Validating a Conceptual Model on Topical Fluoride Hesitancy With Latino Parents.

Fluoride hesitancy is a growing public health challenge and interventions to address it may need to be tailored for minoritized subgroups to address oral health inequities. The goals of this qualitative study were to investigate the extent to which an existing conceptual model on topical fluoride hesitancy is applicable to Latino parents and whether applicability differed between Spanish-speaking Latino (SL) and English-speaking Latino (EL) parents. We conducted semi-structured one-on-one interviews with non-Latino English-speaking parents (N = 50), SL parents (n = 8), and EL parents (n = 8). We coded the transcripts deductively and compared our findings both qualitatively and quantitatively to an existing model on topical fluoride hesitancy comprising 21 categories classified into six domains. We compared frequencies across model domains and categories for Latino versus non-Latino parents as well as for SL versus EL parents. Latino parents were represented across all six domains and 21 categories of the conceptual model. Comparing Latino and non-Latino parents, representation was similar across Domains 1 to 3 (necessity, chemicals, and harm); Latino parents were more highly represented in Domains 4 to 6 (uncertainty, pressure, and choice) compared with non-Latino parents. A larger proportion of EL parents thought a healthy diet was more important than fluoride (Category 1d) and a larger proportion of SL parents felt they did not know enough about fluoride (Category 4a). An existing conceptual model on topical fluoride hesitancy was generally a good fit for SL and EL parents. However, differential representation across model categories suggests that fluoride-related communication and intervention approaches may need to be tailored to Latino parents based on language preference.

Hypotensive Events in Pediatric Patients Receiving Dexmedetomidine for MRI.

PURPOSE: Dexmedetomidine, the preferred pediatric sedating agent for magnetic resonance imaging (MRI), has the side effect of hypotension. Newer recommendations for reporting adverse events in pediatric procedural sedation include using a two-pronged definition. Our aim was to describe the incidence of hypotension in patients undergoing sedated MRI and to identify demographic and clinical factors associated with hypotension, applying a two-pronged definition, where a numerical threshold/clinical criterion must be met as well as at least one clinical intervention performed. DESIGN: An observational cohort study. METHODS: Medical record data were extracted for outpatients less than 18 years of age sedated primarily with dexmedetomidine for MRI in a single center for over a seven-year period. Patients who received propofol as an adjunct were also included. Hypotension was defined using a two-pronged approach, as a 20% reduction in systolic blood pressure from baseline lasting ≥10 minutes, coupled with a fluid bolus. Analysis included descriptive statistics, t tests and logistic regression using discrete-time survival analysis. FINDINGS: Of the 1,590 patient encounters, 90 (5.7%) experienced hypotension. Males were significantly more likely to have hypotension. Patients with hypotension had overall longer appointment times, including longer sedation times and recovery time. Greater blood pressure (BP) variability in the preceding 20 minutes also increased the risk of hypotension. CONCLUSIONS: Our lower incidence of hypotension is likely related to the two-pronged intervention-based definition used, as it likely more accurately reflects clinically meaningful hypotension. To our knowledge, this is the first study using this approach with this population. Research further examining the relationship between prolonged sedation, blood pressure variability, gender, hypotension, and recovery time is needed. Understanding these relationships will help interdisciplinary teams, including nurses in pediatric procedural areas, to reduce the incidence of hypotension, potentially maximize patient safety, and optimize throughput.

GDE6 promotes progenitor identity in the vertebrate neural tube.

