Understanding Online Registry Facilitators and Barriers Experienced by Black Brain Health Registry Participants: The Community Engaged Digital Alzheimer's Research (CEDAR) Study

BACKGROUND

Failure of Alzheimer's disease and related diseases (ADRD) research studies to include and engage Black participants is a major issue, which limits the impact and generalizability of research findings. Little is known about participation of Black adults in online ADRD-related research registries.

OBJECTIVES

As part of the Community Engaged Digital Alzheimer's Research (CEDAR) Study, this study aims to increase our understanding of facilitators and barriers of Black adults to participating in ADRD-related online registries, as well as to understand their preferences for communication channels.

DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS

We invited all Black participants enrolled in the Brain Health Registry (BHR) to complete a cross-sectional online survey. The survey consisted of rating scales and open-text questions asking about their attitudes towards brain health research, reasons for joining and continuing to participate in BHR, difficulties with participating, and preferences for modes of contact and website usage.

RESULTS

Of all invited Black BHR participants (N=3,636), 198 (5.5%) completed the survey. The mean age was 58.4 (SD=11.3), mean years of education were 16.3 (SD=2.4), and 85.5% identified as female. Reported facilitators for joining and continuing to participate in BHR were personal interest (e.g., learning more about own brain health) and altruism (e.g., helping research). Among additional registry features which could encourage return, receiving feedback or scores about BHR tasks was rated the highest. Of those who found BHR participation difficult (21%), the most frequent reason was time burden. The most preferred way of receiving study information was via email. Participants reported that the websites that they used the most were YouTube and Facebook.

DISCUSSION

The results of our study can inform the development of culturally-responsive registry features and engagement efforts to improve inclusion and participation of Black adults in online ADRD research. Providing participants with feedback about their registry performance and reducing the number of registry tasks are among the recommended strategies.

The Community Engaged Digital Alzheimer's Research (CEDAR) Study: A Digital Intervention to Increase Research Participation of Black American Participants in the Brain Health Registry

BACKGROUND

Although Black/African American older adults bear significant inequities in prevalence, incidence, and outcomes of Alzheimer's disease and related dementias, they are profoundly under-included in Alzheimer's Disease research. Community-Engaged Research (e.g., equitable community/science partnerships) is an evidence-based approach for improving engagement of underrepresented populations into Alzheimer's Disease research, but has lacked scalability to the national level. As internet use among older adults from underrepresented populations continues to grow, internet-based research shows promise as a feasible, valid approach to engagement and longitudinal assessment. The Community Engaged Digital Alzheimer's Research (CEDAR) study utilizes a community-engaged research approach to increase the engagement and research participation of Black/African American adults in the Brain Health Registry (BHR) and Alzheimer Disease clinical research.

OBJECTIVES

To describe the methods and evaluate the feasibility of the CEDAR culturally-informed digital platform within BHR.

DESIGN

All Black/African American participants in BHR were invited to enroll in CEDAR and to consider serving on a newly convened Community-Scientific Partnership Board to guide the study. The community board guided the development a culturally-informed cadre of engagement materials and strategies to increase research participation. Engagement strategies included incentives for study task completion, culturally-informed communications (e.g., landing page, emails and social media), resources about brain health, and video and written testimonials by CEDAR participants.

SETTING

BHR, an Internet-based registry and cohort.

PARTICIPANTS

BHR participants self-identifying as Black/African American were invited to enroll. All participants who signed an online informed consent document were enrolled.

MEASUREMENTS

We report the number of participants invited, enrolled, completed tasks, and volunteered to join the community board. We compared the demographics, cognitive profile, and baseline BHR task completion rates between CEDAR participants and all those invited to join the study.

RESULTS

Of 3738 invited, 349 (9.34%) enrolled in CEDAR. 134 (37% of CEDAR participants) volunteered to join the community board, of which 19 were selected for the community board. Compared to those invited, the CEDAR cohort had a higher percentage of female participants (84.5%) and a lower percentage of participants who identify as belonging to more than one ethnocultural group (21.8%). Compared to those did not enroll in CEDAR, those enrolled in CEDAR had a higher percentage of participants completing all BHR tasks (22%) and a higher percentage of participants completing at least one cognitive test (76%). Those enrolled in CEDAR also had a higher percentage of participants having an enrolled study partner (18%).

CONCLUSIONS

A culturally-informed Community-Engaged Research approach, including a remotely-convened community board, to engagement of Black/African American participants in an online research registry is feasible. This approach can be adapted for use in various clinical studies and other settings. Future studies will evaluate the effectiveness of the engagement strategies.

A-06 Current Norms May Overestimate Rates of Neurocognitive Impairment among American Indian and Alaskan Native Adults

Objective

Currently available normative data subsume American Indian and Alaskan Native (AI/AN) populations within the non-Latinx white (NLW) ethnoracial group. The classification accuracy of such norms among AI/AN remains unknown. This cross-sectional study aims to identify whether disparities exist in the rates of neurocognitive impairment (NCI) between AI/AN and NLW adults. < br><br > 

Method

Two hundred community-dwelling adults (50% NLW; 50% Male; M Age = 42 ± 14 years; M Education = 13 ± 3 years) completed comprehensive neurocognitive, quality of education (Wide Range Achievement Test- 4 [WRAT-4]), neuromedical, urine toxicology, and psychiatric/substance use evaluations. Average T-scores were calculated using widely used demographically corrected (age, gender, education) NLW norms to identify NCI (> 1 SD; e.g., Heaton et al., 2004; Heaton & Marcotte, 2000). A comorbid condition propensity score (CCPS) identified the probability to which comorbid conditions (e.g., Heaton et al., 2010) informed ethnoracial identity. <br><br > 

