Negative Differential Interlayer Resistance in WSe2 Multilayers via Conducting Channel Migration with Vertical Double-Side Contacts

The inherent interlayer resistance in two-dimensional (2D) van der Waals (vdW) multilayers is expected to significantly influence the carrier density profile along the thickness, provoking spatial modification and separation of the conducting channel inside the multilayers, in conjunction with the thickness-dependent carrier mobility. However, the effect of the interlayer resistance on the variation in the carrier density profile and its direction along the thickness under different electrostatic bias conditions has been elusive. Here, we reveal the presence of a negative differential interlayer resistance (NDIR) in WSe2 multilayers by considering various contact electrode configurations: (i) bottom contact, (ii) top contact, and (iii) vertical double-side contact (VDC). The contact-structure-dependent shape modification of the transconductance clearly manifests the redistribution of carrier density and indicates the direction of the conducting channel migration along the thickness. Furthermore, the distinct characteristic of the electrically tunable NDIR in 2D WSe2 multilayers is revealed by the observed discrepancy between the top- and bottom-channel resistances determined by four-probe measurements with VDC. Our results provide an optimized device layout and further insights into the distinct carrier transport mechanism in 2D vdW multilayers.

Enhanced Interlayer Charge Injection Efficiency in 2D Multilayer ReS2 via Vertical Double-Side Contacts

Two-dimensional (2D) van der Waals (vdW) layered materials have provided novel opportunities to explore interesting physical properties such as thickness-dependent bandgap, moiré excitons, superconductivity, and superfluidity. However, the presence of interlayer resistance along the thickness and Schottky barrier in metal-to-2D vdW semiconducting materials causes a limited interlayer charge injection efficiency, perturbing various intrinsic properties of 2D vdW multilayers. Herein, we report a simple but powerful contact electrode design to enhance interlayer carrier injection efficiency along the thickness by constructing vertical double-side contact (VDC) electrodes. A 2-fold extended contact area of VDC not only strongly limits an interlayer resistance contribution to the field-effect mobility and current density at the metal-to-2D semiconductor interface but also significantly suppresses both current transfer length (≤1 μm) and specific contact resistivity (≤1 mΩ·cm²), manifesting clear benefits of VDC in comparison with those in conventional top-contact and bottom-contact configurations. Our layout for contact electrode configuration may suggest an advanced electronic device platform for high-performing 2D optoelectronic devices.

Evaluating Predictors of Participation in Telephone-Based Social-Connectedness Interventions for Older Adults: A Dual Machine-Learning and Regression Approach

Social isolation is a well-documented contributor to poor mental and physical health, and interventions promoting social connectedness have been associated with various health benefits. This study examined predictors of participation in a telephone-based social connectedness intervention for socially isolated older adults. Data were obtained from a social-connectedness intervention that paired college students with Houston-area, community-dwelling adults aged 65 years and older and enrolled in Medicare Advantage plans. We combined machine learning and regression techniques to identify significant predictors of program participation. The following machine-learning methods were implemented: (1) k-nearest neighbors, (2) decision tree and ensembles of decision trees, (3) gradient-boosted decision tree, and (4) random forest. The primary outcome was a binary flag indicating participation in the telephone-based social-connectedness intervention. The most predictive variables in the ML models, with scores corresponding to the 90th percentile or greater, were included in the regression analysis. The predictive ability of each model showed high discriminative power, with test accuracies greater than 95%. Our findings suggest that telephone-based social-connectedness interventions appeal to individuals with disabilities, depression, arthritis, and higher risk scores. scores. Recognizing features that predict participation in social-connectedness programs is the first step to increasing reach and fostering patient engagement.

