BACKGROUND & AIMS: :Given the heterogeneous nature of multiple sclerosis (MS), we applied DNA microarray technology to determine whether variability is reflected in peripheral blood (PB) cells. In this study, we studied whole-blood gene expression profiles of 29 patients with relapsing-remitting MS (RRMS) and 25 age- and sex-matched healthy controls. We used microarrays with a complexity of 43K cDNAs. The data were analyzed using sophisticated pathway-level analysis in order to provide insight into the deregulated peripheral immune response programs in MS. We found a remarkable elevated expression of a spectrum of genes known to be involved in immune defense in the PB of MS patients compared to healthy individuals. Cluster analysis revealed that the increased expression of these genes was characteristic for approximately half of the patients. In addition, the gene signature in this group of patients was comparable with a virus response program. We conclude that the transcriptional signature of the PB cells reflects the heterogeneity of MS and defines a sub-population of RRMS patients, who exhibit an activated immune defense program that resembles a virus response program, which is supportive for a link between viruses and MS.

背景与目标： : 鉴于多发性硬化症 (MS) 的异质性，我们应用DNA微阵列技术来确定变异性是否反映在外周血 (PB) 细胞中。在这项研究中，我们研究了29例复发缓解型MS (RRMS) 患者和25例年龄和性别匹配的健康对照者的全血基因表达谱。我们使用了复杂的43K cdna的微阵列。使用复杂的途径水平分析对数据进行分析，以便深入了解MS中放松调节的外周免疫反应程序。与健康个体相比，我们发现MS患者PB中已知参与免疫防御的一系列基因的表达显着升高。聚类分析显示，这些基因的表达增加是大约一半患者的特征。此外，这组患者的基因签名与病毒应答程序相当。我们得出的结论是，PB细胞的转录特征反映了MS的异质性，并定义了RRMS患者的亚群，他们表现出类似于病毒应答程序的激活免疫防御程序，这支持了病毒es和MS之间的联系。

BACKGROUND & AIMS: PURPOSE:Determine if a "nondieting" intervention focused on intensive training in eliciting the relaxation response enhances health outcomes compared with nondieting interventions without such training. DESIGN:Randomized trial with follow-up at 10 weeks, 4 months, and 12 months. SETTING:General community. SUBJECTS:Total of 225 overweight and obese women with at least one other cardiovascular risk factor. INTERVENTIONS:Three 10-week nondieting interventions: a group program (P1) focused on intensive training in techniques for eliciting the relaxation response (n = 60), a group program (P2) focused on healthy eating and physical activity (n = 61), and a self-guided, mail-delivered version of P2 (P3; n = 101). MEASURES:The Revised Symptom Checklist measured psychological distress, the Medical Symptoms Checklist measured the experience of medical symptoms, and the Health-Promoting Lifestyle Profile measured a range of lifestyle behaviors. Self-efficacy for low-fat eating intuitive eating, and body mass index were also assessed. ANALYSIS:An intention-to-treat analysis was used. RESULTS:At 12 months, P1 produced statistically greater improvements in stress management behaviors and medical symptom discomfort and was the only program to significantly improve self-efficacy for low-fat eating. In P1, the effect sizes for reductions in depression (0.75) and interpersonal sensitivity (0.85) were large. At 12 months, mean weight was unchanged. CONCLUSION:Inclusion of intensive relaxation response training in a nondieting program for overweight women enhanced stress management and medical symptoms outcomes but not weight outcomes.

背景与目标：

BACKGROUND & AIMS: :A randomized prevention trial contrasted families who participated in the Strong African American Families Program (SAAF), a preventive intervention for rural African American parents and their 11-year-olds, with control families. This article focuses on the program's effect on primary caregivers' depressive symptoms. Among the 167 caregivers with elevated scores on the Center for Epidemiologic Studies-Depression Scale, SAAF participation was associated with reduced depressive symptoms, enhanced parenting, and perceived improvements in youth behavior. Change in parenting (consistent discipline, youth monitoring, and open communication) but not change in youth intrapersonal competencies significantly mediated intervention effects on caregivers' depression. Results support the link between reduced depressive symptoms and stronger family relationships, particularly the importance of enhanced parenting efficacy in alleviating depressive symptoms.

