Barriers to integrating portable Magnetic Resonance Imaging systems in emergency medical service ambulances for stroke care.

This study examines the barriers to integrating portable Magnetic Resonance Imaging (MRI) systems into ambulance services to enable effective triaging of patients to the appropriate hospitals for timely stroke care and potentially reduce door-to-needle time for thrombolytic administration. The study employs a qualitative methodology using a digital twin of the patient handling process developed and demonstrated through semi-structured interviews with 18 participants, including 11 paramedics from an Emergency Medical Services system and seven neurologists from a tertiary stroke care centre. The interview transcripts were thematically analysed to determine the barriers based on the Systems Engineering Initiative for Patient Safety framework. Key barriers include the need for MRI operation skills, procedural complexities in patient handling, space constraints, and the need for training and policy development. Potential solutions are suggested to mitigate these barriers. The findings can facilitate implementing MRI systems in ambulances to expedite stroke treatment.

This study investigates the challenges of integrating portable MRI systems into ambulances for faster stroke care. It identifies key barriers such as operational skills, procedural complexities, space constraints, and policy development needs, and offers a few solutions to improve emergency stroke treatment.

Investigating the Relationship between Sociodemographic Factors and Bird Identification by Landowners Across a Rural-to-Urban Gradient.

Social, cultural, and economic differences have been shown to influence ecological knowledge. Given the importance of ecological knowledge for appreciation and protection of nature, we sought to investigate the relationship between landowners' sociodemographic attributes and the number of birds listed by landowners on their property across a rural-to-urban gradient. We hypothesized that: (1) age and education would be positively related to the number of birds an individual listed, while gender would be unrelated to the number of birds an individual listed; (2) rural landowners would list a larger number of bird species due to their increased level of exposure to nature and place-based knowledge; and (3) the number of years spent living on a property would positively impact the number of birds an individual listed by increasing the amount of time possible to interact with nature. To test these hypotheses, we conducted a survey of ~1700 landowners (with 59% responding) across a rural-to-urban gradient in southeastern Michigan that asked questions pertaining to age, gender, education, property size, years lived on property, and bird identification. Age, education, and years on property were positively associated with the number of birds listed by landowner. However, sociodemographic factors interacted with the rural-to-urban gradient to determine how such factors influenced landowner listing ability. For example, females listed more birds than males on suburban routes, but not on urban or rural routes. Ultimately, sociodemographic factors were indicators of a person's ability to list bird species on their property.

Applying Ecological Positive Youth Development Theory to Address Co-Occurring Health Disparities Among Immigrant Latino Youth.

This article outlines the theory and resulting approach employed in a multilevel, integrated, collaborative community intervention called Adelante, implemented by a university-community partnership in a Latino immigrant community to address co-occurring health disparities of substance abuse, sex risk, and interpersonal violence among youth. The basis for the intervention is a social-ecological interpretation of positive youth development theory, which focuses on changes in the person environment context and community assets as a preventive mechanism. This approach is viewed as appropriate for a community facing multiple barriers to health equity. The article describes the translation of this positive youth development model to practice, including the design of the intervention, intervention components, and the protocol for evaluation. The Adelante intervention is intended to reduce health disparities and, in addition, to add a broader community model to the evidence base.

Regulation of inflammatory responses by neuregulin-1 in brain ischemia and microglial cells in vitro involves the NF-kappa B pathway.

