Trends in US State Public Health Emergency Laws, 2021-2022.

Objectives. To identify and categorize US state legislation introduced between January 1, 2021, and May 20, 2022, that addresses emergency health authority. Methods. We adapted standard policy surveillance methods to collect and code state bills and enacted laws limiting or expanding the emergency public health authority of state and local officials and agencies. Results. State legislators introduced 1531 bills addressing public health authority; 191 of those were enacted in 43 states and the District of Columbia, including 17 expanding and 65 contracting emergency authority, 163 regulating use, and 30 preempting local use of specific measures such as mask mandates. Conclusions. State laws setting the scope and limits of emergency authority are crucial to effective public health response. These laws are changing in ways that threaten to reduce response capacity. Tracking changes in health law infrastructure is important for evaluating changes in health authority and ensuring that stakeholders recognize these changes. Public Health Implications. The COVID-19 pandemic called for quick, decisive action to limit infections, and when the next outbreak hits, new laws limiting health authority will make such action even more difficult. (Am J Public Health. 2023;113(3):288-296. https://doi.org/10.2105/10.2105/AJPH.2022.307214).

Trends Over Time and Jurisdiction Variability in Supplemental Security Income and State Supplementary Payment Programs for Children With Disabilities.

CONTEXT: Nearly 1.2 million children with disabilities received federally administered Supplemental Security Income (SSI) payments in 2017. Based on a robust review of research and evaluation evidence and microsimulations, The National Academies of Sciences, Engineering, and Medicine committee identified modifications to SSI (ie, increasing the federal SSI benefit maximum by one-third or two-thirds) as 1 of 10 strategies that could reduce the US child poverty rate, improving child health and well-being on a population level. OBJECTIVE: Describing the availability and amount of SSI and State Supplementary Payment (SSP) program benefits to support families of children with disabilities may be a first step toward evaluating The National Academies of Sciences, Engineering, and Medicine-proposed modification to SSI as a potential poverty alleviation and health improvement tool for children with disabilities and their families. DESIGN: We used public health law research methods to characterize the laws (statutes and state agency regulations) governing the federal SSI program and SSP programs in the 50 states and District of Columbia from January 1, 1996, through November 1, 2018. RESULTS: The number of jurisdictions offering supplementary payments (SSP) was relatively stable between 1996 and 2018. In 2018, 23 US jurisdictions legally mandated that SSP programs were available for children. Among the states with SSP payment amounts in their codified laws, SSP monthly benefit amounts ranged from $8 to $64.35 in 1996 and $3.13 to $60.43 in 2018. CONCLUSION: Our initial exploration of SSI-related policies as a tool for improving the economic stability of children with disabilities and their families suggests that current SSPs, in combination with SSI, would not rise to the level of SSI increases proposed by The National Academies of Sciences, Engineering, and Medicine. Understanding more about how SSI and SSP reach children and work in combination with other federal and state income security programs may help identify policies and strategies that better support children with disabilities in low-income households.

Enhanced targeting of CML stem and progenitor cells by inhibition of porcupine acyltransferase in combination with TKI.

Tyrosine kinase inhibitor (TKI) treatment of chronic myeloid leukemia (CML) has limited efficacy against leukemia stem cells (LSC) responsible for disease propagation, and most CML patients require continued TKI treatment to maintain remission. LSC maintenance is related, at least in part, to signals from the bone marrow microenvironment (BMM). Our previous studies have shown that Wnt signaling from the BMM contributes to preservation of CML LSC following TKI treatment. Secretion of Wnt ligands requires their modification by the O-acyl transferase Porcupine (PORCN). Here we investigated the activity of a potent and selective PORCN inhibitor, WNT974, against CML stem and progenitor cells. WNT974 efficiently antagonized Wnt signaling in human CML CD34+ cells, and in combination with the TKI nilotinib (NIL) significantly enhanced inhibition of proliferation and colony-forming potential of CML stem and progenitor cells and reduced their growth in immunodeficient mice in vivo, in comparison with NIL alone. Treatment of transgenic CML mice in vivo with NIL in combination with WNT974 significantly reduced leukemic stem and progenitor cell numbers, reduced regeneration of leukemic long-term hematopoietic stem cells in secondary transplant recipients, and enhanced survival of mice after discontinuation of treatment, in comparison with NIL alone. CML progenitors demonstrated enhanced sensitivity to Wnt stimulation, associated with increased expression of the FZD4 receptor. FZD4 knockdown inhibited CML progenitor growth. These results support further investigation of PORCN targeting to inhibit Wnt secretion and signaling and enhance targeting of CML stem cells while sparing their normal counterparts.

