The Impact of Local Education and Resource Distribution on Maternal Health Behaviors.

INTRODUCTION: Community forum participants voted for an education and resource distribution program (using a baby box) to help reduce local infant mortality. Although multiple sites have implemented similar programs, there is limited peer-reviewed literature about outcomes. METHODS: A retrospective pre- and immediate post-survey design with an intervention (video and written education and resource distribution) in between was utilized with a follow-up survey. The primary research objectives were whether viewing educational videos led to change in self-reported likelihood of select maternal behaviors. Other objectives were whether demographic characteristics were associated with self-reported likelihood of behaviors, and to assess the actual self-reported postpartum behavior. RESULTS: Participants reported a change in likelihood in: asking a WIC counselor for help (p < 0.001); talking with a provider about substance use (p = 0.014), postpartum depression (p < 0.001) and birth control (p = 0.025); and using the baby box as a sleeping space (p < 0.01). After watching the educational videos, college-educated participants were significantly more likely than participants with high school education or less to report likelihood to breastfeed (p = 0.039). Over half of the participants (59.2%) in the follow-up survey reported breastfeeding most to all of the time, compared to 91.5% who reported they were more likely to breastfeed in the post-education survey. The proportion of participants at the follow-up survey who reported bed-sharing most or all of the time (5.7%) was lower than those participants who had said they were likely or very likely to bed-share in the post-education survey (11.3%). Although nearly all participants (98.6%) in the post-education survey reported that they were likely to use the baby box, at the postpartum follow-up, 39.1% reported actual use of the baby box. CONCLUSIONS FOR PRACTICE: The program positively impacted self-reported likelihood of several health behaviors. A community-driven approach to maternal education and resource distribution may be beneficial in other cities.

qPCR assays for Alexandrium fundyense and A. ostenfeldii (Dinophyceae) identified from Alaskan waters and a review of species-specific Alexandrium molecular assays.

Paralytic shellfish poisoning (PSP) poses a serious health threat in Alaska and prevents effective utilization of shellfish resources by subsistence and recreational harvesters. Substantial economic losses also affect shellfish growers during PSP events. The toxins responsible for PSP are produced by dinoflagellates in the genus Alexandrium. Despite the persistent threat posed by PSP and the long history of shellfish toxicity research, there is still confusion concerning the Alexandrium species that cause PSP in Alaska. The primary objective of this study was to identify the toxic Alexandrium species present in Alaska and to develop polymerase chain reaction (PCR) assays for use in screening phytoplankton and sediment samples. Before developing the PCR assays for this study, we evaluated published assays and many were not adequate because of primer dimer formation or because of cross-reactivity. Rather than continue to grapple with the uncertainty and inadequacy of published assays, we developed new assays for the Alexandrium species most likely to be present in Alaska. Only Alexandrium fundyense Group I and A. ostenfeldii were identified from four sampling regions from southeast Alaska to Kodiak Island, indicating that these two species are widely distributed. PCR assays for these two species were converted to quantitative (q)PCR format for use in monitoring programs. During the course of this study, we realized that a systematic evaluation of all published (~150) Alexandrium species-specific assays would be of benefit. Toward this objective, we collated published Alexandrium PCR, qPCR, and in situ hybridization assay primers and probes that targeted the small-subunit (SSU), internal transcribed spacer (ITS/5.8S), or D1-D3 large-subunit (LSU) (SSU/ITS/LSU) ribosomal DNA genes. Each individual primer or probe was screened against the GenBank database and Alexandrium gene sequence alignments constructed as part of this study. These data were used to identify a suite of species-specific Alexandrium assays that can be recommended for evaluation by the global harmful algal bloom community.

NF1 is a critical regulator of muscle development and metabolism.

