Publications by authors named "Eric Hansen"

143 Publications

Promoting healthy trajectories for urban middle school youth through county-funded, parks-based after-school programming.

J Community Psychol 2021 Apr 29. Epub 2021 Apr 29.

Department of Psychology, Florida International University, Miami, Florida, USA.

Ongoing pressure for public schools to prioritize academics has increased attention on after-school settings as a critical space for social-emotional learning (SEL). After-school programs are uniquely positioned to build protective and promotive factors that contribute to positive future orientation, especially within communities where systemic inequities create barriers to high school graduation, higher education, employment, and earnings. This study examines Fit2Lead Youth Enrichment and Sports (YES), a county-funded, parks-based after-school collaboration for middle schoolers that merges mental health and recreation to promote healthy trajectories. Eight Miami neighborhood parks were selected based on county data indicating high rates of violence. An open trial design (N = 9 parks, 198 youth; ages 9-15; 40.5% female; 66.5% Black/African American, 24.9% Hispanic/Latinx, and 76.3% low-income) tested hypotheses that participation for adolescents exposed to community violence would disrupt a commonly reported decline in self-regulation and self-efficacy, and mitigate risk for anxiety and depression. Youth completed questionnaires at the beginning and end of one school year. Paired t-tests revealed no changes from pre to post, and no differences by baseline levels of youth and parent mental health. Findings highlight the promise of prevention programs to disrupt downward trajectories for youth during the risky time of early adolescence.
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http://dx.doi.org/10.1002/jcop.22587DOI Listing
April 2021

Single Subcutaneous Ketamine Dose Followed by Oral Ketamine for Depression Symptoms in Hospice Patients: A Case Series.

J Pain Palliat Care Pharmacother 2021 Apr 13:1-10. Epub 2021 Apr 13.

Natalie M. Latuga, PharmD, BCPS, Debra L. Luczkiewicz, MD, Christopher W. Kerr, MD, PhD, are with Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA.

Management of depression symptoms in hospice patients is complicated by the fact that an appropriate trial of antidepressant therapy requires 4-6 weeks and most hospice patients receive hospice services for less than 8 weeks. Intravenously administered ketamine has been shown to produce rapid improvement in depression symptoms but is not an ideal route for hospice patients and oral ketamine appears to have a slower onset of antidepressant activity. We present a case series that illustrates the use of a single subcutaneous dose of ketamine (0.5 mg/kg) followed by daily oral ketamine (0.5 mg/kg daily) therapy to manage depression symptoms in three hospice patients. Clinical improvement of depression symptoms occurred quickly for all patients as measured by the PHQ-4, numeric ratings, and subjective reporting. A single subcutaneous dose of ketamine followed by oral therapy presents itself as an option to quickly reduce depression symptoms in hospice patients that do not also require additional pain management. Combining the use of the subcutaneous and oral routes takes advantage of the possibly faster onset, home administration, and milder side effects than intravenous dosing. Prospective studies are needed to determine which dosing strategy would be the most beneficial for hospice patients.
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http://dx.doi.org/10.1080/15360288.2021.1883182DOI Listing
April 2021

A digital tool for prevention and management of cold weather injuries-Cold Weather Ensemble Decision Aid (CoWEDA).

Int J Biometeorol 2021 Apr 4. Epub 2021 Apr 4.

Biophysics and Biomedical Modeling Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Avenue, Natick, MA, 01760-5007, USA.

This paper describes a Cold Weather Ensemble Decision Aid (CoWEDA) that provides guidance for cold weather injury prevention, mission planning, and clothing selection. CoWEDA incorporates current science from the disciplines of physiology, meteorology, clothing, and computer modeling. The thermal performance of a cold weather ensemble is defined by endurance times, which are the time intervals from initial exposure until the safety limits are reached. These safety limits correspond to conservative temperature thresholds that provide a warning of the approaching onset of frostbite and/or hypothermia. A validated six-cylinder thermoregulatory model is used to predict human thermal responses to cold while wearing different ensembles. The performance metrics, model, and a database of clothing properties were integrated into a user-friendly software application. CoWEDA is the first tool that allows users to build their own ensembles from the clothing menu (i.e., jackets, footwear, and accessories) for each body region (i.e., head, torso, lower body, hands, feet) and view their selections in the context of physiological strain and the operational consequences. Comparison of predicted values to skin and core temperatures, measured during 17 cold exposures ranging from 0 to -40°C, indicated that the accuracy of CoWEDA prediction is acceptable, and most predictions are within measured mean ± SD. CoWEDA predicts the risk of frostbite and hypothermia and ensures that a selected clothing ensemble is appropriate for expected weather conditions and activities. CoWEDA represents a significant enhancement of required clothing insulation (IREQ, ISO 11079) and wind chill index-based guidance for cold weather safety and survival.
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http://dx.doi.org/10.1007/s00484-021-02113-0DOI Listing
April 2021

COVID-19 Evidence Accelerator: A parallel analysis to describe the use of Hydroxychloroquine with or without Azithromycin among hospitalized COVID-19 patients.

PLoS One 2021 17;16(3):e0248128. Epub 2021 Mar 17.

Syapse, San Francisco, California, United States of America.

Background: The COVID-19 pandemic remains a significant global threat. However, despite urgent need, there remains uncertainty surrounding best practices for pharmaceutical interventions to treat COVID-19. In particular, conflicting evidence has emerged surrounding the use of hydroxychloroquine and azithromycin, alone or in combination, for COVID-19. The COVID-19 Evidence Accelerator convened by the Reagan-Udall Foundation for the FDA, in collaboration with Friends of Cancer Research, assembled experts from the health systems research, regulatory science, data science, and epidemiology to participate in a large parallel analysis of different data sets to further explore the effectiveness of these treatments.

Methods: Electronic health record (EHR) and claims data were extracted from seven separate databases. Parallel analyses were undertaken on data extracted from each source. Each analysis examined time to mortality in hospitalized patients treated with hydroxychloroquine, azithromycin, and the two in combination as compared to patients not treated with either drug. Cox proportional hazards models were used, and propensity score methods were undertaken to adjust for confounding. Frequencies of adverse events in each treatment group were also examined.

