Comparing self-reported vs. parent/caregiver reported levels of social participation for young adults with intellectual disabilities: A pilot study.

BACKGROUND: This study focused on the level of satisfaction of social participation reported by young adults with intellectual disabilities, and the comparison of these levels to those reported by their caregivers. METHODS: Fifteen young adults with intellectual disabilities and their parents/caregivers completed the Patient-Reported Outcomes Measurement Information System Satisfaction with Participation in Discretionary Social Activities-Calibrated Items (PROMIS SF-Social Sat DSA) and the Satisfaction with Social Roles and Activities-Short Form (Neuro-QoL SF). RESULTS: Reports from these young adults were compatible to that of the general population. There was general agreement on the Social Sat DSA between the individuals and their caregivers, but there were differences between groups on the Neuro-QoL SF, with the caregivers typically giving higher scores (p = .025). CONCLUSION: This pilot study demonstrates the importance of involving both the individuals with intellectual disabilities, and their parents/caregivers when conducting survey research. Further research is encouraged.

Exposure of Helicoverpa punctigera pupae to extreme temperatures for extended periods negatively impacts on adult population dynamics and reproductive output.

Understanding the impact that heat stress has on critical life stages of an organism is essential when assessing population responses to extreme events. Heat stress may occur as repeated small-scale events or as a single prolonged event, which may cause different outcomes to the organism. Here, we subjected Helicoverpa punctigera (Wallengren) pupae to two temperatures (44.2 °C and 43 °C) and two exposure treatments - a single 3-h prolonged exposure prolonged and three repeated 1-h exposure period with 24 h recovery time between bouts - to assess the biological traits of individuals. The maximum temperatures were used as they were just below the critical thermal maximum (CTmax) 47.3 °C ± 0.3 °C of pupae for which they could survive exposure. Adults in the prolonged and repeated heat-stressed treatments had 1.70 and 3.34 more days to emergence and 1.57 and 3.30 days extended life span compared to those kept under a constant 25 °C temperature (control treatment). Both pre-oviposition and oviposition periods were extended in the heat-stressed groups. Fecundity in the prolonged and repeated heat-stressed females was reduced by 34.7% and 65.5% eggs in the 43 °C treatment group and by 94.3% and 93.6% eggs in the 44.2 °C treatment group compared to the control group. No eggs from females in either the prolonged and repeated heat-stress groups hatched. We establish that heat stress on pupae can influence the population dynamics of H. punctigera by reducing fecundity as well as extending the pre oviposition period, and affecting adult development. Also, as heat exposure on the parent generation resulted in no offspring production, it is critical to assess cross-generational responses to extreme heat stress.

Identification of key discriminating variables between spinner dolphin (Stenella longirostris) whistle types.

Descriptions of the six different spinner dolphin (Stenella longirostris) whistle types were developed from a random sample of 600 whistles collected across a 2-yr period from a Fijian spinner dolphin population. An exploratory multivariate visualization suggested an inverse relationship between delta and minimum frequency (58.6%) as well as whistle duration (18.1%) as the most discriminating variables in this dataset. All three of these variables were deemed to be significant when considered jointly in a multivariate analysis of variance (MANOVA): delta frequency (F5594 = 27.167, p < 0.0001), minimum frequency (F5594 = 14.889, p < 0.0001), and duration (F5594 = 24.303, p < 0.0001). Significant differences between at least two of the whistle types were found for all five acoustic parameters in univariate analysis of variation (ANOVA) tests. Constant and sine whistles were found to be the most distinctive whistles, whereas upsweep and downsweep whistles were the most similar. The identification of which parameters differ most markedly between whistle types and the relatively high explanatory power of this study's results provide a logical starting point for objective classification of spinner dolphin whistle types using machine learning techniques.

Enhancing Diagnostic Follow-up and Care Coordination for Children with Autism in a Busy Resident Continuity Clinic: Leveraging the Electronic Health Record.