Results

After adjusting for WRAT-4 and CCPS, the results of a logistic regression analysis demonstrated a significant ethnoracial disparity in risk for NCI (X2(3) = 13.88, p<.01, R2 = .07), such that the AI/AN group was at 2.52 times higher odds (32.3% vs. 16.0, CI: 1.15–5.46, p = .01, Cohen’s d = .51) for NCI in comparison to the NLW group. <br><br > 

Conclusions

Published norms for NLW adults may overestimate impairment in AI/AN adults. Thus, population-specific normative data are needed to clarify the classification accuracy of neurocognitive impairment and possible disparities in neurocognitive disorders (e.g., HIV-associated neurocognitive disorders) among AI/AN adults. Future work should replicate these findings among other diverse populations (e.g., Caribbean, Middle Eastern) lacking population-specific normative data.876199.

The Roles of Health Literacy and Physician-Patient Relationship in Self-Reported Health Outcomes Within a Diverse Sample of Persons Living with HIV

Objective

Barriers like poor health literacy and patient-provider communication add to health disparities in diverse populations. Perceived autonomy has been shown to improve patients’ health satisfaction and knowledge of their illness. However, no studies have examined these issues in HIV patients. This study examined the roles of health literacy and physician-patient relationship in health outcomes (e.g., mental health and emotional/physical functioning) in persons living with HIV (PLWH).

Participants and Method

This cross-sectional study included 91 PLWH (74% Latinx and 26% non-Latinx White; 68% Male) who completed the Test of Functional Health Literacy in Adults (TOFHLA), Physician–Patient Relationship Scale (PPRS), and Medical Outcomes Study-HIV Health Survey (MOS). The study variables included: TOFHLA total score, PPRS Part Decision- Making (PDM) and Trust subscales, and MOS Mental Health and Health Transition subscales.

Results

A linear regression showed that our model (ethnicity, TOFHLA, PPRS PDM and Trust) predicted MOS HT (R2 = .14, p < 0.05), such that Latinx ethnicity (β = .30) and better TOFHLA scores (β = -.22) predicted better MOS HT scores (ps < .05). Another regression showed that our model predicted MOS MH (R2 = 0.07, p = <.01), such that greater PPRS PDM scores predicted better MOS MH scores (β = .27, p = <.01).

Conclusions

Ethnicity and better health literacy were related to improved emotional/physical functioning over a 4-week period and greater shared decision-making was related to better overall mental health. These findings highlight the importance of identifying sociocultural factors and interpersonal processes of care to inform culturally-tailored interventions that can result in enhanced and effective treatment for PLWH patients and in improved physical and mental health outcomes.

Does Decision-Making Ability Predict HIV-Associated Neurocognitive Disorder?

Background

Executive dysfunction (EF) in people living with HIV (PLWH) is well-established. However, decision-making, a key aspect of EF, is often overlooked in neurocognitive (NC) evaluations of PLWH. Poor decision-making can detrimentally impact PLWH by increasing risk of poor health outcomes. This study aimed to determine if including a decision-making task in NC evaluations might improve diagnostic formulations.

Participants and Method

This cross-sectional study included 90 PLWH (63 Latinx; 27 non-Latinx white) who were evaluated for HIV-Associated Neurocognitive Disorder (HAND) using established criteria, with the Wisconsin Card Sorting Test (WCST) and Trail Making Test Part B (TMTB) comprising the “traditional” EF domain. The Iowa Gambling Task (IGT) assessed decision-making. Demographically corrected T-scores were calculated for each test. The “traditional” EF tests were averaged into an EF domain T-score. The WCST, TMTB, and IGT were also averaged into a “new” EF+IGT domain T-score.

Results

The new EF+IGT domain T-score significantly predicted HAND diagnosis (R^2 = .14, p < .001). However, using hierarchical regression, the “traditional” EF domain (WCST and TMTB) also significantly predicted HAND (R^2 = .18, p < .001) and adding the IGT Total T-score did not contribute unique variance to the model (R^2 = .18, p < .001; R^2Δ < .001, pΔ = .92).

Conclusions

A new combined EF domain T-score that included decision-making was a significant predictor of HAND diagnosis. However, adding IGT Total Score did not enhance HAND diagnosis compared to “traditional” EF measurement, indicating that the “traditional” EF domain adequately informs HAND diagnosis. A limitation of this study was the small sample size. Given the important health implications of decision-making in PLWH, future research, with a larger sample size is warranted to better conceptualize how decision-making can be incorporated into diagnostic formulations for PLWH.

Abstract P4-02-05: Test-retest fidelity of FDG SUVmax in bone and non-boney metastatic breast cancer lesions in local area network PET/CT scanners

Background: Metabolic activity in lesions, measured by FDG-PET, is often used for assessing tumor aggressiveness and response to therapy. Patients may be scanned on different machines, so quantitative measurements should be reproducible. Reducing SUV variability in PET machines throughout a local network can aid in monitoring patient response to therapy and increase access to clinical trials.

