Fluid protein fold space and its implications.

Fold-switching proteins, which remodel their secondary and tertiary structures in response to cellular stimuli, suggest a new view of protein fold space. For decades, experimental evidence has indicated that protein fold space is discrete: dissimilar folds are encoded by dissimilar amino acid sequences. Challenging this assumption, fold-switching proteins interconnect discrete groups of dissimilar protein folds, making protein fold space fluid. Three recent observations support the concept of fluid fold space: (1) some amino acid sequences interconvert between folds with distinct secondary structures, (2) some naturally occurring sequences have switched folds by stepwise mutation, and (3) fold switching is evolutionarily selected and likely confers advantage. These observations indicate that minor amino acid sequence modifications can transform protein structure and function. Consequently, proteomic structural and functional diversity may be expanded by alternative splicing, small nucleotide polymorphisms, post-translational modifications, and modified translation rates.

JUUL's 2019 Removal of Mint-Flavored Pods and Changes to the Retail Environment of Electronic Nicotine Delivery Systems in Florida and the United States.

INTRODUCTION: The increase in youth electronic nicotine delivery system (ENDS) use coincided with JUUL's rapid rise, which prompted investigations and lawsuits aimed at this leading brand. In response, JUUL discontinued sweet flavors in late 2018, followed by mint flavors in November 2019. We assessed ENDS sales and prices at both the state and national level before and after JUUL's removal of mint flavors. AIMS AND METHODS: Nielsen retail sales data on ENDS products from convenience and food stores in 4-week aggregates were analyzed between January 2019 and January 2020 in Florida and the United States. Standardized units were created. Unit market share and growth rates were calculated for top brands and flavors in the periods before and after JUUL's mint removal. Average prices within brand and product type were calculated. RESULTS: Following JUUL's removal of mint in November 2019, JUUL's market share dropped from over 66% in Florida and the United States to 37.1% (Florida) and 55.1% (United States). In January 2020, the second leading brands were Puff Bar (15.0%) in Florida and Vuse (18.1%) in the United States. Mint market share decreased and share of all other flavor categories increased, particularly menthol and concept. Total ENDS sales increased in Florida but decreased in the United States. Average prices of ENDS devices decreased. CONCLUSIONS: While JUUL's actions led to a decline in its sales, Puff Bar emerged and menthol and concept flavors experienced growth. Findings also demonstrate how changes by influential brands differentially affect purchase patterns at the national and state level. IMPLICATIONS: These findings support the growing body of evidence that tobacco industry self-regulation, with selective flavor removal by the leading ENDS brand in this case, is insufficient to reduce total ENDS sales, including sales of flavored products which are preferred by youth. Results suggest that brand and flavor substitution compensated for the removal of mint JUUL pods. Understanding changes to the ENDS market in response to industry actions, at both the state and national level, can inform future regulation and interventions. These findings can also inform efforts to prevent and reduce youth ENDS use.

A Successful Collaboration Between an Urban School District, a Health System, and a Public Health Department to Address COVID-19 While Returning Children to the Classroom.

We sought to create and implement a set of COVID-19 mitigation processes including reliable testing to minimize in-school transmission of SARS-CoV-2. A large urban school district (> 33,000 students), a city health department, and a free-standing children's hospital partnered to implement multi-layered mitigation procedures which included access to polymerase chain reaction (PCR) testing with same day or next morning results. We tracked COVID-19 cases as well as probable/confirmed transmissions and identified needed mitigations through frequent huddles. During the 2020-2021 school year, there were 13 weeks of hybrid in person learning and 9 weeks of 5 day a week learning. Of the 1936 cases documented, only 3.2% resulted in subsequent school-related transmission. When children felt ill in the classroom, they were isolated within 10 min of reporting ill symptoms (> 90% of the time). PCR test results were routinely available to the school district by 6AM the following morning (79-99% of the time, depending on the learning model). An adaptive, fast-learning partnership across school district, public health, and a children's hospital minimized school-related transmission of COVID-19 and allowed children to safely return to the classroom.

Amino acid signatures of HLA Class-I and II molecules are strongly associated with SLE susceptibility and autoantibody production in Eastern Asians.

