An 18-week model of Parent-Child Interaction Therapy: clinical approaches, treatment formats, and predictors of success for predominantly minoritized families.

Introduction: Disruptive behavior disorders are among the most prevalent pediatric mental health referrals for young children. However, families from historically minoritized social identities have experienced disparities in treatment access, retention, and outcomes. Evidence-based interventions such as Parent-Child Interaction Therapy (PCIT) have been found to be effective in reducing children's disruptive behaviors in minoritized families. However, variable treatment length as a result of skill-based graduation criteria (e.g., observed caregiver verbalizations) may slow and/or hinder treatment progress, particularly for families where expected treatment verbalizations are less linguistically relative (e.g., no exact English to Spanish translations) and/or culturally familiar. Time-limited PCIT has been proposed as a strategy for promoting equity in treatment completion and outcomes amongst minoritized families, because treatment progression and/ or completion is not contingent upon caregiver linguistic skill demonstration. Methods: The current study evaluated the overall effectiveness of an 18-week model of PCIT and examined predictors of retention and treatment outcomes. Participants (N = 488 dyads) included predominantly racially, ethnically, linguistically, and socioeconomically diverse children aged two to eight years, and their caregivers. Results: Overall findings indicate that the 18-week PCIT model is an effective intervention for reducing children's externalizing and internalizing behaviors and improving caregiver parenting skills for most treatment completers. Despite advances in treatment completion, some caregiver social identities and PCIT treatment characteristics were predictive of lower completion rates and/or less optimal treatment outcomes. Discussion: Overall, this study provides strong support for widely disseminating use of the 18-week model of PCIT for most families served. Clinical implications and considerations for continued treatment inequity are discussed.

A single-center, open-label, randomized, parallel-group trial to pilot the effectiveness of a peer coach behavioral intervention versus an active control in reducing anxiety and depression in patients scheduled for total knee replacement.

BACKGROUND: Moving Well is a behavioral intervention for patients with knee osteoarthritis (KOA) scheduled for a total knee replacement (TKR). The objective of this intervention is to help patients with KOA mentally and physically prepare for and recover from TKR. METHODS: This is an open-label pilot randomized clinical trial that will test the feasibility and effectiveness of the Moving Well intervention compared to an attention control group, Staying Well, to reduce symptoms of anxiety and depression in patients with KOA undergoing TKR. The Moving Well intervention is guided by Social Cognitive Theory. During this 12-week intervention, participants will receive 7 weekly calls before surgery and 5 weekly calls after surgery from a peer coach. During these calls, participants will be coached to use principles of cognitive behavioral therapy (CBT), stress reduction techniques, and will be assigned an online exercise program, and self-monitoring activities to complete on their own time throughout the program. Staying Well participants will receive weekly calls of similar duration from research staff to discuss a variety of health topics unrelated to TKR, CBT, or exercise. The primary outcome is the difference in levels of anxiety and/or depression between participants in the Moving Well and Staying Well groups 6 months after TKR. DISCUSSION: This study will pilot test the feasibility and effectiveness of Moving Well, a peer coach intervention, alongside principles of CBT and home exercise, to help patients with KOA mentally and physically prepare for and recover from TKR. TRIAL REGISTRATION: Clinicaltrials.gov. NCT05217420; Registered: January 31, 2022.

Dual Inoculation with Rhizophagus irregularis and Bacillus megaterium Improves Maize Tolerance to Combined Drought and High Temperature Stress by Enhancing Root Hydraulics, Photosynthesis and Hormonal Responses.

Climate change is leading to combined drought and high temperature stress in many areas, drastically reducing crop production, especially for high-water-consuming crops such as maize. This study aimed to determine how the co-inoculation of an arbuscular mycorrhizal (AM) fungus (Rhizophagus irregularis) and the PGPR Bacillus megaterium (Bm) alters the radial water movement and physiology in maize plants in order to cope with combined drought and high temperature stress. Thus, maize plants were kept uninoculated or inoculated with R. irregularis (AM), with B. megaterium (Bm) or with both microorganisms (AM + Bm) and subjected or not to combined drought and high temperature stress (D + T). We measured plant physiological responses, root hydraulic parameters, aquaporin gene expression and protein abundances and sap hormonal content. The results showed that dual AM + Bm inoculation was more effective against combined D + T stress than single inoculation. This was related to a synergistic enhancement of efficiency of the phytosystem II, stomatal conductance and photosynthetic activity. Moreover, dually inoculated plants maintained higher root hydraulic conductivity, which was related to regulation of the aquaporins ZmPIP1;3, ZmTIP1.1, ZmPIP2;2 and GintAQPF1 and levels of plant sap hormones. This study demonstrates the usefulness of combining beneficial soil microorganisms to improve crop productivity under the current climate-change scenario.

