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Introduction: Despite numerous federal investments, chronic disease continues to disproportionately affect certain communities across the United States. Understanding the regional distribution (including any overlaps) of factors that extend beyond built and food environments, especially factors that may adversely affect chronic disease-related behaviors, is important. This case study of Los Angeles County's geospatial landscape sought to address these gaps in research and practice., Methods: We examined the distributions and geographic overlaps between economic hardship, psychological distress, soda consumption, and availability of publicly funded mental health facilities in 8 Service Planning Areas in Los Angeles County. We categorized the geospatial presence of each variable as low, intermediate, or high. We imported all data, collected during 2014-2018, into ArcGIS Pro version 2.3.3 to create 5 bivariate choropleth maps., Results: Levels of economic hardship were not equally distributed across communities; the county was characterized by intermediate levels of soda consumption and psychological distress. Most areas had low or intermediate availability of publicly funded mental health facilities. We also found some discordance between psychological distress and availability of publicly funded mental health facilities, and between economic hardship and availability of these facilities., Conclusion: The need exists to address disparities in economic hardship and to increase access to publicly funded mental health supports and providers in Los Angeles County. The information collected in this case study has policy implications for health, public health, and mental health services planning at the local level.

Background: In Hong Kong, with an increasing number of children experiencing mental health issues, there is a need to not only develop innovative interventions but also develop comprehensive prevention interventions so as to reduce their anxiety symptoms and enhance their emotional management and interpersonal relationships., Objective: The aim of this study was to determine the effectiveness of The Adventures of DoReMiFa, an integration model of the cognitive-behavioral approach and positive psychology by using digital game-based and school-based mental health enhancement intervention to magnify the social and emotional health and well-being of the school children in Hong Kong aged 9 to 11 years., Methods: A quasi-experimental design method was used to evaluate this digital game and school-based intervention. The Adventures of DoReMiFa was piloted in 4 primary schools where students were allocated to either an intervention or a control group. The participants were assessed at pre- and postintervention with a 6-month follow-up measuring their mental health knowledge, levels of anxiety symptoms, positive and negative thinking, perspective-taking, and self-esteem., Results: A total of 459 primary school students from 4 primary schools participated in the study. The response rate on the questionnaires answered on the Web was up to 85.1% (391/459). Compared with the control group, the intervention group was found to have significant association with improved mental health knowledge at the time immediately after the intervention (beta=.46; P=.01) and in the 6-month postintervention period (beta=.66; P<.001); for perspective-taking, the intervention group had exhibited a significant improvement 6 months after the completion of the universal program (beta=1.50; P=.03). The intervention, however, was found not to be effective in reducing the rates of anxiety symptoms and negative thinking among the participating students., Conclusions: The Adventures of DoReMiFa, an integration of a digital game-based and school-based mental health enhancement intervention, was shown to be effective in elevating the knowledge of mental health and promoting perspective-taking in the primary school students of Hong Kong. Although there was insufficient evidence to support a reduction in symptoms of anxiety and negative automatic thoughts, the overall results were still encouraging in that a preventive effect was found, indicating that the program has the potential to enhance the mental well-being of schoolchildren. It also suggests that knowledge enhancement may not necessarily lead to behavior change, and more focused effort may be needed to achieve the translation. The implications and limitations of this study and suggestions for future research were also discussed., (©Angie KY Shum, Eliza SY Lai, Wing Gi Leung, Mabel NS Cheng, Ho Kit Wong, Sam WK So, Yik Wa Law, Paul SF Yip. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 05.04.2019.)