There is emerging evidence for reduced muscle function in children with neurofibromatosis type 1 (NF1). We have examined three murine models featuring NF1 deficiency in muscle to study the effect on muscle function as well as any underlying pathophysiology. The Nf1(+/-) mouse exhibited no differences in overall weight, lean tissue mass, fiber size, muscle weakness as measured by grip strength or muscle atrophy-recovery with limb disuse, although this model lacks many other characteristic features of the human disease. Next, muscle-specific knockout mice (Nf1muscle(-/-)) were generated and they exhibited a failure to thrive leading to neonatal lethality. Intramyocellular lipid accumulations were observed by electron microscopy and Oil Red O staining. More mature muscle specimens lacking Nf1 expression taken from the limb-specific Nf1Prx1(-/-) conditional knockout line showed a 10-fold increase in muscle triglyceride content. Enzyme assays revealed a significant increase in the activities of oxidative metabolism enzymes in the Nf1Prx1(-/-) mice. Western analyses showed increases in the expression of fatty acid synthase and the hormone leptin, as well as decreased expression of a number of fatty acid transporters in this mouse line. These data support the hypothesis that NF1 is essential for normal muscle function and survival and are the first to suggest a direct link between NF1 and mitochondrial fatty acid metabolism.

Overdose prevention activities led by local public health departments, 2019-2023.

BACKGROUND: Drug overdose deaths in the United States increased to historic levels in recent years, with provisional estimates indicating more than 111,000 deaths in the 12 months ending July 2023. In 2019, the Centers for Disease Control and Prevention's Division of Overdose Prevention in collaboration with the National Association of City and County Health Officials, funded local health departments (LHDs) to work on overdose prevention activities. This paper aims to: 1) describe the overdose prevention activities that LHDs implemented during the four eighteen-month funding cycles; 2) identify programmatic successes and areas of opportunity for LHDs to consider when implementing future overdose prevention activities; and to 3) inform policy considerations and future overdose prevention programming at the local level. METHODS: We used programmatic data to identify overdose prevention activities implemented by 45 LHDs. Activities were double-coded according to the social-ecological model and the U.S. Department of Health and Human Services Overdose Prevention Strategies and Guiding Principles. We analyzed final codes to identify distribution and overlap of the Strategies and Guiding Principles across the social ecological model co-occurrences. RESULTS: Approximately 55.9% (n=123) of the 220 overdose prevention activities that were coded took place at the community level, 32.3% (n=71) at the individual level, 8.6% (n=19) at the relationship level, and 3.2% (n=7) at the policy level. Most of the activities were coded as coordination, collaboration, and integration (n=52, 23.6%), harm reduction (n=51, 23.1%), data and evidence (n=47, 21.4%) or reducing stigma (n=24, 10.9%). Few activities were related to primary prevention (n=14, 6.4%), equity (n=14, 6.4%), recovery support (n=11, 5.0%), and evidence-based treatment (n=7, 3.2%). CONCLUSIONS: Localities have primarily implemented activities focused on the community and individual levels, with most of these centered around coordination, collaboration, and integration; harm reduction; or data and evidence. This study identified gaps in overdose prevention for LHDs related to treatment and health equity and that more interventions should be implemented at the relationship and policy levels. Continuing these efforts is important as LHDs explore opportunities to enhance and expand their work in various strategy areas across the social ecology. Findings from this study may be used to inform localities as they design and implement future overdose prevention activities.

Border Health Training for Family Physicians: Is There a Need and Interest?

