The Association Between Screen Time and Outdoor Time on Adolescent Mental Health and Academic Performance: Evidence from Rural China.

Purpose: We examine how adolescent free time allocation-namely, screen time and outdoor time-is associated with mental health and academic performance in rural China. Methods: This paper used a large random sample of rural junior high school students in Ningxia (n = 20,375; age=13.22), with data collected from self-reported demographic questionnaires (to assess free time allocation), the Strengths and Difficulties Questionnaire (to assess mental health), and a standardized math test (to measure academic performance). We utilized a multivariate OLS regression model to examine associations between free time allocation and adolescent outcomes, controlling for individual and family characteristics. Results: Our sample's screen time and outdoor time both averaged around 1 hour. About 10% of the sample adolescents reported behavioral difficulties, while a similar percentage (11%) reported abnormal prosocial behaviors. Adolescents with higher levels of screen time (>2 hours) were 3 percentage points more likely to have higher levels of behavioral difficulties (p<0.001), indicating that excessive screen time was associated with worse mental health. Meanwhile, outdoor time was associated with better mental health, and positive correlations were observed at all levels of outdoor time (compared to no outdoor time, decreasing the likelihood of higher levels of behavioral difficulties by between 3 and 4 percentage points and of lower prosocial scores by between 6 and 8 percentage points; all p's<0.001). For academic performance, average daily screen times of up to 1 hour and 1-2 hours were both positively associated with standardized math scores (0.08 SD, p<0.001; 0.07 SD, p<0.01, respectively), whereas there were no significant associations between outdoor time and academic performance. Conclusion: Using a large sample size, this study was the first to examine the association between adolescent free time allocation with mental health and academic performance, providing initial insights into how rural Chinese adolescents can optimize their free time.

Development of a Campus-Wide Community Service Initiative during a Pandemic.

Community service serves as a major aspect of pharmacy education; however, coronavirus disease 2019 (COVID-19) represented a significant disruption to student involvement. The College of Pharmacy student council, which serves as the local student government organization for the University of Florida College of Pharmacy, Jacksonville campus, developed a community service initiative to offer more consistent opportunities for students to participate in community service events, while adapting to COVID-19 restrictions. A retrospective, qualitative review of this initiative demonstrates the potential value of this model. Prior to this initiative, students relied on individual student organizations to provide service opportunities to their members. This excluded portions of the student body and led to sparse and inconsistent events, with limited variation in the types of service events available. Furthermore, de-centralized planning of service opportunities increased the difficulty of ensuring that COVID-19 safety restrictions were followed appropriately. This initiative resulted in 39 students logging over 200 service hours through nine events in the first seven months after its development. Despite the challenges presented by the COVID-19 pandemic, our centralized initiative serves as a model for improving community service involvement.

Professionalism development through the curriculum: Developing a new system for identifying and tracking professional behavior lapses.

INTRODUCTION: Pharmacy education has evolved from focusing on knowledge alone to highlighting personal and professional growth. Providing a standardized process for tracking, mentoring, and guiding students in professionalism and other soft skills may help achieve compliance with the current Center for the Advancement of Pharmacy Education Educational Outcomes and Accreditation Council for Pharmacy Education Standards 2016. COMMENTARY: Becoming a pharmacist requires more than demonstrating proficiency in tasks and responsibilities associated with pharmacy practice. Exhibiting strong professional behavior and soft skills are important for the clinical practice environment. These behaviors are more difficult to measure due to the broad definition of professionalism. In the academic setting, it is important to identify students struggling in this area. IMPLICATIONS: Promotion of professional behavior and soft skills development is a responsibility of higher education; however, it is difficult to assess. Development and implementation of an effective tracking and monitoring system for professionalism lapses will aid in identifying students struggling with professional behavior and offer mentoring opportunities for student personal growth and professional development.

Tracking the effects of COVID-19 in rural China over time.

BACKGROUND: China issued strict nationwide guidelines to combat the COVID-19 outbreak in January 2020 and gradually loosened the restrictions on movement in early March. Little is known about how these disease control measures affected the 600 million people who live in rural China. The goal of this paper is to document the quarantine measures implemented in rural China outside the epicenter of Hubei Province and to assess the socioeconomic effect of the measures on rural communities over time. METHODS: We conducted three rounds of interviews with informants from 726 villages in seven provinces, accounting for over 25% of China's overall rural population. The survey collected data on rural quarantine implementation; COVID-19 infections and deaths in the survey villages; and effects of the quarantine on employment, income, education, health care, and government policies to address any negative impacts. The empirical findings of the work established that strict quarantine measures were implemented in rural villages throughout China in February. RESULTS: There was little spread of COVID-19 in rural communities: an infection rate of 0.001% and zero deaths reported in our sample. However, there were negative social and economic outcomes, including high rates of unemployment, falling household income, rising prices, and disrupted student learning. Health care was generally accessible, but many delayed their non-COVID-19 health care due to the quarantine measures. Only 20% of villagers received any form of local government aid, and only 11% of villages received financial subsidies. There were no reports of national government aid programs that targeted rural villagers in the sample areas. CONCLUSIONS: By examining the economic and social effects of the COVID-19 restrictions in rural communities, this study will help to guide other middle- and low-income countries in their containment and restorative processes. Without consideration for economically vulnerable populations, economic hardships and poverty will likely continue to have a negative impact on the most susceptible communities.