Optimizing Disaster Preparedness Planning for Minority Older Adults: One Size Does Not Fit All

By 2050, one in five Americans will be 65 years and older. The growing proportion of older adults in the U.S. population has implications for many aspects of health including disaster preparedness. This study assessed correlates of disaster preparedness among community-dwelling minority older adults and explored unique differences for African American and Hispanic older adults. An electronic survey was disseminated to older minority adults 55+, between November 2020 and January 2021 (n = 522). An empirical framework was used to contextualize 12 disaster-related activities into survival an0000000d planning actions. Multivariate logistic regression models were stratified by race/ethnicity to examine the correlates of survival and planning actions in African American and Hispanic older adults, separately. We found that approximately 6 in 10 older minority adults did not perceive themselves to be disaster prepared. Medicare coverage was positively associated with survival and planning actions. Income level and prior experience with disaster were related to survival actions in the African American population. In conclusion, recognizing the gaps in disaster-preparedness in elderly minority communities can inform culturally sensitive interventions to improve disaster preparedness and recovery.

Transition to telemedicine and its impact on missed appointments in community-based clinics

BACKGROUND AND OBJECTIVE

The Coronavirus Aid, Relief, and Economic Security Act led to the rapid implementation of telemedicine across health care office settings. Whether this transition to telemedicine has any impact on missed appointments is yet to be determined. This study examined the relationship between telemedicine usage and missed appointments during the COVID-19 pandemic.

METHOD

This retrospective study used appointment-level data from 55 Federally Qualified Health Centre clinics in Texas between March and November 2020. To account for the nested data structure of repeated appointments within each patient, a mixed-effects multivariable logistic regression model was used to examine associations between telemedicine use and missed appointments, adjusting for patient sociodemographic characteristics, geographic classification, past medical history, and clinic characteristics. The independent variable was having a telemedicine appointment, defined as an audiovisual consultation started and finalized via a telemedicine platform. The outcome of interest was having a missed appointment (yes/no) after a scheduled and confirmed medical appointment. Results from this initial model were stratified by appointment type (in-person vs. telemedicine).

RESULTS

The analytic sample included 278,171 appointments for 85,413 unique patients. The overall missed appointment rate was 18%, and 25% of all appointments were telemedicine appointments. Compared to in-person visits, telemedicine visits were less likely to result in a missed appointment (OR = 0.87, p < .001). Compared to Whites, Asians were less likely to have a missed appointment (OR = 0.82, p < .001) while African Americans, Hispanics, and American Indians were all significantly more likely to have missed appointments (OR = 1.61, p < .001; OR = 1.19, p = .01; OR = 1.22, p < .01, respectively). Those accessing mental health services (OR = 1.57 for in-person and 0.78 for telemedicine) and living in metropolitan areas (OR = 1.15 for in-person and 0.82 for telemedicine) were more likely to miss in-person appointments but less likely to miss telemedicine appointments. Patients with frequent medical visits or those living with chronic diseases were more likely to miss in-person appointments but less likely to miss telemedicine appointments.

CONCLUSIONS

Telemedicine is strongly associated with fewer missed appointments. Although our findings suggest a residual lag in minority populations, specific patient populations, including those with frequent prior visits or chronic conditions, those seeking mental health services, and those living in metropolitan areas were less likely to miss telemedicine appointments than in-person visits. These findings highlight how telemedicine can enable effective and accessible care by reducing missed healthcare appointments.KEY MESSAGESTelemedicine was associated with 13% lower odds of missed appointments.Patients with frequent medical visits or those living with chronic diseases were less likely to miss telemedicine appointments but more likely to miss in-person appointments.Patients seeking mental health services were less likely to miss telemedicine appointments but more likely to miss in-person appointments.Similarly, those living in metropolitan areas were less likely to miss telemedicine appointments but more likely to miss in-person appointments.