Methods: Eighteen female patients with advanced or metastatic breast cancer underwent paired FDG PET/CT test-retest studies with 1-15 days between scans, and without interim change in treatment. Ten patients were studied in the same scanner and 8 patients were studied in 2 different scanners. Five different PET/CT scanners were used (2 GE DSTE, 2 Siemens (BioGraph 6 and mCT), 1 Philips Ingenuity TF). Each PET/CT scanner was calibrated using NIST-traceable reference sources to characterize and reduce variability. All of the images were interpreted by two separate reviewers. SUVmax values in lesions, corresponding normal tissue, and normal liver were collected. Linear mixed models with random intercept (patient effects) were fitted to compare differences in log(|SUVmax % difference|+.01) in multiple lesions per patient.

Results: SUVmax was assessed in a total of 130 lesions (75 bone). The median number of lesions per patient was 5 (range 1-17). Average SUVmax ranged from 1.0 to 18.2 (mean±SD = 6.0±3.2). The median SUVmax difference was 0.4 (8%) for 47 lesions imaged twice in the same scanner, and was 0.6 (13%) for 83 lesions imaged in two different scanners. In a multivariable linear mixed effects model, SUVmax for different scanners within the same institution did not differ more than for the same scanner (p=0.39), but repeat scans with different scanners and site personnel at had an average of 78% greater percentage difference in SUVmax than for the same scanner (p=0.009). In the same model, the average percent difference in SUVmax for bone lesions was estimated as 30% lower than for other sites (p=0.06, 95% confidence interval 0-50%). Examining normal liver uptake, the median SUVmean was 2.5 (range 1.9-3.1) with an median 6.5% difference between measurements (range 1.1%-23.7%) that did not appear to differ based on scanners used for repeat measurements (p=0.47).

Conclusions: The variability in quantitative FDG SUVmax between scans is modest, suggesting reliable reproducibility in appropriately calibrated settings. In our study, bone lesions had somewhat higher fidelity than other tumor sites. Additional studies will address variability in other cancer types. Careful calibration and monitoring of PET/CT scanners, and consistent imaging protocols are necessary in clinical trials that utilize quantitative PET/CT imaging in order to confidently interpret results.

Research Support: NIH grant U01-CA148131 and NCI-SAIC Contract 24XS036-004.

Citation Format: Linden HM, Peterson LM, Kurland B, Roberts T, Specht J, Shields AT, Novakova A, Christopfel R, Byrd D, Muzi M, Mankoff DA, Kinahan P. Test-retest fidelity of FDG SUVmax in bone and non-boney metastatic breast cancer lesions in local area network PET/CT scanners [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-02-05.

BST-2 expression in human hepatocytes is inducible by all three types of interferons and restricts production of hepatitis C virus

Bone marrow stromal cell antigen 2 (BST-2, also known as tetherin, CD317, or HM1.24) has recently been identified as a host restriction factor against diverse families of enveloped viruses. However, the effects of BST-2 on the life cycle of hepatitis C virus (HCV), an enveloped RNA virus, remain unclear and controversial. Here we demonstrated that human hepatocytes including Huh7.5.1 cells, primary human hepatocytes (PHHs), and HepG2 cells constitutively expressed low to moderate levels of endogenous BST-2 on the cell surface, which could be robustly up-regulated by all three types of interferons (IFNs) such as IFN-α, IFN-γ, and IFN-λ. IFN-α and IFN-γ showed a synergistic effect in induction of BST-2 expression on human hepatocytes. Over-expression of BST-2 by BST-2-expressing vector transfection or up-regulation of BST-2 by IFN stimulation markedly suppressed HCV production, whereas shRNA-mediated depletion of endogenous BST-2 significantly enhanced HCV production in infected Huh7.5.1 cells. IFN-mediated anti-HCV activity was partially but significantly diminished by shRNA-mediated knockdown of BST-2 expression, indicating that BST- 2 upregulation is directly involved in IFN-mediated inhibition of HCV production. We also found that both BST-2 and HCV core co-localized with intracellular lipid droplets (LDs), suggesting that BST-2-HCV interaction may take place around LDs as LDs constitute an important intracellular organelle for HCV assembly and replication. Taken together, our data suggest that BST-2 is a host restriction factor against HCV, and induction of BST-2 in hepatocytes could be one of the mechanisms by which current HCV standard therapy (IFN-α plus ribavirin) achieves a sustained virological response (SVR).

Adoptive T cell therapy using antigen-specific CD8+ T cell clones for the treatment of patients with metastatic melanoma: in vivo persistence, migration, and antitumor effect of transferred T cells

Adoptive T cell therapy, involving the ex vivo selection and expansion of antigen-specific T cell clones, provides a means of augmenting antigen-specific immunity without the in vivo constraints that can accompany vaccine-based strategies. A phase I study was performed to evaluate the safety, in vivo persistence, and efficacy of adoptively transferred CD8+ T cell clones targeting the tumor-associated antigens, MART1MelanA and gp100 for the treatment of patients with metastatic melanoma. Four infusions of autologous T cell clones were administered, the first without IL-2 and subsequent infusions with low-dose IL-2 (at 0.25, 0.50, and 1.0 x 10(6) unitsm(2) twice daily for the second, third, and fourth infusions, respectively). Forty-three infusions of MART1MelanA-specific or gp100-specific CD8+ T cell clones were administered to 10 patients. No serious toxicity was observed. We demonstrate that the adoptively transferred T cell clones persist in vivo in response to low-dose IL-2, preferentially localize to tumor sites and mediate an antigen-specific immune response characterized by the elimination of antigen-positive tumor cells, regression of individual metastases, and minor, mixed or stable responses in 8 of 10 patients with refractory, metastatic disease for up to 21 mo.

Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system

PURPOSE

The American Joint Committee on Cancer (AJCC) recently proposed major revisions of the tumor-node-metastases (TNM) categories and stage groupings for cutaneous melanoma. Thirteen cancer centers and cancer cooperative groups contributed staging and survival data from a total of 30,450 melanoma patients from their databases in order to validate this staging proposal.

PATIENTS AND METHODS

There were 17,600 melanoma patients with complete clinical, pathologic, and follow-up information. Factors predicting melanoma-specific survival rates were analyzed using the Cox proportional hazards regression model. Follow-up survival data for 5 years or longer were available for 73% of the patients.

RESULTS

This analysis demonstrated that (1) in the T category, tumor thickness and ulceration were the most powerful predictors of survival, and the level of invasion had a significant impact only within the subgroup of thin (< or = 1 mm) melanomas; (2) in the N category, the following three independent factors were identified: the number of metastatic nodes, whether nodal metastases were clinically occult or clinically apparent, and the presence or absence of primary tumor ulceration; and (3) in the M category, nonvisceral metastases was associated with a better survival compared with visceral metastases. A marked diversity in the natural history of pathologic stage III melanoma was demonstrated by five-fold differences in 5-year survival rates for defined subgroups. This analysis also demonstrated that large and complex data sets could be used effectively to examine prognosis and survival outcome in melanoma patients.

CONCLUSION

The results of this evidence-based methodology were incorporated into the AJCC melanoma staging as described in the companion publication.

Functional analysis of putative restriction-modification system genes in the Helicobacter pylori J99 genome

Helicobacter pylori is a gram-negative bacterium, which colonizes the gastric mucosa of humans and is implicated in a wide range of gastroduodenal diseases. The genomic sequences of two H.pylori strains, 26695 and J99, have been published recently. About two dozen potential restriction-modification (R-M) systems have been annotated in both genomes, which is far above the average number of R-M systems in other sequenced genomes. Here we describe a functional analysis of the 16 putative Type II R-M systems in the H. pylori J99 genome. To express potentially toxic endonuclease genes, a unique vector was constructed, which features repression and antisense transcription as dual control elements. To determine the methylation activities of putative DNA methyltransferases, we developed polyclonal antibodies able to detect DNA containing N6-methyladenine or N4-methylcytosine. We found that <30% of the potential Type II R-M systems in H.pylori J99 strain were fully functional, displaying both endonuclease and methyltransferase activities. Helicobacter pylori may maintain a variety of functional R-M systems, which are believed to be a primitive bacterial 'immune' system, by alternatively turning on/off a subset of numerous R-M systems.

A comparison of lower extremity muscle strength, obesity, and depression scores in elderly subjects with knee pain with and without radiographic evidence of knee osteoarthritis

OBJECTIVE

To determine, in subjects with knee pain but no radiographic changes of tibiofemoral or patellofemoral compartment osteoarthritis (OA), whether mean body weight, quadriceps and hamstring strength, lower extremity muscle mass, depression scores, and perceptions of their general health status differed from those of subjects with symptomatic knee OA.

METHODS

Subjects were 25 women and 10 men with knee pain and radiographic evidence of OA at the baseline examination, and 21 women and 16 men who had knee pain at the baseline examination but no radiographic evidence of knee OA at either baseline examination or followup evaluation performed, on average, 31 months later. These individuals were a subset of a cohort of 462 independently living elderly individuals recruited by telephone interview after random selection through random digit dialing of households in central Indiana. Data from an additional 134 subjects who had neither knee pain nor radiographic changes of OA at either the baseline or followup examination were analyzed for comparison. Lower extremity muscle strength was measured by isokinetic dynamometry, lean tissue (i.e., muscle) mass in the lower extremities by dual x-ray absorptiometry, depression by Center for Epidemiology Depression (CES-D) scale. knee pain by Western Ontario McMaster University OA instrument, and perceived general health status by the Medical Outcome Survey Short Form-36.

RESULTS

In contrast to those with symptomatic knee OA, those who had knee pain but no radiographic evidence of OA were less obese, had hamstring as well as quadriceps weakness, and had CES-D scores high enough to qualify for a diagnosis of clinical depression.

CONCLUSION

Among subjects with knee pain but no OA--and among women in this subset, in particular--knee pain may be a manifestation of depression. rather than of joint disease.

Neonatal thyroxine level and perchlorate in drinking water

Environmental contamination of drinking water has been observed for perchlorate, a chemical able to affect thyroid function. This study examines whether that exposure affected the thyroid function of newborns. Neonatal blood thyroxine (T4) levels for days 1 to 4 of life were compared for newborns from the city of Las Vegas, Nevada, which has perchlorate in its drinking water, and those from the city of Reno, Nevada, which does not (detection limit, 4 micrograms/L [ppb]). This study is based on blood T4 analyses from more than 23,000 newborns in these two cities during the period April 1998 through June 1999. No difference was found in the mean blood T4 levels of the newborns from these two cities. Drinking water perchlorate levels measured monthly for Las Vegas ranged during this study period from non-detectable for 8 months to levels of 9 to 15 ppb for 7 months. Temporal differences in mean T4 level were noted in both cities but were unrelated to the perchlorate exposure. This study was sufficiently sensitive to detect the effects of gender, birth weight, and the day of life on which the blood sample was taken on the neonatal T4 level, but it detected no effect from environmental exposures to perchlorate that ranged up to 15 micrograms/L (ppb).

