Perception of secondary conditions in adults with spina bifida and impact on daily life.

BACKGROUND: Spina bifida is a congenital defect of the neural tube resulting in motor and sensory disruption. Persons with spina bifida can also experience executive function impairments. Secondary conditions are physical, medical, cognitive, emotional, or psychosocial consequences to which persons with disabilities are more susceptible. Our experience suggested clinicians underappreciate the presence and impact of secondary conditions in adults with spina bifida because they do not specifically ask for this information. OBJECTIVE: Describe the presence and impact of secondary conditions on daily life, as perceived by adults with spina bifida. METHODS: A clinic-based sample was recruited from the active patient population of an adult specialty center for spina bifida-related care. All subjects were verbally administered a survey developed through literature review and clinical experience of the researchers. The survey measured the presence and perceived impact of secondary conditions. Recruitment and survey data collection occurred over a 6-month period to maximize age representation. Survey data were stratified by age, gender and lesion level for analysis. RESULTS: Seventy-two respondents completed the survey. Pain was commonly reported, along with pressure ulcers, bowel & bladder concerns, depression, sleep disturbance, and limited social and community participation. No significant relationships were found between the presence or perceived impact of secondary conditions and age, gender or level of lesion. CONCLUSIONS: Secondary conditions in spina bifida are present by early adulthood. Identifying these conditions during clinical encounters requires specific rather than general questions. Future study should evaluate earlier initiation of preventative measures by pediatric providers.

Seizing an opportunity: increasing use of cessation services following a tobacco tax increase.

BACKGROUND: Tobacco tax increases are associated with increases in quitline calls and reductions in smoking prevalence. In 2013, ClearWay Minnesota(SM) conducted a six-week media campaign promoting QUITPLAN® Services (QUITPLAN Helpline and quitplan.com) to leverage the state's tax increase. The purpose of this study was to ascertain the association of the tax increase and media campaign on call volumes, web visits, and enrollments in QUITPLAN Services. METHODS: In this observational study, call volume, web visits, enrollments, and participant characteristics were analyzed for the periods June-August 2012 and June-August 2013. Enrollment data and information about media campaigns were analyzed using multivariate regression analysis to determine the association of the tax increase on QUITPLAN Services while controlling for media. RESULTS: There was a 160% increase in total combined calls and web visits, and an 81% increase in enrollments in QUITPLAN Services. Helpline call volumes and enrollments declined back to prior year levels approximately six weeks after the tax increase. Visits to and enrollments in quitplan.com also declined, but increased again in mid-August. The tax increase and media explained over 70% of variation in enrollments in the QUITPLAN Helpline, with media explaining 34% of the variance and the tax increase explaining an additional 36.1% of this variance. However, media explained 64% of the variance in quitplan.com enrollments, and the tax increase explained an additional 7.6% of this variance. CONCLUSIONS: Since tax increases occur infrequently, these policy changes must be fully leveraged as quickly as possible to help reduce prevalence.

De novo Assembly and Analysis of the Northern Leopard Frog Rana pipiens Transcriptome.

The northern leopard frog Rana (Lithobates) pipiens is an important animal model, being used extensively in cancer, neurology, physiology, and biomechanical studies. R. pipiens is a native North American frog whose range extends from northern Canada to southwest United States, but over the past few decades its populations have declined significantly and is now considered uncommon in large portions of the United States and Canada. To aid in the study and conservation of R. pipiens, this paper describes the first R. pipiens transcriptome. The R. pipiens transcriptome was annotated using Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Eukaryotic Orthologous Groups (KOG). Differential expression analysis revealed universal and tissue specific genes, and endocrine-related genes were identified. Transcriptome assemblies and other sequence data are available for download.

ESTIMATING BACTERIAL DIVERSITY IN SCIRTOTHRIPS DORSALIS (THYSANOPTERA: THRIPIDAE) VIA NEXT GENERATION SEQUENCING.

