Abstract
Background
Directly observed therapy (DOT) remains an integral component of treatment support and adherence monitoring in tuberculosis care. In-person DOT is resource intensive and often ...burdensome for patients. Video DOT (vDOT) has been proposed as an alternative to increase treatment flexibility and better meet patient-specific needs.
Methods
We conducted a pragmatic, prospective pilot implementation of vDOT at 3 TB clinics in Maryland. A mixed-methods approach was implemented to assess (1) effectiveness, (2) acceptability, and (3) cost. Medication adherence on vDOT was compared with that of in-person DOT. Interviews and surveys were conducted with patients and providers before and after implementation, with framework analysis utilized to extract salient themes. Last, a cost analysis assessed the economic impacts of vDOT implementation across heterogeneous clinic structures.
Results
Medication adherence on vDOT was comparable to that of in-person DOT (94% vs 98%, P = .17), with a higher percentage of total treatment doses (inclusive of weekend/holiday self-administration) ultimately observed during the vDOT period (72% vs 66%, P = .03). Video DOT was well received by staff and patients alike, who cited increased treatment flexibility, convenience, and patient privacy. Our cost analysis estimated a savings with vDOT of $1391 per patient for a standard 6-month treatment course.
Conclusions
Video DOT is an acceptable and important option for measurement of TB treatment adherence and may allow a higher proportion of prescribed treatment doses to be observed, compared with in-person DOT. Video DOT may be cost-saving and should be considered as a component of individualized, patient-centered case management plans.
Theoretical perspectives propose that parents' dispositional emotion regulation (ER) tendencies are likely associated with youth mental health concerns. The aim of the current study was to conduct a ...systematic review and meta-analysis to evaluate the relationship between parental dispositional ER tendencies – both maladaptive and adaptive – and youth mental health symptoms. Regarding maladaptive parental ER, 32 unique studies (N = 6399) with 126 effects were included. A significant, small-to-moderate, effect was observed (r = 0.25) such that higher maladaptive parental ER was linked to heightened youth mental health symptoms. No differences were observed based on youth age or psychiatric risk status, yet effects were stronger when drawn from the same informant in contrast to different informants. Further, 12 studies (N = 4241) including 28 effects were identified and a significant, albeit small, relation (r = −0.16) between adaptive parental ER and youth mental health symptoms occurred. A narrative review of these studies evaluating adaptive parental ER and youth mental health symptoms was performed due to the limited number of effects found beyond parental dispositional mindfulness. These findings generally support the notion that parental dispositional ER tendencies are modestly associated with youth mental health concerns. Future directions and clinical implications are discussed.
•Links between parental emotion regulation and youth mental health were analyzed.•Parental maladaptive emotion regulation tendencies were modestly linked to youth mental health symptoms.•The link between parental adaptive emotion regulation and youth mental health symptoms was significant, albeit small.•Research directions and clinical implications for addressing youth mental health are discussed.
Increased expression of the facilitative glucose transporter, GLUT1, leads to glomerulopathy that resembles diabetic nephropathy, whereas prevention of enhanced GLUT1 expression retards nephropathy. ...While many of the GLUT1-mediated effects are likely due to mesangial cell effects, we hypothesized that increased GLUT1 expression in podocytes also contributes to the progression of diabetic nephropathy. Therefore, we generated two podocyte-specific GLUT1 transgenic mouse lines (driven by a podocin promoter) on a db/m C57BLKS background. Progeny of the two founders were used to generate diabetic db/db and control db/m littermate mice. Immunoblots of glomerular lysates showed that transgenic mice had a 3.5-fold (line 1) and 2.1-fold (line 2) increase in GLUT1 content compared with wild-type mice. Both lines showed similar increases in fasting blood glucose and body weights at 24 wk of age compared with wild-type mice. Mesangial index (percent PAS-positive material in the mesangial tuft) increased 88% (line 1) and 75% (line 2) in the wild-type diabetic mice but only 48% (line 1) and 39% (line 2) in the diabetic transgenic mice (P < 0.05, transgenic vs. wild-type mice). This reduction in mesangial expansion was accompanied by a reduction in fibronectin accumulation, and vascular endothelial growth factor (VEGF) levels increased only half as much in the transgenic diabetic mice as in wild-type diabetic mice. Levels of nephrin, neph1, CD2AP, podocin, and GLUT4 were not significantly different in transgenic compared with wild-type mice. Taken together, increased podocyte GLUT1 expression in diabetic mice does not contribute to early diabetic nephropathy; surprisingly, it protects against mesangial expansion and fibronectin accumulation possibly by blunting podocyte VEGF increases.
