Relationship between intervention dosage and success of resource connections in a social needs intervention.

OBJECTIVES: Social needs interventions in medical settings aim to mitigate the effects of adverse social circumstances on health outcomes by connecting vulnerable patients with resources. This study examined the relationship between intervention dosage and the success of resource connections using data from a social needs intervention in multiple clinical settings across the US. STUDY DESIGN: The intervention uses a case management approach to connect patients with unmet needs to resources and services in the community. Intervention dosage was conceptualized as the number of contacts between the navigator and the patient, categorized as direct contact (phone vs. in person) and indirect contact (initiated by the navigator vs. patient). Success of the intervention was conceptualized as 'none,' 'partial,' or 'optimal' for each patient, based on the number of social needs the resource connections addressed. METHODS: Administrative data were extracted for 38,404 unique patients who screened positive for unmet resource needs between 2012 and 2017. Owing to the large sample size, statistical corrections were made to reduce type I error. RESULTS: Multinomial logistic regression analyses showed that higher intervention dosage was related to greater success of resource connections, after adjusting for the patient and site characteristics, and the number of needs (odds ratios ranged from 1.62 to 2.89). In-person contact, although received by only 25% of the patients, was associated with the highest probability of optimal success. CONCLUSIONS: This study demonstrates a feasible way to conceptualize an intervention dose for a social needs intervention that uses a case management approach and has implications for how intervention delivery may improve success of resource connections.

Missing out on Miranda: Investigating Miranda comprehension and waiver decisions in adult inpatients.

Internationally, millions of arrests occur each year, but very little is known about how suspects are informed regarding their rights as the accused and whether these rights are accurately understood. Concerns regarding accurate comprehension are further heightened for suspects with severe mental disorders (SMDs). In the United States alone, it is estimated ≥300,000 mentally disordered suspects are arrested annually and Mirandized (i.e., given American warnings regarding the rights of the accused). Despite this widespread prevalence, only two published studies have specifically targeted impaired Miranda comprehension for persons with SMDs, and none has focused directly on Miranda reasoning and waiver decisions. The current study examined both Miranda comprehension and reasoning for 85 adult inpatients recruited from a private psychiatric hospital with three major findings. First, inpatients extremely poor Miranda recall, averaging only 21.3% of the total warning. Second, none appeared to exhibit adequate abilities for Miranda reasoning. Third, an initial waiver of rights always led to a confession within several minutes of questioning. These findings and methodological issues are discussed for the United States as well as other countries.

The MRCI with juvenile detainees: optimizing performance or emphasizing ecological validity?

The Miranda Rights Comprehension Instruments (MRCI) are intended to be administered to legally involved youths in a setting free from distractions and stressors with the explicit goal of assessing the examinee's best understanding. However, marked disparities have been observed between juveniles' MRCI performance and their unassisted recall of a representative Miranda warning. We hypothesized that youths' very strong MRCI performance might be partially due to prompts and clarifications used whenever incomplete or ambiguous answers are provided. In this archival study, we systematically re-scored three MRCI instruments from 231 legally involved youths to evaluate their original responses (i.e., non-queried scoring). This approach is viewed as more ecologically valid because actual Miranda warnings are typically provided in a routine manner without assistance following each Miranda component. For the large majority of legally involved juveniles, only small differences were noted between standard and non-queried scoring. However, some dramatic decrements were observed, especially on the Comprehension of Miranda Rights-II (CMR-II). More specifically, 15.7% of CMR-II percentiles dropped precipitously by 60% or more, when using the non-queried scores. The results are discussed within the context of optimized performances versus ecological validity as applied to Miranda evaluations.

One American Perspective on the Rights of Accused: An Initial Survey of Miranda Rights in a Broader Context.

In the wake of countless police dramas, commonly held misperceptions endure that the American public knows both Miranda warnings and concomitant rights. Past research has tested public knowledge of Miranda per se, without evaluating additional misconceptions. The current investigation utilizes the European Union's much more all-encompassing safeguards, as delineated in the EU's 2012 Directive and Letter of Rights. Besides knowledge of Miranda, the advisability of these enhanced rights and protections was also assessed. In order to obtain a cross-section of the community, 619 participants were recruited from actual jury pools. Interestingly, they believed that Miranda afforded arrestees many more protections than it actually does. In general, nearly all (>90%) agreed that the accused should be given accurate information (e.g., charges and alleged criminal acts) coupled with an absence of police deception. The potential implications of these findings are discussed as they relate to police practices and due process. Copyright © 2016 John Wiley & Sons, Ltd.