Elasticity-dependent response of malignant cells to viscous dissipation.

The stiffness of the cellular environment controls malignant cell phenotype and proliferation. However, the effect of viscous dissipation on these parameters has not yet been investigated, in part due to the lack of in vitro cell substrates reproducing the mechanical properties of normal tissues and tumors. In this article, we use a newly reported viscoelastic polyacrylamide gel cell substrate, and we characterize the impact of viscous dissipation on three malignant cell lines: DU145 and PC3 derived from prostate and LN229 from brain. The spreading, motility and proliferation rates of these cells were analyzed on 1 kPa and 5 kPa elastic and viscoelastic gels. Surprisingly, the effect of substrate viscous dissipation on cell behavior depended on substrate stiffness for the three cell types tested. We conclude that viscoelasticity controls the spreading, proliferation and migration of malignant cells in vitro. These results highlight the critical role of viscous dissipation in the phenotype and proliferation of malignant cells, especially in stiff tumor environments.

A novel method to make viscoelastic polyacrylamide gels for cell culture and traction force microscopy.

Polyacrylamide hydrogels are commonly used in cell biology, notably to cultivate cells on soft surfaces. Polyacrylamide gels are purely elastic and well adapted to cell culture as they are inert and can be conjugated with adhesion proteins. Here, we report a method to make viscoelastic polyacrylamide gels with mechanical properties more closely resembling biological tissues and suitable for cell culture in vitro. We demonstrate that these gels can be used for traction force microscopy experiments. We also show that multiple cell types respond to the viscoelasticity of their substrate and that viscous dissipation has an influence on cell spreading, contractility, and motility. This new material provides new opportunities for investigating how normal or malignant cells sense and respond to viscous dissipation within the extra-cellular matrix.

Author Correction: Full-length mRNA-Seq from single-cell levels of RNA and individual circulating tumor cells.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

The development and impact of active learning strategies on self-confidence in a newly designed first-year self-care pharmacy course - outcomes and experiences.

BACKGROUND AND PURPOSE: The primary objective of this investigation was to determine the effectiveness of different active learning exercises in a newly-designed flipped-classroom self-care course in applying newly acquired knowledge of self-care and improving the confidence of first-year pharmacy students to recommend self-care treatments and counsel patients. The early development of these skills is essential for the subsequent Community Introductory Pharmacy Practice Experience (CIPPE). EDUCATIONAL ACTIVITY AND SETTING: An unpaired anonymous survey was administered to students, pre- and post-course, to ascertain their opinions on the effectiveness of various teaching strategies and active learning exercises on learning and on their confidence in treatment-planning and patient counseling for self-care patients. Comparison between pre- and post-course Likert scores was conducted using a one-way ANOVA followed by a post-hoc Tukey's test with significance at p = 0.05. All other tests of significance were conducted using a student's t-test with significance at p = 0.05. FINDINGS: Students' self-confidence in developing treatment plans and in counseling for non-prescription drugs and dietary supplements significantly improved from the beginning to the end of this self-care course. The response rate was high in both the pre- (N = 208, 88.1%) and post- (N = 198, 83.9%) course surveys. The positive change in confidence was not reflected in increased performance on the final exam represented by a lower average score than the midterm exam. DISCUSSION AND SUMMARY: Active learning sessions and the flipped classroom approach in this first-year pharmacy self-care course contributed to increased self-confidence in making recommendations and counseling patients on proper use of nonprescription medications and dietary supplements.

Evaluating the effects of diffused lavender in an adult day care center for patients with dementia in an effort to decrease behavioral issues: a pilot study.

