Publication guidelines for human heart rate and heart rate variability studies in psychophysiology-Part 1: Physiological underpinnings and foundations of measurement.

This Committee Report provides methodological, interpretive, and reporting guidance for researchers who use measures of heart rate (HR) and heart rate variability (HRV) in psychophysiological research. We provide brief summaries of best practices in measuring HR and HRV via electrocardiographic and photoplethysmographic signals in laboratory, field (ambulatory), and brain-imaging contexts to address research questions incorporating measures of HR and HRV. The Report emphasizes evidence for the strengths and weaknesses of different recording and derivation methods for measures of HR and HRV. Along with this guidance, the Report reviews what is known about the origin of the heartbeat and its neural control, including factors that produce and influence HRV metrics. The Report concludes with checklists to guide authors in study design and analysis considerations, as well as guidance on the reporting of key methodological details and characteristics of the samples under study. It is expected that rigorous and transparent recording and reporting of HR and HRV measures will strengthen inferences across the many applications of these metrics in psychophysiology. The prior Committee Reports on HR and HRV are several decades old. Since their appearance, technologies for human cardiac and vascular monitoring in laboratory and daily life (i.e., ambulatory) contexts have greatly expanded. This Committee Report was prepared for the Society for Psychophysiological Research to provide updated methodological and interpretive guidance, as well as to summarize best practices for reporting HR and HRV studies in humans.

Chemical resistance testing of plastics: material compatibility of detergent and disinfectant products.

BACKGROUND: Surface cleaning and disinfection is a key part of breaking the chain of transmission and reducing the risk of healthcare associated infections. However, if cleaning and disinfectant formulations are incompatible with surface materials, frequent application can cause premature failure of plastics due to environmental stress cracking (ESC). Material compatibility should be considered when selecting cleaning and disinfecting products. AIM: This study evaluated the tendency of 2-in-1 wet wipes to cause ESC in commonly found healthcare plastics. METHODS: Eight ready-to-use 2-in-1 wet wipes were evaluated for their ability to cause ESC in 13 plastic surfaces in accordance with BS EN ISO-22088-3. Polymers were exposed to fluid extracted from wipes at a fixed strain of 0.5% for seven days and assessed for cracking, crazing, and tensile strength in accordance with ISO 527-2:2012. FINDINGS: All 2-in-1 wet wipes tested contained ESC agents, although the severity of ESC varied. Products with higher pH (>8.0) were responsible for 74% of failures, with 22 of the 39 tested plastics visibly cracking. Although the primary active in all tested wipe formulations were quaternary ammonium compounds, formulations that included small/medium amines or alcohol demonstrated a greater propensity for plastic cracking. CONCLUSION: Each disinfectant formulation exhibits a unique spectrum of microbial efficacy and unique potential to cause surface damage. This may result in device failures and recalls that could compromise patient and staff safety. BS EN ISO-22088-3 can support material compatibility assessments of disinfectant and detergent products before they come to market.

Attention and sensory integration for gait in young adults with autism spectrum disorder.

INTRODUCTION: Altered sensorimotor function is a common feature of autism spectrum disorder (ASD). As a result, spatiotemporal walking patterns are typically affected. Attentional processes relevant for locomotion may be altered in people with ASD. This study assessed the extent to which gait alterations observed under sensory challenging conditions are due to reduced attention-related processes in young adults with ASD. METHODS: Twenty-one adults with ASD and 21 age- and sex-matched neurotypical participants walked at a self-selected pace on a 10-m walkway under 12 sensory/attention conditions: hard or carpet flooring; well-lit or dim lighting; no attention task, an auditory choice-reaction time information-processing task, or a simple reaction time information-processing task. Gait data were collected with a 12-marker motion capture set and a trunk accelerometer. Spatiotemporal characteristics of gait were derived and compared between the two groups across gait conditions. RESULTS: Floor/light conditions impacted gait speed, average step length, average stance time, average step width, and step width variability similarly in both groups (p<0.05). The information processing tasks impacted average step length, gait speed, and step length variability (p<0.05). Group differences were found in step length metrics: the ASD group had decreased average step length during the simple reaction time information-processing task and neurotypical participants did not (p=0.039); the ASD group had increased variability on carpet compared to hard floor and the neurotypical group had no change in variability due to floor (p=0.015). SIGNIFICANCE: These results suggest that attentional set-shifting and somatosensory inputs may play an important role in ASD-related gait alterations. Step length metrics appear to be sensitive to group differences between ASD and neurotypical adults during sensory challenging conditions.