BACKGROUND AND OBJECTIVES: The United States-Mexico border has unique health care challenges due to a range of structural factors. Providers must be trained to address these barriers to improve health outcomes. Family medicine as a specialty has developed various training modalities to address needs for specific content training outside of core curriculum. Our study assessed perceived need, interest, content, and duration of specific border health training (BHT) for family medicine residents. METHODS: Electronic surveys of potential family medicine trainees, faculty, and community physicians assessed appeal, feasibility, preferred content, and duration of BHT. We compared responses from participants from the border region, border states and the rest of the United States in their opinions about modality, duration, content of training, as well as perceived barriers. RESULTS: Seventy-four percent of survey participants agreed that primary care on the border is unique; 79% indicated a need for specialized BHT. Most border-region faculty were interested in participating as instructors. Most residents expressed interest in short-term rotation experience, yet most faculty recommended postgraduate fellowship. Respondents selected language training (86%), medical knowledge (82%), care of asylum seekers (74%), ethics of cross-cultural work (72%), and advocacy (72%) as the top-five needed training areas. CONCLUSIONS: Results of this study indicate a perceived need and sufficient interest in a range of BHT formats to warrant developing additional experiences. Developing a variety of training experiences can engage a wider audience interested in this topic; that should be done in a way ensuring maximum benefit to border-region communities.

Evaluation of a transitions clinic to bridge emergency department and primary care.

BACKGROUND: Suboptimal transitions from the emergency department (ED) to ambulatory settings contribute to poor clinical outcomes and unnecessary nonurgent ED utilization. Care transition clinics (CTCs) are a potential solution by providing ED follow-up and facilitating the bridge to longer-term primary care. OBJECTIVE: The objective was to evaluate the implementation of an ED transitions clinic on 30-day ED revisits and hospital readmissions. DESIGNS: Retrospective cross-sectional study. SETTINGS AND PARTICIPANTS: This study included adults 18 years and older discharged from the ED and reeferred to the CTC. MAIN OUTCOME AND MEASURES: Appointment attendance, follow-up time, and frequencies of care type provided were computed to assess clinic utilization. Rates of 30-day ED revisit and hospital admission were compared between completed and missed appointments using logistic regression. RESULTS: Between March 2021 and March 2022, 373 patients were referred to the CTC totaling 405 appointments. Half (53%) of appointments were completed with a median follow-up time of 4 days (IQR = [2, 7]). The most common care types provided were wound care (44%) and clinical problem management (33%), with wound care appointments more likely to be completed compared with clinical appointments (OR = 1.7, CI = [1.1, 2.8], p = .03). Patients who completed their CTC appointment were 50% less likely to return to the ED in 30 days compared with those who did not complete their appointment (OR = 0.51, CI = [0.27, 0.98], p < .05). No effect was seen for CTC appointment completion on hospital readmission. Transition clinics are a viable method to provide timely access to follow-up for patients discharged from the ED and may help reduce excess ED use for ambulatory care needs.

Making community pharmacies psychologically informed environments (PIE): a feasibility study to improve engagement with people using drug services in Scotland.

AIM: This developmental study tested the feasibility of training pharmacy staff on the psychologically informed environments (PIE) approach to improve the delivery of care. BACKGROUND: Community pharmacies provide key services to people who use drugs (PWUD) through needle exchange services, medication-assisted treatment and naloxone distribution. PWUD often have trauma backgrounds, and an approach that has been demonstrated to work well in the homeless sector is PIEs. METHODS: Bespoke training was provided by clinical psychologists and assessed by questionnaire. Staff interviews explored changes made following PIE training to adapt the delivery of care. Changes in attitude of staff following training were assessed by questionnaire. Peer researchers interviewed patient/client on observed changes and experiences in participating pharmacies. Staff interviews were conducted six months after training to determine what changes, if any, staff had implemented. Normalisation process theory (NPT) provided a framework for assessing change. FINDINGS: Three pharmacies (16 staff) participated. Training evaluation was positive; all participants rated training structure and delivery as 'very good' or 'excellent'. There was no statistically significant change in attitudes. COVID-19 lockdowns restricted follow-up data collection. Staff interviews revealed training had encouraged staff to reflect on their practice and communication and consider potentially discriminatory practice. PIE informed communication skills were applied to manage COVID-19 changes. Staff across pharmacies noted mental health challenges for patients. Five patients were interviewed but COVID-19 delays in data collection meant changes in delivery of care were difficult to recall. However, they did reflect on interactions with pharmacy staff generally. Across staff and patient interviews, there was possible conflation of practice changes due to COVID-19 and the training. However, the study found that training pharmacy teams in PIE was feasible, well received, and further development is recommended. There was evidence of the four NPT domains to support change (coherence, cognitive participation, collective action and reflexive monitoring).

