Enhancing comfort of resident physicians treating adults with intellectual and developmental disabilities by facilitating meaningful interactions.

Background: Many physicians feel uncomfortable caring for patients with intellectual and developmental disabilities (IDD). While some residency training programs include lecture content on IDD, few provide structured experiences with individuals with IDD. One strategy for improving comfort is "contact theory:" increasing interactions with "dissimilar" people can lead to decreased negative attitudes toward that population. Objective: Evaluate the impact of an interactive session on resident physicians' comfort with adults with IDD. Methods: Small groups of resident physicians and artists with IDD collaborated on art projects during the noon conference. A prospective pre-post-intervention survey, including the validated Interaction with Disabled Persons Scale (IDP), evaluated residents' comfort with patients with IDD before and after the session. Results: 53 residents completed both pre- and post-conference surveys. Mean IDP scores decreased from 78.7 (10.9) to 75.8 (9.5; p < 0.01), indicating decreasing discomfort. The mean level of comfort interacting with individuals with IDD increased from uncomfortable 3.6 (1.2), before the intervention, to comfortable 4.4 (1.2) after the intervention (p = <0.01). The mean level of comfort treating individuals with IDD increased from uncomfortable 3.5 (1.1) to comfortable 4.1 (1.3) after the intervention (p < 0.01). Discussion: Providing resident physicians with real-life connections with people with IDD was associated with increased comfort. If statistically significant improvements occurred after one session, future studies should evaluate if additional experiences with people with IDD could have more substantial, lasting impacts on future doctors' comfort with and willingness to care for patients with IDD.

Gender differences in illicit drug access, use and use disorder: Analysis of National Survey on Drug Use and Health data.

Although gender differences in the prevalence of substance use disorders (SUD) have been well-characterized, little is known about when gender differences emerge along the continuum of substance use. Understanding the contribution of gender to risk at key transition points across this continuum is needed to identify potential mechanisms underlying gender differences and to inform improved gender-responsive interventions. To characterize gender differences in the progression of cannabis, cocaine, and heroin use, the current study used data from the United States-based 2015-2019 National Survey on Drug Use and Health to quantify gender differences in: (1) perceived access to drugs, (2) lifetime drug use among individuals with at least some access, and (3) past-year SUD among those who had ever used each drug. Logistic regressions were conducted for each drug to examine gender differences across all three stages, controlling for sociodemographic factors and survey year. Compared to women, men had higher odds of reporting access to and lifetime use of all three drug types. Men also had higher odds of past-year cannabis and cocaine use disorders compared to women. Results suggest gender differences emerge in the earliest stage of drug use (access) and may accumulate across the stages of use. The magnitude of gender differences varied across stages, with the largest differences observed for odds of drug initiation among those with perceived access to each drug. Longitudinal data will be needed to confirm these findings and to provide insight into potential contributors to gender-specific risk and intervention targets across the continuum of drug use severity.

Understanding rabbit owners' willingness to engage in disease prevention behaviors.

Rabbit hemorrhagic disease virus 2 (RHDV2) is a fatal, highly contagious pathogen that infects wild and domestic lagomorphs (rabbits and hares). RHDV2 is an important cause of disease in pet and companion rabbits, has resulted in economic losses for the commercial rabbit industry, and has caused declines of wild lagomorph populations. It is essential for domestic rabbit owners to engage in appropriate actions (e.g., using effective disinfectants, creating secure barriers between domestic and wild rabbits) to protect the health and welfare of their rabbits and reduce the risk of human-mediated spread of RHDV2. Thus, we investigated rabbit owners' stated willingness to engage in nine commonly recommended biosecurity practices and their support for seven potential government-implemented management actions. We administered an online survey to 1790 rabbit owners in the United States between April and August 2021. Respondents were likely to engage in all biosecurity measures and were supportive of most management actions that could be implemented by government agencies. Respondents' willingness to engage in and support biosecurity measures was positively correlated with their perceptions of the importance of biosecurity, risk perceptions pertaining to the impact of RHDV2 on lagomorphs and rabbit-related industries, knowledge of RHDV2, and trust in government to manage RHDV2. Respondents' motivations for owning rabbits, husbandry behaviors, and demographic characteristics also influenced their willingness to engage in or support biosecurity measures. Engaging domestic rabbit owners in collaborative biosecurity measures is critical for protecting domestic rabbit health and preventing potential spillover between domestic and free-roaming lagomorphs, as there are still many uncertainties about how RHDV2 is spreading across the United States and the world. Implementing outreach strategies that communicate the importance and effectiveness of biosecurity practices in protecting rabbit welfare, rabbit-related activities, and wild lagomorph populations may increase the likelihood of rabbit owners adopting biosecurity measures.

IL-15 Priming Alters IFN-γ Regulation in Murine NK Cells.