Results: Neither hydroxychloroquine nor azithromycin, alone or in combination, were significantly associated with time to mortality among hospitalized COVID-19 patients. No treatment groups appeared to have an elevated risk of adverse events.

Conclusion: Administration of hydroxychloroquine, azithromycin, and their combination appeared to have no effect on time to mortality in hospitalized COVID-19 patients. Continued research is needed to clarify best practices surrounding treatment of COVID-19.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248128PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968637PMC
March 2021

The association between neighborhood quality, youth physical fitness, and modifiable cardiovascular disease risk factors.

Ann Epidemiol 2021 05 14;57:30-39. Epub 2021 Feb 14.

Department of Population Health Sciences, Duke University School of Medicine, Durham, NC; Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, NC. Electronic address:

Purpose: Striking disparities persist in cardiovascular disease risk factors among minority youth. We examined the association between multiple indicators of neighborhood quality and minority youth fitness.

Methods: The primary exposure was the Child Opportunity Index (COI), a measure comprised of indicators that facilitate healthy child development. Outcome data were drawn from the 2018-2019 Fit2Play Study (Miami-Dade County, FL). Hotspot analysis evaluated COI spatial clustering. Generalized linear mixed models examined cross-sectional COI-fitness associations.

Results: The sample included 725 youth (53% Black, 43% Hispanic; 5-17 years). Significant neighborhood quality spatial clusters were identified (Gi* = -4.85 to 5.36). Adjusting for sociodemographics, walkability was associated with lower percentiles in body mass index (BMI) and diastolic blood pressure percentiles (DBP) (β = -5.25, 95% CI: -8.88, -1.62 and β = -3.95, 95% CI: -7.02, -0.89, respectively) for all, lower skinfold thickness (β = -4.83, 95% CI: -9.97, 0.31 and higher sit-ups (β = 1.67, 95% CI: -0.17, 3.50) among girls, and lower systolic blood pressure percentiles (SBP) (β = -4.75, 95% CI: -8.99, -0.52) among boys. Greenspace was associated with higher BMI (β = 6.17, 95% CI: 2.47, 9.87), SBP (β = 3.47, 95% CI: -0.05, 6.99), and DBP (β = 4.11, 95% CI: 1.08, 7.13).

Conclusions: COI indicators were positively associated with youth fitness. Disparities in youth cardiovascular disease risk may be modifiable through community interventions and built environment initiatives targeting select neighborhood factors.
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http://dx.doi.org/10.1016/j.annepidem.2021.02.004DOI Listing
May 2021

Objective Measurement of Physical Activity Attributed to a Park-Based Afterschool Program.

J Phys Act Health 2021 Jan 31;18(3):329-336. Epub 2021 Jan 31.

Background: Only 24% of US youth meet physical activity recommendations set by the Centers for Disease Control and Prevention. Research demonstrates that community-based programs provide underresourced minority youth with opportunities for routine physical activity, although limited work draws from accelerometry data. This study objectively assessed youth physical activity attributable to participation (vs nonparticipation) days in a park-based afterschool program in Miami-Dade County, Miami, FL.

Methods: Participants' (n = 66; 60% male; 57% white Hispanic, 25% non-Hispanic black, 14% Black Hispanic, mean age = 10.2 y) physical activity was assessed April to May 2019 over 10 days across 7 park sites using Fitbit (Charge 2) devices. Separate repeated-measures multilevel models were developed to assess the relationship between program daily attendance and total (1) moderate to vigorous physical activity minutes and (2) step counts per day.

Results: Models adjusted for individual-level age, sex, race/ethnicity, poverty, and clustering by park showed significantly higher moderate to vigorous physical activity minutes (β = 25.33 more minutes per day; 95% confidence interval, 7.0 to 43.7, P < .01) and step counts (β = 4067.8 more steps per day; 95% confidence interval, 3171.8 to 4963.8, P < .001) on days when youth did versus did not attend the program.

Conclusions: Study findings suggest that park-based programs may support underserved youth in achieving daily physical activity recommendations.
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http://dx.doi.org/10.1123/jpah.2020-0162DOI Listing
January 2021

Hydroxychloroquine in the treatment of outpatients with mildly symptomatic COVID-19: a multi-center observational study.

BMC Infect Dis 2021 Jan 14;21(1):72. Epub 2021 Jan 14.

Division of Outcomes and Value Research, John Theurer Cancer Center at Hackensack University Medical Center, 92 Second Street, Hackensack, NJ, 07601, USA.

Background: Hydroxychloroquine has not been associated with improved survival among hospitalized COVID-19 patients in the majority of observational studies and similarly was not identified as an effective prophylaxis following exposure in a prospective randomized trial. We aimed to explore the role of hydroxychloroquine therapy in mildly symptomatic patients diagnosed in the outpatient setting.

Methods: We examined the association between outpatient hydroxychloroquine exposure and the subsequent progression of disease among mildly symptomatic non-hospitalized patients with documented SARS-CoV-2 infection. The primary outcome assessed was requirement of hospitalization. Data was obtained from a retrospective review of electronic health records within a New Jersey USA multi-hospital network. We compared outcomes in patients who received hydroxychloroquine with those who did not applying a multivariable logistic model with propensity matching.

Results: Among 1274 outpatients with documented SARS-CoV-2 infection 7.6% were prescribed hydroxychloroquine. In a 1067 patient propensity matched cohort, 21.6% with outpatient exposure to hydroxychloroquine were hospitalized, and 31.4% without exposure were hospitalized. In the primary multivariable logistic regression analysis with propensity matching there was an association between exposure to hydroxychloroquine and a decreased rate of hospitalization from COVID-19 (OR 0.53; 95% CI, 0.29, 0.95). Sensitivity analyses revealed similar associations. QTc prolongation events occurred in 2% of patients prescribed hydroxychloroquine with no reported arrhythmia events among those with data available.

