University System of Ohio

OBJECTIVE: Eating disorders (EDs) and social anxiety disorder (SAD) are highly co-occurring. This comorbidity is extremely relevant, given that individuals with comorbid ED-SAD are less likely to seek and/or benefit from ED treatment. METHOD: We used network analysis to conceptualize ED-SAD comorbidity in a sample of 2,215 participants with a primary diagnosis of ED, SAD, or no known diagnosis. We used novel network analyses methods to select symptoms for our models, identify potential illness pathways (i.e., bridge symptoms) between disorders and underlying vulnerabilities (e.g., perfectionism, social appearance anxiety), and to compare across sample types (e.g., clinical vs. nonclinical). We also tested several novel network analyses methods aimed at the following methodological concerns: (a) topological concerns (i.e., which items should be included in NA models), (b) how to use empirical indices to quantify bridge symptoms and (c) what differences in networks across samples mean. RESULTS: We found that difficulty with drinking beverages and eating in public were bridge symptoms between ED and SAD. We also found that feeling nervous about one's appearance was a bridge symptom. CONCLUSIONS: We identified public eating and drinking as bridge symptoms between EDs and SAD. Future research is needed to test if interventions focused on public eating and drinking might decrease symptoms of both EDs and SAD. Researchers can use this study (code provided) as an exemplar for how to use network analysis, as well as to use network analysis to conceptualize ED comorbidity and compare network structure and density across samples.

Atherosclerosis is an inflammatory disease involving the accumulation of macrophages in the intima. Wnt5a is a noncanonical member of the Wnt family of secreted glycoproteins. Recently, human macrophages have been shown to express Wnt5a upon stimulation with bacterial pathogens in vitro and in granulomatous lesions in the lung of Mycobacterium tuberculosis-infected patients. Wnt5a expression has also been liked to Toll-like receptor-4 (TLR-4), an innate immune receptor implicated in atherosclerosis. These observations, along with the fact that Wnt5a is involved in cell migration and proliferation, led us to postulate that Wnt5a plays a role in atherosclerosis. To investigate this hypothesis, we characterized Wnt5a expression in murine and human atherosclerotic lesions. Tissue sections derived from the aortic sinus to the aortic arch of apolipoprotein E-deficient mice and sections derived from the carotid arteries of patients undergoing endarterectomy were subjected to immunohistochemical analysis. All samples were found to be positive for Wnt5a with predominant staining in the areas of macrophage accumulation within the intima. In parallel, we probed for the presence of TLR-4 and found coincident TLR-4 and Wnt5a expression. For both the Wnt5a and TLR-4 staining, consecutive tissue sections treated with an isotype- and species-matched Ig served as a negative control and exhibited little, if any, reactivity. Quantitative RT-PCR revealed that Wnt5a mRNA expression in RAW264.7 murine macrophages can be induced by stimulation with LPS, a known ligand for TLR-4. Combined, these findings demonstrate for the first time Wnt5a expression in human and murine atherosclerotic lesions and suggest that cross talk between TLR-4 and Wnt5a is operative in atherosclerosis.

This paper explores the effects of allowing large, price-responsive consumers to provide reserves in a power system with significant penetration of wind energy. A bilevel optimization model represents the utility maximization problem of a large consumer, subject to a stochastic day-ahead co-optimization of energy and reserves that a system operator would solve to clear the market while considering wind power uncertainty. An examination of the market outcomes from both an illustrative and a large-scale study using this model allows analysis of a) the effects of the type of behavior of the large consumer (i.e., strategic vs competitive), b) limits on the amount of reserves it is allowed to provide, and c) variability and accuracy of characterization of wind power uncertainty.