Role of altered growth factor receptor-mediated JAK2 signaling in growth and maintenance of human acute myeloid leukemia stem cells.

Acute myeloid leukemia (AML) is sustained by small populations of leukemia stem cells (LSCs) that can resist available treatments and represent important barriers to cure. Although previous studies have shown increased signal transducer and activator of transcription (STAT)3 and STAT5 phosphorylation in AML leukemic blasts, the role of Janus kinase (JAK) signaling in primary AML compared with normal stem cells has not been directly evaluated. We show here that JAK/STAT signaling is increased in LSCs, particularly from high-risk AML. JAK2 inhibition using small molecule inhibitors or interference RNA reduced growth of AML LSCs while sparing normal stem cells both in vitro and in vivo. Increased JAK/STAT activity was associated with increased expression and altered signaling through growth factor receptors in AML LSCs, including receptor tyrosine kinase c-KIT and FMS-related tyrosine kinase 3 (FLT3). Inhibition of c-KIT and FLT3 expression significantly inhibited JAK/STAT signaling in AML LSCs, and JAK inhibitors effectively inhibited FLT3-mutated AML LSCs. Our results indicate that JAK/STAT signaling represents an important signaling mechanism supporting AML LSC growth and survival. These studies support continued evaluation of strategies for JAK/STAT inhibition for therapeutic targeting of AML LSCs.

JAK2/STAT5 inhibition by nilotinib with ruxolitinib contributes to the elimination of CML CD34+ cells in vitro and in vivo.

Chronic myeloid leukemia (CML) stem cell survival is not dependent on BCR-ABL protein kinase and treatment with ABL tyrosine kinase inhibitors cures only a minority of CML patients, thus highlighting the need for novel therapeutic targets. The Janus kinase (JAK)2/signal transducer and activator of transcription (STAT)5 pathway has recently been explored for providing putative survival signals to CML stem/progenitor cells (SPCs) with contradictory results. We investigated the role of this pathway using the JAK2 inhibitor, ruxolitinib (RUX). We demonstrated that the combination of RUX, at clinically achievable concentrations, with the specific and potent tyrosine kinase inhibitor nilotinib, reduced the activity of the JAK2/STAT5 pathway in vitro relative to either single agent alone. These effects correlated with increased apoptosis of CML SPCs in vitro and a reduction in primitive quiescent CML stem cells, including NOD.Cg-Prkdc(scid) IL2rg(tm1Wjl) /SzJ mice repopulating cells, induced by combination treatment. A degree of toxicity toward normal SPCs was observed with the combination treatment, although this related to mature B-cell engraftment in NOD.Cg-Prkdc(scid) IL2rg(tm1Wjl) /SzJ mice with minimal effects on primitive CD34(+) cells. These results support the JAK2/STAT5 pathway as a relevant therapeutic target in CML SPCs and endorse the current use of nilotinib in combination with RUX in clinical trials to eradicate persistent disease in CML patients.

The different faces of impulsivity as links between childhood maltreatment and young adult crime.

Crime is a major public health and safety threat. Many studies have suggested that early exposure to child maltreatment increases an individual's risk for persistent serious crime in adulthood. Despite these findings about the connection between child maltreatment and criminal behavior, there is a paucity of empirically-based knowledge about the processes or pathways that link child maltreatment to later involvement in crime. Using a community sample of 337 young adults (ages 18-25) in a U.S. metropolitan area, the present study examined the role of various facets of impulsivity in linking child maltreatment to crime. A series of factor analyses identified three types of crime including property crime, violent crime, and fraud. Structural equation modelings were conducted to examine the associations among childhood maltreatment, four facets of impulsivity, and criminal behavior, controlling for sociodemographic information, family income and psychological symptoms. The present study found that child emotional abuse was indirectly related to property crime and fraud through urgency while a lack of premeditation mediates the relationship between child neglect and property crime. Child physical abuse was directly related to all three types of crime. Personality traits of urgency and lack of premeditation may play a significant role in the maltreatment-crime link. Preventive interventions targeting impulsivity traits such as urgency and a lack of premeditation might have promising impacts in curbing criminal behavior among maltreatment victims.

