is Scary": Stress, Social Support, and Coping Experiences of Frontline Nurses During the COVID-19 Pandemic.

Despite having previous experience and extensive trauma training, the COVID-19 pandemic presented unprecedented challenges for nurses working in hospital settings. During the pandemic, nurses struggle to care for patients and protect themselves from infection, while navigating ongoing organizational changes. Guided by prior literature on social support and coping, this study explores nurses' experiences of coping with stress while treating COVID-19 patients during the pandemic. In-depth semi-structured interviews were conducted with 14 active staff nurses working in hospitals and one licensed practical nurse (LPN) at a rehabilitation center who treated COVID-19 patients during the pandemic. An inductive thematic analysis was employed to analyze those data, and three overarching themes emerged: (1) nurses' unique experiences in the [COVID-19] trenches, (2) nobody else understands, and (3) coping with stress together. Practically, this study is heuristic and generates an increased understanding of professional communication during times of healthcare crises, illuminating the need to enhance communication skills for both staff nurses and management. This study also extends our understanding of communal coping in the context of healthcare organizations.

Contrasting the efficiency of landscape versus community protection fuel treatment strategies to reduce wildfire exposure and risk.

We examined the financial efficiency and effectiveness of landscape versus community protection fuel treatments to reduce structure exposure and loss to wildfire on a large fire-prone area of central Idaho (USA). The study area contained 63,707 structures distributed in 20 rural communities and resorts, encompassing 13,804 km2. We used simulation modeling to estimate expected structure loss based on burn probability and characteristics of the home ignition zone. We then designed three fuel management strategies that targeted treatments to: 1) the surrounding areas predicted to be the source of exposure to communities from large fires, 2) the home ignition zone, and 3) a combination of the landscape and home ignition zone. We evaluated each treatment scenario in terms of exposure and expected structure loss compared to a no-treatment scenario. The potential revenue from wood products was estimated for each scenario to assess the cost-efficiency. We found that the combined landscape and home ignition zone treatment scenario which treated 5.7% of the study area resulted in the highest overall reduction in predicted exposure (47.5%, 100 structures yr-1) and predicted loss (69.1%, 57 structures yr-1). Home ignition zone treatments provided the best predicted economic and per area treated performance where exposure and loss were reduced by one structure by treating 89 and 111 ha per year, respectively, with an annual cost of $33,645 and $73,672. Revenue from thinning was the highest for landscape fuel treatments and covered 16% of the required investment. This work highlighted economic and risk tradeoffs associated with alternative fuel treatment strategies to protect developed areas from large wildland fires.

The Student Athlete Wellness Portal: Translating Student Athletes' Prescription Opioid Use Narratives into a Targeted Public Health Intervention.

Background and Objectives: The opioid epidemic has permeated all strata of society over the last two decades, especially within the adolescent student athletic environment, a group particularly at risk and presenting their own challenges for science and practice. This paper (a) describes the development of a web-based intervention called the Student Athlete Wellness Portal that models effective opioid misuse resistance strategies and (b) details the findings of a single-group design to test its effectiveness. Materials and Methods: Formative research included 35 student athletes residing in the United States, ages 14 to 21, who had been injured in their school-based sport. They participated in in-depth qualitative interviews to explore narratives relating to their injuries and pain management plans. Inductive analyses of interview transcripts revealed themes of the challenges of being a student athlete, manageable vs. unmanageable pain, and ways to stay healthy. These themes were translated into prevention messages for the portal, which was then tested in a single-group design. Results: Users of the portal (n = 102) showed significant decreases in their willingness to misuse opioids and increases in their perceptions of opioid risks. Conclusions: This manuscript illuminates the processes involved in translating basic research knowledge into intervention scripts and reveals the promising effects of a technology-based wellness portal.

Exploring Indicators of Engagement in Online Learning as Applied to Adolescent Health Prevention: A Pilot Study of REAL media.

