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Osteosarcoma(OS) is a highly aggressive bone cancer for which treatment has remained essentially unchanged for decades. Although OS is characterized by extensive genomic heterogeneity and instability, RB1and TP53have been shown to be the most commonly inactivated tumor suppressors in OS. We previously generated a mouse model with a double knockout (DKO) of Rb1and Trp53within cells of the osteoblastic lineage, which largely recapitulates human OS with nearly complete penetrance. SKP2 is a repression target of pRb and serves as a substrate recruiting subunit of the SCFSKP2complex. In addition, SKP2 plays a central role in regulating the cell cycle by ubiquitinating and promoting the degradation of p27. We previously reported the DKOAA transgenic model, which harbored a knock-in mutation in p27 that impaired its binding to SKP2. Here, we generated a novel p53-Rb1-SKP2triple-knockout model (TKO) to examine SKP2 function and its potential as a therapeutic target in OS. First, we observed that OS tumorigenesis was significantly delayed in TKO mice and their overall survival was markedly improved. In addition, the loss of SKP2also promoted an apoptotic microenvironment and reduced the stemness of DKO tumors. Furthermore, we found that small-molecule inhibitors of SKP2 exhibited anti-tumor activities in vivo and in OS organoids as well as synergistic effects when combined with a standard chemotherapeutic agent. Taken together, our results suggest that SKP2 inhibitors may reduce the stemness plasticity of OS and should be leveraged as next-generation adjuvants in this cancer.

Introduction: The effect of post-operative patella tilt on functional outcomes after total knee arthroplasty remains unclear. Our study aimed to analyze the relationship of post-operative patellar tilt with functional outcome scores after total knee arthroplasty. Materials and Methods: Patient data were retrieved from our institution’s prospectively maintained total knee arthroplasty. Three hundred three patients who underwent unilateral TKA from Jan 2012 to March 2017 were included in the study. After excluding patients with incomplete and lost follow-up data, 213 patients were analyzed. Radiographs of pre-operative and post-operative skyline views were used for patella tilt and patella displacement measurement at pre-op, post-op 1 year, and post-op 2 years. Three functional outcome scoring systems, SF-36, KSS, and WOMAC, were applied for function evaluation at different post-operative time points. Patients were divided into three subgroups according to the patella tilt, which includes less than 5°, 5.1–10°, and more than 10°. Statistical analysis was done to identify the relationship between patella tilt and functional outcomes. Results: Mean post-operative patella tilt was significantly lower than the mean pre-operative patella tilt (3.35 ± 3.91 vs. 5.65 ± 4.41, p< 0.001). There was no significant difference in patella displacement among pre- and post-operative status. KSS functional score was significantly poor at post-op 1 year and KSS objective score at post-op 2 years in patients with more than 10° patella tilt. SF-36 and WOMAC were not significantly different among the groups. There was no significant difference in post-operative function between non-resurfaced and resurfaced patella patients evaluated with three scoring systems. Conclusion: We have found significantly less post-operative patella tilt after TKA than pre-operative patella tilt with or without patella resurfacing. Increased post-operative patella tilt of more than 10° can affect specific functional outcomes. Patella resurfacing does not affect the post-operative functional outcome compared to non-resurfacing of the patella post-op 2 years. Level of Evidence: III.

The weak signals of artificial seismic records contain the subsurface medium information that is required in the inversion. But in the full waveform inversion (FWI), the weak signals contribute less to the objective functions. Therefore, how to improve the contribution of the weak signals in the objective functions of FWI is the problem that needs to be solved urgently. The research shows (Ren, D. 1980. Preliminary research on seismic record and instantaneous frequency. Oil Geophysical Prospecting15 no. 1: 7–21) that instantaneous frequency attributes, which are very sensitive to the changes in subsurface velocity, have the potential to extract the weak signals from the seismic records. However, this frequency can only be estimated from the complex seismic signals. Empirical mode decomposition (EMD) method has been widely used in signal analysis so as to estimate the instantaneous frequency, but it is difficult to be applied in FWI due to the huge computation. In order to solve this problem, the instantaneous frequency is replaced with the first-order approximation of the exponential frequency in FWI. In this paper, the objective functions of the first-order approximate exponential frequency FWI (FRE-EFWI) in elastic waves and the source terms of its back propagation formula were derived. Besides, the FRE-EFWI method was proved to improve the contribution of the weak signals in the objective functions of FWI. In addition, the correctness and effectiveness of the method were demonstrated by the examples of FWI.

