Publications by authors named "Mary Young"

290 Publications

Current and future carbon stocks in coastal wetlands within the Great Barrier Reef catchments.

Glob Chang Biol 2021 Apr 16. Epub 2021 Apr 16.

Centre for Integrative Ecology, School of Life and Environmental Sciences, Deakin University, Burwood, Vic, Australia.

Australia's Great Barrier Reef (GBR) catchments include some of the world's most intact coastal wetlands comprising diverse mangrove, seagrass and tidal marsh ecosystems. Although these ecosystems are highly efficient at storing carbon in marine sediments, their soil organic carbon (SOC) stocks and the potential changes resulting from climate impacts, including sea level rise are not well understood. For the first time, we estimated SOC stocks and their drivers within the range of coastal wetlands of GBR catchments using boosted regression trees (i.e. a machine learning approach and ensemble method for modelling the relationship between response and explanatory variables) and identified the potential changes in future stocks due to sea level rise. We found levels of SOC stocks of mangrove and seagrass meadows have different drivers, with climatic variables such as temperature, rainfall and solar radiation, showing significant contributions in accounting for variation in SOC stocks in mangroves. In contrast, soil type accounted for most of the variability in seagrass meadows. Total SOC stock in the GBR catchments, including mangroves, seagrass meadows and tidal marshes, is approximately 137 Tg C, which represents 9%-13% of Australia's total SOC stock while encompassing only 4%-6% of the total extent of Australian coastal wetlands. In a global context, this could represent 0.5%-1.4% of global SOC stock. Our study suggests that landward migration due to projected sea level rise has the potential to enhance carbon accumulation with total carbon gains between 0.16 and 0.46 Tg C and provides an opportunity for future restoration to enhance blue carbon.
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http://dx.doi.org/10.1111/gcb.15642DOI Listing
April 2021

IL-13 is a driver of COVID-19 severity.

medRxiv 2021 Mar 1. Epub 2021 Mar 1.

Immune dysregulation is characteristic of the more severe stages of SARS-CoV-2 infection. Understanding the mechanisms by which the immune system contributes to COVID-19 severity may open new avenues to treatment. Here we report that elevated interleukin-13 (IL-13) was associated with the need for mechanical ventilation in two independent patient cohorts. In addition, patients who acquired COVID-19 while prescribed Dupilumab had less severe disease. In SARS-CoV-2 infected mice, IL-13 neutralization reduced death and disease severity without affecting viral load, demonstrating an immunopathogenic role for this cytokine. Following anti-IL-13 treatment in infected mice, in the lung, hyaluronan synthase 1 ( ) was the most downregulated gene and hyaluronan accumulation was decreased. Blockade of the hyaluronan receptor, CD44, reduced mortality in infected mice, supporting the importance of hyaluronan as a pathogenic mediator, and indicating a new role for IL-13 in lung disease. Understanding the role of IL-13 and hyaluronan has important implications for therapy of COVID-19 and potentially other pulmonary diseases.

Summary: L-13 levels are elevated in patients with severe COVID-19. In a mouse model of disease, IL-13 neutralization results in reduced disease and lung hyaluronan deposition. Similarly, blockade of hyaluronan's receptor, CD44, reduces disease, highlighting a novel mechanism for IL-13-mediated pathology.
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http://dx.doi.org/10.1101/2020.06.18.20134353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941663PMC
March 2021

Estimating blue carbon sequestration under coastal management scenarios.

Sci Total Environ 2021 Feb 22;777:145962. Epub 2021 Feb 22.

Deakin University School of Life and Environmental Sciences, Warrnambool, VIC 3280, Australia.

Restoring and protecting "blue carbon" ecosystems - mangrove forests, tidal marshes, and seagrass meadows - are actions considered for increasing global carbon sequestration. To improve understanding of which management actions produce the greatest gains in sequestration, we used a spatially explicit model to compare carbon sequestration and its economic value over a broad spatial scale (2500 km of coastline in southeastern Australia) for four management scenarios: (1) Managed Retreat, (2) Managed Retreat Plus Levee Removal, (3) Erosion of High Risk Areas, (4) Erosion of Moderate to High Risk Areas. We found that carbon sequestration from avoiding erosion-related emissions (abatement) would far exceed sequestration from coastal restoration. If erosion were limited only to the areas with highest erosion risk, sequestration in the non-eroded area exceeded emissions by 4.2 million Mg CO by 2100. However, losing blue carbon ecosystems in both moderate and high erosion risk areas would result in net emissions of 23.0 million Mg CO by 2100. The removal of levees combined with managed retreat was the strategy that sequestered the most carbon. Across all time points, removal of levees increased sequestration by only an additional 1 to 3% compared to managed retreat alone. Compared to the baseline erosion scenario, the managed retreat scenario increased sequestration by 7.40 million Mg CO by 2030, 8.69 million Mg CO by 2050, and 16.6 million Mg CO by 2100. Associated economic value followed the same patterns, with large potential value loss from erosion greater than potential gains from conserving or restoring ecosystems. This study quantifies the potential benefits of managed retreat and preventing erosion in existing blue carbon ecosystems to help meet climate change mitigation goals by reducing carbon emissions.
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http://dx.doi.org/10.1016/j.scitotenv.2021.145962DOI Listing
February 2021

IgG Antibodies against SARS-CoV-2 Correlate with Days from Symptom Onset, Viral Load and IL-10.

medRxiv 2020 Dec 7. Epub 2020 Dec 7.

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a pandemic of the respiratory disease coronavirus disease 2019 (COVID-19). Antibody testing is essential to identify persons exposed to the virus and potentially in predicting disease immunity. 183 COVID-19 patients (68 of whom required mechanical ventilation) and 41 controls were tested for plasma IgG, IgA and IgM against the SARS-CoV-2 S1, S2, receptor binding domain (RBD) and N proteins using the MILLIPLEX SARS-CoV-2 Antigen Panel. Plasma cytokines were concurrently measured using the MILLIPLEX® MAP Human Cytokine/Chemokine/Growth Factor Panel A. As expected the 183 COVID-19 positive patients had high levels of IgG, IgA and IgM anti-SARS-CoV-2 antibodies against each of the viral proteins. Sensitivity of anti-S1 IgG increased from 60% to 93% one week after symptom onset. S1-IgG and S1-IgA had specificities of 98% compared to the 41 COVID-19 negative patients. The 68 ventilated COVID-19 positive patients had higher antibody levels than the 115 COVID-19 positive patients who were not ventilated. IgG antibody levels against S1 protein had the strongest positive correlation to days from symptom onset. There were no statistically significant differences in IgG, IgA and IgM antibodies against S1 based on age. We found that patients with the highest levels of anti-SARS-CoV-2 antibodies had the lowest viral load in the nasopharynx. Finally there was a correlation of high plasma IL-10 with low anti-SARS-CoV-2 antibodies. Anti-SARS-CoV-2 antibody levels, as measured by a novel antigen panel, increased within days after symptom onset, achieving > 90% sensitivity and specificity within one week, and were highest in patients who required mechanical ventilation. Antibody levels were inversely associated with viral load but did not differ as a function of age. The correlation of high IL-10 with low antibody response suggests a potentially suppressive role of this cytokine in the humoral immune response in COVID-19.
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http://dx.doi.org/10.1101/2020.12.05.20244541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7743087PMC
December 2020

Bone marrow microenvironments that contribute to patient outcomes in newly diagnosed multiple myeloma: A cohort study of patients in the Total Therapy clinical trials.