The last 2 decades have produced a better understanding of insect-microbial associations and yielded some important opportunities for insect control. However, most of our knowledge comes from model systems. Thrips (Thysanoptera: Thripidae) have been understudied despite their global importance as invasive species, plant pests and disease vectors. Using a culture and primer independent next-generation sequencing and metagenomics pipeline, we surveyed the bacteria of the globally important pest, Scirtothrips dorsalis Hood. The most abundant bacterial phyla identified were Actinobacteria and Proteobacteria and the most abundant genera were Propionibacterium, Stenotrophomonas, and Pseudomonas. A total of 189 genera of bacteria were identified. The absence of any vertically transferred symbiont taxa commonly found in insects is consistent with other studies suggesting that thrips primarilly acquire resident microbes from their environment. This does not preclude a possible beneficial/intimate association between S. dorsalis and the dominant taxa identified and future work should determine the nature of these associations.

Characterization of the Asian Citrus Psyllid Transcriptome.

The Asian citrus psyllid, Diaphorina citri Kuwayama (Hemiptera: Psyllidae) is a vector for the causative agents of Huanglongbing, which threatens citrus production worldwide. This study reports and discusses the first D. citri transcriptomes, encompassing the three main life stages of D. citri, egg, nymph and adult. The transcriptomes were annotated using Gene Ontology (GO) and insecticide-related genes within each life stage were identified to aid the development of future D. citri insecticides. Transcriptome assemblies and other sequence data are available for download at the International Asian Citrus Psyllid Genome Consortium website [http://psyllid.org/download] and at NCBI [http://www.ncbi.nlm.nih.gov/bioproject/29447].

Maternal imprinting at the H19-Igf2 locus maintains adult haematopoietic stem cell quiescence.

The epigenetic regulation of imprinted genes by monoallelic DNA methylation of either maternal or paternal alleles is critical for embryonic growth and development. Imprinted genes were recently shown to be expressed in mammalian adult stem cells to support self-renewal of neural and lung stem cells; however, a role for imprinting per se in adult stem cells remains elusive. Here we show upregulation of growth-restricting imprinted genes, including in the H19-Igf2 locus, in long-term haematopoietic stem cells and their downregulation upon haematopoietic stem cell activation and proliferation. A differentially methylated region upstream of H19 (H19-DMR), serving as the imprinting control region, determines the reciprocal expression of H19 from the maternal allele and Igf2 from the paternal allele. In addition, H19 serves as a source of miR-675, which restricts Igf1r expression. We demonstrate that conditional deletion of the maternal but not the paternal H19-DMR reduces adult haematopoietic stem cell quiescence, a state required for long-term maintenance of haematopoietic stem cells, and compromises haematopoietic stem cell function. Maternal-specific H19-DMR deletion results in activation of the Igf2-Igfr1 pathway, as shown by the translocation of phosphorylated FoxO3 (an inactive form) from nucleus to cytoplasm and the release of FoxO3-mediated cell cycle arrest, thus leading to increased activation, proliferation and eventual exhaustion of haematopoietic stem cells. Mechanistically, maternal-specific H19-DMR deletion leads to Igf2 upregulation and increased translation of Igf1r, which is normally suppressed by H19-derived miR-675. Similarly, genetic inactivation of Igf1r partly rescues the H19-DMR deletion phenotype. Our work establishes a new role for this unique form of epigenetic control at the H19-Igf2 locus in maintaining adult stem cells.

The spring runoff in Nebraska's (USA) Elkhorn River watershed and its impact on two sentinel organisms.