Nearshore marine biodiversity of Osa Peninsula, Costa Rica: Where the ocean meets the rainforest.

Osa Peninsula in remote southwest Costa Rica harbors 2.5% of global terrestrial biodiversity in only 1,200 km2 and has the largest remaining tract of Pacific lowland wet forest in Mesoamerica. However, little is known about the marine ecosystems of this diverse region. Much of the coastline consists of soft sediment exposed to strong wave action. Three major hard bottom habitat types define this region, including: 1) coral reefs around Isla del Caño Biological Reserve, a no-take marine protected area (MPA) of 52 km2, 2) coastal rocky reefs and islets along the peninsula, including Corcovado National Park, and 3) submerged pinnacles just outside the Isla del Caño MPA. Average coral cover at Isla del Caño was 21%, composed primarily of Porites lobata and Pocillopora elegans. In contrast, coastal rocky reefs were dominated by turf algae (39.8%) and macroalgae (20.7%) with low coral cover (1.1%). Submerged pinnacles were dominated by crustose coralline algae (33.3%) and erect coralline algae (25.7%). Fish assemblage characteristics (species richness, abundance, biomass) were significantly higher at the pinnacles compared to the other habitats and was dominated by schooling species such as Haemulon steindachneri, and the herbivores Kyphosus ocyurus, and Acanthurus xanthopterus. Top predators, primarily Triaenodon obesus, Caranx sexfasciatus, and Lutjanus argentimaculatus, were also most abundant at these pinnacles and accounted for the largest differences in fish trophic structure among habitats. Despite Isla del Caño being fully protected from fishing, biomass was similar to fished areas along the coast and lower than the adjacent submerged pinnacles outside the reserve. Similarly, Corcovado National Park includes 20.3 km2 of no-take MPAs; however, there is limited enforcement, and we noted several instances of fishing within the park. The unique configuration of healthy offshore coral reefs and pinnacles connected to coastal habitats provides corridors for many species including large predators such as sharks and other marine megafauna, which warrants additional protection.

SARS-CoV-2 Delta-variant breakthrough infections in nursing home residents at midterm after Comirnaty® COVID-19 vaccination.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant breakthrough infections in nursing home residents following vaccination with Comirnaty® COVID-19 vaccine were characterized. In total, 201 participants (median age, 87 years; range, 64-100; 133 female) from two nursing homes in the Valencian community (Spain) were included. SARS-CoV-2-Spike (S) antibody responses were determined by a lateral flow immunocromatography (LFIC) assay and by quantitative electrochemiluminescent assay in LFIC-negative participants. SARS-CoV-2-S-IFNγ T cells were enumerated by flow cytometry in 10 participants. Nasopharyngeal SARS-CoV-2 RNA loads were quantified by real-time polymerase chain reaction assays. Vaccine breakthrough COVID-19 due to the Delta variant occurred in 39 residents (median age, 87 years; range, 69-96; 31 female) at a median of 6.5 months after vaccination (nine requiring hospitalization). Breakthrough infections occurred at a higher rate (p < 0.0001) in residents who had not been previously infected with SARS-CoV-2 (naïve) (33/108; 18%) than in those with prior diagnosis of SARS-CoV-2 infection (experienced) (6/93; 6.4%), and were more likely (p < 0.0001) to develop in residents who tested negative by LFIC (20/49) at 3 months after vaccination as compared to their LFIC-positive counterparts (19/142). Among LFIC-negative residents, a trend towards lower plasma anti-RBD antibody levels was noticed in those developing breakthrough infection (p = 0.16). SARS-CoV-2 RNA loads in nasopharyngeal specimens were lower in SARS-CoV-2-experienced residents (p < 0.001) and in those testing positive by LFIC (p = 0.13). The frequency of SARS-CoV-2-S-reactive T cells at 3 months was similar in LFIC-negative residents with (n = 7) or without (n = 3) breakthrough infection. Prior history of SARS-CoV-2 infection and detection of S-reactive antibodies by LFIC at 3 months is associated with a lower risk of Delta-variant breakthrough infection in nursing home residents at midterm after Comirnaty® COVID-19 vaccination.

Correlation between impulse oscillometry parameters and asthma control in an adult population.

