Amyloid-related imaging abnormalities-haemosiderin (ARIA-H) in patients with Alzheimer's disease treated with bapineuzumab: a historical, prospective secondary analysis.

BACKGROUND: Amyloid-related imaging abnormalities due to haemosiderin deposition (ARIA-H) occur in patients with mild to moderate dementia due to Alzheimer's disease (AD) and have been reported with increased incidence in clinical trials of amyloid-lowering therapies under development for AD. OBJECTIVE: Our objective was to explore the relationship between the incidences of ARIA-H during treatment with placebo and different doses of bapineuzumab, a humanised monoclonal antibody directed against amyloid ß. METHODS: Two neuroradiologists independently reviewed 2572 GRE/T2* MRI sequences from 262 participants in two phase two clinical trials of bapineuzumab and an open-label extension study. Readers were blinded to the participant's therapy, APOE ε4 genotype and medical history. RESULTS: Several risk factors for small ARIA-H <10 mm (microhaemorrhages) were identified: APOE ε4, bapineuzumab treatment, pre-existing small ARIA-H and use of antithrombotics. The HR (95%CI) for incident ARIA-H <10 mm associated with the number of APOE ε4 alleles was 11.9 (3.3 to 42.5) for 2 versus no alleles and 3.5 (1.0 to 12.0) for 1 versus no allele. The HR for bapineuzumab therapy was 3.5 (1.0 to 12.0); for the presence of baseline ARIA-H <10 mm, it was 3.5 (1.6 to 7.8), and for the use of antithrombotic agents it was 2.2 (1.0 to 4.8). The incidence rate for ARIA-H <10 mm was elevated only in the initial 6 months of active treatment and declined after this interval to a rate similar to that observed in the group treated with placebo. CONCLUSIONS: ARIA-H represents a spectrum of MRI findings due to haemosiderin deposition that appears to be related to impaired vascular integrity. The increased risk for ARIA-H associated with APOE ε4 allele frequency, pre-existing ARIA-H, treatment with bapineuzumab and use of antithrombotic agents provides additional support for this hypothesis of loss of integrity of cerebral vessels due to amyloid burden. TRIAL REGISTRATION: NCT00112073 and NCT00606476.

Gene density and chromosome territory shape.

Despite decades of study of chromosome territories (CT) in the interphase nucleus of mammalian cells, our understanding of the global shape and 3-D organization of the individual CT remains very limited. Past microscopic analysis of CT suggested that while many of the CT appear to be very regular ellipsoid-like shapes, there were also those with more irregular shapes. We have undertaken a comprehensive analysis to determine the degree of shape regularity of different CT. To be representative of the whole human genome, 12 different CT (~41 % of the genome) were selected that ranged from the largest (CT 1) to the smallest (CT 21) in size and from the highest (CT 19) to lowest (CT Y) in gene density. Using both visual inspection and algorithms that measure the degree of shape ellipticity and regularity, we demonstrate a strong inverse correlation between the degree of regular CT shape and gene density for those CT that are most gene-rich (19, 17, 11) and gene-poor (18, 13, Y). CT more intermediate in gene density showed a strong negative correlation with shape regularity, but not with ellipticity. An even more striking correlation between gene density and CT shape was determined for the nucleolar-associated NOR-CT. Correspondingly, striking differences in shape between the X active and inactive CT implied that aside from gene density, the overall global level of gene transcription on individual CT is also an important determinant of chromosome territory shape.

Intra-rater and inter-rater reliability of 3D facial measurements.

Three-dimensional (3D) body scanning technology has applications for obtaining anthropometric data in human-centered and product development fields. The reliability of 3D measurements gathered from 3D scans must be assessed to understand the degree to which this technology is appropriate for use in place of manual anthropometric methods. The intra- and inter-rater reliabilities of 3D facial measurements were assessed among four novice raters using 3D landmarking. Intraclass correlation coefficient (ICC) statistics were calculated for the 3D measurement data collected in three phases to assess baseline reliabilities and improvements in reliabilities as the result of additional training and experience. Based on the results of this study, the researchers found that the collection of 3D measurement data, by multiple raters and using 3D landmarking methods, yielded a high percentage of ICC statistics in the good to excellent (>0.75 ICC) reliability range. Rater training and experience were important considerations in improving intra- and inter-rater reliabilities.

