Headache diagnosis and treatment is the most important focus or concentration area for practising neurologists in America. The American Headache Society, formerly the American Association for the ...Study of Headache, is made up predominantly of neurologists. Recognition of the importance of the teaching and practice of headache medicine, especially migraine, is still incomplete at many academic teaching institutions. Suggestions that this results from inadequate academic hierarchies and education at graduate and post-graduate levels have been made. We therefore undertook a survey of academic practitioners of headache medicine in departments of neurology with membership of the American Headache Society. Subjects and addresses were identified using the 1999-2000 membership directory of the American Headache Society. Practice characteristics and time distribution were assessed. Teaching in undergraduate and resident programmes was also assessed. Fifty-five surveys from 46 institutions in 25 states were judged as adequate for this report. Academic neurologists with interest in headache medicine spent most of their time in clinic, with less than 25% spent doing either research or teaching. Medical schools had an average of 1 h of preclinical and 2 h of clinical teaching in headache. Neurology residents received an average of 3 h of didactic instruction in headache. This report is the first of its kind to review the practice characteristics and culture of headache medicine in the setting of academic departments of neurology. It describes a clinical practice similar to those of other non-academic American neurologists.
Food FARMacy is a clinical-community emergency food assistance program developed in response to food insecurity during the COVID-19 pandemic. Few qualitative studies have examined participant, and ...clinical and community stakeholder experiences with these food assistance programs.
To examine the motivations, experiences, and perceptions of Food FARMacy participants and program stakeholders.
A qualitative study using in-depth interviews between March 2021 and July 2021.
Twenty-four Food FARMacy participants and 10 program stakeholders in New York, NY (Manhattan, Brooklyn, and Queens) older than age 18 years were interviewed.
Interviews were recorded, transcribed, translated, and analyzed using thematic analysis. Participant and program stakeholder interviews were analyzed separately. Themes that were salient in both groups were combined for reporting.
Both program participants and stakeholders perceived: pandemic-related demands combined with reduced resources motivated participation; convenience, safety, and ease of access facilitated program retention; participants valued fresh produce and diversity of foods; the program improved diet and health; minimizing food waste was a priority; and social cohesion was an unexpected program benefit. Two additional themes among only program stakeholders also were identified: aligned values, flexibility, and communication were key to successful partnerships; and trust between community partners and community members drove programmatic success.
Results suggest that a multisite clinical-community partnership to provide emergency food assistance in New York City can be leveraged to reduce barriers to healthy food access and address food insecurity during crises.
Serum is a common sample of convenience for metabolomics studies. Its processing time can be lengthy and may result in the loss of metabolites including those of red blood cells (RBCs). Unlike serum, ...whole blood (WB) is quickly processed, minimizing the influence of variable hemolysis while including RBC metabolites. To determine differences between serum and WB metabolomes, both sample types, collected from healthy volunteers, were assayed by H-NMR (proton nuclear magnetic resonance) spectroscopy. A total of 34 and 50 aqueous metabolites were quantified from serum and WB, respectively. Free hemoglobin (Hgb) levels in serum were measured, and the correlation between Hgb and metabolite concentrations was determined. Most metabolites detected in serum were at higher concentrations in WB with the exception of acetoacetate and propylene glycol. The 18 unique metabolites of WB included adenosine, AMP, ADP, and ATP, which are associated with RBC metabolism. The use of serum results in the underrepresentation of a number of metabolic pathways including branched-chain amino acid degradation and glycolysis and gluconeogenesis. The range of free Hgb in serum was 0.03 to 0.01 g/dL, and eight metabolites were associated (P ≤ 0.05) with free Hgb. The range of free Hgb in serum samples from 18 sepsis patients was 0.02 to 0.46 g/dL. Whole blood and serum have unique aqueous metabolite profiles, but the use of serum may introduce potential pathway bias. Use of WB for metabolomics may be particularly important for studies in diseases such as sepsis in which RBC metabolism is altered, and mechanical and sepsis-induced hemolysis contributes to variance in the metabolome.
School-age children frequently present with mental health (MH) problems in school, affecting their academic experience and outcomes. However, school staff report difficulty in identifying and ...managing such problems. We aimed to determine whether a mental health literacy (MHL) intervention was effective at improving MHL for staff in an urban, predominately Latinx elementary school. A pre/post quasi-experimental design was used. A 20-week MHL intervention that is comprehensive (i.e., not disorder specific) and tiered (i.e., universal as well as targeted services for those with greater needs) was provided as part of an existing school-based mental health prevention and promotion program. A survey adapted from validated measures of MH knowledge and attitudes (including self-efficacy and stigma), as well as use of student support services, was simultaneously administered to staff at the intervention school and a matched comparison school before and after the intervention. Linear and logistic regressions assessed whether changes in MHL and rates of MH referrals varied by school. After controlling for pre-intervention scores, staff in the intervention school had significantly higher knowledge scores (data), higher self-efficacy scores (data), and lower stigma scores (data) in the post-intervention period compared to the comparison school. Following the intervention, more staff in the intervention school reported utilizing student supports to discuss student needs (OR 5.8, 95% CI 2.3–14.6). This intervention, which utilizes a social–ecological framework and tiered approach, led to improvements in MHL of school staff, which may facilitate staff ability to identify and support students’ MH needs.
