Utilization of Cystatin C in the Outpatient Setting.

INTRODUCTION: Serum creatinine is the traditional biomarker for estimating glomerular filtration rate (eGFR). Cystatin C is an alternative biomarker for which estimating equations exist. The use of cystatin C testing, and the interrelationships among the recently revised Chronic Kidney Disease Epidemiology (CKD-EPI) 2021 estimating equations, was evaluated in a national outpatient laboratory dataset. METHODS: Cystatin C results reported on adults between November 2011 and June 2018 by Laboratory Corporation of America Holdings were examined, with classification of ordering providers and diagnostic codes. Updated eGFR results were calculated using the CKD-EPI 2021 equations for each sample with both cystatin C and creatinine values available. The Spearman correlation coefficients were calculated. Reclassification at clinically relevant cut-off values was examined. RESULTS: There were 87,803 serum cystatin C levels among 55,360 patients; mean age 58 ± 17 years; 50% women. Cystatin C usage increased over time and was ordered for many indications. Among 73,367 samples with simultaneous creatinine and cystatin C, r = 0.84 between eGFR-creatinine and eGFR-cystatin. Correlations of eGFR-creatinine, eGFR-cystatin, and the averaged result of the two equations to the new combined equation were r = 0.94, r = 0.97, and r = 0.998, respectively (p < 0.001 for all). Use of combined/averaged equations tended to result in a higher eGFR and upclassification, compared to eGFR-creatinine. CONCLUSION/DISCUSSION: Use of Cystatin C is increasing and has moved beyond the nephrology community and the original indications from the 2012 KDIGO guidelines. Community utilization of cystatin C measurement is likely to expand, and understanding of the relationships between estimating equations will help clinicians optimize their use in the outpatient setting.

Lessons Learned on Recruiting and Retaining Young Fathers in a Parenting and Repeat Pregnancy Prevention Program.

INTRODUCTION: Research shows that mainstream parenting and repeat pregnancy prevention programs generally do not effectively engage with fathers and that young men's levels of participation in such services are low. To support practitioners in overcoming the barriers to recruiting and retaining young fathers, the current study aimed to gather lessons learned from one program's state administrators, case managers, and young fathers about the most effective strategies for engaging this population in intensive case management. METHODS: Three focus groups were conducted. One focus group was held with the creators and managers of the Michigan Adolescent Pregnancy and Parenting Program MI-APPP at the state Department of Health and Human Services (n = 3). The other two groups were designed to jointly engage young fathers currently involved in intensive case management (n = 11) and their case managers (n = 5). A qualitative analysis of the focus group transcripts was conducted using a coding scheme developed from emerging themes in the transcripts and related literature. RESULTS: The findings highlight a selection of those strategies that focus group participants perceived to be most successful in improving male recruitment and retention in intensive ongoing case management. Among these strategies were centralizing feedback from young fathers in program decision making, offering opportunities for young fathers to connect, and challenging staff's negative stereotypes about young fathers. DISCUSSION: Despite the small sample size, the results of this study nevertheless contribute to debates in the field regarding appropriate strategies for engaging young fathers by informing professional practice.

Correction to: Monitoring Quality Across Home Visiting Models: A Field Test of Michigan's Home Visiting Quality Assurance System.

The article "Monitoring Quality Across Home Visiting Models: A Field Test of Michigan's Home Visiting Quality Assurance System", written by Julia Heany, Jennifer Torres, Cynthia Zagar and Tiffany Kostelec, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 05 June 2018 without open access.

Monitoring Quality Across Home Visiting Models: A Field Test of Michigan's Home Visiting Quality Assurance System.