Human leukocyte antigen (HLA) is a key genetic factor conferring risk of systemic lupus erythematosus (SLE), but precise independent localization of HLA effects is extremely challenging. As a result, the contribution of specific HLA alleles and amino-acid residues to the overall risk of SLE and to risk of specific autoantibodies are far from completely understood. Here, we dissected (a) overall SLE association signals across HLA, (b) HLA-peptide interaction, and (c) residue-autoantibody association. Classical alleles, SNPs, and amino-acid residues of eight HLA genes were imputed across 4,915 SLE cases and 13,513 controls from Eastern Asia. We performed association followed by conditional analysis across HLA, assessing both overall SLE risk and risk of autoantibody production. DR15 alleles HLA-DRB1*15:01 (P = 1.4x10-27, odds ratio (OR) = 1.57) and HLA-DQB1*06:02 (P = 7.4x10-23, OR = 1.55) formed the most significant haplotype (OR = 2.33). Conditioned protein-residue signals were stronger than allele signals and mapped predominantly to HLA-DRB1 residue 13 (P = 2.2x10-75) and its proxy position 11 (P = 1.1x10-67), followed by HLA-DRB1-37 (P = 4.5x10-24). After conditioning on HLA-DRB1, novel associations at HLA-A-70 (P = 1.4x10-8), HLA-DPB1-35 (P = 9.0x10-16), HLA-DQB1-37 (P = 2.7x10-14), and HLA-B-9 (P = 6.5x10-15) emerged. Together, these seven residues increased the proportion of explained heritability due to HLA to 2.6%. Risk residues for both overall disease and hallmark autoantibodies (i.e., nRNP: DRB1-11, P = 2.0x10-14; DRB1-13, P = 2.9x10-13; DRB1-30, P = 3.9x10-14) localized to the peptide-binding groove of HLA-DRB1. Enrichment for specific amino-acid characteristics in the peptide-binding groove correlated with overall SLE risk and with autoantibody presence. Risk residues were in primarily negatively charged side-chains, in contrast with rheumatoid arthritis. We identified novel SLE signals in HLA Class I loci (HLA-A, HLA-B), and localized primary Class II signals to five residues in HLA-DRB1, HLA-DPB1, and HLA-DQB1. These findings provide insights about the mechanisms by which the risk residues interact with each other to produce autoantibodies and are involved in SLE pathophysiology.

A sequence-based method for predicting extant fold switchers that undergo α-helix ↔ ß-strand transitions.

Extant fold-switching proteins remodel their secondary structures and change their functions in response to cellular stimuli, regulating biological processes and affecting human health. Despite their biological importance, these proteins remain understudied. Predictive methods are needed to expedite the process of discovering and characterizing more of these shapeshifting proteins. Most previous approaches require a solved structure or all-atom simulations, greatly constraining their use. Here, we propose a high-throughput sequence-based method for predicting extant fold switchers that transition from α-helix in one conformation to ß-strand in the other. This method leverages two previous observations: (a) α-helix â†” ß-strand prediction discrepancies from JPred4 are a robust predictor of fold switching, and (b) the fold-switching regions (FSRs) of some extant fold switchers have different secondary structure propensities when expressed by themselves (isolated FSRs) than when expressed within the context of their parent protein (contextualized FSRs). Combining these two observations, we ran JPred4 on 99-fold-switching proteins and found strong correspondence between predicted and experimentally observed α-helix â†” ß-strand discrepancies. To test the overall robustness of this finding, we randomly selected regions of proteins not expected to switch folds (single-fold proteins) and found significantly fewer predicted α-helix â†” ß-strand discrepancies. Combining these discrepancies with the overall percentage of predicted secondary structure, we developed a classifier to identify extant fold switchers (Matthews correlation coefficient of .71). Although this classifier had a high false-negative rate (7/17), its false-positive rate was very low (2/136), suggesting that it can be used to predict a subset of extant fold switchers from a multitude of available genomic sequences.

A high-throughput predictive method for sequence-similar fold switchers.