Job satisfaction levels among registered nurses (RNs) influence RN recruitment, retention, turnover, and patient outcomes. Researchers examining the relationship between characteristics of nursing leadership and RN job satisfaction have treated RNs as a monolithic group with little research on the satisfaction of hospital-based pediatric RNs. This study assessed the relationship of transformational and transactional nursing leadership characteristics and RN job satisfaction reported by pediatric RNs. This single site study included 935 hospital-based pediatric RNs who completed validated survey items regarding nursing leadership and job satisfaction. A structural equation model (SEM) was applied to assess how autonomy (transformational leadership) and distributive justice (transactional leadership) influence RN job satisfaction, and how RN socio-demographic characteristics influence job satisfaction via autonomy and distributive justice. Findings revealed that both autonomy and distributive justice had significant positive effects on RN job satisfaction but the largest source of influence was autonomy., Determining the level of registered nurse (RN) job satisfaction is a long-standing concern in health care because job satisfaction among RNs employed in hospital settings is lower than all workers [...]

Background: Reconstruction after en bloc resection of the distal tibia has remained an unsettled issue despite many attempts with bone grafts or prostheses in the past. Failures of the previous methods have been attributed to inadequate mechanical strength, poor articular stability, failed osseointegration, and poor soft tissue coverage. To overcome these shortcomings, we designed and applied a 3D-printed megaprosthesis with ankle arthrodesis.Methods: A total of 13 patients underwent resection of a distal tibial tumor and reconstruction with a 3D-printed distal tibial megaprosthesis between January 2017 and November 2020. Mean age was 14.9±6.5 years. Diagnoses included 11 cases of osteosarcoma and 1 case each of low-grade phosphaturic mesenchymal tumor and rhabdomyosarcoma. Baseline characteristics, operative data, complication profiles, and oncologic, and functional outcomes were reviewed and analyzed.Results: All 13 cases attained a wide or marginal resection. During a mean follow-up of 26.8±10.6 months, 1 patient experienced local recurrence and distant metastasis, whereas 3 other patients only developed distant metastasis. Periprosthetic infection subsequent to paronychia occurred in 1 patient 24 months after the operation. No other complications were observed. By the last follow-up, the mean MSTS-93 score was 28.0±1.5.Conclusion: In this relatively small cohort with short-term follow-up, reconstruction with the 3D-printed megaprosthesis with ankle arthrodesis was found to be a safe and efficacious method after resection of a distal tibial malignancy.

Research presented concerns the use of the latent growth model to measure the level and trajectory of human behavioral change, focusing on the application of this model to evaluating the efficacy of intervention programs targeting drug users with a high risk of contracting HIV. The model is shown to chart individual and group targeted behavior over time.

ObjectiveTo develop and pilot test a palliative care intervention for family caregivers of children with rare diseases (FAmily-CEntered pediatric Advance Care Planning-Rare (FACE-Rare)).MethodsFACE-Rare development involved an iterative, family-guided process including review by a Patient and Family Advisory Council, semistructured family interviews and adaptation of two evidence-based person-centred approaches and pilot testing their integration. Eligible families were enrolled in FACE-Rare (the Carer Support Needs Assessment Tool (CSNAT) Approach Paediatric sessions 1 and 2; plusRespecting Choices Next Steps pACP intervention sessions 3 and 4). Satisfaction, quality of communication and caregiver appraisal were assessed.ResultsParents were mean age 40 years, and children 7 years. Children’s diseases were rare enough that description would identify patients. All children were technology dependent. Telemedicine, used with four of seven families, was an effective engagement strategy and decreased subject burden. Families found FACE-Rare valuable following a strategy that firstelicited palliative care needs and a support plan. Eight families were approached for pilot testing. Of the seven mothers who agreed to participate, six began session 1, and of those, 100% completed: all four FACE-Rare sessions, baseline and 2-week postintervention assessments, and a written pACP which described their preferences for medical decision-making to share with their providers. 100% reported FACE-Rare was helpful. The top three CSNAT concerns were: knowing what to expect in the future, having enough time for yourself and financial issues. Benchmarks were achieved and questionnaires were acceptable to parents and thus feasible to use in a larger trial.ConclusionsFACE-Rare provides an innovative, structured approach for clinicians to deliver person-centred care.

