Pediatric Emergency Physicians' Knowledge, Attitudes, and Behaviors Regarding Confidential Adolescent Care.

OBJECTIVES: More than 19 million adolescents seek care in the emergency department (ED) annually. We aimed to describe the knowledge, attitudes, and behaviors related to confidential adolescent care among pediatric ED physicians. METHODS: We conducted a cross-sectional questionnaire of US physician members of the Pediatric Emergency Medicine Collaborative Research Committee survey listserv. The 24-item questionnaire assessed familiarity with adolescent confidentiality laws, attitudes toward providing confidential care, frequency of discussing behavioral health topics confidentially, and factors influencing the decision to provide confidential care. We dichotomized Likert responses and used χ 2 to compare subgroups. RESULTS: Of 476 eligible physicians, 151 (32%) participated. Most (91. 4%) had completed pediatric emergency medicine fellowship. More participants reported familiarity with all sexual health-related laws compared with all mental health-related laws (64% vs 49%, P < 0.001). The median age at which participants thought it was important to begin routinely providing confidential care was 12 years; 9% thought confidential interviews should not be routinely conducted until older adolescence or at all. Their decision to provide confidential care was influenced by the following: chief complaint (97%), time (43%), language (24%), presence of family (23%) or friends (14%), and space (22%). CONCLUSIONS: Respondents reported moderate familiarity with adolescent confidentiality laws. Although they viewed confidential care as something they were comfortable providing, the likelihood of doing so varied. Barriers to confidential care were influenced by their assessment of adolescents' behavioral health risk, which may contribute to health inequity. Future efforts are needed to develop strategies that augment confidential ED care for adolescents.

Fentanyl in an Infant: Taking Our Breath Away.

Pediatric respiratory failure carries a wide differential diagnosis. Toxic ingestion should remain on the differential even at very young ages. There have been increasing reports of fentanyl overdoses among adults; however, this should be considered for accidental pediatric ingestion, especially considering its high potential for mortality. A nine-month-old female presented to the pediatric emergency department with respiratory failure. The patient was noted to be bradypneic with miotic pupils, and therefore, naloxone was given intravenously (IV) with a positive response. The patient required numerous boluses of intravenous naloxone, which ultimately saved her from intubation. The patient's laboratory results were later positive for fentanyl and cocaine. Fentanyl ingestion has a high mortality rate, especially in pediatrics. With increasing fentanyl use, there is a potential for exposure due to not only child abuse and intentional toxicity but also exploratory ingestions.

Pediatric Emergency Medicine Fellowship Education on Adolescent Sexual Health Care.

OBJECTIVES: Many adolescents use the emergency department as their sole resource for primary care and sexual health care. This provides an opportunity to prevent sexually transmitted infections and unintended pregnancy as well as to educate teenagers about their bodies and sexual health. There is no standard curriculum on sexual health as part of pediatric emergency medicine (PEM) fellowship education. Our goal is to evaluate what is taught in PEM fellowship about adolescent sexual health. METHODS: We administered an anonymous questionnaire to both PEM fellows and program directors (PDs). The questionnaire was distributed through the PEM Program Director Survey Committee. The questionnaire was sent to 88 PDs and 305 fellows total. An introductory email explaining the purpose of the study and a link to the online questionnaire was sent. The questionnaire was created using SurveyMonkey (www.surveymonkey.com). Data were analyzed using descriptive statistics. RESULTS: We achieved a 43% survey response rate from PDs (38 of 88) and a 24% survey response rate from fellows (73 of 305). The PD respondents included 61% females, and almost all (86%) are between ages 35 and 54 years. Seventy-three percent of the fellows are female, and they are all between 25 to 44 years old. There was a great deal of variability in the amount of adolescent sexual health education PDs provide their fellows in the form of lectures and bedside teaching cases. A majority of survey respondents (86% of fellows and 66% of the PDs) agreed that there should be a standard PEM curriculum to teach about adolescent sexual health. More than half (53% of PDs and 56% of fellows) are not satisfied with the number of training opportunities for adolescent sexual health. CONCLUSIONS: We found variability in adolescent sexual health training during PEM fellowship, although fellows and PDs agree that there should be a standardized curriculum. We recommend that the American Board of Pediatrics form a committee to decrease variability in the training of PEM fellows on adolescent sexual health.