Introduction In order to achieve the positive outcomes with parents and children demonstrated by many home visiting models, home visiting services must be well implemented. The Michigan Home Visiting Initiative developed a tool and procedure for monitoring implementation quality across models referred to as Michigan's Home Visiting Quality Assurance System (MHVQAS). This study field tested the MHVQAS. This article focuses on one of the study's evaluation questions: Can the MHVQAS be applied across models? Methods Eight local implementing agencies (LIAs) from four home visiting models (Healthy Families America, Early Head Start-Home Based, Parents as Teachers, Maternal Infant Health Program) and five reviewers participated in the study by completing site visits, tracking their time and costs, and completing surveys about the process. LIAs also submitted their most recent review by their model developer. The researchers conducted participant observation of the review process. Results Ratings on the MHVQAS were not significantly different between models. There were some differences in interrater reliability and perceived reliability between models. There were no significant differences between models in perceived validity, satisfaction with the review process, or cost to participate. Observational data suggested that cross-model applicability could be improved by assisting sites in relating the requirements of the tool to the specifics of their model. Discussion The MHVQAS shows promise as a tool and process to monitor implementation quality of home visiting services across models. The results of the study will be used to make improvements before the MHVQAS is used in practice.

Endocytic proteins drive vesicle growth via instability in high membrane tension environment.

Clathrin-mediated endocytosis (CME) is a key pathway for transporting cargo into cells via membrane vesicles; it plays an integral role in nutrient import, signal transduction, neurotransmission, and cellular entry of pathogens and drug-carrying nanoparticles. Because CME entails substantial local remodeling of the plasma membrane, the presence of membrane tension offers resistance to bending and hence, vesicle formation. Experiments show that in such high-tension conditions, actin dynamics is required to carry out CME successfully. In this study, we build on these pioneering experimental studies to provide fundamental mechanistic insights into the roles of two key endocytic proteins-namely, actin and BAR proteins-in driving vesicle formation in high membrane tension environment. Our study reveals an actin force-induced "snap-through instability" that triggers a rapid shape transition from a shallow invagination to a highly invaginated tubular structure. We show that the association of BAR proteins stabilizes vesicles and induces a milder instability. In addition, we present a rather counterintuitive role of BAR depolymerization in regulating the shape evolution of vesicles. We show that the dissociation of BAR proteins, supported by actin-BAR synergy, leads to considerable elongation and squeezing of vesicles. Going beyond the membrane geometry, we put forth a stress-based perspective for the onset of vesicle scission and predict the shapes and composition of detached vesicles. We present the snap-through transition and the high in-plane stress as possible explanations for the intriguing direct transformation of broad and shallow invaginations into detached vesicles in BAR mutant yeast cells.

Pharmacist-Driven Strategies for Hypertension Management in Los Angeles: A Community and Stakeholder Needs Assessment, 2014-2015.

In 2014, the Los Angeles County Department of Public Health received federal funding to improve the prevention and control of hypertension in the population through team-based health care delivery models, such as pharmacist-led medication therapy management. To inform this work, the department conducted a 3-part needs assessment consisting of 1) a targeted context scan of regional policies and efforts, 2) a key stakeholder survey, and 3) a public opinion internet-panel survey of Los Angeles residents. Results suggest that political will and professional readiness exists for expansion of pharmacist-led medication management strategies in Los Angeles. However, several infrastructure and economic barriers, such as a lack of sufficient payment or reimbursement mechanisms for these services, impede progress. The department is using assessment results to address barriers and shape efforts in scaling up pharmacist-led programming in Los Angeles.

NATIVE-It's Your Game: Adapting a Technology-Based Sexual Health Curriculum for American Indian and Alaska Native youth.

Sexually transmitted infection (STI) and birth rates among American Indian/Alaska Native (AI/AN) youth indicate a need for effective middle school HIV/STI and pregnancy prevention curricula to delay, or mitigate, the consequences of early sexual activity. While effective curricula exist, there is a dearth of curricula with content salient to AI/AN youth. Further, there is a lack of sexual health curricula that take advantage of the motivational appeal, reach, and fidelity of communication technology for this population, who are sophisticated technology users. We describe the adaptation process used to develop Native It's Your Game, a stand-alone 13-lesson Internet-based sexual health life-skills curriculum adapted from an existing promising sexual health curriculum, It's Your Game-Tech (IYG-Tech). The adaptation included three phases: (1) pre-adaptation needs assessment and IYG-Tech usability testing; (2) adaptation, including design document development, prototype programming, and alpha testing; and (3) post-adaption usability testing. Laboratory- and school-based tests with AI/AN middle school youth demonstrated high ratings on usability parameters. Youth rated the Native IYG lessons favorably in meeting the needs of AI/AN youth (54-86 % agreement across lessons) and in comparison to other learning channels (57-100 %) and rated the lessons as helpful in making better health choices (73-100 %). Tribal stakeholders rated Native IYG favorably, and suggested it was culturally appropriate for AI/AN youth and suitable for implementation in tribal settings. Further efficacy testing is indicated for Native IYG, as a potential strategy to deliver HIV/STI and pregnancy prevention to traditionally underserved AI/AN middle school youth.

