Total Child Health (United States)

Terpenoids represent the most diverse class of natural products, with a broad spectrum of industrial relevance including applications in green solvents, flavors and fragrances, nutraceuticals, colorants, and therapeutics. They are typically challenging to extract from their natural sources, where they occur in small amounts and mixtures of related but unwanted byproducts. Formal chemical synthesis, where established, is reliant on petrochemistry. Hence, there is great interest in developing sustainable solutions to assemble biosynthetic pathways in engineered host organisms. Metabolic engineering for chemical production has largely focused on microbial hosts, yet plants offer a sustainable production platform. In addition to containing the precursor pathways that generate the terpenoid building blocks as well as the cell structures and compartments required, or tractable localization for the enzymes involved, plants may provide a low input system to produce these chemicals using carbon dioxide and sunlight only. There have been significant recent advancements in the discovery of pathways to terpenoids of interest as well as strategies to boost yields in host plants. While part of the phytochemical field is focusing on the discovery of biosynthetic pathways, this review will focus on advancements using the pathway toolbox and toward engineering plants for the production of terpenoids. We will highlight strategies currently used to produce target products, optimization of known pathways to improve yields, compartmentalization of pathways within cells, and genetic tools developed to facilitate complex engineering of biosynthetic pathways. These advancements in Synthetic Biology are bringing engineered plant systems closer to commercially relevant hosts for the bioproduction of terpenoids.

Abstract The COVID-19 pandemic left an unprecedented impact on the general public health, resulting in hundreds of thousands of deaths in the U.S. alone. Nationwide testing plans were initiated with drive-through being the currently dominant testing approach, which, however, exhausts personal protective equipment supplies, and is unfriendly to individuals not owning a vehicle. Walkup positive pressure testing booths are a safe alternative, whereby a health care provider situated on the inside of an enclosed and positively pressurized booth swabs a patient on the outside through chemical resistant gloves. The booths, however, are too prohibitively priced on the market to allow for nationwide deployment. To mitigate this, we present in this paper a safe, accessible, mobile, and affordable design of positive-pressure COVID-19 testing booths. The booths have successfully passed the Centers for Disease Control and Prevention and Health care Infection Control Practices Advisory Committee pressure, air exchange, and air quality requirements for positive-pressure rooms, following the guidelines for environmental infection control in health care facilities. The booths are manufactured using primarily off-the-shelf components from U.S. vendors with minimized customization, and the final bill of materials does not surpass USD 3,900. Since August 2019, five booths were deployed and used at the Johns Hopkins University School of Nursing, Baltimore City Health Department, and two community health centers in Baltimore. No health care provider was infected when using our booths, which have shown to facilitate walkup testing with decreased personal protective equipment consumption, reduced risk of infection, and enhanced accessibility to lower-income communities and nondrivers.

The objective of the study was to help pediatricians understand and respond to suicidal ideation (SI) in adolescents based on data from 2 widely used screening measures that assessed SI and other psychosocial vulnerabilities in a large, national sample. Adolescents (ages 11-17 years) completed the Patient Health Questionnaire Modified for Teenagers (PHQ-9M) using the Comprehensive Health and Decision Information System software before their well-child visits. Question 9 asks about past 2-week SI. Their parents filled out the Pediatric Symptom Checklist (PSC-17P), which screens for a broad range of psychosocial problems. Chi-square analyses and one-way analysis of variances assessed the relationship between SI and psychosocial problems. Among 5411 adolescents, 266 (4.9%) reported SI at least several days in the past 2 weeks. Among adolescents with SI, 187 (70.3%) reported moderate to very severe depression on the PHQ-9M (≥10), 68.1% were at risk on at least 1 PSC-17P problem subscale, 59.7% on the PSC-17P internalizing scale, 42.9% on PSC-17P overall, 20.6% on PSC-17P externalizing, and 18.5% on PSC-17P attention. Within the subsample endorsing SI nearly all days, 35.7% had a former suicide attempt. The PHQ-9M identifies a clinically heterogeneous subset of approximately 5% of adolescents who report occasional to frequent SI. The PSC-17P corroborates their high degree of overall risk and offers additional information that can help pediatricians assess clinical severity and range of psychosocial problems. Given our limited knowledge of how to predict and prevent an individual adolescent's suicide, the focus of screening should be to identify and help the subset of patients with chronic psychosocial vulnerability of any type.

Each year, ineffective medical management of patients with mental illness compromises the health and well-being of individuals, and also impacts communities and our society. A variety of interrelated factors have impeded the health system's ability to treat patients with behavior health conditions adequately. A key contributing factor is a lack of objective markers to help predict patient response to specific drugs that has led to patterns of “trial and error” prescribing. For many years, clinicians have sought objective data (eg, a laboratory or imaging test) to assist them in selecting appropriate treatments for individual patients. Electroencephalogram (EEG) findings coupled with medication outcomes data may provide a solution. “Crowdsourced” physician registries that reference clinical outcomes to individual patient physiology have been used successfully for cancers. These techniques are now being explored in the context of behavioral health care. The Psychiatric EEG Evaluation Registry (PEER) is one such approach. PEER is a clinical phenotypic database comprising more than 11,000 baseline EEGs and more than 39,000 outcomes of medication treatment for a variety of mental health diagnoses. Collective findings from 45 studies (3130 patients) provide compelling evidence for PEER as a relatively simple, inexpensive predictor of likely patient response to specific antidepressants and likely treatment-related side effects (including suicidal ideation).