Tailorable Electronic and Electric Properties of Graphene with Selective Decoration of Silver Nanoparticles by Laser-Assisted Photoreduction

While graphene shows great potential for diverse device applications, to broaden the scope of graphene-based device applications further, it would be necessary to tune the electronic state of graphene and its resultant electrical properties properly. Surface decoration with metal nanoparticles is one of the efficient doping methods to control the properties of two-dimensional materials. Here, we report the p-type doping effects in single-layer graphene decorated with silver nanoparticles (AgNPs) that were formed area-selectively by the facile one-step photoreduction (PR) process based on focused-laser irradiation. During the PR process, AgNPs were reduced on graphene in AgNO₃ solution by laser-driven photoexcitation followed by chemical reactions. Based on scanning electron microscopy analyses, the morphology characteristics of AgNPs were shown to be modulated by the laser dwell time and power controllably. Further, p-type doping effects were demonstrated using graphene-field-effect transistor structures whose graphene channels were selectively decorated with AgNPs by the PR process, as validated by the decrease in channel resistance and the shift of the Dirac point voltage. Moreover, the growth of AgNPs was observed to be more active on the graphene channel that was laser-annealed ahead of the PR process, leading to enhancing the efficiency of this approach for altering device characteristics.

Evaluating a contact tracing course: How universities can develop the public health workforce

OBJECTIVES

To describe the participants of a university-based COVID-19 contact tracing course and determine whether the course changed knowledge, attitudes, and intention to participate in contact tracing.

PARTICIPANTS

Faculty, staff, and students were eligible.

METHODS

Surveys evaluated the impact of the course on participant intentions to engage in contact tracing. Logistic regression identified characteristics associated with increased likelihood of participating in contact tracing.

RESULTS

Nearly 800 individuals participated, of whom 26.2% identified as Hispanic/Latino and 14.0% as Black. Nearly half (48.8%) planned to conduct contact tracing. While attitudes did not change, knowledge improved (67.9% vs. 93.8% scores on assessments; p < 0.001). Younger participants and Black individuals were more more likely to be confident that they would participate in contact tracing.

CONCLUSIONS

Course completion was associated with increased knowledge. Participants were racially and ethnically diverse, highlighting how universities can partner with health departments to develop workforces that reflect local communities.

Utilization Gaps During the COVID-19 Pandemic: Racial and Ethnic Disparities in Telemedicine Uptake in Federally Qualified Health Center Clinics

BACKGROUND

The Coronavirus Aid, Relief, and Economic Security (CARES) Act led to the rapid implementation of telemedicine across healthcare office settings. This innovation has the potential to improve healthcare use and ensure continuity of care. However, this delivery model could have an unintended consequence of worsening racial/ethnic disparities in healthcare utilization if adoption varies across sub-populations.

OBJECTIVE

To examine associations between telemedicine use and race/ethnicity between 3/1/2020 and 11/30/2020, and the influence of other individual- and geographical-level factors on this relationship.

DESIGN

Cohort study PARTICIPANTS: EMR data from 55 clinics in a FQHC network MAIN MEASURES: The dependent variable was visit type (in-person vs. telemedicine). Predictors of interest were patient race and ethnicity. To account for repeated visits within each patient nested within clinic, a three-level, mixed-effects, multivariable, logistic regression model was used. Subgroup analyses examined correlates of telemedicine use in African American and Hispanic cohorts, separately.

KEY RESULTS

The analytic sample included 233,302 visits for 67,733 unique patients. African Americans (OR = 0.65, 95% CI: 0.61, 0.69), Asians (OR = 0.58, 95% CI: 0.52, 0.65), and American Indians / Alaska Natives and other Pacific Islanders (OR = 0.82, 95% CI: 0.70, 0.98) were significantly less likely to use telemedicine compared to Whites. Hispanics were also less likely to have a telemedicine visit (OR = 0.49, 95% CI: 0.47, 0.51) compared to non-Hispanics. Nonacute visits were more likely to be conducted via telemedicine. Distance to clinic exhibited a dose-response relationship such that patients who lived farthest from the clinics were most likely to have telemedicine visits. In the subgroup analyses to examine predictors of telemedicine use, the dose-response relationship between distance from clinic and telemedicine use persisted, with increasing distance associated with increasing likelihood of telemedicine use, in both African American and Hispanic cohorts. Nonacute visits were associated with telemedicine use in the Hispanic cohort, but not in the Black / African American cohort.

CONCLUSION

Racial/ethnic disparities in telemedicine use persisted among this cohort. However, telemedicine improved utilization for African Americans and Hispanics living farther away from the clinic.