Families, markets, and medicalization: the role of paid support for childbirth and breastfeeding.

Much attention has been given to the commercialization of care and its relationship to the outsourcing of family life, as well as larger social and cultural processes that can change the nature of caring. I engage with this question of why certain aspects of care are provided by the market, using 72 interviews with lactation consultants, doulas, clients, and clinicians, as well as 150 hours of ethnographic observation in the USA. Examining how participants understood the role of these services in the maternity care system and the reasons why clients turned to these services, I found that, in several ways, these forms of care work reflected outsourcing trends. However, lactation consultants and doulas were also acting as advocates and guides, helping their clients navigate the complex medical maternity system. This reflects a fundamental transformation in the nature of maternity support, attributed to the impact of medicalization, both historically and currently.

Consumer information on fetal heart rate monitoring during labor: a content analysis: a content analysis.

Electronic fetal monitoring (EFM) is used for the majority of births that occur in the United States. While there are indications for use of EFM for women with high-risk pregnancies, its use in low-risk pregnancies is less evidence-based. In low-risk women, the use of EFM is associated with an increased risk for cesarean birth compared with the use of intermittent auscultation of the fetal heart rate. The purpose of this investigation was to evaluate the existence of evidence-based information on fetal heart rate monitoring in popular consumer-focused maternity books and Web sites. Content analysis of information in consumer-oriented Web sites and books was completed using the NVivo software (QRSinternational, Melbourne, Australia). Themes identified included lack of clear terminology when discussing fetal monitoring, use of broad categories such as low risk and high risk, limited presentation of information about intermittent auscultation, and presentation of EFM as the standard of care, particularly upon admission into the labor unit. More than one-third of the sources did not mention auscultation, and conflicting information about monitoring methods was presented. The availability of accurate, publically accessible information offers consumers the opportunity to translate knowledge into the power to seek evidence-based care practices during their maternity care experience.

Breast milk and labour support: lactation consultants' and doulas' strategies for navigating the medical context of maternity care.

This article provides a comparison of two occupational groups working in maternity care: International Board Certified Lactation Consultants, who assist women with breastfeeding, and DONA International certified birth doulas, who provide physical, emotional and informational support to birthing women. Using interviews with 18 lactation consultants and 16 doulas working in the USA, I compare these two groups' strategies for gaining entrance to the maternity care team and their abilities to create change in maternity care practices. Due to the organisation of occupational boundaries in maternity care and differences between the influence of the medicalisation of breastfeeding versus that of childbirth on those boundaries, lactation consultants are able to utilise a front-door entrance to the medical maternity system, entering as lactation specialists and advocates, while doulas use a back-door entrance, emphasising their care work and downplaying their advocacy. These different strategies result in different methods being available to each for effecting change. Lactation consultants create formal change, such as changing hospital policies and practices to be more pro-breastfeeding. Doulas create change informally, 'one birth at a time', by creating space for natural birth to occur in the hospital, as well as exposing medical providers to non-medical ways of giving birth.

Differential responses toward conditioned and unconditioned stimuli, but decreased hypothalamic-pituitary-adrenal axis responsiveness in neonatal hippocampal lesioned monkeys.