Porosity and pore space arrangement are essential for heat transfer and the reduction process of iron ore pellets in steelworks. Therefore, the pellet microstructural characterization becomes important for the quality control of the final product, steel, helping in the understanding of its behavior in the blast furnaces. Currently, the most used techniques for characterization are optical microscopy, which offers only two-dimensional results and thus does not represent exactly the reality; and mercury intrusion porosimetry that evaluates only pores connected to the surface, and uses mercury, which is highly harmful to human health. Moreover, they are techniques considered destructive as it is not possible to do other analyzes in the same samples, since they are destroyed. This work proposes to optimize a methodology of three-dimensional characterization of porosity in pellets using the technique of x-ray microtomography (microCT). This is a nondestructive technique that provides 3D information, but presents limitations related to the time of analysis and resolution. It was possible to characterize in 3D pellet samples provided by the Vale company, obtaining the porosity and the pore volume distribution. Open and closed porosity was also measured by a new developed methodology. Thus, the acquisition methodology was optimized, reaching a reduction of time for all the analyzes -it took 3 hours for the analysis of an entire ball. It was confirmed that the resolution had a great impact on the porosity characterization of iron ore pellets, evidenced by the great difference between the porosities measured at the different resolutions reached: 14.83% for 7.6 m, 23.69% for 4 m and 26.75% for 2 m.

Understanding the costs to implement Screening, Brief Intervention, and Referral to Treatment (SBIRT) for adolescent substance use in primary care settings is important for providers in planning for services and for decision makers considering dissemination and widespread implementation of SBIRT. We estimated the start-up costs of two models of SBIRT for adolescents in a multisite U.S. Federally Qualified Health Center (FQHC). In both models, screening was performed by a medical assistant, but models differed on delivery of brief intervention, with brief intervention delivered by a primary care provider in the generalist model and a behavioral health specialist in the specialist model. SBIRT was implemented at seven clinics in a multisite, cluster randomized trial. SBIRT implementation costs were calculated using an activity-based costing methodology. Start-up activities were defined as (a) planning activities (e.g., changing existing electronic medical record system and tailoring service delivery protocols); and (b) initial staff training. Data collection instruments were developed to collect staff time spent in start-up activities and quantity of nonlabor resources used. The estimated average costs to implement SBIRT were $5,182 for the specialist model and $3,920 for the generalist model. Planning activities had the greatest impact on costs for both models. Overall, more resources were devoted to planning and training activities in specialist sites, making the specialist model costlier to implement. The initial investment required to implement SBIRT should not be neglected. The level of resources necessary for initial implementation depends on the delivery model and its integration into current practice.

Parents whose infants are being treated in the NICU are at high risk for depression and anxiety, with negative implications for parenting and infant development. We conducted a systematic review and meta-analysis of NICU-based interventions to reduce maternal depressive or anxiety symptoms. PubMed, Embase, PsychInfo, Cochrane, and CINAHL were searched for relevant studies. Reference lists from selected studies were reviewed. Inclusion criteria included randomized controlled design, a parent-focused intervention delivered in the NICU, valid maternal depressive or anxiety symptom measures at pre- and postintervention, and publication in a peer-reviewed journal in English. Data extraction was conducted independently by 2 coders. Twelve studies met inclusion criteria for qualitative review; 2 were excluded from quantitative analyses for high risk of bias. Fixed- and random-effects models, with 7 eligible studies assessing depressive symptoms, indicated an effect of -0.16 (95% confidence interval [CI], -0.32 to -0.002; P < .05) and, with 8 studies assessing anxiety symptoms, indicated an effect of -0.12 (95% CI, -0.29 to 0.05; P = .17). The subset of interventions using cognitive behavioral therapy significantly reduced depressive symptoms (effect, -0.44; 95% CI, -0.77 to -0.11; P = .01). The small number and methodological shortcomings of studies limit conclusions regarding intervention effects. Combined intervention effects significantly reduced maternal depressive but not anxiety symptoms. The evidence is strongest for the impact of cognitive behavioral therapy interventions on maternal depressive symptoms.

The Healthy Cities approach has been quite widely—if somewhat inconsistently—adopted in North America and has remained alive and reasonably well for a quarter century. It has also been adapted to focus as much or more on smaller communities as on large cities and towns, and to be more community based rather than primarily based in municipal government, and has been adopted by a wide variety of local, state and national partners from the public, non-profit, philanthropic and private sectors. Community initiatives cover a very wide range of environmental, social, economic and other issues and intersect with a number of other city or community-focused initiatives aimed at improving life in cities and communities.