Analysis of school-based asthma screenings and need for care coordination in underserved urban communities.

BACKGROUND: Asthma is one of the most common chronic childhood disease states in the United States and continues to become more prevalent. Data suggest the incidence, morbidity, and mortality of asthma are higher among minority children of lower socioeconomic status living in urban settings. There is a lack of data evaluating the impact of mass school-based asthma screenings and care coordination in underserved communities. OBJECTIVE: This study aimed to determine whether a school-based asthma screening program is effective in identifying children who are at risk of undiagnosed and uncontrolled asthma and whether there is a need for care coordination. METHODS: This study is a retrospective review describing the outcomes of the 2021 school-based asthma screening program. Asthma screening data from 6 participating school districts (prekindergarten to twelfth grade) in the greater Pittsburgh area were included in this review. An asthma screening questionnaire was distributed school-wide and included questions about demographics, previous asthma diagnosis, repeated episodes of asthma, and frequency of symptoms. Based on caregiver-reported answers, children who screened positive for previously diagnosed asthma, uncontrolled asthma, or undiagnosed asthma received care coordination for follow-up care. RESULTS: This study included asthma screening results for 561 participants. Approximately 13% of participants (n = 73) displayed asthma symptoms but did not have a diagnosis of asthma. Of those 73 participants, 9.6% (n = 54) were at risk of uncontrolled asthma. The screening tool also identified 5.6% of participants (n = 32) who had a diagnosis of asthma and were at risk of uncontrolled asthma. CONCLUSIONS: The school-based asthma screening program was effective in identifying children at risk of undiagnosed and uncontrolled asthma. Pharmacists are well positioned to implement asthma screening programs in schools and throughout the community.

Specific and nonspecific effects of naltrexone on goal-directed and habitual models of alcohol seeking and drinking.

BACKGROUND: The opioid-receptor antagonist naltrexone (NTX) reduces goal-directed alcohol drinking in rats presumably by blunting alcohol reward. However, different operant conditioning behavior can be produced by different reinforcement schedules, with goal-directed operant behavior being more sensitive to changes in reward value than less flexible, habit-associated models. We tested the hypothesis that NTX more effectively reduces alcohol drinking and seeking in a goal-directed than in a habit-associated operant model, and more effectively reduces alcohol versus sucrose self-administration, consistent with diminished alcohol reward. METHODS: Rats were trained to self-administer 10% alcohol or 1.5% sucrose in a lever-press task and then underwent a within-subject assessment of NTX (0.1 to 1 mg/kg) effects on operant behavior. A fixed-ratio (FR5) reinforcement schedule was used to model goal-directed behavior, and a variable-interval (VI30) schedule was used to model habitual behavior. RESULTS: As predicted, NTX reduced fluid deliveries earned by the FR5-alcohol group significantly more than all other groups. However, NTX reduced lever presses during self-administration sessions in VI30-trained rats without reducing earned deliveries, due to the low contingency between rate of pressing and fluid deliveries under that schedule. Interestingly, when fluid delivery was withheld (extinction), NTX reduced reward-seeking in all rats. Finally, NTX blocked reinstatement of reward-seeking upon presentation of 0.2 ml alcohol or sucrose and associated cues in the FR5-trained but not VI30-trained rats. CONCLUSIONS: NTX reduced goal-directed alcohol drinking compared with other operant conditions. In addition, NTX blocked reinstatement of reward-seeking in rats trained on the goal-directed FR5 reinforcement schedule but not in rats trained on the habit-like VI30 reinforcement schedule. However, NTX also exerted nonspecific effects on reward-seeking that were revealed under low-effort contingency conditions or absence of reward. Together, these data support the hypothesis that NTX is less effective in conditioning models that are more habit-associated.

Genetic analysis of the PCSK9 locus in psychological, psychiatric, metabolic and cardiovascular traits in UK Biobank.