The tyrosine kinase inhibitor bafetinib inhibits PAR2-induced activation of TRPV4 channels in vitro and pain in vivo.

BACKGROUND AND PURPOSE: Protease-activated receptor 2 (PAR2) is expressed on nociceptive neurons, and can sensitize transient receptor potential (TRP) ion channels to amplify neurogenic inflammation and pain. The mechanisms by which this occurs are not fully understood. PAR2 causes receptor-operated activation of TRPV4 channels and TRPV4 null mice have attenuated PAR2-stimulated neurogenic inflammation and mechanical hyperalgesia. Here we investigate the intracellular signalling mechanisms underlying PAR2-induced TRPV4 channel activation and pain. EXPERIMENTAL APPROACH: Responses of non-transfected and TRPV4-transfected HEK293 cells to agonists of PAR2 (trypsin and SLIGRL) and TRPV4 channels (GSK1016790A) were determined using calcium imaging. Inhibitors of TRPV4 channels (HC067047), sarcoendoplasmic reticulum calcium transport ATPase (thapsigargin), Gαq (UBO-QIC), tyrosine kinases (bafetinib and dasatinib) or PI3 kinases (wortmannin and LY294002) were used to investigate signalling mechanisms. In vivo effects of tyrosine kinase inhibitors on PAR2 -induced mechanical hyperalgesia were assessed in mice. KEY RESULTS: In non-transfected HEK293 cells, PAR2 activation transiently increased intracellular calcium ([Ca(2+) ]i ). Functional expression of TRPV4 channels caused a sustained increase of [Ca(2+) ]i , inhibited by HC067047, bafetinib and wortmannin; but not by thapsigargin, UBO-QIC, dasatinib or LY294002. Bafetinib but not dasatinib inhibited PAR2-induced mechanical hyperalgesia in vivo. CONCLUSIONS AND IMPLICATIONS: This study supports a role for tyrosine kinases in PAR2-mediated receptor-operated gating of TRPV4 channels, independent of Gαq stimulation. The ability of a tyrosine kinase inhibitor to diminish PAR2-induced activation of TRPV4 channels and consequent mechanical hyperalgesia identifies bafetinib (which is in development in oncology) as a potential novel analgesic therapy.

Tracking forest phenology and seasonal physiology using digital repeat photography: a critical assessment.

Digital repeat photography is becoming widely used for near-surface remote sensing of vegetation. Canopy greenness, which has been used extensively for phenological applications, can be readily quantified from camera images. Important questions remain, however, as to whether the observed changes in canopy greenness are directly related to changes in leaf-level traits, changes in canopy structure, or some combination thereof. We investigated relationships between canopy greenness and various metrics of canopy structure and function, using five years (2008­2012) of automated digital imagery, ground observations of phenological transitions, leaf area index (LAI) measurements, and eddy covariance estimates of gross ecosystem photosynthesis from the Harvard Forest, a temperate deciduous forest in the northeastern United States. Additionally, we sampled canopy sunlit leaves on a weekly basis throughout the growing season of 2011. We measured physiological and morphological traits including leaf size, mass (wet/dry), nitrogen content, chlorophyll fluorescence, and spectral reflectance and characterized individual leaf color with flatbed scanner imagery. Our results show that observed spring and autumn phenological transition dates are well captured by information extracted from digital repeat photography. However, spring development of both LAI and the measured physiological and morphological traits are shown to lag behind spring increases in canopy greenness, which rises very quickly to its maximum value before leaves are even half their final size. Based on the hypothesis that changes in canopy greenness represent the aggregate effect of changes in both leaf-level properties (specifically, leaf color) and changes in canopy structure (specifically, LAI), we developed a two end-member mixing model. With just a single free parameter, the model was able to reproduce the observed seasonal trajectory of canopy greenness. This analysis shows that canopy greenness is relatively insensitive to changes in LAI at high LAI levels, which we further demonstrate by assessing the impact of an ice storm on both LAI and canopy greenness. Our study provides new insights into the mechanisms driving seasonal changes in canopy greenness retrieved from digital camera imagery. The nonlinear relationship between canopy greenness and canopy LAI has important implications both for phenological research applications and for assessing responses of vegetation to disturbances.