Although most experimentally characterized proteins with similar sequences assume the same folds and perform similar functions, an increasing number of exceptions is emerging. One class of exceptions comprises sequence-similar fold switchers, whose secondary structures shift from α-helix <-> ß-sheet through a small number of mutations, a sequence insertion, or a deletion. Predictive methods for identifying sequence-similar fold switchers are desirable because some are associated with disease and/or can perform different functions in cells. Here, we use homology-based secondary structure predictions to identify sequence-similar fold switchers from their amino acid sequences alone. To do this, we predicted the secondary structures of sequence-similar fold switchers using three different homology-based secondary structure predictors: PSIPRED, JPred4, and SPIDER3. We found that α-helix <-> ß-strand prediction discrepancies from JPred4 discriminated between the different conformations of sequence-similar fold switchers with high statistical significance (P < 1.8*10-19 ). Thus, we used these discrepancies as a classifier and found that they can often robustly discriminate between sequence-similar fold switchers and sequence-similar proteins that maintain the same folds (Matthews Correlation Coefficient of 0.82). We found that JPred4 is a more robust predictor of sequence-similar fold switchers because of (a) the curated sequence database it uses to produce multiple sequence alignments and (b) its use of sequence profiles based on Hidden Markov Models. Our results indicate that inconsistencies between JPred4 secondary structure predictions can be used to identify some sequence-similar fold switchers from their sequences alone. Thus, the negative information from inconsistent secondary structure predictions can potentially be leveraged to identify sequence-similar fold switchers from the broad base of genomic sequences.

Extant fold-switching proteins are widespread.

A central tenet of biology is that globular proteins have a unique 3D structure under physiological conditions. Recent work has challenged this notion by demonstrating that some proteins switch folds, a process that involves remodeling of secondary structure in response to a few mutations (evolved fold switchers) or cellular stimuli (extant fold switchers). To date, extant fold switchers have been viewed as rare byproducts of evolution, but their frequency has been neither quantified nor estimated. By systematically and exhaustively searching the Protein Data Bank (PDB), we found ∼100 extant fold-switching proteins. Furthermore, we gathered multiple lines of evidence suggesting that these proteins are widespread in nature. Based on these lines of evidence, we hypothesized that the frequency of extant fold-switching proteins may be underrepresented by the structures in the PDB. Thus, we sought to identify other putative extant fold switchers with only one solved conformation. To do this, we identified two characteristic features of our ∼100 extant fold-switching proteins, incorrect secondary structure predictions and likely independent folding cooperativity, and searched the PDB for other proteins with similar features. Reassuringly, this method identified dozens of other proteins in the literature with indication of a structural change but only one solved conformation in the PDB. Thus, we used it to estimate that 0.5-4% of PDB proteins switch folds. These results demonstrate that extant fold-switching proteins are likely more common than the PDB reflects, which has implications for cell biology, genomics, and human health.

Association Between Social Media Use and Vaping Among Florida Adolescents, 2019.

INTRODUCTION: With the growing popularity of vaping, evidence has emerged about the association between social media use and vaping among adolescents, possibly because of the proliferation of e-cigarette advertisements and other related content on social media. Our study examined the association between social media use and vaping among adolescents. METHODS: Using data from the 2019 Florida Youth Tobacco Survey (N = 10,776), we conducted logistic regression models on adolescent vaping status (experimental and current vaping) by nondaily and daily use of social media platforms - Facebook, Instagram, Twitter and Snapchat, controlling for other confounders. RESULTS: Use of all 4 selected social media platforms was significantly associated with vaping status (P <.001 for all). Once jointly analyzed, daily use of Instagram was significantly associated with increased relative risks of experimental (adjusted relative risk ratio [aRRR] = 1.76; 95% CI, 1.38-2.25) and current vaping (aRRR = 1.51; 95% CI, 1.16-1.95); nondaily use of Snapchat was significantly associated with increased relative risk of experimental (aRRR = 1.57; 95% CI, 1.17-2.10) and current vaping (aRRR = 1.87; 95% CI, 1.31-2.66); daily use of Snapchat was associated with increased relative risk of experimental (aRRR = 2.38; 95% CI, 1.85-3.08) and current vaping (aRRR = 5.09; 95% CI, 3.78-6.86); nondaily use of Facebook was associated with increased relative risk of current vaping (aRRR = 1.20; 95% CI, 1.00-1.43), and nondaily use of Twitter was associated with increased relative risk of current vaping (aRRR = 1.29; 95% CI, 1.07-1.56). CONCLUSION: Multilevel efforts are warranted to monitor social media use and vaping status among adolescents, including media use monitoring plans, developing counter-marketing campaigns, and strict regulatory action on social media.

Changes in Recall to E-Cigarette Advertisement Exposure among Florida Youth, 2016-2019.