Objectives: To study factors that influence the self-reported use of condoms among injection drug users and crack smokers. Study Design: A cross-sectional design was used to collect data from drug-using heterosexual men (n = 247) and women (n = 107). Results: Participants were largely African American (79.4%), male (69.8%), and unmarried (90.1%). The mean age for men was 39.9 years, 35.5 years for women. Drug user groups consisted of individuals who used both crack cocaine and injection drugs (40.1%), noninjecting crack smokers (33.1%), and noncrack-smoking injection drug users (26.8%). Daily injection drug or crack use was reported by 62.9% of the sample. One third of the sample reported recent vaginal sex with more than one partner. More than 70% of the participants frequently used drugs when having sex. Logistic regression showed that individuals who were high when having vaginal sex were less likely to use condoms than people who were not high (odds ratio [OR] 0.82; 95% confidence interval [CI], 0.68-0.99); individuals whose partners got high when having sex were more likely to report condom use (OR 1.20; 95% CI, 1.01-1.42); individuals were less likely to use condoms when having sex with a main partner (OR 0.40; 95% CI, 0.20-0.80); individuals who believed it was important to use condoms were more likely to use condoms ([Beta] = 0.57, P [is less than] 0.00); and people who believed condoms reduced sexual pleasure were less likely to use condoms ([Beta] = 0.53, P [is less than] 0.00). Conclusions: In addition to being sensitive to partner characteristics, sex risk-reduction interventions targeting users of injection drugs or crack must address the widespread use of psychoactive drugs that occurs immediately before and during sex because such use presents a significant impediment to the employment of safer-sex techniques that rely on condoms. Until such interventions are in place, access to drug abuse treatment is a critical dimension of human immunodeficiency virus and other sexually transmitted disease prevention., People who use drugs during sex appear less likely to use a condom. This was the conclusion of a study of 247 men and 107 women who used drugs. One-third smoked crack cocaine only, 27% injected other drugs and 40% did both. Almost two-thirds used drugs on a daily basis. About 70% used drugs before or during sex and this group was less likely to use a condom during sex. Drug treatment should be a high priority to prevent the spread of HIV infection.

Background and Objectives: This study describes self-reported histories of sexually transmitted diseases (STD) with respect to gender and ethnicity and examines the factors that influence the use of condoms among heterosexual users of injection drugs and/or crack cocaine. Study Design: A cross-sectional design was used to interview 1046 active users of illicit drugs living in Columbus and Dayton, Ohio. Results: STD was common among 29% of the white men, 53.6% of the black men, 55.9% of the white women, and 64.7% of the black women self-reporting previous infection. Among women, stepwise logistic regression showed that cohabitating with a spouse or a sex partner (OR 0.28; 95% CI, 0.06 to 0.77) and exchanging sex for drugs (OR 0.31; 95% CI, 0.11 to 0.88) were associated negatively with always using a condom during vaginal sex in the previous month, whereas exchanging sex for money (OR 4.48; 95% Cl, 1.88 to 10.95) was associated positively. Among men, cohabitating with a spouse or a sex partner (OR 0.13; 95% CI, 0.06 to 0.31), having had an STD (OR 0.53; 95% CI, 0.33 to 0.85), and currently using injection drugs (OR 0.52; 95% Cl, 0.33 to 0.84) were associated negatively with condom use. Conclusions: Users of illicit drugs are at high risk for the acquisition and transmission of STD. More research is needed to understand better the sex practices of users of injection drugs and crack cocaine so that appropriate interventions can be developed., Injection drug and crack cocaine users may not use condoms consistently and may be at risk for acquiring sexually transmitted diseases (STDs). Researchers interviewed 1,046 injection drug and crack users regarding condom usage and history of STDs. Women and men living with a steady sex partner were less likely to use condoms. Men with histories of STDs used condoms less than men without previous STD infection. Women who traded sex for money used condoms frequently, while women who traded sex for drugs seldom used condoms. More blacks reported histories of STD infection than whites.

Background:An individual's personal social network influences behavior; one is more likely to adopt behaviors consistent with norms within the network to avoid social stigma. Personal social network types, which are associated with individual behaviors, have been identified for new mothers: exclusive (kin centric) and expansive (not kin centric).Objective:To analyze the impact of personal social network type on breastfeeding practices in U.S.-born Black and White mothers.Methods:Mothers of infants <6 months old completed surveys about their personal social networks and feeding practices. Multinomial logit models examined how social network types moderated effects of sociodemographic factors on feeding practices.Results:Of 402 mothers, 67% self-identified as Black and 33% as White. Forty-six percent were exclusively breastfeeding; 26% were mixed breast and formula feeding. The likelihood of exclusively breastfeeding was positively associated with percentage of network members who had breastfed; this association was stronger for mothers with exclusive networks than those with expansive networks (β= 2.74, p< 0.001 versus β= 1.78, p= 0.03). Black race was positively correlated with exclusive breastfeeding or mixed feeding for mothers with exclusive networks (β= 1.50, p= 0.046; β= 1.86, p= 0.02, respectively). Lower educational level was negatively correlated with exclusive breastfeeding; this correlation was stronger for mothers with exclusive networks (β= −1.91, p= 0.002 versus β= −1.70, p= 0.04). Lower educational level was also negatively correlated with mixed feeding for mothers with exclusive networks (β= −1.61, p= 0.02).Conclusions:Mothers' personal social network type likely moderates the relationship between sociodemographic variables and feeding practices. While the influence of having network members with breastfeeding experience is important, the magnitude of influence is stronger in exclusive networks.