Conclusions: In this retrospective observational study of SARS-CoV-2 infected non-hospitalized patients hydroxychloroquine exposure was associated with a decreased rate of subsequent hospitalization. Additional exploration of hydroxychloroquine in this mildly symptomatic outpatient population is warranted.
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http://dx.doi.org/10.1186/s12879-021-05773-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807228PMC
January 2021

The Feasibility of Collecting Longitudinal Cardiovascular and Fitness Outcomes From a Neighborhood Park-Based Fitness Program in Ethnically Diverse Older Adults: A Proof-of-Concept Study.

J Aging Phys Act 2020 Dec 20:1-9. Epub 2020 Dec 20.

This proof-of-concept study examined feasibility of assessing longitudinal changes in body mass index, strength, mobility, and cardiovascular health outcomes in older, racial/ethnic minority adults participating in a park-based physical activity program. Study feasibility was based on follow-through data collection procedures and ability to manage and implement data collection, enrollment, and repeated measures data collection in older adults (≥50 years; n = 380; 45% Hispanic, 41% non-Hispanic Black) over a 28-month period. Mixed models were developed to estimate the effects of program participation over time on participant cardiovascular and fitness outcomes and across poverty and age subgroups. Model estimates adjusted for individual-level sociodemographics showed improvements across each 4 month time point in arm strength (0.55 arm curl; 95% confidence interval [0.33, 0.77]) and systolic (-0.68 mmHg; 95% confidence interval [-1.22, -0.13]) and diastolic (-0.47 mmHg; 95% confidence interval [-0.79, -0.16]) blood pressure. An Age × Poverty interaction found greater improvements in systolic and diastolic blood pressure among younger participants living in low poverty (vs. older in higher poverty). Study of the longitudinal association between fitness class participation and health outcomes was feasible in park-based settings.
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http://dx.doi.org/10.1123/japa.2020-0139DOI Listing
December 2020

Palliative Medical Management of Inoperable Malignant Bowel Obstruction With "Triple Therapy": Dexamethasone, Octreotide, and Metoclopramide.

Am J Hosp Palliat Care 2021 Apr 21;38(4):340-345. Epub 2020 Oct 21.

Department of Supportive and Palliative Care, 2074Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.

Context: Malignant bowel obstruction (MBO) is a complication of advanced malignancy. For inoperable patients, symptoms are often treated using analgesics, anticholinergics, and anti-emetics. There are, however, few published guidelines for the medical management of MBO.

Objective: To measure the effect of the combination of dexamethasone, octreotide, and metoclopramide ("triple therapy") in patients with MBO, compared to patients who received none of the 3 medications ("no drug therapy").

Methods: A retrospective cohort study of patients with MBO admitted in a single-center comprehensive cancer center. Patients who received dexamethasone, octreotide, and metoclopramide during their hospitalization for treatment of inoperable MBO were selected for analysis. Patients were excluded if they received a venting gastric tube. Rate of de-obstruction as well as time to de-obstruction were measured.

Results: There were 20 patients identified who received all 3 drugs of interest, and 29 patients identified who received none of the 3 medications. There was no statistically significant difference in rates of de-obstruction between the 2 groups, though there was a non-significant trend toward patients who received triple therapy were more likely to reach de-obstruction, compared to patients who had no drug therapy (95% vs. 83%, p = 0.379); there was no significant difference in adjusted analysis.

Conclusion: In patients with inoperable MBO, there was no statistically significant difference in rates of de-obstruction with triple drug therapy compared to patients who received none of the 3 drugs, though the study may not have been powered to detect a difference and further investigation is warranted.
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http://dx.doi.org/10.1177/1049909120968249DOI Listing
April 2021

A Practical Approach to Nonmedical Opioid Use in Palliative Care Patients With Cancer: Using the PARTNERS Framework.

J Pain Symptom Manage 2020 12 31;60(6):1253-1259. Epub 2020 Aug 31.

Department of Supportive and Palliative Care, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA; Department of Geriatrics and Palliative Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.

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http://dx.doi.org/10.1016/j.jpainsymman.2020.08.031DOI Listing
December 2020

Longitudinal Effects of Transportation Vulnerability on the Association Between Racial/Ethnic Segregation and Youth Cardiovascular Health.

J Racial Ethn Health Disparities 2021 Jun 2;8(3):618-629. Epub 2020 Sep 2.

Department of Pediatrics, University of Miami Miller School of Medicine, 1601 NW 12th Ave, Miami, FL, USA.

Background: Transportation vulnerability (defined as lack of personal/public transportation access) is particularly prevalent in areas with high racial/ethnic segregation where communities typically lack proximity to quality education, jobs, healthy food, playgrounds, and medical care. Prior research has shown an association between residential segregation and youth cardiovascular health, although little work has examined the effects of transportation vulnerability on this relationship.

Methods: Longitudinal mixed methods were used to compare the effects of transportation vulnerability on the association between changes in exposure to residential segregation (defined as the uneven geographic distribution of minorities) and five cardiovascular health outcomes across sex in minority youth for up to four consecutive years of participation in an afterschool fitness program during 2010-2018 (n = 2742; Miami-Dade County, Florida, US).

Results: After accounting for child race/ethnicity, age, year, and poverty, girls with high transportation vulnerability and reduced exposure to segregation (vs. increased or no change in segregation) showed the most improvements across all outcomes, including body mass index percentile (26% (95% CI 23.84, 28.30)), sum of skinfold thicknesses (18% (95% CI 14.90, 20.46)), run time (17% (95% CI 14.88, 18.64)), systolic blood pressure percentile (15% (95% CI 11.96, 17.08)), and diastolic blood pressure percentile (12% (95% CI 9.09, 14.61)).

Conclusion: Transportation inequities related to concentrated racial/ethnic segregation may be an important factor in reducing disparities in youth cardiovascular health, particularly among girls. These study findings provide important longitudinal evidence in support of health interventions to reduce transportation vulnerability for racial/ethnic minority youth in underserved areas.
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http://dx.doi.org/10.1007/s40615-020-00821-8DOI Listing
June 2021

Tocilizumab among patients with COVID-19 in the intensive care unit: a multicentre observational study.