Identification of genetic loci associated with primary angle-closure glaucoma in the basset hound.

PURPOSE: Primary angle-closure glaucoma (PACG) in dogs is usually caused by the gradual collapse of the iridocorneal angle and cleft, eventually leading to aqueous humor (AH) outflow obstruction. The condition occurs in several breeds of dogs and the prognosis for affected animals is typically poor. We have identified several basset hound (BH) pedigrees, as well as unrelated cases with characteristic PACG that in many aspects recapitulates PACG in human patients. The goal of this study was to utilize the BH PACG model to characterize the genetics of PACG, and potentially discover genetic factors contributing to PACG in humans and animals. METHODS: We conducted a genome-wide logistic regression test for association using 37 PACG cases and 41 unaffected controls. Population stratification and cryptic relatedness were assessed using a multidimensional scaling analysis. The expression of two candidate genes within the target tissues of the BH eye was assessed by immunohistochemistry. RESULTS: We report significant associations at two novel loci, specifically BICF2P31912 in COL1A2 on chromosome 14 with a per-allele odds ratio (OR, 95% confidence interval [CI]) of 3.35 (1.73-6.51), P(genome)=3.6×10⁻4; and BICF2P893476 residing in proximity to RAB22A on chromosome 24 with a per-allele OR (95% CI) of 3.93 (1.78-8.66), P(genome)=4.9×10⁻4. COL1A2 and RAB22A demonstrated widespread expression throughout the eye and were prominently noted in the ciliary body (CB), trabecular meshwork (TM), and iris. CONCLUSIONS: Our finding of two genetic associations supports the potential segregation of PACG risk-conferring variants in the BH. The genetic associations identified may contribute to mechanisms underlying the pathogenesis of PACG, which remain to be elucidated.

My owner, right or wrong: the effect of familiarity on the domestic dog's behavior in a food-choice task.

Dogs are strongly influenced by human behavior, and they readily form bonds with specific humans. Yet these lines of inquiry are not often combined. The goal of this study was to investigate whether such bonds would play a role in how dogs behave in response to human signals. Using various types of signals, we compared dogs' use of information from a familiar human (their owner) versus an unfamiliar human when choosing between two food containers. In some conditions, the owner indicated a container that gave food and a stranger indicated a container that did not; in other conditions, this was reversed. Dogs more often chose the container indicated by or nearest to their owner, even when this container never yielded a food reward. In two conditions, dogs chose at chance: a control condition in which both pointers were strangers and a condition in which the owner and stranger sat reading books and provided no social signal. This is the first study to directly compare owners to strangers in a single food-choice situation. Our results suggest that dogs make decisions by attending preferentially to social signals from humans with whom they have become familiar.

Challenging Pennsylvania's Firearm Preemption Law as a Public Health Danger: The Case of Philadelphia.

Firearm violence has soared in American cities, but most states statutorily preempt municipal firearm regulation. This article describes a unique collaboration in Philadelphia among elected officials, public health researchers, and attorneys that has led to litigation based on original quantitative analyses and grounded in innovative constitutional theories and statutory interpretation.

Building A Comprehensive, Longitudinal Dataset to Advance Research on the Efficacy of State-Level Anti-bullying Legislation: 1999 to 2017.

Bullying is one of the most common forms of youth violence and is associated with myriad adverse consequences over the life course. There has been increasing interest in examining whether anti-bullying legislation is effective in preventing bullying victimization and its negative effects. However, a lack of data structures that comprehensively and longitudinally assess anti-bullying legislation and its provisions has hampered this effort. We provide 18 years of data (1999-2017) on anti-bullying legislation and amendments across 50 U.S. states and the District of Columbia, which we are making publicly available at LawAtlas.org. This article describes how the legal content analysis was conducted, provides information on the reliability of the coding, and details provisions of the legislation that were coded, such as funding provisions and enumerated groups (a total of 122 individual codes are provided). Over 90% of states had at least one amendment to their legislation during this 18-year period (range: 0-22; Mean = 6.1), highlighting both the evolving content of anti-bullying statutes and the importance of tracking these changes with longitudinal data. Additionally, we offer illustrative examples of the kinds of research questions that might be pursued with these new data. For instance, using survival analyses, we show that a variety of state characteristics (e.g., political leaning of state legislatures) predict time to adoption of key provisions of anti-bullying legislation (e.g., the comprehensiveness of legal provisions). Finally, we end with a discussion of how the dataset might be used in future research on the efficacy of anti-bullying legislation.

