Barriers and facilitators to recruitment of underrepresented research participants: Perspectives of clinical research coordinators.

Background: Insufficient recruitment of groups underrepresented in medical research threatens the generalizability of research findings and compounds inequity in research and medicine. In the present study, we examined barriers and facilitators to recruitment of underrepresented research participants from the perspective of clinical research coordinators (CRCs). Methods: CRCs from one adult and one pediatric academic medical centers completed an online survey in April-May 2022. Survey topics included: participant language and translations, cultural competency training, incentives for research participation, study location, and participant research literacy. CRCs also reported their success in recruiting individuals from various backgrounds and completed an implicit bias measure. Results: Surveys were completed by 220 CRCs. CRCs indicated that recruitment is improved by having translated study materials, providing incentives to compensate participants, and reducing the number of in-person study visits. Most CRCs had completed some form of cultural competency training, but most also felt that the training either had no effect or made them feel less confident in approaching prospective participants from backgrounds different than their own. In general, CRCs reported having greater success in recruiting prospective participants from groups that are not underrepresented in research. Results of the implicit bias measure did not indicate that bias was associated with intentions to approach a prospective participant. Conclusions: CRCs identified several strategies to improve recruitment of underrepresented research participants, and CRC insights aligned with insights from research participants in previous work. Further research is needed to understand the impact of cultural competency training on recruitment of underrepresented research participants.

Terrestrial atmospheric composition from stellar occultations.

Stellar ultraviolet light transmitted through the earth's upper atmosphere is strongly absorbed by ozone and molecular oxygen. The stellar ultraviolet photometers aboard the Orbiting Astronomical Observatory (OAO-2) satellite have measured the intensity changes of several stars during occultation of the star by the earth's atmosphere. From the occultation data the nighttime vertical number density profiles of molecular oxygen at altitudes from 120 to 200 kilometers and of ozone at altitudes from 60 to 100 kilometers have been obtained.

Distribution and variability of redox zones controlling spatial variability of arsenic in the Mississippi River Valley alluvial aquifer, southeastern Arkansas.

Twenty one of 118 irrigation water wells in the shallow (25-30 m thick) Mississippi River Valley alluvial aquifer in the Bayou Bartholomew watershed, southeastern Arkansas had arsenic (As) concentrations (<0.5 to 77 microg/L) exceeding 10 microg/L. Sediment and groundwater samples were collected and analyzed from the sites of the highest, median, and lowest concentrations of As in groundwater in the alluvial aquifers located at Jefferson County, Arkansas. A traditional five-step sequential extraction was performed to differentiate the exchangeable, carbonate, amorphous Fe and Mn oxide, organic, and hot HNO(3)-leachable fraction of As and other compounds in sediments. The Chao reagent (0.25 M hydroxylamine hydrochloride in 0.25 M HCl) removes amorphous Fe and Mn oxides and oxyhydroxides (present as coatings on grains and amorphous minerals) by reductive dissolution and is a measure of reducible Fe and Mn in sediments. The hot HNO(3) extraction removes mostly crystalline metal oxides and all other labile forms of As. Significant total As (20%) is complexed with amorphous Fe and Mn oxides in sediments. Arsenic abundance is not significant in carbonates or organic matter. Significant (40-70 microg/kg) exchangeable As is only present at shallow depth (0-1 m below ground surface). Arsenic is positively correlated to Fe extracted by Chao reagent (r=0.83) and hot HNO(3) (r=0.85). Arsenic extracted by Chao reagent decreases significantly with depth as compared to As extracted by hot HNO(3). Fe (II)/Fe (the ratio of Fe concentration in the extracts of Chao reagent and hot HNO(3)) is positively correlated (r=0.76) to As extracted from Chao reagent. Although Fe (II)/Fe increases with depth, the relative abundance of reducible Fe decreases noticeably with depth. The amount of reducible Fe, as well as As complexed to amorphous Fe and Mn oxides and oxyhydroxides decreases with depth. Possible explanations for the decrease in reducible Fe and its complexed As with depth include historic flushing of As and Fe from hydrous ferric oxides (HFO) by microbially-mediated reductive dissolution and aging of HFO to crystalline phases. Hydrogeochemical data suggests that the groundwater in the area falls in the mildly reducing (suboxic) to relatively highly reducing (anoxic) zone, and points to reductive dissolution of HFO as the dominant As release mechanism. Spatial variability of gypsum solubility and simultaneous SO(4)(2-) reduction with co-precipitation of As and sulfide is an important limiting process controlling the concentration of As in groundwater in the area.