The generation of neurons in the central nervous system is a complex, stepwise process necessitating the coordinated activity of mitotic progenitors known as radial glia. Following neural tube closure, radial glia undergo a period of active proliferation to rapidly expand their population, creating a densely packed neurepithelium. Simultaneously, radial glia positioned across the neural tube are uniquely specified to produce diverse neuronal sub-types. Although these cellular dynamics are well studied, the molecular mechanisms governing them are poorly understood. The six-transmembrane Glycerophosphodiester Phosphodiesterase proteins (GDE2, GDE3, and GDE6) comprise a family of cell-surface enzymes expressed in the embryonic nervous system. GDE proteins can release Glycosylphosphatidylinositol-anchored proteins from the cell surface via cleavage of their lipid anchor. GDE2 has established roles in motor neuron differentiation and oligodendrocyte maturation, and GDE3 regulates oligodendrocyte precursor cell proliferation. Here, we describe a role for GDE6 in early neural tube development. Using RNAscope, we show that Gde6 mRNA is expressed by ventricular zone progenitors in the caudal neural tube. Utilizing in-ovo electroporation, we show that GDE6 overexpression promotes neural tube hyperplasia and ectopic growths of the neurepithelium. At later stages, electroporated embryos exhibit an expansion of the ventral patterning domains accompanied by reduced cross-repression. Ultimately, electroporated embryos fail to produce the full complement of post-mitotic motor neurons. Our findings indicate that GDE6 overexpression significantly affects radial glia function and positions GDE6 as a complementary factor to GDE2 during neurogenesis.

A Qualitative Assessment of Factors Influencing Fluoride-Hesitant Parents' Trust of Dentists.

PURPOSE: The purpose of this study was to use fluoride-hesitant parents as a model to identify the factors that erode versus build trust in their child's dentists. METHODS: A qualitative study was conducted using a semi-structured interview guide with fluoride-hesitant parents recruited from two dental clinics and through snowball sampling. A content analysis was performed to identify factors that erode versus build parents' trust in their child's dentist. RESULTS: Of the 56 parents interviewed, most were female (91.1 percent) and white (57.1 percent) and had a mean age of 41±9.7 (standard deviation) years. Factors identified included five that erode trust (having trust violated previously, sensing discrepancies, getting pushed to accept fluoride, feeling dismissed, and sensing bias) and four that build trust (being treated as an individual, having a dentist who communicates, feeling supported and respected, and having a choice). CONCLUSIONS: Dentists' understanding of the factors that erode and build trust with parents could help providers develop patient-centered communication strategies.

A conceptual model on caregivers' hesitancy of topical fluoride for their children.

BACKGROUND: Topical fluoride hesitancy is a well-documented and growing public health problem. Despite extensive evidence that topical fluoride is safe and prevents tooth decay, an increasing number of caregivers are hesitant about their children receiving topical fluoride, leading to challenges in clinical settings where caregivers refuse preventive care. PURPOSE: To explore the determinants of topical fluoride hesitancy for caregivers with dependent children. METHODS: In this qualitative study, we interviewed 56 fluoride-hesitant caregivers to develop an inductive conceptual model of reasons why caregivers are hesitant. RESULTS: The core construct of the conceptual model of topical fluoride hesitancy centered on caregivers "wanting to protect and not mess up their child". Six domains comprised this core construct: thinking topical fluoride is unnecessary, wanting to keep chemicals out of my child's body, thinking fluoride is harmful, thinking there is too much uncertainty about fluoride, feeling pressured to get topical fluoride, and feeling fluoride should be a choice. CONCLUSIONS: Topical fluoride hesitancy is complex and multifactorial. Study findings provide insight for future efforts to understand and optimize caregivers' preventive care decision making.

Qualitative evaluation of the pre-implementation phase of a rural dental clinic co-located within a health center in the Pacific Northwest of the United States.

OBJECTIVE: The development of a dental clinic within an existing Rural Health Clinic (RHC) was proposed to improve access to dental care for Medicaid enrollees in Washington. This qualitative study assessed the implementation of a co-located dental clinic in a rural community during the pre-implementation phase. Additionally, we sought to determine the needs and expectations of community members living in this rural Washington county. METHODS: This study took place in Jefferson County, Washington, a Dental Health Professional Shortage Area. Semi-structured interviews were conducted with 42 participants, consisting of administrators (n = 9), health providers (n = 9) and community members (n = 24). Administrators and health providers were interviewed by phone. Community members were interviewed in-person at Jefferson Healthcare primary care clinics or by phone. Interview data were deductively coded, and thematic analysis with a hybrid inductive-deductive approach was used to analyse coded data. RESULTS: Five themes were identified regarding local needs and expectations: dental care as a major need in the community, persisting barriers to dental care access, expecting more than a 'Medicaid experience', visions for a clinic that serves the community, and solutions outside the clinic to improve community oral health. CONCLUSIONS: By improving access to dental care, a co-located dental clinic is helping to address general dental care needs in rural communities. Policy-level solutions that address housing and food insecurity, improve public transportation, and retain and expand low-income adult Medicaid dental benefits may be needed to overcome persisting barriers to oral health.