Creating Compassion: Using Art for Empathy Learning with Urban Youth.

Social-emotional learning (SEL) curricula are being increasingly implemented with young children; however, access to comprehensive programs can be prohibitive for programs limited by finances, time, or other factors. This article describes an exploratory case study that investigates the use of creative activity in the direct promotion of empathy and indirect promotion of other social-emotional skills for early elementary children in an urban-based after-school setting. A novel curriculum, Creating Compassion, which combines art engagement with explicit behavioral instruction, serves as a promising avenue for social-emotional skill development, and has particular importance for children from low-income households. Five children from racially minoritized backgrounds in grades kindergarten and first attended the Creating Compassion group intervention. Group-level data and individual data of direct behavior ratings suggested a modest increase in empathy development, responsible decision-making, and self-management skills and thereby provide a preliminary basis for further effectiveness investigation. Suggestions for future research in this area are discussed in addition to social justice implications.

Clinical tests for screening and diagnosis of cervical spine myelopathy: a systematic review.

OBJECTIVE: The purpose of this review was to investigate the diagnostic accuracy for screening and confirmation of clinical tests for cervical spine myelopathy (CSM) and to investigate the quality of the studies that have investigated these values. METHODS: This study was a systematic review that used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Search terms for PubMed included myelopathy; diagnosis, differential; sensitivity and specificity; and physical examination. Search terms for Cumulative Index to Nursing and Allied Health Literature were limited to myelopathy and sensitivity and specificity. Qualitative assessment included report of diagnostic accuracy metrics (sensitivity, specificity, and positive and negative likelihood ratios) and quality scores using the Quality Assessment of Diagnostic Accuracy Studies tool. Scores were created for single tests and clustered test findings. RESULTS: After evaluation, 12 full-text articles were selected, scored, and tabulated. Nearly all of the 18 tests demonstrated high levels of specificity and low levels of sensitivity, suggesting that they are poor screening tools. Only one study was scored as high quality. One study involved clustering of test findings but was considered low quality. CONCLUSION: Nearly all of the clinical tests for CSM seem to be poor screening tools, which implies that manually oriented clinicians may perform treatment methods in a situation of doubt or uncertainly. More high-quality studies are needed, and manual therapists need to be cognizant that the current clinical tests for CSM lack strong diagnostic accuracy measures that are necessary for clinical decision making.

Education in the Time of COVID: At-a-Distance Training in Neuromusculoskeletal Ultrasonography.

Point of care ultrasound is important to the specialty of physical medicine and rehabilitation (PM&R) to aid in the diagnosis and treatment of a variety of neuromusculoskeletal conditions commonly seen in practice. However, across Canada, resident education of sonoanatomy skills is variable. There remain no standards in terms of how ultrasound is taught as part of the residency curriculum as set by the Royal College of Physicians and Surgeons of Canada. As such, residents are often required to find their own educational opportunities. This report describes an alternative approach to learning these skills that was inspired by disruption due to coronavirus disease 2019 in first year residency. This report explores how a PM&R resident was able to develop valuable ultrasound skills from home using not only textbooks and videos, but also new and novel teleguidance technology, namely an ultrasound probe that connects to a clinician's own smart devices to display images.

Human 21T breast epithelial cell lines mimic breast cancer progression in vivo and in vitro and show stage-specific gene expression patterns.