INTRODUCTION: The Centers for Disease Control and Prevention reported increases in exposure to e-cigarette ads among US middle and high school students from 2014-2016. This study examines changes in exposure to e-cigarette ads by source among youth in Florida. Methods: We analyzed Florida Youth Tobacco Survey (FYTS) data from 2016-2019 (n = 149,407). We calculated the weighted prevalence of exposure to ads by source (on radio, TV, internet, billboards/outdoor signs, or magazines/newspapers) across years and tested differences in prevalence from 2016-2019. We used logistic regression to examine the changes from 2016-2019 and further conducted multivariable logistic regression to examine the likelihood of past-30-day e-cigarette ad recall as a function of sociodemographics, tobacco use among family members, and current use of tobacco products. Results: Exposure to any type of e-cigarette ads decreased significantly from 2016 (weighted, 55.4%, 95% CI = 54.7, 56.1) to 2018 (47.3%, 95% CI = 46.6, 48.1), but rebounded in 2019 (57.0%, 95% CI = 55.7, 58.4). In multivariable logistic models, the following correlates were consistently associated with higher past-30-day exposure to any source of e-cigarette ads: survey year of 2019 (vs. 2016), being a high school (vs. middle school) student, female (vs. male), current use of e-cigarettes, current other tobacco use, and having a family member who uses tobacco. Conclusion: These findings suggest the need for continued surveillance of e-cigarette marketing practices and policies to prevent youth exposure to e-cigarette ads.

Effect of a Statewide Media Campaign on Smoking Cessation Among Florida Adults.

INTRODUCTION: Since December 2010, Florida's Bureau of Tobacco Free Florida has aired a statewide tobacco education campaign to encourage smoking cessation. The Tobacco Free Florida campaign consists of evidence-based advertisements primarily characterized by strong emotional content and graphic imagery designed to increase awareness of the health risks of tobacco use. We evaluated the effect of the media campaign on population-level quit attempts by using a statewide representative sample of Florida adults aged 18 or older. METHODS: We examined data from 5,418 Florida adult cigarette smokers and recent quitters aged 18 or older from the Florida Adult Tobacco Survey, an annual, cross-sectional survey conducted from 2011 through 2018. The primary outcome was incidence of quit attempts in the previous 12 months. We used multivariable logistic regression models to estimate the odds of making a quit attempt as a function of advertising levels across state media markets. Rates of quit attempts in Florida were also estimated. RESULTS: Approximately 66% of smokers in the study made at least 1 quit attempt. Exposure to the campaign was associated with increased odds of a quit attempt in the previous 12 months (odds ratio = 1.25; P = .02) among smokers and recent quitters. The Tobacco Free Florida campaign was associated with an estimated 332,604 additional smokers making quit attempts per year during the study period. CONCLUSION: The Tobacco Free Florida campaign affected cessation-related behaviors in Florida over an 8-year period. Evidence-based state tobacco education campaigns can accelerate progress toward the goal of reducing adult smoking.

The risk of low risk: First time motherhood, prematurity and dyadic well-being.

Premature birth has a well-documented impact on infants, mothers and their dyadic interactions. First time motherhood in the context of low risk premature birth-relatively unexplored in the literature-is a specific experience that sits at the nexus of premature infancy, motherhood and the processes that underpin dyadic connection. This qualitative study analyzed semistructured interviews with first time mothers of low risk premature babies. Findings were generated in response to research questions concerning mothers' meaning-making, bonding and identity. Findings demonstrated that maternal meaning-making emerged from a dyadic framework. When mothers or their infants were considered outside of a dyadic context, surplus suffering inadvertently occurred. Findings have important implications for infant mental health practice in medical settings, for postnatal support in the aftermath of premature birth, and for understanding the meaning of risk.