Utilizing a Behavioral Health Bundle to Improve Patient and Clinician Safety for Hospitalized Children.

Due to limited psychiatric hospital availability, increasing numbers of pediatric patients with behavioral health (BH) needs are hospitalized in medical units in the US Patients and staff are at increased risk for safety events like self-harm or aggression. Our study aimed to decrease safety events by 25% over a year among hospitalized children with BH diagnoses by implementing an intervention bundle. METHODS: A multidisciplinary team developed and implemented a BH intervention bundle that included a BH equipment cart, an electronic medical record tool for BH patient identification/stratification, a de-escalation team, daily operational BH phone call, and staff training with a safety checklist. The primary outcome measure was the number of reported safety events in BH patients. Process measure was "medically avoidable days", wherein a medically cleared patient remained hospitalized awaiting transfer to inpatient psychiatric units; balance measure was staff perception of the workflow. RESULTS: Although not statistically significant, we noted a downward trend in safety events per 1,000 patient days from 0.47 preintervention to 0.34 postintervention (28% decrease). Special cause variation was not achieved for BH safety events or medically avoidable days. Although one-third of staff members felt the BH bundle was helpful, many reported it as impeding workflow and expressed ongoing discomfort caring for BH patients. CONCLUSIONS: The implementation of a BH intervention bundle requires significant institutional support and interdisciplinary coordination. Despite additional training, equipment, and staff support, we did not achieve measurable improvements in patient safety and care coordination. Additional studies to measure impact and improve care for this population are needed.

Brief Resolved Unexplained Event: Not Just a New Name for Apparent Life-Threatening Event.

OBJECTIVES: This study aimed to evaluate patients who presented to the pediatric emergency department with an apparent life-threatening event (ALTE) to (1) determine if these patients would meet the criteria for brief resolved unexplained event (BRUE), a new term coined by the American Academy of Pediatrics in May, 2016; (2) risk stratify these patients to determine if they meet the BRUE low-risk criteria; and (3) evaluate outcomes of patients meeting the criteria for BRUE. METHODS: We conducted a retrospective chart review of patients who presented to a large urban academic center pediatric emergency department with an ALTE from January 2013 to May 2015 (before the publication of the BRUE guideline). Children ≤12 months of age were identified by the International Classification of Diseases, Ninth/Tenth Revision. Two physician reviews were performed to determine if patients met the ALTE diagnostic criteria. Data were then extracted from these charts to complete objectives. RESULTS: Seventy-eight patients met the diagnostic criteria for ALTE. Only 1 of those patients met the diagnostic criteria for BRUE, but not for low-risk BRUE. This patient underwent an extensive inpatient evaluation and was eventually discharged after monitoring with a benign diagnosis. Most patients did not meet the criteria for BRUE because the event was not unexplained. CONCLUSIONS: Only 1 patient who presented to the ED with ALTE met the criteria for BRUE, and this patient did not meet the low-risk criteria. This study corroborates previous research on BRUE and continues to highlight the importance of conducting a thorough history and physical examination on all patients presenting to the ED with concerning events.

Monocytes complexed to platelets differentiate into functionally deficient dendritic cells.