Engagement is central to the effectiveness of online health messages and the related educational programs that aim to deliver these messages to the intended audience (Li, Won, Yang et al. 2019: Lin, Hung, Kinshuk et al. 2019). Drawing from health communication and social learning theories, the Theory of Active Involvement (TAI) (Greene, 2013) posits that an online prevention program's impact depends on how engaged participants are. In practice, measuring engagement in this context has relied primarily on self-report measures (e.g., Hamutoglu, Gemikonakli, Duman et al. 2019). However, the emergence and growth of online learning platforms to deliver health-specific information offers other options for assessing engagement. This includes program analytics that capture interaction with content and facilitate examination of patterns via multiple indicators such as responses to interactive questions and time spent in the program (Herodotou, Rienties, Boroowa, et al. 2019; Li, Wong, Yang et al. 2019; van Leeuwen, 2019). However, little is known about the relationships between these different indicators of engagement as it applies to health curricula. This study uses self-report, observational, and program analytic data collected on a small (N = 38) sample using REAL media, an online substance use prevention program, to examine relationships among various indicators of engagement. Findings suggest a cluster of indicators across the three modalities that provide a useful way of measuring engagement. A cluster centered around complexity suggests a separate factor to be considered when designing engaging interventions.

Differential Effects of Parental "drug talk" Styles and Family Communication Environments on Adolescent Substance Use.

The current study examines the relationships among adolescent reports of parent-adolescent drug talk styles, family communication environments (e.g., expressiveness, structural traditionalism, and conflict avoidance), and adolescent substance use. ANCOVAs revealed that the 9th grade adolescents (N = 718) engaged in four styles of "drug talks" with parents (e.g., situated direct, ongoing direct, situated indirect, and ongoing indirect style) and these styles differed in their effect on adolescent substance use. Multiple regression analyses showed that expressiveness and structural traditionalism were negatively related to adolescent substance use, whereas conflict avoidance was positively associated with substance use. When controlling for family communication environments and gender, adolescents with an ongoing indirect style reported the lowest use of substance. The findings suggest implications and future directions for theory and practice.

Trends of Parent-Adolescent Drug Talk Styles in Early Adolescence.

The present study seeks to understand how parents as prevention agents approach substance use prevention messages during the period of early adolescence. Students (N = 410) in a drug prevention trial completed surveys from 7th to 9th grade. Using longitudinal data, a series of latent transition analyses was conducted to identify major trends of parent-adolescent drug talk styles (i.e., never talked, situated direct, ongoing direct, situated indirect, and ongoing indirect) in control and treatment conditions. Findings demonstrate a developmental trend in drug talk styles toward a situated style of talk as youth transitioned from 7th grade to 9th grade. Findings also show that even though the drug prevention trial did not specifically target parental communication, parents in the treatment condition provide more ongoing substance use prevention messages to their adolescent children than do parents in the control condition. The present study discusses relevant developmental issues, potential intervention effects, and future research directions for communication research in substance use prevention.

Entertainment-Education Videos as a Persuasive Tool in the Substance Use Prevention Intervention "keepin' it REAL".

Based on social cognitive theory and narrative engagement theory, the current study examined hypothesized indirect effects of engagement with keepin' it REAL (kiR) curriculum entertainment-education (E-E) videos on youth alcohol use via youth drug offer refusal efficacy. Students in 7th grade (N = 1,464) at 25 public schools in two Midwestern states were randomly assigned to one of the two versions of the kiR curriculum, the kiR urban version and the kiR rural version. Each version had their own set of five culturally-grounded E-E videos depicting communicative skills to refuse drug offers. Differential effects for engagement components were expected depending on the degree of cultural matching. Pre/post surveys were administered at the beginning and the end of 7th grade. Structural equation modeling analysis resulted in partial support for the research hypotheses. Rural youth receiving the urban curriculum who reported higher interest in the E-E videos were more likely to report having higher refusal efficacy, and in turn, less likely to use alcohol. Rural youth receiving the rural curriculum who identified with the E-E video main characters were more likely to report having higher refusal efficacy, and in turn, less likely to use alcohol. Implications for E-E health promotion are discussed.

Parental Messages about Substance Use in Early Adolescence: Extending a Model of Drug-Talk Styles.