This study examines the drug use patterns, sexual practices, condom use, knowledge and attitudes toward sexually transmitted diseases (STD)s and AIDS, and seroprevalence of human immunodeficiency virus (HIV) and syphilis among women who use crack in Dayton, Ohio. In 1990, two indigenous outreach workers recruited 150 participants who were not in drug treatment programs, who were 18 years of age or older, and had used crack in the previous 3 months. Structured interviews revealed that 90% of the sample were black, 78% used crack 'daily,' 93% had multiple sexual partners, and 49% had 10 or more male sexual partners in the last 3 months. A majority (67%) of the women felt they were in need of drug treatment. No reactive syphilis serologies were detected in 138 serum samples; 2 women (1.4%) were HIV seropositive. This case study provides insight into the high-risk sexual behaviors of crack users in a medium-sized, midwestern city. The study demonstrates the value of indigenous outreach prevention and STD screening initiatives in reaching this segment of our society, which has a high risk of acquiring STDs.

To compare the communication experiences and preferences of racial/ethnic minority and non-Hispanic white (NHW) families in the pediatric intensive care unit (PICU), including their interactions with bedside nurses.

We performed a retrospective study to determine the time frame for symptom resolution in 78 pediatric patients hospitalized with laboratory-confirmed early-disseminated or late-stage Lyme disease. The vast majority of the patients improved promptly after receiving appropriate antibiotics. Patients with a longer duration of arthritis before the institution of therapy experienced a longer time to recovery.

Background: Little is known about sex practices that increase the risk of contracting HIV infection or the level of HIV and AIDS knowledge among sexually transmitted disease (STD) patients in China. Objective: To describe AIDS and HIV knowledge, sexual practices, and factors associated with never using condoms among patients at an STD clinic in Jinan, China. Study Design: Clinic patients (n = 498) were randomly sampled to answer AIDS and HIV knowledge questions and to report sexual practices, including condom use. Results: Patients had low levels of AIDS and HIV knowledge and engaged in high-risk sex behaviors. The majority of patients reported having had multiple sex partners. When having sex, few men and no women reported always using condoms. Gender, age, residence, AIDS and HIV knowledge, and having multiple sex partners were significantly associated with never using condoms. Conclusion: STD clinic patients report having engaged in high-risk sex behaviors. More research is needed to better understand the factors relevant to developing risk-reduction interventions for these patients in China.

Executive function, a set of cognitive skills important to social and academic outcomes, is a specific area of cognitive weakness in children with congenital heart disease (CHD). We evaluated the prevalence and profile of executive dysfunction in a heterogeneous sample of school aged children with CHD, examined whether children with executive dysfunction are receiving school services and support, and identified risk factors for executive dysfunction at school age. Ninety‐one school aged patients completed questionnaires, including the Behavior Rating Inventory of Executive Function (BRIEF) and a medical history questionnaire. An age‐ and gender‐ matched control sample was drawn from a normative database. Children with CHD had a higher rate of parent reported executive dysfunction (OR = 4.37, P< .0001), especially for working memory (OR = 8.22, P< .0001) and flexibility (OR = 8.05, P< .0001). Those with executive dysfunction were not more likely to be receiving school services (P> .05). Gender, premature birth (≤37 weeks), and CHD with aortic obstruction were predictive of executive dysfunction, especially for behavior regulation skills. School aged children with CHD have an increased prevalence of executive dysfunction, especially problems with working memory and flexibility, and are underserved by the school system. The increased risk for executive dysfunction in those with CHD and prematurity or CHD with aortic obstruction suggests an etiology of delayed brain development in the fetal and neonatal periods, while male gender may increase susceptibility to brain injury. This study highlights the need for regular neurodevelopmental follow up in children with CHD, and a need to better understand mechanisms that contribute to adverse neurodevelopmental outcomes.

Supplemental Digital Content is available in the text.