In addition to their role in hemostasis, platelets store numerous immunoregulatory molecules such as CD40L, TGFß, ß2-microglobulin, and IL-1ß and release them upon activation. Previous studies indicate that activated platelets form transient complexes with monocytes, especially in HIV infected individuals and induce a proinflammatory monocyte phenotype. Because monocytes can act as precursors of dendritic cells (DCs) during infection/inflammation as well as for generation of DC-based vaccine therapies, we evaluated the impact of activated platelets on monocyte differentiation into DCs. We observed that in vitro cultured DCs derived from platelet-monocyte complexes (PMCs) exhibit reduced levels of molecules critical to DC function (CD206, dendritic cell-specific intercellular adhesion molecule-3-grabbing nonintegrin, CD80, CD86, CCR7) and reduced antigen uptake capacity. DCs derived from PMCs also showed reduced ability to activate naïve CD4+ and CD8+ T cells, and secrete IL-12p70 in response to CD40L stimulation, resulting in decreased ability to promote type-1 immune responses to HIV antigens. Our results indicate that formation of complexes with activated platelets can suppress the development of functional DCs from such monocytes. Disruption of PMCs in vivo via antiplatelet drugs such as Clopidogrel/Prasugrel or the application of platelet-free monocytes for DCs generation in vitro, may be used to enhance immunization and augment the immune control of HIV.

Novel Mechanism of Microvesicle Regulation by the Antiviral Protein Tetherin During HIV Infection.

Background Microvesicles are cell membrane-derived vesicles that have been shown to augment inflammation. Specifically, monocyte-derived microvesicles (MDMVs), which can express the coagulation protein tissue factor, contribute to thrombus formation and cardiovascular disease. People living with HIV experience higher prevalence of cardiovascular disease and also exhibit increased levels of plasma microvesicles. The process of microvesicle release has striking similarity to budding of enveloped viruses. The surface protein tetherin inhibits viral budding by physically tethering budding virus particles to cells. Hence, we investigated the role of tetherin in regulating the release of MDMVs during HIV infection. Methods and Results The plasma of aviremic HIV-infected individuals had increased levels of tissue factor + MDMVs, as measured by flow cytometry, and correlated to reduced tetherin expression on monocytes. Superresolution confocal and electron microscopy showed that tetherin localized at the site of budding MDMVs. Mechanistic studies revealed that the exposure of monocytes to HIV-encoded Tat triggered tetherin loss and subsequent rise in MDMV production. Overexpression of tetherin in monocytes led to morphologic changes in the pseudopodia directly underneath the MDMVs. Further, tetherin knockout mice demonstrated a higher number of circulating MDMVs and less time to bleeding cessation. Conclusions Our studies define a novel regulatory mechanism of MDMV release through tetherin and explore its contribution to the procoagulatory state that is frequently observed in people with HIV. Such insights could lead to improved therapies for individuals infected with HIV and also for those with cardiovascular disease.

The Impact of Perpetrator Characteristics on the Completion of a Partner Abuse Intervention Program.

This study examined how type of perpetrator (family only [FO] vs. generally violent [GV]), readiness to change, and stake in conformity function separately and together in predicting completion of a partner abuse intervention program (PAIP). Data were collected from 192 male perpetrators of intimate partner violence (IPV) who were court mandated to attend a PAIP. Participants were categorized as FO violent or GV based on a combination of their self-report and official records of violence. Stake in conformity has been defined as the degree to which an individual is invested in the values and institutions of a society. A composite stake in conformity score was computed for each participant based on his education level, and marital and employment status. Each participant was also assigned a stage of change score based on his responses on a validated measure of stage of change for domestic violence perpetrators. Analyses indicated that stage of change was not related to program completion or attendance. Type of perpetrator and stake in conformity composite score were significantly related to program completion. Perpetrators with higher stake in conformity scores and individuals categorized as FO attended more PAIP sessions and were more likely to complete the program. When both predictors were examined together, only stake in conformity composite score uniquely predicted program attendance and completion. These findings provide additional evidence that subtype of IPV perpetrator has implications for treatment responsiveness and provide preliminary evidence for the value of improved measurement of investment in societal institutions.

