Objective sleep and cardiometabolic biomarkers: results from the community of mine study.

Study Objectives: Examining multiple dimensions of sleep health may better capture associations between sleep and health risks, including cardiometabolic disease (CMD). Hispanics have elevated risk for inadequate sleep and CMD biomarkers. Few studies have explored whether associations between sleep and CMD differ by Hispanic ethnicity. Methods: Leveraging data from the Community of Mine (CoM) study, a cross-sectional investigation of 602 ethnically diverse participants, we derived accelerometer-measured sleep duration and efficiency, and self-reported sleep quality. Accelerometer-measured sleep exposures were analyzed both as continuous and categorical variables. Multivariate and quantile regression models were used to assess associations between sleep and CMD biomarkers (insulin resistance, systolic blood pressure, and low-density-lipoprotein cholesterol), controlling for age, sex, ethnicity, education, smoking status, and body mass index. We examined the potential effect modification of Hispanic ethnicity. Results: We observed mixed results based on CMD biomarkers and sleep exposure. Increased sleep duration was significantly related to low-density lipoprotein cholesterol in adjusted models (estimate = 0.06; 95% CI: 0.02, 0.11). Poor sleep efficiency was associated with greater insulin resistance in the adjusted quantile (estimate = 0.20; 95% CI: 0.04, 0.36) model at the 90th percentile. Self-reported sleep quality was not associated with CMD outcomes. There was no evidence of effect modification by Hispanic ethnicity. Conclusions: In this cohort, sleep health measures were found to have mixed and at times opposing effects on CMD outcomes. These effects did not demonstrate an interaction with Hispanic ethnicity.

Aircraft and road traffic noise, insulin resistance, and diabetes: The role of neighborhood socioeconomic status in San Diego County.

Evidence linking traffic noise to insulin resistance and diabetes is limited and unanswered questions remain regarding the potential effect modification by neighborhood socioeconomic status (nSES). We aimed to assess socioeconomic inequalities in noise exposure, whether road and aircraft noise exposures were associated with insulin resistance or diabetes, and whether nSES modified these relationships. Among the Community of Mine Study in San Diego County, road and aircraft noise exposure at enrollment was calculated based on the static (participant's administrative boundary, and circular buffer around participant homes), and dynamic (mobility data by global positioning system, GPS) spatio-temporal aggregation methods. Associations of noise with insulin resistance (HOMA-IR) or type 2 diabetes (T2DM) were quantified using generalized estimating equation models adjusted for sex, age, ethnicity, individual income, and air pollution (nitrogen dioxide) exposure. Additive interaction between noise and nSES was assessed. Among 573 participants (mean age 58.7 y), participants living in low nSES were exposed to higher levels of aircraft and road noise using noise level at the census tract, circular buffer, or Kernel Density Estimation (KDE) of GPS data. Participants exposed to road noise greater or equal to the median (53 dB(A)) at the census tract and living in low nSES had an increased level of insulin resistance (ß = 0.15, 95%CI: -0.04, 0.34) and higher odds of T2DM (Odds Ratio = 2.34, 95%CI: 1.12, 4.90). A positive additive interaction was found as participants living in low nSES had higher odds of T2DM. The impact of noise exposure on insulin resistance and T2DM differs substantially by nSES. Public health benefits of reducing exposure to road or aircraft noise would be larger in individuals living in low nSES.

How do environmental characteristics jointly contribute to cardiometabolic health? A quantile g-computation mixture analysis.

Accumulating evidence links cardiometabolic health with social and environmental neighborhood exposures, which may contribute to health inequities. We examined whether environmental characteristics were individually or jointly associated with insulin resistance, hypertension, obesity, type 2 diabetes, and metabolic syndrome in San Diego County, CA. As part of the Community of Mine Study, cardiometabolic outcomes of insulin resistance, hypertension, BMI, diabetes, and metabolic syndrome were collected in 570 participants. Seven census tract level characteristics of participants' residential environment were assessed and grouped as follows: economic, education, health care access, neighborhood conditions, social environment, transportation, and clean environment. Generalized estimating equation models were performed, to take into account the clustered nature of the data and to estimate ß or relative risk (RR) and 95 % confidence intervals (CIs) between each of the seven environmental characteristics and cardiometabolic outcomes. Quantile g-computation was used to examine the association between the joint effect of a simultaneous increase in all environmental characteristics and cardiometabolic outcomes. Among 570 participants (mean age 58.8 ± 11 years), environmental economic, educational and health characteristics were individually associated with insulin resistance, diabetes, obesity, and metabolic syndrome. In the mixture analyses, a joint quartile increase in all environmental characteristics (i.e., improvement) was associated with decreasing insulin resistance (ß, 95 %CI: -0.09, -0.18-0.01)), risk of diabetes (RR, 95 %CI: 0.59, 0.36-0.98) and obesity (RR, 95 %CI: 0.81, 0.64-1.02). Environmental characteristics synergistically contribute to cardiometabolic health and independent analysis of these determinants may not fully capture the potential health impact of social and environmental determinants of health.

