Profiling B cell immunodominance after SARS-CoV-2 infection reveals antibody evolution to non-neutralizing viral targets.

Dissecting the evolution of memory B cells (MBCs) against SARS-CoV-2 is critical for understanding antibody recall upon secondary exposure. Here, we used single-cell sequencing to profile SARS-CoV-2-reactive B cells in 38 COVID-19 patients. Using oligo-tagged antigen baits, we isolated B cells specific to the SARS-CoV-2 spike, nucleoprotein (NP), open reading frame 8 (ORF8), and endemic human coronavirus (HCoV) spike proteins. SARS-CoV-2 spike-specific cells were enriched in the memory compartment of acutely infected and convalescent patients several months post symptom onset. With severe acute infection, substantial populations of endemic HCoV-reactive antibody-secreting cells were identified and possessed highly mutated variable genes, signifying preexisting immunity. Finally, MBCs exhibited pronounced maturation to NP and ORF8 over time, especially in older patients. Monoclonal antibodies against these targets were non-neutralizing and non-protective in vivo. These findings reveal antibody adaptation to non-neutralizing intracellular antigens during infection, emphasizing the importance of vaccination for inducing neutralizing spike-specific MBCs.

Crossreactive αß T Cell Receptors Are the Predominant Targets of Thymocyte Negative Selection.

The precise impact of thymic positive and negative selection on the T cell receptor (TCR) repertoire remains controversial. Here, we used unbiased, high-throughput cloning and retroviral expression of individual pre-selection TCRs to provide a direct assessment of these processes at the clonal level in vivo. We found that 15% of random TCRs induced signaling and directed positive (7.5%) or negative (7.5%) selection, depending on strength of signal, whereas the remaining 85% failed to induce signaling or selection. Most negatively selected TCRs exhibited promiscuous crossreactivity toward multiple other major histocompatibility complex (MHC) haplotypes. In contrast, TCRs that were positively selected or non-selected were minimally crossreactive. Negative selection of crossreactive TCRs led to clonal deletion but also recycling into intestinal CD4(-)CD8ß(-) intraepithelial lymphocytes (iIELs). Thus, broadly crossreactive TCRs arise at low frequency in the pre-selection repertoire but constitute the primary drivers of thymic negative selection and iIEL lineage differentiation.

Seeking health information online among U.S. pregnant women: findings from the 2009-2018 National Health Interview Surveys.

Seeking health information online has gained in popularity. However, few studies have investigated seeking health information online among U.S. pregnant women. The aim of this study was to investigate the patterns, trends, and characteristics of pregnant women in the U.S. who seek health information online. We obtained data from the National Health Interview Survey from 2009 to 2018. The study population consisted of women aged 18 to 49 years who self-reported being pregnant. Complex survey weighting and Chi-squared tests were used to evaluate trends and compare characteristics of online users and nonusers. Multivariable logistic regression analyses were used to evaluate characteristics associated with seeking health information online. Significantly more pregnant women sought health information online in 2018 compared to 2009 (72.9 percent, standard error [SE]: 3.3, 95 percent confidence interval [CI]: 66.3 percent-79.5 percent, vs. 60.7 percent, SE: 3.3, 95 percent CI: 54.0 percent-67.4 percent, p < .01). Pregnant women who were identified as white or Black, who had more education, and who had higher incomes were significantly more likely to report seeking health information online. Healthcare providers should actively initiate conversations to address the safety, accuracy, and reliability of online health information for their pregnant patients.

A perspective review of cannabis use and sexual offenses.

Substance abuse is an established risk factor for crime and violence, including sexual violence. Nevertheless, the link between cannabis use and sexual offenses remains poorly understood. Cannabis use has a broad effect on sexual functioning and can have both acute and lasting adverse effects on psychological functioning, which in turn can elevate the risk of sexual offending behavior. Yet there is a scarcity of studies that have examined the link between cannabis use and sexual offending. To help fill the gap, this perspective review investigates the link between substance use and crime with a particular emphasis on cannabis use and its effects on sexual and psychological functioning. It then explores how these mechanisms may contribute to sexual offenses and recidivism, with a final discussion on how cannabis use should be conceptualized as a risk factor for sexual violence.