Exploring typology categorizations of male perpetrators: a methodology study / La exploración de las categorizaciones de la tipología de los varones violentos en la pareja: un estudio metodológico

Intimate partner violence (IPV) perpetrators were categorized based on whether they were generally violent (GV) or family only violent (FO) using self-report or arrest records. Classification criteria to assess recidivism in perpetrators of IPV were evaluated herein to determine the incremental validity of using a perpetrator's criminal history in addition to their self-report information for categorization purposes. The concordance rates for categorizing subtypes of male perpetrators were compared for two methods, namely, self-report versus criminal history data. Categorizations were made based on self-reported history of violence and federal criminal records separately. Between measures consistency was defined as whether or not the self-report categorizations matched federal criminal record categorizations. It was hypothesized that self-report would not be sufficient as the sole method of categorizing male perpetrators, and the use of criminal history data would add to the validity of the categorization system. Self-reports of aggression were higher than criminal records of aggression. Using data sources together may yield the best outcomes for offenders and society. Implications are discussed

Se clasificaron los varones que ejercen violencia en las relaciones de pareja (VP) en función de si eran violentos en general (VG) o solo en el entorno familiar (VF), empleando registros de autoinformes o de arrestos. Se analizaron los criterios de clasificación para evaluar la reincidencia de los infractores de VP con el fin de determinar la validez incremental del uso de los antecedentes penales del infractor, además de la información procedente de su autoinforme para la clasificación. Se compararon los índices de concordancia para categorizar los subtipos de infractores masculinos para dos métodos: los datos procedentes de autoinforme y los de antecedentes penales. La categorización se basó en la historia de violencia autoinformada y en los antecedentes penales por separado. La congruencia entre medidas se definió como la coincidencia o discrepancia de la categorización de autoinforme con la categorización de antecedentes penales. Se planteó la hipótesis de que el autoinforme no bastaba como único método para clasificar a los infractores masculinos y que el uso de datos procedentes de antecedentes penales aumentaba la validez del sistema de categorización. Hubo más autoinformes sobre agresión que antecedentes penales de agresión. El uso conjunto de ambos podría tener mejores resultados, tanto para los delincuentes como para la sociedad. Se discuten las implicaciones de estos resultados

Frontal brain activity and cognitive processing speed in multiple sclerosis: An exploration of EEG neurofeedback training.

BACKGROUND: Cognitive deficits including impaired information processing speed as assessed by the Symbol Digit Modalities Test (SDMT) are common in multiple sclerosis (MS). Oscillatory markers of processing speed may be extracted from magnetoencephalographic (MEG) and electroencephalographic (EEG) resting-state recordings. In this context, an increased proportion of frontal slow-wave (theta, 4-8 Hz) to fast-wave (beta, 13-30 Hz) EEG activity was indicative of impaired SDMT performance. Such an increased theta/beta ratio may reflect oscillatory slowing associated with deficits in attention control. Therapeutic approaches that consider atypical oscillatory activity in MS remain sparse. OBJECTIVES: In a cross-sectional design, we examined the relation between SDMT performance, the EEG theta/beta ratio and its components. We also explored longitudinally, whether EEG neurofeedback could be used to induce a putatively adaptive alteration in these EEG parameters, toward a pattern indicative of improved processing speed. METHODS: N = 58 MS patients (RRMS/SPMS/PPMS N: 18/35/3, 2 cases excluded) participated in a neuropsychological examination and a resting-state EEG recording. Subsequently, N = 10 patients received neurofeedback training for two weeks in a hospitalized setting. The purpose was to reduce the frontal theta/beta ratio through operant conditioning. RESULTS: In the cross-sectional examination, patients with slow SDMT speed displayed an increased theta/beta ratio, relative to those with normal speed. This involved increased frontal theta power, whereas beta power was equal across groups. The theta/beta ratio remained stable during neurofeedback across sessions of the two-week training period. In an exploratory secondary analysis, within sessions a reduction in the theta/beta ratio during active training blocks relative pre/post session resting-states was observed, driven by reduced theta power. CONCLUSIONS: These findings provide support for utilizing frontal EEG theta activity as an inverse marker of processing speed in MS. Across sessions, there was no support for successful operant conditioning of the theta/beta ratio during the two-week training period. The observed state-specific shift within sessions, involving a transient reduction in theta activity, nevertheless may provide a rationale for a further investigation of neurofeedback as a treatment approach in MS.