PLoS Med 2020 11 4;17(11):e1003323. Epub 2020 Nov 4.

Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America.

Background: The tumor microenvironment (TME) is increasingly appreciated as an important determinant of cancer outcome, including in multiple myeloma (MM). However, most myeloma microenvironment studies have been based on bone marrow (BM) aspirates, which often do not fully reflect the cellular content of BM tissue itself. To address this limitation in myeloma research, we systematically characterized the whole bone marrow (WBM) microenvironment during premalignant, baseline, on treatment, and post-treatment phases.

Methods And Findings: Between 2004 and 2019, 998 BM samples were taken from 436 patients with newly diagnosed MM (NDMM) at the University of Arkansas for Medical Sciences in Little Rock, Arkansas, United States of America. These patients were 61% male and 39% female, 89% White, 8% Black, and 3% other/refused, with a mean age of 58 years. Using WBM and matched cluster of differentiation (CD)138-selected tumor gene expression to control for tumor burden, we identified a subgroup of patients with an adverse TME associated with 17 fewer months of progression-free survival (PFS) (95% confidence interval [CI] 5-29, 49-69 versus 70-82 months, χ2 p = 0.001) and 15 fewer months of overall survival (OS; 95% CI -1 to 31, 92-120 versus 113-129 months, χ2 p = 0.036). Using immunohistochemistry-validated computational tools that identify distinct cell types from bulk gene expression, we showed that the adverse outcome was correlated with elevated CD8+ T cell and reduced granulocytic cell proportions. This microenvironment develops during the progression of premalignant to malignant disease and becomes less prevalent after therapy, in which it is associated with improved outcomes. In patients with quantified International Staging System (ISS) stage and 70-gene Prognostic Risk Score (GEP-70) scores, taking the microenvironment into consideration would have identified an additional 40 out of 290 patients (14%, premutation p = 0.001) with significantly worse outcomes (PFS, 95% CI 6-36, 49-73 versus 74-90 months) who were not identified by existing clinical (ISS stage III) and tumor (GEP-70) criteria as high risk. The main limitations of this study are that it relies on computationally identified cell types and that patients were treated with thalidomide rather than current therapies.

Conclusions: In this study, we observe that granulocyte signatures in the MM TME contribute to a more accurate prognosis. This implies that future researchers and clinicians treating patients should quantify TME components, in particular monocytes and granulocytes, which are often ignored in microenvironment studies.
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http://dx.doi.org/10.1371/journal.pmed.1003323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641353PMC
November 2020

Immunomodulation in Pomalidomide, Dexamethasone, and Daratumumab-Treated Patients with Relapsed/Refractory Multiple Myeloma.

Clin Cancer Res 2020 Nov 14;26(22):5895-5902. Epub 2020 Sep 14.

Bristol Myers Squibb, Summit, New Jersey.

Purpose: Addition of daratumumab to pomalidomide and low-dose dexamethasone (LoDEX) is a safe and effective combination for relapsed/refractory multiple myeloma treatment. We sought to better understand immune combinational benefit of pomalidomide and daratumumab with LoDEX.

Patients And Methods: Immunophenotypic changes were analyzed in peripheral blood from longitudinal sampling of patients treated with this triplet regimen from cohort B of the CC4047-MM-014 phase II trial (NCT01946477).

Results: Consistent with the daratumumab mechanism, treatment led to decreased natural killer (NK) and B cells. In contrast, pronounced increases occurred in activated and proliferating NK and T cells, appreciably in CD8 T cells, along with reduction in naïve and expansion of effector memory compartments. Timing of T-cell changes correlated with pomalidomide dosing schedule. Enhanced activation/differentiation did not result in increased exhausted T-cell phenotypes or increases in regulatory T cells. Similar immune enhancements were also observed in patients previously refractory to lenalidomide.

Conclusions: These data support a potential mechanism for enhanced immune-mediated cytotoxicity in which daratumumab-mediated NK-cell diminution is partially offset by pomalidomide effects on the remaining NK-cell pool. Furthermore, daratumumab antimyeloma activity and elimination of CD38 T cells (regulatory/activated) provide a rationale for therapeutic combination with direct tumoricidal activity and immunomodulation of pomalidomide-directed T-cell enhancements. These data highlight enhancements in immune subpopulations for the combination of daratumumab with pomalidomide and potentially with next-generation cereblon-targeting agents.
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http://dx.doi.org/10.1158/1078-0432.CCR-20-1781DOI Listing
November 2020

Sex Trafficking in the United States: A Scoping Review.

J Evid Based Soc Work (2019) 2020 Nov-Dec;17(6):714-748. Epub 2020 Jul 17.

Department of Epidemiology, University of Florida , Gainesville, Florida, USA.

Purpose: Human trafficking is a public health social work issue. This review aimed to present the current state (nature and extent) of sex trafficking research, categorize best practices, and identify recommendations for professionals.

Methods: Comprehensive literature searches of online databases were conducted to identify eligible articles from January 2000 to March 2019.

Results: The search yielded 467 studies, 87 met the predetermined criteria for inclusion. Seven themes identified: awareness, identification, at-risk populations, health issues, implementation of trafficking legislation, service and program implementation, and exploiters.

Discussion And Implications For Practice: Findings indicate the need for additional research to determine the most effective practices to increase awareness and identification, widespread TVPA implementation, reduce risk factors and resulting health disparities, offer services to survivors and prevention of potential victims.

Conclusion: There should be significant efforts to enhance all sex trafficking research in the United States to implement effective, sustainable and evidence-based interdisciplinary interventions.
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http://dx.doi.org/10.1080/26408066.2020.1765934DOI Listing
December 2020

Development of a Minority Prostate Cancer Research Digest: Communication Strategy Statement for Black Men.

J Cancer Educ 2020 Jul 7. Epub 2020 Jul 7.

College of Pharmacy, University of Florida, Orlando, FL, USA.