El nacimiento prematuro tiene un impacto bien documentado en los infantes, madres y sus interacciones diádicas. La maternidad primeriza dentro del contexto de nacimiento prematuro de bajo riesgo -relativamente no explorado en la literatura- es una experiencia específica que se asienta en la coyuntura entre infancia prematura, maternidad y los procesos que respaldan la conexión diádica. Este estudio cualitativo analizó entrevistas semiestructuradas con madres primerizas de bebés prematuros de bajo riesgo. Los resultados fueron generados como respuesta a las preguntas de la investigación relativas a los procesos de dar sentido, establecer conexión de afectividad, así como de identidad de las madres. Los resultados demostraron que el proceso materno de dar sentido surgió de un marco diádico. Cuando las madres o sus infantes fueron considerados fuera de un contexto diádico, ocurrió por inadvertencia un sufrimiento en exceso. Los resultados tienen implicaciones importantes para la práctica de salud mental infantil en escenarios médicos, para el apoyo en el período que sigue al nacimiento prematuro, así como para la comprensión del significado de riesgo.

La naissance prématurée a un impact bien documenté sur les nourrissons, les mères et leurs interactions dyadiques. Le fait d'être mère pour la première fois dans le contexte d'une naissance prématurée à faible risque - relativement peu exploré dans les recherches - est une expérience spécifique qui se situe au coeur de la petite enfance prématurée, de la maternité et des processus qui soutiennent la connexion dyadique. Cette analyse qualitative a analysé des entretiens semi-structurés avec des mères étant mères pour la première fois et ayant eu des bébés prématurés à faible risque. Les résultats ont été générés en réponse à des questions de recherches concernant la quête de signification des mères, leur lien et leur identité. Les résultats démontrent que la quête de signification maternelle émergeait d'une structure dyadique. Lorsque les mères ou leurs bébés étaient considérés au dehors de ce contexte dyadique une souffrance excédentaire s'est produite par inadvertance. Les résultats ont des implications importantes pour la pratique de santé mentale du nourrisson dans des contextes médicaux, à la fois pour le soutien postnatal après une naissance prématurée et pour la compréhension de la signification du risque.

Prevalence and characteristics of secondhand smoke and secondhand vapour exposure among youth.

BACKGROUND: It is well established that secondhand smoke (SHS) is harmful, and concern about the potential dangers associated with secondhand vapour (SHV) (ie, vapour from electronic vapour products, EVP) is growing. The present study examines the prevalence and characteristics associated with SHS and SHV exposure. METHODS: Data from youth aged 11-17 who completed the 2016 Florida Youth Tobacco Survey (n=58 616) were analysed. Demographics, past 30 day SHS and SHV exposure, environmental factors, cigarette and EVP use status, SHS and SHV harm perceptions, and tobacco susceptibility were assessed. Weighted multivariable logistic regressions were performed to examine characteristics associated with SHS and SHV exposure, and SHS and SHV exposure with tobacco susceptibility. RESULTS: Overall, 42% of Florida youth reported SHS exposure and 29% reported SHV exposure during the past 30 days. Living in a home where tobacco use was permitted (vs not permitted) was positively associated with SHS (adjusted OR (AOR) 2.57) and SHV exposure (AOR 1.56). Perceived SHS as harmful (vs not harmful) was positively associated with SHS (AOR 1.73) and SHV exposure (AOR 1.97), while perceived SHV as harmful was negatively associated with SHS (AOR 0.86) and SHV exposure (AOR 0.56). SHS and SHV exposure was significantly associated with susceptibility to cigarette and EVP use (AOR 1.40 and 2.08, respectively). CONCLUSIONS: Almost one-third of Florida youth reported SHV exposure. Factors associated with SHS and SHV exposure are somewhat similar, and exposure to SHS and SHV is associated with tobacco susceptibility in youth. Promoting tobacco-free homes is needed to protect youth from SHS and SHV exposure.

Tobacco Product Use Among Youths With and Without Lifetime Asthma - Florida, 2016.

The increasing availability of diverse tobacco products has led to complex tobacco product use patterns among youths (1). Use by youths of products containing nicotine in any form is unsafe (2); among young persons with asthma, use of combustible tobacco products, particularly cigarettes, is associated with worsening symptoms, poor asthma control, and an increased need for medical management (3,4). Studies suggest that youths with asthma adopt health risk behaviors, including tobacco product use, at rates similar to or higher than those of youths without asthma (3-7); however, these studies are often limited to a partial list of tobacco product types among high school students. To assess current use (≥1 days during the past 30 days) of one or more of five tobacco product types (cigarettes, electronic cigarettes [defined as e-cigarettes, e-cigars, vape pipes, vaping pens, e-hookah, and hookah pens], hookah, smokeless tobacco, or cigars) among Florida middle school (grades 6-8) and high school (grades 9-12) students with or without a previous medical diagnosis of asthma, the Florida Department of Health analyzed data from the 2016 Florida Youth Tobacco Survey (FYTS). In 2016, 11.1% of middle school and 27.9% of high school students with asthma, and 7.9% of middle school and 24.2% of high school students without asthma, reported any current tobacco product use. Current use of each tobacco product type was considerably higher among students with asthma than among those without asthma. E-cigarettes were the most commonly used tobacco product type reported by middle and high school students with asthma (7.9% and 19.6%, respectively) and without asthma (5.8% and 17.2%, respectively). Statewide tobacco prevention strategies could help reduce all forms of tobacco product use among youths, particularly among those with asthma.