IMPORTANCE: Involuted infantile facial hemangiomas (IHs) may adversely affect the social skills of children. OBJECTIVE: To assess the social impact of involuted facial IHs, with or without prior treatment, in preteen children. DESIGN, SETTING, AND PARTICIPANTS: An observational, cross-sectional study of social anxiety and skills in preteen children with facial IHs diagnosed during infancy. The study took place in an academic institution and a community dermatology practice between January 1, 2013, and July 30, 2014. Records on 236 children with IHs located in a cosmetically sensitive area were identified; of those, 144 potential participants (parents) were reached by telephone and mailed study packets. Thirty completed questionnaires were returned. Data analysis was performed from August 1, 2014, to September 7, 2015. INTERVENTIONS: The questionnaires included the following psychiatric scales: (1) Social Anxiety Scale for Children–Revised (SASC-R), completed by parents and children, including the domains of Fear of Negative Evaluation and Social Avoidance/Distress in New Situations (SAD-New) (higher scores indicate greater social anxiety), and (2) Social Competency Inventory (SCI), completed by parents, including the domains of Prosocial Behavior and Social Initiative (lower scores indicate poorer social competency). MAIN OUTCOMES AND MEASURES: Demographics, clinical details, and survey responses were collected. Analysis was conducted using t tests to compare scores for each survey domain with established normative data and between sex as well as between treatment vs nontreatment groups. RESULTS: Of the 144 potential participants, 30 (21%) responded. The mean age of the preteen subjects was 10.0 years (range, 5.4-12.9 years) with a 2:1 female to male ratio. Twenty-five children (83%) had a single IH, and the remaining 5 participants (17%) had multiple IHs, with at least 1 IH in a cosmetically sensitive area. The periocular region was the most common site of the IH (10 [33%]), followed by the nose (6 [20%]), cheek (5 [17%]), forehead (4 [13%]), lip or perioral region (4 [13%]), and ear (1 [3%]). Eighteen children (60%) had received treatment for their IH. With results reported as mean (SD), the SASC-R test showed that social anxiety of the children was not increased over normative data; however, those who did not receive IH treatment had significantly greater anxiety for new situations compared with those who received treatment (SAD-New: 15.5 [5.1] vs 11.5 [3.8]; P = .02). Results of the SCI scale indicated that the Prosocial Orientation domain score for the children was similar to normative data (3.96 [0.48] vs 3.89 [0.55], P = .50). Social Initiative domain scores were significantly poorer in children who did not receive treatment vs those who received treatment (3.45 [0.43] vs 4.03 [0.55]; P = .006). CONCLUSIONS AND RELEVANCE: Preteen children with involuted, untreated facial IHs have higher Social Anxiety domain scores in new situations and decreased Social Initiative domain scores compared with children who receive treatment for facial IH. Although this study is limited by a small sample size, it raises important considerations for whether early treatment of facial IHs in cosmetically sensitive areas has a beneficial effect on social skills in preteens.

The Strategies Used by People to Promote Health (SUPPH) is an instrument used to measure self-reported self-efficacy in patient populations. Self-efficacy has a major impact on quality of life and psychological well-being. Previous findings of dimensionality of the SUPPH vary, and cultural differences exist suggesting the need for further investigation and psychometric testing to establish construct validity of the SUPPH in different cultures.

Patient-reported outcomes related to symptoms, function, and quality of life during and following cancer treatment can guide care for pediatric cancer patients. To advance the science of patient-reported outcomes, the National Institutes of Health funded the Patient-Reported Outcomes Measurement Information System (PROMIS).

To determine the neurocognitive deficits associated with newly diagnosed untreated childhood absence epilepsy (CAE), develop a model describing the factorial structure of items measuring academic achievement and 3 neuropsychological constructs, and determine short-term differential neuropsychological effects on attention among ethosuximide, valproic acid, and lamotrigine.

The Pediatric Patient-Reported Outcomes Measurement Information System (PROMIS) measures were developed using modern measurement theory and tested in a variety of settings to assess the quality of life, function, and symptoms of children and adolescents experiencing a chronic illness and its treatment. Developed in English, this set of measures had not been translated into Chinese.

IMPORTANCE: Advance care planning (ACP) prepares patients and their families for future health care decisions; however, the needs of adolescent oncology patients for participation in ACP have not been well studied. OBJECTIVE: To examine the efficacy of family-centered ACP. DESIGN AND SETTING: Two-group randomized controlled trial in a pediatric oncology program. PARTICIPANTS: Sixty adolescents aged 14 to 21 years with cancer and their surrogates or families were enrolled in the study between January 17, 2011, and March 29, 2012. INTERVENTION: Thirty dyads received 3- to 60-minute sessions 1 week apart. Intervention dyads completed (1) the Lyon Family-Centered ACP Survey, (2) the Respecting Choices interview, and (3) Five Wishes. Control subjects received standard care plus information. MAIN OUTCOME MEASURES: Statement of treatment preferences and Decisional Conflict Scale score. RESULTS: The mean age of the adolescents was 16 years; 36 (60%) were male, 30 (50%) white, 26 (43%) black, and 4 (7%) Asian. Diagnoses were as follows: leukemia (14 patients [47%]), brain tumor (8 [27%]), solid tumor (6 [20%]), and lymphoma (2 [7%]). Significantly increased congruence was observed for intervention dyads compared with controls for 4 of the 6 disease-specific scenarios; for example, for situation 2 (“treatment would extend my life by not more than 2 to 3 months”), intervention dyads demonstrated higher congruence (κ = 0.660; P &lt; .001) vs control dyads (κ = −0.0636; P = .70). Intervention adolescents (100%) wanted their families to do what is best at the time, whereas fewer control adolescents (62%) gave families this leeway. Intervention adolescents were significantly better informed about end-of-life decisions (t = 2.93; effect size, 0.961; 95% CI, 0.742-1.180; P = .007). Intervention families were more likely to concur on limiting treatments than controls. An ethnic difference was found in only one situation. CONCLUSIONS: Advance care planning enabled families to understand and honor their adolescents' wishes. Intervention dyads were more likely than controls to limit treatments. Underserved African American families were willing to participate.

This study explores a large panel of cytokines in plasma and CSF of patients with Aicardi-Goutières syndrome (AGS) at different ages, in order to establish signatures of cytokines most predictive of AGS.