Since prostate cancer incidence, prevalence and mortality are still highest among Black men in the United States, it is important to effectively address the factors that contribute to prostate cancer disparities in this at-risk population as well as their low participation in biomedical research/clinical trials. An effective communication strategy that can be used to disseminate information with high public health impact to Black men is one way to combat prostate cancer disparities. The objective of this study was to develop a Minority Prostate Cancer (MiCaP) research communication strategy using focus group methodology and expert in-depth interviews. The communication strategy statement developed in this study provides a guide for message concepts and materials for Black men, including communication content, source, channel, and location. Specifically, it provides recommendations on how to deliver information, how to choose the language and relevant images, how to gain attention, who is preferred to deliver messages, and other ways to engage Black men in health communication strategies. The communication strategy statement was used to develop the MiCaP Research Digest, a research communication program that is currently being tested in Orange County, Duval County, Leon County, Gadsden County, and the Tampa Bay area of Florida.
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http://dx.doi.org/10.1007/s13187-020-01815-0DOI Listing
July 2020

Measuring early childhood development with The Early Human Capability Index (eHCI): a reliability and validity study in China.

BMC Pediatr 2020 06 30;20(1):323. Epub 2020 Jun 30.

Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Background: With the importance of early childhood development more recognized by the international society, low-cost and cross-culturally comparable measures of early childhood development is in great demand, both in China and worldwide. In this study, we aim to test the psychometrics of the Chinese version of The Early Human Capability Index (eHCI), which is designed as a measurement for school readiness in large population.

Methods: We evaluated the internal consistency, test-retest reliability, inter-rater reliability, factor structure, criterion-related validity, and discriminant validity of the eHCI in 20,324 preschool children in Shanghai. We also compared eHCI scores with test result of ASQ in 815 children in Yexian and EAP-ECDS in 6947 children in Daming.

Results: The ICC between parents and teachers were 0.83 and 0.63 for Literacy Numeracy and Overall Development. The confirmatory factor analyses showed good model fit (χ2 = 509,323, p < 0.001; CFI = 0.901; RMSEA = 0.038). The correlations between the scores of eHCI and other ECD metrics ranged between r = - 0.42 and r = 0.53. The scale discriminated between children's developmental level based on sex, parental education, family income, family assets, and nutrition status.

Conclusions: Results from Chinese population suggested that eHCI is valid and reliable for measuring early childhood development in children aged 3-6 years. The eHCI can be applied to map the global distribution of early childhood development for allocating scarce resources to help those in greatest demand. Longitudinal studies are warranted to test its predictive validity for later outcomes.
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http://dx.doi.org/10.1186/s12887-020-02210-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325662PMC
June 2020

Driving Outside the Wire: Examining Factors Impacting Veterans' Postdeployment Driving.

OTJR (Thorofare N J) 2020 10 27;40(4):235-244. Epub 2020 Apr 27.

University of Florida, Gainesville, USA.

Combat Veterans (CVs) deployed to Iraq or Afghanistan experience driving difficulty, based on medical conditions and/or deployment exposures, elevating their risk of motor vehicle crash-related injury or death. To address grounded theory rigor and incorporate constructs such as the Person Environment Occupation Performance model, we revised the Hannold et al. (2013) conceptual framework. We conducted two focus groups with seven CVs. Conceptual framework revisions were based on an iterative process and thematic analysis. We elicited CVs' perspectives on deployment training, driving pre- and postdeployment, strategies, and intervention preferences. Personal, environmental, and task factors underpinned CVs' driving. Participants described triggers (e.g., stressful stimuli), use of environmental (e.g., car controls) or personal (e.g., avoiding traffic) strategies, and outcomes of appropriate or risky driving. Findings illustrated CVs' driving difficulty and informed development of a Veteran-centric driving intervention. Improving driving fitness has implications for Veterans' participation and community integration.
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http://dx.doi.org/10.1177/1539449220914533DOI Listing
October 2020

Attitude change and increased confidence with management of chronic breathlessness following a health professional training workshop: a survey evaluation.

BMC Med Educ 2020 Mar 30;20(1):90. Epub 2020 Mar 30.

School of Health Sciences, Innovation, Implementation and Clinical Translation in Health (IIMPACT), University of South Australia, Adelaide, South Australia, Australia.

Background: Clinicians and people living with chronic breathlessness have expressed a need to better understand and manage this symptom. The aim of this study was to evaluate a 3-day health professional training workshop on the practical management of chronic breathlessness.

Methods: Workshop design and delivery were based on current understandings and clinical models of chronic breathlessness management, principles of transformative learning, and included sessions co-designed with people living with breathlessness. Registrants were invited to complete pre and post-workshop surveys. Pre and 1-week post-workshop online questionnaires assessed familiarity and confidence about workshop objectives (0[lowest]-10[highest] visual analogue scale), attitudes and practices regarding chronic breathlessness (agreement with statements on 5-point Likert scales). Post-workshop, participants were asked to describe implementation plans and anticipated barriers. Baseline familiarity and confidence were reported as mean (SD) and change examined with paired t-tests. Pre-post attitudes and practices were summarised by frequency/percentages and change examined non-parametrically (5-point Likert scale responses) or using a McNemar test of change (binary responses).

Results: Forty-seven of 55 registrants joined the study; 39 completed both pre and post-workshop questionnaires (35 female; 87% clinicians; median 8 years working with people with chronic breathlessness). Post-workshop, greatest gains in confidence were demonstrated for describing biopsychosocial concepts unpinning chronic breathlessness (mean change confidence = 3.2 points; 95% CI 2.7 to 4.0, p < 0.001). Respondents significantly changed their belief toward agreement that people are able to rate their breathlessness intensity on a scale (60 to 81% agreement) although only a minority strongly agreed with this statement at both time points (pre 11%, post 22%). The largest shift in attitude was toward agreement (z statistic 3.74, p < 0.001, effect size r = 0.6) that a person's experience of breathlessness should be used to guide treatment decisions (from 43 to 73% strong agreement). Participants' belief that cognitive behavioural strategies are effective for relief of breathlessness changed further toward agreement after the workshop (81 to 100%, McNemar test chi- square = 5.14, p = 0.02).

Conclusion: The focus of this training on biopsychosocial understandings of chronic breathlessness and involvement of people living with this symptom were valued. These features were identified as facilitators of change in fundamental attitudes and preparedness for practice.
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http://dx.doi.org/10.1186/s12909-020-02006-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7106669PMC
March 2020

Integrative network modeling reveals mechanisms underlying T cell exhaustion.

Sci Rep 2020 02 5;10(1):1915. Epub 2020 Feb 5.

Bristol-Myers Squibb, Summit, NJ, USA.