This analysis describes the socioeconomic attributes of neighborhoods adjacent to low-income neighborhoods with ≥50% of households that are Supplemental Nutrition Assistance Program Education (SNAP-Ed) eligible. It compares the pricing, availability, and quality of fresh produce between these neighborhoods in Los Angeles County. The Los Angeles County Department of Public Health utilized 2013-2014 community-level data from the Communities of Excellence in Nutrition, Physical Activity and Obesity Prevention (CX3) Project to examine the geographic patterns of fresh produce purchases and accessibility in SNAP-Ed eligible census tracts. Community indicators collected by CX3 included information on pricing, availability, and quality of fruits and vegetables from grocery stores (n = 108) in these eligible neighborhoods (n = 21). Correlation statistics were generated to explore the effects of adjacent neighborhoods' socioeconomic status on fruit and vegetable pricing, availability, and quality in the selected neighborhoods ("CX3 neighborhoods"). Poverty data were obtained from the United States Census' American Community Survey. Residents of CX3 neighborhoods that were surrounded by mixed income neighborhoods paid 43% more for fresh produce than CX3 neighborhoods surrounded by other similarly low-income neighborhoods (median produce price, $1.50 versus $1.05). Study results suggest that while quality of produce remains an issue, it is the higher pricing of fresh produce in CX3 neighborhoods - i.e., in the presence of other surrounding mixed income neighborhoods (those with relatively higher income) - that appeared to potentiate food access barriers. Future SNAP-Ed efforts should take this pricing pattern under consideration when designing, planning, and/or implementing nutrition-related programs in these neighborhoods.

Background and Purpose: Chronic impairment of the arm and hand is a common consequence of stroke. Animal and human studies indicate that brief bursts of vagus nerve stimulation (VNS) in conjunction with rehabilitative training improve recovery of motor function after stroke. In this study, we tested whether VNS could promote generalization, long-lasting recovery, and structural plasticity in motor networks., Methods: Rats were trained on a fully automated, quantitative task that measures forelimb supination. On task proficiency, unilateral cortical and subcortical ischemic lesions were administered. One week after ischemic lesion, rats were randomly assigned to receive 6 weeks of rehabilitative training on the supination task with or without VNS. Rats then underwent 4 weeks of testing on a task assessing forelimb strength to test generalization of recovery. Finally, the durability of VNS benefits was tested on the supination task 2 months after the cessation of VNS. After the conclusion of behavioral testing, viral tracing was performed to assess synaptic connectivity in motor networks., Results: VNS enhances plasticity in corticospinal motor networks to increase synaptic connectivity to musculature of the rehabilitated forelimb. Adding VNS more than doubled the benefit of rehabilitative training, and the improvements lasted months after the end of VNS. Pairing VNS with supination training also significantly improved performance on a similar, but untrained task that emphasized volitional forelimb strength, suggesting generalization of forelimb recovery., Conclusions: This study provides the first evidence that VNS paired with rehabilitative training after stroke (1) doubles long-lasting recovery on a complex task involving forelimb supination, (2) doubles recovery on a simple motor task that was not paired with VNS, and (3) enhances structural plasticity in motor networks., (© 2018 American Heart Association, Inc.)