NK effector functions can be triggered by inflammatory cytokines and engagement of activating receptors. NK cell production of IFN-γ, an important immunoregulatory cytokine, exhibits activation-specific IFN-γ regulation. Resting murine NK cells exhibit activation-specific metabolic requirements for IFN-γ production, which are reversed for activating receptor-mediated stimulation following IL-15 priming. Although both cytokine and activating receptor stimulation leads to similar IFN-γ protein production, only cytokine stimulation upregulates Ifng transcript, suggesting that protein production is translationally regulated after receptor stimulation. Based on these differences in IFN-γ regulation, we hypothesized that ex vivo IL-15 priming of murine NK cells allows a switch to IFN-γ transcription upon activating receptor engagement. Transcriptional analysis of primed NK cells compared with naive cells or cells cultured with low-dose IL-15 demonstrated that primed cells strongly upregulated Ifng transcript following activating receptor stimulation. This was not due to chromatin accessibility changes in the Ifng locus or changes in ITAM signaling, but was associated with a distinct transcriptional signature induced by ITAM stimulation of primed compared with naive NK cells. Transcriptional analyses identified a common signature of c-Myc (Myc) targets associated with Ifng transcription. Although Myc marked NK cells capable of Ifng transcription, Myc itself was not required for Ifng transcription using a genetic model of Myc deletion. This work highlights altered regulatory networks in IL-15-primed cells, resulting in distinct gene expression patterns and IFN-γ regulation in response to activating receptor stimulation.

Association between clinician specialty and prescription of preventive medication for young adults with migraine: A retrospective cohort study.

OBJECTIVE: We aimed to compare the prescribing patterns of preventive medications between pediatric and adult neurologists for young adults with migraine. BACKGROUND: Although preventive medications are effective for adults with migraine, studies in children have failed to demonstrate similar efficacy. As a result, lifestyle modifications and non-pharmacological interventions are often emphasized in children. It is not known whether young adults are prescribed preventive medications at different rates according to whether they are cared for by an adult or pediatric neurologist. METHODS: We performed a multicenter retrospective cohort analysis of patients with migraine aged 18-25 years who were seen by a pediatric or adult neurologist at Mass General Brigham Hospital between 2017 and 2021. The primary outcome was whether the patient received a prescription for any preventive medication during the study period. RESULTS: Among the 767 included patients, 290 (37.8%) were seen by a pediatric neurologist. Preventive medications were prescribed for 131/290 (45.2%; 95% confidence interval [CI]: 39.5%, 51.0%) patients seen by a pediatric neurologist and 206/477 (43.2%; 95% CI: 39.0%, 47.7%) patients seen by an adult neurologist (p = 0.591). In the mixed effects logistic regression model, clinician specialty was not associated with preventive medication use (adjusted odds ratio [AOR] 1.20, 95% CI: 0.62, 2.31). Female sex (AOR 1.69, 95% CI: 1.07, 2.66) and number of visits during the study period (AOR 1.64, 95% CI: 1.49, 1.80) were associated with receiving preventive medication. CONCLUSION: Approximately two fifths of young adults with migraine were prescribed preventive medications, and this proportion did not differ according to clinician specialty. Although these findings suggest that pediatric and adult neurologists provide comparable care, both specialties may be underusing preventive medications in this patient population.

IL-15 priming alters IFN-γ regulation in murine NK cells.

Natural killer (NK) effector functions can be triggered by inflammatory cytokines and engagement of activating receptors. NK cell production of IFN-γ, an important immunoregulatory cytokine, exhibits activation-specific IFN-γ regulation. Resting murine NK cells exhibit activation-specific metabolic requirements for IFN-γ production, which are reversed for activating receptor-mediated stimulation following IL-15 priming. While both cytokine and activating receptor stimulation leads to similar IFN-γ protein production, only cytokine stimulation upregulates Ifng transcript, suggesting that protein production is translationally regulated after receptor stimulation. Based on these differences in IFN-γ regulation, we hypothesized that ex vivo IL-15 priming of murine NK cells allows a switch to IFN-γ transcription upon activating receptor engagement. Transcriptional analysis of primed NK cells compared to naïve cells or cells cultured with low-dose IL-15 demonstrated that primed cells strongly upregulated Ifng transcript following activating receptor stimulation. This was not due to chromatin accessibility changes in the Ifng locus or changes in ITAM signaling, but was associated with a distinct transcriptional signature induced by ITAM stimulation of primed compared to naïve NK cells. Transcriptional analyses identified a common signature of c-Myc (Myc) targets associated with Ifng transcription. While Myc marked NK cells capable of Ifng transcription, Myc itself was not required for Ifng transcription using a genetic model of Myc deletion. This work highlights altered regulatory networks in IL-15 primed cells, resulting in distinct gene expression patterns and IFN-γ regulation in response to activating receptor stimulation.