PURPOSE: A high-quality primary care clinic should provide clear action points and important care coordination for a child receiving a new diagnosis of autism spectrum disorder (ASD). Unfortunately, a substantial proportion of caregivers report little-to-no post-diagnosis support from their home clinics and primary care providers often report lack of training and resources in providing these supports. METHODS: We implemented an intervention package to investigate the impact on the frequency and quality of follow-up care for children with ASD in a busy, high-volume resident continuity clinic. The package consisted of a care coordination scheduling pathway and a standardized clinical template-embedded in the electronic health record (EHR)-that guided providers through best-practice recommendations and patient resources. RESULTS: As a result of these interventions, 74% of patients had ASD-specific follow-up, a more than threefold increase from baseline with a majority of providers using the EHR-embedded template to guide their visit. Providers also indicated a high degree of usability for the system and that it aided them in following best-practice guidelines for ASD care. CONCLUSION: Through explicit scheduling pathways and a novel EHR template, we saw a significant increase in ASD-specific follow-up visits and implementation of best practices for ASD care, demonstrating a new process for training and engaging primary care providers in clear action steps for post-diagnostic care without having to rely on tertiary referrals.

Two audits of the diagnosis of oral cancer and the two-week rule following referrals from primary care practitioners in Newcastle.

AIM: The aim of the two audits was to evaluate the success of the two-week rule in the oral and maxillofacial surgery (OMFS) department at the Newcastle General Hospital (NGH) and then subsequently in the oral surgery and oral medicine departments at Newcastle Dental Hospital (NDH). METHODS: All two-week referrals seen at the NGH over a one-year period were examined retrospectively. An identical subsequent audit was carried out at the NDH over a second one-year period, also retrospectively. RESULTS: In the initial audit at the NGH, a total of 63 two-week referrals were received during the one-year period analysed. Of these, 57 (90%) were seen within the appropriate time period, and 60 (95%) conformed to the Department of Health guidelines. Seven (11%) of the 63 referred patients were diagnosed with head and neck cancer, indicating a positive oncology detection rate of 11%.In the later audit at the NDH, 49 urgent referrals were assessed. Forty-three of the 49 referrals (88%) were seen within the appropriate time period and thirty-nine (80%) were compliant with the referring guidelines. Forty-five patients attended for assessment and the resultant positive oncology detection rate for these patients was 7%. In both audits, the patients diagnosed as having positive oncology results all had referrals that were compliant with the Department of Health guidelines. CONCLUSIONS: Both of these audits indicated that the national guide- lines for two-week referrals were usually appropriately followed in the two departments that were audited. However, in the future, further education of referring practitioners should ensure that these guidelines are followed better, making the service provided more efficient for all concerned.

The Ketogenic Diet: Considerations for Cancer Survivorship.

PURPOSE OF REVIEW: This article aims to evaluate the current practice of the ketogenic diet (KD) in oncology by discussing feasibility, impact on quality of life, and implications for dietetic practice. Articles discussed were selected based on an adult oncology population with emphasis on publications from the last 5 years. RECENT FINDINGS: There is a paucity of randomized prospective trials and articles reviewed were heterogeneous in nature, limiting the ability to draw conclusions about the KDs role in cancer care and survivorship. Despite the lack of evidence, patients with cancer are interested in KD. The authors highlight barriers to supporting implementation of KD and recommend the inclusion of a registered dietitian with experience in KD to ensure safety and support the nutrition goals of patients with cancer. Thorough, well-designed randomized control trials are needed to elucidate the potential advantages of this diet therapy in cancer care and survivorship.

Cross-Sectional Analysis of Medical Conditions in the U.S. Deaf Transgender Community.

Purpose: This first U.S.-based, descriptive study of transgender Deaf adults looks to contribute to the gap in research regarding those who lie at the intersection of Deaf and transgender identities. The study objective is to identify characteristics that associate with medical conditions, including depression and anxiety disorders, among Deaf transgender adults. Methods: We gathered self-reported data from 74 Deaf transgender adults who used American Sign Language. Modified Poisson regression with robust standard errors was used to calculate relative risk estimates of having a medical condition among nonbinary individuals compared with gender binary individuals. Results: The sample lifetime prevalence for medical conditions in the Deaf transgender sample were as follows: 48.6% for depression/anxiety disorders, 28.8% for hypertension, 20.3% for lung conditions, 16.2% for arthritis/rheumatism, 12.3% for diabetes, 7.0% for cirrhosis/liver/kidney problems, 5.5% for heart conditions, and 2.7% for cancer. In cross-tabulation analysis across binary and nonbinary subsamples, the lifetime prevalence was significantly different only for depression and anxiety disorder with higher percentage in the nonbinary subsample. After adjusting for covariates in a regression model, identification as nonbinary increased a Deaf person's risk for being diagnosed with depression or anxiety disorder by 80% (95% confidence interval, 1.11-2.90) relative to Deaf people who self-identified as a binary gender. Conclusion: Study findings suggest that the Deaf transgender community is at risk for developing mental and physical health conditions.