Articulatory vowel lengthening and coordination at phrasal junctures

Recent work has demonstrated that progressively stronger prosodic boundaries result in increasing amounts of lengthening for consonant gestures, both preceding and following the boundary. The present experiment extends these earlier findings by considering kinematic data collected with a magnetometer to determine (1) if vocalic gestures demonstrate lengthening patterns comparable to those of consonantal gestures due to adjacent prosodic boundaries, and (2) if the relative timing of consonant and vowel gestures is affected by adjacent boundaries. A magnetometer system was used to track articulator movements of 3 speakers producing sentences in which a /... C(1)V(1)(#)C(2)V(2).../ sequence was embedded with varying medial boundaries. All subjects demonstrated lengthening of the vocalic articulation before stronger boundaries. Additionally, effects on the relative timing of words spanning a boundary and the relative timing of segments in boundary-adjacent syllables were observed.

Assessing the effects of thyroid suppression on benign solitary thyroid nodules. A model for using quantitative research synthesis

Systematic review of the available information with a modified, largely quantitative method of research synthesis disclosed that an initial trial of thyroid hormone suppression therapy leads to clinically significant (> or = 50%) reduction of nodule size or arrest of nodule growth in a subset of patients with benign solitary thyroid nodules. In fact, in addition to objective improvements due to decreasing nodule size, L-T4 suppression therapy may benefit patients by reducing perinodular thyroid volume. Consequently, both pressure symptoms and cosmetic complaints may improve (9, 68). Additional studies for the assessment of the risks versus benefits of supraphysiologic doses of L-T4, the optimal level of thyroid suppression and the dose needed to achieve this magnitude of reduction, the optimal length of the initial trial, and the conditions for the continuation of L-T4 thyroid suppression therapy, as well as the identification of markers for patients most likely to respond to this therapy, are warranted. Finally, quantitative assessment of available evidence as described here may be applicable to the review of other controversial issues as well.

Renal polyamine excretion, tubular amino acid reabsorption and molecular genetics in cystinuria

Cystinuria is an autosomal recessive disorder of the tubular and intestinal resorption of cystine, ornithine. lysine and arginine leading to nephrolithiasis. Three cystinuria types can be distinguished by the mode of inheritance (true recessive or intermediate) and by the pattern of the intestinal amino acid transport. In the present study phenotypes were assessed by the urinary excretion of amino acids related to creatinine, the percentage tubular amino acid reabsorption and the urinary excretion of polyamines as a possible indicator of the intestinal transport defect. However, our thorough phenotyping did not reveal more than two cystinuria types. Genotypes were examined in linkage analyses and single-strand conformation polymorphism-based mutation identification. The SLC3A1 mutations M467T and T216M were disease causing in our homozygous patients of type I cystinuria. We can show the association of type I cystinuria with SLC3A1 and of non-type I cystinuria with a yet unidentified gene on chromosome 19q13.1. Our phenotype and genotype analyses provide evidence for only two types of cystinuria in the investigated patient cohort.

Angiogenesis and vascular growth factor receptor expression in malignant melanoma

The growth and metastases of many solid tumors are dependent on the recruitment of new blood vessels. Tumor angiogenesis is most likely initiated by paracrine release of growth factors that bind to their corresponding endothelial cell surface receptors. To determine whether angiogenesis and growth factor receptor expression are consistent findings in malignant melanoma, primary human melanomas were examined for mRNA expression of receptors for fibroblast growth factors (FGFR-1, FGFR-2), vascular endothelial growth factor (VEGFR-1, VEGFR-2), and the receptors Tiel and Tie2. Charts were reviewed and archival formalin-fixed, paraffin-embedded primary tumors were obtained from patients with thin (<1 mm; n = 10), intermediate (1 to 4 mm; n = 10), or thick malignant melanoma (>4 mm; n = 8). Also examined was whether melanoma cell lines could induce endothelial growth factor receptor synthesis by metabolic labeling. It was found that tumor vascularity did not correlate with clinical stage, melanoma thickness, or clinical outcome. It was also found that melanoma cell lines were not capable of directly regulating endothelial cell synthesis of growth factor receptors. However, expression of Tiel and VEGFR-2 mRNA by the tumor vasculature in select stage IA-IIB patients, and FGFR-1 mRNA expression by the tumor cells in the same clinical stages was found. The expression of these growth factor receptors did not correlate with clinical outcome. These data suggest that angiogenesis is not a prominent characteristic of primary malignant melanoma lesions and that the endothelial cell expression of Tiel and VEGFR-2 in vivo is probably not directly induced by the tumor.

Quadriceps strength in women with radiographically progressive osteoarthritis of the knee and those with stable radiographic changes

OBJECTIVE

To explore the relationship between lower extremity weakness and the progression of established radiographic changes of knee osteoarthritis (OA).

METHODS

The study cohort of 342 elderly subjects was recruited from central Indiana by random digit dialing. We analyzed 79 subjects who had definite radiographic changes of unilateral or bilateral knee OA at baseline and for whom baseline data for lower extremity muscle strength and lean tissue mass and baseline and followup assessments of knee pain were available. Radiographs were graded for severity of OA at baseline and again about 2.5 years later (mean 31.5 months). Knee pain was evaluated at the same examination. Strength of the knee flexors and extensors was assessed bilaterally at baseline by isokinetic dynamometry and lower extremity muscle mass by dual energy x-ray absorptiometry.