The Norms and Corporatization of Medicine Influence Physician Moral Distress in the United States.

PhenomenonMoral distress, which occurs when someone's moral integrity is seriously compromised because they feel unable to act in accordance with their core values and obligations, is an increasingly important concern for physicians. Due in part to limited understanding of the root causes of moral distress, little is known about which approaches are most beneficial for mitigating physicians' distress. Our objective was to describe system-level factors in United States (U.S.) healthcare that contribute to moral distress among pediatric hospitalist attendings and pediatric residents.ApproachIn this qualitative study, we conducted one-on-one semi-structured interviews with pediatric hospitalist attendings and pediatric residents from 4 university-affiliated, freestanding children's hospitals in the U.S. between August 2019 and February 2020. Data were coded with an iteratively developed codebook, categorized into themes, and then synthesized.FindingsWe interviewed 22 hospitalists and 18 residents. Participants described in detail how the culture of medicine created a context that cultivated moral distress. Norms of medical education and the practice of medicine created conflicts between residents' strong sense of professional responsibility to serve the best interests of their patients and the expectations of a hierarchical system of decision-making. The corporatization of the U.S. healthcare system created administrative and financial pressures that conflicted with the moral responsibility felt by both residents and hospitalists to provide the care that their patients and families needed.InsightsThese findings highlight the critical role of systemic sources of moral distress. These findings suggest that system-level interventions must supplement existing interventions that target individual health care providers. Preventing and managing moral distress will require a broad approach that addresses systemic drivers, such as the corporatization of medicine, which are entrenched in the culture of medicine.

Parkinson-causing mutations in LRRK2 impair the physiological tetramerization of endogenous α-synuclein in human neurons.

α-Synuclein (αSyn) aggregation in Lewy bodies and neurites defines both familial and 'sporadic' Parkinson's disease. We previously identified α-helically folded αSyn tetramers, in addition to the long-known unfolded monomers, in normal cells. PD-causing αSyn mutations decrease the tetramer:monomer (T:M) ratio, associated with αSyn hyperphosphorylation and cytotoxicity in neurons and a motor syndrome of tremor and gait deficits in transgenic mice that responds in part to L-DOPA. Here, we asked whether LRRK2 mutations, the most common genetic cause of cases previously considered sporadic PD, also alter tetramer homeostasis. Patient neurons carrying G2019S, the most prevalent LRRK2 mutation, or R1441C each had decreased T:M ratios and pSer129 hyperphosphorylation of their endogenous αSyn along with increased phosphorylation of Rab10, a widely reported substrate of LRRK2 kinase activity. Two LRRK2 kinase inhibitors normalized the T:M ratio and the hyperphosphorylation in the G2019S and R1441C patient neurons. An inhibitor of stearoyl-CoA desaturase, the rate-limiting enzyme for monounsaturated fatty acid synthesis, also restored the αSyn T:M ratio and reversed pSer129 hyperphosphorylation in both mutants. Coupled with the recent discovery that PD-causing mutations of glucocerebrosidase in Gaucher's neurons also decrease T:M ratios, our findings indicate that three dominant genetic forms of PD involve life-long destabilization of αSyn physiological tetramers as a common pathogenic mechanism that can occur upstream of progressive neuronal synucleinopathy. Based on αSyn's finely-tuned interaction with certain vesicles, we hypothesize that the fatty acid composition and fluidity of membranes regulate αSyn's correct binding to highly curved membranes and subsequent assembly into metastable tetramers.

Phenotypic and Genetic Variability of Isolates of ZIKV-2016 in Brazil.