E1--E4-mediated keratin phosphorylation and ubiquitylation: a mechanism for keratin depletion in HPV16-infected epithelium.

The keratin IF network of epidermal keratinocytes provides a protective barrier against mechanical insult, it is also a major player in absorbing stress in these cells. The human papilloma virus (HPV) type 16 E1--E4 protein accumulates in the upper layers of HPV16-infected epithelium and is known to associate with and reorganise the keratin IF network in cells in culture. Here, we show that this function is conserved amongst a number of HPV alpha-group E1--E4 proteins and that the differentiation-dependent keratins are also targeted. Using time-lapse microscopy, HPV16 E1--E4 was found to effect a dramatic cessation of keratin IF network dynamics by associating with both soluble and insoluble keratin. Network disruption was accompanied by keratin hyperphosphorylation at several sites, including K8 S73, which is typically phosphorylated in response to stress stimuli. Keratin immunoprecipitated from E1--E4-expressing cells was also found to be ubiquitylated, indicating that it is targeted for proteasomal degradation. Interestingly, the accumulation of hyperphosphorylated, ubiquitylated E1--E4-keratin structures was found to result in an impairment of proteasomal function. These observations shed new light on the mechanism of keratin IF network reorganisation mediated by HPV16 E1--E4 and provide an insight into the depletion of keratin co-incident with E1--E4 accumulation observed in HPV-infected epithelium.

The potential contribution of marital-cohabitation status to racial, ethnic, and nativity differentials in birth outcomes in Texas.

Disparities in infant mortality by race/ethnicity and nativity are widely known. Patterns of marriage and union formation also vary by race, ethnicity and nativity and may contribute to disparities in birth outcomes. Using population level data, we build on previous research of race/ethnic disparities in birth outcomes by investigating the role of union status. Data come from the 2006 Birth Record from Texas Vital Statistics. The final sample size included 369,839 births to Texas women aged 18 and older. Birth outcomes were constructed from indicators of low birth weight and preterm birth. Logistic regression estimates odds of low birth weight and preterm birth by race/ethnicity and nativity and union status. Race/ethnicity/nativity and union status are significant and independent predictors of birth outcomes. US born Black and Mexican Origin mothers had higher odds of preterm birth and low birth weight babies compared to US born White mothers. Unmarried mothers had higher odds of adverse birth outcomes compared to married women. There was only modest support that the association between race/ethnicity/nativity status and birth outcomes could be explained by divergent patterns in union status. Though disparities in birth outcomes are persistent across race, ethnicity and nativity, the results suggest that union status at birth is a very weak factor in accounting for these disparities. Differing patterns in union status did not account for the Black-White and Mexican Origin-White gaps in infant health outcomes. Additional research aimed at uncovering the processes that put these mothers and infants at higher risk is needed.

Assessing Goals-of-Care Documentation during the COVID-19 Patient Surge in an Academic Safety-Net Medical Center.