Podocyte dysfunction, one of the major causes of proteinuria, leads to glomerulosclerosis and end stage renal disease, but its underlying mechanism remains poorly understood. Here we show that ...Wnt/beta-catenin signaling plays a critical role in podocyte injury and proteinuria. Treatment with adriamycin induced Wnt and activated beta-catenin in mouse podocytes. Overexpression of Wnt1 in vivo activated glomerular beta-catenin and aggravated albuminuria and adriamycin-induced suppression of nephrin expression, whereas blockade of Wnt signaling with Dickkopf-1 ameliorated podocyte lesions. Podocyte-specific knockout of beta-catenin protected against development of albuminuria after injury. Moreover, pharmacologic activation of beta-catenin induced albuminuria in wild-type mice but not in beta-catenin-knockout littermates. In human proteinuric kidney diseases such as diabetic nephropathy and focal segmental glomerulosclerosis, we observed upregulation of Wnt1 and active beta-catenin in podocytes. Ectopic expression of either Wnt1 or stabilized beta-catenin in vitro induced the transcription factor Snail and suppressed nephrin expression, leading to podocyte dysfunction. These results suggest that targeting hyperactive Wnt/beta-catenin signaling may represent a novel therapeutic strategy for proteinuric kidney diseases.
We present measurements of the pseudorapidity distribution of primary charged particles produced in Au+Au collisions at three energies, sqrts(NN)=19.6, 130, and 200 GeV, for a range of collision ...centrali-ties. The distribution narrows for more central collisions and excess particles are produced at high pseudorapidity in peripheral collisions. For a given centrality, however, the distributions are found to scale with energy according to the "limiting fragmentation" hypothesis. The universal fragmentation region described by this scaling grows in pseudorapidity with increasing collision energy, extending well away from the beam rapidity and covering more than half of the pseudorapidity range over which particles are produced. This approach to a universal limiting curve appears to be a dominant feature of the pseudorapidity distribution and therefore of the total particle production in these collisions.
Objective The purpose of this study was to describe relations among maternal demographic and lifestyle characteristics and midpregnancy levels of angiogenic markers (soluble Fms-like tyrosine ...kinase-1, placental growth factor, soluble endoglin). Study Design In a large pregnancy cohort, linear models were used to evaluate relations among maternal characteristics and midpregnancy angiogenic markers with and without covariate adjustment. Associations were examined in a subcohort that included term and preterm deliveries (n = 1302) and among “normal” term pregnancies (n = 668). Results Concentrations of all factors declined with increasing maternal body mass index. Multiparous women had lower soluble Fms-like tyrosine kinase-1 levels than primiparous women. Higher placental growth factor and slightly lower soluble endoglin levels were observed among women who smoked at enrollment, but not among those women who quit before enrollment. African American women had higher levels of all markers. Conclusion Understanding relations among maternal characteristics and levels of angiogenic factors may improve studies that use these markers to examine etiology and/or to predict adverse pregnancy outcome.
Recent work has drawn attention to the previously underrecognized role that irritability plays in childhood psychopathology. Despite increased recognition of the clinical importance of pediatric ...irritability as a transdiagnostic symptom dimension, there is a lack of evidence-based treatments for this population that simultaneously and equitably addresses both child and contextual (e.g., parental) factors implicated in the development and maintenance of associated emotional and behavioral difficulties. In the current pilot study, we adapted the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) for the treatment of pediatric irritability in a sample of 19 children (ages 8 to 12) with primary presenting concerns of irritability and/or disruptive behaviors. Results supported the feasibility and acceptability of this treatment and provided preliminary evidence that such an approach may yield improved outcomes for symptoms of pediatric irritability and disruptive behaviors. Implications of these findings for future research and clinical interventions for pediatric irritability are discussed.
•Retrospective chart review of transdiagnostic treatment for pediatric irritability.•Parents of irritable youth find transdiagnostic treatment acceptable.•Treatment shown to be feasible for clinicians and families.•Data support initial efficacy of treatment in reducing pediatric irritability.