The possibility of a Zika virus epidemic resurgence requires studies to understand its mechanisms of pathogenicity. Here, we describe the isolation of the Zika virus from breast milk (Rio-BM1) and compare its genetic and virological properties with two other isolates (Rio-U1 and Rio-S1) obtained during the same epidemic period. Complete genomic analysis of these three viral isolates showed that they carry characteristics of the American isolates and belong to the Asian genotype. Furthermore, we detected eight non-synonymous single nucleotide variants and multiple nucleotide polymorphisms that reflect phenotypic changes. The new isolate, Rio-BM1, showed the lowest replication rates in mammalian cells, induced lower cell death rates, was more susceptible to treatment with type I IFN, and was less pathogenic than Rio-U1 in a murine model. In conclusion, the present study shows evidence that the isolate Rio-BM1 is more attenuated than Rio-U1, probably due to the impact of genetic alterations in the modulation of virulence. The results obtained in our in vitro model were consistent with the pathogenicity observed in the animal model, indicating that this method can be used to assess the virulence level of other isolates or to predict the pathogenicity of reverse genetic constructs containing other polymorphisms.

Congenital duodenal obstruction - Advances in diagnosis, surgical management, and associated controversies.

Congenital duodenal obstruction (CDO) occurs due to intrinsic and extrinsic mechanisms but is most often caused by intrinsic duodenal atresia and stenosis. This review will summarize the history, epidemiology, and etiologies associated with the most common causes of CDO. The clinical presentation, complex diagnostic considerations, and current surgical repair options for duodenal atresia and stenosis will also be discussed. Finally, both historical and recent controversies which continue to affect the surgical decision-making in the management of these patients will be highlighted.

Intersecting systemic and personal barriers to accessing social services: qualitative interviews in northern California.

BACKGROUND: Addressing social risks in the clinical setting can increase patient confidence in the availability of community resources and may contribute to the development of a therapeutic alliance which has been correlated with treatment adherence and improved quality of life in mental health contexts. It is not well understood what barriers patients face when trying to connect to community resources that help address social risks. This paper aims to describe patient-reported barriers to accessing and using social needs-related resources to which they are referred by a program embedded in a safety net primary care clinic. METHODS: This is a qualitative assessment of patient-reported barriers to accessing and using social needs assistance programs. We conducted over 100 in-depth interviews with individuals in Northern California who participated in a navigation and referral program to help address their social needs and describe a unique framework for understanding how policies and systems intersect with an individual's personal life circumstances. RESULTS: Individuals described two distinct domains of barriers: 1) systems-level barriers that were linked to the inequitable distribution of and access to resources, and 2) personal-level barriers that focused on unique limitations experienced by each patient and impacted the way that they accessed services in their communities. While these barriers often overlapped or manifested in similar outcomes, this distinction was key because the systems barriers were not things that individuals could control or overcome through their own initiative or by increasing individual capacity. CONCLUSIONS: Respondents describe intersecting systemic and personal barriers that compound patients' challenges to getting their social needs met; this includes both a picture of the inequitable distribution of and access to social services and a profile of the limitations created by individual life histories. These results speak to the need for structural changes to improve adequacy, availability, and accessibility of social needs resources. These findings highlight the need for advocacy to address systems barriers, especially the stigma that is faced by people who struggle with a variety of health and social issues, and investment in incentives to strengthen relationships between health care settings and social service agencies.

How Attendings Can Help Residents Navigate Moral Distress: A Qualitative Study.

