Parent feeding practices in infants and toddlers referred to a hospital-based feeding program in the United States.

While considerable research exists on parent feeding practices for infants and toddlers, past research has not focused on children with feeding problems. The goal of this study was to identify parent feeding practices in a sample of infants (n = 178) and toddlers (n = 221) referred to a hospital-based feeding clinic and then examine how these parent feeding practices were correlated with specific feeding problems. Parents completed surveys to report child demographics, feeding problems, and use of 54 feeding practices. Forty-eight (88.8%) of 54 practices were utilized more often for toddlers than for infants. Exploratory factor analysis with the 54 practices and the full sample (n = 399) produced the 16-item Baby Parent Mealtime Action Scale (BPMAS) with three dimensions: Multiple Food Offers, Use of Cereal/Pureed Foods, Use of Toys/TV. Controlling for demographics, hierarchical regression examined how each BPMAS dimension was associated with five feeding problems (underweight, tube feeding, texture problems, limited diet, mealtime disruption). Multiple Food Offers (e.g., daily offering of vegetables, offering foods from the family meal) was the dimension most correlated with fewer feeding problems such as tube feeding (ß = -0.220, p < 0.001), texture rejection (ß = -0.361, p < 0.001), and limited diet variety (ß = -0.175, p < 0.001), but also with more mealtime disruption (ß = 0.231, p < 0.001). Use of Toys/TV was correlated with more mealtime disruption (ß = 0.260, p < 0.001). In addition to demonstrating a correlation between parent feeding practices and feeding problems, this study also found adding cereal/pureed foods to be common and while the dimension, Use of Cereal/Pureed Foods, was not significantly correlated with any specific feeding problem, this dimension provides an expanded understanding of cereal usage.

Impact of a dedicated center for atrial fibrillation on resource utilization and costs.

BACKGROUND: Atrial fibrillation (AF) affects millions of Americans each year and can lead to high levels of resource utilization through emergency department (ED) visits and inpatient stays. HYPOTHESIS: We hypothesized that referral of patients to a dedicated Center for AF from the ED would reduce costs of care. METHODS: The University of Pittsburgh Center for AF serves as a rapid referral center for patients with AF to avoid unnecessary inpatient admissions and provide specialized care. Patients that presented to the ED with AF and met prespecified criteria were directed to rapid outpatient follow-up instead of inpatient admission. The primary outcome of interest was 30-day total costs. Secondary outcomes included outpatient costs, inpatient costs, 90-day costs, and inpatient stay characteristics. RESULTS: We identified 96 patients (median age 65, 38% women) referred to the center for AF for a new diagnosis of AF between October 2017 and December 2019 and matched 96 control patients. After 30 days of follow-up, patients referred to the center for AF had a lower average cost ($619 vs. $1252, p < 0.001) compared to controls, driven by lower costs of ED care tempered by slightly higher outpatient costs. Thirty-day admissions and lengths of stay were also lower. These differences were persistent at 90 days. CONCLUSION: Directing patients with AF that present to the ED to follow-up at a dedicated Center for AF significantly reduced overall costs, while reducing subsequent inpatient admissions and total lengths of stay in the hospital.

Using photovoice to identify sexual health needs in Latina early adolescents.

Adolescence is a period of exploration of sexuality and of its integration into personality. Existing research on Latina adolescents, however, has been largely limited to disease and pregnancy prevention, ignoring the integration of sexual well-being with other aspects of health. Accordingly, this paper presents findings from a photovoice project with 11-12 year old Latina students, implemented to investigate topics related to cultural identity, gender and sexual health. The data were generated over a 12-week period in an urban middle school in Central Texas by 17 youth collaborators. Findings provide a platform for discussion of how Latina young people's ideas align with or diverge from current sexual health discourses within a racial/ethnic context. We highlight opportunities and constraints with regard to identifying sexual health needs from young Latina students' own perspectives, in an attempt to contribute to the body of literature on sexual health in middle school students, as well as the lessons learned through our efforts.

The Combined Effects of Immediate and Delayed Positive Reinforcement to Increase Consumption of Solid Food: A Brief Report.

Background: While positive reinforcement is perhaps the most common component in interventions for feeding problems, the literature suggests it is not sufficient to address more severe problems. Method: An ABACDB reversal design was used to evaluate the effectiveness of praise, in-session reinforcement, and a visual cue + post-session reinforcement to increase solid food consumption in a nine-year-old boy with an intellectual disability who was completely dependent upon gastrostomy tube feeds. Results and Discussion: A combination of praise, in-session reinforcement, and the visual cue + post-session reinforcement was more effective at increasing bites consumed than praise combined with either one of the other two components. The results suggested a multiplicative effect. Multiple reinforcement components may be considered in the treatment of persons with feeding problems as either an alternative to escape extinction or a method of minimizing escape extinction.