A Focal Impact Model of Traumatic Brain Injury in Xenopus Tadpoles Reveals Behavioral Alterations, Neuroinflammation, and an Astroglial Response.

Traumatic Brain Injury (TBI) is a global driver of disability, and we currently lack effective therapies to promote neural repair and recovery. TBI is characterized by an initial insult, followed by a secondary injury cascade, including inflammation, excitotoxicity, and glial cellular response. This cascade incorporates molecular mechanisms that represent potential targets of therapeutic intervention. In this study, we investigate the response to focal impact injury to the optic tectum of Xenopus laevis tadpoles. This injury disrupts the blood-brain barrier, causing edema, and produces deficits in visually-driven behaviors which are resolved within one week. Within 3 h, injured brains show a dramatic transcriptional activation of inflammatory cytokines, upregulation of genes associated with inflammation, and recruitment of microglia to the injury site and surrounding tissue. Shortly afterward, astrocytes undergo morphological alterations and accumulate near the injury site, and these changes persist for at least 48 h following injury. Genes associated with astrocyte reactivity and neuroprotective functions also show elevated levels of expression following injury. Since our results demonstrate that the response to focal impact injury in Xenopus resembles the cellular alterations observed in rodents and other mammalian models, the Xenopus tadpole offers a new, scalable vertebrate model for TBI.

Air pollution and metabolic disorders: Dynamic versus static measures of exposure among Hispanics/Latinos and non-Hispanics.

INTRODUCTION: Exposure to air pollution disproportionately affects racial/ethnic minorities that could contribute to health inequalities including metabolic disorders. However, most existing studies used a static assessment of air pollution exposure (mostly using the residential address) and do not account for activity space when modelling exposure to air pollution. The aim of this study is to understand how exposure to air pollution impacts metabolic disorders biomarkers, how this effect differs according to ethnicity, and for the first time compare these findings with two methods of exposure assessment: dynamic and static measures. METHODS: Among the Community of Mine study, a cross-sectional study conducted in San Diego County, insulin resistance, diabetes, hypertension, obesity, dyslipidemia, and metabolic syndrome (MetS) were assessed. Exposure to air pollution (PM2.5, NO2, traffic) was calculated using static measures around the home, and dynamic measures of mobility derived from Global Positioning Systems (GPS) traces using kernel density estimators to account for exposure variability across space and time. Associations of air pollution with metabolic disorders were quantified using generalized estimating equation models to account for the clustered nature of the data. RESULTS: Among 552 participants (mean age 58.7 years, 42% Hispanic/Latino), Hispanics/Latinos had a higher exposure to PM2.5 compared to non-Hispanics using static measures. In contrast, Hispanics/Latinos had less exposure to PM2.5 using dynamic measures. For all participants, higher dynamic exposure to PM2.5 and NO2 was associated with increased insulin resistance and cholesterol levels, and increased risk of obesity, dyslipidemia and MetS (RR 1.17, 95% CI: 1.07-1.28; RR 1.21, 95% CI: 1.12-1.30, respectively). The association between dynamic PM2.5 exposure and MetS differed by Hispanic/Latino ethnicity. CONCLUSION: These results highlight the importance of considering people's daily mobility in assessing the impact of air pollution on health.

Influence of Pediatric Endoscopic Endonasal Skull Base Resections on Midface and Skull Base Development.