Self-perceived disaster preparedness in minority older adults: A cross-sectional study

OBJECTIVE

Evidence suggests that people of color, especially African Americans and non-White Hispanics, residing in low-income communities are the most vulnerable to natural disasters. This study assessed individual level of self-perceived disaster preparedness, disaster response actions, and sociodemographic predictors of disaster preparedness among older minority adults in Houston, Texas.

METHOD

Working with Houston-area community-based organizations and senior-living centers, a cross-sectional survey, available in English and Spanish, was disseminated between November 2020 and January 2021.

PARTICIPANTS

Five hundred and twenty-two older minority adults aged 55+ completed the electronic survey.

MAIN OUTCOME MEASURE(S)

The main outcome measure was the level of self-perceived preparedness regarding emergencies and disastersie, prepared vs not prepared-among the study participants.

RESULTS

Overall, about 58 percent of older minority adults did not perceive themselves to be prepared. Compared to individuals reporting annual incomes below $25,000, individuals reporting annual incomes between $25,000 and $74,999 were more likely to report being prepared [odds ratio (OR) = 2.28, 95 percent confidence interval (CI) = 1.29, 4.05]. Individuals who tested positive or had a close family member test positive for COVID-19 experienced 2.16 times higher odds of having self-perceived disaster preparedness than those who did not [OR = 2.16, 95 percent CI = 1.37, 3.42]. None of the other covariates were statistically significant.

CONCLUSIONS

While we observed no differences in self-perceived disaster preparedness between African American and Hispanic older adults, our findings suggest the importance of prior experience/exposure to previous disasters and the role of socioeconomic status in self-perceived disaster preparedness in minority older adults.

Correlates of Social Isolation Among Community-Dwelling Older Adults During the COVID-19 Pandemic

Background: The past year has severely curtailed social interactions among older adults given their high rates of COVID-19 morbidity and mortality. This study examined social, behavioral, and medical correlates of social isolation among community-dwelling older adults during the COVID-19 pandemic and stratified findings to explore unique differences in two typically neglected populations, African American and Hispanic older adults.

Methods: Working with community-based organizations and senior living centers, the research team administered a survey to older adults 55 years of age and older (n = 575). The survey assessed COVID-19 prevention behaviors, medical conditions, and lived experiences, including feelings of social isolation, in the target population. Responses to a previously validated social isolation question informed a dichotomous social isolation dependent variable. Multivariable logistic regression was used to adjust for sociodemographic characteristics, medical conditions, unmet caregiving needs, and COVID-19 prevention behaviors. Results from the regression model were stratified by race/ethnicity to examine correlates of social isolation in African American and Hispanic older adults, separately.

Results: Overall, female sex and a higher level of education were also positively associated with social isolation (OR = 2.46, p = 0.04; OR = 5.49, p = 0.02) while having insurance exhibited an inverse relationship (OR = 0.25, p = 0.03). Unmet caregiving needs were strongly associated with social isolation (OR = 6.41, p < 0.001) as was having any chronic conditions (OR = 2.99, p = 0.02). Diabetes was the single strongest chronic condition predictor of social isolation. Among minority older adults, a different pattern emerged. For Hispanic older adults, language, unmet caregiving needs, and social distancing were strongly associated with social isolation; while unmet caregiving needs, having 1+ chronic conditions and adhering to social distancing guidelines were significant predictors in African American older adults.

Conclusion: These findings suggest that social isolation affects older adults in a myriad of ways and support the need for culturally sensitive initiatives to mitigate the effect of social isolation in these vulnerable populations.

Early Impacts of the COVID-19 Pandemic on Telehealth Patterns in Primary Care, Mental Health, and Specialty Care Facilities in Texas

OBJECTIVES

Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, many US clinics have shifted some or all of their practice from in-person to virtual visits. In this study, we assessed the use of telehealth among primary care and specialty clinics, by targeting healthcare administrators via multiple channels.

METHODS

Using an online survey, we assessed the use of, barriers to, and reimbursement for telehealth. Respondents included clinic administrators (chief executive officers, vice presidents, directors, and senior-level managers).