Background: Borderline risk lesions such as flat epithelial atypia (FEA) are increasingly being diagnosed on biopsy. The need for surgery is being debated. In this study, we determined the frequency of histological upgrade following a diagnosis of FEA on biopsy and evaluated potential predictive factors., Methods: Retrospective review was done of 194 women who underwent biopsy of indeterminate lesions (total 195 lesions) that were diagnosed as FEA. The review covered a 10-year period. Cases where malignancy was also present together with FEA within the same biopsy cores were excluded., Results: Lesions diagnosed as FEA on biopsy were mostly asymptomatic and presented as microcalcifications on mammogram. Flat epithelial atypia was the only abnormality detected in one-third of cases, was associated with a benign or another borderline lesion in another third and was associated with atypical ductal hyperplasia (ADH) in another third. Six patients (3.1%) were later found to have ductal carcinoma-in-situ (DCIS) at surgery. The presence of ADH in the biopsy was the only predictor of histological upgrade to malignancy (P = 0.04, OR 11.24, 95% CI 1.10 - 115.10), and was present in 5 of the 6 patients. Surgery was advised in the last patient because of radiology-pathology discordance. Thirty-six lesions (18.5%) were not excised and no interval progression or malignancy was found on follow up., Conclusion: Histological upgrade to malignancy was uncommon in lesions found on biopsy to be FEA. Non-operative management of biopsy-proven FEA can be considered in the absence of ADH and radiology-pathology discordance., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Digital game-based learning (DGBL) makes use of the entertaining power of digital games for educational purposes. Effectiveness assessment of DGBL programs has been underexplored and no attempt has been made to simultaneously model both important components of DGBL: learning attainment (ie, educational purposes of DGBL) and engagement of users (ie, entertaining power of DGBL) in evaluating program effectiveness., Objective: This study aimed to describe and evaluate an Internet-based DGBL program, Professor Gooley and the Flame of Mind, which promotes mental health to adolescents in a positive youth development approach. In particular, we investigated whether user engagement in the DGBL program could enhance their attainment on each of the learning constructs per DGBL module and subsequently enhance their mental health as measured by psychological well-being., Methods: Users were assessed on their attainment on each learning construct, psychological well-being, and engagement in each of the modules. One structural equation model was constructed for each DGBL module to model the effect of users' engagement and attainment on the learning construct on their psychological well-being., Results: Of the 498 secondary school students that registered and participated from the first module of the DGBL program, 192 completed all 8 modules of the program. Results from structural equation modeling suggested that a higher extent of engagement in the program activities facilitated users' attainment on the learning constructs on most of the modules and in turn enhanced their psychological well-being after controlling for users' initial psychological well-being and initial attainment on the constructs., Conclusions: This study provided evidence that Internet intervention for mental health, implemented with the technologies and digital innovations of DGBL, could enhance youth mental health. Structural equation modeling is a promising approach in evaluating the effectiveness of DGBL programs., Competing Interests: Conflicts of Interest: None declared.

Background: A pilot study about the effectiveness of a universal school-based programme, "The Little Prince is Depressed", for preventing depression in Chinese adolescents in Hong Kong was conducted and reported previously. This study used a larger sample to examine the effectiveness and sustainability of the programme., Methods: This study used quasi-experimental design. Twelve schools enrolled in "The Little Prince is Depressed" programme either as an intervention or a control condition. The intervention schools carried out the 12-session programme in two phases: the professional-led first phase and the teacher-led second phase. All participants were required to complete a questionnaire at three time points measuring their (1) depressive, anxiety, and stress levels; (2) knowledge of mental health; (3) attitudes towards mental illness; (4) perceived social support; and (5) help-seeking behaviours., Results: A total of 3,391 students participated in the study. The level of depressive symptoms did not reduce significantly at post-intervention; however, a delayed effect was observed at follow-up assessment for the participants of the teacher-led group in reducing anxiety and stress levels. Also, the knowledge of mental health and attitudes towards mental illness of the intervention-group participants significantly improved at post-test, and the outcomes were maintained at 4 to 5 months after the intervention in both the professional-led and the teacher-led conditions (p<.05). A preference among schoolchildren for whom to seek help from was identified., Conclusions: The universal depression prevention programme was effective in enhancing knowledge of mental health and promoting a more positive attitude towards mental illness among adolescents in Hong Kong. In particular, the teacher-led group showed better outcomes than the professional-led group in reducing students' anxiety and stress at follow-up period. The programme can achieve sustainability in schools if teachers are provided with adequate support.