The objectives of the present study were to determine 1) if temporal variability influenced the toxicity of Elkhorn River, Nebraska, USA, water, and 2) if the toxic effect was consistent between 2 sentinel organisms, the fathead minnow (Pimephales promelas) and the northern leopard frog (Rana pipiens). During spring 2012, atrazine indicator strips were used to document the occurrence of agrichemical pulses in the Elkhorn River. Polar organic chemical integrative samplers (POCIS) were deployed for 14 d during both a pulse and a postpulse period as indicated by the atrazine strips. Pesticide concentrations detected in the POCIS extracts ranged from 1.6-fold to 281-fold higher during the pulse period compared to the postpulse period. Fish and frog bioassays were conducted for 7 d, and hepatic mRNA expression of vitellogenin (VTG) and estrogen receptor alpha (ERα) was determined by quantitative real-time polymerase chain reaction. Compared with lab water controls, fish exposed to water collected during an agrichemical pulse experienced significant reductions in VTG and ERα, whereas exposed female frogs did not. Male leopard frogs, in contrast, experienced significant increases in the expression of ERα, whereas pulse-exposed male minnows did not. The significant effects observed following agrichemical pulse exposure demonstrate that episodic agrichemical runoff adversely impacts sentinel organisms, and that the adverse impacts observed depend on the sex and species of the sentinel organism.

Minnesota's smokefree policies: impact on cessation program participants.

BACKGROUND: Smokefree policies are enacted to protect individuals from secondhand smoke; however, these laws may have broader cessation effects. PURPOSE: This study investigated the relationship between Minnesota's local and statewide smokefree policies and quitting outcomes among cessation program enrollees. METHODS: Data were collected from 2006 to 2008 from two groups of participants (n=1644 pre-statewide law; n=1273 post-statewide law) and analyzed in 2009. Website enrollees were surveyed by Internet or telephone 6 months post-enrollment. Others were surveyed by telephone 7 months post-enrollment. RESULTS: Those who enrolled in a cessation program after the statewide smokefree law were more likely to quit (p<0.05, relative risk [RR]=1.15) and were predicted to achieve a 30-day abstinence rate 4.1 percentage points greater than that achieved by those who quit pre-statewide law (30.9% vs 26.8%, respectively). Participants who quit post-statewide law were less likely to relapse and were predicted to have a relapse rate 6.4 percentage points below those who quit pre-statewide law (p<0.05, RR=0.87). Each additional year residing in or adjacent to a county with a local smokefree ordinance in place, up until the time of the statewide law, reduced the likelihood of achieving abstinence post-statewide law (p<0.001, RR=0.92) and increased the likelihood of relapse and the predicted relapse rate (p<0.05, RR=1.05). CONCLUSIONS: Abstinence and relapse rates for those enrolling in cessation programs appeared more favorable after the implementation of Minnesota's statewide smokefree law, suggesting that smokefree policies may have a small but beneficial impact on cessation outcomes. Previous exposure to local smokefree ordinances may lessen this effect.

The relation between media promotions and service volume for a statewide tobacco quitline and a web-based cessation program.

BACKGROUND: This observational study assessed the relation between mass media campaigns and service volume for a statewide tobacco cessation quitline and stand-alone web-based cessation program. METHODS: Multivariate regression analysis was used to identify how weekly calls to a cessation quitline and weekly registrations to a web-based cessation program are related to levels of broadcast media, media campaigns, and media types, controlling for the impact of external and earned media events. RESULTS: There was a positive relation between weekly broadcast targeted rating points and the number of weekly calls to a cessation quitline and the number of weekly registrations to a web-based cessation program. Additionally, print secondhand smoke ads and online cessation ads were positively related to weekly quitline calls. Television and radio cessation ads and radio smoke-free law ads were positively related to web program registration levels. There was a positive relation between the number of web registrations and the number of calls to the cessation quitline, with increases in registrations to the web in 1 week corresponding to increases in calls to the quitline in the subsequent week. Web program registration levels were more highly influenced by earned media and other external events than were quitline call volumes. CONCLUSION: Overall, broadcast advertising had a greater impact on registrations for the web program than calls to the quitline. Furthermore, registrations for the web program influenced calls to the quitline. These two findings suggest the evolving roles of web-based cessation programs and Internet-use practices should be considered when creating cessation programs and media campaigns to promote them. Additionally, because different types of media and campaigns were positively associated with calls to the quitline and web registrations, developing mass media campaigns that offer a variety of messages and communicate through different types of media to motivate tobacco users to seek services appears important to reach tobacco users. Further research is needed to better understand the complexities and opportunities involved in simultaneous promotion of quitline and web-based cessation services.

