Order Keepers or Immigration Agents? Latine Immigrant Views of Law Enforcement in Healthcare Settings.

BACKGROUND: Police and security presence in healthcare settings have grown. There are few studies exploring perceptions of these law enforcement agents among US Latine immigrants, who can be vulnerable to immigration enforcement actions due to past and ongoing criminalization and anti-immigrant policies. OBJECTIVE: To explore Latine immigrants' perceptions of law enforcement in healthcare settings. DESIGN: Exploratory, semi-structured qualitative interviews asked participants about their perspectives of law enforcement in healthcare settings. PARTICIPANTS: English- and Spanish-speaking adult patients (n = 19) from a Federally Qualified Health Center (FQHC) in Los Angeles, CA, serving predominantly low-income Latine immigrants. APPROACH: We used the framework method for analysis to establish a codebook and inform our thematic interpretation. KEY RESULTS: We identified three themes: (1) perceptions of safety offered by police officers are separated from the role of immigration officers; (2) perceptions of police officers are integrated into broader perceptions of the healthcare system; and (3) lived experiences, including immigration status, influenced valence response to officer uniforms and perceptions of officers. Most participants viewed police officers positively as maintaining order and safety, separating them from federal immigration enforcement actions, and reflecting on local, state, and organizational "sanctuary" or immigrant-friendly policies. Individuals with precarious immigration status more often saw officers as intimidating. Immigration enforcement remained a key concern. CONCLUSIONS: Differentiating police and security roles from immigration enforcement in healthcare could improve Latine immigrant trust and access. Future studies should explore perspectives of Latine immigrants in localities without sanctuary laws or organizational immigrant-friendly policies.

Neurological Care of Refugees and Other Forcibly Displaced Persons.

There are more than 100 million forcibly displaced persons (FDPs) in the world today, including a high number of people who experience neurologic symptoms and presentations. This review summarizes the conceptual frameworks for understanding neurological health risks and conditions across the migration journey (premigration, migration journey, and postmigration) and life span, including special attention to pediatric FDPs. The interaction with psychiatric illness is discussed, as well as the available published data on neurologic presentations in FDPs in the medical literature. A social determinant of health lens is used to provide ways in which forcible displacement can influence brain health and neurological outcomes. Priorities and future needs for the neurological care of refugees and other FDPs are suggested.

Impact of the Integrative Oncology Scholars Program on Oncology Providers' Key Knowledge of Dietary Supplements and Antioxidants for Providing Evidence-based Oncology Care.

Dietary supplements are commonly used among cancer survivors. Oncology providers rarely receive training about dietary supplements. We evaluated whether e-learning modules could improve oncology providers' dietary supplement knowledge. Oncology providers participated in the National Cancer Institute funded Integrative Oncology Scholars (IOS) program. We used posttest readiness assurance tests (RAT) to measure knowledge acquisition from modules. One cohort completed a pre and posttest RAT to assess change in knowledge. Multivariate linear regression models adjusted for gender, race, profession, and years in practice were used to determine if these characteristics were associated with posttest RAT performance and change in pre to posttest RAT scores. Scholars (N = 101) included 86% (N = 87) females; age 44 ± 10 years; 72% (N = 73) Non-Hispanic White; years in practice mean range 11-15 ± 10. There were 37 physicians, 11 physician assistants, 23 nurses, 21 social workers, 2 psychologists, 4 pharmacists, and 2 physical therapists. The posttest dietary supplement and antioxidant RAT scores for all Scholars were 67 ± 18% and 71 ± 14%. In adjusted models there were no significant associations between dietary supplement and antioxidant posttest RAT scores with Scholar characteristics. Change in RAT scores for dietary supplement and antioxidants were 25% ± 23 and 26% ± 27 (P < 0.0001). In adjusted models, there were no significant predictors of change in dietary supplement RATs. For antioxidant RATs, profession was associated with change in scores (P = 0.021). Improvement in Scholar's test scores demonstrate the IOS program can significantly increase oncology providers' knowledge of dietary supplements and antioxidants.

In our own words: key terms and trends in psychoanalytic history.

Inspired by the work of Fonagy (2008) and Dent and Christian (2019), this study applies a form of quantitative textual analysis to 300 terms of psychoanalytic interest in the PEP archives by tracking their historical prevalence in five-year increments using the aggregate number of articles featuring each term in the field's journals. Our results confirm some of the more well-known inflection points in the history and application of psychoanalytic theory, while also revealing some intriguing surprises. Psychoanalysis remains fundamentally a depth psychology, yet it has increasingly acknowledged the external causes of distress and trauma. Changes in the prevalence of terminology around psychopathology, defense mechanisms, development, gender and sexuality, and psychoanalytic technique are discussed.