The hippocampus is important for long-term memory storage, but also plays a role in regulating the hypothalamic-pituitary-adrenal (HPA) axis and emotional behaviors. We previously reported that early hippocampal damage in monkeys result in increased anxious expression and blunted HPA responses to an acute stressor. Here, we further probe their responses toward aversive stimuli (conditioned and unconditioned) and evaluate HPA axis dysfunction. Responses toward social, innate, and learned aversive stimuli, fear potentiated acoustic startle, and pituitary-adrenal function were investigated in 13 adult rhesus monkeys with neonatal hippocampal lesions (Neo-Hibo=6) and controls (Neo-C=7). Neo-Hibo monkeys' responses depend on the type of unconditioned stimulus, with increased anxiety behaviors toward social and learned, but decreased reactivity toward innate stimuli. Neo-C and Neo-Hibo monkeys exhibited similar performance learning conditioned cues and safety signals. Neo-Hibo monkeys were less sensitive to HPA axis stimulation, potentially suggesting adrenal fatigue. Current findings suggest that the hippocampus plays a large role in regulating not only anxiety behaviors, but also the HPA-axis, a neural system crucial to regulate how we respond to the world around us. These data have important clinical significance considering that many developmental neuropsychiatric disorders exhibit altered hippocampal structure and function, emotional and HPA axis dysregulation.

A Road Map for Academic Developmental-Behavioral Pediatric Practices to Increase Access.

ABSTRACT: There are currently at least 19 million children and adolescents in the United States with disorders of development (learning disorders, attention-deficit/hyperactivity disorder, intellectual disabilities, autism, motor incoordination/cerebral palsy, etc.) and only approximately 800 board-certified developmental-behavioral pediatricians (DBPs) practicing nationally. Given the astronomical mismatch between the number of children and adolescents with developmental disorders and the number of board-certified DBPs, developmental-behavioral pediatric consultations are likely the most inaccessible in all of medicine. With the goal of increasing access to these consultations, an academic developmental-behavioral practice in a large urban hospital system developed a longitudinal "Road Map," led by our team of social workers, which is designed to provide such services while continuing to focus DBP efforts on initial consultative evaluation and diagnosis of as many children as possible. The programs that this new Road Map has provided have allowed the DBP practice not only to increase access to developmental evaluations but also to provide more holistic and targeted care from the point of being added to the waiting list and then throughout the life span at vital transition periods. Especially given the extreme mismatch between the scarce number of practicing DBPs and the prodigious number of pediatric patients with disorders of development, our hope is that other centers will consider replicating this innovative care model to address the ever-growing need for specialized DBP consultation and longitudinal wraparound care for our patients and families.

Emotional responses in monkeys differ depending on the stimulus type, sex, and neonatal amygdala lesion status.

The amygdala plays an essential role in evaluating social information, threat detection, and learning fear associations. Yet, most of that knowledge comes from studies in adult humans and animals with a fully developed amygdala. Given the considerable protracted postnatal development of the amygdala, it is important to understand how early damage to this structure may impact the long-term development of behavior. The current study examined behavioral responses toward social, innate, or learned aversive stimuli among neonatal amygdala lesion (Neo-Aibo; males = 3, females = 3) or sham-operated control (Neo-C; males = 3, females = 4) rhesus macaques. Compared with controls, Neo-Aibo animals exhibited less emotional reactivity toward aversive objects, including faster retrieval of food reward, fewer fearful responses, and more manipulation of objects. This lower reactivity was only seen in response to social and innate aversive stimuli, whereas Neo-Aibo animals had similar responses to controls for learned aversive stimuli. The current study also detected sex differences in behavioral response to aversive stimuli, such that, as compared with males, females took longer to retrieve the food reward across all aversive stimuli types, but only expressed more hostility and more coo vocalizations during learned aversive trials. Early amygdala damage impacted the expression of some, but not all, sex differences. For example, neonatal amygdala damage eliminated the sex difference in object manipulation. These findings add important information that broaden our understanding of the role of the amygdala in the expression of sexually dimorphic behaviors, as well as its role in learning fear associations and threat detection. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Interneuron Functional Diversity in the Mouse Accessory Olfactory Bulb.