BACKGROUND: We previously demonstrated that neuregulin-1 (NRG-1) was neuroprotective in rats following ischemic stroke. Neuroprotection by NRG-1 was associated with the suppression of pro-inflammatory gene expression in brain tissues. Over-activation of brain microglia can induce pro-inflammatory gene expression by activation of transcriptional regulators following stroke. Here, we examined how NRG-1 transcriptionally regulates inflammatory gene expression by computational bioinformatics and in vitro using microglial cells. METHODS: To identify transcriptional regulators involved in ischemia-induced inflammatory gene expression, rats were sacrificed 24 h after middle cerebral artery occlusion (MCAO) and NRG-1 treatment. Gene expression profiles of brain tissues following ischemia and NRG-1 treatment were examined by microarray technology. The Conserved Transcription Factor-Binding Site Finder (CONFAC) bioinformatics software package was used to predict transcription factors associated with inflammatory genes induced following stroke and suppressed by NRG-1 treatment. NF-kappa B (NF-kB) was identified as a potential transcriptional regulator of NRG-1-suppressed genes following ischemia. The involvement of specific NF-kB subunits in NRG-1-mediated inflammatory responses was examined using N9 microglial cells pre-treated with NRG-1 (100 ng/ml) followed by lipopolysaccharide (LPS; 10 µg/ml) stimulation. The effects of NRG-1 on cytokine production were investigated using Luminex technology. The levels of the p65, p52, and RelB subunits of NF-kB and IkB-α were determined by western blot analysis and ELISA. Phosphorylation of IkB-α was investigated by ELISA. RESULTS: CONFAC identified 12 statistically over-represented transcription factor-binding sites (TFBS) in our dataset, including NF-kBP65. Using N9 microglial cells, we observed that NRG-1 significantly inhibited LPS-induced TNFα and IL-6 release. LPS increased the phosphorylation and degradation of IkB-α which was blocked by NRG-1. NRG-1 also prevented the nuclear translocation of the NF-kB p65 subunit following LPS administration. However, NRG-1 increased production of the neuroprotective cytokine granulocyte colony-stimulating factor (G-CSF) and the nuclear translocation of the NF-kB p52 subunit, which is associated with the induction of anti-apoptotic and suppression of pro-inflammatory gene expression. CONCLUSIONS: Neuroprotective and anti-inflammatory effects of NRG-1 are associated with the differential regulation of NF-kB signaling pathways in microglia. Taken together, these findings suggest that NRG-1 may be a potential therapeutic treatment for treating stroke and other neuroinflammatory disorders.

DEFINING THE "COMMUNITY" FOR A COMMUNITY-BASED PUBLIC HEALTH INTERVENTION ADDRESSING LATINO IMMIGRANT HEALTH DISPARITIES: AN APPLICATION OF ETHNOGRAPHIC METHODS.

Although Latino and other immigrant populations are the driving force behind population increases in the U.S., there are significant gaps in knowledge and practice on addressing health disparities in these populations. The Avance Center for the Advancement of Immigrant/Refugee Health, a health disparities research center in the Washington, DC area, includes as part of its mission a multi-level, participatory community intervention (called Adelante) to address the co-occurrence of substance abuse, violence and sex risk among Latino immigrant youth and young adults. Research staff and community partners knew that the intervention community had grown beyond its Census-designated place (CDP) boundaries, and that connection and attachment to community were relevant to an intervention. Thus, in order to understand current geographic and social boundaries of the community for sampling, data collection, intervention design and implementation, the research team conducted an ethnographic study to identify self-defined community boundaries, both geographic and social. Beginning with preliminary data from a pilot intervention and the original CDP map, the research included: geo-mapping de-identified addresses of service clients from a major community organization; key informant interviews; and observation and intercept interviews in the community. The results provided an expanded community boundary profile and important information about community identity.

Sensory Neuron-TRPV4 Modulates Temporomandibular Disorder Pain Via CGRP in Mice.