OBJECTIVE: Haemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS) are life-threatening systemic hyperinflammatory syndromes that can develop in most inflammatory contexts. They can progress rapidly, and early identification and management are critical for preventing organ failure and mortality. This effort aimed to develop evidence-based and consensus-based points to consider to assist clinicians in optimising decision-making in the early stages of diagnosis, treatment and monitoring of HLH/MAS. METHODS: A multinational, multidisciplinary task force of physician experts, including adult and paediatric rheumatologists, haematologist/oncologists, immunologists, infectious disease specialists, intensivists, allied healthcare professionals and patients/parents, formulated relevant research questions and conducted a systematic literature review (SLR). Delphi methodology, informed by SLR results and questionnaires of experts, was used to generate statements aimed at assisting early decision-making and optimising the initial care of patients with HLH/MAS. RESULTS: The task force developed 6 overarching statements and 24 specific points to consider relevant to early recognition of HLH/MAS, diagnostic approaches, initial management and monitoring of HLH/MAS. Major themes included the simultaneous need for prompt syndrome recognition, systematic evaluation of underlying contributors, early intervention targeting both hyperinflammation and likely contributors, careful monitoring for progression/complications and expert multidisciplinary assistance. CONCLUSION: These 2022 EULAR/American College of Rheumatology points to consider provide up-to-date guidance, based on the best available published data and expert opinion. They are meant to help guide the initial evaluation, management and monitoring of patients with HLH/MAS in order to halt disease progression and prevent life-threatening immunopathology.

OBJECTIVES: To determine whether there is a latent structure among measures used to evaluate rehabilitation outcomes for persons with traumatic brain injury and if the construct of participation is discernible within this structure. DESIGN: Exploratory factor analyses of 2 cross-sectional cohorts of rehabilitation patients who sustained a traumatic brain injury up to 5 years prior to assessment. PRIMARY MEASURES: Community Integration Questionnaire (CIQ), Craig Handicap Assessment and Reporting Technique (CHART), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Satisfaction With Life Scale (SWLS). RESULTS: Both factor analyses suggested a latent structure composed of 3 factors that were interpreted as representing the Activities and Participation dimensions of the World Health Organization's International Classification of Functioning, Disability and Health (ICF), and a third representing Subjective Well-Being. Low to moderate correlations were found between factors. CONCLUSIONS: The World Health Organization's ICF excludes subjective well-being; however the factor analyses indicate that it is a distinct domain not incorporated into Activities and Participation. The SF-36, CIQ, and CHART can, in combination, evaluate all 3 domains, but not alone. The SF-36 appears to be sensitive to the affective, but not the cognitive, aspect of Subjective Well-Being. A measure of life satisfaction would be a useful supplement to traditional measures of rehabilitation outcome.

Abstract One hypothesized reason for why a disproportionately low number of men enter caregiving fields is how such men are perceived. In two studies, drawing upon the Stereotype Content Model and the lack‐of‐fit model, we tested whether men would encounter more social (e.g., likeability bias) and economic (e.g., hiring or job opportunity bias) penalties than women in caregiving professions due to perceptions that men are less warm than women. In all three studies, we created job or employment materials in which the gender of the candidate or employee was manipulated. In Study 1, a female preschool teacher received higher warmth ratings than a male preschool teacher, which in turn predicted preference for the female teacher over the male teacher. In Study 2, a female social worker was rated more highly in warmth and job hireability than a male social worker; warmth also mediated the relationships between gender and both likeability and job hireability. In Study 3, a male preschool teacher was rated lower in warmth, likeability, job hireability, and job suitability than both a female preschool teacher and a preschool teacher with an unspecified gender. There were no differences between perceived competence of men and women in caregiving positions when competence was assessed. Implications for the factors that predict adverse reactions to and penalties against men in caregiving occupations, as well as interventions to combat the potential negative effects of such penalties on men's interest in caregiving careers, are discussed.