OBJECTIVE: To explore how pediatric hospitalist attendings can recognize, prevent, and mitigate moral distress among pediatric residents. METHODS: We conducted a qualitative study, utilizing a deductive approach, from August 2019 to February 2020 at 4 university-affiliated, freestanding children's hospitals in the United States using semistructured, one-on-one interviews with pediatric residents and pediatric hospitalist attendings. All transcripts were coded by pairs of research team members. Using constant comparative analysis, codes were categorized into themes and subsequently grouped into domains. We then conceptualized the relationships between the domains. RESULTS: We interviewed 40 physicians (18 residents, 22 attendings) and identified specific strategies for attendings to help residents navigate moral distress, which were categorized into 4 proactive and 4 responsive themes. The proactive themes included strategies employed before morally distressing events to minimize impact: ensuring attendings' awareness of residency factors influencing residents' moral distress; knowing available support resources; creating a learning environment that lays the foundation for mitigating distress; and recognizing moral distress in residents. The responsive themes included strategies that help mitigate the impact of morally distressing situations after they occur: partnering with the senior resident to develop a team-specific plan; consideration of who will participate in, the timing of, and content of the debrief. CONCLUSIONS: We present multiple strategies that attendings can implement to learn to recognize, prevent, and mitigate moral distress among residents. Our findings highlight the need for both proactive and reactive strategies and offer a possible roadmap for attending physicians to help their residents navigate moral distress.

Peripancreatic schwannoma: A case report.

INTRODUCTION: Schwannomas are a benign tumor of peripheral nerve sheath origin. Although most commonly arising in the extremities, head, and neck there have been rare cases of schwannomas presenting within or adjacent to the pancreas reported in the literature. PRESENTATION OF CASE: We present an asymptomatic and otherwise healthy 57-year-old male with an incidental peripancreatic mass measuring 3.5 × 3.7 cm found on abdominal computed tomography (CT). The patient underwent complete enucleation of the mass at our hospital. Pathological analysis of the excised specimen showed spindle shaped cells. Immunohistochemical staining was positive for S100 protein expression, confirming the definitive diagnosis of peripancreatic schwannoma. The patient's postoperative course was uneventful. DISCUSSION: Schwannoma is a commonly benign, encapsulated, and slowly growing tumor arising from myelin producing cells of peripheral nerves. A schwannoma presenting within or adjacent to solid abdominal viscera, such as the pancreas, may be challenging to diagnose preoperatively as it may mimic other lesions. Radiological appearance of schwannoma may be nonspecific and definitive diagnosis is reliant upon pathological analysis. The use of endoscopic ultrasound (EUS) with fine needle aspiration (FNA) may assist the clinician in preoperative diagnosis, however these interventions are not widely available. Accurate preoperative diagnosis of a peripancreatic schwannoma is of high importance as it may preclude unnecessary pancreatectomy or radical resection. CONCLUSION: Although rare, schwannoma should be part of the differential diagnosis of a cystic or solid appearing mass within or surrounding the pancreas. Total resection carries an excellent prognosis with little to no documented recurrence.

Recovery of Synthetic Zika Virus Based on Rio-U1 Isolate Using a Genetically Stable Two Plasmid System and cDNA Amplification.

In 2016, the world experienced the unprecedented Zika epidemic. The ZIKV emerged as a major human pathogen due to its association with the impairment of perinatal development and Guillain-Barré syndrome. The occurrence of these severe cases of Zika points to the significance of studies for understanding the molecular determinants of flavivirus pathogenesis. Reverse genetics is a powerful method for studying the replication and determinants of pathogenesis, virulence, and viral attenuation of flaviviruses, facilitating the design of vaccines and therapeutics. However, the main hurdle in the development of infectious clones is the instability of full-length cDNA in Escherichia coli. Here, we described the development of a genetically stable and efficient infectious clone based on the ZIKV Rio-U1 isolated in the 2016 epidemic in Brazil. The employed strategy consisted of cloning the viral cDNA genome into two stable plasmid subclones and obtaining a high-quality cDNA template with increment in DNA mass for in vitro transcription by PCR amplification. The strategy for developing a ZIKV infectious cDNA clone designed in this study was successful, yielding a replicative and efficient clone-derived virus with high similarities with its parental virus, Rio-U1, by comparison of the proliferation capacity in mammal and insect cells. The infection of AG129 immunocompromised mice caused identical mortality rates, with similar disease progression and morbidity in the animals infected with the parental and the cDNA-derived virus. Histopathological analyses of mouse brains infected with the parental and the cDNA-derived viruses revealed a similar pathogenesis degree. We observed meningoencephalitis, cellular pyknosis, and neutrophilic invasion adjacent to the choroid plexus and perivascular cuffs with the presence of neutrophils. The developed infectious clone will be a tool for genetic and functional studies in vitro and in vivo to understand viral infection and pathogenesis better.