Modulation of RNA polymerase assembly dynamics in transcriptional regulation.

The interaction of transcription factors with target genes is highly dynamic. Whether the dynamic nature of these interactions is merely an intrinsic property of transcription factors or serves a regulatory role is unknown. Here we have used single-cell fluorescence imaging combined with computational modeling and chromatin immunoprecipitation to analyze transcription complex dynamics in gene regulation during the cell cycle in living cells. We demonstrate a link between the dynamics of RNA polymerase I (RNA Pol I) assembly and transcriptional output. We show that transcriptional upregulation is accompanied by prolonged retention of RNA Pol I components at the promoter, resulting in longer promoter dwell time, and an increase in the steady-state population of assembling polymerase. As a consequence, polymerase assembly efficiency and, ultimately, the rate of entry into processive elongation are elevated. Our results show that regulation of rDNA transcription in vivo occurs via modulation of the efficiency of transcription complex subunit capture and assembly.

Applications of the Premack Principle: A Review of the Literature.

The Premack principle states that any Response A can reinforce any other Response B if the independent rate of A is greater than the independent rate of B. This theory demonstrates reinforcer relativity, where the relative probabilities of responses can be more impactful than preference. Applying the Premack principle involves arranging the environment to restrict access to certain responses based on relative probabilities of a set of given responses. Though the Premack principle is described in modern behavior analytic texts, Konarski et al. identified a lack of empirical evidence to support its application. The purpose of the current paper is to systematically review the extant literature using the Premack principle and evaluate how and if researchers have applied reinforcer relativity as described by Premack and the subsequent effectiveness of these procedures. Additionally, we make recommendations for practitioners and future researchers based on our findings.

Increased expression of peripheral blood leukocyte genes implicate CD14+ tissue macrophages in cellular intestine allograft rejection.

Recurrent rejection shortens graft survival after intestinal transplantation (ITx) in children, most of whom also experience early acute cellular rejection (rejectors). To elucidate mechanisms common to early and recurrent rejection, we used a test cohort of 20 recipients to test the hypothesis that candidate peripheral blood leukocyte genes that trigger rejection episodes would be evident late after ITx during quiescent periods in genome-wide gene expression analysis and would achieve quantitative real-time PCR replication pre-ITx (another quiescent period) and in the early post-ITx period during first rejection episodes. Eight genes were significantly up-regulated among rejectors in the late post-ITx and pre-ITx periods, compared with nonrejectors: TBX21, CCL5, GNLY, SLAMF7, TGFBR3, NKG7, SYNE1, and GK5. Only CCL5 was also up-regulated in the early post-ITx period. Among resting peripheral blood leukocyte subsets in randomly sampled nonrejectors, CD14(+) monocytes expressed the CCL5 protein maximally. Compared with nonrejectors, rejectors demonstrated higher counts of both circulating CCL5(+)CD14(+) monocytes and intragraft CD14(+) monocyte-derived macrophages in immunohistochemistry of postperfusion and early post-ITx biopsies from the test and an independent replication cohort. Donor-specific alloreactivity measured with CD154(+) T-cytotoxic memory cells correlated with the CCL5 gene and intragraft CD14(+) monocyte-derived macrophages at graft reperfusion and early post-ITx. CCL5 gene up-regulation and CD14(+) macrophages likely prime cellular ITx rejection. Infiltration of reperfused intestine allografts with CD14(+) macrophages may predict rejection events.

Allospecific CD154 + T-cytotoxic memory cells as potential surrogate for rejection risk in pediatric intestine transplantation.