Estimating the differences in critical thermal maximum and metabolic rate of Helicoverpa punctigera (Wallengren) (Lepidoptera: Noctuidae) across life stages.

Temperature is a crucial driver of insect activity and physiological processes throughout their life-history, and heat stress may impact life stages (larvae, pupae and adult) in different ways. Using thermolimit respirometry, we assessed the critical thermal maxima (CTmax-temperature at which an organism loses neuromuscular control), CO2 emission rate (V́CO2) and Q10 (a measure of V́CO2 temperature sensitivity) of three different life stages of Helicoverpa punctigera (Wallengren) by increasing their temperature exposure from 25 °C to 55 °C at a rate of 0.25 °C min-1 . We found that the CTmax of larvae (49.1 °C ± 0.3 °C) was higher than pupae (47.4 °C ± 0.2 °C) and adults (46.9 °C ± 0.2 °C). The mean mass-specific CO2 emission rate (ml V́CO2 h-1) of larvae (0.26 ± 0.03 ml V́CO2 h-1) was also higher than adults (0.24 ± 0.04 ml V́CO2 h-1) and pupae (0.06 ± 0.02 ml V́CO2 h-1). The Q10: 25-35 °C for adults (2.01 ± 0.22) was significantly higher compared to larvae (1.40 ± 0.06) and Q10: 35-45 °C for adults (3.42 ± 0.24) was significantly higher compared to larvae (1.95 ± 0.08) and pupae (1.42 ± 0.98) respectively. We have established the upper thermal tolerance of H. punctigera, which will lead to a better understanding of the thermal physiology of this species both in its native range, and as a pest species in agricultural systems.

Health Disparities Among Mid-to-Older Deaf LGBTQ Adults Compared with Mid-to-Older Deaf Non-LGBTQ Adults in the United States.

Purpose: To compare chronic health and mental health conditions between mid-to-older deaf lesbian, gay, bisexual, transgender, and queer (LGBTQ) and mid-to-older non-LGBTQ adults who are 45 years or older. Methods: Medical conditions and mental health disorders data were gathered from 981 mid-to-older deaf adults (178 LGBTQ and 803 non-LGBTQ) who took the Health Information National Trends Survey in American Sign Language between 2015 and 2019. Modified Poisson regression with robust standard errors was used to calculate relative risk estimates and 95% confidence intervals for all medical conditions and mental health disorders with self-reported LGBTQ status as the main predictor, adjusting for known health correlates. Results: Consistent with the LGBTQ health disparity in the general population, our study findings indicated health disparities for certain medical conditions (e.g., lung disease, arthritis, and comorbidity) and mental health disorders (e.g., depression and anxiety) among mid-to-older deaf LGBTQ compared with non-LGBTQ deaf adults. Conclusion: Like the LGBTQ counterparts in the general population, deaf LGBTQ adults may require more frequent and comprehensive health care services. Culturally and linguistically competent care by providers may be invaluable in reducing such health inequities, particularly when provider education and training is undertaken through an intersectional framework that considers the interaction and context of multiple patient and provider social identities.

Deaf LGBTQ Patients' Disclosure of Sexual Orientation and Gender Identity to Health Care Providers.

INTRODUCTION: Even with accessible communication, deaf patients who self-identify as LGBTQ might or might not feel comfortable disclosing their sexual orientation/gender identity to a health care provider based on social stigma concerns and previous negative experiences with healthcare providers. The current study examined whether deaf LGBTQ individuals' patient centered communication and level of comfort in sharing health information in the presence of an interpreter contributed to coming out to providers. METHODS: Using an online health survey in American Sign Language (ASL) and English, data was gathered from 313 (32% persons of color) self-identified LGBTQ deaf adults across diverse cities in the U.S.A. Binary logistic regression was used to examine the relationships between sexual orientation, gender identity, patient centered communication, and sharing health information with healthcare providers in front of an interpreter, and disclosing orientation/identity to healthcare providers. RESULTS: After controlling for sociodemographic and patient-related variables, cisgender women were significantly less likely to disclose their LGBTQ identities to healthcare providers compared with cisgender men. Being accepted as LGBTQ by loved ones and high perceived patient centered communication significantly increased the likelihood of coming out to providers. The presence of an ASL interpreter did not prevent or promote the deaf LGBTQ patients' decision to share health information with their healthcare provider. CONCLUSION: Implications for future research and recommendations for providers seeking to develop greater intersectional cultural competencies are discussed, with emphasis on the need for providers to be familiar with health access challenges and inequities facing deaf bisexual and queer women.