背景与目标： : 一项随机预防试验将参加 “强非裔美国人家庭计划” (SAAF) 的家庭与对照家庭进行了对比，该计划是针对农村非裔美国人父母及其11岁儿童的预防干预措施。本文重点介绍该计划对主要照顾者抑郁症状的影响。在流行病学研究中心-抑郁量表得分较高的167名照顾者中，SAAF的参与与减轻的抑郁症状，增强的育儿能力和青少年行为的改善有关。父母的改变 (一致的纪律，青少年的监督和开放的沟通)，但青少年的个人内部能力的改变却没有显着调节对照顾者抑郁的干预作用。结果支持减轻抑郁症状与加强家庭关系之间的联系，尤其是增强育儿功效对减轻抑郁症状的重要性。

BACKGROUND & AIMS: :This article was developed to provide new radiation safety officers with the basic information needed for ensuring safety, security, and control of industrial radiography sources and to discuss licensing requirements and other information pertaining to the management of radiation safety programs associated with these sources.

背景与目标： : 本文旨在为新的辐射安全官员提供确保工业射线照相术源的安全性，安全性和控制所需的基本信息，并讨论与这些源相关的辐射安全计划管理有关的许可要求和其他信息。

BACKGROUND & AIMS: :"Outings to Your Taste" is an innovative program that aims to improve the nutritional status and social network of elderly people who receive home-delivered meals. This article examines participation in one of the program's components, outings to community restaurants. Participation data were collected on-site and information about client characteristics was collected in at-home interview surveys of targeted clients (n = 144). While about half of the clients had tried at least one outing, more than 25% of them participated in at least one third of the outings offered to them. Results indicate that the program attracted a variety of clients in terms of sociodemographic, health, and social isolation characteristics.

背景与目标： : “按您的口味郊游” 是一项创新计划，旨在改善接受家庭用餐的老年人的营养状况和社交网络。本文探讨了参与该计划的组成部分之一，即社区餐厅的郊游。现场收集参与数据，并在针对目标客户的家庭访谈调查中收集有关客户特征的信息 (n = 144)。虽然大约一半的客户尝试了至少一次郊游，但其中超过25% 的客户参加了至少3分之1的郊游。结果表明，该计划在社会人口统计学，健康和社会隔离特征方面吸引了各种客户。

BACKGROUND & AIMS: :Purpose: Using a new analysis program for scanning laser-Doppler flowmetry (SLDF) by a Heidelberg retina flowmeter (HRF), we studied the relation between flow and visual field or disc morphology.Subjects and Methods: In 42 eyes of 21 patients with normal tension glaucoma (NTG) the mean-flow of the HRF blood flow parameters at the disc rim was measured and analyzed by a new analysis program for perfusion maps (the SLDF analysis tool), to minimize the influence of large vessels or/and artifacts caused by small eye movements. We investigated whether difference of the mean-flow between a pair of eyes had any relation to differences between a pair of eyes in visual field indices and those in disc morphological measurements of the Heidelberg retina tomograph.Results: We found statistically significant correlations between the mean-flow and optic disc parameters (Disk Area, Cup Area, Height Variation Contour, Cup Volume, Rim Volume, Mean RNFL Thickness). We found no statistically significant correlations between the mean-flow and visual field parameters (mean deviation, corrected pattern standard deviation).Conclusion: The results suggested that eyes with less flow in the optic disc rim have more advanced glaucomatous morphological changes.

背景与目标： : 目的: 使用一种新的分析程序，通过海德堡视网膜流量计 (HRF) 扫描激光多普勒流量计 (SLDF)，我们研究了流量与视野或椎间盘形态之间的关系。主题和方法: 在21例正常眼压性青光眼 (NTG) 患者的42眼中，通过新的灌注图分析程序 (SLDF分析工具) 测量并分析了椎间盘边缘处HRF血流参数的平均流量，以最大程度地减少由小眼球运动引起的大血管或/和伪影的影响。我们调查了两只眼睛之间的平均流量的差异是否与两只眼睛在视野指标和海德堡视网膜断层扫描仪的椎间盘形态测量中的差异有任何关系。结果: 我们发现平均流量和视盘参数 (椎间盘面积，杯面积、高度变化轮廓、杯体积、轮辋体积、平均RNFL厚度)。我们发现平均流量与视野参数 (平均偏差，校正模式标准偏差) 之间没有统计学上的显着相关性。结论: 结果表明，视盘边缘流量较少的眼睛具有更高级的青光眼形态变化。