A qualitative exploration of positive body image experiences among nonbinary individuals.

One group whose positive body image experiences remain under-explored is individuals who identify as nonbinary, gender fluid, and/or genderqueer (including other nonbinary identities). Thus, we sought to answer the questions: What does it look like to have a positive body image for a nonbinary person? and How do nonbinary persons form and maintain a positive body image? To answer these questions, we conducted in-depth, semi-structured interviews with 15 nonbinary individuals who were assessed as having positive body image using the Body Appreciation Scale-2 (Tylka & Wood-Barcalow, 2015a). Data were analyzed using reflexive thematic analysis. Four themes were identified as characterizing the core features of positive body image among nonbinary persons: body appreciation, body- and self-acceptance, bodily appearance embodied their authentic self, and holding flexible ideals for ways of being. Six themes were identified as related to on-going processes that explain how body image is formed and maintained among nonbinary persons: reframing negative body image information, staging resistance, experiencing representation, receiving and giving social support, practicing self-compassion and self-care, and using dress to create a satisfying presentation of self. In keeping with the tenets of queer theory, findings reflected how gender identity set a context for participants' positive body image experiences.

Assessing Preference in a Paired-Stimulus Arrangement with Captive Vultures (Aegypius Monachus).

Vultures play an important role in our ecosystem by filtering out bacteria and viruses harmful to humans (e.g., rabies, botulism). However, many vultures remain in human care due to skill deficits and behavioral excesses, which can be treated using behavior-management practices that rely on effective (often edible) reinforcers. The current study replicated the forced-choice or paired-stimulus preference assessment with five birds of prey. Across all vultures, participants displayed a preference for animal (e.g., meat) over nonanimal stimuli (e.g., fruit), and mice meat was the most preferred edible for 4 of the 5 vultures. The application of this methodology to birds of prey might allow rehabilitators, conservationists, and other caretakers to make greater gains in training vultures to both acquire new skills and decrease problem behavior using highly preferred edible items.

Interprofessional Collaboration to Optimize Trauma-Informed Care in Pediatric Forensics.

ABSTRACT: There are many challenges in providing trauma-informed healthcare to pediatric victims of sexual abuse and their families. We address this through collaborative interprofessional efforts within our hospital facility, located in a Midwestern adult Level 1 and pediatric trauma center. Our sexual assault nurse examiner team is composed of eight nurses and provides 24/7 coverage. The child abuse team located in our hospital includes one board-certified child abuse pediatrician, one certified pediatric nurse practitioner, and a licensed clinical social worker. The application of trauma-informed care using case scenarios involving both teams is described in this article.

Understanding firewomen's fit problems with their coats and pants and its impact on mobility and safety.

BACKGROUND: Inadequately fitting turnout coats and pants hamper mobility and safety of firewomen. Previous research has established that firewomen are dissatisfied with their turnout coats and pants. Yet, there has been minimal in-depth research into the specific fit problems and consequences of these problems on the workplace health of firewomen. OBJECTIVE: The researchers sought to uncover common fit problems firewomen have with turnout coats and pants, and their impact on mobility and safety while performing work. METHODS: The researchers performed a qualitative analysis of in-depth interviews of 35 firewomen. RESULTS: The study illuminated specific fit problems firewomen have with their turnout coats and pants. These fit challenges include challenges with the overall proportions of the turnout coats and pants as well as issues of length and how the turnout coats and pants fit around their body (circumference), leading to concerns about mobility and safety. CONCLUSIONS: This study builds an understanding of specific fit problems on the ability of firewomen to do their challenging work in a safe and stress-free manner. Firewomen's protective apparel should protect and empower all firewomen. To adequately protect firewomen, manufactures should prioritize the implementation of these findings to improve the safety and mobility that firewomen's turnout coats and pants offer them.

Building a Safe and Healthy America: Eliminating Corporal Punishment via Positive Parenting.

corporal punishment (CP) is associated with negative short-term and long-term children outcomes. However, many caregivers continue to administer spankings and other forms of CP. Pediatric nurse practitioners are in a unique position to affect change in parental behavior related to CP use and other parenting practices. This article will summarize the research on the dangers of CP and the corresponding benefits of positive parenting. It defines positive parenting and offers resources pediatric health care providers, including pediatric nurse practitioners, can use to educate both themselves and caregivers about specific discipline techniques appropriate to each developmental stage. Finally, it suggests practice strategies pediatric nurse practitioners can use to help caregivers replace CP and other harsh parenting practices with positive parenting to build a safe and healthy America.