RESULTS

A total of 85 complete responses were recorded, 79% of which represented solo or group practices and 63% reported a daily patient census >50. The proportion of clinics that delivered ≥50% of their consults using telehealth increased from 16% in March to 42% in April, 35% in May, and 30% in June. Clinics identified problems with telehealth reimbursement; although 63% of clinics reported that ≥75% of their telehealth consults were reimbursed, only 51% indicated that ≥75% of their telehealth visits were reimbursed at par with in-person office visits. Sixty-five percent of clinics reported having basic or foundational telehealth services, whereas only 9% of clinics reported advanced telehealth maturity. Value-based care participating clinics were more likely to report advanced telehealth services (27%), compared with non-value-based care clinics (3%).

CONCLUSIONS

These findings highlight the adaptability of clinics to quickly transition and adopt telehealth. Uncertainty about reimbursement and policy changes may make the shift temporal, however.

COVID-19 and Telehealth Operations in Texas Primary Care Clinics: Disparities in Medically Underserved Area Clinics

The COVID-19 pandemic has dramatically altered the landscape of health care delivery, prompting a rapid, widespread adoption of telehealth in primary care practices. Using a pooled sample of 1,344 primary care clinics in Texas, we examined the adoption of telehealth in Texas during the initial months of the COVID-19 pandemic, by comparing medically underserved area (MUA) clinics and non-medically underserved area (non-MUA) clinics. Our analysis suggests that compared with MUA clinics, clinics in non-MUAs were more likely to conduct a majority of their visits via telehealth before May 1st, 2020. However, later surveys indicated that differences in telehealth use between MUA and non-MUA clinics lessened, suggesting that some of the barriers that MUA clinics initially faced might have resolved over time. This research provides an additional perspective in discussions about telehealth adoption on a widespread, permanent basis in Texas and the U.S.

Outcomes of Intrathecal Baclofen Therapy Compared With Deep Brain Stimulation in a Patient With Dystonic Cerebral Palsy: A Case Report

Deep brain stimulation (DBS) in internal globus pallidus is considered to be a good option for controlling generalized dystonia in patients with this condition. In this relation, it is known that DBS has already been shown to have significant effects on primary dystonia, but is seen as controversial in secondary dystonia including cerebral palsy (CP). On the other hand, intrathecal baclofen (ITB) has been known to reduce spasticity and dystonia in patients who did not respond to oral medications or botulinum toxin treatment. Here, we report a patient with dystonic CP, who received the ITB pump implantation long after the DBS and who noted remarkable improvement in the 36-Item Short Form Health Survey, Dystonia Rating Scale, Modified Barthel Index, and visual analog scale scores for pain after an ITB pump implantation was used as compared with DBS. To our knowledge, the present case report is the first to demonstrate the effects of an ITB pump on reducing pain and dystonia and improving quality of life and satisfaction, compared with DBS in a patient with CP.

Environmental Enrichment Upregulates Striatal Synaptic Vesicle-Associated Proteins and Improves Motor Function