Increased cardiac vagal tone in childhood-only, adolescent-only, and persistently antisocial teenagers: the mediating role of low heart rate.

BACKGROUND: Cardiac vagal tone is an indicator of parasympathetic nervous system functioning, and there is increasing interest in its relation to antisocial behavior. It is unclear however whether antisocial individuals are characterized by increased or decreased vagal tone, and whether increased vagal tone is the source of the low heart rate frequently reported in antisocial populations. METHODS: Participants consisted of four groups of community-dwelling adolescent boys aged 15.7 years: (1) controls, (2) childhood-only antisocial, (3) adolescent-only antisocial, and (4) persistently antisocial. Heart rate and vagal tone were assessed in three different conditions: rest, cognitive stressor, and social stressor. RESULTS: All three antisocial groups had both lower resting heart rates and increased vagal tone compared to the low antisocial controls across all three conditions. Low heart rate partially mediated the relationship between vagal tone and antisocial behavior. CONCLUSIONS: Results indicate that increased vagal tone and reduced heart rate are relatively broad risk factors for different developmental forms of antisocial behavior. Findings are the first to implicate vagal tone as an explanatory factor in understanding heart rate - antisocial behavior relationships. Future experimental work using non-invasive vagus nerve stimulation or heart rate variability biofeedback is needed to more systematically evaluate this conclusion.

Long-term stability of respiratory sinus arrhythmia among adults with and without a history of depression.

Respiratory sinus arrhythmia (RSA) is an index of parasympathetic nervous system activity reflecting respiratory influences on heart rate. This influence is typically measured as high frequency heart rate variability (HF-HRV) or root mean square of successive differences (RMSSD) of adjacent inter-beat intervals. Examining the long-term stability of its measurement is important as levels of resting RSA have been conceptualized as a marker of individual differences; in particular, of an individual's autonomic regulation and affect-related processes, including emotion regulation. At present, it is not known if resting RSA levels reflect stable differences over a long-term period (i.e., >1 year). Even less is known about how RSA stability differs as a function of depression history and whether it relates to depression risk trajectories. In the present study, we examined the 1.5-year test-retest reliability of resting RSA using the intraclass correlation coefficient (ICC) in 82 adults: n = 41 with a history of depression (ever-depressed); n = 41 controls with no depression history (never-depressed). HF-HRV was fairly stable in both groups (ever-depressed ICC = 0.55, never-depressed ICC = 0.54). RMSSD was also fairly stable in ever-depressed adults (ICC = 0.57) and never-depressed controls (ICC = 0.40). ICC values for both indices did not differ between groups per overlapping 95% confidence intervals. Therefore, RSA stability as assessed by both frequency (HF-HRV) and time domain (RMSSD) measures was not attenuated by a depression history. Implications and the need for future research are discussed.

Maternal invalidation and child RSA reactivity to frustration interact to predict teacher-reported aggression among at-risk preschoolers.