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BACKGROUND & AIMS: :Parents and school staff play important roles in promoting children's oral health. Our study goals were to investigate whether an intervention targeting parents and school staff can improve the oral-health behavior and oral-health status of schoolchildren. Three-hundred and ninety-two schoolchildren in six schools in Tehran participated in a group randomized trial from September 2010 to March 2011. Schools were randomly allocated into three groups: comprehensive, student, and control. Intervention in the comprehensive group consisted of strategies to encourage children, their parents, and school staff to increase the frequency of toothbrushing and flossing. In the student group, the intervention targeted only children. The control group received no intervention. The primary outcome was change in oral-health behaviors (brushing and flossing), while the secondary outcomes were changes in oral hygiene and Community Periodontal indices and in Health Belief Model components. Multilevel modeling was employed for data analyses. Students who were in the comprehensive intervention group brushed and flossed significantly more frequently compared with those in the student intervention group. Although students' gingival health improved significantly in the comprehensive intervention group, such significant improvement was not seen in the student group. In conclusion, promising results are seen when the oral-health education targets both school and home settings.

背景与目标： : 家长和学校工作人员在促进儿童口腔健康方面发挥着重要作用。我们的研究目标是调查针对父母和学校工作人员的干预措施是否可以改善学童的口腔健康行为和口腔健康状况。德黑兰六所学校的392名学童参加了从2010年9月到2011年3月的分组随机试验。学校被随机分为三组: 综合，学生和对照。综合小组的干预措施包括鼓励儿童，其父母和学校工作人员增加刷牙和使用牙线的频率的策略。在学生群体中，干预针对的是独生子女。对照组不接受干预。主要结局是口腔健康行为 (刷牙和使用牙线) 的变化，而次要结局是口腔卫生和社区牙周指数和健康信念模型成分的变化。采用多级建模进行数据分析。与学生干预组相比，综合干预组的学生刷牙和使用牙线的频率明显更高。尽管综合干预组学生的牙龈健康状况显着改善，但在学生组中并未看到这种显着改善。总之，当口腔健康教育针对学校和家庭环境时，可以看到令人鼓舞的结果。

BACKGROUND & AIMS: BACKGROUND:Blood-borne viral infections, such as HIV and hepatitis C (HCV), are common infections among people who inject drugs (PWID). This study aims to determine the prevalence of HIV and HCV infection among PWID accessing the first legal syringe services program (SSP) in the state of Florida, along with examining baseline correlates of HIV and HCV infection. METHODS:Baseline behavioral enrollment assessments of 837 participants accessing an SSP for the first time were analyzed. Patients self-reporting or testing HIV or HCV positive at the enrollment visit were included. Socio-demographic, drug use, and injection-related risk behaviors in the last 30 days were compared across groups defined by all combinations of HIV and HCV serostatus. Bivariate and multivariable logistic regression models were used to assess correlates of baseline HCV and HIV infection independently. RESULTS:Overall prevalence for HCV and HIV infection were 44.4% and 10.2%, respectively. After adjusting for confounders, the most significant correlates of baseline HCV infection were age (aOR = 1.01), lower education level (aOR = 1.13), currently homeless (aOR = 1.16), injecting more than seven times a day (aOR = 1.14), reusing syringes (aOR = 1.18), and sharing injection equipment (aOR = 1.13). The most significant predictors of baseline HIV infection were age (aOR = 1.01), non-Hispanic Black race (aOR = 1.28), Hispanic ethnicity (aOR = 1.12), gay or bisexual orientation (aOR = 1.22), and methamphetamine injection (aOR = 1.22). In addition, heroin injection (aOR = 0.92) was significantly associated with a lower odds of HIV infection. DISCUSSION/CONCLUSION:Baseline behavioral predictors differed between HIV infection and HCV infection among participants accessing syringe services. Understanding the risk factors associated with each infection should be considered when developing additional harm reduction interventions tailored for diverse PWID populations served at SSPs.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:In the 2011 US hospital prevalence survey of healthcare-associated infections and antimicrobial use 50% of patients received antimicrobial medications on the survey date or day before. More hospitals have since established antimicrobial stewardship programs. We repeated the survey in 2015 to determine antimicrobial use prevalence and describe changes since 2011. METHODS:The Centers for Disease Control and Prevention's Emerging Infections Program sites in 10 states each recruited ≤25 general and women's and children's hospitals. Hospitals selected a survey date from May-September 2015. Medical records for a random patient sample on the survey date were reviewed to collect data on antimicrobial medications administered on the survey date or day before. Percentages of patients on antimicrobial medications were compared; multivariable log-binomial regression modeling was used to evaluate factors associated with antimicrobial use. RESULTS:Of 12 299 patients in 199 hospitals, 6084 (49.5%; 95% CI, 48.6-50.4%) received antimicrobials. Among 148 hospitals in both surveys, overall antimicrobial use prevalence was similar in 2011 and 2015, although the percentage of neonatal critical care patients on antimicrobials was lower in 2015 (22.8% vs 32.0% [2011]; P = .006). Fluoroquinolone use was lower in 2015 (10.1% of patients vs 11.9% [2011]; P < .001). Third- or fourth-generation cephalosporin use was higher (12.2% vs 10.7% [2011]; P = .002), as was carbapenem use (3.7% vs 2.7% [2011]; P < .001). CONCLUSIONS:Overall hospital antimicrobial use prevalence was not different in 2011 and 2015; however, differences observed in selected patient or antimicrobial groups may provide evidence of stewardship impact.