Failure to clear antigens causes CD8 T cells to become increasingly hypo-functional, a state known as exhaustion. We combined manually extracted information from published literature with gene expression data from diverse model systems to infer a set of molecular regulatory interactions that underpin exhaustion. Topological analysis and simulation modeling of the network suggests CD8 T cells undergo 2 major transitions in state following stimulation. The time cells spend in the earlier pro-memory/proliferative (PP) state is a fixed and inherent property of the network structure. Transition to the second state is necessary for exhaustion. Combining insights from network topology analysis and simulation modeling, we predict the extent to which each node in our network drives cells towards an exhausted state. We demonstrate the utility of our approach by experimentally testing the prediction that drug-induced interference with EZH2 function increases the proportion of pro-memory/proliferative cells in the early days post-activation.
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http://dx.doi.org/10.1038/s41598-020-58600-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002445PMC
February 2020

Quantifying welfare gains of coastal and estuarine ecosystem rehabilitation for recreational fisheries.

Sci Total Environ 2020 Mar 23;710:134680. Epub 2019 Nov 23.

School of Life and Environmental Science, Centre for Integrative Ecology, Deakin University, Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125, Australia.

Coastal and estuarine ecosystems, such as mangroves, tidal marshes and seagrass meadows, provide a range of ecosystem services, but have seen extensive degradation and decline. Effective protection and rehabilitation of coastal ecosystems requires an understanding of how efforts may improve associated ecosystem services. In this study, we present a spatially-explicit angler catch function to predict boat-based recreational catch as a function of ecosystem and angler characteristics. We developed a choice model to investigate where recreational anglers launch their boats and fish in southeast Australia. By linking the recreational catch models with a choice model, we were able to quantify welfare gains of ecosystem rehabilitation. We found welfare gains across fishing locations varied widely due to heterogeneous coverage of seagrass. The welfare gains of different fishing locations ranged from near-zero in areas of low seagrass coverage, to AU $19.18 (10% increase in seagrass area) and to AU $85.55 (30% increase) per trip in location of high seagrass coverage. Given two million fishing trips occurring per year in Port Phillip Bay, and one million in Western Port, the aggregated welfare gain could scale up to AU $6.2 million with a 10% increase in seagrass coverage, and AU $22 million per annum with a 30% increase in seagrass. We also calculated the welfare loss associated with total loss of seagrass ecosystem in each fishing location to represent the current value, which varied significantly, ranging from near-zero in some locations to AU $87.47 per trip in other locations. Over the past several decades, the bay-wide seagrass ecosystem has dropped by 36.7% in Western Port, resulting in potential welfare loss of an estimated AU $ 86.7 million per annum. Our analyses provide insightful spatial policy implications for coastal and marine ecosystem rehabilitation in the region.
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http://dx.doi.org/10.1016/j.scitotenv.2019.134680DOI Listing
March 2020

Exacerbation action plans for patients with COPD and comorbidities: a randomised controlled trial.

Eur Respir J 2019 11 7;54(5). Epub 2019 Nov 7.

College of Medicine and Public Health, Flinders University, Adelaide, Australia.

This international randomised controlled trial evaluated whether COPD patients with comorbidities, trained in using patient-tailored multidisease exacerbation action plans, had fewer COPD exacerbation days than usual care (UC).COPD patients (Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification II-IV) with ≥1 comorbidity (ischaemic heart disease, heart failure, diabetes, anxiety, depression) were randomised to a patient-tailored self-management intervention (n=102) or UC (n=99). Daily symptom diaries were completed for 12 months. The primary outcome "COPD exacerbation days per patient per year" was assessed using intention-to-treat analyses.No significant difference was observed in the number of COPD exacerbation days per patient per year (self-management: median 9.6 (interquartile range (IQR) 0.7-31.1); UC: median 15.6 (IQR 3.0-40.3); incidence rate ratio (IRR) 0.87 (95% CI 0.54; 1.39); p=0.546). There was a significantly shorter duration per COPD exacerbation for self-management (self-management: median 8.1 (IQR 4.8-10.1) days; UC: median 9.5 (IQR 7.0-15.1) days; p=0.021), with no between-group differences in the total number of respiratory hospitalisations (IRR 0.76 (95% CI 0.42; 1.35); p=0.348), but a lower probability of ≥1 for respiratory-related hospitalisation compared to UC (relative risk 0.55 (95% CI 0.35; 0.87); p=0.008). No between-group differences were observed in all-cause hospitalisations (IRR 1.07 (95% CI 0.66; 1.72)) or mortality (self-management: n=4 (3.9%); UC: n=7 (7.1%); relative risk 0.55 (95% CI 0.17; 1.84)).Patient-tailored exacerbation action plans for COPD patients with comorbidities did not significantly reduce exacerbation days, but reduced the duration per COPD exacerbation and the risk of having at least one respiratory-related hospitalisation during follow-up, without excess all-cause mortality.
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http://dx.doi.org/10.1183/13993003.02134-2018DOI Listing
November 2019

IL-33 drives group 2 innate lymphoid cell-mediated protection during Clostridium difficile infection.

Nat Commun 2019 06 20;10(1):2712. Epub 2019 Jun 20.

Department of Microbiology, Immunology and Cancer Biology, University of Virginia Health System, Charlottesville, VA, 22908, USA.

Clostridium difficile (C. difficile) incidence has tripled over the past 15 years and is attributed to the emergence of hypervirulent strains. While it is clear that C. difficile toxins cause damaging colonic inflammation, the immune mechanisms protecting from tissue damage require further investigation. Through a transcriptome analysis, we identify IL-33 as an immune target upregulated in response to hypervirulent C. difficile. We demonstrate that IL-33 prevents C. difficile-associated mortality and epithelial disruption independently of bacterial burden or toxin expression. IL-33 drives colonic group 2 innate lymphoid cell (ILC2) activation during infection and IL-33 activated ILC2s are sufficient to prevent disease. Furthermore, intestinal IL-33 expression is regulated by the microbiota as fecal microbiota transplantation (FMT) rescues antibiotic-associated depletion of IL-33. Lastly, dysregulated IL-33 signaling via the decoy receptor, sST2, predicts C. difficile-associated mortality in human patients. Thus, IL-33 signaling to ILC2s is an important mechanism of defense from C. difficile colitis.
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http://dx.doi.org/10.1038/s41467-019-10733-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6586630PMC
June 2019

Viremia Trajectories of HIV in HIV-Positive Women in the United States, 1994-2017.

JAMA Netw Open 2019 05 3;2(5):e193822. Epub 2019 May 3.

Department of Medicine, Georgetown University Medical Center, Washington, DC.

Importance: Viral suppression of HIV is an important treatment goal to decrease morbidity, mortality, and risk of transmission to others.

Objective: To characterize longitudinal HIV viral load outcomes among women enrolled in the Women's Interagency HIV Study (WIHS).

Design, Setting, And Participants: A prospective cohort study of HIV-positive women with semiannual study visits and a minimum of 5 follow-up visits was conducted from 1994 to 2017. The WIHS sites included in this analysis are in Brooklyn and Bronx, New York; Chicago, Illinois; San Francisco, California; and Washington, DC.