Context/Objectives: It is paramount that clinicians assess and document patients' priorities to guide goal-concordant interventions, especially during a public health crisis. Design: Retrospective chart review. Setting: Academic safety-net medical center in central Massachusetts, United States. Methods: We examined electronic medical records (EMRs) to discern goals-of-care (GOC) conversations with COVID-19 patients seen at some point by palliative care during their hospitalization, and all clinicians' use of a structured note template during the peak incidence of COVID-19 from March to May 2020. Patients were grouped based on comorbidities and preadmission living situation. GOC discussions were categorized into three types: code status decisions, other treatment decisions, and no treatment decisions. Results: Nearly all (97%) patients had GOC documentation within 48 hours of admission. Forty-four percent of first GOC conversations incorporated the template. Patients with dementia living in nursing facilities had GOC documentation within hours of hospital admission, whereas healthier patients had their first GOC conversation at one week of hospitalization. Decisions about code status predominated in the first (83%) and second (49%) discussions, followed by a focus on other treatment decisions in subsequent discussions (44%-57%). Many did not require a treatment decision (19%-27%) but focused on quality-of-life definitions. Nearly all survivors were discharged to a facility and only four patients returned home. Many survivors died within three months (case fatality rate: 77%). Conclusions: GOC documentation using a structured template combined with easy EMR retrievability and clinician training holds promise for aligning patients' values with real-time medical decisions, during and after the pandemic.

Intensive physical therapy after emergency laparotomy: Pilot phase of the Incidence of Complications following Emergency Abdominal surgery Get Exercising randomized controlled trial.

BACKGROUND: Postoperative pneumonia and delayed physical recovery are significant problems after emergency laparotomy. No randomized controlled trial has assessed the feasibility, safety, or effectiveness of intensive postoperative physical therapy in this high-risk acute population. METHODS: The internal pilot phase of the Incidence of Complications after Emergency Abdominal Surgery: Get Exercising (ICEAGE) trial was a prospective, randomized controlled trial that evaluated the feasibility, safety, and clinical trial processes of providing intensive physical therapy immediately following emergency laparotomy. Fifty consecutive patients were recruited at the principal participating hospital and randomly assigned to standard-care or intensive physical therapy of twice daily coached breathing exercises for 2 days and 30 minutes of daily supervised rehabilitation over the first 5 postoperative days. RESULTS: Interventions were provided exactly as per protocol in 35% (78 of 221 patients) of planned treatment sessions. Main barriers to protocol delivery were physical therapist unavailability on weekends (59 of 221 patients [27%]), awaiting patient consent (18 of 99 patients [18%]), and patient fatigue (26 of 221 patients [12%]). Despite inhibitors to treatment delivery, the intervention group still received twice as many breathing exercise sessions and four times the amount of physical therapy over the first 5 postoperative days (23 minutes [interquartile range, 12-29 minutes] vs. 86 minutes [interquartile range, 53-121 minutes]; p < 0.001). One adverse event was reported from 78 rehabilitation sessions (1.3%), which resolved fully on cessation of activity without escalation of medical care. CONCLUSION: Intensive postoperative physical therapy can be delivered safely and successfully to patients in the first week after emergency laparotomy. The ICEAGE trial protocol resulted in intervention group participants receiving more coached breathing exercises and spending significantly more time physically active over the first 5 days after surgery compared with standard care. It was therefore recommended to progress into the multicenter phase of ICEAGE to definitively test the effect of intensive physical therapy to prevent pneumonia and improve physical recovery after emergency laparotomy. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level II.

Continuing education mitigates the negative consequences of adolescent childbearing.

Beginning childbearing during adolescence is consistently linked with negative outcomes for both children and parents. Many have attributed this association to maternal background characteristics which are often difficult to change through policy. Though maternal educational attainment is often a side effect of adolescent childbearing, it also represents a potential avenue through which we can help young mothers overcome the obstacles associated with an early birth. The data for this study come from the 1997 Child Development Supplement of the Panel Study of Income Dynamics, a nationally representative sample of mothers and their children (N = 3,193). Data are used to explore the cognitive stimulation and emotional support in the home, measured using the HOME Scale (Caldwell and Bradley in Home observation for measurement of the environment. University of Arkansas at Little Rock, Little Rock, 1984). OLS regression models how maternal education moderates the association between age at first birth and quality of children's home environment. Adolescent mothers scored significantly lower on the indicator of home environment than older mothers. However, when continuing education was considered, maternal age at first birth was no longer significantly associated with the home environment. The negative consequences of early births were mediated by adolescent mothers' continuing education efforts. While interventions are needed to reduce adolescent childbearing, these results highlight the need to ensure that adolescent mothers are provided support to continue their education following delivery. The negative consequences of adolescent births are not inevitable. Encouraging school retention may help young mothers form a safe, healthy, nurturing, and developmentally appropriate home environment.