U.S. National Park visitor perceptions and behavioral intentions towards actions to prevent white-nose syndrome.

In the United States, the discovery and spread of white-nose syndrome (WNS) has drastically changed how bats and caves are managed. The U.S. National Park Service has been instrumental in the national response to WNS, as it manages extensive cave resources and has a close relationship with the public. However, managers lack information on visitor support for disease prevention measures designed to slow the spread of WNS and minimize human disturbance of vulnerable bat populations. This study utilized the Theory of Planned Behavior to determine how visitor attitudes, subjective norms, and perceived behavioral controls influenced their behavior regarding WNS preventive actions, including participation in educational programming on bats, wearing clothes or shoes in caves that have not been contaminated with the fungus that causes WNS, walking over decontamination mats, and complying with cave closures. During summer of 2019, data were collected using an on-site survey of 1365 visitors to eight U.S. national park units: Oregon Caves, Lava Beds, Carlsbad Caverns, El Malpais, Wind Cave, Jewel Cave, Mammoth Cave, and Cumberland Gap. Visitors were willing to participate in all preventative actions addressed in the survey (77.7%-96.7%). Visitors expressed that engaging in these actions was very desirable (36.0%-65.6%), and their decision to engage in these actions was most strongly influenced by park staff (39.2%-68.8%) or signage (35.5%-61.9%). Attitudes and subjective norms were positive predictors of behavioral intentions for all measures. Perceived behavioral control was not a direct predictor for behavioral intent, but its interaction with attitudes and subjective norms had a moderating influence on intention to comply with multiple WNS preventive actions. With the continued spread of WNS and emergence of other threats to bats, understanding visitor behavioral intent and underlying factors will facilitate successful implementation of preventive actions that are publicly supported and promote conservation of bat populations in U.S. national parks.

Development and Evaluation of an Integrated Outpatient Infusion Care Model for the Treatment of Pediatric Headache.

BACKGROUND: Care for pediatric patients with headache often occurs in high-cost settings such as emergency departments (EDs) and inpatient settings. Outpatient infusion centers have the potential to reduce care costs for pediatric headache management. METHODS: In this quality improvement study, we describe our experience in creating the capacity to support an integrated outpatient pediatric headache infusion care model through an infusion center. We compare costs of receiving headache treatment in this model with those in the emergency and inpatient settings. Because dihydroergotamine (DHE) is a costly infusion, encounters at which DHE was administered were analyzed separately. We track the number of ED visits and inpatient admissions for headache using run charts. As a balancing measure, we compare treatment efficacy between the infusion care model and the inpatient setting. RESULTS: The mean percentage increase in cost of receiving headache treatment in the inpatient setting with DHE was 61% (confidence interval [CI]: 30-99%), and that without DHE was 582% (CI: 299-1068%) compared with receiving equivalent treatments in the infusion center. The mean percentage increase in cost of receiving headache treatment in the ED was 30% (CI: -15 to 100%) compared with equivalent treatment in the infusion center. After the intervention, ED visits and inpatient admissions for headache decreased. The mean change in head pain was similar across care settings. CONCLUSIONS: Our findings demonstrate that developing an integrated ambulatory care model with infusion capacity for refractory pediatric headache is feasible, and our early outcomes suggest this may have a favorable impact on the overall value of care for this population.

Down the Rabbit Hole: Domestic Rabbit Owners' Perceptions of Rabbit Hemorrhagic Disease Virus 2.

Rabbit hemorrhagic disease virus 2 (RHDV2) is a highly contagious pathogen that infects wild and domestic rabbits and hares (lagomorphs). Globally, RHDV2 has resulted in substantial economic losses for commercial rabbit trade and caused wild lagomorph population declines. Previous research on RHDV2 suggests that human-mediated movement of rabbits may contribute to the spread of RHDV2. We conducted the first survey of individuals who own or interact with domestic rabbits to identify their rabbit husbandry behaviors and knowledge of, and concerns about, RHDV2. In 2021, we surveyed 1807 rabbit owners, breeders, and rescue staff in the USA. Respondents had a high level of knowledge about RHDV2. Respondents believed RHDV2 posed a high risk to rabbit-related activities and were concerned about its economic and ecological impacts. Nearly half of respondents always kept their rabbits indoors, but 10.7% of respondents allowed their rabbits outside frequently on properties used by wild lagomorphs. Respondents with five rabbits or less were generally willing to vaccinate their rabbits, but respondents with larger herds argued that vaccines were cost prohibitive. Given respondents' concerns about RHDV2, communication about disease prevention should highlight the adverse ecological and economic consequences of RHDV2.

Aging and the perception of texture-defined form.