Clinical end-points dictate large trial enrollments and exclude children with the rare intestine transplant procedure (ITx), who experience higher drug-related morbidity. We evaluate the novel rejection-risk parameter, allo-(antigen)-specific CD154 + TcMs (i) as surrogates for ACR using Prentice's criteria, (ii) for association with immunosuppression targets to determine Fleming's surrogate end-point designation, and (iii) as time-to-event end-point in a simulated comparison of alemtuzumab (NCT#01208337, n = 14) and rabbit anti-human thymocyte globulin (rATG, n = 16) among 30 children with ITx. CD154 + TcM were measured in MLR before, and at 1-60 and 61-200 days after ITx (NCT#01163578). CD154 + TcM correlate significantly with rejection severity (Spearman r = 0.685, p = 2.03E-5) and associate with biopsy-proven ITx rejection with sensitivity/specificity of 94%/84% [corrected] independent of immunosuppressant. Previously stated sensitivity of 90% is incorrect. [corrected]. The rejection-risk threshold of CD154 + TcM resolves rapidly in 200-day follow-up (46 ± 20 vs. 158 ± 59 days, p = 0.009, K-M) with alemtuzumab, which demonstrates lower 90-day ACR incidence (50% vs. 69%, p=NS, Fisher's exact), and is associated with accelerated prednisone minimization to ≤2.5 mg/day, compared with rATG (120 ± 28 vs. 180 ± 30 days, p = 0.027, K-M). As a surrogate end-point, time-to-rejection-risk resolution measured with CD154 + TcM portends 50% reduction in sample sizes in a simulated trial of alemtuzumab vs. rATG. Rejection-risk assessment with CD154 + TcM may enable informed immunosuppression minimization, and preliminary efficacy comparisons in pediatric ITx.

Altered cerebral blood flow patterns associated with pathologic worry in the elderly.

BACKGROUND: Generalized anxiety disorder (GAD) is the most prevalent anxiety disorder among the elderly and has high functional and cognitive morbidity. However, late-life GAD is relatively understudied and its functional neuroanatomy is uncharted. Several imaging studies have suggested abnormalities in the cognitive control systems of emotion regulation in anxiety disorders in young adults. The aim of this study was to examine the neural correlates of emotion regulation in late-life GAD. METHOD: We compared 7 elderly GAD subjects and 10 elderly nonanxious comparison subjects using functional MRI. Regional cerebral blood flow (rCBF) was measured using pulsed arterial spin labeling perfusion MRI at rest and during an emotion regulation paradigm. RESULTS: Relative to the rest condition, elderly nonanxious comparison subjects had increased rCBF during worry induction (WI) in the right insula, bilateral amygdala, and associative temporooccipital areas. Elderly GAD subjects had increased rCBF during WI in the associative temporooccipital areas, but not in the insula or the amygdala. During worry suppression (WS), elderly nonanxious comparison subjects had increased rCBF in the prefrontal cortex (PFC) and dorsal ACC. Elderly GAD subjects had no changes in rCBF during WS in the PFC. CONCLUSIONS: When attempting to regulate their emotional responses, elderly anxious subjects failed to activate prefrontal regions involved in the downregulation of negative emotions. These results, showing that elderly anxious subjects are not effectively engaging the PFC in suppressing worry, may be clinically relevant for developing personalized therapeutic strategies for the treatment of late-life GAD.

Classroom Based Intensive Toilet Training for Children with Autism Spectrum Disorder.

The purpose of this study was to investigate the effects of an intensive toilet training program on continence and self-initiation for elementary children with autism spectrum disorder (ASD). Researchers used a non-concurrent multiple baseline design (Watson and Workman in J Behav Ther Exp Psychiatry 12:257-259, 1981, https://doi.org/10.1016/0005-7916(81)90055-0 ) with regulated randomization (Koehler and Levin in Psychol Methods 3(2):206, 1998, https://doi.org/10.1037/1082-989X.3.2.206 ) to evaluate the effects of the intensive protocol with four students with ASD in the classroom where they received special education services. The protocol included increased access to fluids, contingent time intervals for sit schedules, programmed reinforcement, and dry checks. All four participants met mastery criteria and maintained independent toileting after the study's completion. Three participants began self-initiating to use the restroom. The implications and recommendations for future research are discussed.

Augmentative and Alternative Communication and Speech Production for Individuals with ASD: A Systematic Review.

This review evaluated the effects of augmentative and alternative communication (AAC) on speech development in children with autism spectrum disorders (ASD); replicated, updated, and extended the systematic review by Schlosser and Wendt (American Journal of Speech-Language Pathology 17:212-230, 2008). Twenty-five single case design articles and three group design articles published between 1975 and May 2020 met inclusion criteria related to participant characteristics, intervention type, design, and visual analysis of dependent variable outcomes. Overall, AAC resulted in improved speech production; however, speech gains that did occur did not surpass AAC use.

Loss of Elp1 perturbs histone H2A.Z and the Notch signaling pathway.