Correction to: Is vitamin C enough? A case report of scurvy in a five-year-old girl and review of the literature.

Following publication of the original article [1], the authors reported that an out-of-date version of Figure 1 had been incorporated in the published article.

Is vitamin C enough? A case report of scurvy in a five-year-old girl and review of the literature.

BACKGROUND: Numerous cases of scurvy secondary to diet limitations have been reported in the literature with most being boys with special needs. To date, the focus of the literature describing vitamin C deficiency has been the medical sequelae of the deficiency. There has been little attention given underlying diet limitations causing the vitamin C deficiency. CASE PRESENTATION: A five-year-old female with typical development initially presented with rash, then later for pain in both lower extremities. After evaluation revealed vitamin C deficiency, she was admitted into an intensive day treatment feeding program. A feeding assessment found she had life-long problems with eating and had a diet that never exceeded ten foods. Across the course of treatment, she learned to eat 29 new foods. At six-month follow-up her body mass index had increased from the 1st to the 61st percentile. At one-year follow-up her body mass index was at the 85th percentile. All sequalae of her deficiency resolved. CONCLUSIONS: This case is unusual as most reported studies describe males with special needs. The severity of her eating issues suggest providers may consider referral to allied health professionals to address diet limitations for both children identified with nutrient deficiencies as well as children whose selective eating places them at risk for nutritional deficiencies or problems with growth. The child we described was anemic, like 42% of children described in the case literature on scurvy and like 32% of the children in this literature, our patient was underweight. In the literature, comorbid nutrient deficiencies were reported in 22% of the scurvy case studies. We suggest vitamin C supplementation is a necessary component for addressing vitamin C deficiency, but insufficient for addressing the diet limitations causing the nutrient deficiency.

Sensory Eating Problems Scale (SEPS) for children: Psychometrics and associations with mealtime problems behaviors.

The present study developed the 22-item Sensory Eating Problems Scale (SEPS) to measure sensory aspects for children surrounding eating, documented psychometrics of SEPS subscales, and examined their association with mealtime behavior problems. Study participants were 449 caretakers of children referred to feeding clinics, including children in three special needs status groups: autism spectrum disorder (ASD), other special needs, and no special needs. Caretakers completed surveys to report children's demographics, four measures of children's mealtime behavior problems, and five-point ratings for how often children showed various sensory feeding reactions. Exploratory factor analysis of the sensory feeding items identified six SEPS subscales with acceptable goodness-of-fit, internal reliability, and test-retest reliability: Food Touch Aversion, Single Food Focus, Gagging, Temperature Sensitivity, Expulsion, and Overstuffing. ANCOVAs revealed that child demographics most associated with higher SEPS subscale scores were younger age and special needs. Multiple regression analyses found that children's mealtime behavior problems were most often associated with SEPS subscales of Food Touch Aversion, Single Food Focus, Expulsion, and Overstuffing, with the set of six subscales explaining 18-44% of variance in mealtime behavior problems. Suggestions for how clinicians and researchers may find the SEPS useful for assessment and intervention are provided.

Racial-ethnic microaggressions, coping strategies, and mental health in Asian American and Latinx American college students: A mediation model.

The current study examined the link between racial-ethnic microaggressions and psychological distress among 308 Asian American (n = 164) and Latinx American (n = 144) college students (54% female). Additionally, coping strategies (engagement and disengagement) were examined as potential mediators in this link. A confirmatory factor analysis (CFA) of the Racial-Ethnic Microaggressions Scale (REMS) was conducted to test the factor structure with an Asian American and Latinx American emerging adult population (Ages 18-26). A multigroup path analysis of the analytic model was then performed to examine the hypothesized relations between racial-ethnic microaggressions, coping strategies, and psychological distress among Asian American and Latinx American participants. Results of the CFA did not support the original 6-factor structure of the REMS in this sample. However, a 1-factor structure (i.e., total scale score) indicated good fit. Findings from the path analysis indicated that among the total sample, racial-ethnic microaggressions were directly linked to increased psychological distress. Furthermore, engagement coping strategies partially mediated this relationship and were linked to less psychological distress. (PsycINFO Database Record

The Relationships Among Perceived Discrimination, Marianismo Gender Role Attitudes, Racial-Ethnic Socialization, Coping Styles, and Mental Health Outcomes in Latina College Students.