The obesity epidemic in South Dakota: how big is the problem?

Obesity is an increasing problem both in the United States and South Dakota. Currently, 30.3 percent of South Dakota adults self-report being obese, which is higher than the national prevalence and also increasing at a faster rate than other states. The obesity rate for South Dakota 2- to 5-year-olds from limited-income households is 16.4 percent and above the national prevalence. Obesity prevalence among students Kindergarten through grade 12 was 16.0 percent for the 2009-2010 school year, not higher than national data.

A multi-institutional study of the Family Conference Objective Structured Clinical Exam: a reliable assessment of professional communication.

BACKGROUND: To test the value of a simulated Family Conference Objective Structured Clinical Exam (OSCE) for resident assessment purposes, we examined the generalizability and construct validity of its scores in a multi-institutional study. METHODS: Thirty-four first-year (PG1) and 27 third-year (PG3) surgery residents (n = 61) from 6 training programs were tested. The OSCE consisted of 2 cases (End-of-Life [EOL] and Disclosure of Complications [DOC]). At each program, 2 clinicians and 2 standardized family members rated residents using case-specific tools. Performance was measured as the percentage of possible score obtained. We examined the generalizability of scores for each case separately. To assess construct validity, we compared PG1 with PG3 performance using repeated measures multivariate analysis of variance (MANOVA). RESULTS: The relative G-coefficient for EOL was .890. For DOC, the relative G-coefficient was .716. There were no significant performance differences between PG1 and PG3 residents. CONCLUSIONS: This OSCE provides reliable assessments suitable for formative evaluation of residents' interpersonal communication skills and professionalism.

The comparative effectiveness of clinic, work-site, phone, and Web-based tobacco treatment programs.

INTRODUCTION: Tobacco treatment programs may be offered in clinical settings, at work-sites, via telephone helplines, or over the Internet. Little comparative data exist regarding the real-world effectiveness of these programs. This paper compares the reach, effectiveness, and costs of these different modes of cessation assistance. METHODS: This is an observational study of cohorts of participants in Minnesota's QUITPLAN programs in 2004. Cessation assistance was provided in person at 9 treatment centers, using group counseling at 68 work-sites, via a telephone helpline, or via the Internet. The main outcomes of the study are enrollment by current smokers, self-reported 30-day abstinence, and cost per quit. Reach was calculated statewide for the helpline and Web site, regionally for the treatment centers, and for the employee population for work-site programs. RESULTS: Enrollment was greatest for the Web site (n = 4,698), followed by the helpline (n = 2,351), treatment centers (n = 616), and work-sites (n = 479). The Web site attracted younger smokers. Smokers at treatment centers had higher levels of nicotine dependence. The helpline reached more socially disadvantaged smokers. Responder 30-day abstinence rates were higher for the helpline (29.3%), treatment centers (25.8%), and work-sites (19.6%) compared with the online program (12.5%). These differences persisted after controlling for baseline differences in participant characteristics and use of pharmacological therapy. The cost per quit was lowest for the Web site program ($291 per quit, 95% CI = $229-$372). DISCUSSION: Treatment center, work-site, helpline, and Web site programs differ in their reach, effectiveness, and estimated cost per quit. Each program plays a part in assisting populations of tobacco users in quitting.

Utilization of smoking cessation informational, interactive, and online community resources as predictors of abstinence: cohort study.