Elongator dysfunction is increasingly recognized as a contributor to multiple neurodevelopmental and neurodegenerative disorders including familial dysautonomia, intellectual disability, amyotrophic lateral sclerosis, and autism spectrum disorder. Although numerous cellular processes are perturbed in the context of Elongator loss, converging evidence from multiple studies has resolved Elongator's primary function in the cell to the modification of tRNA wobble uridines and the translational regulation of codon-biased genes. Here we characterize H2a.z, encoding the variant H2a histone H2A.Z, as an indirect Elongator target. We further show that canonical Notch signaling, a pathway directed by H2A.Z, is perturbed as a consequence of Elp1 loss. Finally, we demonstrate that hyperacetylation of H2A.Z and other histones via exposure to the histone deacetylase inhibitor Trichostatin A during neurogenesis corrects the expression of Notch3 and rescues the development of sensory neurons in embryos lacking the Elp1 Elongator subunit.

Minimizing and Reporting Momentary Time-Sampling Measurement Error in Single-Case Research.

Research indicates that momentary time sampling (MTS) is often the best interval-measurement system when observing duration of behavior. Several recent studies recommended considering mean duration of target behavior, as well as durations of measurement intervals and observation sessions, to minimize measurement error in MTS. This report describes the steps we used to minimize measurement error in a single-case design research study. Further, we detail our methods for monitoring and reporting MTS measurement error across conditions by intermittently collecting and analyzing duration per occurrence measurements.

cAMP signaling regulates histone H3 phosphorylation and mitotic entry through a disruption of G2 progression.

cAMP signaling is known to have significant effects on cell growth, either inhibitory or stimulatory depending on the cell type. Study of cAMP-induced growth inhibition in mammalian somatic cells has focused mainly on the combined role of protein kinase A (PKA) and mitogen-activated protein (MAP) kinases in regulation of progression through the G1 phase of the cell cycle. Here we show that cAMP signaling regulates histone H3 phosphorylation in a cell cycle-dependent fashion, increasing it in quiescent cells but dramatically reducing it in cycling cells. The latter is due to a rapid and dramatic loss of mitotic histone H3 phosphorylation caused by a disruption in G2 progression, as evidenced by the inhibition of mitotic entry and decreased activity of the CyclinB/Cdk1 kinase. The inhibition of G2 progression induced through cAMP signaling is dependent on expression of the catalytic subunit of PKA and is highly sensitive to intracellular cAMP concentration. The mechanism by which G2 progression is inhibited is independent of both DNA damage and MAP kinase signaling. Our results suggest that cAMP signaling activates a G2 checkpoint by a unique mechanism and provide new insight into normal cellular regulation of G2 progression.

Escitalopram for older adults with generalized anxiety disorder: a randomized controlled trial.

CONTEXT: Generalized anxiety disorder (GAD) is one of the most common psychiatric disorders in older adults; however, few data exist to guide clinicians in efficacious and safe treatment. Selective serotonin reuptake inhibitors (SSRIs) are efficacious for younger adults with GAD, but benefits and risks may be different in older adults. OBJECTIVE: To examine the efficacy, safety, and tolerability of the SSRI escitalopram in older adults with GAD. DESIGN, SETTING, AND PARTICIPANTS: A randomized controlled trial in primary care practices and related specialty clinics in Pittsburgh, Pennsylvania, of 177 participants aged 60 years or older with a principal diagnosis of GAD randomized to receive either escitalopram or placebo and conducted between January 2005 and January 2008. INTERVENTIONS: Twelve weeks of 10 to 20 mg/d of escitalopram (n = 85) or matching placebo (n = 92). MAIN OUTCOME MEASURES: Cumulative response defined by Clinical Global Impressions-Improvement score of much or very much improved; time to response; and anxiety and role functioning changes measured by the Clinical Global Impressions-Improvement scale, Hamilton Anxiety Rating Scale, Penn State Worry Questionnaire, Late-Life Function and Disability Instrument activity limitations subscale, and the role-emotional impairment and social function subscales of the Medical Outcome Survey 36-item Short Form. RESULTS: In the primary analytic strategy in which participants (n = 33) were censored at the time of dropout, mean cumulative response rate for escitalopram was 69% (95% confidence interval [CI], 58%-80%) vs 51% (95% CI, 40%-62%) for placebo (P = .03). A conservative intention-to-treat analysis showed no difference in mean cumulative response rate between escitalopram and placebo (57%; 95% CI, 46%-67%; vs 45%; 95% CI, 35%-55%; P = .11). Participants treated with escitalopram showed greater improvement than with placebo in anxiety symptoms and role functioning (Clinical Global Impressions-Improvement scale: effect size, 0.93; 95% CI, 0.50-1.36; P < .001; Penn State Worry Questionnaire: 0.30; 95% CI, 0.23-0.48; P = .01; activity limitations: 0.32; 95% CI, 0.01-0.63; P = .04; and the role-emotional impairment and social function: 0.96; 95% CI, 0.03-1.90; P = .04). Adverse effects of escitalopram (P < .05 vs placebo) were fatigue or somnolence (35 patients [41.1%]), sleep disturbance (12 [14.1%]), and urinary symptoms (8 [9.4%]). CONCLUSIONS: Older adults with GAD randomized to escitalopram had a higher cumulative response rate for improvement vs placebo over 12 weeks; however, response rates were not significantly different using an intention-to-treat analysis. Further study is required to assess efficacy and safety over longer treatment durations. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00105586.