This study extends a typology of parent-offspring drug talk styles to early adolescents and investigates associations with adolescent substance use. Data come from a self-report survey associated with a school-based, 7th grade drug prevention curriculum. Mixed methods were used to collect data across four measurement occasions spanning 30 months. Findings highlight the frequencies of various drug-talk styles over time (i.e., situated direct, ongoing direct, situated indirect, ongoing indirect, never talked), messages adolescents hear from parents, and comparisons of alcohol, cigarette, and marijuana use by drug-talk style. This study advances an understanding of parent-adolescent communication about substances and holds practical implications for drug prevention efforts.

Assessing Transboundary Wildfire Exposure in the Southwestern United States.

We assessed transboundary wildfire exposure among federal, state, and private lands and 447 communities in the state of Arizona, southwestern United States. The study quantified the relative magnitude of transboundary (incoming, outgoing) versus nontransboundary (i.e., self-burning) wildfire exposure based on land tenure or community of the simulated ignition and the resulting fire perimeter. We developed and described several new metrics to quantify and map transboundary exposure. We found that incoming transboundary fire accounted for 37% of the total area burned on large parcels of federal and state lands, whereas 63% of the area burned was burned by ignitions within the parcel. However, substantial parcel to parcel variation was observed for all land tenures for all metrics. We found that incoming transboundary fire accounted for 66% of the total area burned within communities versus 34% of the area burned by self-burning ignitions. Of the total area burned within communities, private lands contributed the largest proportion (36.7%), followed by national forests (19.5%), and state lands (15.4%). On average seven land tenures contributed wildfire to individual communities. Annual wildfire exposure to structures was highest for wildfires ignited on state and national forest land, followed by tribal, private, and BLM. We mapped community firesheds, that is, the area where ignitions can spawn fires that can burn into communities, and estimated that they covered 7.7 million ha, or 26% of the state of Arizona. Our methods address gaps in existing wildfire risk assessments, and their implementation can help reduce fragmentation in governance systems and inefficiencies in risk planning.

Designed Cultural Adaptation and Delivery Quality in Rural Substance Use Prevention: an Effectiveness Trial for the Keepin' it REAL Curriculum.

This study examined how cultural adaptation and delivery quality of the school-based intervention keepin' it REAL (kiR) influenced adolescent substance use. The goal of the study was to compare the effectiveness of the multi-cultural, urban (non-adapted) kiR intervention, a re-grounded (adapted) rural version of the kiR intervention and control condition in a new, rural setting. A total of 39 middle schools in rural communities of two states in the USA were randomly assigned to one of three conditions (i.e., control, non-adapted urban kiR, and adapted rural kiR). Data included adolescent self-reported lifetime substance use and observers' ratings of delivery quality from video recordings of lessons. Ratings of delivery quality were used to create four comparison groups (i.e., low/high delivery quality in non-adapted/urban kiR condition and low/high quality in adapted/rural kiR condition). Controlling for substance use in the 7th grade, findings compared 9th graders' (N = 2781) lifetime alcohol, cigarette, marijuana, and chewing tobacco use. Mixed model analyses revealed that rural youth receiving the culturally adapted/rural curriculum reported significantly less cigarette use than rural youth in the control condition regardless of delivery quality. In the non-adapted/urban condition, youth receiving high delivery quality delivery reported less marijuana use than those receiving low delivery quality condition. However, substance use outcomes of youth receiving high and low delivery quality in the non-adapted intervention did not differ significantly from those the control group. Findings support the effectiveness of the culturally adapted/rural keepin' it REAL curriculum for rural youth.

"In Principle We Have Agreement, But in Practice It Is a Bit More Difficult": Obtaining Organizational Buy-In to Patient-Centered Medical Home Transformation.

The patient-centered medical home (PCMH) is a model of care that emphasizes the coordination of patient treatment among health care providers. Practice transformation to this model, however, presents a number of challenges. One of these challenges is getting the buy-in of all personnel to commit to making organizational changes in the journey to becoming a nationally recognized medical home. This study investigated internal messages of buy-in as communicated by practices transitioning to this type of care. Grounding itself in stakeholder theory, this study analyzed interviews with staff, administration, and practitioners from 20 medical practices in a mid-Atlantic state. The analysis revealed three overarching themes: (a) communication among staff that is open, consistent; (b) implementation of reinforcement techniques; and (c) access to a change implementer who encourages successful evolution. Discussion of these themes provides recommendations for communication approaches to organizational buy-in for medical practices hoping to become a PCMH.