Trends and Characteristics of the US Adult Population's Behavioral Patterns in Web-Based Prescription Filling: National Survey Study.

BACKGROUND: Filling a prescription on the web has become an alternative to in-person pharmacies for individuals to access their medications. However, the adoption of web-based filling has been gradual, and the use patterns remain to be unclear. OBJECTIVE: This study aims to estimate the trend and prevalence of web-based prescription-filling behavior and identify associated factors among adults in the United States. METHODS: We used data from the US National Health Interview Survey (NHIS) from 2009 to 2018. Adult respondents (aged ≥18 years and over) self-reported their behavior of web-based prescription filling, which was defined as having filled a prescription using the internet in the past 12 months during the survey year. We reported trends using weighted percentages adjusted by the NHIS complex sampling design. We used descriptive statistics and multivariable logistic regression models to examine trends and identify factors associated with web-based prescription-filling behavior. RESULTS: The estimated number of adults reporting web-based prescription-filling behavior significantly increased from 13,319,877 (13,319,877/225,217,942, 5.91%) in 2009 to 28,308,262 (28,308,262/246,611,125, 11.48%) in 2018 (P<.001). Those who were more likely to report filling a prescription on the web were aged between 35 and 74 years, female, White, and frequent users of the computer or internet; these adults also reported higher education, higher income, insurance coverage, and poorer health status. CONCLUSIONS: Web-based prescription-filling behavior among US adults has increased significantly from 2009 to 2018. Health care providers should be aware of the upward trend in the use of web-based pharmacies and ensure the clinical safety of web-based prescriptions.

Geosocial Factors Associated With Adherence to Statin Medications.

BACKGROUND: Individual patient characteristics, social determinants, and geographic access may be associated with patients engaging in appropriate health behaviors. OBJECTIVE: To assess the relationship between statin adherence, geographic accessibility to pharmacies, and neighborhood sociodemographic characteristics in Michigan. METHODS: The proportion of days covered (PDC) was calculated from pharmacy claims of a large insurer of adults who had prescriptions for statins between July 2009 and June 2010. A PDC ≥0.80 was defined as adherent. The predictor of interest was a ZIP code tabulation area (ZCTA)-level measure of geographic accessibility to pharmacies, measured using a method that integrates availability and access into a single index. We fit unadjusted models as well as adjusted models controlling for age, sex, and ZCTA-level measures of socioeconomic status (SES), racial isolation (RI) of non-Hispanic blacks, and urbanicity. RESULTS: More than 174 000 patients' claims data were analyzed. In adjusted models, pharmacy access was not associated with adherence (0.99; 95% CI: 0.96, 1.03). Greater RI (0.87; 95% CI: 0.85, 0.88) and urban status (0.93; 95% CI: 0.89, 0.96) were associated with lower odds of adherence. Individuals in ZCTAs with higher SES had higher odds of adherence, as were men and older age groups. CONCLUSION AND RELEVANCE: Adherence to statin prescriptions was lower for patients living in areas characterized as being racially segregated or lower income. Initiating interventions to enhance adherence, informed by understanding the social and systematic barriers patients face when refilling medication, is an important public health initiative that pharmacists practicing in these areas may undertake.

Disparities in the Use of Guideline-Based Pharmacotherapy Exist for Atherosclerotic Cardiovascular Disease and Heart Failure Patients Who Have Intellectual/Developmental Disabilities in a Commercially Insured Database.