The impact on medical practice of commitments to change following CME lectures: a randomized controlled trial.

BACKGROUND: Self-reported commitment to change (CTC) could be a potentially valuable method to address the need for continuing medical education (CME) to demonstrate clinical outcomes. AIM: This study determines: (1) are clinicians who make CTCs more likely to report changes in their medical practices and (2) do these changes persist over time? METHODS: Intervention participants (N = 80) selected up to three commitments from a predefined list following the lecture, while control participants (N = 64) generated up to three commitments at 7 days post-lecture. At 7 and 30 days post-lecture, participants were queried if any practice change occurred as a result of attending the lecture. RESULTS: About 91% of the intervention group reported practice changes consistent with their commitments at 7 days. Only 32% in the control group reported changes (z = 7.32, p < 0.001). At 30 days, more participants in the intervention group relative to the control group reported change (58% vs. 22%, z = 3.74, p < 0.01). Once a participant from either group made a commitment, there were no differences in reported changes (63% vs. 67%, z = <0.00, p = 0.38). CONCLUSION: Integration of CTC is an effective method of reinforcing learning and measuring outcomes.

A 'snap shot' of the health of homeless people in inner Sydney: St Vincent's Hospital.

OBJECTIVES: The poor health profile of people who are homeless results in a disproportionate use of health resources by these people. An in-hospital count of demographic and health data of homeless patients was conducted on two occasions at St Vincent's Hospital in Sydney as an indicator of health resource utilisation for the Sydney region. METHODS: Two in-hospital counts were conducted of homeless patients within the boundaries of St Vincent's Hospital to coincide with the inaugural City of Sydney homeless street counts in winter 2008 and summer 2009. Data collected included level of homelessness, principal diagnosis, triage category, bed occupancy and linkages to services post hospital discharge. RESULTS: Homeless patients at St Vincent's utilised over four times the number of acute ward beds when compared with the state average. This corresponds to a high burden of mental health, substance use and physical health comorbidities in homeless people. There was high utilisation of mental health and drug and alcohol services by homeless people, and high levels of linkages with these services post-discharge. There were relatively low rates of linkage with general practitioner and ambulatory care services. CONCLUSION: Increasing knowledge of the health needs of the homeless community will assist in future planning and allocation of health services.

Online training of behavioral health providers for primary care practice.

Introduction: Many behavioral health providers have not received training in primary care practice during their education. Since 2007, the online Certificate in Primary Care Behavioral Health course has been completed by thousands of behavioral health providers. An evaluation of the course assessed whether learner's baseline confidence in their abilities to address behavioral health concerns in primary care settings changed over time, whether learning outcomes for live offerings of the course differed from asynchronous offerings, and whether learning outcomes for psychologists and social workers differed. Method: Learners were asked to rate their confidence in their abilities using 10 retrospective pre-post questions. Responses from 14 cohorts of learners, between 2011 and 2019 were assessed. T-tests and analyses of variance were used to compare groups. Results: Learners' baseline confidence in their abilities changed in three of the areas assessed. Those completing the course asynchronously reported outcomes equal to or greater than those completing the course synchronously. In all but one domain, psychologists and social workers reported equal increases in their confidence. Discussion: Learners reported significant improvements in confidence in their ability to work as behavioral health providers in primary care. With one exception, these findings did not differ for psychologists and social workers. Over time, baseline confidence of behavioral health providers enrolling in the course increased in some areas, particularly those focused on patients with substance use disorders. Learning outcomes for the asynchronous version of the course support the continued delivery of asynchronous training of behavioral health providers working in primary care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Oral health curriculum evaluation tool (OHCET) for primary care training programs.