Extragenic suppressors of the nimX2(cdc2) mutation of Aspergillus nidulans affect nuclear division, septation and conidiation.

The Aspergillus nidulans NIMX(CDC2) protein kinase has been shown to be required for both the G(2)/M and G(1)/S transitions, and recent evidence has implicated a role for NIMX(CDC2) in septation and conidiation. While much is understood of its G(2)/M function, little is known about the functions of NIMX(CDC2) during G(1)/S, septation, and conidiophore development. In an attempt to better understand how NIMX(CDC2) is involved in these processes, we have isolated four extragenic suppressors of the A. nidulans nimX2(cdc2) temperature-sensitive mutation. Mutation of these suppressor genes, designated snxA-snxD for suppressor of nimX, affects nuclear division, septation, and conidiation. The cold-sensitive snxA1 mutation leads to arrest of nuclear division during G(1) or early S. snxB1 causes hyperseptation in the hyphae and sensitivity to hydroxyurea, while snxC1 causes septation in the conidiophore stalk and aberrant conidiophore structure. snxD1 leads to slight septation defects and hydroxyurea sensitivity. The additional phenotypes that result from the suppressor mutations provide genetic evidence that NIMX(CDC2) affects septation and conidiation in addition to nuclear division, and cloning and biochemical analysis of these will allow a better understanding of the role of NIMX(CDC2) in these processes.

Etiological factors in manic-depressive psychoses.

Fifty consecutive patients with bipolar affective psychosis are reviewed, and the genetic and electroencephalographic findings set against extant hypotheses about inheritance of the disorder and the etiological homogeneity of the syndrome. Inheritance in this sample appears usually not to be X-linked. The syndrome seems etiologically heterogeneous in that some patients have an early onset and prominent genetic determinants, while in others without apparent hereditary predisposition, the illness start later and show electroencephalographic evidence of cerebral dysfunction.

Schizophrenia subdivided by the family history of affective disorder. A comparison of symptomatology and course of illness.

Schizophrenics meeting DSM-III criteria were divided, based on family history of affective disorder in first-degree relatives, into three groups: N-schizophrenics, no relative with affective disorder; U-schizophrenics, a relative with unipolar affective disorder; and B-schizophrenics, a relative with bipolar affective disorder. Although N- and U-schizophrenics displayed similar symptoms during the prodromal, actively psychotic, and remitted stages of their illness, U-schizophrenics were significantly more likely to have a depressive syndrome develop during the follow-up period. Compared with N-schizophrenics, B-schizophrenics were more depressed during the prodrome, were more elated and catatonic when actively psychotic, had fewer residual symptoms when remitted, and were much more likely to have a manic syndrome develop during the follow-up period. Even when DSM-III criteria are met, hesitation is indicated in diagnosing schizophrenia in patients with a first-degree relative with bipolar illness.

Paranoid psychosis (delusional disorder) and schizophrenia. A family history study.

Family studies have played a central role in the controversy over the nosologic status of paranoid psychosis or delusional disorder (DD). In this study, 12 cases of DD were blindly rediagnosed from a cohort of 146 schizophrenics. The prevalence of schizophrenia in the relatives of the DD probands was significantly less than that found in the relatives of the schizophrenics. Affective illness was equally uncommon in both groups of relatives. Inferiority feelings clustered significantly in the relatives of the DD probands. From a familial perspective, DD is not closely related to schizophrenia or affective illness but does have a familial link to inferiority feelings. Investigators should take cognizance of the entity of DD as one possible source of the heterogeneity within "schizophrenia."

Schizophrenia with premorbid inferiority feelings. A distinct subgroup?

This study examines whether the presence of premorbid inferiority feelings (PIFs) defines a distinct subgroup of schizophrenia. Of 122 clinically diagnosed schizophrenics, 93% of whom met DSM-III criteria for schizophrenic disorder, 31 were found to have PIFs. By family history, schizophrenia was significantly less common in first-degree relatives of schizophrenics with (1.5%) than without (9.1%) PIFs, while affective disorders were equally common in both groups of relatives. Compared with schizophrenics without PIFs, schizophrenics with PIFs were significantly more likely to have been in a stressful environment at the onset of their disorder, to have an embarrassing physical handicap, to be less severely thought-disordered, and to have a lower rate of relapse on follow-up. From a genetic, etiologic, symptomatic, and prognostic perspective, the presence of PIFs may define a distinct subgroup of schizophrenia.

Age at onset in schizophrenia. A familial perspective.