背景与目标：

BACKGROUND & AIMS: :The purpose of the present study was to establish a rat bipedal walking model to examine the effects of bipedal walking on the central nervous system by training rats to perform bipedal walking over a period of 3 months. The characteristics of bipedal walking were investigated using kinematic and electromyographic methods in established bipedal walking models. Stable bipedal walking was achieved in rats by training them to stand with an upright posture and to walk with the hindlimbs using bipedal-walking training equipment to obtain a water reward. A stable head position in the rat bipedal walking model was attained primarily by closing the swing-phase period with a large angular change in the hip, knee, and ankle joints. The EMG burst pattern of the knee extensor (m. rectus femoris) and the erector muscle of the spine (m. longissimus) during bipedal walking was similar to that during quadrupedal walking in rats. We established two bipedal walking models using normal and forelimb-amputated rats. Comparative studies of these two bipedal walking models are expected to provide the information about the influence of forelimb movements on neuronal control of bipedal walking.

背景与目标： : 本研究的目的是建立大鼠双足步行模型，通过训练大鼠进行3个月的双足步行来检查双足步行对中枢神经系统的影响。在建立的双足步行模型中，使用运动学和肌电图方法研究了双足步行的特征。通过训练大鼠以直立姿势站立并使用双足行走训练设备与后肢行走以获得水奖励，可以在大鼠中实现稳定的双足行走。大鼠双足步行模型中的稳定头部位置主要是通过在髋关节，膝关节和踝关节的角度变化较大的情况下结束摆动阶段来实现的。两足行走过程中膝盖伸肌 (股直肌) 和脊柱直立肌 (长肌) 的EMG爆发模式与大鼠四足行走过程中相似。我们使用正常和前肢截肢的大鼠建立了两个双足步行模型。对这两种双足步行模型的比较研究有望提供有关前肢运动对双足步行神经元控制的影响的信息。

BACKGROUND & AIMS: :Palliative Performance Scale (PPS) scores have shown potential for prognosticating survival in Caucasian samples, but have not been studied for prognostic value in cancer patients from minority groups. Using data obtained from a retrospective chart audit of 492 cancer patients admitted over an 18-month period to a minority-serving home-based hospice and palliative care program, we examined the relationship between PPS scores and length of survival (survival days). Patients with PPS scores of 10% to 30% had fewer survival days than those with scores of 40% and those with scores of 50% to 100% (median=6, 19, and 34 days, respectively; F=25.02, P<0.001). A PPS score of 40% serves as a reliable inclusion criterion for a study requiring two weeks for completion, whereas 50% to 100% is required for a three-week study. Findings from a predominantly minority sample are similar to those from predominantly Caucasian samples.

背景与目标： : 姑息行为量表 (PPS) 评分已显示出预测白种人样本生存的潜力，但尚未对少数群体的癌症患者的预后价值进行研究。使用回顾性图表审计获得的数据，对在18个月内接受少数族裔家庭临终关怀和姑息治疗计划的492例癌症患者进行了回顾性图表审计，我们检查了PPS评分与生存时间 (生存天数) 之间的关系。PPS评分为10% 至30% 的患者的生存天数少于评分为40% 的患者和评分为50% 至100% 的患者 (中位数分别为6、19和34天; F = 25.02，P<0.001)。40% 的PPS评分是需要两周才能完成的研究的可靠纳入标准，而三周的研究则需要50% 100%。来自少数族裔样本的发现与来自主要白种人样本的发现相似。