BACKGROUND: Aggression is a transdiagnostic indicator of risk and represents one of the most common reasons children are referred for mental health treatment. Theory and research highlight the impact of maternal invalidation on child aggression and suggest that its influence may vary based on differences in child physiological reactivity. Moreover, the interaction between these risk factors may be particularly pronounced among children of mothers with emotion regulation (ER) difficulties. The current study examined the independent and interactive effects of maternal invalidation and child physiological reactivity to frustration on teacher-reported aggression in an at-risk sample of preschool children. METHOD: Participants included 77 mothers (Mage = 33.17 years, s.d. = 4.83; 35% racial/ethnic minority) and their children (Mage = 42.48 months; s.d. = 3.78; 56% female; 47% racial/ethnic minority). Groups of mothers with and without clinician-rated ER difficulties reported on maternal invalidation, and child respiratory sinus arrhythmia (RSA) was assessed continuously during a frustration task as an indicator of physiological reactivity. Teachers or daycare providers reported on child aggression. RESULTS: Results demonstrated positive associations between maternal ER difficulties and both maternal invalidation and child RSA reactivity to frustration. As expected, the interaction between maternal invalidation and child RSA reactivity was significant, such that higher maternal invalidation and greater child RSA reactivity to frustration predicted more aggression in a daycare or preschool setting. Importantly, this effect was demonstrated while controlling for demographic covariates and baseline RSA. CONCLUSIONS: Findings are in line with diathesis-stress and biosocial models of risk and point to multiple targets for prevention and early intervention.

Provision of chaplaincy services in U.S. hospitals: A strategic conformity perspective.

BACKGROUND: Increasingly, hospitals are expected to provide patient-centered care that attends to patients' health needs, including spiritual care needs. Chaplaincy services help to meet patients' spiritual care needs, which have been shown to have a positive impact on health outcomes. Variation in the provision of chaplaincy services suggests hospitals do not uniformly conform to the expectation of making chaplaincy services available. PURPOSE: The aim of this study was to examine the availability and factors that influence hospitals' provision of chaplaincy services. METHODOLOGY: Data were combined from the American Hospital Association annual surveys with the Area Health Resource File at the county level from 2010 to 2019. Observations on general, acute-care community hospitals were analyzed (45,384 hospital-year observations) using logistic regression that clustered standard errors at the hospital level. RESULTS: Hospitals with Joint Commission accreditation, more staffed beds, nonprofit and government ownership, teaching status, one or more intensive care units, a higher percentage of Medicare inpatient days, church affiliation, and system membership were more likely to provide chaplaincy services than their counterparts. Certification as a trauma hospital and market competition showed no influence on the provision of chaplaincy services. CONCLUSION: The lack of chaplaincy services in many hospitals may be due to limited resources, workforce shortage, or a lack of consensus on scope and nature of chaplaincy services. PRACTICE IMPLICATIONS: Chaplaincy services are an underutilized resource that influences patient experience, clinician burnout and turnover, and the goal of ensuring care is patient-centered. Administrators should consider stronger partnerships where services are provided; researchers and policymakers should consider how the lack of these services in some hospitals may reinforce existing health disparities.

Experimental carotid baroreceptor stimulation reduces blood flow velocities in the anterior and middle cerebral arteries of healthy individuals.

This study investigated effects of experimental baroreceptor stimulation on bilateral blood flow velocities in the anterior and middle cerebral arteries (ACA and MCA) using functional transcranial Doppler sonography. Carotid baroreceptors were stimulated by neck suction in 33 healthy participants. Therefore, negative pressure (- 50 mmHg) was applied; neck pressure (+ 10 mmHg) was used as a control condition. Heart rate (HR) and blood pressure (BP) were also continuously recorded. Neck suction led to reductions in bilateral ACA and MCA blood flow velocities, which accompanied the expected HR and BP decreases; HR and BP decreases correlated positively with the ACA flow velocity decline. The observations suggest reduction of blood flow in the perfusion territories of the ACA and MCA during baroreceptor stimulation. Baroreceptor-related HR and BP decreases may contribute to the cerebral blood flow decline. The findings underline the interaction between peripheral and cerebral hemodynamic regulation in autoregulatory control of cerebral perfusion.

From whence it came: Biological Psychology.