Lancet Rheumatol 2020 Oct 14;2(10):e603-e612. Epub 2020 Aug 14.

Division of Outcomes and Value Research, Hackensack, NJ, USA.

Background: Tocilizumab, a monoclonal antibody directed against the interleukin-6 receptor, has been proposed to mitigate the cytokine storm syndrome associated with severe COVID-19. We aimed to investigate the association between tocilizumab exposure and hospital-related mortality among patients requiring intensive care unit (ICU) support for COVID-19.

Methods: We did a retrospective observational cohort study at 13 hospitals within the Hackensack Meridian Health network (NJ, USA). We included patients (aged ≥18 years) with laboratory-confirmed COVID-19 who needed support in the ICU. We obtained data from a prospective observational database and compared outcomes in patients who received tocilizumab with those who did not. We applied a multivariable Cox model with propensity score matching to reduce confounding effects. The primary endpoint was hospital-related mortality. The prospective observational database is registered on ClinicalTrials.gov, NCT04347993.

Findings: Between March 1 and April 22, 2020, 764 patients with COVID-19 required support in the ICU, of whom 210 (27%) received tocilizumab. Factors associated with receiving tocilizumab were patients' age, gender, renal function, and treatment location. 630 patients were included in the propensity score-matched population, of whom 210 received tocilizumab and 420 did not receive tocilizumab. 358 (57%) of 630 patients died, 102 (49%) who received tocilizumab and 256 (61%) who did not receive tocilizumab. Overall median survival from time of admission was not reached (95% CI 23 days-not reached) among patients receiving tocilizumab and was 19 days (16-26) for those who did not receive tocilizumab (hazard ratio [HR] 0·71, 95% CI 0·56-0·89; p=0·0027). In the primary multivariable Cox regression analysis with propensity matching, an association was noted between receiving tocilizumab and decreased hospital-related mortality (HR 0·64, 95% CI 0·47-0·87; p=0·0040). Similar associations with tocilizumab were noted among subgroups requiring mechanical ventilatory support and with baseline C-reactive protein of 15 mg/dL or higher.

Interpretation: In this observational study, patients with COVID-19 requiring ICU support who received tocilizumab had reduced mortality. Results of ongoing randomised controlled trials are awaited.

Funding: None.
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http://dx.doi.org/10.1016/S2665-9913(20)30277-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428303PMC
October 2020

Hydroxychloroquine and tocilizumab therapy in COVID-19 patients-An observational study.

PLoS One 2020 13;15(8):e0237693. Epub 2020 Aug 13.

Hackensack Meridian Health, Hackensack New Jersey and Hackensack Meridian School of Medicine, Nutley, New Jersey, United States of America.

Hydroxychloroquine has been touted as a potential COVID-19 treatment. Tocilizumab, an inhibitor of IL-6, has also been proposed as a treatment of critically ill patients. In this retrospective observational cohort study drawn from electronic health records we sought to describe the association between mortality and hydroxychloroquine or tocilizumab therapy among hospitalized COVID-19 patients. Patients were hospitalized at a 13-hospital network spanning New Jersey USA between March 1, 2020 and April 22, 2020 with positive polymerase chain reaction results for SARS-CoV-2. Follow up was through May 5, 2020. Among 2512 hospitalized patients with COVID-19 there have been 547 deaths (22%), 1539 (61%) discharges and 426 (17%) remain hospitalized. 1914 (76%) received at least one dose of hydroxychloroquine and 1473 (59%) received hydroxychloroquine with azithromycin. After adjusting for imbalances via propensity modeling, compared to receiving neither drug, there were no significant differences in associated mortality for patients receiving any hydroxychloroquine during the hospitalization (HR, 0.99 [95% CI, 0.80-1.22]), hydroxychloroquine alone (HR, 1.02 [95% CI, 0.83-1.27]), or hydroxychloroquine with azithromycin (HR, 0.98 [95% CI, 0.75-1.28]). The 30-day unadjusted mortality for patients receiving hydroxychloroquine alone, azithromycin alone, the combination or neither drug was 25%, 20%, 18%, and 20%, respectively. Among 547 evaluable ICU patients, including 134 receiving tocilizumab in the ICU, an exploratory analysis found a trend towards an improved survival association with tocilizumab treatment (adjusted HR, 0.76 [95% CI, 0.57-1.00]), with 30 day unadjusted mortality with and without tocilizumab of 46% versus 56%. This observational cohort study suggests hydroxychloroquine, either alone or in combination with azithromycin, was not associated with a survival benefit among hospitalized COVID-19 patients. Tocilizumab demonstrated a trend association towards reduced mortality among ICU patients. Our findings are limited to hospitalized patients and must be interpreted with caution while awaiting results of randomized trials. Trial Registration: Clinicaltrials.gov Identifier: NCT04347993.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237693PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7425928PMC
August 2020

Global Retinoblastoma Presentation and Analysis by National Income Level.

JAMA Oncol 2020 05;6(5):685-695

Imam Hussein Cancer Center, Karbala, Iraq.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale.

Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis.

Design, Setting, And Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017.

Main Outcomes And Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis.

Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]).

Conclusions And Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.
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http://dx.doi.org/10.1001/jamaoncol.2019.6716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047856PMC
May 2020

Scalable Synthesis of InAs Quantum Dots Mediated through Indium Redox Chemistry.

J Am Chem Soc 2020 03 19;142(9):4088-4092. Epub 2020 Feb 19.

Department of Chemistry, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States.