Environmental enrichment (EE) is a therapeutic paradigm that consists of complex combinations of physical, cognitive, and social stimuli. The mechanisms underlying EE-mediated synaptic plasticity have yet to be fully elucidated. In this study, we investigated the effects of EE on synaptic vesicle-associated proteins and whether the expression of these proteins is related to behavioral outcomes. A total of 44 CD-1® (ICR) mice aged 6 weeks were randomly assigned to either standard cages or EE (N = 22 each). Rotarod and ladder walking tests were then performed to evaluate motor function. To identify the molecular mechanisms underlying the effects of EE, we assessed differentially expressed proteins (DEPs) in the striatum by proteomic analysis. Quantitative real-time polymerase chain reaction (qRT-PCR), western blot, and immunohistochemistry were conducted to validate the expressions of these proteins. In the behavioral assessment, EE significantly enhanced performance on the rotarod and ladder walking tests. A total of 116 DEPs (54 upregulated and 62 downregulated proteins) were identified in mice exposed to EE. Gene ontology (GO) analysis demonstrated that the upregulated proteins in EE mice were primarily related to biological processes of synaptic vesicle transport and exocytosis. The GO terms for these biological processes commonly included Synaptic vesicle glycoprotein 2B (SV2B), Rabphilin-3A, and Piccolo. The qRT-PCR and western blot analyses revealed that EE increased the expression of SV2B, Rabphilin-3A and Piccolo in the striatum compared to the control group. Immunohistochemistry showed that the density of Piccolo in the vicinity of the subventricular zone was significantly increased in the EE mice compared with control mice. In conclusion, EE upregulates proteins associated with synaptic vesicle transport and exocytosis such as SV2B, Rabphilin-3A and Piccolo in the striatum. These upregulated proteins may be responsible for locomotor performance improvement, as shown in rotarod and ladder walking tests. Elucidation of these changes in synaptic protein expression provides new insights into the mechanism and potential role of EE.

Relationship Between Swallowing Function and Maximum Phonation Time in Patients With Parkinsonism

Objective

To identify the relationship between maximum phonation time (MPT) and swallowing function, as well as the elements of swallowing, in order to provide a rationale for speech therapy in patients with Parkinsonism manifesting dysphagia.

Methods

Thirty patients with Parkinsonism who underwent speech evaluation and videofluoroscopic swallowing study (VFSS) were recruited. The MPT, the longest periods of sustained pronunciation of /aa/, was evaluated. The VFSS was evaluated using Penetration Aspiration Scale (PAS), National Institutes of Health-Swallowing Safety Scale (NIH-SSS), and Videofluoroscopic Dysphagia Scale (VDS). The relationship between dysphagia scales and MPT was analyzed using Pearson correlation. The difference in VDS variables between subgroups (Parkinson disease or Parkinsonian syndrome, independent or dependent ambulation, and normal or abnormal MPT) and the difference in MPT between subgroups based on the VDS variables were analyzed using the independent t-test.

Results

Bolus formation and laryngeal elevation functions were significantly higher in the normal MPT group compared with the impaired group. In the VDS variables, patients with intact bolus formation, oral transit time, pharyngeal swallow triggering, and laryngeal elevation showed significantly longer MPTs compared with the impaired groups. In addition, MPT was significantly correlated with the VDS and modestly correlated with the NIH-SSS, but not the PAS, suggesting that phonatory function is related to the oropharyngeal swallowing function, but not directly to the aspiration itself.

Conclusion

The correlation between MPT and several swallowing-related elements was identified, indicating an interactive correlation between swallowing and phonation. This result justifies voice therapy as a treatment for dysphagia in patients with Parkinsonism.

Direct identification of generalized Prandtl-Ishlinskii model inversion for asymmetric hysteresis compensation

In this study, we present an identification-based direct construction of the inverse generalized Prandtl-Ishlinskii (P-I) model to facilitate inverse model-based feedforward compensation of asymmetric hysteresis nonlinearities. Compared with the derivation of the inverse model analytically from a generalized P-I model, this direct modeling approach has the following advantages. First, direct inverse model identification is formulated as a nonlinear optimization problem, which is not subject to the constraint condition on the generalized P-I model's threshold and density functions, where this is indispensable for the analytical model inversion procedure. Second, this approach may be a simple and attractive alternative when the identification precision of a generalized P-I model is limited by the constraint condition, which necessarily results in insufficient hysteresis compensation functionality for the analytically derived inverse model. Finally, direct inverse model identification can overcome the drawbacks of the analytical inversion method, including the accumulation of parameter estimation errors in an analytical inverse model because these parameters are computed from the generalized P-I model's parameters in a recursive manner. Our experimental results demonstrated that the implementation of open-loop control with the directly identified inverse generalized P-I model as a feedforward compensator achieved precise compensation for the asymmetric hysteresis nonlinearities of a piezoelectric stack actuator.