A brief, informal historical review of Biological Psychology is provided. The founding of the journal is related to the organization of psychophysiologists in the mid twentieth century. The distinctive rationale for the founding of the journal at this time is discussed. The sequence of editors and their impact on the journal is reviewed. Overall, the journal remains robust while continuing to strive for expanded content on biological processes as related to psychological processes in both human and animal participants.

An exploration of barriers to access to trial of labor and vaginal birth after cesarean in the United States: a scoping review.

INTRODUCTION: Increasing the number of vaginal birth after cesarean (VBAC) deliveries is one strategy to reduce the cesarean rate in the United States. Despite evidence of its safety, access to trial of labor after cesarean (TOLAC) and VBAC are limited by many clinical and non-clinical factors. We used a scoping review methodology to identify barriers to access of TOLAC and VBAC in the United States and extract potential leverage points from the literature. CONTENT: We searched PubMed, Embase, Cochrane, and CINAHL for peer-reviewed, English-language studies published after 1990, focusing on access to TOLAC and/or VBAC in the United States. Themes and potential leverage points were mapped onto the Minority Health and Health Disparities Research Framework. The search yielded 21 peer-reviewed papers. SUMMARY: Barriers varied across levels of influence and included factors related to restrictive clinical guidelines, provider reluctance, geographic disparities, and midwifery scopes of practice. While barriers varied in levels of influence, the majority were related to systemic and interpersonal factors. OUTLOOK: Barriers to TOLAC and VBAC exist at many levels and are both clinical and non-clinical in nature. The existing body of literature can benefit from more research examining the impact of recent revisions to clinical guidelines related to VBAC as well as additional qualitative studies to more deeply understand the complexity of provider reluctance.

The role of youths' cardiac autonomic balance and parental responses to youth emotion in vulnerability to borderline personality disorder development.

Developmental models of borderline personality disorder (BPD) emphasize the effects of youths' biological vulnerabilities and their experiences of parental responses to emotion, as well as the interaction between these two elements. The current study evaluated the independent and interactive effects of two indices of autonomic nervous system response and parental responses to youth negative emotions on severity and exacerbation of youths' BPD features during the transition to adolescence. The sample consisted of 162 psychiatric youth (10-14 years; 47.2% female) and their parents. At baseline, youth and their parents completed a lab-based conflict discussion during which parasympathetic and sympathetic nervous system response were measured and indices of sympathetic-parasympathetic balance and coactivation/coinhibition were calculated. Youth also reported on supportive and non-supportive parental responses. At baseline and after 9 months, youth self-reported on their BPD features. Results demonstrated that shifting toward sympathetic dominance independently predicted exacerbation of BPD across 9 months. Additionally, fewer experiences of supportive parental responses and more non-supportive parental responses were associated with greater severity of BPD features in youth. This study highlights the role of autonomic response to parent-child conflict as well as the significance of parental responses to youth emotion for the development of BPD during this developmental window.

Using Mean Arterial Pressure in Hypertension Diagnosis versus Using Either Systolic or Diastolic Blood Pressure Measurements.

Hypertension is a severe and highly prevalent disease. It is considered a leading contributor to mortality worldwide. Diagnosis guidelines for hypertension use systolic and diastolic blood pressure (BP) together. Mean arterial pressure (MAP), which refers to the average of the arterial blood pressure through a single cardiac cycle, can be an alternative index that may capture the overall exposure of the person to a heightened pressure. A clinical hypothesis, however, suggests that in patients over 50 years old in age, systolic BP may be more predictive of adverse events, while in patients under 50 years old, diastolic BP may be slightly more predictive. In this study, we investigated the correlation between cerebrovascular changes, (impacted by hypertension), and MAP, systolic BP, and diastolic BP separately. Several experiments were conducted using real and synthetic magnetic resonance angiography (MRA) data, along with corresponding BP measurements. Each experiment employs the following methodology: First, MRA data were processed to remove noise, bias, or inhomogeneity. Second, the cerebrovasculature was delineated for MRA subjects using a 3D adaptive region growing connected components algorithm. Third, vascular features (changes in blood vessel's diameters and tortuosity) that describe cerebrovascular alterations that occur prior to and during the development of hypertension were extracted. Finally, feature vectors were constructed, and data were classified using different classifiers, such as SVM, KNN, linear discriminant, and logistic regression, into either normotensives or hypertensives according to the cerebral vascular alterations and the BP measurements. The initial results showed that MAP would be more beneficial and accurate in identifying the cerebrovascular impact of hypertension (accuracy up to 95.2%) than just using either systolic BP (accuracy up to 89.3%) or diastolic BP (accuracy up to 88.9%). This result emphasizes the pathophysiological significance of MAP and supports prior views that this simple measure may be a superior index for the definition of hypertension and research on hypertension.