BACKGROUND: Patients who have intellectual/developmental disabilities (IDDs) develop atherosclerotic cardiovascular disease (ASCVD) or heart failure (HF) at rates similar to or higher than the general population. They also face disparities accessing and using health care services. OBJECTIVE: To determine if disparities exist in the use of guideline-based pharmacotherapy (GBP) for ASCVD or HF for adults with IDD. METHODS: Using the 2014 Clinformatics Data Mart Database, adults with ASCVD or HF were divided into IDD or non-IDD groups. Patients with contraindications for GBP medications were excluded. Use of GBP between IDD and non-IDD groups was examined. Subgroup analysis included comparisons between IDD groups. RESULTS: For HF, 1011 patients with IDD and 236,638 non-IDD patients were identified. For ASCVD, 2190 IDD and 790,343 non-IDD patients were identified. We found that 47.9%, 35.8%, and 13.1% of IDD and 58.7%, 48.4%, and 18.9% of non-IDD patients had pharmacy claims for statins (P < 0.001), ß-blockers (P < 0.001), or antiplatelet therapy (P < 0.001), respectively. For HF, 46.8% and 50.3% of IDD and 59.8% and 55.4% of non-IDD patients had pharmacy claims for ß-blockers (P < 0.001) and angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs; P = 0.003), respectively. In all but one multivariate regression models patients with IDD were less likely to use GBP than patients in the non-IDD group. Subgroup analysis revealed that patients who had Down syndrome had lower GBP use in 4 of the 5 measures. CONCLUSION AND RELEVANCE: Disparities exist in the use of GBP for patients with IDD with ASCVD or HF. Patients who have an IDD should be examined by clinicians to ensure appropriate access to and use of GBP.

In-home comprehensive medication reviews for adults with intellectual or developmental disability: A pilot study.

OBJECTIVES: To assess the feasibility of conducting in-home comprehensive medication reviews (CMRs) and to identify and intervene when appropriate for medication-related problems (MRPs) found in medication regimens taken by people with an intellectual or developmental disability. SETTING: Community-based group homes in southeast Michigan. PRACTICE DESCRIPTION: Implementation and evaluation of a pilot program conducting CMRs within community-based group homes. PRACTICE INNOVATION: An in-home CMR conducted by a clinical pharmacist. EVALUATION: Identified MRPs, pharmacist recommendations, recommendation acceptance, time spent directly on intervention, and barriers to implementation. RESULTS: CMRs were conducted for 15 patients identified as receiving 5 or more medications by their community support agency. Thirty-six MRPs were identified (mean ± SD of 2.4 ± 1.5 per person). The most common MRPs were a medication that was being taken with no indication for its use (7 occurrences) and identification of an untreated medical problem (7). Other MRPs included wrong dose (5); patient or caregiver indicated that the medication was not working (4); wrong dosage form was being used or given (3); duplication of therapy (2); pharmacy error (2); extended release medications were being crushed before administration (2); and wrong administration time, drug ordered but not given, drug-disease potential interaction, and poor drug administration technique (1 for each). The interventions included sending information letters to the group home manager containing information to be discussed with the patient's physician or telephone calls made directly to the prescriber or pharmacy. The interventions made by telephone calls to prescribers included 3 calls to physicians to discuss 5 MRPs, and 3 telephone calls for pharmacy-related MRPs, all of which were accepted. CONCLUSION: The results of this prospective pilot project provide justification to further explore the role of conducting independent CMRs for patients with an intellectual or developmental disability living in the community to ensure safe and effective use of their medications.

Comparison of Uninjured and Concussed Adolecent Athletes on the Concussion Balance Test (COBALT).

BACKGROUND AND PURPOSE: Dizziness and balance problems are common symptoms following sports-related concussion (SRC). Most sports require high-level balance skills that integrate the sensory inputs used for balance. Thus, a comprehensive assessment of postural control following SRC is recommended as an integral part of evaluation and management of the injury. The purpose of this exploratory study was to examine performance differences between uninjured and concussed athletes on the Concussion Balance Test (COBALT), as well as complete preliminary analyses of criterion-related validity and reliability of COBALT. METHODS: COBALT is an 8 condition test developed for both preseason and postinjury assessment using force plate technology to measure sway velocity under dynamic postural conditions that challenge the vestibular system. Retrospective COBALT data obtained through chart review for 132 uninjured athletes and 106 concussed age-matched athletes were compared. RESULTS: All uninjured athletes were able to complete the assessment, compared with only 55% of concussed athletes. Concussed athletes committed significantly more errors than uninjured athletes. Sway velocity for concussed athletes was higher (worse) than that for uninjured athletes on 2 conditions in COBALT. DISCUSSION AND CONCLUSIONS: By examining an athlete's ability to complete the protocol, error rate, and sway velocity on COBALT postinjury, the clinician can identify balance function impairment, which may help the medical team develop a more targeted treatment plan, and provide objective input regarding recovery of balance function following SRC.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A204).