We examined the impact of familial factors on age at onset in schizophrenia. Results from a literature review and from new analyses of two family studies and one twin study of schizophrenia support the following hypotheses: (1) no strong or consistent relationship exists between age at onset in schizophrenia and recurrence risk for schizophrenia in relatives; (2) age at onset in schizophrenia is not strongly related to the recurrence risk for other psychiatric disorders in relatives; and (3) in systematically ascertained pairs of affected siblings, the age at onset of schizophrenia is modestly correlated, whereas the correlation in age at onset in concordant monozygotic twin pairs is much higher. These results suggest that (1) from a familial perspective, early- and late-onset adult schizophrenia appear to be the same disorder, and (2) given that an individual will develop schizophrenia, familial factors, which may be genetic, influence the age at onset of the condition.

Pharmacology of propylthiouracil (PTU) in pregnant hyperthyroid women: correlation of maternal PTU concentrations with cord serum thyroid function tests.

Previous studies have characterized the pharmacology of propylthiouracil (PTU) in normal and hyperthyroid subjects, but there is little information available regarding PTU pharmacokinetics in pregnant hyperthyroid women. We investigated the serum PTU response to an oral dose of PTU in six hyperthyroid pregnant women both ante- and postpartum. The serum PTU profile during the third trimester of pregnancy was qualitatively similar to that in nonpregnant subjects, but serum PTU concentrations were consistently lower in the late third trimester compared with postpartum values. Cord serum PTU concentrations were consistently higher than simultaneously obtained maternal serum PTU concentrations, suggesting slower PTU clearance in the fetus. There was a significant inverse correlation (r = -0.92; P = 0.026) between the maternal serum PTU area under the curve in the third trimester and the cord serum free T4 index.

Familial and sporadic schizophrenia: a symptomatic, prognostic, and EEG comparison.

The authors examined the differences between 30 patients with familial schizophrenia (those with a schizophrenic first-degree relative) and 83 patients with sporadic schizophrenia (those with a negative family history for schizophrenia). Although the two groups showed no difference in the intensity of 1) flattened, depressed, or elevated affect, 2) auditory hallucinations, and 3) delusions, more of the familial (56.7%) than the sporadic (18.1%) schizophrenic patients had severe thought disorders. EEGs were performed while the patients were taking neuroleptics; 72.3% of the sporadic schizophrenic patients and 43.3% of the familial patients had an abnormal tracing. The authors conclude that the division of schizophrenia into familial and sporadic forms may represents a valid subclassification.

Failed suicide attempt by emission gas poisoning.

After prolonged exposure to emission gases from his car, a patient survived, probably because of low carbon monoxide levels in the emission gases of his modern car. The authors anticipate a reduction in fatalities when this method of suicide is used.

Risk factors for measles vaccine failure among immunized students.

An outbreak of measles occurred in a municipal school system which had reported 98% of students immunized against measles. A case-control study was conducted to determine reasons for vaccine failure. Vaccine failure was associated with immunizations that could not be documented in the provider's records. Among children with provider-documented immunization, vaccine failure was associated with vaccination at 12 to 14 months of age with an odds ratio of 4.73. Among children vaccinated at 15 months or older, vaccine failure was not associated with time elapsed since vaccination. Studies should be conducted to determine whether unreliable immunization records are a more widespread problem. Further consideration should be given to routine revaccination of children previously vaccinated at 12 to 14 months of age.

A new sampling strategy for linkage studies in psychoses.

Linkage between stuttering and manic-depression has been postulated to account for the reported association between these conditions, in three large pedigrees. This finding permits a novel and potentially more productive sampling strategy to be used in future linkage studies.

Postulated genetic linkage between manic-depression and stuttering.

We record pedigrees of three families in which stuttering and bipolar illnesses are found. An association between the two conditions is demonstrated, and linkage analysis suggests that the respective genes could occur at linked loci. The implications of this finding are noted.

Sunny hospital rooms expedite recovery from severe and refractory depressions.

Bright light therapy is an effective treatment for seasonal affective disorder, an uncommon condition marked by mild winter depression. Bright lights have been used as adjuncts in the pharmacological treatment of other types of depressive illness. The rooms in our psychiatric inpatient unit are so placed that half are bright and sunny and the rest are not. Reasoning that some patients were getting light therapy inadvertently, we compared the lengths of stay of depressed patients in sunny rooms with those of patients in dull rooms. Those in sunny rooms had an average stay of 16.9 days compared to 19.5 days for those in dull rooms, a difference of 2.6 days (15%): P < 0.05.