Parenteral lipids shape gut bile acid pools and microbiota profiles in the prevention of cholestasis in preterm pigs.

Multi-component lipid emulsions, rather than soy-oil emulsions, prevent cholestasis by an unknown mechanism. Here, we quantified liver function, bile acid pools, and gut microbial and metabolite profiles in premature parenterally fed pigs given a soy-oil lipid emulsion, Intralipid (IL), a multi component lipid emulsion, SMOFlipid (SMOF), a novel emulsion with a modified fatty-acid composition [experimental emulsion (EXP)], or a control enteral diet (ENT) for 22 days. We assayed serum cholestasis markers, measured total bile acid levels in plasma, liver, and gut contents, and analyzed colonic bacterial 16S rRNA gene sequences and metabolomic profiles. Serum cholestasis markers (i.e., bilirubin, bile acids, and γ-glutamyl transferase) were highest in IL-fed pigs and normalized in those given SMOF, EXP, or ENT. Gut bile acid pools were lowest in the IL treatment and were increased in the SMOF and EXP treatments and comparable to ENT. Multiple bile acids, especially their conjugated forms, were higher in the colon contents of SMOF and EXP than in IL pigs. The colonic microbial communities of SMOF and EXP pigs had lower relative abundance of several gram-positive anaerobes, including Clostridrium XIVa, and higher abundance of Enterobacteriaceae than those of IL and ENT pigs. Differences in lipid and microbial-derived compounds were also observed in colon metabolite profiles. These results indicate that multi-component lipid emulsions prevent cholestasis and restore enterohepatic bile flow in association with gut microbial and metabolomic changes. We conclude that sustained bile flow induced by multi-component lipid emulsions likely exerts a dominant effect in reducing bile acid-sensitive gram-positive bacteria.

Decontamination of the Infected Implant Surface: A Scanning Electron Microscope Study.

A number of treatment options have been explored for peri-implantitis. Seven rough-surfaced implants that failed from peri-implantitis were retrieved. Surfaces were treated by different methods: saline, chlorhexidine, citric acid, 35% phosphoric acid etch gel, hydrogen peroxide, implantoplasty, airborne-particle abrasion, laser, and titanium brush. Implants were observed under scanning electron microscopy. Chemical agents failed to remove any biologic debris. Airborne-particle abrasion, laser, and titanium brush removed part of the biologic debris, and implantoplasty showed complete biologic debris removal. In ex vivo failed implants, implantoplasty showed complete disturbance and removal of bacterial biofilm.

New generation lipid emulsions increase brain DHA and improve body composition, but not short-term neurodevelopment in parenterally-fed preterm piglets.

New generation, multicomponent parenteral lipid emulsions provide key fatty acids for brain growth and development, such as docosahexaenoic acid (DHA) and arachidonic acid (AA), yet the content may be suboptimal for preterm infants. Our aim was to test whether DHA and AA-enriched lipid emulsions would increase activity, growth, and neurodevelopment in preterm piglets and limit brain inflammation. Cesarean-delivered preterm pigs were given three weeks of either enteral preterm infant formula (ENT) or TPN with one of three parenteral lipid emulsions: Intralipid (IL), SMOFlipid (SMOF) or an experimental emulsion (EXP). Activity was continuously monitored and weekly blood sampling and behavioral field testing performed. At termination of the study, whole body and tissue metrics were collected. Neuronal density was assessed in sections of hippocampus (HC), thalamus, and cortex. Frontal cortex (FC) and HC tissue were assayed for fatty acid profiles and expression of genes of neuronal growth and inflammation. After 3 weeks of treatment, brain DHA content in SMOF, EXP and ENT pigs was higher (P < 0.01) in FC but not HC vs. IL pigs. There were no differences in brain weight or neuron density among treatment groups. Inflammatory cytokine TNFα and IL-1ß expression in brain regions were increased in IL pigs (P < 0.05) compared to other groups. Overall growth velocity was similar among groups, but IL pigs had higher percent body fat and increased insulin resistance compared to other treatments (P < 0.05). ENT pigs spent more time in higher physical activity levels compared to all TPN groups, but there were no differences in exploratory behavior among groups. We conclude that a soybean oil emulsion increased select brain inflammatory cytokines and multicomponent lipid emulsions enriched with DHA and AA in parenteral lipids results in increased cortical DHA and improved body composition without affecting short term neurodevelopmental outcomes.