Outcomes of intrathecal baclofen therapy in patients with cerebral palsy and acquired brain injury

Intrathecal baclofen (ITB) has been known to reduce spasticity which did not respond to oral medications and botulinum toxin treatment. However, few results have been reported comparing the effects of ITB therapy in patients with cerebral palsy (CP) and acquired brain injury. This study aimed to investigate beneficial and adverse effects of ITB bolus injection and pump therapy in patients with CP and to compare outcomes to patients with acquired brain injury such as traumatic brain injury and hypoxic brain injury. ITB test trials were performed in 37 patients (19 CP and 18 acquired brain injury). Based on ambulatory function, CP patients were divided into 2 groups: 11 patients with nonambulatory CP and 8 patients with ambulatory CP. Change of spasticity was evaluated using the Modified Ashworth Scale. Additional positive or negative effects were also evaluated after ITB bolus injection. In patients who received ITB pump implantation, outcomes of spasticity, subjective satisfaction and adverse events were evaluated until 12 months post-treatment. After ITB bolus injection, 32 patients (86.5%) (CP 84.2% versus acquired brain injury 88.9%) showed a positive response of reducing spasticity. However, 8 patients with CP had negative adverse effects. Particularly, 3 ambulatory CP patients showed standing impairment and 1 ambulatory CP patient showed impaired gait pattern such as foot drop because of excessive reduction of lower extremity muscle tone. Ambulatory CP patients received ITB pump implantation less than patients with acquired brain injury after ITB test trials (P = .003 by a chi-squared test). After the pump implantation, spasticity was significantly reduced within 1 month and the effect maintained for 12 months. Seventeen patients or their caregivers (73.9%) were very satisfied, whereas 5 patients (21.7%) suffered from adverse events showed no subjective satisfaction. In conclusion, ITB therapy was effective in reducing spasticity in patients with CP and acquired brain injury. Before ITB pump implantation, it seems necessary to perform the ITB bolus injection to verify beneficial effects and adverse effects especially in ambulatory CP.

Family CHAOS is associated with glycaemic control in children and adolescents with type 1 diabetes mellitus

BACKGROUND

Despite advances in the medical management of type 1 diabetes mellitus (T1DM), for many, glycaemic control remains substandard. Other factors are clearly important in determining success, or lack thereof, with diabetes management. With this in mind, we have investigated whether family CHAOS may provide a novel tool to identify when environmental confusion could impact on diabetes management and subsequent glycaemic control.

METHODS

A case-control study of children and adolescents with established T1DM and age-/sex-matched controls was conducted. Demographic information, both maternal and paternal CHAOS scores, and HbA1c were collected. Statistical analysis was undertaken to explore associations between T1DM and CHAOS and between CHAOS and HbA1c.

RESULTS

Data on 65 children with T1DM and 60 age-/sex-matched controls were obtained. There was no evidence of group differences for maternal CHAOS (p = 0.227), but paternal CHAOS scores were higher for the T1DM group (p = 0.041). Greater maternal and paternal CHAOS scores were both associated with higher HbA1c (p ≤ 0.027). The maternal association remained after controlling for diabetes duration, SMBG frequency, and insulin therapy.

CONCLUSION

In children with T1DM, there appears to be a negative association between increased environmental confusion, as rated by CHAOS, and glycaemic control. In addition, when compared to controls, fathers of children and adolescents with T1DM appear to experience CHAOS differently to mothers. These findings contribute to the growing body of literature exploring psychosocial factors in T1DM. Continuing efforts are required to fully understand how the family and psychosocial environment interact with diabetes to impact on long-term health outcomes.

Intuitive eating is associated with glycaemic control in adolescents with type I diabetes mellitus

BACKGROUND

While there have been considerable advances in the medical management of type 1 diabetes mellitus (T1DM), for many, glycaemic control remains substandard. Nutrition and eating behaviour are important additional factors to consider with regards to T1DM management and outcomes. Intuitive eating is one such factor, and has not previously been investigated in T1DM. With this in mind, we undertook a study examining the relationship between intuitive eating and glycaemic control in adolescents with T1DM.