In the mouse accessory olfactory bulb (AOB), inhibitory interneurons play an essential role in gating behaviors elicited by sensory exposure to social odors. Several morphological classes have been described, but the full complement of interneurons remains incomplete. In order to develop a more comprehensive view of interneuron function in the AOB, we performed targeted patch clamp recordings from partially overlapping subsets of genetically labeled and morphologically defined interneuron types. Gad2 (GAD65), Calb2 (calretinin), and Cort (cortistatin)-cre mouse lines were used to drive selective expression of tdTomato in AOB interneurons. Gad2 and Calb2-labeled interneurons were found in the internal, external, and glomerular (GL) layers, whereas Cort-labeled interneurons were enriched within the lateral olfactory tract (LOT) and external cellular layer (ECL). We found that external granule cells (EGCs) from all genetically labeled subpopulations possessed intrinsic functional differences that allowed them to be readily distinguished from internal granule cells (IGCs). EGCs showed stronger voltage-gated Na+ and non-inactivating voltage-gated K+ currents, decreased IH currents, and robust excitatory synaptic input. These specific intrinsic properties did not correspond to any genetically labeled type, suggesting that transcriptional heterogeneity among EGCs and IGCs is not correlated with expression of these particular marker genes. Intrinsic heterogeneity was also seen among AOB juxtaglomerular cells (JGCs), with a major subset of Calb2-labeled JGCs exhibiting spontaneous and depolarization-evoked plateau potentials. These data identify specific physiological features of AOB interneurons types that will assist in future studies of AOB function.

Cochlear implantation for single-sided deafness in children and adolescents.

OBJECTIVE: To evaluate outcomes in pediatric and adolescent patients with single-sided deafness (SSD) undergoing cochlear implantation. METHODS: A retrospective cohort design at two tertiary level academic cochlear implant centers. The subjects included nine children ages 1.5 to 15 years-old with single-sided deafness (SSD) who had undergone cochlear implantation in the affected ear. Objective outcome measures included were speech reception testing in quiet and noise, bimodal speech reception threshold testing in noise, tinnitus suppression, and device usage. RESULTS: Nine pediatric and adolescent patients with SSD were implanted between 2011 and 2017. The median age at implantation was 8.9 years (range, 1.5-15.1) and the children had a median duration of deafness 2.9 years (range, 0.8-9.5). There was variability in testing measures due to patient age. Median pre-operative aided word recognition scores on the affected side were <30% regardless of the testing paradigm used. Six patients had pre-operative word testing (4 CNC, median score 25%; 2 MLNT, 8% and 17%). Four patients had pre-operative sentence testing (3 AzBio, median score 44%; 1 HINT-C, 57%). Median post-implantation follow-up interval was 12.3 months (range, 3-27.6 months). Six subjects had post-operative word recognition testing (CNC median, 70%; MLNT 50%, 92%) with a median improvement of 45.5% points. Five subjects had post-operative sentence testing (AzBio, median 82%; HINT, median 76%), with a median improvement of 40.5% points. Eight patients are full time users of their device. Tinnitus and bimodal speech reception thresholds in noise were improved. CONCLUSION: Pediatric subjects with SSD benefit substantially from cochlear implantation. Objective speech outcome measures are improved in both quiet and noise, and bimodal speech reception thresholds in noise are greatly improved. There is a low rate of device non-use.

Healthy Native Youth: Improving Access to Effective, Culturally-Relevant Sexual Health Curricula.