Timing of Prenatal Magnetic Resonance Imaging in the Assessment of Congenital Diaphragmatic Hernia.

INTRODUCTION: Fetal magnetic resonance imaging (MRI) has been used to stratify severity of congenital diaphragmatic hernia (CDH) after ultrasound diagnosis. The purpose of this study was to determine if timing of MRI influenced prediction of severity of outcome in CDH. METHODS: A single institution retrospective review of all CDH referred to our institution from February 2004 to May 2017 was performed. Patients were included if they underwent at least 2 fetal MRIs prior to delivery. Prenatal MRI indices including observed-to-expected total fetal lung volume (o/e TFLV) were evaluated. Indices were categorized by trimester, either 2nd (20-27 weeks gestation) or 3rd trimester (>28 weeks gestation) and further analyzed for outcome predictability. Primary outcomes were survival, extracorporeal membrane oxygenation (ECMO), and pulmonary hypertension (PAH). Student t test and logistic and linear regression were used for data analyses. RESULTS: Of 256 fetuses evaluated for CDH, 197 were further characterized by MRI with 57 having both an MRI in the 2nd and 3rd trimesters. There was an average of 9.95 weeks (±4.3) between the 1st and 2nd MRI. Second trimester o/e TFLV was the only independent predictor of survival by logistic regression (OR 0.890, p < 0.01). Third trimester MRI derived lung volumes were associated with, and independent predictors of, severity of PAH and need for ECMO. Interval TFLV growth was a strong predictor of PAH postnatally (OR 0.361, p < 0.01). Overall cohort survival was 79%. CONCLUSION: Accuracy of MRI lung volumes to predict outcomes is dependent on the -gestational age at the time of exam. While MRI lung volumes at either the 2nd or 3rd trimester are predictive of morbidity, 2nd trimester lung volumes strongly correlated with mortality.

Assistive technology self-management intervention for older Hispanics: a feasibility study.

Purpose: Even though assistive technology (AT) can overcome disabilities, Hispanics are among the least likely to use AT. We aimed to assess the feasibility of an assistive technology AT and disability self-management intervention concerning recruitment, retention, adherence, acceptability, preliminary evaluation of participants' responses to intervention and preliminary efficacy.Methods: We used mixed-method intervention design with a pre- and post-test quantitative model with an experimental intervention and qualitative data obtained after the intervention. Ten older Hispanics were enrolled in an eight weeks group intervention. Instruments to measure feasibility and pre/post participants' report outcomes of quality of life (Psychosocial Impact of Assistive Device Scale [PIADS] Short Form), global health (PROMIS General Health Short Form), self-efficacy (Self-efficacy Scale) and performance difficulties (Individualized Prioritized Problem Assessment [IPPA]) were used.Results: Recruitment, retention and adherence rates were high, the intervention was acceptable, and the participants reported outcomes, such as: new knowledge and skills, enhanced activity performance and participation, increased safety and willingness to use AT, decreased performance difficulties and enhanced quality of life.Conclusion: The intervention was feasible and acceptable and is promising in decreasing performance difficulties in daily activities as well as in having a positive impact in older Hispanics' quality of life.IMPLICATIONS FOR REHABILITATIONOlder Hispanics living in Puerto Rico experience a high prevalence of disabilities in independent living.In a relative small sample this study shows that an assistive technology (AT) and disability self-management intervention for older Hispanics living in Puerto Rico is feasible to be delivered in a group format and in the community context.Older Hispanics living in Puerto Rico can potentially decrease performance difficulties in daily living activities and improved their quality of life through assistive technology and disability self-management interventions.