Background Effects of neighborhood contextual features have been found for many diseases, including bone fractures in adults. Our study objective was to evaluate the association between neighborhood characteristics and pediatric bone fracture rates. We hypothesized that neighborhood indices of deprivation would be associated with higher fracture rates.Materials and Methods Pediatric bone fracture cases treated at a tertiary, academic, urban pediatric emergency department between 2003 and 2006 were mapped to census block groups using geographical information systems software. Fracture rates were calculated as fractures per 1000 children in each census block. Exploratory factor analysis of socioeconomic indicators was performed using 2000 census block data. Factor scores were used to predict odds of bone fracture at the individual level while adjusting for mean age, sex composition, and race/ethnicity composition at census block level using our sample data.Results We analyzed 3764 fracture visits in 3557 patients representing 349 distinct census blocks groups. Fracture rates among census blocks ranged from 0 to 207 per 1000 children/study period. Logistic regression modeling identified 2 factors (race/education and large families) associated with increased fracture risk. Census variables reflecting African American race, laborer/service industry employment, long-term block group residence, and lower education levels strongly loaded on the race/education factor. The large families factor indicated the children-to-families ratio within the block group. The poverty factor was not independently associated with fracture risk.Conclusions Thus, neighborhood characteristics are associated with risk for fractures in children. These results can help inform translational efforts to develop targeted strategies for bone fracture prevention in children.

The City of Hope Quality of Life–Ostomy Questionnaire is a widely accepted scale to assess quality of life in ostomy patients. However, the validity and reliability of the Chinese version (C-COH) have not been studied.

Patients' trust in their primary care providers has important implications in terms of health outcomes and, among minority patients, mitigating racial health disparities. This study aims to identify family, provider, and health care setting characteristics that predict African American parents' trust in their child's primary care provider and whether provider partnership-building communication style explains this association.

ABSTRACTIllicit drug use in the rural United States is increasingly common, yet little is known about drug users' treatment-seeking behaviors. This study identifies predictors of substance abuse treatment entry over 24 months among 710 illicit stimulant users in rural areas of Ohio, Arkansas, and Kentucky. Active users of powdered cocaine, crack cocaine, and/or methamphetamine (MA) were recruited using respondent-driven sampling. Participants completed structured interviews at baseline and follow-up questionnaires every 6 months for 24 months. Data were analyzed using the Cox proportional hazards model. The paper is informed by the Anderson-Newman Model. Overall, 18.7% of the sample entered treatment. Ohio or Kentucky residence, perceived need for substance abuse treatment, higher Addiction Severity Index (ASI) legal problem composite scores, prior substance abuse treatment, and tranquilizer use were positively associated with treatment entry. Nondaily crack cocaine users and marijuana users were less likely to enter treatment. The findings can help inform rural substance abuse treatment program development and outreach.

ABSTRACTThe goal of the present study was to identify the multidimensional factor structure of external barriers to substance abuse treatment and test its invariance across gender, ethnic, and age groups in a sample of 518 substance abusers assessed at a centralized intake unit. Exploratory (EFA) and confirmatory factor analyses (CFA) demonstrated a well-defined multidimensional factor structure of highly differentiated external barrier factors: time conflict, treatment accessibility, treatment entry difficulty, and financial problems. Furthermore, multi-group CFA tests were used to test equivalencies of the measurement and structural models. The statistical fit results supported the invariance of the ethnic groups. Although there were some gender and age differences in measurement and structural relations among the external barrier facets, the model fit indices results provided support for the invariance of both measurement and structural models. The findings suggest that it would be reasonable to consider the pattern of factor loadings and structure relations as invariant across gender, ethnic, and age groups.

ABSTRACTThe goal of this study was to more fully understand readiness for treatment in a pre-treatment sample of 446 substance abusers. Structural Equation Modeling (SEM) was used to: (1) examine the relationships between readiness factors identified in the Pre-Treatment Readiness Scale; and (2) identify the effects of predisposing, illness, and inhibiting determinants on the factors. As with in-treatment samples, Problem Recognition was found to influence Treatment Readiness, although through a different intervening factor, Desire for Change rather than Desire for Help. A fourth factor, Treatment Reluctance, was also influenced by the Desire for Change factor. Fixed characteristics such as age and gender had minimal influences on readiness factors, as did inhibiting characteristics that reflected recent functioning. Illness characteristics including drug severity and perceived treatment barriers had a more robust influence on readiness factors. This study provides an increased understanding of readiness for treatment among pre-treatment substance abusers and also supported the construct validity of the Pre-Treatment Readiness Scale.