Main Outcomes And Measures: Women were categorized into groups based on their probability of achieving viral load suppression below 200 copies/mL using logistic trajectory modeling. Multinomial regression analysis was used to identify factors associated with placement in the group with the highest probability of viremia.

Results: At baseline, the mean (SD) age of the 1989 women was 36.9 (8.0) years, mean CD4+ T-lymphocyte count was 467/mm3, median (interquartile range) HIV RNA was 6200.0 (384.5-41 678.0) copies/mL, and 1305 women (65.6%) were African American. Three trajectory groups were identified with low (568 [28.6%]), intermediate (784 [39.4%]), and high (637 [32.0%]) probability of viremia above 200 copies/mL. The mean (SD) cumulative years of viral suppression were 18.7 (4.0) years, 12.2 (3.1) years, and 5.8 (2.9) years in the respective groups. Factors associated with high probability of viremia included younger age (odds ratio [OR]. 0.99; 95% CI, 0.98-0.99; P = .03), African American race (odds ratio [OR], 2.43; 95% CI, 1.75-3.37), P < .001), Hispanic race/ethnicity (OR, 1.50; 95% CI, 1.03-2.19; P = .04), increased levels of depressive symptoms (OR, 1.17; 95% CI, 1.01-1.36; P = .03), drug use (OR, 1.23; 95% CI, 1.01-1.51; P = .04), lower CD4+ T-lymphocyte counts (OR, 95% CI, 0.82; 0.80-0.85; P < .001), and unstable housing (OR, 1.25, 95% CI, 1.03-1.50; P = .02). Between 2015 and 2017, 71.2% of women demonstrated sustained viral suppression: 89.6% (310 of 346) of those with low viremia, 83.4% (346 of 415) with intermediate, and 35.2% (112 of 318) with high probability of viremia.

Conclusions And Relevance: This longitudinal approach suggested that the probability of viremia decreased substantially over time for most participants, including among women with earlier histories of incomplete viral suppression. The findings from this study suggest that continued efforts are needed to address mental health, social, behavioral and structural factors that were identified as associated with high probability of HIV viremia over time.
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http://dx.doi.org/10.1001/jamanetworkopen.2019.3822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537820PMC
May 2019

Local and regional scale habitat heterogeneity contribute to genetic adaptation in a commercially important marine mollusc (Haliotis rubra) from southeastern Australia.

Mol Ecol 2019 06 9;28(12):3053-3072. Epub 2019 Jun 9.

School of Life and Environmental Sciences, Centre for Integrative Ecology, Deakin University, Geelong, Victoria, Australia.

Characterising adaptive genetic divergence among conspecific populations is often achieved by studying genetic variation across defined environmental gradients. In marine systems this is challenging due to a paucity of information on habitat heterogeneity at local and regional scales and a dependency on sampling regimes that are typically limited to broad longitudinal and latitudinal environmental gradients. As a result, the spatial scales at which selection processes operate and the environmental factors that contribute to genetic adaptation in marine systems are likely to be unclear. In this study we explore patterns of adaptive genetic structuring in a commercially- harvested abalone species (Haliotis rubra) from southeastern Australia, using a panel of genome-wide SNP markers (5,239 SNPs), and a sampling regime informed by marine LiDAR bathymetric imagery and 20-year hindcasted oceanographic models. Despite a lack of overall genetic structure across the sampling distribution, significant genotype associations with heterogeneous habitat features were observed at local and regional spatial scales, including associations with wave energy, ocean current, sea surface temperature, and geology. These findings provide insights into the potential resilience of the species to changing marine climates and the role of migration and selection on recruitment processes, with implications for conservation and fisheries management. This study points to the spatial scales at which selection processes operate in marine systems and highlights the benefits of geospatially-informed sampling regimes for overcoming limitations associated with marine population genomic research.
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http://dx.doi.org/10.1111/mec.15128DOI Listing
June 2019

Perception of Older Adults Toward Smartwatch Technology for Assessing Pain and Related Patient-Reported Outcomes: Pilot Study.

JMIR Mhealth Uhealth 2019 03 26;7(3):e10044. Epub 2019 Mar 26.

Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States.

Background: Chronic pain, including arthritis, affects about 100 million adults in the United States. Complexity and diversity of the pain experience across time and people and its fluctuations across and within days show the need for valid pain reports that do not rely on patient's long-term recall capability. Smartwatches can be used as digital ecological momentary assessment (EMA) tools for real-time collection of pain scores. Smartwatches are generally less expensive than smartphones, are highly portable, and have a simpler user interface, providing an excellent medium for continuous data collection and enabling a higher compliance rate.

Objective: The aim of this study was to explore the attitudes and perceptions of older adults towards design and technological aspects of a smartwatch framework for measuring patient report outcomes (PRO) as an EMA tool.

Methods: A focus group session was conducted to explore the perception of participants towards smartwatch technology and its utility for PRO assessment. Participants included older adults (age 65+), with unilateral or bilateral symptomatic knee osteoarthritis. A preliminary user interface with server communication capability was developed and deployed on 10 Samsung Gear S3 smartwatches and provided to the users during the focus group. Pain was designated as the main PRO, while fatigue, mood, and sleep quality were included as auxiliary PROs. Pre-planned topics included participants' attitude towards the smartwatch technology, usability of the custom-designed app interface, and suitability of the smartwatch technology for PRO assessment. Discussions were transcribed, and content analysis with theme characterization was performed to identify and code the major themes.

Results: We recruited 19 participants (age 65+) who consented to take part in the focus group study. The overall attitude of the participants toward the smartwatch technology was positive. They showed interest in the direct phone-call capability, availability of extra apps such as the weather apps and sensors for tracking health and wellness such as accelerometer and heart rate sensor. Nearly three-quarters of participants showed willingness to participate in a one-year study to wear the watch daily. Concerns were raised regarding usability, including accessibility (larger icons), notification customization, and intuitive interface design (unambiguous icons and assessment scales). Participants expressed interest in using smartwatch technology for PRO assessment and the availability of methods for sharing data with health care providers.

Conclusions: All participants had overall positive views of the smartwatch technology for measuring PROs to facilitate patient-provider communications and to provide more targeted treatments and interventions in the future. Usability concerns were the major issues that will require special consideration in future smartwatch PRO user interface designs, especially accessibility issues, notification design, and use of intuitive assessment scales.
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http://dx.doi.org/10.2196/10044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454335PMC
March 2019

Elevated Depressive Symptoms Are a Stronger Predictor of Executive Dysfunction in HIV-Infected Women Than in Men.

J Acquir Immune Defic Syndr 2019 07;81(3):274-283

Departments of Psychiatry and Psychology, University of Illinois at Chicago College of Medicine, Chicago, IL.