BACKGROUND & AIMS: OBJECTIVES:To inform strategic decisions on respiratory syncytial virus (RSV) vaccine development and identify critical endpoints likely to drive the vaccine's medical and economic impact. DESIGN:A decision-analysis model populated using healthcare utilization data and costs from the literature; vaccine efficacy and duration based on assumptions. SETTING:Vaccination in the physician office setting in the USA. PARTICIPANTS:A hypothetical cohort of newborn infants. INTERVENTION:Vaccination of children at low and high risk of respiratory sequelae with a theoretical RSV vaccine vs palivizumab prophylaxis for children at high risk. OUTCOME MEASURES:Medical and economic value of RSV vaccination, including cost per quality adjusted life-year (QALY) gained. RESULTS:Using base-case assumptions (efficacy 50% at birth; half-life 12 months), RSV vaccination would prevent 23,069 hospitalizations and 66 deaths per vaccinated birth cohort in the USA. Excluding vaccination costs, direct medical costs for RSV would reduce by $236 million, and income and productivity losses by $134 million. Assuming a vaccine cost per course similar to Rotarix® in the USA ($232 including administration fees), the cost per QALY gained would be $93,401 (95% CI: $65,815-$126,060) from the healthcare system perspective and $65,115 (95% CI: $41,003-$93,679) from the societal perspective. The net cost (healthcare system perspective) per life-year saved would be $216,120 (95% CI: $161,184-$263,981); the cost per hospitalization averted would be $19,172 (95% CI: $14,679-$22,093). Aside from efficacy, the vaccine's impact is sensitive to the start of protective immunity and the duration of protection. CONCLUSIONS:Development of an RSV vaccine would substantially reduce inpatient hospitalizations and outpatient visits. It would also have an impact on infant mortality. To demonstrate the full medical and economic value of the vaccine, appropriate endpoints or endpoint surrogates for hospitalization, mortality, and total case reductions should be collected during vaccine development.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Brief Contact Interventions (BCIs) after a suicide attempt (SA) are an important element of prevention against SA and suicide. They are easier to generalize to an entire population than other forms of intervention. VigilanS generalizes to a whole French region a BCI combining resource cards, telephone calls and mailings, according to a predefined algorithm. It was implemented gradually in the Nord-Pas-de-Calais (NPC), France, between 2015 and 2018. Here, we evaluate the effectiveness of VigilanS, in terms of SA reduction, using annual data collected by participating centers. Hypothesis tested: the higher the VigilanS implementation in a center (measured by penetrance), the greater the decrease in the number of SA observed in this center. METHODS:The study period was from 2014 to 2018, across all of NPC centers. We performed a series of linear regressions, each center representing a statistical unit. The outcome was the change in the number of SA, relative to the initial number, and the predictive variable was VigilanS' penetrance: number of patients included in VigilanS over the total number of SA. Search for influential points (points beyond threshold values of 3 influence criteria) and weighted least squares estimations were performed. RESULTS:Twenty-one centers were running VigilanS in 2018, with an average penetrance of 32%. A significant relationship was identified, showing a sharp decrease in SA as a function of penetrance (slope = - 1.13; p = 3*10- 5). The model suggested that a 25% of penetrance would yield a SA decrease of 41%. CONCLUSION:VigilanS has the potential to reduce SA. Subgroup analyzes are needed to further evaluate its effectiveness. Subgroup analyses remain to be done, in order to evaluate the specific variations of SA by group.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:Worksite provision of paid time off for parent participation in a school-based healthy weight program may improve treatment adherence and outcomes. The current pilot study examined whether parents who received worksite support for attendance at a school-based healthy weight program would attend more sessions, lose more weight, and make healthier changes in home food environments than parents who did not receive worksite support. METHOD:Thirty-eight urban, low-income African American and Mexican American mothers of kindergartners were randomized to an integrated school-parent-worksite program that targeted healthy home food environments and energy balance self-monitoring or the identical school-based program without worksite support. Ten sessions were delivered to parent participants during afterschool hours. Process measures included session attendance and energy balance log completion. Outcome measures included parent body mass index (BMI) change, child BMI z-score change, and home food inventory (HFI) score changes over 12 months. RESULTS:RESULTS showed better weight change for parents (i.e., BMI unit reduction of 1.4 vs. 0.3 in comparison group, p = .001), increased parental attendance, and improvements in the home food environment when parents received paid time off from their worksite for their participation in the healthy weight program. Child weight change was also observed despite no direct contact with children. CONCLUSIONS:The current pilot study provides support for the hypothesis that worksite support for school-based interventions may improve health outcomes that depend on parental involvement. Removing barriers to attendance in a healthy weight program resulted in improved treatment adherence and outcomes in low-income, minority parents and children.

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