Exploring resting-state EEG brain oscillatory activity in relation to cognitive functioning in multiple sclerosis.

OBJECTIVE: Neurophysiologic monitoring parameters related to cognition in Multiple Sclerosis (MS) are sparse. Previous work reported an association between magnetoencephalographic (MEG) alpha-1 activity and information processing speed. While this remains to be replicated by more available electroencephalographic (EEG) methods, also other established EEG markers, e.g. the slow-wave/fast-wave ratio (theta/beta ratio), remain to be explored in this context. METHODS: Performance on standard tests addressing information processing speed and attention (Symbol-Digit Modalities Test, SDMT; Test of Attention Performance, TAP) was examined in relation to resting-state EEG alpha-1 and alpha-2 activity and the theta/beta ratio in 25MS patients. RESULTS: Increased global alpha-1 and alpha-2 activity and an increased frontal theta/beta ratio (pronounced slow-wave relative to fast-wave activity) were associated with lower SDMT processing speed. In an exploratory analysis, clinically impaired attention was associated with a significantly increased frontal theta/beta ratio whereas alpha power did not show sensitivity to clinical impairment. CONCLUSIONS: EEG global alpha power and the frontal theta/beta ratio were both associated with attention. The theta/beta ratio involved potential clinical sensitivity. SIGNIFICANCE: Resting-state EEG recordings can be obtained during the routine clinical process. The examined resting-state measures may represent feasible monitoring parameters in MS. This notion should be explored in future intervention studies.

Transfer and Distribution of Gunshot Residue through Glass Windows.

Research into the deposition patterns of primer gunshot residue (GSR) beyond a primary target was previously nonexistent. This study aimed to determine the deposition patterns of GSR once a bullet passed through an initial target and continued on its path into additional targets. Multiple repetitions were performed to assess the GSR deposition patterns after a bullet was shot through a closed window into either a dummy or a wall within an enclosed room. Samples were taken from both the primary and secondary target holes as well as from nontarget areas. Significant amounts of GSR were found on all samples. The results show that GSR continues to be deposited along the path of the bullet after passing through a primary glass target. These findings reiterate the lack of probative value in collecting GSR samples from gunshot victims even if they are in an enclosed area separate from the shooter.

Preventive and therapeutic challenges in combating Zika virus infection: are we getting any closer?

The neuroteratogenic nature of Zika Virus (ZIKV) infection has converted what would have been a tropical disease into a global threat. Zika is transmitted vertically via infected placental cells especially in the first and second trimesters. In the developing central nervous system (CNS), ZIKV can infect and induce apoptosis of neural progenitor cells subsequently causing microcephaly as well as other neuronal complications in infants. Its ability to infect multiple cell types (placental, dermal, and neural) and increased environmental stability as compared to other flaviviruses (FVs) has broadened the transmission routes for ZIKV infection from vector-mediated to transmitted via body fluids. To further complicate the matters, it is genetically similar (about 40%) with the four serotypes of dengue virus (DENV), so much so that it can almost be called a fifth DENV serotype. This homology poses the risk of causing cross-reactive immune responses and subsequent antibody-dependent enhancement (ADE) of infection in case of secondary infections or for immunized individuals. All of these factors complicate the development of a single preventive vaccine candidate or a pharmacological intervention that will completely eliminate or cure ZIKV infection. We discuss all of these factors in detail in this review and conclude that a combinatorial approach including immunization and treatment might prove to be the winning strategy.

Improving communication between obstetric and neonatology teams for high-risk deliveries: a quality improvement project.