Tribal health educators across the United States have found it challenging to locate engaging, culturally-relevant sexual health curricula for American Indian and Alaska Native (AI/AN) youth. Healthy Native Youth is a new online resource that provides a "one-stop-shop" for tribal health advocates to access age-appropriate curricula. The site was designed by a team of advisers representing a diverse group of tribal communities, using a collaborative planning process. The website content and navigation was then refined through usability testing with the target audience. The portal allows users to filter and compare curricula on multiple dimensions, including: age, delivery setting, duration, cost, and evidence of effectiveness, to determine best-fit. It includes all materials needed for implementation free-of-charge, including: facilitator training tools, lesson plans, materials to support participant marketing and recruitment, information about each program's cultural relevance, evaluation methods and findings, and references to publications and reports. The website currently includes mCircle of Life, Native It's Your Game, Native STAND, Native VOICES, and Safe in the Village, among others. Since its launch in August 2016, the site has had over 31,000 page views in all 50 States. The Healthy Native Youth portal provides educators in rural communities a promising new tool to support the dissemination and implementation of evidence-based health curricula in geographically-disbursed AI/AN communities. Lessons learned during the design and dissemination of the Healthy Native Youth website may be of value to other Indigenous populations interested in our approach and our findings.

Cochlear implantation for single-sided deafness: A multicenter study.

OBJECTIVES/HYPOTHESIS: To report the preliminary outcomes of patients with single-sided deafness and asymmetric hearing loss undergoing cochlear implantation at two centers. STUDY DESIGN: Retrospective review and prospective data collection. METHODS: Patients with single-sided deafness who underwent cochlear implantation at two centers were included. Pre- and postoperative measures included monosyllabic word and sentence recognition in quiet for the ear implanted, and sentence recognition in noise in the best-aided bilateral condition. RESULTS: Average monosyllabic word recognition scores in quiet improved significantly from 11.3% (standard deviation [SD] 15.6%) preoperatively to 48.7% (SD 24.2%) at the 3-month postactivation interval, although they did not increase significantly between the 3-month and 6-month intervals. Sentence recognition scores in quiet increased significantly from 18.4% (SD 28.5%) preoperatively to 65.9% (SD 17.9%) at the 3-month postactivation interval, but not between the 3-month and 6-month intervals. Sentence recognition in noise in the best-aided bilateral condition increased from 59% (SD 16.3%) preoperatively to 72% (SD 16.0%) at 6-months postactivation, though the difference was not statistically significant. Thirteen of the participants reported tinnitus prior to surgery. Of those, 12 reported that tinnitus was improved after implantation, and one reported that tinnitus was unchanged. CONCLUSION: Preliminary results suggest that speech recognition in a singly deafened ear is significantly improved after cochlear implantation, although speech recognition in noise measured in the bilateral condition remains the same at 6-months postactivation. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:223-228, 2017.

Cortical Plasticity and Reorganization in Pediatric Single-sided Deafness Pre- and Postcochlear Implantation: A Case Study.

HYPOTHESIS: The purpose of this study was to examine changes in cortical development and neuroplasticity in a child with single-sided deafness (SSD) before and after cochlear implantation (CI). BACKGROUND: The extent to which sensory pathways reorganize in childhood SSD is not well understood and there is currently little evidence demonstrating the efficacy of CI in children with SSD. METHODS: High-density 128-channel electroencephalography (EEG) was used to collect cortical auditory evoked potentials (CAEP), cortical visual evoked potentials (CVEP), and cortical somatosensory evoked potentials (CSSEP) in a child with SSD, pre-CI and at subsequent sessions until approximately 3 years post-CI in her right ear which occurred at age 9.86 years. Behavioral correlates of speech perception and sound localization were also measured. RESULTS: Pre-CI, high-density EEG showed evidence of delayed auditory cortical response morphology, auditory cortical development strongly contralateral (to the normal hearing ear), evidence of increased cognitive load, and cross-modal reorganization by the visual and somatosensory modalities. The post-CI developmental trajectory provided clear evidence of age-appropriate development of auditory cortical responses, and decreased cross-modal reorganization, consistent with improved speech perception and sound localization. CONCLUSION: Post-CI, the child demonstrated age-appropriate auditory cortical development and improved speech perception and sound localization suggestive of significant benefits from cochlear implantation. Reversal of somatosensory recruitment was clearly apparent, and only a residual amount of visual cross-modal plasticity remained postimplantation. Overall, our results suggest that CI in pediatric SSD patients may benefit from a highly plastic cortex in childhood.

Internet-Based Delivery of Evidence-Based Health Promotion Programs Among American Indian and Alaska Native Youth: A Case Study.