This paper describes our efforts to promote “media literacy” and media resistance skills in boys and girls ages 9-11 who were participating in a controlled evaluation of a 10-lesson prevention program designed to improve nutrition and exercise behavior and to promote self-acceptance and body esteem. Our approach to a critical evaluation of mass media focused on student content analyses of nutritional and body shape messages, followed by consideration of the disparity of their findings and emphasis on healthy messages about eating, weight, and shape in the entire curriculum. This approach was by and large ineffective in both grades, and was not well-received by nearly a third of the teachers. However, the entire curriculum was moderately successful in increasing knowledge, and it had a positive effect on 5th graders' attitudes toward fat people. Images and content from the mass media, scattered throughout the lessons and homework assignments, may have been instrumental in these effects. Implications of these findings are discussed with respect to the need for a different type of media literacy lesson and for a more systemic approach to primary prevention.

Objective: Computerized intravenous (IV) infusion pumps ("smart pumps") provide decision support to nurse end users at patients' bedsides during IV medication administration, but little is known about nurses' experiences using this technology in clinical practice. Our objective was to improve understanding about the use of smart pumps in clinical practice. Methods: Four focus groups of 60 to 90 minutes were held with practicing registered nurses in March and April 2005. Sessions were audiotaped, transcribed verbatim, and analyzed using deductive and inductive methods to answer our research question about smart pump usage and to identify emergent themes in the data. Results: Nurse participants had an average of 3½ years of experience using smart pumps in diverse clinical settings. Several mechanical issues related to pump use were noted, including difficulties with tubing, battery life, and pump weight. Challenges associated with smart pump usage such as inconsistencies in the smart pump drug library and IV medication preparation were also discussed. Nurses described different strategies to overcome smart pump use challenges including disabling the safety software features of the smart pumps, especially in cases where there were differences between drug volumes and concentrations, limitations on dosing units, or limitations on medication administration rates. Conclusions: Smart pumps offer the potential to improve IV medication administration safety in the medication administration process, but work-arounds can introduce the possibility of new errors. Organizations introducing smart pumps should investigate actual usage at the point of care, and consider opportunities to accommodate modifications to the decision support software, or implement use standards to facilitate appropriate smart pump use.

As with any sensory input, music might be expected to incorporate the processing of information about the safety of the environment. Little research has been done on how such processing has evolved and how different kinds of sounds may affect the experience of certain environments. In this article, we investigate if music, as a form of auditory information, can trigger the experience of safety. We hypothesized that (1) there should be an optimal, subjectively preferred degree of information density of musical sounds, at which safety-related information can be processed optimally; (2) any deviation from the optimum, that is, both higher and lower levels of information density, should elicit experiences of higher stress and danger; and (3) in general, sonic scenarios with music should reduce experiences of stress and danger more than other scenarios. In Experiment 1, the information density of short music-like rhythmic stimuli was manipulated via their tempo. In an initial session, listeners adjusted the tempo of the stimuli to what they deemed an appropriate tempo. In an ensuing session, the same listeners judged their experienced stress and danger in response to the same stimuli, as well as stimuli exhibiting tempo variants. Results are consistent with the existence of an optimum information density for a given rhythm; the preferred tempo decreased for increasingly complex rhythms. The hypothesis that any deviation from the optimum would lead to experiences of higher stress and danger was only partly fit by the data. In Experiment 2, listeners should indicate their experience of stress and danger in response to different sonic scenarios: music, natural sounds, and silence. As expected, the music scenarios were associated with lowest stress and danger whereas both natural sounds and silence resulted in higher stress and danger. Overall, the results largely fit the hypothesis that music seemingly carries safety-related information about the environment.

OBJECTIVE: This study evaluated the effects of a social determinants of health (SDH) screening tool and service referral on emergency department (ED) use among patients at a Federally Qualified Health Center primary care clinic. STUDY DESIGN: Quasi-experimental. SAMPLE: Three-hundred and eleven English-speaking patients 18 years and older. MEASURES: The Core 5 SDH screening tool consists of five yes/no items assessing food, housing, utilities, transportation, and safety needs. The number of ED visits 3 months before and after the intervention were collected from electronic health records. INTERVENTION: The research team administered the Core 5 SDH screening tool and if desired, referred patients with an identified need for SDH services. RESULTS: Approximately 43% of patients reported a SDH need with food insecurity most prevalent (62.2%). The number of ED visits was significantly lower 3 months post-intervention compared to 3 months before for the 125 participants who wanted and received the SDH service referral (IRR = 0.64, 95% CI = 0.41, 0.99) and for the 35 participants who reported receiving some/all of the needed services at the 2-week follow-up (IRR = 0.36, 95% CI = 0.17, 0.76). CONCLUSIONS: Addressing patients' SDH needs may reduce ED visits, lower healthcare costs, and ultimately, improve health.