Next-generation optoelectronic applications centered in the near-infrared (NIR) and short-wave infrared (SWIR) wavelength regimes require high-quality materials. Among these materials, colloidal InAs quantum dots (QDs) stand out as an infrared-active candidate material for biological imaging, lighting, and sensing applications. Despite significant development of their optical properties, the synthesis of InAs QDs still routinely relies on hazardous, commercially unavailable precursors. Herein, we describe a straightforward single hot injection procedure revolving around In(I)Cl as the key precursor. Acting as a simultaneous reducing agent and In source, In(I)Cl smoothly reacts with a tris(amino)arsenic precursor to yield colloidal InAs quantitatively and at gram scale. Tuning the reaction temperature produces InAs cores with a first excitonic absorption feature in the range of 700-1400 nm. A dynamic disproportionation equilibrium between In(I), In metal, and In(III) opens up additional flexibility in precursor selection. CdSe shell growth on the produced cores enhances their optical properties, furnishing particles with center emission wavelengths between 1000 and 1500 nm and narrow photoluminescence full-width at half-maximum (FWHM) of about 120 meV throughout. The simplicity, scalability, and tunability of the disclosed precursor platform are anticipated to inspire further research on In-based colloidal QDs.
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http://dx.doi.org/10.1021/jacs.9b12350DOI Listing
March 2020

How Effective Is Palliative Care in Improving Patient Outcomes?

Curr Treat Options Oncol 2020 02 5;21(2):12. Epub 2020 Feb 5.

Department of Supportive and Palliative Care, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.

Opinion Statement: As palliative care (PC) continues its rapid growth, an emerging body of evidence is demonstrating that its approach of interdisciplinary supportive care benefits many patient populations, including in the oncology setting. As studies and data proliferate, however, questions persist about who, what, why, when, and how PC as well as the ideal time for a PC consult and length of involvement. When comparing outcomes from chemotherapy trials, it is important to consider the dosing regimens used in the various studies. In the same way, it is important to account for the "dose" of the PC interventions utilized across studies, and apples to apples comparisons are needed in order to draw accurate conclusions about PC's benefits. Studies which include a true interdisciplinary PC intervention consistently show improvements in patient quality of life, as well as cost savings, with further study needed for other outcomes. These benefits cannot be extrapolated to care which may be labeled "palliative care," but which does not meet the standard of true interdisciplinary PC. The ultimate question is: Does PC indeed improve outcomes?
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http://dx.doi.org/10.1007/s11864-020-0702-xDOI Listing
February 2020

Association of a Park-Based Violence Prevention and Mental Health Promotion After-School Program With Youth Arrest Rates.

JAMA Netw Open 2020 Jan 3;3(1):e1919996. Epub 2020 Jan 3.

Miller School of Medicine, Department of Pediatrics, University of Miami, Miami, Florida.

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http://dx.doi.org/10.1001/jamanetworkopen.2019.19996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6991325PMC
January 2020

A review of treatment for retinopathy of prematurity.

Expert Rev Ophthalmol 2019 29;14(2):73-87. Epub 2019 Mar 29.

John A. Moran Eye Center, University of Utah, Salt Lake City, USA.

Introduction: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide.

Areas Covered: Recent methods to identify and manage treatment-warranted vascularly active ROP are recognized and being compared to standard care by laser treatment in prospective large-scale clinical studies. Pharmacologic anti-angiogenic (anti-VEGF) treatment has changed the natural history of vascularly active ROP by reducing stage 3 intravitreal neovascularization and extending physiologic retinal vascularization in many infants. Tractional retinal detachments in stage 4 ROP after treatment with anti-VEGF agents show additional fibrovascular complexity compared to eyes treated with laser only. We review current management and outcomes for vascularly active and fibrovascular retinal detachment in ROP (stages 3, 4, 5 ROP), highlighting the evidence from recent clinical studies. Included are technical details important in surgery for retinal detachment in ROP. Literature searches were employed through PubMed.

Expert Opinion: Methods in pediatric imaging, safer pharmacologic treatments, and surgical techniques continue to advance to improve future ROP outcomes.
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http://dx.doi.org/10.1080/17469899.2019.1596026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6874220PMC
March 2019

Buprenorphine for Cancer Pain in Patients With Nonmedical Opioid Use: A Retrospective Study at a Comprehensive Cancer Center.

Am J Hosp Palliat Care 2020 May 7;37(5):350-353. Epub 2019 Nov 7.

Department of Supportive and Palliative Care. Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA.

Background: Outpatients with cancer commonly have nonmedical opioid use (NMOU) behaviors and use opioids to dull emotional and existential suffering. Buprenorphine is often used for cancer pain due to less reported euphoria when compared to other opioids.

Methods: A retrospective review was done in patients who were prescribed buprenorphine for cancer pain. Pain scores were reported on a Likert pain scale of 1 to 10. Nonmedical opioid use was defined as patients taking opioids for emotional pain at or above the maximum prescribed amount.

Results: For 16 patients, the mean pain score prior to buprenorphine (pain pre) was 8.3 (Standard deviation (Std) 1.6), and the mean pain score on follow-up post-buprenorphine (pain post) was 6.1 (Std 2.3) with a reduction in mean pain score (pain change) of -2.0 (Std 2.9, = .059). Those patients without NMOU had a pain prescore of 9.5 (Std 1.0) and pain post of 4.3 (Std 2.5) with a mean pain change of -5.0 (Std 1.7, = .20). The mean pain change in those with chemical coping (-1.3/Std 2.7), illicit drug use (-2.8/Std 1.0), or psychiatric comorbidity (-2.4/Std 2.7) were reduced after buprenorphine, however, not statistically significant. Outpatient rotation to buprenorphine was well tolerated.

Conclusions: The pain score in those patients without NMOU was significantly lower after rotation to buprenorphine than those with NMOU. We deduce that in those with NMOU, it is more challenging to achieve pain relief with buprenorphine. Overall, for all patients, rotation to buprenorphine resulted in a marginally significantly reduced pain score.
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http://dx.doi.org/10.1177/1049909119884358DOI Listing
May 2020

Blue Light Emitting Defective Nanocrystals Composed of Earth-Abundant Elements.

Angew Chem Int Ed Engl 2020 Jan 3;59(2):860-867. Epub 2019 Dec 3.

Department of Chemistry, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA.