Dreaming away depression: the role of REM sleep and dreaming in affective disorders.

REM sleep and dreaming may play a crucial role in the processing of affect. In a recent study, we demonstrated that dream content is related to prevailing mood state and that certain types of dream precede upward mood changes in bipolar disorder (manic-depression). To replicate and extend initial findings, we monitored sleep, dream content and mood, in both bipolar and unipolar patients hospitalized for depression. All patients (n = 24) were recruited in a depressed state. During this trial, subjects reported their dreams and rated their mood each morning. They also had their sleep recorded intermittently using the Nightcap, a compact computerized home sleep monitoring device. We found that: (i) REM latency tends to increase as the mood improves in bipolars but is stable (and even decreases with mood improvements) in unipolar depressives; (ii) dream content continues to systematically relate to prevailing mood state, but the patterns seen are different in unipolars and bipolars; (iii) dreams of death are frequent in bipolar disorder and mark the transition of a mood shift upward.

Prevailing mood, mood changes and dreams in bipolar disorder.

In this preliminary and exploratory study, we collected the dream reports and mood ratings of 6 outpatients with bipolar disorder over a 6-month period to compare the relationship between dream themes and mood states. We found that neutral mood states were associated with mundane, routine or uneventful dreams while manic states featured bizarre and improbable dream themes. Neither depressed nor mixed states showed a consistent trend in dream themes. By categorizing the dreams that preceded mood shifts, we were able to identify a particular type of dream that seemed to precede a mood shift, particularly in the direction of mania. Shifts to mania were heralded by dreams of death and bodily injury. Forthcoming depression was more clearly associated with a decrease in overall number of dreams reported. The significance of dreaming in relation to mood is discussed in terms of these preliminary findings and our bipolar dream scale is offered for the convenience of subsequent investigators.

Accumulation of ergosta-8,14-dien-3beta-ol by Saccharomyces cerevisiae cultured with an azasterol antimycotic agent.

15-Aza-25-methylene-D-homocholesta-8,14-dien-3beta-ol, an antimycotic agent, at a concentration of 75 ng/ml inhibited ergosterol biosynthetis in Saccharomyces cerevisiae strain 3701B resulting in the accumulation of an unusual sterol. Experimental data presented indicate that this sterol is ergosta-8,14-dien-3beta-ol. The accumulation of the compound is supportive of current models of biosynthetic pathways for sterols in yeast and is consistent with inhibition by the azasterol of the delta14 sterol reductase.

Use of dynamically coated capillaries for the routine analysis of methamphetamine, amphetamine, MDA, MDMA, MDEA, and cocaine using capillary electrophoresis.

A rapid, accurate, precise, reproducible, economical, and environmentally gentle method using capillary electrophoresis (CE) is presented for the routine analysis of methamphetamine, amphetamine, MDA, MDMA, MDEA, and cocaine in seized drugs. The methodology uses a 32 cm by 50 microm capillary (length to detector 23.5 cm) with a commercially available buffer kit and diode array UV detection. Dynamic coating of the capillary surface is accomplished by flushing with base for 1 min, a proprietary polycation for 1 min, and then a proprietary polyanion for 2 min. This approach provides a relatively high and stable electroosmotic flow (EOF), even at low pHs. The background electrolyte (BGE) contains 75 mM phosphate buffer (pH 2.5) with the same polyanion as above. Using this methodology, amphetamine, methamphetamine, MDA, MDMA, MDEA, and an internal standard (n-butylamphetamine) are baseline resolved in less than 5 min. The run-to-run migration time %RSDs and peak area %RSDs are typically <0.3% and <2.1%, respectively. The day-to-day and capillary-to-capillary migration time %RSDs are <1.5% and <2.1%, respectively. The %RSDs of the relative migration times compared with the internal standard on a day-to-day and capillary-to-capillary basis are <0.2% and <0.06%, respectively. The linear dynamic range using peak areas range from 0.003 to 0.10 mg/mL. The correlation coefficients are >0.9998, with all calibration curves passing at or near the origin. Similar data are obtained for cocaine and its internal standard henyltoloxamine. None of the compounds usually encountered in illicit samples interfere with the target compound (e.g., methamphetamine and cocaine) or the internal standard. Quantitative results for synthetic mixtures and seized exhibits are in good agreement with actual values, and also with results obtained from other techniques. The relatively high EOF for the dynamically coated capillary system allows for the screening of basic, acidic, and neutral adulterants in drug seizures; identification is facilitated by the use of automated UV library searches.