BACKGROUND: The association between greater utilization of Web-assisted tobacco interventions and increased abstinence rates is well recognized. However, there is little information on how utilization of specific website features influences quitting. OBJECTIVE: To determine the association between utilization of informational, interactive, and online community resources (eg. bulletin boards) and abstinence rates, with the broader objective to identify potential strategies for improving outcomes for Web-assisted tobacco interventions. METHODS: In Spring 2004, a cohort of 607 quitplan.com users consented to participate in an evaluation of quitplan.com, a Minnesota branded version of QuitNet.com. We developed utilization measures for different site features: general information, interactive diagnostic tools and quit planning tools, online expert counseling, passive (ie, reading of bulletin boards) and active (ie, public posting) online community engagement, and one-to-one messaging with other virtual community members. Using bivariate, multivariate, and path analyses, we examined the relationship between utilization of specific site features and 30-day abstinence at 6 months. RESULTS: The most commonly used resources were the interactive quit planning tools (used by 77% of site users). Other informational resources (ie, quitting guides) were used more commonly (60% of users) than passive (38%) or active (24%) community features. Online community engagement through one-to-one messaging was low (11%) as was use of online counseling (5%). The 30-day abstinence rate among study participants at 6 months was 9.7% (95% Confidence Interval [CI] 7.3% - 12.1%). In the logistic regression model, neither the demographic data (eg, age, gender, education level, employment, or insurance status) nor the smoking-related data (eg, cigarettes per day, time to first morning cigarette, baseline readiness to quit) nor use of smoking cessation medications entered the model as significant predictors of abstinence. Individuals who used the interactive quit planning tools once, two to three times, or four or more times had an odds of abstinence of 0.65 (95% Confidence Interval [CI] 0.22 - 1.94), 1.87 (95% CI 0.77 - 4.56), and 2.35 (95% CI 1.0 - 5.58), respectively. The use of one-to-one messages (reference = none vs 1 or more) entered the final model as potential predictor for abstinence, though the significance of this measure was marginal (OR = 1.91, 95% CI 0.92 - 3.97, P = .083). In the path analysis, an apparent association between active online community engagement and abstinence was accounted for in large part by increased use of interactive quitting tools and one-to-one messaging. CONCLUSIONS: Use of interactive quitting tools, and perhaps one-to-one messaging with other members of the online community, was associated with increased abstinence rates among quitplan.com users. Designs that facilitate use of these features should be considered.

Expanding access to nicotine replacement therapy through Minnesota's QUITLINE partnership.

BACKGROUND: Partnerships can expand the reach and effectiveness of quitlines while conserving limited tobacco control dollars. OBJECTIVE: To describe how the addition of free nicotine replacement therapy (NRT) to the "QUITPLAN Helpline" in Minnesota influenced triage and transfer to health plan quitlines and how efforts taken to re-establish balance in the partnership expanded population based access to NRT. METHODS: NRT provision began in September 2002. Call volumes, transfer rates and ClearWay Minnesota dollars spent serving health plan members were examined from May 2001 through November 2005. The process by which health plan quitlines began providing NRT as a result of the addition of NRT to the QUITPLAN Helpline in September 2002 was explored through interviews with health plan representatives. RESULTS: Following the addition of NRT to the QUITPLAN Helpline, the percentage of health plan members transferred to their health plans decreased because callers were resisting transfer to their health plans for telephone counselling that did not include NRT. Transfer rates eventually returned to pre-NRT levels following sequential implementation of scripting changes, transfer requirements and collection of health plan identification numbers. These changes reduced ClearWay Minnesota dollars spent on providing services to insured Minnesotans. Through the partnership, all Minnesotans currently have access to both telephone counselling and NRT either at no or low cost. CONCLUSIONS: Minnesota's partnership has effectively expanded access to NRT through quitlines. The increased use of partnerships for providing quitline services may be effective in broadening population access while conserving limited tobacco control dollars for those without cessation benefits.