BACKGROUND: Primary care training schools and programs lack a validated tool to assess their oral health curriculum, and researchers lack a tool to compare oral health curricula across programs/schools and different disciplines. OBJECTIVE: This study describes the process and results of creating a 15-item oral health curriculum evaluation tool (OHCET). METHODS: Three-phased development of the OHCET from 2018 to 2020 including (a) Delphi group/tool development; (b) tool pilot test; and (c) tool validation/cognitive interviews. RESULTS: A total of 23 program deans/directors participated in the tool validation/cognitive interviews. Summarizing accuracy scores of all 15 items, the mean accuracy score was 87.1. There was a high correlation (0.917) between the program's total score and the program director's self-assessed competence of their learners at the time of graduation. CONCLUSIONS: The OHCET was validated and can be used in primary care training programs and schools across the country for institutional evaluation and for research purposes. Program directors and deans can also have some confidence that their ability to subjectively assess their learner's oral health knowledge and skills at graduation is accurate.

The Rapid Mood Screener (RMS): a novel and pragmatic screener for bipolar I disorder.

OBJECTIVE: Depressive episodes and symptoms of bipolar I disorder are commonly misdiagnosed as major depressive disorder (MDD) in primary care. The novel and pragmatic Rapid Mood Screener (RMS) was developed to screen for manic symptoms and bipolar I disorder features (e.g. age of depression onset) to address this unmet clinical need. METHODS: A targeted literature search was conducted to select concepts thought to differentiate bipolar I from MDD and screener tool items were drafted. Items were tested and refined in cognitive debriefing interviews with individuals with self-reported bipolar I or MDD (n = 12). An observational study was conducted to evaluate predictive validity. Participants with clinical interview-confirmed bipolar I or MDD diagnoses (n = 139) completed a draft 10-item screening tool and other questionnaires. Data were analyzed to identify the smallest possible subset of items with optimized sensitivity and specificity. RESULTS: Adults with confirmed bipolar I (n = 67) or MDD (n = 72) participated in the observational study. Ten draft screening tool items were reduced to 6 final RMS items based on the item-level analysis. When 4 or more items of the RMS were endorsed ("yes"), sensitivity was 0.88 and specificity was 0.80; positive and negative predictive values were 0.80 and 0.88, respectively. These properties were an improvement over the Mood Disorder Questionnaire in the same analysis sample while using 60% fewer items. CONCLUSION: The pragmatic 6-item RMS differentiates bipolar I disorder from MDD in patients with depressive symptoms, providing real-world guidance to primary care practitioners on whether a more comprehensive assessment for bipolar I disorder is warranted.

Impact of dynamic sub-populations within grafted chains on the protein binding and colloidal stability of PEGylated nanoparticles.

Polyethylene glycol grafting has played a central role in preparing the surfaces of nano-probes for biological interaction, to extend blood circulation times and to modulate protein recognition and cellular uptake. However, the role of PEG graft dynamics and conformation in determining surface recognition processes is poorly understood primarily due to the absence of a microscopic picture of the surface presentation of the polymer. Here a detailed NMR analysis reveals three types of dynamic ethylene glycol units on PEG-grafted SiO2 nanoparticles (NPs) of the type commonly evaluated as long-circulating theranostic nano-probes; a narrow fraction with fast dynamics associated with the chain ends; a broadened fraction spectrally overlapped with the former arising from those parts of the chain experiencing some dynamic restriction; and a fraction too broad to be observed in the spectrum arising from units closer to the surface/graft which undergo slow motion on the NMR timescale. We demonstrate that ethylene glycol units transition between fractions as a function of temperature, core size, PEG chain length and surface coverage and demonstrate how this distribution affects colloidal stability and protein uptake. The implications of the findings for biological application of grafted nanoparticles are discussed in the context of accepted models for surface ligand conformation.