Medication adherence patterns in aortic dissection survivors.

BACKGROUND & OBJECTIVES: Beta-blockers have been shown to improve survival in both type A and type B acute aortic dissection (AAD) patients. Calcium channel blockers have been shown to selectively improve survival only in type B AAD patients. There is a lack of data on medication adherence in AAD survivors. The purpose of this study was to assess medication adherence in patients who survived an AAD. METHODS: This was a cross-sectional survey-based study of individuals from a single medical centre which was part of the larger International Registry of Acute Aortic Dissection (IRAD). Patients with type A or B AAD who survived to discharge were included in this study. Individuals who were deceased based on the results of an online Social Security Death Index were excluded from the study. Data were obtained from both a survey and also from abstraction from the local academic institution's IRAD registry. A survey packet was sent to patients. One section of this survey was dedicated to assessing medication adherence using the 4-item Morisky scale. RESULTS: Eighty two completed surveys were returned; 74 patients completed the section of the survey pertaining to medication adherence (response rate 38%). Morisky score was ≥1.0 for 27 (36%) patients and 0 for 47 (64%) patients. Thirty three patients reported yes to 'forget to take medications' and eight reported yes to 'careless with medications.' Medication non-adherence (defined as a score of ≥1.0 on Morisky) was associated with increased follow up recurrence of chest pain at one year of follow up. Only two patients stopped their antihypertensive on their own and did not cite a reason for doing this. INTERPRETATION & CONCLUSIONS: The medication adherence rate for patients who survived an AAD was 64 per cent at a median (Q1, Q3) of 7.1 yr (5.6, 11.5) after discharge, as per the Morisky scale. The clinicians should educate their patients on the importance of antihypertensive therapy and assess for forgetfulness and carelessness at each clinic visit, as well as understand patients' beliefs about drug therapy, all of which have been shown to increase medication adherence.

Variations of a Commonly Used Medication Adherence Assessment Scale: Do Changes in Scale Change Structure Results?

Background: Medication nonadherence is a major barrier to both patients and health care professionals when trying to manage medical conditions. An appropriate self-report adherence tool would be helpful in determining a patient's medication adherence. Objectives: To observe variations in scale scores based on modifications to an Original Adherence Scale, with the hypothesis that making modifications to the Original Adherence Scale will create variations in the percentage of adherent patients. Methods: This cross-sectional study utilized mailed surveys to people identified in a prescription claims administrative dataset who had a pharmacy claim for at least 2 antihypertensive medications. One thousand people were equally divided and randomly placed in 1 of 4 groups: Original Adherence Scale Group, Time Reference Scale Group, 4-Point Likert-Type Scale Group, Multiple Medication Scales Group. Each scale underwent assessment of internal reliability using Cronbach's α. Changes made to the Original 4-item scale included altering the time reference period from 3 months to 7 days, changing response options from Yes/No to a Likert-type scale, and incorporating multiple scales so that the respondent may report on up to 4 different options. Results: There were 437 surveys completed appropriately, yielding a 46.4% response rate. The overall scale scores indicating perfect adherence was 51.8% for the 4-Point Likert-Type Scale Group, 66.5% for the Multiple Medication Scales Group, 68.8% for the Original Adherence Scale Group, and 78.9% for the Time Reference Scale Group. Conclusion: When there are more selection options, a change in time reference, or more medications reported, the amount of adherent patients varied.

Refined comorbidity index based on dimensionality of comorbidity for use in studies of health-related quality of life.