In this study 28 younger and older observers discriminated the global shapes of objects that were defined by differences in texture. The judged stimulus patterns were 3-point micropattern textures. On any given trial, a texture-defined shape (either a vertically- or horizontally-oriented rectangle) was presented; the observers' task was to discriminate between the two rectangles. The task difficulty was manipulated by varying the deviation from colinearity of each of the individual 3-point texture elements between figure and background (the larger the difference in deviation between figure and ground, the higher the discrimination performance). The results revealed a substantial effect of age. In order for the older observers to reliably discriminate the shape of the target rectangle (with a d' value of 1.5), they needed differences from colinearity that were 54.4 percent larger than those required for the younger observers. While older adults can utilize differences in texture to perceive global shape, their ability is nevertheless significantly impaired.

Practical Advices for Treating Chronic Pain in the Time of COVID-19: A Narrative Review Focusing on Interventional Techniques.

BACKGROUND: Since the management of chronic pain has become even more challenging secondary to the occurrence of SARS-CoV-2 outbreaks, we developed an exhaustive narrative review of the scientific literature, providing practical advices regarding the management of chronic pain in patients with suspected, presumed, or confirmed SARS-CoV-2 infection. We focused particularly on interventional procedures, where physicians are in closer contact with patients. METHODS: Narrative Review of the most relevant articles published between June and December of 2020 that focused on the treatment of chronic pain in COVID-19 patients. RESULTS: Careful triage of patients is mandatory in order to avoid overcrowding of hospital spaces. Telemedicine could represent a promising tool to replace in-person visits and as a screening tool prior to admitting patients to hospitals. Opioid medications can affect the immune response, and therefore, care should be taken prior to initiating new treatments and increasing dosages. Epidural steroids should be avoided or limited to the lowest effective dose. Non urgent interventional procedures such as spinal cord stimulation and intrathecal pumps should be postponed. The use of personal protective equipment and disinfectants represent an important component of the strategy to prevent viral spread to operators and cross-infection between patients due to the SARS-CoV-2 outbreaks.

Pediatric Episodic Migraine with Aura: A Unique Entity?

Migraine headache is a common cause of pain and disability in children and adolescents and is a major contributor to frequently missed school days and limitations in activities. Of children and adolescents with migraine headache, approximately one-third have migraine with aura (MA). MA is often considered to be similar to migraine without aura (MO), and thus, many studies do not stratify patients based on the presence of aura. Because of this, treatment recommendations are often analogous between MA and MO, with a few notable exceptions. The purpose of this review is to highlight the current evidence demonstrating the unique pathophysiology, clinical characteristics, differential diagnosis, co-morbidities, and treatment recommendations and responses for pediatric MA.

Temporal integration in the perception and discrimination of solid shape.

Two experiments evaluated the importance of temporal integration for the perception and discrimination of solid object shape. In Experiment 1, observers anorthoscopically viewed moving or stationary cast shadows of naturally shaped solid objects (bell peppers, Capsicum annuum) through narrow (4-mm wide) slits. At any given moment, observers could only see a very small portion of the overall object shape (generally less than 10%). The results showed that the observers' discrimination performance for the moving cast shadows was much higher than that obtained for the stationary shadows, demonstrating the ability to temporally integrate the piecemeal momentary information about shape that was available through the narrow apertures. In a second experiment, estimates of the strength of the observers' impressions of solid shapes rotating in depth were obtained as well as discrimination accuracies; perceptions of the original moving condition were compared with a new condition where the frames of the apparent motion sequences depicting solid objects in continuous motion (behind the slits) were randomly scrambled. The observers perceived the anorthoscopic displays as depicting solid objects rotating in depth, but only in the continuous motion condition. Interestingly, the discrimination performance in the scrambled condition remained relatively high-observers were still able to integrate information across the multiple scrambled frames in order to produce discrimination performance that was significantly higher than that obtained in the stationary shadow condition. This study was the first to thoroughly evaluate whether and to what extent human observers can effectively discriminate and perceive solid object shape anorthoscopically.

The Visual Perception of Large-Scale Distances Outdoors.

The ability of 32 younger (ages ranged from 19 to 32 years) and older adults (ages ranged from 65 to 83 years) to visually perceive outdoor distances was evaluated; we used the method of equal-appearing intervals. On any given trial, the observers adjusted five distance intervals in depth so that they all appeared equivalent in magnitude (and equal to a standard initial egocentric distance of 6 m). The judgments of approximately two thirds of the younger and older observers exhibited varying degrees of perceptual compression, while those of the remaining one third were essentially accurate. Unlike a number of previous studies that evaluated the perception of shorter distances, no significant effects of age were obtained in the current experiment. In particular, there were no significant effects of age upon either accuracy or precision. The ability of human observers to evaluate large-scale distances outdoors is well maintained with increasing age.