The association between severe mental illness (SMI) and cardiovascular and metabolic disease (CMD) is poorly understood. PCSK9 is expressed in systems critical to both SMI and CMD and influences lipid homeostasis and brain function. We systematically investigated relationships between genetic variation within the PCSK9 locus and risk for both CMD and SMI. UK Biobank recruited ~500,000 volunteers and assessed a wide range of SMI and CMD phenotypes. We used genetic data from white British ancestry individuals of UK Biobank. Genetic association analyses were conducted in PLINK, with statistical significance defined by the number of independent SNPs. Conditional analyses and linkage disequilibrium assessed the independence of SNPs and the presence of multiple signals. Two genetic risk scores of lipid-lowering alleles were calculated and used as proxies for putative lipid-lowering effects of PCSK9. PCSK9 variants were associated with central adiposity, venous thrombosis embolism, systolic blood pressure, mood instability, and neuroticism (all p < 1.16 × 10-4). No secondary signals were identified. Conditional analyses and high linkage disequilibrium (r2 = 0.98) indicated that mood instability and central obesity may share a genetic signal. Genetic risk scores suggested that the lipid-lowering effects of PCSK9 may be causal for greater mood instability and higher neuroticism. This is the first study to implicate the PCSK9 locus in mood-disorder symptoms and related traits, as well as the shared pathology of SMI and CMD. PCSK9 effects on mood may occur via lipid-lowering mechanisms. Further work is needed to understand whether repurposing PCSK9-targeting therapies might improve SMI symptoms and prevent CMD.

Motivators and barriers to adoption of Improved Land Management Practices. A focus on practice change for water quality improvement in Great Barrier Reef catchments.

To protect and improve water quality in the Great Barrier Reef, the Queensland Government's Reef 2050 Water Quality Improvement Plan targets that 90% of sugarcane, horticulture, cropping and grazing lands in priority areas be managed using best management practices for sediment, nutrient and pesticides by 2025. Progress towards this target is insufficient and variable across catchments and industries. The motivation to adopt improvements in management practices is heavily influenced by social, economic, cultural and institutional dimensions. In this paper we synthesise the literature on how these human dimensions influence decision making for land management practice and highlight where future investment could be focussed. We highlight that focussing on -1) investigating systems to support landholder decision making under climate uncertainty (risk); 2) generating a better understanding of the extent and drivers of landholder transaction cost; 3) understanding if there are competing 'right' ways to farm; and 4) improving understanding of the social processes, trust and power dynamics within GBR industries and what these means for practice change- could improve practice change uptake in the future.

Modelling the impacts of climate change on riverine thermal regimes in western Canada's largest Pacific watershed.

Quantification of climate change impacts on the thermal regimes of rivers in British Columbia (BC) is crucial given their importance to aquatic ecosystems. Using the Air2Stream model, we investigate the impact of both air temperature and streamflow changes on river water temperatures from 1950 to 2015 across BC's 234,000 km2 Fraser River Basin (FRB). Model results show the FRB's summer water temperatures rose by nearly 1.0 °C during 1950-2015 with 0.47 °C spread across 17 river sites. For most of these sites, such increases in average summer water temperature have doubled the number of days exceeding 20 °C, the water temperature that, if exceeded, potentially increases the physiological stress of salmon during migration. Furthermore, river sites, especially those in the upper and middle FRB, show significant associations between Pacific Ocean teleconnections and regional water temperatures. A multivariate linear regression analysis reveals that air temperature primarily controls simulated water temperatures in the FRB by capturing ~80% of its explained variance with secondary impacts through river discharge. Given such increases in river water temperature, salmon returning to spawn in the Fraser River and its tributaries are facing continued and increasing physical challenges now and potentially into the future.

Equivalent mismatch negativity deficits across deviant types in early illness schizophrenia-spectrum patients.

Neurophysiological abnormalities in auditory deviance processing, as reflected by the mismatch negativity (MMN), have been observed across the course of schizophrenia. Studies in early schizophrenia patients have typically shown varying degrees of MMN amplitude reduction for different deviant types, suggesting that different auditory deviants are uniquely processed and may be differentially affected by duration of illness. To explore this further, we examined the MMN response to 4 auditory deviants (duration, frequency, duration+frequency "double deviant", and intensity) in 24 schizophrenia-spectrum patients early in the illness (ESZ) and 21 healthy controls. ESZ showed significantly reduced MMN relative to healthy controls for all deviant types (p<0.05), with no significant interaction with deviant type. No correlations with clinical symptoms were present (all ps>0.05). These findings support the conclusion that neurophysiological mechanisms underlying processing of auditory deviants are compromised early in illness, and these deficiencies are not specific to the type of deviant presented.