Purpose: Impulse oscillometry (IOS) has been proposed as an alternative test to evaluate the obstruction of small airways and to detect changes in airways earlier than spirometry. In this study, we sought to determine the utility and association of IOS parameters with spirometry and asthma control in an adult population. Patients and methods: Adults 14-82 years of age with asthma were classified into uncontrolled asthma (n=48), partially controlled asthma (n=45), and controlled asthma (n=49) groups, and characterized with fractional exhaled nitric oxide (FENO), IOS, and spirometry in a transversal analysis planned as a one-visit study. The basic parameters evaluated in IOS are resistance at 5 Hz (R5), an index affected by the large and small airway; resistance at 20 Hz (R20), an index of the resistance of large airways; difference between R5 and R20 (R5-R20), indicative of the function of the small peripheral airways; reactance at 5 Hz (X5), indicative of the capacitive reactance in the small peripheral airways; resonance frequency (Fres), the intermediate frequency at which the reactance is null, and reactance area (XA), which represents the total reactance (area under the curve) at all frequencies between 5 Hz to Fres. Results: There were statistical differences between groups in standard spirometry and IOS parameters reflecting small peripheral airways (R5, R10, R5-R20, Fres, XA and X5) (P<0.001). Accuracy of IOS and/or spirometry to discriminate between controlled asthma vs partially controlled asthma and uncontrolled asthma was low (AUC=0.61). Using linear regression models, we found a good association between spirometry and IOS. In order to evaluate IOS as an alternative or supplementary method for spirometry, we designed a predictive model for spirometry from IOS applying a penalized regression model (Lasso). Then, we compared the original spirometry values with the values obtained from the predictive model using Bland-Altman plots, and the models showed an acceptable bias in the case of FEV1/FVC, FEV1%, and FVC%. Conclusion: IOS did not show a discriminative capacity to correctly classify patients according to the degree of asthma control. However, values of IOS showed good association with values of spirometry. IOS could be considered as an alternative and accurate complement to spirometry in adults. In a predictive model, spirometry values estimated from IOS tended to overestimate in low values of "real" spirometry and underestimate in high values.

Disease-Free Survival for Patients with Thin Melanomas according to the American Joint Committee on Cancer 8th Edition.

BACKGROUND: The recently implemented AJCC 8th edition TNM staging system for malignant melanoma (MM) changed the definition for T1a and T1b tumours. OBJECTIVES: To analyse differences in disease-free survival (DFS) among patients with thin MM staged according to both AJCC 7th and 8th editions. METHODS: An observational study including 285 patients with cutaneous thin MM (thickness ≤1 mm). Cases were staged as T1a and T1b using both 7th and 8th editions. Neither regional nor visceral diseases were present at diagnosis. DFS curves were generated according to the Kaplan-Meier method. RESULTS: An 8% shift of patients from a T1a towards a T1b stage group was observed after applying the AJCC 8th edition. According to this 8th edition, DFS for T1a patients was significantly longer than for T1b patients (log-rank test; p = 0.005); 5-year DFS for T1a and T1b was 100 and 95%, respectively (Wilcoxon test; p = 0.002). According to the AJCC 7th edition, DFS did not significantly differ for T1a and T1b patients; 5-year DFS for T1a and T1b was 99 and 97%, respectively (p > 0.05). CONCLUSIONS: The AJCC 8th edition seems to be a better tool for staging thin melanomas.

The Role of Cleaning Products in Epidemic Allergic Contact Dermatitis to Methylchloroisothiazolinone/Methylisothiazolinone.

BACKGROUND: Sensitivity to methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) has increased rapidly over recent years. This increase is mainly related to the extensive use of high concentrations of MI in cosmetic products, although a growing number of cases of occupational allergic contact dermatitis are caused by MCI/MI. OBJECTIVE: The aim of this study was to examine the association between the increase in MCI/MI sensitization and the work performed by the patients in our area. METHODS: A retrospective study was undertaken of the records of a total of 1179 patients who had undergone contact skin patch tests for MCI/MI from January 2005 to December 2015. A multivariate logistic regression analysis was performed to identify the factors independently associated with sensitivity to MCI/MI. RESULTS: A constant increase in MCI/MI sensitization was observed over the observation period. The only work associated with a significant increase in the prevalence of MCI/MI sensitization was cleaning, with 38.5% of the cleaning professionals with MCI/MI sensitization consulting for cosmetics-related dermatitis. CONCLUSIONS: Occupational sensitization to MCI/MI in cleaning professionals is worryingly increasing. This, in turn, could possibly account for many cases of cosmetics-associated contact dermatitis. Our findings suggest that a review of the regulations with regard to isothiazolinone concentrations in industrial and household detergents is necessary.

Clinicopathological characteristics of cutaneous malignant melanoma in patients at a tertiary hospital in Macaronesia. Survival as a function of locoregional prognostic factors per the American Joint Committee on Cancer.