Aridity and land use negatively influence a dominant species' upper critical thermal limits.

Understanding the physiological tolerances of ectotherms, such as thermal limits, is important in predicting biotic responses to climate change. However, it is even more important to examine these impacts alongside those from other landscape changes: such as the reduction of native vegetation cover, landscape fragmentation and changes in land use intensity (LUI). Here, we integrate the observed thermal limits of the dominant and ubiquitous meat ant Iridomyrmex purpureus across climate (aridity), land cover and land use gradients spanning 270 km in length and 840 m in altitude across northern New South Wales, Australia. Meat ants were chosen for study as they are ecosystem engineers and changes in their populations may result in a cascade of changes in the populations of other species. When we assessed critical thermal maximum temperatures (CTmax) of meat ants in relation to the environmental gradients we found little influence of climate (aridity) but that CTmax decreased as LUI increased. We found no overall correlation between CTmax and CTmin. We did however find that tolerance to warming was lower for ants sampled from more arid locations. Our findings suggest that as LUI and aridification increase, the physiological resilience of I. purpureus will decline. A reduction in physiological resilience may lead to a reduction in the ecosystem service provision that these populations provide throughout their distribution.

Fisheries-independent surveys identify critical habitats for young scalloped hammerhead sharks (Sphyrna lewini) in the Rewa Delta, Fiji.

Sharp declines in numerous shark populations around the world have generated considerable interest in better understanding and characterising their biology, ecology and critical habitats. The scalloped hammerhead shark (SHS, Sphyrna lewini) is subject to a multitude of natural and anthropogenic threats that are often exacerbated within the coastal embayments and estuaries used during SHS early life stages. In this study, we describe the temporal and spatial distribution, age class composition, and reproductive biology of SHS in the Rewa Delta (RD), Fiji. A total of 1054 SHS (including 796 tagged individuals; 101 of which were recaptured) were captured from September 2014 to March 2016 in the RD. A majority of the captures in this area were neonates and young-of-the-year (YOY) (99.8%). Significant seasonality in patterns of occurrence of both neonates and YOY individuals suggests a defined parturition period during the austral summer. Between the seven sampling sites in the RD we also found significant differences in SHS neonate catch per unit of effort, and average total length of individuals. According to the data, the RD is likely to represent an important nursery area for SHS up to one year of age.

Quantitative Light-induced Fluorescence-Digital as an oral hygiene evaluation tool to assess plaque accumulation and enamel demineralization in orthodontics.

OBJECTIVE: To assess the use of Quantitative Light-induced Fluorescence-Digital as an oral hygiene evaluation tool during orthodontic treatment. MATERIALS AND METHODS: In this prospective, randomized clinical trial, 33 patients undergoing fixed orthodontic appliance treatment were randomly allocated to receive oral hygiene reinforcement at four consecutive appointments using either white light (WL) or Quantitative Light-induced Fluorescence-Digital (QLF) images, taken with a device, as visual aids. Oral hygiene was recorded assessing the QLF images for demineralization, by fluorescence loss (ΔF), and plaque coverage (ΔR30). A debriefing questionnaire ascertained patient perspectives. RESULTS: There were no significant differences in demineralization (P  =  .56) or plaque accumulation (P  =  .82) between the WL and QLF groups from T0 to T4. There was no significant reduction in demineralization, ΔF, in the WL, or the QLF group from T0-T4 (P > .05); however, there was a significant reduction in ΔR30 plaque scores (P < .05). All the participants found being shown the images helpful, with 100% of the QLF group reflecting that it would be useful to have oral hygiene reinforcement for the full duration of treatment compared with 81% of the WL group (OR 2.3; P < .05). CONCLUSIONS: Quantitative Light-induced Fluorescence-Digital can be used to detect and monitor demineralization and plaque during orthodontics. Oral hygiene reinforcement at consecutive appointments using WL or QLF images as visual aids is effective in reducing plaque coverage. In terms of clinical benefits, QLF and WL images are of similar effectiveness; however, patients preferred the QLF images.

The effects of low-dose, high-LET radiation exposure on three models of behavior in C57BL/6 mice.