OBJECTIVE: The purpose of this study is to use imaging data to determine if endoscopic endonasal surgery (EES) for skull base tumor resection interrupts skull base growth and development, resulting in an atrophic midface skeletal structure, compared to matched normal controls. METHODS: Data were collected by a retrospective chart review done on children aged 16 years and below who underwent endoscopic tumor resection and had pre- and postoperative magnetic resonance imaging with relevant midface anatomy. 121 normal controls were matched to 20 EES patients by age and gender. Three measurements related to midface anatomy were taken from 1 sagittal T1 slice and 1 axial T2 slice of each scan. Statistical analysis was used to compare growth measures between cases and controls. RESULTS: Twenty patients who underwent EES between November 2015 and April 2018 met our inclusion criteria. The mean age of the patients, 11 males and 9 females, was 10 years, and 8 patients (38%) were aged 7 years or younger. Six patients who had a high-flow CSF leak obtained a nasoseptal flap. A student T test and multivariate regression analysis found that EES did not affect midface and skull base growth. Among the variables assessed, age appears to be the only driver of growth. CONCLUSION: There were no identified differences in craniofacial growth in pediatric patients undergoing EES for skull base tumor resection as compared to the control group. EES does not appear to significantly interfere with midface/skull base development and is a good surgical option for pediatric patients.

Device-Measured and Self-Reported Active Travel Associations with Cardiovascular Disease Risk Factors in an Ethnically Diverse Sample of Adults.

Active travel (AT) provides an opportunity to alleviate the physical inactivity and climate crises contributing to the global chronic disease burden, including cardiovascular diseases (CVD). Though AT shows promising links to reduced CVD risk, prior studies relied on self-reported AT assessment. In the present study, device-measured and self-reported AT were compared across population subgroups and relationships with CVD risk biomarkers were evaluated for both measures. The study recruited an ethnically diverse sample (N = 602, mean age 59 years, 42% Hispanic/Latino ethnicity) from neighborhoods that varied by walkability and food access. AT was assessed using concurrently collected accelerometer and GPS data and self-report data from a validated survey. Relationships with body mass index (BMI), triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure (BP), and moderate-to-vigorous physical activity (MVPA) were modeled using multivariable linear regression. Devices captured more AT than did self-report. We found differences in AT measures by population subgroups, including race, ethnicity, education, income, vehicle access, and walkability. Men had more accelerometer-measured MVPA, though women self-reported more daily minutes. Both device and survey AT measures were positively associated with total accelerometer-measured MVPA, though the relationship was stronger with device-measured AT. Device-measured AT was associated with lower BMI. No other CVD risk biomarker was associated with either AT measure. No effect modification by Hispanic/Latino ethnicity was detected. Further studies with device-based measures are warranted to better understand the relationship between AT and cardiovascular health.

A survey of adult preferences regarding recruitment for pediatric research.

OBJECTIVE: Although subject recruitment is one of the most critical aspects of human subject research, there is a lack of studies prospectively examining the recruitment preferences of adults for research involving children. METHODS: This was a cross-sectional study of adults accompanying patients at an otolaryngology clinic in a pediatric medical center. Anonymous questionnaires were distributed in English and Spanish to one adult for every patient. Questions assessed the respondent's preferences for research recruitment including contact method preferences, contact preferences for medical profession type, and whether they would expect a child to receive a small gift for participating in a research study. Fisher's exact tests were used to assess the association between the primary predictor, language, and each outcome. RESULTS: 566 surveys were collected. 505 (89.1%) were completed in English and 61 (10.7%) were completed in Spanish. Spanish-speaking respondents were more likely to prefer talking to a doctor (76.7%) than English-speaking respondents (40.1%, p < 0.05). Spanish-speaking respondents were more likely to prefer talking over the phone (48.3%) than English-speaking respondents (17.3%, p < 0.05). Spanish-speaking respondents were more likely to prefer communicating via text messaging (41.7%) than English-speaking respondents (16.3%, p < 0.05). English-speaking respondents were more likely to prefer communicating through the patient portal of an electronic health record (EHR) (19%) than Spanish-speaking respondents(3.3%, p < 0.05). Mothers were more likely to prefer talking to a nurse/physician's assistant (20%) than fathers (10%, p < 0.05). Mothers were more likely to prefer talking to research staff (20%) than fathers (9%, p < 0.05). Mothers were more likely to prefer communication via text-message (22%) than fathers (6%, p < 0.05). Spanish-speaking respondents were more likely to prefer pediatric patients receiving a small monetary gift for participating in clinical research (70%) than English-speaking respondents (30%, p < 0.05). CONCLUSION: There was a significant association between preference for recruitment method and primary language spoken by the respondent. Further inquiry is required to understand these differences between English and Spanish speakers.

Predictors of Pediatric Tracheostomy Outcomes in the United States.