Copper-based ternary (I-III-VI) chalcogenide nanocrystals (NCs) are compositionally-flexible semiconductors that do not contain lead (Pb) or cadmium (Cd). Cu-In-S NCs are the dominantly studied member of this important materials class and have been reported to contain optically-active defect states. However, there are minimal reports of In-free compositions that exhibit efficient photoluminescence (PL). Here, we report a novel solution-phase synthesis of ≈4 nm defective nanocrystals (DNCs) composed of copper, aluminum, zinc, and sulfur with ≈20 % quantum yield and an attractive PL maximum of 450 nm. Extensive spectroscopic characterization suggests the presence of highly localized electronic states resulting in reasonably fast PL decays (≈1 ns), large vibrational energy spacing, small Stokes shift, and temperature-independent PL linewidth and PL lifetime (between room temperature and ≈5 K). Furthermore, density functional theory (DFT) calculations suggest PL transitions arise from defects within a CuAl S crystal lattice, which supports the experimental observation of highly-localized states. The results reported here provide a new material with unique optoelectronic characteristics that is an important analog to well-explored Cu-In-S NCs.
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http://dx.doi.org/10.1002/anie.201911436DOI Listing
January 2020

Development of a quantitative polymerase chain reaction assay and environmental DNA sampling methods for Giant Gartersnake (Thamnophis gigas).

PLoS One 2019 16;14(9):e0222493. Epub 2019 Sep 16.

Cramer Fish Sciences-Genidaqs, West Sacramento, CA, United States of America.

The Giant Gartersnake (Thamnophis gigas) is a low density visually evasive species with a low detection probability based on standard field survey methods (e.g., traps, visual census). Habitat loss has resulted in extirpations or serious declines for T. gigas populations throughout the southern two thirds of its historic range. Uncertainty regarding its current distribution and occupancy present management challenges for the species. Enhancing survey sensitivity through development of environmental DNA sampling (eDNA) methods would improve compliance monitoring under the Endangered Species Act, recovery planning for T. gigas, and evaluation of California's Central Valley tule marsh habitat on which this species depends. To address these needs, we designed and validated diagnostic quantitative Polymerase Chain Reaction (qPCR) assays for identifying portions of the Cytochrome B (CytB) and the Nicotinamide adenine dinucleotide (NADH) dehydrogenase subunit 4 (ND4) genes of the T. gigas mitochondrial genome. The designed ND4 qPCR assay was not specific to T. gigas DNA and amplified DNA from a closely related and spatially co-occurring Thamnophis species (T.s. fitchi). The CytB T. gigas qPCR assay proved specific to a species level with a sensitivity that reliably detected T. gigas DNA at a concentration of 2.0x10-5 ng μL-1. To assess detection range, coordinated field sampling was conducted at aquatic sites with an observed and documented population of T. gigas. The T. gigas qPCR assay reliably detected DNA from samples taken 300m downstream from the known source. We then used environmental eDNA sampling and qPCR analysis to augment unsuccessful trap surveys in the southern range of T. gigas and detected DNA in 28 of the 52 locations sampled, confirming that T. gigas was still present at some sites where physical trapping failed to identify presence. QPCR-based DNA detection coupled with eDNA sampling methods provides an effective means to obtain critical population metrics from this otherwise cryptic, federally protected and hard to study organism, offering great promise for elucidating patterns of occupancy with greater efficiency and at far less cost than trapping methods, particularly where detection probabilities are low.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0222493PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6746398PMC
March 2020

Health system reconstitution syndrome: an often misunderstood phenomenon in global health practice.

Health Policy Plan 2019 Oct;34(8):618-624

Clinical Department, Partners In Health, 800 Boylston Street Suite 300, Boston, MA, USA.

The beginning of the 21st century was marked by the new definition and framework of health systems strengthening (HSS). The global movement to improve access to high-quality care garnered new resources to design and implement comprehensive HSS programs. In this effort, billions of dollars flowed from novel mechanisms such as The Global Fund to Fight AIDS, Tuberculosis and Malaria; Gavi, the Vaccine Alliance; and several bilateral funders. However, poor health outcomes, particularly in low-income countries, raise questions about the effectiveness of HSS program implementation. While several evaluation projects focus on the ultimate impact of HSS programs, little is known about the short- and mid-term reactions occurring throughout the active implementation of HSS interventions. Using the well-documented WHO framework of six HSS building blocks, we describe the evolution and phases of health system reconstitution syndrome (HSRS), including: (1) quiescent phase, (2) reactive phase, (3) restorative phase and (4) stability phase. We also discuss the implications of HSRS on global health funding, implementation, policy and research. Recognizing signs of HSRS could improve the rigour of HSS program design and minimize premature decisions regarding the progress of HSS interventions.
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http://dx.doi.org/10.1093/heapol/czz072DOI Listing
October 2019

Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology.

J Natl Compr Canc Netw 2019 08;17(8):977-1007

National Comprehensive Cancer Network.

In recent years, the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Adult Cancer Pain have undergone substantial revisions focusing on the appropriate and safe prescription of opioid analgesics, optimization of nonopioid analgesics and adjuvant medications, and integration of nonpharmacologic methods of cancer pain management. This selection highlights some of these changes, covering topics on management of adult cancer pain including pharmacologic interventions, nonpharmacologic interventions, and treatment of specific cancer pain syndromes. The complete version of the NCCN Guidelines for Adult Cancer Pain addresses additional aspects of this topic, including pathophysiologic classification of cancer pain syndromes, comprehensive pain assessment, management of pain crisis, ongoing care for cancer pain, pain in cancer survivors, and specialty consultations.
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http://dx.doi.org/10.6004/jnccn.2019.0038DOI Listing
August 2019

Fluorescence Lifetime Imaging Ophthalmoscopy (FLIO) in Eyes With Pigment Epithelial Detachments Due to Age-Related Macular Degeneration.

Invest Ophthalmol Vis Sci 2019 07;60(8):3054-3063

Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, United States.

Purpose: To investigate fluorescence lifetime imaging ophthalmoscopy (FLIO) in neovascular AMD and pigment epithelial detachments (PEDs).