RESULTS

Mean peak knee extensor strength of women with progressive OA, before and after adjustment for lower extremity muscle mass, was about 9% lower than that in those with stable radiographic changes, but this difference was not statistically significant. No difference was apparent between the 2 groups with respect to knee flexor (hamstring) strength. The decrease in quadriceps strength among women with progressive OA, relative to those with stable OA, did not appear to be attributable to knee pain, and knee extensor strength at baseline bore no apparent relationship to the development or progression of knee pain among those with OA.

CONCLUSION

We have shown previously that quadriceps weakness may be of etiologic importance in development of knee OA. The absence of a significant difference in quadriceps strength between subjects with radiographically stable OA and those whose joint damage progressed suggests that factors other than quadriceps weakness are more important determinants of OA progression.

Geometry, kinematics, and acoustics of Tamil liquid consonants

Tamil is unusual among the world's languages in that some of its dialects have five contrasting liquids. This paper focuses on the characterization of these sounds in terms of articulatory geometry and kinematics, as well as their articulatory-acoustic relations. This study illustrates the use of multiple techniques--static palatography, magnetic resonance imaging (MRI), and magnetometry (EMMA)--for investigating both static and dynamic articulatory characteristics using a single native speaker of Tamil. Dialectal merger and neutralization phenomena exhibited by the liquids of Tamil are discussed. Comparisons of English /[symbol: see text]/ and /l/ with Tamil provide evidence for generality in underlying mechanisms of rhotic and lateral production. The articulatory data justify the postulation of a class of rhotics and a class of laterals in Tamil, but do not provide evidence in favor of a larger class of liquids. Such a superclass appears to have largely an acoustic basis.

Reduced quadriceps strength relative to body weight: a risk factor for knee osteoarthritis in women?

OBJECTIVE

To determine whether baseline lower extremity muscle weakness is a risk factor for incident radiographic osteoarthritis (OA) of the knee.

METHODS

This prospective study involved 342 elderly community-dwelling subjects (178 women, 164 men) from central Indiana, for whom baseline and followup (mean interval 31.3 months) knee radiographs were available. Lower extremity muscle strength was measured by isokinetic dynamometry and lean tissue (i.e., muscle) mass in the lower extremities by dual x-ray absorptiometry.

RESULTS

Knee OA was associated with an increase in body weight in women (P = 0.0014), but not in men. In both sexes, lower extremity muscle mass exhibited a strong positive correlation with body weight. In women, after adjustment for body weight, knee extensor strength was 18% lower at baseline among subjects who developed incident knee OA than among the controls (P = 0.053), whereas after adjustment for lower extremity muscle mass, knee extensor strength was 15% lower than in the controls (P not significant). In men, in contrast, adjusted knee extensor strength at baseline was comparable to that in the controls. Among the 13 women who developed incident OA, there was a strong, highly significant negative correlation between body weight and extensor strength (r = -0.740, P = 0.003), that is, the more obese the subject, the greater the reduction of quadriceps strength. In contrast, among the 14 men who developed incident OA, a modest positive correlation existed between weight and quadriceps strength (r = 0.455, P = 0.058). No correlation between knee flexor (hamstring) strength and knee OA was seen in either sex.

CONCLUSION

Reduced quadriceps strength relative to body weight may be a risk factor for knee OA in women.

Desmoplastic malignant melanoma presenting as an erythematous nodule tumor

Desmoplastic malignant melanoma is an uncommon neoplasm that presents both as a clinical and diagnostic challenge. Prognosis is frequently adversely affected by misdiagnosis and delayed diagnosis of this tumor, which is often amelanotic. We report a case of an amelanotic desmoplastic malignant melanoma that presented as an erythematous nodular tumor.

The effect of African-American acculturation on neuropsychological test performance in normal and HIV-positive individuals. The HIV Neurobehavioral Research Center (HNRC) Group

Two studies were conducted to examine the relationship of acculturation to neuropsychological test performance among (1) medically healthy, neurologically normal African Americans (N = 170); and (2) HIV positive (HIV+) subgroups of African Americans and Whites (Ns = 20) matched on age, education, sex, and HIV disease stage. Acculturation was measured through self report for all participants, and linguistic behavior (Black English use) was assessed in a subset of medically healthy individuals (N = 25). After controlling for the effects of age, education, and sex, medically healthy African Americans who reported less acculturation obtained lower scores on the WAIS-R Information subtest and the Boston Naming Test than did more acculturated individuals. Black English use was associated with poor performance on Trails B and the WAIS-R Information subtest. HIV+ African Americans scored significantly lower than their HIV+ White counterparts on the Category Test, Trails B, WAIS-R Block Design and Vocabulary subtests, and the learning components of the Story and Figure Memory Tests. However, after accounting for acculturation, ethnic group differences on all measures but Story Learning became nonsignificant. These results suggest that there are cultural differences within ethnic groups that relate to neuropsychological test performance, and that accounting for acculturation may improve the diagnostic accuracy of certain neuropsychological tests.