Background: HIV-infected (HIV+) women seem to be more vulnerable to neurocognitive impairment (NCI) than HIV+ men, perhaps in part due to mental health factors. We assessed the association between elevated depressive symptoms and NCI among HIV+ and HIV-uninfected (HIV-) women and men.

Setting: Women's Interagency HIV Study and Multicenter AIDS Cohort Study.

Methods: Eight hundred fifty-eight HIV+ (429 women; 429 men) and 562 HIV- (281 women; 281 men) completed the Center for Epidemiologic Studies Depression (16 cutoff) Scale and measures of psychomotor speed/attention, executive, and motor function over multiple visits (or time points). Women's Interagency HIV Study and Multicenter AIDS Cohort Study participants were matched according to HIV status, age, race/ethnicity, and education. Generalized linear mixed models were used to examine interactions between biological sex, HIV serostatus, and depression on impairment (T-scores <40) after covariate adjustment.

Results: Despite a higher frequency of depression among men, the association between depression and executive function differed by sex and HIV serostatus. HIV+ women with depression had 5 times the odds of impairment on a measure of executive control and inhibition versus HIV- depressed women and 3 times the odds of impairment on that measure versus HIV+ depressed men. Regardless of group status, depression was associated with greater impairment on processing speed, executive (mental flexibility), and motor function (P's < 0.05).

Conclusions: Depression contributes to NCI across a broad range of cognitive domains in HIV+ and HIV- individuals, but HIV+ depressed women show greater vulnerabilities in executive function. Treating depression may help to improve cognition in patients with HIV infection.
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http://dx.doi.org/10.1097/QAI.0000000000002029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254882PMC
July 2019

Dysregulation in Genital Tract Soluble Immune Mediators in Postmenopausal Women Is Distinct by HIV Status.

AIDS Res Hum Retroviruses 2019 03 4;35(3):251-259. Epub 2019 Feb 4.

3 Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia.

A rise in new HIV diagnoses among older adults is characterized by poor prognosis and reduced survival times. Although heterosexual transmission remains the main route of infection in women, little is known regarding immune functions in the genital tract of postmenopausal women, especially those who are HIV positive. Furthermore, effects of hormone replacement therapy (HRT) on the genital tract immune system are unclear. Using the Women's Interagency HIV Study repository, we obtained cervical-vaginal lavage (CVL) samples from premenopausal and postmenopausal HIV-positive and HIV-negative women, some of whom were on HRT. Samples were assayed for interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α, secretory leukocyte protease inhibitor (SLPI), Elafin, human beta defensin-2 (HBD2), and macrophage inflammatory protein (MIP)-3α using ELISA. Anti-HIV activity in CVL was measured using TZM-bl indicator cells. Among HIV-positive women, the plasma viral load was significantly higher and CD4 count was significantly lower in postmenopausal compared with premenopausal women. Postmenopausal women, irrespective of HIV status, had significantly lower levels of HBD2 compared with premenopausal women. Among the HIV-negative individuals, postmenopausal women had significantly lower levels of MIP-3α, IL-6, and SLPI compared with premenopausal women. In contrast, HIV-positive postmenopausal women had significantly higher levels of TNF-α compared with HIV-positive premenopausal women. In most cases, HRT groups resembled the postmenopausal groups. No significant differences in anti-HIV activity by menopausal or by HIV status were noted. Our findings indicate that the female genital tract immune microenvironment is distinct by menopausal status and HIV status. Further studies are needed to assess the risk of HIV acquisition/transmission in this population.
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http://dx.doi.org/10.1089/AID.2018.0234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6909396PMC
March 2019

Use of Social Network Strategy Among Young Black Men Who Have Sex With Men for HIV Testing, Linkage to Care, and Reengagement in Care, Tennessee, 2013-2016.

Public Health Rep 2018 Nov/Dec;133(2_suppl):43S-51S

2 Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.

Objectives: Tennessee was 1 of 8 states that received funding from the Care and Prevention in the United States Demonstration Project, which aimed to reduce HIV-related morbidity and mortality among racial/ethnic and sexual minority populations. The objective of this study was to describe implementation of a social network strategy (SNS) program, which leverages personal connections in social networks, to reach people with undiagnosed HIV infection for HIV testing. We targeted young black men who have sex with men (MSM) at 3 agencies in Memphis and Nashville, Tennessee, during 2013-2016.

Methods: Specialists at the 3 agencies identified MSM with and without diagnosed HIV infection (ie, recruiters) who could recruit members from their social networks for HIV testing (ie, network associates). Both recruiters and network associates received OraQuick rapid and confirmatory HIV tests. We used χ and Fisher exact tests to assess differences in demographic characteristics, HIV testing, and care engagement status by agency.

Results: Of 1752 people who were tested for HIV in the SNS program, 158 (9.0%) tested positive; of these, 80 (50.6%) were newly diagnosed with HIV. Forty-seven of the 78 (60.3%) people who were previously diagnosed with HIV were not in care in the previous 12 months; of these, 27 (57.4%) were reengaged in medical care. Of 80 people newly diagnosed with HIV, 44 (55.0%) were linked to care.

Conclusions: The SNS program ascertained HIV status among a high-risk population in a heavily burdened region. Further program evaluation is needed to understand how to improve linkage to care among people with newly diagnosed HIV.
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http://dx.doi.org/10.1177/0033354918801893DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262520PMC
May 2019

Optimal soil carbon sampling designs to achieve cost-effectiveness: a case study in blue carbon ecosystems.

Biol Lett 2018 09 26;14(9). Epub 2018 Sep 26.

School of Life and Environmental Sciences, Centre for Integrative Ecology, Deakin University, Geelong, Victoria, Australia.

Researchers are increasingly studying carbon (C) storage by natural ecosystems for climate mitigation, including coastal 'blue carbon' ecosystems. Unfortunately, little guidance on how to achieve robust, cost-effective estimates of blue C stocks to inform inventories exists. We use existing data (492 cores) to develop recommendations on the sampling effort required to achieve robust estimates of blue C. Using a broad-scale, spatially explicit dataset from Victoria, Australia, we applied multiple spatial methods to provide guidelines for reducing variability in estimates of soil C stocks over large areas. With a separate dataset collected across Australia, we evaluated how many samples are needed to capture variability within soil cores and the best methods for extrapolating C to 1 m soil depth. We found that 40 core samples are optimal for capturing C variance across 1000's of kilometres but higher density sampling is required across finer scales (100-200 km). Accounting for environmental variation can further decrease required sampling. The within core analyses showed that nine samples within a core capture the majority of the variability and log-linear equations can accurately extrapolate C. These recommendations can help develop standardized methods for sampling programmes to quantify soil C stocks at national scales.
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http://dx.doi.org/10.1098/rsbl.2018.0416DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170757PMC
September 2018

Association of Urinary Biomarkers of Kidney Injury with Estimated GFR Decline in HIV-Infected Individuals following Tenofovir Disoproxil Fumarate Initiation.