Cardiac timing and threatening stimuli influence response inhibition and ex-Gaussian parameters of reaction time in a Go/No-go task.

Sensorimotor responses vary as a function of the cardiac cycle phase. These effects, known as cardiac cycle time effects, have been explained by the inhibition of cardiac afferent signals on information processing. However, the validity of cardiac cycle time effects is challenged by mixed findings. Factors such as current information processing and affective context may modulate cardiac cycle time effects and account for inconsistencies in the literature. The current study examines the influence of cardiac cycle time and threatening stimuli on two aspects of sensorimotor processing, response speed and inhibition. Thirty-four participants (Mage  = 19.35 years; 29 female) completed an auditory Go/No-go task in no face, neutral face, and fearful face conditions. Faces were presented at either cardiac diastole or systole. Participants' reaction times (RTs) during Go trials and failures in response inhibition during No-go trials were recorded. The ex-Gaussian model was fit to RT data in each condition deriving the parameters, mu (µ) and tau (τ), that indicate response speed and attentional lapses, respectively. Repeated measures ANOVA were used to analyze behavioral data. Results showed that cardiac systole prolonged µ but decreased τ, and that cardiac diastole reduced inhibition errors in the fearful face condition but not in other conditions. These findings indicate that cardiac timing differentially modulates sensory-perceptual and top-down attentional processes and cardiac timing interacts with threatening contexts to influence response inhibition. These results highlight the specificity of cardiac cycle time effects on sensorimotor processing.

Isotemporal Associations of Device-Measured Sedentary Time and Physical Activity with Cardiac-Autonomic Regulation in Previously Pregnant Women.

BACKGROUND: High sedentary time (ST) and low physical activity may increase cardiovascular risk, potentially though cardiac-autonomic dysregulation. This study investigated associations of statistically exchanging device-measured ST and physical activity with measures of cardiac-autonomic regulation in previously pregnant women. METHOD: This cross-sectional, secondary analysis included 286 women (age = 32.6 ± 5.7 years; 68% white) measured 7-15 years after delivery. ST and light (LPA), moderate (MPA), vigorous (VPA), and moderate-to-vigorous (MVPA) intensity physical activity were measured by ActiGraph GT3X. ST was further partitioned into long (≥ 30 min) and short (< 30 min) bouts. MVPA was also partitioned into long (≥ 10 min) and short (< 10 min) bouts. Cardiac-autonomic regulation was assessed by heart rate variability (HRV) (resting heart rate, natural log transformed standard deviation of normal R-R intervals [lnSDNN], natural log-transformed root mean square of successive differences [lnRMSSD]) from a 5-min seated ECG. Progressive isotemporal substitution models adjusted for confounders. Sensitivity analyses removed women with related underlying medical conditions and who did not meet respiration rate criteria. RESULTS: Initial analyses found no significant associations with HRV when exchanging 30 min of ST and physical activity (p > 0.05). Yet, replacing long- and short-bout ST with 30 min of long-bout MVPA yielded significantly higher (healthier) lnRMSSD (B = 0.063 ± 0.030 and B = 0.056 ± 0.027, respectively; both p < 0.05). Sensitivity analyses strengthened these associations and yielded further associations of higher lnSDNN and lnRMSSD when replacing 30 min of short-bout MVPA with equivalent amounts of long-bout MVPA (B = 0.074 ± 0.037 and B = 0.091 ± 0.046, respectively). CONCLUSION: Replacing ST with long-bout MVPA is a potential strategy to improve cardiac-autonomic function in previously pregnant women.