High-throughput amplicon sequencing of rRNA genes requires a copy number correction to accurately reflect the effects of management practices on soil nematode community structure.

Nematodes are abundant consumers in grassland soils, but more sensitive and specific methods of enumeration are needed to improve our understanding of how different nematode species affect, and are affected by, ecosystem processes. High-throughput amplicon sequencing is used to enumerate microbial and invertebrate communities at a high level of taxonomic resolution, but the method requires validation against traditional specimen-based morphological identifications. To investigate the consistency between these approaches, we enumerated nematodes from a 25-year field experiment using both morphological and molecular identification techniques in order to determine the long-term effects of annual burning and nitrogen enrichment on soil nematode communities. Family-level frequencies based on amplicon sequencing were not initially consistent with specimen-based counts, but correction for differences in rRNA gene copy number using a genetic algorithm improved quantitative accuracy. Multivariate analysis of corrected sequence-based abundances of nematode families was consistent with, but not identical to, analysis of specimen-based counts. In both cases, herbivores, fungivores and predator/omnivores generally were more abundant in burned than nonburned plots, while bacterivores generally were more abundant in nonburned or nitrogen-enriched plots. Discriminate analysis of sequence-based abundances identified putative indicator species representing each trophic group. We conclude that high-throughput amplicon sequencing can be a valuable method for characterizing nematode communities at high taxonomic resolution as long as rRNA gene copy number variation is accounted for and accurate sequence databases are available.

Prenatal diagnosis of the Klippel-Trenaunay-Weber syndrome.

The Klippel-Trenaunay-Weber syndrome is a complex developmental disorder of the vascular and skeletal systems. While many features of the syndrome are congenital, it has not been diagnosed often before birth. This paper describes a case of Klippel-Trenaunay-Weber syndrome diagnosed at 19 weeks' gestation on the basis of sonographic findings and family history. The clinical variability of the syndrome is emphasized and the importance of family history in differential diagnosis is stressed.

The future of hypnosis through the remainder of the decade: a Delphi poll.

We predicted the future of hypnosis for the next 10 years using the Delphi method--the best available forecasting tool. A panel of 89 experts in the field of hypnosis completed a 44-item questionnaire that addressed future developments in these areas: (1) training and preparation, (2) general applications of hypnosis, (3) theory, and (4) research. Also predicted was the likelihood of occurrence of certain cogent events in the field. Results indicated probable increases in emphasis in nearly all areas surveyed. We also solicited nominations for major contributors to the field of hypnosis, major books on hypnosis, and journals most likely to publish articles on hypnosis.

Children's reactions to transgressions: effects of the actor's apology, reputation and remorse.

This experiment examined children's reactions to a transgression in which one child's property was damaged by another who (a) had a reputation as a good or bad child, (b) apologized or did not, and (c) later expressed remorse when talking about the incident or was happy and unremorseful. As expected, actors who had a good reputation or were remorseful were seen as more likable, as having better motives, as doing the damage unintentionally, as more sorry and as less blameworthy. Further, actors who were good and remorseful were punished least, suggesting that punishment was applied in a rehabilitative fashion. The actor's reputation determined how his or her actions were interpreted: bad actors were seen as more worried about punishment when they expressed remorse and older children thought they apoligized merely to avoid punishment. Interestingly, apologies were effective in reducing punishment and making the actor seem more likable, and this was true irrespective of the other factors. The apology-forgiveness script may be such an ingrained aspect of social life that its appearance automatically improves the actor's position. The reactions of second and fifth graders were generally similar, although the younger children displayed less coherent relationships between judgements.

Neurobehavioral effects of prenatal alcohol: Part I. Research strategy.