Early breast cancer progression involves advancement through specific morphological stages including atypical ductal hyperplasia (ADH), ductal carcinoma in situ (DCIS) and invasive mammary carcinoma (IMC), although not necessarily always in a linear fashion. Observational studies have examined genetic, epigenetic and gene expression differences in breast tissues representing these stages of progression, but model systems which would allow for experimental testing of specific factors influencing transition through these stages are scarce. The 21T series cell lines, all originally derived from the same patient with metastatic breast cancer, have been proposed to represent a mammary tumor progression series. We report here that three of the 21T cell lines indeed mimic specific stages of human breast cancer progression (21PT-derived cells, ADH; 21NT-derived cells, DCIS; 21MT-1 cells, IMC) when grown in the mammary fat pad of nude mice, albeit after a year. To develop a more rapid, readily manipulatable in vitro assay for examining the biological differences between these cell lines, we have used a 3D Matrigel system. When the three cell lines were grown in 3D Matrigel, they showed characteristic morphologies, in which quantifiable aspects of stage-specific in vivo behaviors (ie, differences in acinar structure formation, cell polarization, colony morphology, cell proliferation, cell invasion) were recapitulated in a reproducible fashion. Gene expression profiling revealed a characteristic pattern for each of the three cell lines. Interestingly, Wnt pathway alterations are particularly predominant in the early transition from 21PTci (ADH) to 21NTci (DCIS), whereas alterations in expression of genes associated with control of cell motility and invasion phenomena are more prominent in the later transition of 21NTci (DCIS) to 21MT-1 (IMC). This system thus reveals potential therapeutic targets and will provide a means of testing the influences of identified genes on transitions between these stages of pre-malignant to malignant growth.

Confronting the opioid epidemic: public opinion toward the expansion of treatment services in Virginia.

BACKGROUND: Public opinion polls have consistently shown Americans prefer treatment over arrest policies for opioid users. As the opioid epidemic remains a major health problem in the United States, it is important to determine the type of treatment policies the public would support. Theoretically, government should take into consideration the opinion of its constituents when deciding how to act. As such, the 2018 Virginia Commonwealth Public Policy Poll determined levels of support for the expansion of community-based treatment in one's community. RESULTS: Overall, the results showed 80% of Virginians (n = 788) supported the expansion of community-based treatment centers in their neighborhood, 69% supported the use of housing in their community, while less than half supported the provision of clean needles to IV drug users so they do not use dirty needles that could spread infection. Multivariate analyses revealed education, sex, and political party affiliation are significant factors in predicting support for the expansion of services. CONCLUSIONS: Given the lack of progress made by the government in reducing the supply and demand of drugs over the course of the war on drugs, it is time to move away from punitive policies to responsible and pragmatic approaches that include the expansion of community-based treatment.

Capacity demands of phoneme selection in word production: new evidence from dual-task experiments.

Three dual-task experiments investigated the capacity demands of phoneme selection in picture naming. On each trial, participants named a target picture (Task 1) and carried out a tone discrimination task (Task 2). To vary the time required for phoneme selection, the authors combined the targets with phonologically related or unrelated distractor pictures (Experiment 1) or words, which were clearly visible (Experiment 2) or masked (Experiment 3). When pictures or masked words were presented, the tone discrimination and picture naming latencies were shorter in the related condition than in the unrelated condition, which indicates that phoneme selection requires central processing capacity. However, when the distractor words were clearly visible, the facilitatory effect was confined to the picture naming latencies. This pattern arose because the visible related distractor words facilitated phoneme selection but slowed down speech monitoring processes that had to be completed before the response to the tone could be selected.

Telephone-based diet and exercise coaching and a weight-loss supplement result in weight and fat loss in 120 men and women.

PURPOSE: Determine the effects of telephone-based coaching and a weight-loss supplement on the weight and body fat (BF) of overweight adults. DESIGN: Randomized, placebo-controlled experiment with assessments at baseline, 2 months, and 4 months. SETTING: Community. SUBJECTS: Sixty overweight or obese men and 60 overweight or obese women, 25 to 60 years INTERVENTION: Eleven 30-minute telephone coaching sessions were spaced throughout the study; the initial conversation lasted 60 to 90 minutes. Supplement or placebo capsules were taken daily over the 17 weeks. MEASURES: Weight was measured using an electronic scale, and BF was assessed using dual energy x-ray absorptiometry. RESULTS: Subjects taking the placebo lost 1.8 +/- 3.3 kg of weight and 0.7 +/- 2.2 kg of BF, whereas supplement users lost more: 3.1 +/- 3.7 kg of weight (F = 4.1, P = .045) and 1.7 +/- 2.6 kg of BF (F = 4.4, p = .039). Participants receiving no coaching lost 1.8 +/- 3.3 kg of weight and 0.7 +/- 2.2 kg of BF, whereas adults receiving coaching lost more: 3.2 +/- 3.6 kg of weight (F = 4.8, p = .032) and 1.6 +/- 2.5 kg of BF (F = 4.2, p = .044). Adults receiving both the supplement and coaching had the greatest losses of weight and BF, suggesting an additive effect (F = 3.2, p = .026; F = 2.9, p = .039, respectively). CONCLUSIONS: Both treatments, coaching and the supplement, viewed separately and in combination, worked to help subjects lose weight and BF. Adults can be educated and motivated via telephone to change behaviors leading to weight loss, and a weight-loss supplement can be included to increase success.