OBJECTIVES: To investigate the outcomes of pediatric tracheostomy as influenced by demographics and comorbidities. STUDY DESIGN: Retrospective national database review. SETTING: Fifty-two children's hospitals across the United States. SUBJECTS AND METHODS: Hospitalization records from Pediatric Health Information System database dated 2010 to 2018 with patients younger than 18 years and procedure codes for tracheostomy were extracted. The primary outcome was total length of stay. The secondary outcomes were 30-day readmission, mortality, and posttracheostomy length of stay. RESULTS: A total of 14,155 children were included in the analysis. The median total length of stay was 77 days and increased from 59 to 103 days between 2010 and 2018 (P < .001). The median posttracheostomy length of stay was 34 days and also increased from 27 to 49 days (P < .001). On multivariate regression analyses, the total and posttracheostomy lengths of stay were significantly increased in children younger than 1 year, patients of black race, hospitals in the non-West regions, those discharged to home, and those with comorbidities. Socioeconomic indicators such as insurance type and estimated household income were associated with no difference or small effect sizes. Regions and comorbidities were associated with differences in 30-day readmission (overall 26%), while in-hospital mortality was primarily associated with age and comorbidities (overall 8.6%). CONCLUSION: Pediatric tracheostomy requires substantial health care resources with length of stay escalating over recent years. Age, race, region, discharge destination, and comorbidities were associated with differences in length of stay.

Modest benefit of frenotomy for infants with ankyloglossia and breastfeeding difficulties.

INTRODUCTION: With nationwide effort to increase breastfeeding rates in newborns and infants in recent years, there has been a dramatic increase in the diagnosis of ankyloglossia, and the resultant otolaryngology referral for frenotomy. Overall, there is a paucity of data on the expected benefit of frenotomy in this population and the subsequent breastfeeding rate. The objectives of this study were to assess the effect of office-based frenotomy on improving breastfeeding difficulties among infants with ankyloglossia from a patient-centered perspective and examine associated effects of frenotomy and ankyloglossia type on breastfeeding. METHODS: Maternal-infant dyads were referred to a tertiary care otolaryngology practice for assessment of ankyloglossia. A prospective cohort study was conducted in this population from January 2017 to September 2018. Mothers completed questionnaires regarding the quality of breastfeeding before the frenotomy procedure in the office and were subsequently contacted by phone to complete the same questionnaires 1 week and 3 months after the initial encounter. Treating physicians reported ankyloglossia type and expected improvement at the time of the procedure. Descriptive statistics and paired analyses were used to analyze post-frenotomy breastfeeding outcomes and ascertain likelihood of improvement. RESULTS: During the study period, the mothers of 343 infants agreed to participate in the study by completing the initial questionnaire. Of these infants, 314 (91.5%) underwent frenotomy. Most infants were classified as having either type I (35.3%) or type II (45.2%) ankyloglossia with 16.9% having posterior ankyloglossia and 2.6% with no ankyloglossia. At 1-week post-frenotomy the largest group of patients (35%) had mild improvement in breastfeeding abilities compared to baseline with 14% and 7% reporting moderate or marked improvement respectively. At 3 months after the initial consultation, significantly more patients reported moderate (27%) or marked (17%) improvement when compared to baseline although the exclusively breastfeeding rate at 3 months was low at 20.3% for this cohort. CONCLUSIONS: This prospective study demonstrated that frenotomy had a modestly positive effect on breastfeeding ability from the mother's perspective in infants referred for ankyloglossia. It is important to educate patients on the multi-factorial nature of breastfeeding and to set realistic expectations prior to recommending the procedure.

Disaggregating Hispanic American Cancer Mortality Burden by Detailed Ethnicity.