PURPOSE: To refine two subscales of the health-related quality of life comorbidity index (HRQoL-CI) into a single index measure. METHODS: The 2010 and 2012 Medical Expenditure Panel Surveys were utilized as development and validation datasets, respectively. The least absolute shrinkage and selection operator was applied to select important comorbidity candidates associated with HRQoL. Exploratory factor analysis and confirmatory factor analysis (CFA) were used to assess dimensionality in comorbidity. Statistical weights were derived based on standardized factor loadings from CFA and regression coefficients from the model predicting HRQoL. Prediction errors and model R(2) values were compared between HRQoL-CI and Charlson CI (CCI). RESULTS: Eighteen comorbid conditions were identified. CFA models indicated that the second-order multidimensional comorbidity structure had a better fit to the data than did the first-order unidimensional structure. The predictive performance of the refined scale under a multidimensional structure utilizing statistical weights outperformed the original scale and CCI in terms of average prediction error and R(2) in the prediction models (R(2) values from refined scale model are 0.25, 0.30, and 0.28 versus those from CCI of 0.10, 0.09, and 0.06 for general health, SF-6D, and EQ-5D, respectively). CONCLUSION: The dimensionality of comorbidity and the weight scheme significantly improved the performance of the refined HRQoL-CI. The refined single HRQoL-CI measure appears to be an appropriate and valid instrument specific for risk adjustment in studies of HRQoL. Future research that validates the refined scales for different cultures, age groups, and healthcare settings is warranted.

Metformin use and asthma outcomes among patients with concurrent asthma and diabetes.

BACKGROUND AND OBJECTIVE: Metformin is a first-line treatment for patients with diabetes. Recent animal studies indicated that metformin can reduce airway inflammation. However, it remains unclear whether the use of metformin can help patients maintain asthma control. The purpose of this study was to evaluate the association between the use of metformin and asthma-related outcomes, which include asthma-related hospitalization, asthma-related emergency room visits and asthma exacerbation, among patients with concurrent asthma and diabetes. METHODS: We conducted an 11-year (2001-2011) retrospective cohort study using the Taiwan National Health Insurance Research Database. Patients with concurrent asthma and diabetes were included. The date of the first observed prescription of metformin was defined as the index date. For each metformin user, two matched metformin non-users of the same age and gender were randomly selected. Patients were followed for 3 years to measure the occurrence of asthma-related outcomes. Multivariable logistic regression models were used to assess the association between metformin use and asthma-related outcomes. RESULTS: Of 1332 patients with concurrent asthma and diabetes, 444 (33.3%) were metformin users. Compared with non-users, metformin users had a lower risk of asthma-related hospitalization (OR = 0.21, 95% CI: 0.07-0.63) and asthma exacerbation (OR = 0.39, 95% CI: 0.19-0.79). CONCLUSION: The risk of asthma-related outcomes was lower for metformin users than non-users. Health-care providers should consider metformin as a treatment strategy for patients with concurrent asthma and diabetes.

Masters Swimmers Use More Dietary Supplements Than a Large National Comparison Population in the United States.

The use of dietary supplements was compared between a cohort of committed exercisers, U.S. Masters Swimming (USMS) members (n = 1,042), and the general U.S. population, exemplified by respondents to the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2010 (n = 6,209). USMS swimmers were significantly more likely to take dietary supplements (62%) than the general U.S. adult population, as represented by the NHANES population (37%). Those taking dietary supplements were older, more likely to be female and Caucasian, and more highly educated and affluent than those not taking supplements (p < .001 for all). When adjusted for age, race, gender, annual income, and education, masters swimmers were still more likely (p < .001) to use dietary supplements than the NHANES cohort. In addition, masters swimmers were significantly more likely (p < .001) to use either creatine or dehydroepiandrosterone or testosterone than those in the NHANES cohort.

Statin use and self-reported swimming performance in US masters swimmers.

Exercise and treating hyperlipidaemia with statins are two integral components of the American Heart Association guidelines to reduce cardiovascular risk in adults. Since statins can cause myalgias and myopathies, they could affect the duration or intensity of an exercise regimen. To determine the impact of statin use in adult masters swimmers, a survey was distributed to examine the association between swimming performance and statin usage in adult swimmers (≥35 years). After excluding those with chronic diseases or taking drugs that reduce physical capacity, 749 swimmers (118 taking statins, 73 not taking statins to control elevated cholesterol and 558 controls) were included in a regression model to determine the factors significantly affecting the duration and intensity of swimming workouts. Age and gender were significantly (P ≤ 0.001) associated with the distance swam per 60 min. Younger, male swimmers completed more yards per 60-min workout. Use of statins was not significantly associated with yards swam per 60-min workout. Nor did statin usage affect the number of swim sessions per month or the length of swim session. Evidently, statins do not cause enough fatigue or pain in masters swimmers to require a decrease in the duration or intensity of workouts.