Objectives: To evaluate the effects of diffused lavender on the frequency of behavioral issues [BIs], defined as a composite of restlessness/wandering [RW], agitation [AGT], anger [ANG], and anxiety [ANX] in an adult day care center. Secondary objectives evaluate systematic differences on the frequency of BIs between age cohorts, gender, and individual behaviors. Design: Pre-post quasi-experimental study. Setting: Private nonprofit adult day care center for patients with dementia. Participants: Elderly patients older than 65 years of age with a clinical diagnosis of dementia, who require daytime monitoring. Intervention: Lavender aromatherapy twice a day for 20 min during a two-month period during active clinic days. Measurements: Behavioral issues were recorded using the behavior/intervention monthly flow record during the pre- and post-intervention periods. Results: There was no significant difference on frequency of BIs between pre-intervention and post-intervention periods (p = .06). There was a significant difference between pre-intervention and post-intervention total number of AGT occurrences (129 vs. 25; p value < .01). There was no significant difference between age cohorts for computed difference of RW, ANG, and ANX issues. There was a significant difference between age cohorts for computed difference of AGT (p value = .04) as the 70-85 age cohort showed less agitation compared to the 85-100 age cohort. Conclusion: The use of diffused lavender twice daily has shown to reduce the frequency of agitation in elderly patients with dementia, especially in the 70-85 age cohort. Though diffused lavender did not show statistical differences in the frequency of other behaviors (restlessness/wander, anger, anxiety), the study population may have been too small to find a difference.

Measurement invariance of the people of Color Racial Identity Attitudes Scale with Asian Americans.

Racial identity has been linked to a number of important psychological outcomes, including perceptions of racism, self-esteem, and psychological well-being in Asian American populations. Although the People of Color Racial Identity Attitudes Scale (PRIAS; Helms, 1995) is the most widely used measure in Asian American racial identity research, numerous competing measurement models of the PRIAS have been identified in independent Asian American samples. Therefore, this study tested these competing PRIAS measurement models and also examined PRIAS measurement invariance across generational status, gender, and ethnicity using a combined sample of 1,946 Asian American college students and community adults. Study findings demonstrated the superiority of a 12-item 4-factor PRIAS measurement model that was consistent with Helms's original racial identity theory, suggesting that the PRIAS operates in an equivalent manner across generational status, gender, and ethnicity. Study limitations and future directions for research are discussed.

A network-based method to evaluate quality of reproducibility of differential expression in cancer genomics studies.

BACKGROUND: Personalized cancer treatments depend on the determination of a patient's genetic status according to known genetic profiles for which targeted treatments exist. Such genetic profiles must be scientifically validated before they is applied to general patient population. Reproducibility of findings that support such genetic profiles is a fundamental challenge in validation studies. The percentage of overlapping genes (POG) criterion and derivative methods produce unstable and misleading results. Furthermore, in a complex disease, comparisons between different tumor subtypes can produce high POG scores that do not capture the consistencies in the functions. RESULTS: We focused on the quality rather than the quantity of the overlapping genes. We defined the rank value of each gene according to importance or quality by PageRank on basis of a particular topological structure. Then, we used the p-value of the rank-sum of the overlapping genes (PRSOG) to evaluate the quality of reproducibility. Though the POG scores were low in different studies of the same disease, the PRSOG was statistically significant, which suggests that sets of differentially expressed genes might be highly reproducible. CONCLUSIONS: Evaluations of eight datasets from breast cancer, lung cancer and four other disorders indicate that quality-based PRSOG method performs better than a quantity-based method. Our analysis of the components of the sets of overlapping genes supports the utility of the PRSOG method.

Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain.

For patients with low back pain, skeletal muscle relaxants are often initiated after failure of first-line analgesics. However, these medications (reviewed in this article) are controversial alternatives that carry risks of adverse effects and increased cost.

mRNA-Seq of single prostate cancer circulating tumor cells reveals recapitulation of gene expression and pathways found in prostate cancer.

Circulating tumor cells (CTC) mediate metastatic spread of many solid tumors and enumeration of CTCs is currently used as a prognostic indicator of survival in metastatic prostate cancer patients. Some evidence suggests that it is possible to derive additional information about tumors from expression analysis of CTCs, but the technical difficulty of isolating and analyzing individual CTCs has limited progress in this area. To assess the ability of a new generation of MagSweeper to isolate intact CTCs for downstream analysis, we performed mRNA-Seq on single CTCs isolated from the blood of patients with metastatic prostate cancer and on single prostate cancer cell line LNCaP cells spiked into the blood of healthy donors. We found that the MagSweeper effectively isolated CTCs with a capture efficiency that matched the CellSearch platform. However, unlike CellSearch, the MagSweeper facilitates isolation of individual live CTCs without contaminating leukocytes. Importantly, mRNA-Seq analysis showed that the MagSweeper isolation process did not have a discernible impact on the transcriptional profile of single LNCaPs isolated from spiked human blood, suggesting that any perturbations caused by the MagSweeper process on the transcriptional signature of isolated cells are modest. Although the RNA from patient CTCs showed signs of significant degradation, consistent with reports of short half-lives and apoptosis amongst CTCs, transcriptional signatures of prostate tissue and of cancer were readily detectable with single CTC mRNA-Seq. These results demonstrate that the MagSweeper provides access to intact CTCs and that these CTCs can potentially supply clinically relevant information.

Single-neuron RNA-Seq: technical feasibility and reproducibility.