Computer Assisted Instruction to Teach Academic Content to Students With Intellectual Disability: A Review of the Literature.

Special educators are relying more heavily on computer assisted instruction (CAI) programs to teach academic content to students with intellectual disability (ID) than ever before. Research in this area is growing; however, no formal review of the literature has been conducted to examine the efficacy of using CAI to teach academic content to students with ID. This review explores the nature of academic content taught to students with ID using CAI, the CAI programs used to provide instruction, research methodology, and student learning outcomes associated with CAI. We also address gaps in the research while making suggestions for focusing future efforts to keep pace with changes in technology and the increasing implementation of CAI in special education classrooms.

Depressive symptoms, sexual activity, and substance use among adolescents in Kampala, Uganda.

BACKGROUND: Adolescents experience high rates of depression, initiation of sexual activity, and substance use. OBJECTIVES: To better understand the demographics of adolescents presenting to an adolescent clinic in Uganda, and to elucidate which factors are associated with depressive symptoms, sexual initiation, and substance use. METHODS: A retrospective review was performed on intake forms obtained during interviews with adolescents presenting to the Makerere/Mulago Columbia Adolescent Health Clinic (MMCAH) in Kampala, Uganda. RESULTS: Depressive symptoms in adolescents were correlated with having a chronic illness (p=.026), and reported poor quality of home life (p<.001). Initiation of sexual activity was also correlated with chronic illness (p=.008) and poor quality of home life (p=.006). Substance use was correlated with maternal death (p=.041), chronic illness (p=.038), and substance use among family members (p<.001) and friends (p<.001). CONCLUSIONS: Knowing the aforementioned risk factors can help us better understand the needs of adolescents presenting to MMCAH, and allows us to develop targeted interventions aimed at decreasing health risks in Kampala's adolescent population.

Physician knowledge, attitude, and experience with advance care planning, palliative care, and hospice: results of a primary care survey.

PURPOSE: To evaluate primary care physicians' understanding of and experience with advance care planning (ACP), palliative care, and hospice and how this might affect their utilization of these services. METHODS: Investigator-generated survey. RESULTS: Older age, more years in practice, and more personal and professional experience with ACP were correlated with an increase in the percentage of patients with progressive, chronic life-limiting diseases with whom physicians discussed advance directives. Overall, 97.5% of physician's expressed comfort in discussing ACP yet reported discussing advance directives with only 43% of appropriate patients. DISCUSSION: Often, discussions about ACP or referrals to palliative care or hospice do not occur until the patient is near the end of life. Our results indicate that primary care physician's personal and professional experience with ACP may be contributing to some of the barriers to these discussions.

Regulation of positive and negative emotion: effects of sociocultural context.

Previous research has demonstrated that the use of emotion regulation strategies can vary by sociocultural context. In a previous study, we reported changes in the use of two different emotion regulation strategies at an annual alternative cultural event, Burning Man (McRae et al., 2011). In this sociocultural context, as compared to typically at home, participants reported less use of expressive suppression (a strategy generally associated with maladaptive outcomes), and greater use of cognitive reappraisal (a strategy generally associated with adaptive outcomes). What remained unclear was whether these changes in self-reported emotion regulation strategy use were characterized by changes in the regulation of positive emotion, negative emotion, or both. We addressed this issue in the current study by asking Burning Man participants separate questions about positive and negative emotion. Using multiple datasets, we replicated our previous findings, and found that the decreased use of suppression is primarily driven by reports of decreased suppression of positive emotion at Burning Man. By contrast, the increased use of reappraisal is not characterized by differential reappraisal of positive and negative emotion at Burning Man. Moreover, we observed novel individual differences in the magnitude of these effects. The contextual changes in self-reported suppression that we observe are strongest for men and younger participants. For those who had previously attended Burning Man, we observed lower levels of self-reported suppression in both sociocultural contexts: Burning Man and typically at home. These findings have implications for understanding the ways in which certain sociocultural contexts may decrease suppression, and possibly minimize its associated maladaptive effects.