This paper, Part I of a three-part series, reviews the literature on the neurobehavioral effects of prenatal alcohol exposure and describes a large group of tests assembled to assess neurobehavioral outcomes of alcohol teratogenesis in 7-year-old children. This paper presents the distribution of these test scores for our sample and discusses their relationships with an alcohol binge score and with full-scale IQ. This group of tests is suitable for children with a wide range of abilities and provides a broad assessment of neurobehavioral deficits. Part II of this series describes a new method of statistical analysis, Partial Least Squares (PLS), which is particularly well suited to complex multivariate data sets such as these, and with its aid, examines the effects of prenatal alcohol exposure on IQ, achievement, vigilance and classroom behavior, a total of 43 outcome scores. Part III examines prenatal alcohol effects on outcomes from the broad group of 164 scores deriving from 17 neuropsychologic tests, using the Partial Least Squares methodology, and summarizes the implications of our findings for the behavioral teratology of alcohol.

Independent dysmorphology evaluations at birth and 4 years of age for children exposed to varying amounts of alcohol in utero.

Two groups of 4-year-old children were examined by a dysmorphologist without knowledge of previous examination results or prenatal exposure and categorized as to whether or not they showed fetal alcohol effects. A priori classification of children into the two groups was on the basis of their mothers' self-report of drinking when interviewed during pregnancy. Children born to 108 mothers in a "heavier" drinking group (absolute alcohol concentration greater than or equal to 30 mL/d [1.0 oz/d]) were compared with a matched group of children born to 97 mothers whose average absolute alcohol concentration was less than 0.3 mL/d (0.01 oz/d). The percentage of children with fetal alcohol effects in the heavier drinking v the comparison group was 20.4% v 9.3%. When fetal alcohol effects were studied in relation to only the absolute alcohol concentration scores, there was a significantly greater chance of a child being classified as having fetal alcohol effects with increasing levels of alcohol exposure prior to recognition of pregnancy (P = .013). A logistic regression, run on the absolute alcohol concentration scores and other primary exposures, indicated that fetal alcohol effects classification was not significantly related to nicotine, caffeine, or marijuana but was significantly related to absolute alcohol concentration scores even after statistically adjusting for these other exposures (P = .002). Classification of fetal alcohol effects at 4 years of age was compared to a fetal alcohol effects classification obtained at birth by an independent dysmorphologist in a sample of 75 subjects examined at both ages, and 80% of the infants classified as having fetal alcohol effects at birth were classified as having fetal alcohol effects at 4 years of age.(ABSTRACT TRUNCATED AT 250 WORDS)

Restriction fragment-length polymorphisms of class II gene sequences in mice expressing minor structural variants of I-Ak and I-Ap.

Serologic and structural analyses of the I-A molecules expressed among a large collection of wild mouse-derived H-2 haplotypes has led to the definition of "families" of I-A alleles which encode antigenically similar molecules that are identical in more than 90% of their tryptic peptides. Two of these families, denoted the I-Ak and I-Ap families, consist of 10 I-A alleles which encode I-A molecules whose structures are closely related to either I-Ap or I-Ak. The evolutionary relationships of the I-A alleles in these families were assessed by a molecular analysis of their genomic structures. The A alpha and A beta alleles within these I-A families were compared by analysis of restriction fragment-length polymorphisms (RFLP) detected at high stringency by Southern blot hybridization with DNA probes specific for either A alpha or A beta. The polymorphic restriction enzyme sites detected in this survey were distributed over more than 7 kb of genomic DNA surrounding each gene. Because both A alpha and A beta are encoded by about 700 bp of exon DNA, the majority of the restriction enzyme sites assayed by this RFLP analysis reflect polymorphisms in noncoding regions. The DNA sequence homologies of these alleles were estimated from the RFLP results with seven restriction endonucleases by calculating the fraction homologous value as defined previously. The results indicate that evolutionarily dissimilar I-A alleles can encode I-A molecules with very similar structures. The five I-A alleles in the I-Ak family could be divided into two discrete groups, denoted K1 and K2, on the basis of their restriction fragment (RF) genotypes. The RF genotypes of alleles within each group shared more than 80% of the restriction fragments for both A and A beta. In contrast, the RF genotypes of alleles in group K1 differed extensively from those in group K2, indicating that alleles in these separate groups may not be evolutionarily closely related. These observations suggest that gene conversion or intragenic recombinational events may have been involved in the evolution of groups K1 and K2 in the I-Ak family. The RF genotypes of alleles in the I-Ap family demonstrated a close evolutionary relationship among all but two of the alleles. These two alleles encoded I-A molecules whose structures were the least related to I-Ap of any of the alleles in the I-Ap family.(ABSTRACT TRUNCATED AT 400 WORDS)