Summoning is a key component of communication between obstetrics and neonatal resuscitation team (NRT) in advance of deliveries. A paging system is a commonly used summoning tool. The timeliness and information contained in the page help NRT to optimally prepare for postdelivery infant care. Our aim was to increase the frequency that summoning pages contained gestational age and reason for NRT attendance to >90%. At baseline, 8% of pages contained gestational age and 33% of pages contained a reason for NRT attendance. Sequential Plan-Do-Study-Act cycles were used as our model for quality improvement. During the 8-month improvement period, the per cent of pages increased to 97% for gestational age and 97% for reason for NRT attendance. Measures of page timeliness, our balancing measure, did not change. Summoning communication between obstetric and NRT is crucial for optimal perinatal outcomes. The active involvement of all stakeholders throughout the project resulted in the development of a standardised paging tool and a more informative paging process, which is a key communication tool used in many centres.

A qualitative study of tobacco use in eight economically disadvantaged Dominican Republic communities.

Understanding social conditions prior to intervention design can enhance tobacco control interventions. This paper describes formative research conducted in 2010 about tobacco use in eight economically disadvantaged Dominican Republic communities, four of which participated in a previous intervention study (2003-2008). A combined US-Dominican team used a rapid assessment process to collect qualitative social and cultural data on tobacco use, knowledge and attitudes; plus observations about social and policy factors, such as exposure to secondhand smoke (SHS), tobacco regulations, pregnancy, health care provider (HCP) practices and sustainability of the 2003-2008 intervention. This assessment found that tobacco use varied by age. While all ages typically used cigarettes, older adults used relatively more unprocessed tobacco, which is seen as less harmful and less addictive. Middle-aged smokers typically used commercial cigarettes, which are viewed as dangerous, addictive, expensive and offensive. Young adults reported avoiding smoking, but using relatively more smokeless tobacco. Smoking during pregnancy has reportedly decreased. SHS was viewed as harmful, although smoke-free homes were uncommon. HCPs discussed tobacco issues mostly for patients with tobacco-related conditions. Sustainability of the 2003-2008 intervention appeared to be linked to active Community Technology Centers with strong leadership, and community social capital. This information could be used to design better targeted interventions in these communities.

Tobacco Cessation in Economically Disadvantaged Dominican Republic Communities: Who are the Ex-Users?

INTRODUCTION: Tobacco use and harm continue to increase in low- and middle income countries (LMICs) globally. Smoking cessation is the most effective means of reducing morbidity and mortality from tobacco use. Increasing the prevalence of ex-users is an indicator of population cessation. AIMS: This study provides the first examination of factors associated with ex-tobacco use status in the Dominican Republic (DR), a LMIC in the Latin America and Caribbean region. METHODS: Baseline surveillance was conducted for 1177 randomly selected households in 7 economically disadvantaged DR communities (total N=2680 adult household members). RESULTS: Ex-user prevalence was 10.6% (1.0%-18.5% across communities), 14.8% were current users (9.1-20.4), and quit ratios were 41.7% (9.7%-52.7%). Among ever-users, females (OR 2.02, 95% CI 1.41, 2.90), older adults (45-64: OR 1.75, 95% CI 1.12, 2.74; 65+: OR 2.09, 95% CI 1.29, 3.39), and those who could read/write (OR 1.64, 95% CI 1.08, 2.50), had health conditions (OR 1.63, 95% CI 1.11, 2.41), and lived with ex-users (OR 1.70, 95% CI 1.12, 2.58) were over 60% to two times as likely to be ex-users. Those from remote communities (OR 0.52, 95% CI 0.36, 0.74), using chewed tobacco (OR 0.14, 95% CI 0.04, 0.48) and living with tobacco users (OR 0.55, 95% CI 0.37, 0.81) were less likely to be ex-users. CONCLUSIONS: Ex-user prevalence and quit ratios were lower than for high income countries. Implementing broad tobacco control measures, combined with clinically targeting vulnerable groups, may increase tobacco cessation to most effectively reduce this public health crisis.