Understanding brain function involves improved knowledge about how the genome specifies such a large diversity of neuronal types. Transcriptome analysis of single neurons has been previously described using gene expression microarrays. Using high-throughput transcriptome sequencing (RNA-Seq), we have developed a method to perform single-neuron RNA-Seq. Following electrophysiology recording from an individual neuron, total RNA was extracted by aspirating the cellular contents into a fine glass electrode tip. The mRNAs were reverse transcribed and amplified to construct a single-neuron cDNA library, and subsequently subjected to high-throughput sequencing. This approach was applied to both individual neurons cultured from embryonic mouse hippocampus, as well as neocortical neurons from live brain slices. We found that the average pairwise Spearman's rank correlation coefficient of gene expression level expressed as RPKM (reads per kilobase of transcript per million mapped reads) was 0.51 between five cultured neuronal cells, whereas the same measure between three cortical layer 5 neurons in situ was 0.25. The data suggest that there may be greater heterogeneity of the cortical neurons, as compared to neurons in vitro. The results demonstrate the technical feasibility and reproducibility of RNA-Seq in capturing a part of the transcriptome landscape of single neurons, and confirmed that morphologically identical neurons, even from the same region, have distinct gene expression patterns.

A review of abuse-deterrent opioids for chronic nonmalignant pain.

Chronic nonmalignant pain, which affects millions of people, is the most common reason patients seek medical care. Both current and potential opioid analgesics are discussed, along with new technologies used to prevent abuse.

Full-length mRNA-Seq from single-cell levels of RNA and individual circulating tumor cells.

Genome-wide transcriptome analyses are routinely used to monitor tissue-, disease- and cell type­specific gene expression, but it has been technically challenging to generate expression profiles from single cells. Here we describe a robust mRNA-Seq protocol (Smart-Seq) that is applicable down to single cell levels. Compared with existing methods, Smart-Seq has improved read coverage across transcripts, which enhances detailed analyses of alternative transcript isoforms and identification of single-nucleotide polymorphisms. We determined the sensitivity and quantitative accuracy of Smart-Seq for single-cell transcriptomics by evaluating it on total RNA dilution series. We found that although gene expression estimates from single cells have increased noise, hundreds of differentially expressed genes could be identified using few cells per cell type. Applying Smart-Seq to circulating tumor cells from melanomas, we identified distinct gene expression patterns, including candidate biomarkers for melanoma circulating tumor cells. Our protocol will be useful for addressing fundamental biological problems requiring genome-wide transcriptome profiling in rare cells.

Direct measurement of DNA affinity landscapes on a high-throughput sequencing instrument.

Several methods for characterizing DNA-protein interactions are available, but none have demonstrated both high throughput and quantitative measurement of affinity. Here we describe 'high-throughput sequencing'-'fluorescent ligand interaction profiling' (HiTS-FLIP), a technique for measuring quantitative protein-DNA binding affinity at unprecedented depth. In this approach, the optics built into a high-throughput sequencer are used to visualize in vitro binding of a protein to sequenced DNA in a flow cell. Application of HiTS-FLIP to the protein Gcn4 (Gcn4p), the master regulator of the yeast amino acid starvation response, yielded ~440 million binding measurements, enabling determination of dissociation constants for all 12-mer sequences having submicromolar affinity. These data revealed a complex interdependency between motif positions, allowed improved discrimination of in vivo Gcn4p binding sites and regulatory targets relative to previous methods and showed that sets of genes with different promoter affinities to Gcn4p have distinct functions and expression kinetics. Broad application of this approach should increase understanding of the interactions that drive transcription.

Ideas and innovations: inclusion of pharmacists in chronic pain management services in a primary care practice.

Nonmalignant chronic pain management involves an ongoing process of complex evaluations including proper patient selection, proper prescribing, and careful monitoring. In the Pain Management Refill Clinic, patients are stabilized on an opioid regimen by either a pain specialist or a primary care physician (PCP). The PCP assumes long-term prescription of the regimen and proper follow-up. The inclusion of pharmacists in the management of patients suffering from chronic pain has allowed the physicians to improve opioid prescribing, documentation, and monitoring in accordance with chronic nonmalignant pain guidelines.

The cultural adjustment and mental health of Japanese immigrant youth.

Interviews were conducted with eight Japanese immigrant youth about their experiences with respect to adjusting to life in the United States, dealing with discrimination, and coping with cultural challenges. They were also questioned about their mental health and family and peer relations. Results indicate that participants managed to maintain bicultural identities and to cope with the problems that they encountered. Nevertheless, they experienced the following difficulties: racism and prejudice, language barriers, and conflict regarding identity and values. In terms of coping, participants mostly relied on friends for support; only one had sought the help of a professional counselor. The implications of the findings are discussed in terms of working with immigrant youth from Japan.