To investigate the behavioral consequences of exposure to whole-body irradiation such as might occur for astronauts during space flight, female C57BL/6 mice were exposed to 0, 0.1, 0.5 or 2 Gy accelerated iron ions (56Fe, Z = 26, beta = 0.9, LET = 148.2 keV/microm) of 1 GeV per nucleon using the Alternating Gradient Synchrotron at the Brookhaven National Laboratory. Animal testing began 2 weeks after exposure and continued for 8 weeks. Under these conditions, there were few significant effects of radiation on open-field, rotorod or acoustic startle activities at any of the times examined. The lack of radiation effects in these behavioral models appears to offer reassurance to NASA mission designers. These results suggest that there may be negligible effects of HZE radiation on many behaviors during a 2-8-week period immediately after radiation.

Indo-Pacific bottlenose dolphin (Tursiops aduncus) habitat preference in a heterogeneous, urban, coastal environment.

BACKGROUND: Limited information is available regarding the habitat preference of the Indo-Pacific bottlenose dolphin (Tursiops aduncus) in South Australian estuarine environments. The need to overcome this paucity of information is crucial for management and conservation initiatives. This preliminary study investigates the space-time patterns of habitat preference by the Indo-Pacific bottlenose dolphin in the Port Adelaide River-Barker Inlet estuary, a South Australian, urbanised, coastal environment. More specifically, the study aim was to identify a potential preference between bare sand substrate and seagrass beds, the two habitat types present in this environment, through the resighting frequency of recognisable individual dolphins. RESULTS: Photo-identification surveys covering the 118 km2 sanctuary area were conducted over 2 survey periods May to August 2006 and from March 2009 to February 2010. Sighting frequency of recognisable individual Indo-Pacific bottlenose dolphins established a significant preference for the bare sand habitat. More specifically, 72 and 18% of the individuals sighted at least on two occasions were observed in the bare sand and seagrass habitats respectively. This trend was consistently observed at both seasonal and annual scales, suggesting a consistency in the distinct use of these two habitats. CONCLUSIONS: It is anticipated that these results will benefit the further development of management and conservation strategies.

Identification by mass spectrometry of CD8(+)-T-cell Mycobacterium tuberculosis epitopes within the Rv0341 gene product.

Identification of Mycobacterium tuberculosis proteins that can provide immunological protection against tuberculosis is essential for the development of a more effective vaccine. To identify new vaccine targets, we have used immunoaffinity chromatography to isolate class I HLA-A*0201-peptide complexes from M. tuberculosis-infected cells and sequenced the isolated peptides by mass spectrometry. From this material, we have identified three peptides derived from a single M. tuberculosis protein that is encoded by the M. tuberculosis Rv0341 gene. Although no known protein encoded by the Rv0341 gene has been described, it is predicted to give rise to a 479-amino-acid protein with a molecular mass of 43.9 kDa. The three peptides identified are all nested and were found to be antigenic, in that they were capable of inducing peptide-specific, CD8(+) T cells from healthy blood donors in vitro and capable of recognizing and lysing M. tuberculosis-infected dendritic cells. This methodology provides a powerful tool for the identification of M. tuberculosis proteins that can be evaluated as potential vaccine candidates.

Naturally occurring peptides associated with HLA-A2 in ovarian cancer cell lines identified by mass spectrometry are targets of HLA-A2-restricted cytotoxic T cells.

Identifying naturally occurring peptides bound to HLA class I molecules recognized by HLA-restricted cytotoxic T lymphocytes (CTL) is both relevant and central to the development of effective immunotherapeutic strategies against cancer. Several cancer-related genes have been reported for ovarian cancer, but very few are known to be naturally processed T cell epitopes. In the present study we used mass spectrometry to identify 16 novel HLA-A2-bound peptides from HLA-A2(+) ovarian cancer cell lines. All 16 peptides are derived from source proteins with diverse functions and marked homology to known proteins found in public databases. Synthetic peptide analogues of identified sequences were found to stabilize HLA-A2.1, albeit with varying affinities. The peptides were found to be antigenic in that a primary CD8(+) CTL response could be elicited from normal donor blood. The CTL generated were not only peptide specific, but failed to recognize targets pulsed with control peptides. In addition, recognition of shared HLA-A2-restricted epitopes by these CTL is suggested by their reactivity with a subset of HLA-A2(+) tumor lines and freshly isolated cancer cells or cell lines established from peritoneal ascites. These results were further corroborated by competitive inhibition of lysis of an otherwise susceptible cell line in the presence of cold peptide-pulsed targets. Furthermore, lack of recognition of several HLA-A2(+) control cell lines or cells isolated from normal ovaries suggests that these peptides are cancer related. These findings broaden the list of CTL-defined antigens that could lead to the development of multi-epitope vaccines for the treatment of ovarian cancer.