How nurse-led practices perceive implementation of the patient-centered medical home.

PURPOSE: The Affordable Care Act (ACA) promotes the Patient-Centered Medical Home (PCMH) model as a way to improve healthcare quality, the patient experience, and has identified nurse-led primary care as a mechanism meeting the increasing demand for quality primary care. The purpose of this study was to investigate the implementation of a PCMH model in nurse-led primary care practices and to identify facilitators and barriers to the implementation of this model. METHODS: Data were collected through in-depth interviews with providers and staff in nurse-led practices. RESULTS: These data suggest two categories of processes that facilitate the integration of PCMH in the nurse-led practice setting: patient-oriented facilitators and organizational facilitators. In addition, a number of barriers were identified to implementing the PCMH model. Overall, these practices creatively engaged in the transformation process by structuring themselves as a complex adaptive system and building upon the core principles of nurse-led care. CONCLUSION: Since the core principles of nurse-led care map onto many of the same principles of the PCMH model, this study discusses the possibility that nurse-led practices may experience fewer barriers when transitioning into PCMHs.

A Longitudinal Study of Parental Anti-Substance-Use Socialization for Early Adolescents' Substance-Use Behaviors.

The present study examines the role of communication in shaping norms and behaviors with significant personal and societal consequences. Based on primary socialization theory and the general theory of family communication, parental anti-substance-use socialization processes were hypothesized to influence early adolescents' substance use norms and behaviors. Using longitudinal data (N =1,059), the results revealed that parent-adolescent prevention communication about substance use in the media and parental anti-substance-use injunctive norms were positively associated with early adolescents' personal anti-substance-use norms, which, in turn, led to decreases in recent alcohol, cigarette, and marijuana use. It was also found that family expressiveness and structural traditionalism positively related to the hypothesized association between parental socialization processes and early adolescents' norms and behaviors.

Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home.

INTRODUCTION: Hypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patient-centered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control. METHODS: The PCMH transformation initiative conducted 118 semistructured interviews at 17 primary care practices in southeastern Pennsylvania between January 2011 and January 2012. Clinicians (n = 47), medical assistants (n = 26), office administrators (n = 12), care managers (n = 11), front office staff (n = 7), patient educators (n = 4), nurses (n = 4), social workers (n = 4), and other administrators (n = 3) participated in interviews. Study personnel used thematic analysis to identify themes related to hypertension care. RESULTS: Clinicians described difficulties in expanding services under PCMH to meet the needs of the growing number of patients with hypertension as well as how perceptions of hypertension control differed from actual performance. Staff and office administrators discussed achieving patient-centered hypertension care through patient education and self-management support with personalized care plans. They indicated that patient report cards were helpful tools. Participants across all groups discussed a team- and systems-based approach to hypertension care. CONCLUSION: Practices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care.

Production possibility frontiers and socioecological tradeoffs for restoration of fire adapted forests.

We used spatial optimization to analyze alternative restoration scenarios and quantify tradeoffs for a large, multifaceted restoration program to restore resiliency to forest landscapes in the western US. We specifically examined tradeoffs between provisional ecosystem services, fire protection, and the amelioration of key ecological stressors. The results revealed that attainment of multiple restoration objectives was constrained due to the joint spatial patterns of ecological conditions and socioeconomic values. We also found that current restoration projects are substantially suboptimal, perhaps the result of compromises in the collaborative planning process used by federal planners, or operational constraints on forest management activities. The juxtaposition of ecological settings with human values generated sharp tradeoffs, especially with respect to community wildfire protection versus generating revenue to support restoration and fire protection activities. The analysis and methods can be leveraged by ongoing restoration programs in many ways including: 1) integrated prioritization of restoration activities at multiple scales on public and adjoining private lands, 2) identification and mapping of conflicts between ecological restoration and socioeconomic objectives, 3) measuring the efficiency of ongoing restoration projects compared to the optimal production possibility frontier, 4) consideration of fire transmission among public and private land parcels as a prioritization metric, and 5) finding socially optimal regions along the production frontier as part of collaborative restoration planning.