Economic Choice and Heart Rate Fractal Scaling Indicate That Cognitive Effort Is Reduced by Depression and Boosted by Sad Mood.

BACKGROUND: People with depression typically exhibit diminished cognitive control. Control is subjectively costly, prompting speculation that control deficits reflect reduced cognitive effort. Evidence that people with depression exert less cognitive effort is mixed, however, and motivation may depend on state affect. METHODS: We used a cognitive effort discounting task to measure propensity to expend cognitive effort and fractal structure in the temporal dynamics of interbeat intervals to assess on-task effort exertion for 49 healthy control subjects, 36 people with current depression, and 67 people with remitted depression. RESULTS: People with depression discounted more steeply, indicating that they were less willing to exert cognitive effort than people with remitted depression and never-depressed control subjects. Also, steeper discounting predicted worse functioning in daily life. Surprisingly, a sad mood induction selectively boosted motivation among participants with depression, erasing differences between them and control subjects. During task performance, depressed participants with the lowest cognitive motivation showed blunted autonomic reactivity as a function of load. CONCLUSIONS: Discounting patterns supported the hypothesis that people with current depression would be less willing to exert cognitive effort, and steeper discounting predicted lower global functioning in daily life. Heart rate fractal scaling proved to be a highly sensitive index of cognitive load, and data implied that people with lower motivation for cognitive effort had a diminished physiological capacity to respond to rising cognitive demands. State affect appeared to influence motivation among people with current depression given that they were more willing to exert cognitive effort following a sad mood induction.

A social network analysis of interorganisational collaboration: Efforts to improve social connectedness.

The Covid-19 pandemic has challenged public health practitioners and clinicians at multiple levels to intentionally consider the impact of social isolation on health outcomes. Many community-based programmes design interventions to address tangible challenges within the social determinants of health, such as asset insecurity or food insecurity, to address health inequities. The growing need to address social isolation within marginalised communities also requires organisations to collaborate and create community partnerships that strengthen their own social integration within the community. The present research reports on the results of a Social Network Analysis (SNA) of community programmes within three southern U.S. cities and their local collaborations to address social isolation. After interviewing representatives of 46 community organisations, it was found that social service organisations that also offer public health services play a central role in community efforts to improve social isolation. The participating organisations primarily collaborate through referrals and information sharing, and report inadequate resources. With a growing recognition that social services and supports play a considerable role in addressing health inequities, this study provides evidence of opportunities for interorganisational collaboration to promote individual and community health.

Cell Squeeze: driving more effective CD8 T-cell activation through cytosolic antigen delivery.

Cell Squeeze is a novel technology that relies on temporarily disrupting the cell membrane to deliver cargo directly into the cytosol. This approach is applicable to a broad range of cell types (peripheral blood mononuclear cells, red blood cells, hematopoietic stem cells, etc.) and cargos (peptides, proteins, small molecules, nucleic acids, and gene-editing complexes) while minimally disrupting normal cell function. By enabling direct cytosolic delivery, one can use this technology to dramatically enhance major histocompatibility complex (MHC) class I presentation of antigens (Ags) for CD8+ T-cell activation-a longstanding challenge for the therapeutic cancer vaccine field that has generally relied on cross-presentation of endocytosed Ags. In addition, by coupling improved MHC class I presentation with coexpression of additional stimulatory factors or systemic immune modulators, one can further enhance the potential impact of an antitumor CD8 response. Pursuing a more direct cellular engineering strategy, which is independent of viral transduction, genetic manipulation, and expansion steps, enables <24 h manufacturing of autologous cell therapies. Through generation of more sophisticated, multifunctional, cell-based vaccines, clinical testing of this technology will elucidate its potential for impact across multiple tumor types.