METHODS

A case-control study of adolescents with established T1DM, and age/sex matched controls was conducted. Demographic information, the Intuitive Eating Scale (IES), and HbA1c were collected. Statistical analysis was undertaken to explore associations between the IES and HbA1c as a marker of glycaemic control.

RESULTS

Data on 38 adolescents with T1DM, and 39 age/sex matched controls were obtained. Those with T1DM had significantly lower (by 0.5 SD) IES scores compared to controls (p = 0.009). Higher values of both total IES and the Eating for physical rather than emotional reasons subscale were associated with lower HbA1c: HbA1c 22% lower/whole unit increase in total IES mean score, HbA1c 11% lower/whole unit increase in Eating for physical rather than emotional reasons mean score, p = 0.017 and p = 0.009 respectively.

CONCLUSION

In adolescents with T1DM, there appears to be a strong association between intuitive eating, in particular the effect of emotion on eating, and glycaemic control. In addition, those with T1DM have lower scores for their intuitive eating behaviour compared to controls. Emotional eating could be a future target for screening and potentially intervening in those with T1DM, as part of a wider treatment package to improve glycaemic control. Continuing efforts are needed to fully understand the important dynamics of diabetes, adolescence, diet, emotion, and how these factors affect long term outcomes in those with T1DM.

SP600125 overcomes antimitotic drug-resistance in cancer cells by increasing apoptosis with independence of P-gp inhibition

The purpose of this study was to identify conditions that increase the sensitivity of resistant cancer cells to antimitotic drugs. Using MTS assays, microscopic observation, assessment of cleaved PARP, FACS analysis, and Hoechst staining, we found that the c-Jun N-terminal kinase (Jnk) inhibitor SP600125 (SP) sensitized the antimitotic drug-resistant KBV20C cancer cell line. The sensitization mechanism was independent of p-glycoprotein (P-gp) inhibition. Interestingly, SP-induced sensitization was greater in resistant KBV20C cancer cells than in KB parent cells. The mechanism of SP-induced sensitization involved G2 arrest. KBV20C cells treated with SP and antimitotic drugs were more sensitized than cells treated with SP alone. This suggests that SP can restore sensitization for antimitotic drugs in resistant cancer cells. Our findings may contribute to the development of SP-based combination therapies for patients receiving anti-cancer agents that target microtubules.

Salinomycin sensitizes cancer cells to the effects of doxorubicin and etoposide treatment by increasing DNA damage and reducing p21 protein

BACKGROUND AND PURPOSE

Salinomycin (Sal) has recently been shown to inhibit various cancer stem cells. Here, we investigated whether Sal could sensitize cancer cells to the effects of doxorubicin (DOX) or etoposide (ETO).

EXPERIMENTAL APPROACH

Using the Comet assay, immunocytochemistry and Western blot analysis, we assessed the ability of Sal to increase DNA breakage. We performed a cell proliferation assay to determine cell viability, cellular detachment, increased pre-G1 region, Annexin V staining and TUNEL assay to measure the ability of Sal to increase apoptosis.

KEY RESULTS

Sal increased DNA breakage and phosphorylated levels of p53 and H2AX. Sal also induced the formation of DNA foci with pH2AX and 53BP1. Furthermore, Sal increased the sensitivity of cancer cells to the apoptotic effects of DOX or ETO. We found that pH2AX, pBRCA1, p53BP1 and pChk1 levels were greatly increased after co-treatment of Sal with DOX or ETO. The level of anti-apoptotic p21 protein was increased by DOX or ETO but decreased by Sal, which increased proteasome activity.

CONCLUSIONS AND IMPLICATIONS

This is the first study to report that Sal increases DNA damage, and this effect plays an important role in the increased apoptosis caused by Sal. Overall, we demonstrated that the ability of Sal to sensitize cancer cells to the effects of DOX or ETO is associated with an increase in DNA damage and a decrease in anti-apoptotic protein p21 levels. These results may contribute to the development of Sal-based chemotherapy for cancer patients receiving DOX or ETO treatment.