The need for computing in the HEP community follows cycles of peaks and valleys mainly driven by conference dates, accelerator shutdown, holiday schedules, and other factors. Because of this, the ...classical method of provisioning these resources at providing facilities has drawbacks such as potential overprovisioning. As the appetite for computing increases, however, so does the need to maximize cost efficiency by developing a model for dynamically provisioning resources only when needed. To address this issue, the HEPCloud project was launched by the Fermilab Scientific Computing Division in June 2015. Its goal is to develop a facility that provides a common interface to a variety of resources, including local clusters, grids, high performance computers, and community and commercial Clouds. Initially targeted experiments include CMS and NOvA, as well as other Fermilab stakeholders. In its first phase, the project has demonstrated the use of the "elastic" provisioning model offered by commercial clouds, such as Amazon Web Services. In this model, resources are rented and provisioned automatically over the Internet upon request. In January 2016, the project demonstrated the ability to increase the total amount of global CMS resources by 58,000 cores from 150,000 cores - a 38 percent increase - in preparation for the Recontres de Moriond. In March 2016, the NOvA experiment has also demonstrated resource burst capabilities with an additional 7,300 cores, achieving a scale almost four times as large as the local allocated resources and utilizing the local AWS s3 storage to optimize data handling operations and costs. NOvA was using the same familiar services used for local computations, such as data handling and job submission, in preparation for the Neutrino 2016 conference. In both cases, the cost was contained by the use of the Amazon Spot Instance Market and the Decision Engine, a HEPCloud component that aims at minimizing cost and job interruption. This paper describes the Fermilab HEPCloud Facility and the challenges overcome for the CMS and NOvA communities.
How much higher can HTCondor fly? Fajardo, E M; Dost, J M; Holzman, B ...
Journal of physics. Conference series,
12/2015, Letnik:
664, Številka:
6
Journal Article
Recenzirano
Odprti dostop
The HTCondor high throughput computing system is heavily used in the high energy physics (HEP) community as the batch system for several Worldwide LHC Computing Grid (WLCG) resources. Moreover, it is ...the backbone of GlidelnWMS, the pilot system used by the computing organization of the Compact Muon Solenoid (CMS) experiment. To prepare for LHC Run 2, we probed the scalability limits of new versions and configurations of HTCondor with a goal of reaching 200,000 simultaneous running jobs in a single internationally distributed dynamic pool. In this paper, we first describe how we created an opportunistic distributed testbed capable of exercising runs with 200,000 simultaneous jobs without impacting production. This testbed methodology is appropriate not only for scale testing HTCondor, but potentially for many other services. In addition to the test conditions and the testbed topology, we include the suggested configuration options used to obtain the scaling results, and describe some of the changes to HTCondor inspired by our testing that enabled sustained operations at scales well beyond previous limits.
Maternal depression during gestation is an adverse factor in fetal brain development that manifests in later childhood behavioral problems. Fetal heart rate variability (FHRV) mediated by ...parasympathetic input is a marker of gestational nervous system development. Biological mediators of adverse effects of maternal depression may involve the mother's corticosteroids; however, links between depression, corticosteroids, and early nervous system development remain inconclusive.
Heart rate was recorded in 23 fetuses by transabdominal Doppler at 28-33 weeks gestation. The SD of interbeat intervals over 20 min assessed FHRV. Maternal depression ratings and hair concentrations of cortisol and cortisone were assayed. An auditory sensory gating paradigm assessed newborn development of cerebral inhibition. Parents rated their infant's temperament characteristics on the Infant Behavior Questionnaire-Revised Short Form (IBQ-R).
Maternal depression was associated with lower FHRV, especially for male fetuses, β = -0.633, P = 0.045. Maternal depression was associated with lower cortisol to total corticosteroids ratios, β = -0.519, P = 0.033. Lower cortisol ratios were associated with decreased FHRV, β = 0.485, P = 0.019. Decreased FHRV was associated with increased newborn sensory gating deficits, β = -0.992, P = 0.035, indicating poorer development of cerebral inhibition. Higher FHRV was related to increased infant IBQ-R self-regulatory behaviors, r = 0.454, P = 0.029.
Maternal depression is associated via corticosteroids with decreased development of nervous system control of fetal heart rate. Decreased FHRV indicates developmental alterations in gestation that correlate with altered brain function and subsequent regulatory challenges in early infancy.
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