Cystatin C--a new marker of glomerular filtration rate in children independent of age and height

OBJECTIVES

Serum creatinine is the most common endogenous marker of renal function. The proportionality between creatinine production and muscle mass requires adjustment for height and body composition. The low molecular weight protein cystatin C is produced by all nucleated cells and eliminated by glomerular filtration. Therefore, cystatin C was studied as an alternative marker of glomerular filtration rate (GFR) in children.

METHODS

Cystatin C and creatinine were measured in sera from inulin clearance (CIn) examinations performed in 184 children aged 0.24 to 17.96 years. CIn ranged from 7 to 209 mL/min/1.73 m (median, 77).

RESULTS

The reciprocal of cystatin C correlated better with CIn (r = 0.88) than the reciprocal of creatinine (r = 0.72). Stepwise regression analysis identified no covariates for the correlation between cystatin C and CIn, whereas height was a covariate for creatinine. Using an estimate of GFR from serum creatinine and height, correlation with CIn was similar to cystatin C, but female gender and dystrophy were associated with an overestimation of GFR. Diagnostic accuracy in the identification of reduced GFR measured as area under the receiver-operating characteristic plot was 0.970 +/- 0.135 (mean +/- SE) for cystatin C and 0.894 +/- 0.131 for creatinine (NS). A cutoff cystatin C concentration of 1.39 mg/L had 90% sensitivity and 86% specificity for detecting abnormal GFR.

CONCLUSION

Unlike creatinine, serum cystatin C reflects renal function in children independent of age, gender, height, and body composition.

3H-morphine-6beta-glucuronide binding in brain membranes and an MOR-1-transfected cell line

Morphine-6beta-glucuronide (M6G) is a potent morphine metabolite. In an effort to further explore its mechanisms of action, we synthesized 3H-M6G of high specific activity and examined its binding. Although its affinity toward traditional mu receptors is similar to morphine in binding assays in brain and in Chinese hamster ovary cells stably transfected with MOR-1, M6G is >100-fold more potent than morphine in analgesic assays. This apparent discrepancy cannot be explained by differing intrinsic activities of the two drugs because both agents are partial agonists with similar efficacies in adenylyl cyclase assays in the transfected cell lines. Behavioral studies have implied the possibility of a distinct M6G receptor. Detailed binding studies in brain tissue reveal evidence for heterogeneity. Nonlinear regression analysis of 3H-M6G saturation studies reveals two components. The lower-affinity component (K(D) = 1.93 +/- 0.6 nM) corresponds to labeling of traditional mu receptors. In addition, 3H-M6G labels another site of low abundance with very high affinity (K(D) = 68 +/- 7 pM). Competition studies indicate that both sites are relatively mu selective. However, several compounds clearly distinguish between the two sites. These binding studies support the concept of a unique M6G receptor responsible for its analgesic activity.

Effects of self-care education on the health status of inner-city patients with osteoarthritis of the knee

OBJECTIVE

To evaluate a concise program of self-care education delivered by an arthritis nurse specialist as an adjunct to primary care for inner-city patients with knee osteoarthritis (OA).

METHODS

An attention-controlled clinical trial; 211 inner-city patients with knee OA were assigned arbitrarily to education (E) or attention-control (AC) conditions. Group E received an individualized 30-60-minute educational intervention that emphasized nonpharmacologic management of joint pain, preservation of function by problem-solving, and practice of principles of joint protection. Brief telephone contacts 1 week and 4 weeks later monitored and reinforced new self-care activities. Group AC viewed a 20-minute standardized public education presentation on arthritis and received followup telephone calls (only to encourage continued participation in the study). Outcomes included the Health Assessment Questionnaire (HAQ) Disability and Discomfort Scales, 10-cm visual analog scales measuring knee pain at rest and while walking, and the Quality of Well-Being (QWB) scale. Assessments were made at baseline and at 4-month intervals for 1 year.

RESULTS

A total of 165 subjects (78%) completed all assessments. After control for baseline status, group E had significantly lower scores for disability and resting knee pain throughout the year of postintervention followup (P < 0.05 for both). Effects were somewhat discordant. By 12 months, functional benefits had begun to wane, while the effect on resting knee pain had grown. The overall effects of education on walking knee pain, overall joint pain (by HAQ), and general health status (by QWB) were not significant.

CONCLUSION

Self-care education for inner-city patients with knee OA, delivered as an adjunct to primary care, was found to result in notable preservation of function and control of resting knee pain. The magnitude of the observed effects compares well with those of more labor-intensive and time-consuming intervention models. However, more sustained preservation of function and consistent effects on pain may require prolonged, more proactive followup, either by the patient educator or by a trained clinical assistant dedicated to the task of supporting self-care by patients with knee OA.

Sex differences in visual recognition memory: support for a sex-related difference in attention in adults and children

The selectivity hypothesis of Meyers-Levy (1989) proposes that cognitive sex differences reflect underlying differences in information processing between males and females. Males are considered to be more likely to organize information in a self-related manner, whereas females are more likely to adopt a comprehensive approach to information processing. We tested this hypothesis in children (10-15 years) and adults using recognition memory tasks. Tests were devised which employed male-oriented objects, female oriented objects, or random objects. In both the child and adult samples, females performed significantly better than males on tests using random and female-oriented objects. Males performed at the level of females only when tested for recognition of male-oriented objects. These results demonstrate that this sex difference is present prior to puberty and support the concept of sex differences in information processing.