Methods: A total of 46 eyes with PEDs (>350 μm) as well as age-matched healthy controls were included in this study. We found 28 eyes showed neovascular AMD (nvAMD), and 17 had nonneovascular (dry) AMD (dAMD). The Heidelberg Engineering FLIO excited fluorescence at 473 nm. Fluorescence decays were detected in two spectral channels (498-560 nm; 560-720 nm) to determine fluorescence lifetimes of endogenous fluorophores in their specific spectral emission ranges. Mean fluorescence lifetimes (τm) were investigated. Multimodal imaging was reviewed by two ophthalmologists who circumscribed and classified PEDs as either serous (n = 4), hemorrhagic (n = 4), fibrovascular (n = 16), drusenoid (n = 17), or mixed (n = 5). Blood samples from a healthy subject and a patient with PED were investigated in a quartz cuvette.

Results: Eyes with nvAMD show similar FLIO patterns to dAMD: ring-shaped prolongations of τm 3 to 6 mm from the fovea. Different PED-forms show characteristic τm, while serous and hemorrhagic PEDs exhibit shortened τm, drusenoid PEDs show prolonged τm, and τm in fibrovascular PEDs is variable. Areas corresponding to sub-/intraretinal fluid display shortened τm. Ex vivo studies of blood also show short τm.

Conclusions: The previously described dAMD-related FLIO pattern is also present in nvAMD. Short τm in serous, fibrovascular, and hemorrhagic PEDs as well as sub/intraretinal fluid may disrupt this pattern. FLIO appears to differentiate between PEDs, hemorrhage, and fluid. Additionally, ex vivo studies of human blood help to better interpret FLIO images.
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http://dx.doi.org/10.1167/iovs.19-26835DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6660189PMC
July 2019

Two-Year Changes in Neighborhood Juvenile Arrests After Implementation of a Park-Based Afterschool Mental Health Promotion Program in Miami-Dade County, Florida, 2015-2017.

Am J Public Health 2019 06;109(S3):S214-S220

Emily M. D'Agostino, Eric Hansen, Hersila H. Patel, Zafar Ahmed, Deirdre Okeke, and Maria I. Nardi are with Miami-Dade Parks, Recreation, and Open Spaces Department, Miami, FL. Stacy L. Frazier is with Florida International University, Department of Psychology, Miami. At the time of the study, Sarah E. Messiah was with University of Miami, Department of Pediatrics and Public Health Sciences, Miami.

To examine the association of Fit2Lead, an afterschool park-based youth mental health promotion program, and neighborhood juvenile arrests (2015-2017) in Miami-Dade County, Florida. We tracked juvenile (ages 12-17 years) arrest rates over 2 years of program implementation across zip codes matched by (1) park and (2) baseline sociodemographics and youth arrests. Fit2Lead mental and physical health, meditation, resilience, and life skills activities were offered in 12 high-need areas for youths (n = 501) aged 12 to 17 years. We tested the association of Fit2Lead implementation (binary variable) and change in juvenile arrest rates by zip code, adjusting for area-level gender, age, race/ethnicity, single-parent households, and poverty. Fit2Lead was offered in areas composed of 48% male youths, 60% Hispanics, 29% non-Hispanic Blacks, 33% single-parent households, and 33% of residents living in poverty. After covariate adjustment, zip codes with Fit2Lead implementation showed a significant mean reduction ( < .001) in youth arrests per 10 000 youths aged 12 to 17 years per year compared with zip codes without program implementation (b = -6.9; 95% confidence interval = -9.21, -4.65). Park-based programs may have the potential to promote mental health and resilience, and also to prevent violence among at-risk youths.
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http://dx.doi.org/10.2105/AJPH.2019.305050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6595515PMC
June 2019

Changes in cardiovascular health and physical fitness in ethnic youth with intellectual disabilities participating in a park-based afterschool programme for two years.

J Appl Res Intellect Disabil 2019 Nov 20;32(6):1478-1489. Epub 2019 Jun 20.

Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.

Background: Youth with intellectual disabilities are more likely to be an unhealthy weight and less physically active than youth without intellectual disability.

Objective: The effects of Fit2Play, a park-based afterschool programme on cardiovascular/fitness health outcomes among youth with intellectual disability, were prospectively assessed.

Methods: Youth ages 6 to 22 with intellectual disability who participated in Fit2Play for either one or two school years between 2010 and 2016 (N = 297, mean age 14.1 years, 70% Hispanic, 20% non-Hispanic black, 72% male) were examined via a fitness battery at the beginning/end of the school year(s). Effects of length of Fit2Play participation on body mass index (BMI) %ile, skinfold thicknesses, systolic/diastolic blood pressure (SBP/DBP) %iles, fitness tests, and health and wellness knowledge) were evaluated via two-level repeated measures analysis adjusted for child gender, age, ethnicity and area-level poverty.

Results: Adjusted models showed that up to two years of Fit2Play participation was significantly associated with improved BMI %ile, skinfold thicknesses, SPB/DBP %iles and PACER scores (p < 0.05 for all). One and two years of programme participation was associated with a 6% [95% CI: 0.92, 0.96] and 10% [95% CI: 0.87, 0.93] reduction in SBP%ile, respectively (p < 0.001), and a 36% [95% CI: 1.28, 1.45] and 57% [95% CI: 1.44, 1.70] increase in PACER score laps, respectively, compared to baseline.

Conclusions: Results here suggest that park-based, structured afterschool programmes with a focus on health and wellness can be a rich resource for this nation by offering both exclusive and immersion programmes for children with intellectual disability to foster cardiovascular health in all youth.
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http://dx.doi.org/10.1111/jar.12642DOI Listing
November 2019

Does transportation vulnerability explain the relationship between changes in exposure to segregation and youth cardiovascular health?

Health Place 2019 05 24;57:265-276. Epub 2019 May 24.

Department of Pediatrics, University of Miami Miller School of Medicine, 1601 NW 12th Ave, Miami, FL, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, 1601 NW 12th Ave, Miami, FL, USA.