Health literacy and medication administration performance by caregivers of adults with developmental disabilities.

OBJECTIVES: To measure health literacy (HL) of caregivers of adults with intellectual/developmental disabilities (IDDs); to determine the association between HL and a medication administration task (MAT) assessment; and to identify caregiver characteristics associated with higher HL and MAT scores. DESIGN: Cross-sectional study. SETTING: Southeastern Michigan. PARTICIPANTS: Caregivers, aged 18 years or older, who provided supportive care of adults with IDDs. INTERVENTIONS: Survey and demonstration. MAIN OUTCOME MEASURES: Short Test of Functional Health Literacy in Adults (STOFHLA); a MAT assessment consisting of interpretation of five sets of medication instructions followed by demonstration of understanding using a pill box; and a survey of caregivers' demographics, medication-related experiences, education, characteristics of persons for whom they provide care, and care-related activities performed. RESULTS: A total of 47 caregivers provided data. Caregivers had a mean age of 45.7 ± 14.6 years; 41 (87.2%) were women and 38 (80.9%) had education beyond high school. Caregivers were involved in obtaining medication from pharmacies, reminded the person with IDD to take medications and/or administered them to the person, documented medication and health information, and accompanied persons with IDD to physician offices. Most did not conduct monitoring procedures. The STOFHLA mean score was 34.5 ± 2.5 (median, 35; range, 22-36), while the MAT mean score was 12.0 ± 2.2 (median, 12; range, 6-15). Compared with family caregivers, direct support staff more frequently had undergone some medication training and had other people with whom they could discuss medication questions, but they had worked with the person with IDD a significantly shorter amount of time. No significant differences in STOFHLA and MAT scores between the family caregivers and direct support staff were observed. Caregiver education was significantly correlated with the STOFHLA score. MAT scores were not significantly correlated with caregiver characteristics. CONCLUSION: Caregivers are involved in the medication use process for people who have IDD. Ensuring caregiver understanding of medication regimens and/or improving medication-related HL may be an important step to ensure safe and effective use of medications by people with IDD.

Services provided by community pharmacies in Wayne County, Michigan: a comparison by ZIP code characteristics.

OBJECTIVE: To document the availability of selected pharmacy services and out-of-pocket cost of medication throughout a diverse county in Michigan and to assess possible associations between availability of services and price of medication and characteristics of residents of the ZIP codes in which the pharmacies were located. DESIGN: Cross-sectional telephone survey of pharmacies coupled with ZIP code-level census data. SETTING: 503 pharmacies throughout the 63 ZIP codes of Wayne County, MI. MAIN OUTCOME MEASURES: The out-of-pocket cost for a 30 days' supply of levothyroxine 50 mcg and brand-name atorvastatin (Lipitor-Pfizer) 20 mg, availability of discount generic drug programs, home delivery of medications, hours of pharmacy operation, and availability of pharmacy-based immunization services. Census data aggregated at the ZIP code level included race, annual household income, age, and number of residents per pharmacy. RESULTS: The overall results per ZIP code showed that the average cost for levothyroxine was $10.01 ± $2.29 and $140.45 + $14.70 for Lipitor. Per ZIP code, the mean (± SD) percentages of pharmacies offering discount generic drug programs was 66.9% ± 15.0%; home delivery of medications was 44.5% ± 22.7%; and immunization for influenza was 46.7% ± 24.3% of pharmacies. The mean (± SD) hours of operation per pharmacy per ZIP code was 67.0 ± 25.2. ZIP codes with higher household income as well as higher percentage of residents being white had lower levothyroxine price, greater percentage of pharmacies offering discount generic drug programs, more hours of operation per week, and more pharmacy-based immunization services. The cost of Lipitor was not associated with any ZIP code characteristic. CONCLUSION: Disparities in the cost of generic levothyroxine, the availability of services such as discount generic drug programs, hours of operation, and pharmacy-based immunization services are evident based on race and household income within this diverse metropolitan county.