Auditory selective attention: an fMRI investigation

In the present experiment, 25 adult subjects discriminated speech tokens ([ba]/[da]) or made pitch judgments on tone stimuli (rising/falling) under both binaural and dichotic listening conditions. We observed that when listeners performed tasks under the dichotic conditions, during which greater demands are made on auditory selective attention, activation within the posterior (parietal) attention system and at primary processing sites in the superior temporal and inferior frontal regions was increased. The cingulate gyrus within the anterior attention system was not influenced by this manipulation. Hemispheric differences between speech and nonspeech tasks were also observed, both at Broca's Area within the inferior frontal gyrus and in the middle temporal gyrus.

Command hallucinations in outpatients with schizophrenia

BACKGROUND

The presence of command hallucinations in individuals with schizophrenia may result in an increase in clinical monitoring to reduce the perceived risk of violent behavior. However, the issue of whether command hallucinations hold any clinical relevance in relatively stable outpatient samples has not been established.

METHOD

The clinical and research records of individuals with schizophrenia who participated in outpatient research protocols at the University of California, San Diego were reviewed for the presence of command hallucinations. Information on clinical characteristics was collected in a detailed chart review from 106 patient records.

RESULTS

Command hallucinations were reported by one half of all patients with auditory hallucinations, and these hallucinations often were violent in content. Yet, in over a third of the patients, these hallucinations had not been documented in their clinical charts, but instead were uncovered during a secondary source review. Patients with command hallucinations generally did not differ on prognostic or clinical course variables. However, the 2 patients who committed suicide during the study were patients with command hallucinations.

CONCLUSION

Although command hallucinations may be more frequent than clinicians generally note, in most cases they have minimal influence on the outcome of schizophrenia. However, in outpatients with schizophrenia who have a history of suicide attempts, suicidal command hallucinations should be taken seriously.

Using regions and indices in EPG data reduction

This note describes how dynamic electropalatography (EPG) can be used for the acquisition and analysis of articulatory data. Various data reduction procedures developed to analyze the electropalatographic data are reported. Specifically, these procedures concern two interesting areas in EPG data analysis--first, the novel use of speaker-specific articulatory regions and second, the development of arithmetic indices to quantify time-varying articulatory behavior and reflect reduction and coarticulation.

Features and outcome of no-reflow after percutaneous coronary intervention

No-reflow is an uncommon complication that may occur after revascularization of patients with acute myocardial infarction, after interventions in saphenous vein bypass grafts, and after the use of some new interventional devices. However, the clinical impact of no-reflow after coronary intervention is unknown. Accordingly, this study examined the incidence, clinical presentation, angiographic characteristics, and outcome of no-reflow after percutaneous coronary intervention. No-reflow was defined as an acute reduction in antegrade flow (< or = 1, as defined by the Thrombolysis in Myocardial Infarction [TIMI] trial) not attributable to abrupt closure, high-grade stenosis, or spasm of the original target lesion. Among 10,676 coronary interventions performed between October 1988 and June 1993, no-reflow occurred in 66 patients (0.6%). These patients were compared with a subgroup of 500 consecutive patients who did not exhibit no-reflow. The incidence of no-reflow was 30 of 9,431 (0.3%) for percutaneous transluminal coronary angioplasty, 1 of 317 (0.3%) for excimer laser, 8 of 104 (7.7%) for Rotablator (Heart Technologies, Bellevue, Washington), 21 of 469 (4.5%) for extraction atherectomy, and 6 of 355 (1.7%) for directional atherectomy. Compared with those without no-reflow, patients with no-reflow experienced a 10-fold higher incidence of in-hospital death (15%) and acute myocardial infarction (31%). Correlates of in-hospital mortality included acute myocardial infarction on presentation (p = 0.006) and final flow < 3 (as defined by the TIMI trial) at completion of the procedure (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Urinary calcium and oxalate excretion in children

We have established normal values for calcium/creatinine (Ca/Cr) and oxalate/creatinine (Ox/Cr) ratios in 25 infants (aged 1-7 days) and 391 children (aged 1 month to 14.5 years) and compared these with values obtained in 137 children with post-glomerular haematuria and 27 with nephrolithiasis. Oxalate was measured by ion chromatography. Nomograms of Marshall and Robertson were used to calculate urine saturation to calcium oxalate. The Ca/Cr ratio was normally distributed whereas the Ox/Cr ratio had a log-normal distribution. The molar ratio of Ca/Cr was the lowest in the first days of life and the highest between 7 month and 1.5 years (mean +/- SD = 0.39 +/- 0.28 mmol/mmol). Following a slight decrease it stabilised by the age of 6 years (0.34 +/- 0.19 mmol/mmol). The highest Ox/Cr values were measured during the 1st month of life [geometric mean 133 (range 61-280) mumol/mmol], followed by a gradual decrease until 11 years of age [mean 24 (range 6-82) mumol/mmol]. Thirty-six haematuric children had hypercalciuria (26%), 23 had absorptive hypercalciuria, 13 renal type. Children with absorptive hypercalciuria on a calcium-restricted diet had significantly higher oxalate excretion than those with renal hypercalciuria and the control group [38 (range 28-49) vs. 22 (range 16-29) and 23 (range 22-27) mumol/mol respectively, P < 0.01]. Calcium oxalate urine saturation of stone patients was higher than that of patients with haematuria and the normal population (1.18 +/- 0.05 vs. 1.06 +/- 0.03, P < 0.03 and 0.84 +/- 0.03, P < 0.001 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)