Discusses the authors’ approach to experiential learning in a two‐semester “engineering physics” course at a large metropolitan university in the USA. A student‐centered methodology stressing teamwork while incorporating individual creativity is used in an interdisciplinary course setting. Students practice transferable skills relevant to today’s technological workplace. Discusses the methodology and lessons learned in the context of higher education in the USA and abroad.

Access to different forms of education has become more prevalent in recent years. Online learning design requires innovative pedagogical practices. Dr. Bloomberg provides strategies for online course design, student engagement, andpedagogical methodology.

Abstract The dynamics of institutional power need to be addressed through structural practices that support prospects for authentic, democratic partnerships.

The purpose of this study is to characterize the V pre‐notched specimens with different relative depth ratio and the relative distance ratio by the AE signals in in situ three‐point bending tests. Simultaneously, during the bending process, the V pre‐notched specimen is in situ monitored by the opto‐digital microscope. In order to analyze the depth of V‐notch and the distance between the side V‐notches and the middle V‐notch effect on the specimens, a finite element analysis model is built by ABAQUS. Combining the in situ images, the AE signals and the finite element analysis (FEA) results, it is found that the experiment results are consistent with the FEA results. It is demonstrated that the amplitude of AE signals can effectively characterize the crack initiation, crack growth, and crack fast instability fracture.

SIGNIFICANCE: Delivering personalized three-dimensional (3D)-printed solutions for our patients is easier now than it has ever been. This technological revolution makes things possible that it would be extremely challenging to achieve using traditional approaches. PURPOSE: The purpose of this study was to increase awareness among the optometric and vision science community of opportunities to apply 3D printing to enhance clinical practice and research. METHODS: A widely available fused deposition modeling 3D printing approach was used to fabricate several plastic items for use in optometric practice and low vision rehabilitation. RESULTS: The authors will share nine optometric extensions of 3D printing: (1) an attachment for glare-acuity testing, (2) a disposable cover paddle to limit infection spread for red-eye visits, (3) ophthalmic equipment repair/modification, (4) ophthalmic lens thickness calipers, (5) NoIR lens filter flipper, (6) Optivisor faceplate, (7) EasyPocket lanyard card holder, (8) dome magnifier handle, and (9) a phoropter near card holder. CONCLUSIONS: Designing customized solutions and problem-solving for our patients and offices are becoming easier to do using 3D printing every year. The possible applications for this technology are constantly being expanded. This technology allows for cost-effective production of solutions, some of which would not be feasible otherwise.

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Solubility of CO 2 in media formed one-or-more of four forms of inorganic carbon species: carbonic acid, aqueous carbon dioxide, bicarbonate, and carbonate and generated hydrogen ion affecting the medium pH. The saturated TIC and pH were studied using RO water, RO+, GM and GM+ with air (0.038%), 0.5%, 1.0%, 1.5%, 2.0% and 10% CO 2 under atmospheric pressure at temperatures of 25, 35, 45, and 55C. Chemical species existing in the media formed additional inorganic carbon species functioning as a buffer, resulting in raising the medium pH. The NaOH boosted the TIC holding capacity of the media and improved the saturated pH. At a specific CO 2 -enriched air and medium, the saturated pH linearly increased with respect to increased temperature, which implied the decreasing of TIC. However, the saturated TIC concentration nonlinearly decreased with respect to temperature. At a specific medium and temperature, the saturated pH nonlinearly decreased with respect to increased CO 2 concentration whereas the TIC concentration linearly increased with respect to increased CO 2 -enriched air. At a specific CO 2 -enriched air, medium and temperature, increasing of TIC concentration decreased the medium pH. The saturated TIC and pH became stable at a same period of time; however, the correlation of the TIC and pH was invalid. The saturated pH can be used to specify the saturation condition of TIC.