BACKGROUND: American Indian and Alaska Native (AI/AN) youth face multiple health challenges compared to other racial/ethnic groups, which could potentially be ameliorated by the dissemination of evidence-based adolescent health promotion programs. Previous studies have indicated that limited trained personnel, cultural barriers, and geographic isolation may hinder the reach and implementation of evidence-based health promotion programs among AI/AN youth. Although Internet access is variable in AI/AN communities across the United States, it is swiftly and steadily improving, and it may provide a viable strategy to disseminate evidence-based health promotion programs to this underserved population. OBJECTIVE: We explored the potential of using the Internet to disseminate evidence-based health promotion programs on multiple health topics to AI/AN youth living in diverse communities across 3 geographically dispersed regions of the United States. Specifically, we assessed the Internet's potential to increase the reach and implementation of evidence-based health promotion programs for AI/AN youth, and to engage AI/AN youth. METHODS: This randomized controlled trial was conducted in 25 participating sites in Alaska, Arizona, and the Pacific Northwest. Predominantly AI/AN youth, aged 12-14 years, accessed 6 evidence-based health promotion programs delivered via the Internet, which focused on sexual health, hearing loss, alcohol use, tobacco use, drug use, and nutrition and physical activity. Adult site coordinators completed computer-based education inventory surveys, connectivity and bandwidth testing to assess parameters related to program reach (computer access, connectivity, and bandwidth), and implementation logs to assess barriers to implementation (program errors and delivery issues). We assessed youths' perceptions of program engagement via ratings on ease of use, understandability, credibility, likeability, perceived impact, and motivational appeal, using previously established measures. RESULTS: Sites had sufficient computer access and Internet connectivity to implement the 6 programs with adequate fidelity; however, variable bandwidth (ranging from 0.24 to 93.5 megabits per second; mean 25.6) and technical issues led some sites to access programs via back-up modalities (eg, uploading the programs from a Universal Serial Bus drive). The number of youth providing engagement ratings varied by program (n=40-191; 48-60% female, 85-90% self-identified AI/AN). Across programs, youth rated the programs as easy to use (68-91%), trustworthy (61-89%), likeable (59-87%), and impactful (63-91%). Most youth understood the words in the programs (60-83%), although some needed hints to complete the programs (16-49%). Overall, 37-66% of the participants would recommend the programs to a classmate, and 62-87% found the programs enjoyable when compared to other school lessons. CONCLUSIONS: Findings demonstrate the potential of the Internet to enhance the reach and implementation of evidence-based health promotion programs, and to engage AI/AN youth. Provision of back-up modalities is recommended to address possible connectivity or technical issues. The dissemination of Internet-based health promotion programs may be a promising strategy to address health disparities for this underserved population. TRIAL REGISTRATION: Clinicaltrials.gov NCT01303575; https://clinicaltrials.gov/ct2/show/NCT01303575 (Archived by WebCite at http://www.webcitation.org/6m7DO4g7c).

miR-27 and miR-125 Distinctly Regulate Muscle-Enriched Transcription Factors in Cardiac and Skeletal Myocytes.

MicroRNAs are noncoding RNAs of approximately 22-24 nucleotides which are capable of interacting with the 3' untranslated region of coding RNAs (mRNAs), leading to mRNA degradation and/or protein translation blockage. In recent years, differential microRNA expression in distinct cardiac development and disease contexts has been widely reported, yet the role of individual microRNAs in these settings remains largely unknown. We provide herein evidence of the role of miR-27 and miR-125 regulating distinct muscle-enriched transcription factors. Overexpression of miR-27 leads to impair expression of Mstn and Myocd in HL1 atrial cardiomyocytes but not in Sol8 skeletal muscle myoblasts, while overexpression of miR-125 resulted in selective upregulation of Mef2d in HL1 atrial cardiomyocytes and downregulation in Sol8 cells. Taken together our data demonstrate that a single microRNA, that is, miR-27 or miR-125, can selectively upregulate and downregulate discrete number of target mRNAs in a cell-type specific manner.