Clin J Am Soc Nephrol 2018 09 28;13(9):1321-1329. Epub 2018 Aug 28.

Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, San Francisco, California;

Background And Objectives: Tenofovir disoproxil fumarate (tenofovir) is associated with elevated concentrations of biomarkers of kidney damage and dysfunction in individuals with HIV. The relationship of these kidney biomarkers with longitudinal kidney function decline is unknown.

Design, Setting, Participants, & Measurements: We evaluated associations of 14 urinary biomarkers of kidney injury with changes in eGFR among 198 men and women with HIV who initiated tenofovir between 2009 and 2015 in the Multicenter AIDS Cohort Study and Women's Interagency HIV Study. Urinary biomarkers included albumin-to-creatinine ratio, -1-microglobulin, -2-microglobulin, cystatin C, kidney injury molecule-1 (KIM-1), IL-18, neutrophil gelatinase-associated lipocalin (NGAL), clusterin, osteopontin, uromodulin, monocyte chemoattractant protein-1, EGF, trefoil factor 3, and chitinase 3-like protein 1. We used multivariable linear mixed-effect models controlling for demographics, traditional kidney disease risk factors, and HIV-related risk factors to evaluate associations of baseline biomarkers with first-year changes in eGFR, and associations of year 1 and first-year change in biomarkers with changes in eGFR from year 1 to year 3. We used the least absolute shrinkage and selection operator method to identify a parsimonious set of biomarkers jointly associated with changes in eGFR.

Results: Median eGFR before tenofovir initiation was 103 (interquartile range, 88-116) ml/min per 1.73 m. During the first year of tenofovir use, eGFR decreased on average by 9.2 (95% confidence interval, 6.5 to 11.9) ml/min per 1.73 m and was stable afterward (decrease of 0.62; 95% confidence interval, -0.85 to 2.1 ml/min per 1.73 m per year). After multivariable adjustment, higher baseline -2-microglobulin, KIM-1, and clusterin were associated with larger first-year eGFR declines, whereas higher baseline uromodulin was associated with a smaller eGFR decline. First-year increase in urinary cystatin C and higher year 1 IL-18 were associated with larger annual eGFR declines from year 1 to year 3. The parsimonious models identified higher pre-tenofovir clusterin and KIM-1, lower pre-tenofovir uromodulin, and higher year 1 IL-18 as jointly associated with larger eGFR declines.

Conclusions: Urinary biomarkers of kidney injury measured before and after tenofovir initiation are associated with subsequent changes in eGFR in individuals with HIV.

Podcast: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_08_28_CJASNPodcast_18_9_S.mp3.
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http://dx.doi.org/10.2215/CJN.01700218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140559PMC
September 2018

Do vaccination interventions have effects? A study on how poultry vaccination interventions change smallholder farmer knowledge, attitudes, and practice in villages in Kenya and Tanzania.

Trop Anim Health Prod 2019 Jan 17;51(1):213-220. Epub 2018 Aug 17.

International Livestock Research Institute, PO Box 30709, Nairobi, 00100, Kenya.

Poultry are important for many poor households in developing countries, but there are many constraints to poultry production, including disease. One of the most important diseases of chickens is Newcastle disease (ND). Even though there are effective vaccines against this disease available in most countries, uptake by small-scale poultry keepers is often low. In this study, two areas in Kenya and Tanzania were studied, where some villages had received additional support to get vaccination and other villages had not. In Kenya, 320 households from 10 villages were interviewed, of which half of the villages had active promotion of vaccination through village-based advisors. In Tanzania, 457 households were interviewed, of which 241 came from villages that have had active support through either a project or government extension services. Knowledge about vaccines and the attitudes towards vaccinating against ND was evaluated using mixed multivariable logistic models. Results indicate that in Kenya, the most important determinants for understanding the function of a vaccine were having had support in the village and to have knowledge about ND signs, while in Tanzania gender and previous vaccine use were important in addition to having had support. Attitudes towards vaccination were mainly determined by knowledge, where more knowledge about how vaccines work in general or about ND contributed to more positive attitudes. Among Kenyan farmers that had never used the vaccine before, the amount of birds they lost to disease and predators also influenced attitudes. In conclusion, this study supports the notion that knowledge is a very important component of extension support and that simply making vaccines available may not be sufficient for high levels of uptake.
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http://dx.doi.org/10.1007/s11250-018-1679-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6347585PMC
January 2019

Differences in Cognitive Function Between Women and Men With HIV.

J Acquir Immune Defic Syndr 2018 09;79(1):101-107

Department of Psychiatry, Rush University Medical Center, Chicago, IL.

Background: Women may be more vulnerable to HIV-related cognitive dysfunction compared with men because of sociodemographic, lifestyle, mental health, and biological factors. However, studies to date have yielded inconsistent findings on the existence, magnitude, and pattern of sex differences. We examined these issues using longitudinal data from 2 large, prospective, multisite, observational studies of US women and men with and without HIV.

Setting: The Women's Interagency HIV Study (WIHS) and Multicenter AIDS Cohort Study (MACS).

Methods: HIV-infected (HIV+) and uninfected (HIV-) participants in the Women's Interagency HIV Study and Multicenter AIDS Cohort Study completed tests of psychomotor speed, executive function, and fine motor skills. Groups were matched on HIV status, sex, age, education, and black race. Generalized linear mixed models were used to examine group differences on continuous and categorical demographically corrected T-scores. Results were adjusted for other confounding factors.

Results: The sample (n = 1420) included 710 women (429 HIV+) and 710 men (429 HIV+) (67% non-Hispanic black; 53% high school or less). For continuous T-scores, sex by HIV serostatus interactions were observed on the Trail Making Test parts A & B, Grooved Pegboard, and Symbol Digit Modalities Test. For these tests, HIV+ women scored lower than HIV+ men, with no sex differences in HIV- individuals. In analyses of categorical scores, particularly the Trail Making Test part A and Grooved Pegboard nondominant, HIV+ women also had a higher odds of impairment compared with HIV+ men. Sex differences were constant over time.

Conclusions: Although sex differences are generally understudied, HIV+ women vs men show cognitive disadvantages. Elucidating the mechanisms underlying these differences is critical for tailoring cognitive interventions.
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http://dx.doi.org/10.1097/QAI.0000000000001764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092201PMC
September 2018

Prostate Cancer Screening Perception, Beliefs, and Practices Among Men in Bamenda, Cameroon.

Am J Mens Health 2018 09 16;12(5):1463-1472. Epub 2018 Apr 16.

3 Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.