Disruption of a cystine transporter downregulates expression of genes involved in sulfur regulation and cellular respiration.

Cystine and cysteine are important molecules for pathways such as redox signaling and regulation, and thus identifying cellular deficits upon deletion of the Saccharomyces cerevisiae cystine transporter Ers1p allows for a further understanding of cystine homeostasis. Previous complementation studies using the human ortholog suggest yeast Ers1p is a cystine transporter. Human CTNS encodes the protein Cystinosin, a cystine transporter that is embedded in the lysosomal membrane and facilitates the export of cystine from the lysosome. When CTNS is mutated, cystine transport is disrupted, leading to cystine accumulation, the diagnostic hallmark of the lysosomal storage disorder cystinosis. Here, we provide biochemical evidence for Ers1p-dependent cystine transport. However, the accumulation of intracellular cystine is not observed when the ERS1 gene is deleted from ers1-Δ yeast, supporting the existence of modifier genes that provide a mechanism in ers1-Δ yeast that prevents or corrects cystine accumulation. Upon comparison of the transcriptomes of isogenic ERS1+ and ers1-Δ strains of S. cerevisiae by DNA microarray followed by targeted qPCR, sixteen genes were identified as being differentially expressed between the two genotypes. Genes that encode proteins functioning in sulfur regulation, cellular respiration, and general transport were enriched in our screen, demonstrating pleiotropic effects of ers1-Δ. These results give insight into yeast cystine regulation and the multiple, seemingly distal, pathways that involve proper cystine recycling.

Lessons Learned from Twelve Years of Partnered Tobacco Cessation Research in the Dominican Republic.

Engaging partners for tobacco control within low and middle income countries (LMICs) at early stages of tobacco control presents both challenges and opportunities in the global effort to avert the one billion premature tobacco caused deaths projected for this century. The Dominican Republic (DR) is one such early stage country. The current paper reports on lessons learned from 12 years of partnered United States (US)-DR tobacco cessation research conducted through two NIH trials (Proyecto Doble T, PDT1 and 2). The projects began with a grassroots approach of working with interested communities to develop and test interventions for cessation and secondhand smoke reduction that could benefit the communities, while concurrently building local capacity and providing resources, data, and models of implementation that could be used to ripple upward to expand partnerships and tobacco intervention efforts nationally. Lessons learned are discussed in four key areas: partnering for research, logistical issues in setting up the research project, disseminating and national networking, and mentoring. Effectively addressing the global tobacco epidemic will require sustained focus on supporting LMIC infrastructures for tobacco control, drawing on lessons learned across partnered trials such as those reported here, to provide feasible and innovative approaches for addressing this modifiable public health crisis.

Neural correlates of visuo-spatial working memory encoding--an EEG study.

The aim of the present electroencephalographic (EEG) study was to investigate neuronal correlates of working memory encoding in a visuo-spatial serial delayed match-to-sample task. A rapid serial visual presentation approach was used to dissociate brain activity related to encoding of visuo-spatial targets and cortical activity evoked by suppression of distracting information. During the task EEG was recorded and steady-state visually evoked potentials (SSVEPs) were calculated. Finally, standardized low-resolution electromagnetic tomography (sLORETA) was used to determine brain regions involved in visuo-spatial working memory encoding. A distributed task-relevant network comprising right temporal, parietal, and occipital areas was identified. Results suggest that activity of this network is amplified during actual encoding of targets into visual working memory, whereas the same network is attenuated in its activation when distracting visual information should be suppressed. Left prefrontal and anterior cingulate cortices do not seem to be involved in encoding of targets but only in suppression of distracting information, likely reflecting activity of an attention-based supervisory system. These results strongly emphasise the linkage between visuo-spatial attention and working memory during amplification of selected and suppression of irrelevant information.