Localization of structural variations distinguishing I-Ak-related molecules to the alpha 1 and beta 1 domains.

The structural variations that distinguish the A molecules encoded by wild-derived H-2 complexes which express Ak-related molecules have been localized into the alpha 1 and beta 1 domains by radiochemical sequence analyses of tryptic peptides. The A alpha subunits of B10.STC90 (Akv1) and W12A (Akv2) differ from those of B10.BR (Ak) in two adjacent tryptic peptides spanning positions 43 to 71 in the alpha 1 domain. The A beta subunit of W12A differs from that of B10.BR in two peptides spanning positions 26 to 29 and 95 to 106. Isoleucine and leucine residues present at positions 28 and 95, respectively, in the B10.BR A beta subunit are not found in the corresponding positions in W12A A beta subunits. Both of these A beta sequence variations are in the beta 1 domain. B10.STC90 A beta subunits are identical to those of W12A except for a structural variation in the beta 1 domain affecting the HPLC retention time of a peptide spanning positions 49 to 63. These results suggest that these A molecules are encoded by closely related class II gene alleles which have diversified by the accumulation of discrete mutations within the exons encoding the alpha 1 and beta 1 domains of the A molecule. Our previous functional analyses of these minor variant A molecules have demonstrated that they are readily distinguished with A molecule-specific alloreactive T lymphocytes. Together, these findings suggest that minor structural variations in the alpha 1 and beta 1 domains of the A molecule can dramatically modify the allodeterminants recognized by alloreactive T lymphocytes.

The effect of E. coli endotoxin on the developing rat liver. II. Immunohistochemical localization of alpha-fetoprotein in rat liver multinucleated giant cells.

Immunoperoxidase histochemical staining techniques have been used previously to localize alpha-fetoprotein (AFP) in hepatocytes from rat and human liver tissues. In this study, we extended these observations by examining liver tissues from rat fetuses exposed to E. coli endotoxin in order to document the presence of AFP in hepatic multinucleated giant cells. Liver sections were examined under light microscopy after incubation with purified antibody-peroxidase conjugates and histochemical stains. These sections showed a positive reaction for AFP in giant cells and hepatocytes that appeared as granular, brown intracytoplasmic deposits in cells throughout the hepatic lobule. Furthermore, a direct correlation was found between the number of positively stained giant cells and the serum concentration of AFP. The findings demonstrated that AFP distribution in endotoxin-induced liver injury is confined to isolated hepatocytes and multinucleated giant cells. This observation provides evidence that the origin of the giant cell in toxin-exposed fetal rat liver may be the hepatocyte.

Recombination and mutation of class II histocompatibility genes in wild mice.

We have compared the tryptic peptide fingerprints of the A alpha, A beta, E alpha, and E beta subunits encoded by four wild-derived H-2 complexes expressing A molecules closely related to Ak. The A molecules encoded by these Ak-related mice have A alpha and A beta subunits that differ from A alpha k and A beta k by less than 10% of their tryptic peptides. Comparisons among the four wild-derived A molecules suggested that these contemporary A alpha and A beta alleles arose by sequential mutational events from common ancestor A alpha and A beta alleles. These results suggest that A alpha and A beta may co-evolve as an A beta A alpha gene duplex in wild mice. Tryptic peptide fingerprint comparisons of the E beta gene linked to these Ak-related A beta A alpha gene duplexes indicate that two encode E beta d-like subunits, whereas another encodes an E beta s-like subunit. These results strongly suggest that the A beta A alpha duplex and E beta recombine in wild mouse populations. The significantly different evolutionary patterns exhibited by the class II genes encoding A vs E molecules are discussed.