The goal of the present study was to identify the dimensions present in items representing internal barriers to substance abuse treatment and to test their invariance across gender, ethnic, and age groups. Twenty items from the Barriers to Treatment Inventory (BTI) were used to assess the structure and nature of the internal treatment barriers of 518 clients presenting to a central intake unit for a substance abuse assessment. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) revealed that a five factor model provided the best fit to the data. Internal treatment barriers were best described by five dimensions: absence of problem, negative social support, fear of treatment, privacy concerns, and committed lifestyle. Extending the confirmatory factor analysis to test multi-group invariance, there were some differences in measurement and structural relations among the internal barrier dimensions across gender, ethnic, and age groups. However, the lack of invariance was small and practically insubstantial. The findings led to the conclusion that the theoretical constructs measured by the five internal barrier dimensions are equivalent across important characteristics in this population.

The Diagnostic Interview Schedule for DSM-IV was used to assess the lifetime prevalence of psychiatric disorder among not-in-treatment crack cocaine users (N313). The most common dependencies involved cocaine (59.7%), alcohol (37.7%), and cannabis (12.1%). The most common nondependency disorders were antisocial personality disorder (ASPD; 24%), depression (17.8%), and posttraumatic stress disorder (PTSD; 11.8%). Comorbidity was present in 36.4% of the sample. Proportionately more white than black users were dependent on cocaine, alcohol, amphetamine, and sedative-hypnotics. More white than black users experienced ASPD, depression, PTSD, and attention deficit disorder. Proportionately fewer black users suffered comorbid disorders. Proportionately more men had ASPD, whereas more women had PTSD and phobias. Multinominal modeling revealed that black users and users with a high school education were less likely to have comorbid disorders; married users were less likely to have nondependency disorders. White crack users were more likely to have comorbidity, complicating their treatment.

Comparative studies on regional HIV seroprevalence or seropositivity rate among injection drug users (IDUs) have focused primarily on assessing the risk factors for HIV infection. This study used a nonparametric analytic approach, known as standardization and decomposition, to to compare HIV seropositivity rates among IDUs between low- and high-HIV-prevalence regions in the United States. The regional difference in HIV seropositivity rate was decomposed into different components: (1) a “rate effect,” which was attributed to the differences in factor-specific rates, and (2) “compositional factor effects,” which were attributed to the differences in distributions of sociodemographic factors across regions. The analytic results show that the regional difference in HIV seropositivityrate was considerable (21.04%); however, the difference would be adjusted down to 17.65% if sociodemographic factors were proportionally distributed across the regions. Differential distribution of ethnic groups between the two regions accounted for about 15.02% of the regional difference in HIV seropositivity rate. The application of the standardization and decomposition method provides HIV researchers with opportunities to look at familiar data from a different perspective.

The Medical Outcomes Study SF-36 has been used infrequently with substance abusers.

Abstract: Standardization and decomposition are widely used analytic techniques in population studies for adjusting the impact of compositional factors on rates. This study demonstrates the application of these methods to behavior and health studies. Bootstrapping is used to estimate standard errors of the component effects and to conduct significance tests for them. The authors have developed a Windows-based computer program that is demonstrated in the study for standardization and decomposition analysis by using empirical data on HIV seropositivity rates in two injection-drug-using populations in the northeastern United States.

There is currently no consensus regarding the best techniques or surgical strategies with which to maximize intercalary allograft reconstruction outcomes. The purpose of the current study was to assess which techniques and methods are being utilized by North American orthopaedic oncologists.

AbstractThis study compares the drug use and needle risk behaviors among 733 crack-smoking injection drug users (IDUs) and 518 nonsmoking IDUs. Participants were recruited in Dayton and Columbus, Ohio, for the Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research Program from 1992 to 1996. Crack-smoking IDUs were more likely to be male, African-American, and 30 to 40 years of age, but less likely to be married or living with a sex partner compared to nonsmokers. Daily crack users were less likely to be daily injectors but more likely to use alcohol daily when compared to non-crack users and less-than-daily crack smokers. IDUs who smoked crack less than daily were more likely to have injected with needles and syringes used by others. There is an urgent need for additional research on the relationship between drug injection and crack smoking as well as improved HIV risk-reduction interventions that include drug abuse treatment components focusing on issues surrounding crack-cocaine addiction.

This exploratory study examines differences in the prevalence of drug use by gender among twelfth grade students (n = 464) in selected rural and suburban high schools in west-central Ohio. The lifetime use of alcohol and other drugs is common among all groups. Proportionally fewer boys in rural schools than boys in suburban schools reported the use of marijuana, inhalants, and LSD, or recent episodes of drunkenness. No statistically significant differences emerged between girls in rural and, suburban schools. Afterschool employment practices may help explain the observed differences. [Translations are provided in the International Abstracts Section of this issue.]

In a study examining the correspondence between self-reported drug use and drug urinalysis, 128 injection drug users (IDUs), who were subjects in an AIDS prevention research project, were asked to provide urine samples, which would be tested for the presence of the metabolites of opiates and cocaine. Ninety-five IDUs provided samples for testing. Of these, twenty IDUs (21.1%) who reported abstinence from opiates and cocaine for the six months prior to the completion of a follow-up questionnaire had their claims contradicted by urinalysis results. Logit regression analyses revealed that IDUs whose primary drug of choice was both crack and injected cocaine and those who were black were significantly more likely to have misrepresented their current drug use status than other groups. The implications of these findings are discussed.