BACKGROUND: Despite suffering high ultraviolet radiation levels, few data on malignant melanoma (MM) in Macaronesia are available. METHODS: Observational study of cutaneous MM cases diagnosed during a period of 12 years at a tertiary hospital in Canary Islands. RESULTS: A total of 532 patients (female/male = 1.4) with an average age of 56 years were included; 5% developed more than one MM, and 7% reported family history of MM. Phototype II (43%), dark eyes (41%), and dark hair (41%) predominated. There was a lower frequency of light-colored hair and eyes in those born in the Canary Islands. The most frequent locations of MM were on the back for men (37%) and on the lower extremities for women (35%). Among the infiltrating tumors (83%), the (median) thickness was 1.07 mm (women, 0.90 mm; men, 1.21 mm). Anatomopathological ulceration (AU) and a mitotic rate ≥1 mitosis/mm2 (HMR) were recorded in 27% of patients. Patients with regional disease constituted 12% of the population. The most common stage was IA (34%). Melanoma-specific survival (MSSV) decreased significantly with thickness, presence of AU, HMR, and sentinel lymph node disease. These four variables were independent prognostic factors. The five-year MSSV varied between 100% (stage IA) and 39% (stage IIIC). CONCLUSIONS: The characteristics of the patients were similar to those published in datasets from continental Europe, although the pigmentary features were darker in those originating from Macaronesia. The prognostic parameters described in the 7th edition of the American Joint Committee on Cancer (AJCC) independently predict MSSV in our patients.

Continuous Space Estimation: Increasing WiFi-Based Indoor Localization Resolution without Increasing the Site-Survey Effort.

Although much research has taken place in WiFi indoor localization systems, their accuracy can still be improved. When designing this kind of system, fingerprint-based methods are a common choice. The problem with fingerprint-based methods comes with the need of site surveying the environment, which is effort consuming. In this work, we propose an approach, based on support vector regression, to estimate the received signal strength at non-site-surveyed positions of the environment. Experiments, performed in a real environment, show that the proposed method could be used to improve the resolution of fingerprint-based indoor WiFi localization systems without increasing the site survey effort.

Povidone-iodine induced post-surgical irritant contact dermatitis localized outside of the surgical incision area. Report of 27 cases and a literature review.

BACKGROUND: Povidone-iodine solution is an antiseptic that is used worldwide as surgical paint and is considered to have a low irritant potential. Post-surgical severe irritant dermatitis has been described after the misuse of this antiseptic in the surgical setting. METHODS: Between January 2011 and June 2013, 27 consecutive patients with post-surgical contact dermatitis localized outside of the surgical incision area were evaluated. Thirteen patients were also available for patch testing. RESULTS: All patients developed dermatitis the day after the surgical procedure. Povidone-iodine solution was the only liquid in contact with the skin of our patients. Most typical lesions were distributed in a double lumbar parallel pattern, but they were also found in a random pattern or in areas where a protective pad or an occlusive medical device was glued to the skin. The patch test results with povidone-iodine were negative. CONCLUSIONS: Povidone-iodine-induced post-surgical dermatitis may be a severe complication after prolonged surgical procedures. As stated in the literature and based on the observation that povidone-iodine-induced contact irritant dermatitis occurred in areas of pooling or occlusion, we speculate that povidone-iodine together with occlusion were the causes of the dermatitis epidemic that occurred in our surgical setting. Povidone-iodine dermatitis is a problem that is easily preventable through the implementation of minimal routine changes to adequately dry the solution in contact with the skin.

Comparison of shear bond strength of brackets recycled using micro sandblasting and industrial methods.

OBJECTIVE: To evaluate in vitro the shear bond strength of brackets recycled by sandblasting with aluminum oxide particles of different sizes or reconditioned industrially after successive rebonding. MATERIALS AND METHODS: Eighty brackets were bonded and debonded sequentially three times. After the first debonding, brackets were divided into four groups: (group 1) sandblasting with aluminum oxide particles of 25 µ, (group 2) 50 µ, and (group 3) 110 µ, and (group 4) industrial recycling. Bond strength and adhesive material remaining on debonded bracket bases were evaluated for each successive debond. RESULTS: No significant differences were detected between the four groups following the first recycle (P > .05). After the second recycle, bond strength was significantly greater for the industrially recycled group than the other groups (P < .016). When shear bond strength was compared within each recycling method, the bond strength of sandblasted brackets decreased with the increase of particle size and with each recycle; for the industrially recycled group, no significant differences were detected between the three sequences (P > .016). In the evaluation of bond material remnant, the industrially recycled group left significantly less bond material after successive recycling than the other groups did (P < .016). Within each recycling method, the adhesive remnant decreased significantly after successive debond (P < .016). CONCLUSIONS: Industrial recycling obtained better results than sandblasting after three successive debondings. The brackets' shear bond strength decreased as the size of the aluminum oxide particle used for sandblasting increased and as recycling was repeated.