Prostate Cancer (CaP) is the most commonly diagnosed cancer among Cameroonian men. Due to inadequate infrastructure, record keeping, and resources, little is known about its true burden on the population. There are rural/urban disparities with regards to awareness, screening, treatment, and survivorship. Furthermore, use of traditional medicine and homeopathic remedies is widespread, and some men delay seeking conventional medical treatment until advanced stages of CaP. This study examined the perceptions, beliefs, and practices of men in Cameroon regarding late stage CaP diagnoses; identified factors that influence screening decision; and ascertained how men decided between traditional or conventional medicine for CaP diagnosis and treatment. Semistructured focus groups were used to collect data from men in Bamenda, Cameroon. Qualitative data analysis was used to analyze transcripts for emerging themes and constructs using a socio-ecological framework. Twenty-five men participated in the study, with an average age of 59. Most of the participants had never received a prostate screening recommendation. Socioeconomic status, local beliefs, knowledge levels, awareness of CaP and screening methods, and stigma were prominent themes. A significant number of Cameroonian men receive late stage CaP diagnosis due to lack of awareness, attitudes, cultural beliefs, self-medication, and economic limitation. To effectively address these contributing factors to late stage CaP diagnosis, a contextually based health education program is warranted and should be tailored to fill knowledge gaps about the disease, dispel misconceptions, and focus on reducing barriers to utilization of health services.
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http://dx.doi.org/10.1177/1557988318768596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142138PMC
September 2018

More than a job: Career development of individuals with cystic fibrosis.

Work 2018 ;59(3):425-437

University of Florida, Behavioral Science and Community Health, Gainesville, FL, USA.

Background: Cystic fibrosis and its employment corollaries have received little attention despite the fact that complications of CF represent numerous theorized barriers to optimal career outcomes.

Objectives: The objective of the study was to conduct grounded theory research that results in an understanding of the employment experiences of people with CF and ultimately a substantive grounded theory of career development applicable to individuals with this disease.

Methods: This study utilized the grounded theory method of qualitative inquiry. A purposive sample of ten young adults with CF participated in in-depth semi-structured qualitative interviews. Analysis of the interview transcripts followed the constant comparative approach to coding, which identified core themes and sub-themes and culminated in a conceptual framework of variables influencing employment and career development.

Results: An ecologically-based grounded theory of career development was developed. Major themes that influenced employment and career development were illness appraisal, occupational compromise, persistence, and altruism. Two patterns of career development outcomes emerged - the uninterrupted and the interrupted.

Conclusions: A complicated interaction of numerous ecological variables (individual characteristics, personal contextual factors, mediating factors, and the environment) collectively influenced career development. The presence of CF alone did not guarantee negative effects on career development.
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http://dx.doi.org/10.3233/WOR-182694DOI Listing
October 2018

The Role and Influence of Prostate Cancer Caregivers Across the Care Continuum.

Health Promot Pract 2019 05 29;20(3):436-444. Epub 2018 Mar 29.

1 University of Florida, Gainesville, FL, USA.

Background: Black men endure a disproportionate burden of morbidity and mortality related to prostate cancer (CaP). Increasingly family members are assuming the role of providing care and support to family members with chronic disease. Understanding the role and influence of the caregiver is a necessary part of developing resources to assist individuals learning to provide care.

Aim: The analysis aimed to explore CaP survivors' perceptions of the role and influence of family caregivers to better understand existing opportunities for improving experiences and outcomes for both the caregiver and the care receiver.

Design: Secondary analysis of qualitative interview transcripts. Data were analyzed to explore new inquiries related to CaP survivors' perceptions of family caregivers' role and influence at each stage of care. Content analysis was used to group data into established categories.

Data Source: Data included qualitative interview transcripts with 32 CaP survivors from the Florida Prostate Cancer Care and Survivorship Project.

Results: The role of the family caregiver is complex. Caregivers in this community seem to have a significant influence on behavior modification and cues to action for Black men with prostate cancer. According to the men in this group, caregivers functioned as normalizing agents, coordinating care and creating a new normal, throughout the various stages of care and survivorship.

Conclusions: Findings inform areas for future research to develop culturally tailored health promotion programs designed to improve outcomes and address the needs of both the family caregiver and the care receiver across the care continuum.
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http://dx.doi.org/10.1177/1524839918764667DOI Listing
May 2019

State of Early Child Development Research, Practice, and Policy for Most Vulnerable Children: A Global Perspective.

Authors:
Mary Eming Young

New Dir Child Adolesc Dev 2017 Dec;2017(158):11-23

Harvard University.

Interventions to enhance development of children ages 0-6 have profound benefits for children, families, and societies. The benefits are well documented, recognized internationally, and supportive of policies and programs targeting early child development (ECD). Intervening in the early years is a critical first step toward alleviating poverty, reducing inequality, and ensuring a productive workforce for the global economy. The challenges presented by the almost 250 million at-risk children in low- and middle-income countries and the main obstacles to investing in ECD demand a paradigm shift in social policy and an action agenda integrated with the world's sustainable development goals for 2030. There are four main tasks and three essential building blocks for ECD action.
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http://dx.doi.org/10.1002/cad.20221DOI Listing
December 2017

Stigma, Partners, Providers and Costs: Potential Barriers to PrEP Uptake among US Women.

J AIDS Clin Res 2017 Sep 25;8(9). Epub 2017 Sep 25.

Georgetown University, Washington, D.C., USA.

Background: Pre-Exposure Prophylaxis (PrEP) use has remained low among US women while significantly increasing among men who have sex with men. Besides lack of awareness, women face several social and structural barriers in gaining access to and using PrEP.

Methods: Four focus group discussions with 20 HIV-negative women who live in the Washington DC metropolitan area.

Results: The women expressed concerns about social and structural barriers to PrEP use. They were afraid that stigma related to using "HIV medicines" could affect PrEP use as well. They are worried that family and friends may question their reasons for taking anti-retrovirals and suspect that they were HIV-positive. They expected hostile reactions from male partners, including accusations of infidelity and introducing mistrust in their relationships. Communicating with health care providers about sexual matters in general and their need for PrEP in particular were identified as further barriers. Women reported that providers rarely ask about risk behaviors related to HIV acquisition; that short visits hinder establishing a trusting relationship to discuss sensitive matters. They were concerned that disclosure of risk behaviors may result in judgmental responses and harsh treatment from providers. Lastly, women were concerned that PrEP costs, including insurance coverage and copays, would keep PrEP out of their reach. While cognizant of the potential barriers, women were unwavering in their determination to find ways to circumvent challenges to PrEP access.

Conclusion: Social and structural barriers may impede women's access to PrEP despite their own reported interest. Continued efforts to reduce HIV stigma, improve patient-provider relationships and ensure affordability of PrEP may increase the likelihood that women will use this important prevention modality.
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http://dx.doi.org/10.4172/2155-6113.1000730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5708581PMC
September 2017