The role of nanotopographical extracellular matrix (ECM) cues in vascular endothelial cell (EC) organization and function is not well-understood, despite the composition of nano- to microscale fibrillar ECMs within blood vessels. Instead, the predominant modulator of EC organization and function is traditionally thought to be hemodynamic shear stress, in which uniform shear stress induces parallel-alignment of ECs with anti-inflammatory function, whereas disturbed flow induces a disorganized configuration with pro-inflammatory function. Since shear stress acts on ECs by applying a mechanical force concomitant with inducing spatial patterning of the cells, we sought to decouple the effects of shear stress using parallel-aligned nanofibrillar collagen films that induce parallel EC alignment prior to stimulation with disturbed flow resulting from spatial wall shear stress gradients. Using real time live-cell imaging, we tracked the alignment, migration trajectories, proliferation, and anti-inflammatory behavior of ECs when they were cultured on parallel-aligned or randomly oriented nanofibrillar films. Intriguingly, ECs cultured on aligned nanofibrillar films remained well-aligned and migrated predominantly along the direction of aligned nanofibrils, despite exposure to shear stress orthogonal to the direction of the aligned nanofibrils. Furthermore, in stark contrast to ECs cultured on randomly oriented films, ECs on aligned nanofibrillar films exposed to disturbed flow had significantly reduced inflammation and proliferation, while maintaining intact intercellular junctions. This work reveals fundamental insights into the importance of nanoscale ECM interactions in the maintenance of endothelial function. Importantly, it provides new insight into how ECs respond to opposing cues derived from nanotopography and mechanical shear force and has strong implications in the design of polymeric conduits and bioengineered tissues.

Study Objective: Working memory deficits in children with obstructive sleep apnea (OSA) have been reported in previous studies, but the results were inconclusive. This study tried to address this issue by delineating working memory functions into executive processes and storage/maintenance components based on Baddeley's working memory model., Methods: Working memory and basic attention tasks were administered on 23 OSA children aged 8-12 years and 22 age-, education-, and general cognitive functioning-matched controls. Data on overnight polysomnographic sleep study and working memory functions were compared between the two groups. Associations between respiratory-related parameters and cognitive performance were explored in the OSA group., Results: Compared with controls, children with OSA had poorer performance on both tasks of basic storage and central executive components in the verbal domain of working memory, above and beyond basic attention and processing speed impairments; such differences were not significant in the visuo-spatial domain. Moreover, correlational analyses and hierarchical regression analyses further suggested that obstructive apnea-hypopnea index (OAHI) and oxygen saturation (SpO2) nadir were associated with verbal working memory performance, highlighting the potential pathophysiological mechanisms of OSA-induced cognitive deficits., Conclusions: Verbal working memory impairments associated with OSA may compromise children's learning potentials and neurocognitive development. Early identification of OSA and assessment of the associated neurocognitive deficits are of paramount importance. Reversibility of cognitive deficits after treatment would be a critical outcome indicator., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: We developed an aligned bi-layered vascular graft derived from human induced pluripotent stem cells (iPSCs) that recapitulates the cellular composition, orientation, and anti-inflammatory function of blood vessels., Materials & Methods: The luminal layer consisted of longitudinal-aligned nanofibrillar collagen containing primary endothelial cells (ECs) or iPSC-derived ECs (iPSC-ECs). The outer layer contained circumferentially oriented nanofibrillar collagen with primary smooth muscle cells (SMCs) or iPSC-derived SMCs(iPSC-SMCs)., Results: On the aligned scaffolds, cells organized F-actin assembly within 8º from the direction of nanofibrils. When compared to randomly-oriented scaffolds, EC-seeded aligned scaffolds had significant reduced inflammatory response, based on adhesivity to monocytes., Conclusion: This study highlights the importance of anisotropic scaffolds in directing cell form and function, and has therapeutic significance as physiologically relevant blood vessels., Competing Interests: Financial & competing interests disclosureThis study was supported in part by grants from the US NIH (R00HL098688 and EB020235-01 to NFH), Merit Review Award (1I01BX002310) from the Department of Veterans Affairs Biomedical Laboratory Research and Development to NF Huang, the Stanford Chemistry Engineering & Medicine for Human Health to NF Huang, the Stanford Cardiovascular Institute to NF Huang and the California Institute of Regenerative Medicine (CIRM Early Translational Research Award TR3-05569) to B Chen. KH Nakayama was supported by fellowships from the National Heart, Lung and Blood Institute (1T32HL098049) and the American Heart Association (15POST25560045). PA Joshi was supported by a fellowship from the San José State University Consortium for Stem Cell Internships in Laboratory-based Learning. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.No writing assistance was utilized in the production of this manuscript.