The current study examined the links between perceived discrimination, marianismo gender role beliefs, racial-ethnic socialization (preparation for bias), coping strategies (engagement vs. disengagement), and mental health outcomes among 211 Latina college students. First, the authors investigated predictions about mediation effects of ethnic socialization and marianismo in the association between perceived discrimination and coping strategies. Second, they tested predictions about mediation effects of coping strategies in the link between perceived discrimination and mental health outcomes. Results of path analyses showed that perceived discrimination was positively related to familismo and spiritual marianismo pillars, preparation for bias, and engagement coping strategies. Furthermore, the link between perceived discrimination and engagement coping strategies was partially mediated via preparation for bias. Finally, perceived discrimination, disengagement coping strategies and self-silencing marianismo attitudes were negatively linked to mental health. Overall, these findings highlight the complex ways in which coping strategies are linked with one's ethnic and gender socialization and related to perceived discrimination and mental health outcomes. El presente estudio examinó las relaciones entre la discriminación percibida, la socialización étnicaracial (preparación de discriminación), roles de marianismo creencias, estrategias (de compromiso frente a la desconexión) y los resultados de salud mental entre los 211 estudiantes universitarias Latinas. Primero, se investigó predicciones sobre los efectos de mediación de socialización étnica y el marianismo en la asociación entre las estrategias de afrontamiento y la discriminación percibida. También, investigamos las predicciones acerca de los efectos de mediación de las estrategias de supervivencia en la relación entre la discriminación percibida y el salud mental. Los resultados de los análisis mostraron que discriminación percibida fue relacionado positivamente con la preparación para la discriminación, el familismo y pilares Marianismo espirituales, así como las estrategias de participación de afrontamiento. Además, la relación entre las estrategias de afrontamiento de compromiso y la discriminación percibida fue parcialmente mediada a través de la preparación de discriminación. Finalmente, la discriminación percibida, las estrategias de afrontamiento y "selfsilencing" Marianismo actitudes estaban relacionado negativamente a la salud mental. En general, estos resultados ponen de relieve las complejas formas en que las estrategias de afrontamiento están vinculados con la propia socialización étnica y de género y relacionadas con la discriminación percibida y los resultados de salud mental.

High-lysine corn produced by the combination of enhanced lysine biosynthesis and reduced zein accumulation.

Corn is one of the major crops in the world, but its low lysine content is often problematic for animal consumption. While exogenous lysine supplementation is still the most common solution for today's feed corn, high-lysine corn has been developed through genetic research and biotechnology. Reducing the lysine-poor seed storage proteins, zeins, or expressing a deregulated lysine biosynthetic enzyme, CordapA, has shown increased total lysine or free lysine content in the grains of modified corn plants, respectively. Here, by combining these two approaches through genetic crosses, the total lysine content has more than doubled in F1 progeny. We also observe a synergy between the transgenic zein reduction and the enhanced lysine biosynthesis by CordapA expression. The zein reduction plants are found to accumulate higher levels of aspartate, asparagine and glutamate, and therefore, provide excess precursors for the enhanced lysine biosynthesis.

Matrix-assisted laser desorption ionization time-of-flight mass spectrometry analysis of zeins in mature maize kernels.

A high-throughput method has been developed to allow rapid analysis of maize seed storage proteins by matrix-assisted laser desorption time-of-flight mass spectrometry. The extraction solution containing an organic solvent, a reducing agent, and a volatile base has been optimized to enable extraction of all classes of zein proteins (alpha-, beta-, gamma-, and delta-). A near-saturating concentration of matrix, 2-(4-hydroxyphenylazo)benzoic acid, was necessary to obtain strong peaks for the most lipophilic zeins, the alpha-zeins. Zein proteins with small mass differences, difficult to separate by sodium dodecyl sulfate polyacrylamide gel electrophoresis, were resolved through this analysis. Mass signals corresponding to the 10-kDa delta-, 15-kDa beta-, 16-kDa gamma-, 27-kDa gamma-, and several 19 and 22-kDa alpha-zeins were detected. The zein identities were further confirmed by the association of the number of cysteine residues in each zein MS peak, as determined by iodoacetamide derivatization, with the number predicted from its coding sequence. The relative zein abundance in the zein MS peaks was also correlated with the relative zein EST abundance among endosperm EST libraries. This method was utilized to examine the zein composition of a number of corn inbred lines and opaque mutants.

Improving nutritional quality of maize proteins by expressing sense and antisense zein genes.

The predominant proteins in maize grain are a family of alcohol-soluble prolamin storage proteins called zeins. They account for >50% of total seed proteins but are deficient in several essential amino acids. As a result, the corn grain is considered to be nutritionally poor for monogastric animals with respect to key essential amino acids, most notably lysine, tryptophan, and methionine. Thus, corn mutants with reduced levels of zeins, such as opaque-2 (o2), have been demonstrated to possess grain with improved nutritional quality characteristics. The o2 mutant has a superior amino acid composition and has been used through conventional breeding to develop Quality Protein Maize (QPM) for human and animal consumption in developing countries. With the understanding of molecular genetics of zeins and progress in biotechnology, an alternative approach to zein reduction is explored here. Through the targeted reduction of the 19-kDa alpha-zeins, increased levels of lysine, tryptophan, and methionine have been engineered in grain of transgenic hybrids. Currently, the agronomic properties and nutritional values of these transgenic lines are being evaluated.