Efficacy and safety of ripretinib in patients with KIT-altered metastatic melanoma.

BACKGROUND: Ripretinib, a broad-spectrum KIT and platelet-derived growth factor receptor A switch-control tyrosine kinase inhibitor, is approved for the treatment of adult patients with advanced gastrointestinal stromal tumor as ≥ fourth-line therapy. We present the efficacy and safety of ripretinib in patients with KIT-altered metastatic melanoma enrolled in the expansion phase of the ripretinib phase I study. PATIENTS AND METHODS: Patients with KIT-altered metastatic melanoma were enrolled and treated with ripretinib at the recommended phase II dose of 150 mg once daily in 28-day cycles. Investigator-assessed responses according to Response Evaluation Criteria In Solid Tumors version 1.1 were carried out on day 1 of cycles 3, 5, 7, every three cycles thereafter, and at a final study visit. RESULTS: A total of 26 patients with KIT-altered metastatic melanoma (25 with KIT mutations, 1 with KIT-amplification) were enrolled. Patients had received prior immunotherapy (n = 23, 88%) and KIT inhibitor therapy (n = 9, 35%). Confirmed objective response rate (ORR) was 23% [95% confidence interval (CI) 9%-44%; one complete and five partial responses] with a median duration of response of 9.1 months (range, 6.9-31.3 months). Median progression-free survival (mPFS) was 7.3 months (95% CI 1.9-13.6 months). Patients without prior KIT inhibitor therapy had a higher ORR and longer mPFS (n = 17, ORR 29%, mPFS 10.2 months) than those who had received prior KIT inhibitor treatment (n = 9, ORR 11%, mPFS 2.9 months). The most common treatment-related treatment-emergent adverse events (TEAEs) of any grade in ≥15% of patients were increased lipase, alopecia, actinic keratosis, myalgia, arthralgia, decreased appetite, fatigue, hyperkeratosis, nausea, and palmar-plantar erythrodysesthesia syndrome. There were no grade ≥4 treatment-related TEAEs. CONCLUSIONS: In this phase I study, ripretinib demonstrated encouraging efficacy and a well-tolerated safety profile in patients with KIT-altered metastatic melanoma, suggesting ripretinib may have a clinically meaningful role in treating these patients.

Community-Based Asset Security: A Scoping Review.

OBJECTIVES: To explore how and what programs or projects address asset security at the community level as a social determinant of health. DATA SOURCES: To conduct a scoping review following Preferred Reporting Items for Systemic Reviews and Meta-analyses guidelines, the databases searched included CINAHL, EconLit, Embase, Pubmed/Medline, and the Sociological Collection of EBSCOhost. REVIEW METHODS: Keywords used for article identification were ("asset" AND "community") OR ("asset security" AND "community"). Studies were included if published between 1990 and 2019, written in English, and published in a peer-review journal. Reference lists of selected articles were also reviewed for additional articles. Two authors reviewed titles and abstracts separately, then reviewed full-texts for sample selection. RESULTS: After identifying 2,585 articles, researchers refined the final sample to 28 articles. Programs or projects within the sample focused on direct financial interventions or indirect interventions. Direct interventions included financial programs, such as Individual Development Accounts, or ownership opportunities, such as cooperatives or microenterprises. Indirect interventions included those focused on the built environment, such as asset mapping to identify a community's resources, or focused on education, such as those for social workers. CONCLUSIONS: Financial programs, ownership opportunities, assessments of the built environment, and targeted education complement one another to influence a community's assets from many angles. Income inequality has evolved from repeated institutionalized practices that inadvertently reinforce that inequality. Published literature emphasizes the local nature of needs and challenges, culturally responsive efforts, and that observing an impact often requires longitudinal efforts.