Evaluating conditional release in not guilty by reason of insanity acquittees: a prospective follow-up study in Virginia.

Detailed research on treatment and risk management approaches with not guilty by reason of insanity acquittees (NGRI) during their conditional release is needed as states increasingly use community-based services for these individuals. Grounded in case law, and supported by follow-up studies demonstrating low recidivism rates, states have been encouraged in their efforts to conditionally release NGRI acquittees. The authors evaluated a state-wide sample of 127 NGRI acquittees released into the community after spending a mean of 61.63 months (SD = 76.54) in the hospital. One hundred individuals were committed to the hospital for lengthier treatment (M hospital time = 77.23 months, SD = 79.84), but 27 individuals were released to the community after a relatively short hospital stay (M hospital time = 5.60 months, SD = 3.01). Regarding release, 96 individuals (75.6%) maintained their conditional release. After evaluating a host of demographic and standardized risk data, the following variables predicted revocation on conditional release: previous failure on conditional release, nonadherence with hospital treatment, dangerousness to others, and previous violent charges. A multivariate survival analysis determined criminal behavior and previous failure on conditional release predicted time to revocation. The results of this study demonstrate the importance of considering standardized risk variables in the community-based management of forensic patients. In addition, the data are supportive of continued attempts at moving insanity acquittees from the hospital to the community via conditional release.

The endogenous Mtv8 locus and the immunoglobulin repertoire.

The vast diversity of mammalian adaptive antigen receptors allows for robust and efficient immune responses against a wide number of pathogens. The antigen receptor repertoire is built during the recombination of B and T cell receptor (BCR, TCR) loci and hypermutation of BCR loci. V(D)J recombination rearranges these antigen receptor loci, which are organized as an array of separate V, (D), and J gene segments. Transcription activation at the recombining locus leads to changes in the local three-dimensional architecture, which subsequently contributes to which gene segments are utilized for recombination. The endogenous retrovirus (ERV) mouse mammary tumor provirus 8 (Mtv8) resides on mouse chromosome 6 interposed within the large array of light chain kappa V gene segments. As ERVs contribute to changes in genomic architecture by driving high levels of transcription of neighboring genes, it was suggested that Mtv8 could influence the BCR repertoire. We generated Mtv8-deficient mice to determine if the ERV influences V(D)J recombination to test this possibility. We find that Mtv8 does not influence the BCR repertoire.

Framework for an interprofessional experience addressing health and disability for health professional students.

BACKGROUND AND PURPOSE: A Health and Disabilities Interprofessional Education (IPE) course was implemented to join three healthcare disciplines together to collaboratively plan, implement, and reflect on professional roles and responsibilities. The goal and purpose of this course was to create an advancement of interprofessional education and practice within health science professions early in their students' programs utilizing innovative teaching methods working directly with individuals with disabilities. EDUCATIONAL ACTIVITY AND SETTING: 72 students were assigned to interprofessional teams of 10-11 people. Through asynchronous and synchronous learning activities, student teams worked together to plan and conduct community-based client interviews. FINDINGS: Quantitative and qualitative evaluation methods were used to explore the impact of interprofessional experiential learning experiences. Qualitative data showed a greater awareness and understanding of the different roles and responsibilities in interprofessional teams as well as a greater appreciation for the value of interacting with persons with disabilities (PWD) during their training. Quantitative data showed a significant change in students' understanding of their roles and responsibilities as a member of an interprofessional team, their confidence with working with PWD in a future healthcare capacity, as well as their understanding of how the social determinants of health may influence the healthcare experience of a PWD. SUMMARY: Interprofessional education and experiential learning opportunities are good ways to facilitate "real" patient care experiences and team roles and responsibilities. This enables healthcare students to practice communication, build relationships, and understand the lived experience of their patients.