Sodium hydroxide solution was mixed with cyanobacteria growth media (50% RO water and 50% BG -11) in a ratio of 1 mL of 3M NaOH per liter a of media (3mM/L) to examine the effects on CO 2 solubility using air (0.038%), 0.1%, 0.5%, 1.0%, 1.5%, 2.0% and 10% CO 2 under atmospheric pressure at temperatures of 25, 35, 45, and 55C. In addition, the solubility of 0.5% and 1.0% CO 2 -enriched air was investigated its behavior with respect to changing of NaOH concentration. The NaOH solution played a significant role for CO 2 solubility in increasing CO 2 solubility holding capacity. Ratios of TIC response among 0.1%, 0.5%, 1.0%, 1.5%, and 2.0% CO 2 solubility to NaOH were approximately 1 and 2 for 10.0% CO 2 compared to 0.1%, 0.5%, 1.0%, 1.5%, and 2.0% CO 2 ,which was much less than the theoretical driving force ratio of these CO 2 levels. These ratios decreased with respect to increased temperature. The TIC from CO 2 solubility was linearly proportional to the amount of the NaOH solution used and to the increased CO 2 levels. Experimental results yielded meaningful correlations of TIC concentrations and a bulk parameter as a function of temperatures, CO 2 concentrations and amounts of the NaOH concentration.

Background Stem-like progenitor exhausted CD8 + T cells (T PEX ), located within the tumor-draining lymph nodes (TDLNs), are responsible for maintaining tumor-specific responses in cancer. Although cytokines such as interleukin (IL)-15 are known to expand CD8 + T-cell subsets, transforming growth factor (TGF)-β in the TDLN is known to arrest the egress of these T PEX to the tumor microenvironment. We hypothesized that combining IL-15 stimulatory and TGF-β blocking activity would boost antitumor responses mediated by T PEX in the TDLN. Methods We developed a bifunctional TGF-βRII/IL-15 protein complex (HCW9218) and evaluated its antitumor activity in two murine models of melanoma and breast cancer. Peripheral blood, TDLN and tumor-infiltrating CD8 + T cells were characterized by flow cytometry following a single subcutaneous dose (s.c.) of HCW9218. Transcription profiling of CD8 + T cells in both murine models was performed. Synergistic activity of HCW9218 with immune-checkpoint inhibitors (ICIs) was evaluated. Finally, safety and immune profiling in patients with chemo-refractory/relapsed solid tumors was performed in a Phase 1 dose-escalating trial. Results HCW9218 was capable of localizing to the TDLNs and tumors after s.c. administration, neutralized TGF-β, expanded T PEX in TDLNs, increased chemokine-expressing effectors in peripheral circulation and promoted their infiltration into murine tumors. These data were corroborated in RNA sequencing analysis of TDLNs. ICIs significantly enhanced the effects of HCW9218 on T PEX and synergistically improved HCW9218 antitumor efficacy in melanoma and reduced spontaneous lung metastasis in breast cancer models. In a Phase 1 clinical trial, HCW9218 monotherapy was well-tolerated, reduced serum TGF-β levels, promoted and sustained CD8 + T-cell expansion in peripheral blood and CD8 + T-cell infiltration in tumor biopsies. Stable disease was reported for four of six subjects (67%) with advanced ovarian cancer treated with HCW9218. Conclusions Our findings demonstrate that combination therapy targeting immune cells critical for antitumor responses and blocking immune-suppressive environment significantly improves antitumor therapeutic efficacy. These findings provide a strong basis for using HCW9218 to enhance the efficacy of ICIs against solid tumors in the clinical setting.

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