Functional analysis and treatment of self-injurious feather plucking in a black vulture (Coragyps atratus).

The etiology and maintenance of self-injurious feather plucking (FP) have been attributed to biological and environmental processes, yet a definitive solution has not been found. The current study investigated the application of a functional analysis and function-based treatment to reduce the FP of a black vulture (Coragyps atratus). FP was found to be maintained by positive reinforcement in the form of contingent attention. A treatment consisting of noncontingent reinforcement decreased FP, and levels of FP remained low during schedule thinning. The current study further demonstrates the validity of function-based assessment and treatment with captive animals.

"On a Journey to Appreciate What My Body Does for Me": Qualitative Results from a Positive Body Image Pilot Intervention Study.

Research suggests body appreciation is related to mental, physical, and sexual health behaviors and outcomes that are relevant to social workers and public health clinicians. As such, it is imperative to develop and test interventions that aim to improve body appreciation. The current study is part of a larger pilot intervention study that utilized 3D scanning technology. During the intervention, 18-25-year-old women digitally "painted" their avatar on a computer based on a series of prompts from the researcher. The purpose of this study is to qualitatively explore how a small subsample of the participants (n = 18) experienced this innovative intervention and how they view themselves differently post-intervention. Using thematic analysis, we uncovered three themes: 1) ways of defining body image, 2) importance of body function over aesthetics, and 3) body acceptance and appreciation. This study provides support for the use of one-time individual-level interventions focused on body appreciation and functionality over appearance. Implications are discussed.

Commercial Sexual Exploitation of Children: An Update for the Forensic Nurse.

Commercial sexual exploitation of children (CSEC) is the sexual abuse of children through buying, selling, or trading their sexual services. This may involve engaging a child under the age of 18 years in prostitution, pornography, stripping, exotic dancing, escort services, or other sexual services. CSEC is a problem of epidemic proportions throughout the world including the United States; however, the actual number of CSEC victims in the United States is unknown. Studies indicate that most child victims are seen by a healthcare provider while being trafficked and that many victims receive care at a pediatric hospital within 1 year of their identification as a victim. CSEC is a significant pediatric healthcare problem. It is vital that forensic nurses possess a thorough understanding of the problem and be poised to better identify, intervene, and prevent CSEC. In this article, we focus on risk factors commonly experienced by victims, recruitment strategies used by traffickers, indicators to identify child victims, and intervention and educational strategies of relevance to forensic nurses.

Effect of firefighters' personal protective equipment on gait.

The biomechanical experiment with eight male and four female firefighters demonstrates that the effect of adding essential equipment: turnout ensemble, self-contained breathing apparatus, and boots (leather and rubber boots), significantly restricts foot pronation. This finding is supported by a decrease in anterior-posterior and medial-lateral excursion of center of plantar pressure (COP) trajectory during walking. The accumulation of this equipment decreases COP velocity and increases foot-ground contact time and stride time, indicating increased gait instability. An increase in the flexing resistance of the boots is the major contributor to restricted foot pronation and gait instability as evidenced by the greater decrease in excursion of COP in leather boots (greater flexing resistance) than in rubber boots (lower resistance). The leather boots also shows the greatest increase in foot contact time and stride time. These negative impacts can increase musculoskeletal injuries in unfavorable fire ground environments.

Corporal Punishment: Evaluation of an Intervention by PNPs.