BACKGROUND: Hispanics are the largest minority population in the United States (18%). They represent a heterogeneous and growing population. Cancer is the leading cause of death among Hispanics, yet few studies have described cancer mortality burden by specific Hispanic group nationwide. METHODS: Cancer-related deaths from U.S. death certificates for the years 2003-2012 were analyzed for decedents identifying as Mexican, Puerto Rican, Cuban, and Central or South American. We calculated descriptive statistics, including potential years of lives lost (PYLL), age-adjusted rates, standardized mortality ratios, and fitted JoinPoint regression models, to evaluate annual trends by Hispanic group, using non-Hispanic Whites (NHW) as the reference population. RESULTS: We identified 287,218 cancer-related deaths among Hispanics and 4,570,559 among NHWs. Mortality trends were heterogeneous across Hispanic groups. Female NHWs and male Puerto Ricans had the greatest rates of adjusted PYLL per 1,000 (NHWs, 19.6; Puerto Ricans, 16.5). Liver cancer was ranked among the top 5 cancer-related deaths for every Hispanic group, but not for NHWs. Stomach cancer mortality was twice as high for most Hispanic groups when compared with NHWs and especially high for Mexicans [male standardized mortality ratio (SMR), 2.07; 95% confidence interval (CI), 2.01-2.13; female SMR, 2.62; 95% CI, 2.53-2.71]. CONCLUSIONS: We observed marked heterogeneity in cancer mortality across Hispanic groups. Several cancers affect Hispanics disproportionately compared with NHWs. Screening programs in Hispanics should be considered for stomach and liver cancer. IMPACT: Disaggregated analysis of Hispanics is needed to fully understand cancer burden among the diverse Hispanic population and is critical for cancer prevention and control efforts.

Holopothrips chaconi sp.n. (Thysanoptera: Phlaeothripinae) from leaf-vein galls on Piper species (Piperaceae) in Costa Rica

AbstractMost species of the Neotropical genus Holopothrips are associated with plant galls but very little is known about their biology. Here, we provide observations on the biology of a new species of Holopothrips associated with leaf-vein galls on four species of Piper at a cloud forest site (Zurquí de Moravia) in Costa Rica. This species colonized the galls soon after the gall-inducing cecidomyiid or one of its parasitoids emerged, and several generations of thrips appeared to occupy the empty galls. A total of 175 empty galls from 34 leaves were collected, brought to the laboratory for dissection under the microscope, and the contents quantified. Holopothrips occupied approximately 75 % of the galled leaves and among the latter they occupied about 40 % of the galls. Every combination of adults, nymphs and eggs was found, which implies that adult thrips move in and out of galls, and possibly do not defend their galls from invasion by other members of their species. However, when disturbed, both nymphs and adults raise the tip of their abdomen and emit a distinctive odor, suggesting a defensive reaction against potential predators. Preliminary evidence suggests that they feed on gall tissue lining the inner cavity and spend very little time outside the galls. The thrips is described as a new species, and is one of only four known species of Holopothrips to have the unusual condition of two pairs of epimeral setae on the pronotum. This new species was compared to these other three Holothrips species, and the remarkable variation of the female spermatheca and the male sternal pore plate is illustrated. Further research is needed to confirm that several generations of thrips occupy empty galls, to determine whether adult thrips do indeed move between galls, and to explore in greater detail their possible chemical defense. Rev. Biol. Trop. 63 (4): 1035-1042. Epub 2015 December 01.

ResumenLa mayoría de las especies del género neotropical Holopothrips se asocian a las agallas de plantas pero se sabe muy poco de su biología. Aquí, se provee observaciones sobre la biología de una nueva especie de Holopothrips que se asocia a las agallas de venas foliares en cuatro especies de Piper en un bosque nuboso (Zurquí de Moravia) de Costa Rica. Esta especie coloniza las agallas luego de que el cecidómido inductor o un parasitoide del mismo emerge, y aparentemente varias generaciones de trips ocupan las agallas vacías. Un total de 175 agallas vacías en 34 hojas fueron recolectadas, llevadas al laboratorio para disección bajo el microscopio y se cuantificó su contenido. Holopothrips ocupaba aproximadamente el 75 % de las hojas con agallas y en ellas el 40 % de las agallas. Se encontró toda combinación de adultos, ninfas y huevos, lo cual implica que los trips adultos entran y salen y posiblemente no defienden sus agallas de la invasión de otros miembros de su especie. Sin embargo, adultos y ninfas, levantan la punta del abdomen al ser perturbados, emitiendo un olor distintivo que sugiere una reacción defensiva ante posibles depredadores. La evidencia preliminar indica que se alimentan del tejido interior de la agalla y pasan muy poco tiempo fuera de la misma. Se describe la especie nueva y es una de sólo cuatro especies conocidas de Holopothrips que poseen dos pares de setas epimorales en el pronoto. Al compararla con estas otras especies surge una marcada variación en la espermateca de la hembra y en las placas del poro esternal en el macho, los cuales se ilustran. Se requiere más investigación para confirmar la sugerencia que varias generaciones de trips ocupan las agallas vacias, para determinar si es cierto que los trips adultos se mueven entre agallas, y para explorar en más detalle la supuesta defensa química.