Vestibular Stimulation for ADHD: randomized controlled trial of Comprehensive Motion Apparatus.

OBJECTIVE: This research evaluates effects of vestibular stimulation by Comprehensive Motion Apparatus (CMA) in ADHD. METHOD: Children ages 6 to 12 (48 boys, 5 girls) with ADHD were randomized to thrice-weekly 30-min treatments for 12 weeks with CMA, stimulating otoliths and semicircular canals, or a single-blind control of equal duration and intensity, each treatment followed by a 20-min typing tutorial. RESULTS: In intent-to-treat analysis (n = 50), primary outcome improved significantly in both groups (p = .0001, d = 1.09 to 1.30), but treatment difference not significant (p = .7). Control children regressed by follow-up (difference p = .034, d = 0.65), but overall difference was not significant (p = .13, d = .47). No measure showed significant treatment differences at treatment end, but one did at follow-up. Children with IQ-achievement discrepancy > or = 1 SD showed significantly more CMA advantage on three measures. CONCLUSION: This study illustrates the importance of a credible control condition of equal duration and intensity in trials of novel treatments. CMA treatment cannot be recommended for combined-type ADHD without learning disorder.

Manual therapy provided by physical therapists in a hospital-based setting: a retrospective analysis.

OBJECTIVE: The purpose of this study was to compare outcomes, complications, and hospital disposition in a cohort of patients hospitalized for low back pain who receive physical therapist (PT)-administered manual therapy (mobilization and manipulation) vs those who do not receive manual therapy. METHODS: The study was a retrospective data collection that used the Nationwide Inpatient Sample. Seventy-five patients hospitalized with low back pain who receive PT-administered manual therapy were matched using specific covariates with patients with low back who did not receive manual therapy. Bivariate analyses and regression modeling were used to determine comparisons between the 2 groups. RESULTS: Findings indicated that patients who received PT manual therapy had significantly longer lengths of hospital stay (P < .01) and had significantly higher inflation-adjusted costs of care (P < .01). After regression modeling and adjustments for covariates, findings for length of stay were still higher in the PT manual therapy group (P < .01), but costs were significantly lower for this group (P < .01). There were minimal findings of complications. CONCLUSIONS: Of 106 340 patients admitted for low back pain originally queried, only 75 patients (0.07%) received manual therapy, a markedly small number of patients. Outcomes may be reflective of the low effect size of manual therapy in a hospital setting or the inability to control for referral and hospital care patterns, thus disallowing appropriate matching.

Use of physical therapy in patients hospitalized with a diagnosis of generalized weakness: a retrospective study.

In a retrospective analysis of data from a national database, we observed and compared the presence of complications, lengths of stay, inflation-adjusted charges, and discharge statuses of two groups of patients hospitalized with a primary diagnosis of generalized weakness who did or did not receive physical therapy (PT) services. From a sample of patients (n = 38,991 cumulative from 1988 through 2003) from the Nationwide Inpatient Sample (NIS), 2.3% of patients admitted to the hospital with generalized weakness received PT intervention. Patients hospitalized with a primary diagnosis of generalized weakness who received PT services were sicker, had more selected secondary complications, and were demographically and socioeconomically dissimilar from patients who did not receive PT services. Quantitative analyses indicate that PT patients had longer inpatient hospital stays, more nonroutine discharges, and higher inflation-adjusted charges. The results are consistent with the interpretation that outcomes such as those examined here (nonroutine discharge, length of stay, and charges at discharge) are related to referral patterns in which only the most serious comorbidities qualify patients for referral for PT intervention services.