INTRODUCTION: Corporal punishment (CP) is defined as the use of physical force with the intention of causing a child to experience pain but not injury for the purpose of correction or control of the child's behavior. CP has been linked to a variety of negative consequences for children, including physical abuse, eternalizing behavioral problems, and slowed cognitive development. Many American children continue to experience CP at the hands of their parents and other caregivers. The purpose of this study was to evaluate learner attitude toward CP before and after implementation of a pediatric nurse practitioner-designed educational intervention and influences upon learner attitude and beliefs about CP. METHOD: This study used a pre- and postsurvey design to assess learner attitude about CP before and after participation in an educational intervention. Influences upon learner attitudes and beliefs regarding CP were also described. Learners (N = 882) were health care providers. RESULTS: Nearly all learners (n = 747; 84.7%) stated that the way their parents disciplined them influenced their attitudes toward CP. Fewer than one fifth of learners who were also parents (n = 126; 14.4%) reported that their child's health care provider had ever discussed child discipline with them. Prior to the educational intervention, more than one third of learners (n = 351; 39.88%) endorsed spanking as sometimes necessary, yet significantly fewer learners (n = 251; 28.9%; p < .001) made this statement after the educational intervention. Child discipline management was included in the health care provider education for fewer than half of learners (n = 365; 41.4%). DISCUSSION: The potential for experiencing CP as a child to result in negative consequences for children has been well documented, yet many American parents continue to use CP as a form of child discipline, and some pediatric health care professionals continue to endorse its use. Pediatric health care providers, including nurses and pediatric nurse practitioners, need to be educated about child discipline and CP. All pediatric health care providers need to advocate for the use of positive parenting principles and discourage the use of CP.

Veracity for children in pediatric forensics.

Child sexual abuse is a heinous crime, and school-age children are the age group most commonly victimized. When occurring within the family, it is particularly difficult and confusing for the child to disclose. The role of the sexual assault nurse examiner, and the challenges in applying the ethical concept of veracity when caring for these young victims is examined, using vignettes based on actual situations. It is essential for the forensic nurse to be able to understand and apply theories of childhood development to these cases in order to facilitate communication with the child, while providing assurance that they are believed.

Amyloid-related imaging abnormalities in patients with Alzheimer's disease treated with bapineuzumab: a retrospective analysis.

BACKGROUND: Amyloid-related imaging abnormalities (ARIA) have been reported in patients with Alzheimer's disease treated with bapineuzumab, a humanised monoclonal antibody against amyloid ß. ARIA include MRI signal abnormalities suggestive of vasogenic oedema and sulcal effusions (ARIA-E) and microhaemorrhages and haemosiderin deposits (ARIA-H). Our aim was to investigate the incidence of ARIA during treatment with bapineuzumab, and evaluate associated risk factors. METHODS: Two neuroradiologists independently reviewed 2572 fluid-attenuated inversion recovery (FLAIR) MRI scans from 262 participants in two phase 2 studies of bapineuzumab and an open-label extension study. Readers were masked to the patient's treatment, APOE ɛ4 genotype, medical history, and demographics. Patients were included in risk analyses if they had no evidence of ARIA-E in their pre-treatment MRI, had received bapineuzumab, and had at least one MRI scan after treatment. We used Kaplan-Meier survival analysis to examine the distribution of incident ARIA-E from the start of bapineuzumab treatment and proportional hazards regression models to assess risk factors associated with ARIA. FINDINGS: 210 patients were included in the risk analyses. 36 patients (17%) developed ARIA-E during treatment with bapineuzumab; 15 of these ARIA-E cases (42%) had not been detected previously. 28 of these patients (78%) did not report associated symptoms. Adverse events, reported in eight symptomatic patients, included headache, confusion, and neuropsychiatric and gastrointestinal symptoms. Incident ARIA-H occurred in 17 of the patients with ARIA-E (47%), compared with seven of 177 (4%) patients without ARIA-E. 13 of the 15 patients in whom ARIA were detected in our study received additional treatment infusions while ARIA-E were present, without any associated symptoms. Occurrence of ARIA-E increased with bapineuzumab dose (hazard ratio [HR] 2·24 per 1 mg/kg increase in dose, 95% CI 1·40-3·62; p=0·0008) and presence of APOE ɛ4 alleles (HR 2·55 per allele, 95% CI 1·57-4·12; p=0·0001). INTERPRETATION: ARIA consist of a spectrum of imaging findings with variable clinical correlates, and some patients with ARIA-E remain asymptomatic even if treatment is continued. The increased risk of ARIA among APOE ɛ4 carriers, its association with high bapineuzumab dose, and its timecourse in relation to dosing suggest an association between ARIA and alterations in vascular amyloid burden. FUNDING: Elan Corporation, Janssen Alzheimer Immunotherapy, Wyeth Pharmaceuticals, and Pfizer.