Multiple indicators of HIV risk behaviors are not yet well developed in the field of drug abuse and AIDS prevention, with most research relying on single-item measures. Weak or inconclusive statistical analyses often result from measurement errors. This study illustrates the problems of biased statistical estimates when single-item measures with measurement errors are used. Using HIV risk behaviors among injection drug users as an example, this study shows the impact of measurement error on statistical results in path analysis. The results suggest that more attention is needed to address the issue of measurement reliability in survey data. Measurement error should be taken into account in analyzing HIV risk behaviors, and appropriate multiple indicators for a full range of HIV risk behaviors should be developed to deal successfully with the “errors-in-variables” problem.

AbstractVarialions in the drug use patterns of injection drug users (IDUs) can have important implications for public health efforts aimed at reducing drug abuse and the transmission of the human immunodeficiency virus. This article describes and compares the characteristics of IDUs living in four Ohio cities and compares African-American and While IDUs at a statewide level. Data from 2.001 IDUs who were recruited for the National AIDS Demonstration Research project between 1989 and 1991 in Columbus, Cleveland, Cincinnati, and Dayton were compared on a number of variables by city and by ethnicity using descriptive statistics and ANCOVA analysis. Significant differences among IDUs in the four cities exist for the use of alcohol, marijuana, cocaine, crack, heroin, speedball, other opioids, shooting gallery use, “safer” needle practices, treatment history, and self-help participation. Differences by ethuicity emerged on all variables except marijuana use, overall injection frequency, and incarceration experience, The results suggest that dramatic differences exist between African-American and While IDUs, and among IDUs in cities relatively close together, regardless of ethnicity, These findings should be considered when developing policy and programs for prevention and treatment activities targeting IDUs.

Synovial sarcoma (SS) is an aggressive soft-tissue cancer with a poor prognosis and a propensity for local recurrence and distant metastasis. In this study, we investigated whether S phase kinase-associated protein (Skp2) plays an oncogenic role in tumor initiation, progression, and metastasis of SS. Our study revealed that Skp2 is frequently overexpressed in SS specimens and SS18-SSX transgenic mouse tumors, as well as correlated with clinical stages. Next, we identified that genetic depletion of Skp2 reduced mesenchymal and stemness markers, and inhibited the invasive and proliferative capacities of SS cell lines. Furthermore, Skp2 depletion markedly suppressed the growth of SS xenografts tumors. Treatment of SS cell lines with the skp2 inhibitor flavokawain A (FKA) reduced Skp2 expression in a dose-dependent manner and resulted in cell cycle arrest and apoptosis. FKA also suppressed the invasion and tumor-initiating properties in SS, similar to the effects of Skp2 knockdown. In addition, a combination of FKA and conventional chemotherapy showed a synergistic therapeutic efficacy. Taken together, our results suggest that Skp2 plays an essential role in the biology of SS by promoting the mesenchymal state and cancer stemness. Given that chemotherapy resistance is often associated with cancer stemness, strategies of combining Skp2 inhibitors with conventional chemotherapy in SS may be desirable.

ObjectivesTo identify patient-reported paediatric advance care planning (pACP) needs of adolescents living with HIV and to examine the congruence with their family’s perception of their needs.MethodsA cross-sectional survey among six paediatric hospital-based outpatient HIV specialty clinics. Participants included 48 adolescent/family dyads (n=96 participants) within a larger study facilitating pACP. The main outcome measure was the Lyon Advance Care Planning Survey – Adolescent and Surrogate Versions-Revised.ResultsAdolescents’ mean age was 18 years (range ≥14–<21); 54% male; 92% African-American; 27% with prior AIDS diagnosis. If dying, 92% believed in completing an advance directive; 85% preferred to die at home;88% knowing how to say good bye; 71% being off machines that extend lifeand 77% dying a natural death. Best timing for end-of-life (EOL) decisions was while healthy(38%), when first diagnosed(17%), when first sick from a life-threatening illness(4%), when first hospitalised(8%), if dying(4%) and all of the above(19%). Prevalence-adjusted bias-adjusted Kappa (PABAK) measured congruence in pACP needs within adolescent/family dyads. There was substantial congruence in that being free from pain(PABAK=0.83), and understanding your treatment choices(PABAK=0.92) were very important or important. There was discordance about being off machines that extend life(PABAK=0.08) and when is the best time to bring up EOL decisions(PABAK=0.32).ConclusionsAreas of discordance were associated with life-sustaining choices and when to have the EOL conversation. Targeted, adolescent/family-centred, evidence-based pACP interventions are needed to improve family understanding of youth’s EOL wishes.Trial registration numberNCT01289444; Results.