Language development has been consistently linked with socioeconomic status (SES), with children from lower SES backgrounds at higher risk for language delays. The objective of this study is to ...investigate the relationship between familial social service use and language development during the first year of life. Thirty-one low-income mothers and their infants were recruited from the New York metropolitan area. Mothers provided information about demographics and utilization of social services (Women, Infants, and Children (WIC), food stamps, Medicaid, and public housing). Infant language skills were assessed using the Preschool Language Scale. Multiple linear regressions were used to investigate the relationship between social service use and language skills. We found that the number of social services utilized was not an overall significant linear predictor of language skills. However, social service use interacted with poverty level to predict language skills. Specifically, for families living in deep poverty, higher service use significantly predicted higher infant language scores (β = 3.4,
= 0.005). These results suggest that social services may be an appropriate target to help narrow socioeconomic disparities in language development.
The possibility of implementing a Berezinskii–Kosterlitz–Thouless topological phase transition in a Josephson medium of two-level high-temperature superconductors induced by a magnetic field has been ...studied. The effect of temperature and external magnetic field on the transport properties of the YBa
2
Cu
3
O
7–δ
granular high-temperature superconductor considered as a model object is studied experimentally. For the first time, an anomalous behavior of the magnetoresistance isotherms is detected in a narrow range of temperature and external magnetic field indicating a topological phase transition in the Josephson medium of granular high-temperature superconductors.
How the brain maps sensory information to adaptive behavior remains unresolved. A new study in this issue of Neuron (Le Merre et al., 2017) uncovers learning-related recruitment of higher cortical ...areas into the rapid sensory processing stream that links a whisker stimulus to rewarded action.
How the brain maps sensory information to adaptive behavior remains unresolved. A new study in this issue of Neuron uncovers learning-related recruitment of higher cortical areas into the rapid sensory processing stream that links a whisker stimulus to rewarded action.
Sepsis therapeutics have a poor history of success in clinical trials, due in part to the heterogeneity of enrolled patients. Pharmacometabolomics could differentiate drug response phenotypes and ...permit a precision medicine approach to sepsis.
To use existing serum samples from the phase 1 clinical trial of l-carnitine treatment for severe sepsis to metabolically phenotype l-carnitine responders and nonresponders.
Serum samples collected before (T0) and after completion of the infusion (T24, T48) from patients randomized to either l-carnitine (12 g) or placebo for the treatment of vasopressor-dependent septic shock were assayed by untargeted (1)H-nuclear magnetic resonance metabolomics. The normalized, quantified metabolite data sets of l-carnitine- and placebo-treated patients at each time point were compared by analysis of variance with post-hoc testing for multiple comparisons. Pathway analysis was performed to statistically rank metabolic networks.
Thirty-eight metabolites were identified in all samples. Concentrations of 3-hydroxybutyrate, acetoacetate, and 3-hydroxyisovalerate were different at T0 and over time in l-carnitine-treated survivors versus nonsurvivors. Pathway analysis of pretreatment metabolites revealed that synthesis and degradation of ketone bodies had the greatest impact in differentiating l-carnitine treatment response. Analysis of all patients based on pretreatment 3-hydroxybutyrate concentration yielded distinct phenotypes. Using the T0 median 3-hydroxybutyrate level (153 μM), patients were categorized as either high or low ketone. l-Carnitine-treated low-ketone patients had greater use of carnitine as evidenced by lower post-treatment l-carnitine levels. The l-carnitine responders also had faster resolution of vasopressor requirement and a trend toward a greater improvement in mortality at 1 year (P = 0.038) compared with patients with higher 3-hydroxybutyrate.
The results of this preliminary study, which were not readily apparent from the parent clinical trial, show a unique metabolite profile of l-carnitine responders and introduce pharmacometabolomics as a viable strategy for informing l-carnitine responsiveness. The approach taken in this study represents a concrete example for the application of precision medicine to sepsis therapeutics that warrants further study.
Patient-derived xenograft (PDX) models are frequently used for translational cancer research, and are assumed to behave consistently as the tumor ages. However, growth rate constancy as a function of ...time is unclear. Notably, variable PDX growth rates over time might have implications for the interpretation of translational studies. We characterized four PDX models through several in vivo passages from primary human head and neck squamous cell carcinoma and salivary gland adenoid cystic carcinoma. We developed a mathematical approach to merge growth data from different passages into a single measure of relative tumor volume normalized to study initiation size. We analyzed log-relative tumor volume increase with linear mixed effect models. Two oral pathologists analyzed the PDX tissues to determine if histopathological feature changes occurred over in vivo passages. Tumor growth rate increased over time. This was determined by repeated measures linear regression statistical analysis in four different PDX models. A quadratic statistical model for the temporal effect predicted the log-relative tumor volume significantly better than a linear time effect model. We found a significant correlation between passage number and histopathological features of higher tumor grade. Our mathematical treatment of PDX data allows statistical analysis of tumor growth data over long periods of time, including over multiple passages. Non-linear tumor growth in our regression models revealed the exponential growth rate increased over time. The dynamic tumor growth rates correlated with quantifiable histopathological changes that related to passage number in multiple types of cancer.
PDF