Temporomandibular disorder (TMD) pain that involves inflammation and injury in the temporomandibular joint (TMJ) and/or masticatory muscle is the most common form of orofacial pain. We recently found that transient receptor potential vanilloid-4 (TRPV4) in trigeminal ganglion (TG) neurons is upregulated after TMJ inflammation, and TRPV4 coexpresses with calcitonin gene-related peptide (CGRP) in TMJ-innervating TG neurons. Here, we extended these findings to determine the specific contribution of TRPV4 in TG neurons to TMD pain, and examine whether sensory neuron-TRPV4 modulates TMD pain via CGRP. In mouse models of TMJ inflammation or masseter muscle injury, sensory neuron-Trpv4 conditional knockout (cKO) mice displayed reduced pain. Coexpression of TRPV4 and CGRP in TMJ- or masseter muscle-innervating TG neurons was increased after TMJ inflammation and masseter muscle injury, respectively. Activation of TRPV4-expressing TG neurons triggered secretion of CGRP, which was associated with increased levels of CGRP in peri-TMJ tissues, masseter muscle, spinal trigeminal nucleus, and plasma in both models. Local injection of CGRP into the TMJ or masseter muscle evoked acute pain in naïve mice, while blockade of CGRP receptor attenuated pain in mouse models of TMD. These results suggest that TRPV4 in TG neurons contributes to TMD pain by potentiating CGRP secretion. PERSPECTIVE: This study demonstrates that activation of TRPV4 in TG sensory neurons drives pain by potentiating the release of pain mediator CGRP in mouse models of TMJ inflammation and masseter muscle injury. Targeting TRPV4 and CGRP may be of clinical potential in alleviating TMD pain.

Caretaking behaviors by adolescent children of mothers with and without a history of depression.

In a sample of 72 mothers with and without a history of depression and their adolescent children, maternal depression history, current maternal depressive symptoms, intrusive and withdrawn parental behavior, and adolescent caretaking behaviors were examined as predictors of adjustment in these youth. Two types of caretaking behaviors were examined: emotional (e.g., caring for a parent's emotional distress) and instrumental (e.g., looking after younger siblings). Although adolescents of mothers with and without a history of depression were comparable on levels of both types of caretaking, caretaking was associated with adolescents' reports of anxiety-depression and mothers' reports of social competence only for adolescents of mothers with a history of depression. Moreover, regression models showed that among children of mothers with a history of depression, emotional, but not instrumental, caretaking was related to adolescents' anxiety-depression symptoms and social competence after controlling for current parental depressive symptoms and stressful parenting behaviors. Theoretical and clinical implications are discussed.

Prognostic utility of plasma lactate measured between 24 and 48 h after initiation of early goal-directed therapy in the management of sepsis, severe sepsis, and septic shock.

BACKGROUND: Based on the proven efficacy of lactate in predicting mortality and morbidity in sepsis when measured early in the resuscitative protocol, our group hypothesized that this utility extends later in the course of care. This study sought to investigate the prognostic potential of plasma lactate clearance measured 24-48 h after the initiation of treatment for nonsurgical patients with sepsis, severe sepsis, and septic shock. METHODS: Plasma lactate values, measured 24-48 h after the initiation of treatment, were collected in nonsurgical septic, severe septic, and septic shock patients. The primary outcome was 30-day mortality, while secondary outcomes included requirements for vasopressors and boluses of intravenous fluids. Analysis of these three outcomes was performed while controlling for clinical severity as measured by Sequential Organ Failure Assessment (SOFA), renal dysfunction, and hepatic dysfunction. Lactate clearance was defined as the percent change in plasma lactate levels measured after 24-48 h of treatment from the plasma lactate level at initial presentation. RESULTS: Two hundred twenty-nine nonsurgical patients were divided into two groups, clearers (above median lactate clearance [31.6 %]) and nonclearers (below median lactate clearance [31.6 %]). The adjusted odds ratio of mortality in clearers compared to nonclearers was 0.39 (CI 0.20-0.76) (p = 0.006). For vasopressor requirement, the adjusted odds ratio was 0.41 (CI 0.21-0.79) in clearers compared to nonclearers (p = 0.008). For intravenous fluid bolus requirement, the adjusted odds ratio was 0.81 (CI 0.48-1.39) in clearers compared to nonclearers (p = 0.45). CONCLUSIONS: Lower plasma lactate clearance 24-48 h after the initiation of treatment is associated with higher 30-day mortality and requirements for vasopressors in nonsurgical septic patients and may be a useful noninvasive measurement for guiding late-sepsis treatment. Further investigation looking at mechanisms and therapeutic targets to improve lactate clearance in late sepsis may improve patient mortality and outcomes.