N-terminal nesprin-2 variants regulate ß-catenin signalling.

The spatial compartmentalisation of biochemical signalling pathways is essential for cell function. Nesprins are a multi-isomeric family of proteins that have emerged as signalling scaffolds, herein, we investigate the localisation and function of novel nesprin-2 N-terminal variants. We show that these nesprin-2 variants display cell specific distribution and reside in both the cytoplasm and nucleus. Immunofluorescence microscopy revealed that nesprin-2 N-terminal variants colocalised with ß-catenin at cell-cell junctions in U2OS cells. Calcium switch assays demonstrated that nesprin-2 and ß-catenin are lost from cell-cell junctions in low calcium conditions whereas emerin localisation at the NE remained unaltered, furthermore, an N-terminal fragment of nesprin-2 was sufficient for cell-cell junction localisation and interacted with ß-catenin. Disruption of these N-terminal nesprin-2 variants, using siRNA depletion resulted in loss of ß-catenin from cell-cell junctions, nuclear accumulation of active ß-catenin and augmented ß-catenin transcriptional activity. Importantly, we show that U2OS cells lack nesprin-2 giant, suggesting that the N-terminal nesprin-2 variants regulate ß-catenin signalling independently of the NE. Together, these data identify N-terminal nesprin-2 variants as novel regulators of ß-catenin signalling that tether ß-catenin to cell-cell contacts to inhibit ß-catenin transcriptional activity.

Baclofen Toxicity in a Patient with Hemodialysis-Dependent End-Stage Renal Disease.

BACKGROUND: Oral baclofen toxicity is extremely rare, but can affect patients with renal disease due to the drug's predominant renal clearance of approximately 69-85%. Patients with severely impaired renal function typically develop symptoms soon after initiating baclofen therapy, even at relatively low doses. CASE REPORT: A 69-year-old woman with a history of hemodialysis-dependent end-stage renal disease presented to the Emergency Department with encephalopathy, ataxia, and dystonia after the addition of a recent baclofen prescription for back pain (10 mg twice daily). She had been taking baclofen as prescribed for approximately 1 week when, the day prior to admission, she had increased her dose to a total of 40 mg. Diagnostic studies demonstrated the patient had chronic, end-stage renal disease and a supratherapeutic concentration of baclofen. Signs and symptoms resolved with hemodialysis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is of critical importance for emergency physicians to appreciate impaired baclofen clearance in those with underlying renal disease to obviate the potential for significant drug toxicity.

Loperamide-Induced Torsades de Pointes: A Case Series.

BACKGROUND: Loperamide is an over-the-counter, inexpensive, antidiarrheal opioid that can produce life-threatening toxicity at high concentrations. CASE REPORT 1: A 28-year-old man with a history of depression and substance abuse disorder (SUD) presented to the emergency department (ED) with shortness of breath and lightheadedness. He ingested large amounts of loperamide daily. The patient's initial electrocardiogram (ECG) demonstrated sinus rhythm, right axis deviation, undetectable PR interval, QRS 168 ms, and QTc 693 ms. He was administered intravenous sodium bicarbonate and magnesium sulfate and admitted to the intensive care unit, eventually developing Torsades de Pointes (TdP). He was given lidocaine and isoproterenol infusions, and an external pacemaker was placed. He was discharged in stable condition on hospital day (HD) 16. CASE REPORT 2: A 39-year-old woman with a history of hepatitis C, depression, and SUD was transported to the ED after reported seizure-like activity. The patient experienced TdP in the ED and admitted to ingesting large amount of loperamide daily. An ECG demonstrated sinus rhythm, right axis deviation, PR interval 208 ms, QRS interval 142 ms, and QTc 687 ms. She was administered intravenous magnesium, sodium bicarbonate, and isoproterenol. After intensive care unit admission, the patient experienced no further TdP and was discharged on HD 6. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should proceed with caution when treating patients with loperamide toxicity. Even in asymptomatic patients and drug discontinuance, obtain consultation with a medical toxicologist, promptly treat ECG abnormalities aggressively, and admit all patients for further monitoring.