From recruitment to senescence: food shapes the age-dependent pattern of breeding performance in a long-lived bird.

We used a long-term data set (26 years) from Audouin's Gull (Larus audouinii), a long-lived seabird, to address the relationship between the age-dependent pattern of reproductive performance and environmental conditions during breeding. Although theoretical models predict that the youngest and oldest breeders (due to inexperience and senescence, respectively) will perform less well than intermediate age classes, few empirical data exist regarding how this expected pattern varies with food availability. To assess the influence of age and food availability (corrected by population size of the main consumers to take into account density dependence) on a number of breeding parameters (laying dates, egg volume, clutch size, and hatching success), we modeled mean and variances of these parameters by incorporating heterogeneity into generalized linear models. All parameters varied with age and to different degrees, depending on food availability. As expected, performance improved with increased food supply, and the observed age pattern was quadratic, with poorer breeding performances occurring in extreme ages. For most parameters (except for laying dates, for which age and food did not interact), the pattern changed with food somewhat unexpectedly; the differences in performance between age classes were higher (i.e., the quadratic pattern was more noticeable) when food was more readily available than when food availability was lower. We suggest that, under poor environmental conditions, only high-quality individuals of the younger and older birds bred and that the differences in breeding performance between age classes were smaller. Although variances for egg volume were constant, variances for laying dates were highest for the youngest breeders and tended to decrease with age, either due to the selection of higher-quality individuals or to a greater frequency of birds skipping breeding with age, especially when food was in low supply. Our results show that mean and variances of breeding parameters changed with age, but that this pattern was different for each parameter and also varied according to food availability. It is likely that, other than food, certain additional factors (e.g., sex, cohort effects, density dependence) also influence changes in breeding performance with age, and this may preclude the finding of a common pattern among traits and among studies on different taxa.

Pediatric dermatology consultations: a retrospective analysis of inpatient consultations referred to the dermatology service.

To analyze the care provided by consultant dermatologists to hospitalized pediatric patients, we retrospectively studied the records of inpatient pediatric consultation requests received by a hospital dermatology department between 2000 and 2009. The diagnoses were recorded according to the International Classification of Diseases, Ninth Revision (ICD-9). In a high percentage of cases, the problem was addressed in a single visit, and few additional tests were ordered. The most common diagnostic groups were diseases of the skin and subcutaneous tissue (ICD-9: 680-709). The most frequent specific diagnosis was atopic dermatitis (ICD-9: 691.8). Our series shows that the role of dermatologists as consultants for pediatric inpatients is similar to their role in outpatient consultations.

Morphological alterations in skeletal muscle of spontaneously hypertensive rats

Se estudiaron los músculos Extensor digitorum longus (EDL) y soleus de ratas espontáneamente hipertensas (SHR), comparándolas con ratas normotensas Wistar Kyoto (WKY). La evaluación cuantitativa de los capilares y la clasificación de las fibras musculares se hizo con microscopía de luz, mientras que el estudio ultraestructural permitió visualizar cambios morfológicos. No se encontraron diferencias en la proporción de los tipos de fibras, o en los índices de capilaridad entre las ratas controles y las SHR. Una reducción del área de las fibras IIB se encontró en el músculo EDL de las SHR. El estudio ultraestructural mostró anormalidades en los capilares de ambos músculos en las SHR; en las secciones transversales de células endoteliales se observó engrosamiento del citoplasma, además distribución irregular de caveolas y vesículas pinocíticas, la membrana basal capilar mostró una anchura irregular, con algunas partes engrosadas y reduplicadas. Algunos pericitos fueros prominentes. En el espacio intersticial se encontraron macrófagos. En algunas fibras se hallaron sarcómeros estructuralmente desorganizados, el sistema sarcotubular hinchado, abundantes vacuolas autofágicas, y células satélites proliferativas. Las fibrillas de colágeno fueron abundantes. La presencia de restos celulares, vacuolas autofágicas y la pérdida del sarcolema, indicaron necrosis muscular. Se puede concluir que, aun cuando no se demostró la rarefacción anatómica (disminución numérica) en las SHR, los capilares musculares estaban alterados, lo cual puede ser el sustrato de la rarefacción funcional. En los músculos EDL y soleo de las SHR, los signos de una miopatía leve con fibrosis focal estuvieron presentes.