Transportation vulnerability (lack of community/personal access to transportation that in turn increases the risk for health or financial consequences in the event of hardship/disease/disasters) may be an important mechanistic factor linking residential segregation to youth cardiovascular health inequities. This natural experiment examined the impact of transportation vulnerability on the association between changes in exposure to residential segregation and cardiovascular health among minority youth (n = 2,129, mean age 9.1 years, 54% male; 52% Hispanic, 48% non-Hispanic black [NHB]; 49% high area poverty) over two years. Two-level generalized linear mixed models with random intercepts were fit to test the effects of transportation vulnerability on the association between changes in segregation and cardiovascular health (body mass index percentile (BMIP), sum of skinfold thicknesses, 400 m run time, systolic and diastolic blood pressure percentiles (SBPP and DBPP, respectively) over two school years and across gender. After adjusting for potential confounders (individual-level race/ethnicity, age, time, and park-area poverty), improvements in cardiovascular health were greatest for girls exposed to reduced segregation with high compared with low transportation vulnerability for all outcomes. Specifically, BMIP and SBPP decreased 29% (IRR 95% CI: 0.69, 0.73) and 13% (IRR 95% CI: 0.85, 0.90) vs. 10% (IRR 95% CI: 0.84, 0.96) and no significant change (IRR 95% CI: 0.88, 1.00), for high and low transportation vulnerability, respectively. Adjusted models showed the greatest improvements in cardiovascular health for boys exposed to reduced segregation and low compared with high transportation vulnerability for BMIP and skinfold thicknesses. Specifically, BMIP and skinfold thicknesses decreased 33% (IRR 95% CI: 0.73, 0.81) and 21% (IRR 95% CI: 0.74, 0.84) vs. increased 8% (IRR 95% CI: 1.05, 1.11) and no significant change (IRR 95% CI: 0.96, 1.03), for low and high transportation vulnerability, respectively. Policy interventions that promote transportation equity should be further studied as a means to reduce youth cardiovascular health disparities, particularly for girls living in areas with high racial/ethnic segregation.
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http://dx.doi.org/10.1016/j.healthplace.2019.04.002DOI Listing
May 2019

Zinc Thiolate Enables Bright Cu-Deficient Cu-In-S/ZnS Quantum Dots.

Small 2019 07 22;15(27):e1901462. Epub 2019 May 22.

Department of Chemistry, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA.

Copper indium sulfide (CIS) colloidal quantum dots (QDs) are a promising candidate for commercially viable QD-based optical applications, for example as colloidal photocatalysts or in luminescent solar concentrators (LSCs). CIS QDs with good photoluminescence quantum yields (PLQYs) and tunable emission wavelength via size and composition control are previously reported. However, developing an understanding and control over the growth of electronically passivating inorganic shells would enable further improvements of the photophysical properties of CIS QDs. To improve the optical properties of CIS QDs, the focus is on the growth of inorganic shells via the popular metal-carboxylate/alkane thiol decomposition reaction. 1) The role of Zn-carboxylate and Zn-thiolate on the formation of ZnS shells on Cu-deficient CIS (CDCIS) QDs is studied, 2) this knowledge is leveraged to yield >90% PLQY CDCIS/ZnS core/shell QDs, and 3) a mechanism for ZnS shells grown from zinc-carboxylate/alkane thiol decomposition is proposed.
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http://dx.doi.org/10.1002/smll.201901462DOI Listing
July 2019

After-school poly-strengths programming for urban teens at high risk for violence exposure.

Transl Behav Med 2019 05;9(3):541-548

Florida International University, Miami, FL.

Violence exposure increases teens' risk for emotion dysregulation, anxiety, depression, and aggression towards peers. Teens of color are disproportionately more likely to be exposed to violence and less likely to receive mental health services. Community after-school programs can help reduce disparities by offering opportunities for skills development and mental health promotion to mitigate risk associated with violence exposure. The present study explores the promise of a parks-based after-school paid internship program for black and Latinx teens with weekly, group-based enrichment to promote educational attainment, job skills, and health behaviors. University and park administrators collaborated to design a program comprised of paid work (10 hr/week at US$9.05/hr) and weekly 2 hr enrichment (e.g., job skills, meditation, and sleep health psychoeducation). The sample includes 38 youth (n = 38; 15-17 years old [M = 16.26, SD = .73]; 42.1 per cent female; 95.2 per cent non-Latinx black, 4.8 per cent Latinx white). Data analyses include pre-/post-measures of violent and nonviolent adversity, emotion regulation, anxiety, depression, and self-efficacy to manage peer conflict. There were no significant changes from Time 1 (T1) to Time 2 (T2) in teen-reported cognitive reappraisal, emotion suppression, anxiety, depression, or self-efficacy to resolve peer conflict. Teens with more violence exposure at T1 reported significant reductions in anxiety at T2. Teens with more overall adversity reported significant reductions in anxiety and improvements in self-efficacy to resolve peer conflict. Findings indicate that after-school programs infused with poly-strengths programming can benefit diverse teens at high risk for violence exposure.
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http://dx.doi.org/10.1093/tbm/ibz013DOI Listing
May 2019

The Osteopathic Applicant.

J Emerg Med 2019 Apr;56(4):e65-e69

Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanons.

The number of osteopathic students choosing emergency medicine (EM) as a specialty is continuously increasing. However, EM remains a competitive specialty. Accordingly, in this article we guide osteopathic students interested in EM through the Comprehensive Osteopathic Medical Licensing Examination (COMLEX), the United States Medical Licensing Examination (USMLE), third- and fourth-year rotations, and the match process. Additionally, we provide tips on the process of applying to allopathic programs and we discuss the timeline of both the allopathic and osteopathic match. Finally, we discuss the effect of the Single Accreditation System and the Memorandum of Understanding, an agreement to merge the allopathic and osteopathic graduate medical education systems into a single graduate medical education accreditation system. This is expected to be completed as of July 1, 2020. Therefore, we elucidate the expectations for osteopathic applicants (particularly with regards to the USMLE and COMLEX examinations).
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http://dx.doi.org/10.1016/j.jemermed.2018.11.003DOI Listing
April 2019