The Effect of Survey Nonresponse on Quitline Abstinence Rates: Implications for Practice.

INTRODUCTION: Quitline outcome studies are used to maintain and improve the effectiveness of these evidence-based cessation services. Nonresponse has the potential to bias survey results and many US and Canadian quitlines are reporting survey response rates below 50%. This study examines the effect of nonresponse bias on quit rates in three state quitline populations. Results provide implications of nonresponse bias for quitline practice. METHODS: Quit status, defined as abstinent for 30 days or more 7 months after registering for services, was collected from Minnesota, Hawaii, and Florida quitline participants that responded to a survey. We assigned each responder to a wave based on the number of contacts required to obtain a survey response. RESULTS: The latest two responder groups had the lowest quit rates within each state, although results were not statistically significant. Quit rates in the latest responder wave (Wave 6) were between 4% and 13% points lower than the earliest responders (Wave 1). The cumulative quit rates show what the quit rate would have been had the study ended after the corresponding wave. In all four studies, the cumulative quit rate was lowest in Wave 6. CONCLUSION: To increase accuracy of quit rates, quitlines should focus on increasing survey response rates. Suggestions for improving survey response rates are provided.

Identifying e-cigarette vape stores: description of an online search methodology.

BACKGROUND: Although the overall impact of Electronic Nicotine Delivery Systems (ENDS) on public health is unclear, awareness, use, and marketing of the products have increased markedly in recent years. Identifying the increasing number of 'vape stores' that specialise in selling ENDS can be challenging given the lack of regulatory policies and licensing. This study assesses the utility of online search methods in identifying ENDS vape stores. METHODS: We conducted online searches in Google Maps, Yelp, and YellowPages to identify listings of ENDS vape stores in Florida, and used a crowdsourcing platform to call and verify stores that primarily sold ENDS to consumers. We compared store listings generated from the online search and crowdsourcing methodology to list licensed tobacco and ENDS retailers from the Florida Department of Business and Professional Regulation. RESULTS: The combined results from all three online sources yielded a total of 403 ENDS vape stores. Nearly 32.5% of these stores were on the state tobacco licensure list, while 67.5% were not. Accuracy of online results was highest for Yelp (77.6%), followed by YellowPages (77.1%) and Google (53.0%). CONCLUSIONS: Using the online search methodology we identified more ENDS vape stores than were on the state tobacco licensure list. This approach may be a promising strategy to identify and track the growth of ENDS vape stores over time, especially in states without a systematic licensing requirement for such stores.

Maternal Perceptions Related to Eating and Obesity Risk Among Low-Income African American Preschoolers.

Objectives Health disparities are prevalent in the U.S., with low-income African American children suffering from high rates of obesity and related conditions. Better understanding of parental attitudes and barriers related to healthy eating and obesity risk is needed to suggest more effective intervention foci for this at-risk population. Methods African American caregivers of 3-5 year old children were recruited for focus groups and a questionnaire completion from two Head Start programs in a southeastern state of the U.S. The Social Cognitive Theory was utilized to develop a focus group guide. Focus group recordings were transcribed verbatim and analyzed using the comparative content analysis. Results Eight focus groups (all participants were mothers) yielded the following main themes: (1) general nutrition knowledge but common misconceptions about foods/beverages; (2) beliefs that meals have to include meat and starch and be home-cooked to be healthy; (3) desire to feed children better than their own parents; (4) lack of family support and child pickiness perceived as the greatest barriers to healthy eating; (5) awareness of family history of diseases; and (6) low concern about children's current diet and weight status. Over 25 % of mothers underestimated their child weight status. Conclusions Our findings highlight the importance of understanding maternal perspectives related to food, eating, and weight among low-income African American mothers of preschoolers. Nutrition educators should be aware of misconceptions and recognize that mothers might not perceive diet quality in early childhood as having strong impact on the child's future health and/or obesity risks.