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BackgroundGenetic ancestry, sex, and individual alleles have been associated with multiple sclerosis (MS) susceptibility.ObjectiveTo determine whether established risk factors for disease onset are associated with relapse rate in pediatric MS.MethodsWhole-genome genotyping was performed for 181 MS or high-risk clinically isolated syndrome patients from two pediatric MS centers. Relapses and disease-modifying therapies were recorded as part of continued follow-up. Participants were characterized for 25-hydroxyvitamin D serum status. Ancestral estimates (STRUCTURE v2.3.1), human leukocyte antigen (HLA)-DRB1*15 carrier status (direct sequencing), sex, and a genetic risk score (GRS) of 110 non-HLA susceptibility single-nucleotide polymorphisms (SNPs) were evaluated for association with relapse rate with Cox and negative binomial regression models.ResultsOver 622 patient-years, 408 relapses were captured. Girls had greater relapse rate than boys (incident rate ratio (IRR) = 1.40, 95% confidence interval (CI) = 1.04-1.87, p = 0.026). Participants were genetically diverse; ~40% (N = 75) had

We explored the association between baseline gut microbiota (16S rRNA biomarker sequencing of stool samples) in 17 relapsing-remitting pediatric MS cases and risk of relapse over a mean 19.8 months follow-up. From the Kaplan-Meier curve, 25% relapsed within an estimated 166 days from baseline. A shorter time to relapse was associated with Fusobacteria depletion (p=0.001 log-rank test), expansion of the Firmicutes (p=0.003), and presence of the Archaea Euryarchaeota (p=0.037). After covariate adjustments for age and immunomodulatory drug exposure, only absence (vs. presence) of Fusobacteria was associated with relapse risk (hazard ratio=3.2 (95% CI: 1.2-9.0), p=0.024). Further investigation is warranted. Findings could offer new targets to alter the MS disease course.

Abstract Background Understanding the use of tele-intensive care unit (ICU) services is an essential component in evaluating current practice and informing future use as the adoption and application of teleICU services expands. We sought to explore if novel ways to utilize teleICU services can emerge within an established, consulting-style teleICU model considering the program’s flexible, provider-driven operation. Methods This was a qualitative study of one teleICU/hospital dyad using semi-structured interviews from a convenience sample of ICU (n = 19) and teleICU (n = 13) nurses. Interviews were analyzed using directed content analysis to identify themes that describe their experiences with teleICU using a deductive codebook developed from an expert consensus (American Association of Critical Care Nurses) AACN statement on teleICU nursing. Results Three themes were identified through the qualitative content analysis: [1] nurses described unique teleICU knowledge, including systems thinking and technological skills, [2] the teleICU partnership supported quality improvement initiatives, and [3] elements of the work environment influenced perceptions of teleICU and its use. When elements of the work environment, such as effective communication and role clarity, were not present, teleICU use was variable. Conclusions Flexible, provider-driven approaches for integrating teleICU services into daily practice may help define the future use of the teleICU model’s applicability. Future work should focus on the importance of effective communication and role clarity in integrating the emerging teleICU services into teleICU/ICU practice.

Hawai'i is a unique and special place to conduct environmental science inquiry through place based learning and scientific investigation. Here, we describe and evaluate a unique professional development program for science teachers in Hawai'i that integrates the traditional approach of providing training to improve content knowledge, with the overarching theme of scientific inquiry and investigation through short duration research experiences. Ten middle and high school teachers primarily from Hawai'i public high schools participated in the four week, full time professional development course, producing novel place-based lesson plans to execute in their home classrooms. Pre and post analyses of teacher reported confidence levels in teaching ten environmental and marine science topics showed significant improvements after the course. In addition, teachers continued professional relationships with scientists and instructors of the program through synergistic activities including partnering in grant proposal submissions, participating in related university offered programs for K-12 audiences, and facilitating student research internships with university scientists. Despite the overwhelming positive evaluations by teachers of the value and efficacy of the program, lack of funding and access to equipment were reported as anticipated limitations to implementing their newly gained knowledge in the classroom. Nonetheless, the program's success demonstrates that both teachers and scientists can benefit from a course of this nature, and using this framework, other organizations might adapt elements of the course to provide a similar place-based program in their respective back yards. (Contains 7 tables, 2 figures, and 1 footnote.)

Solid hydrogen has increasingly hindered rotation under high pressure, but the effect on spin isomer populations had not been directly probed. Here the authors measure NMR spectra of solid hydrogen up to the megabar, and observe the crossover to a spin 1/2 dipolar system above 70 GPa where distinction between ortho and para spin isomers is lost.

Abstract Objective To evaluate whether multiple sessions of transcranial direct current stimulation (tDCS) applied to the primary motor (M1) cortex paired with aerobic exercise can improve walking functions in multiple sclerosis (MS). Methods MS participants were recruited for a double‐blind, parallel‐arm, randomized, sham‐controlled trial and assigned to 10 sessions (5 d/wk for 2 weeks) of either active or sham tDCS paired with unloaded cycling for 20 minutes. Stimulation was administered over the left M1 cortex (2.5 mA; anode over C3/cathode over FP2). Gait spatiotemporal parameters were assessed using a wearable inertial sensor (10‐meter and 2‐minute walking tests). Measurements were collected at baseline, end of tDCS intervention, and 4‐week postintervention to test for duration of any benefits. Results A total of 15 participants completed the study, nine in the active and six in the sham condition. The active and sham groups were matched according to gender (50% vs. 40% female), neurologic disability (median EDSS 5.5 vs. 5), and age (mean 52.1 ± 12.9 vs. 53.7 ± 9.8 years). The active group had a significantly greater increase in gait speed (0.87 vs. 1.20 m/s, p

The title compounds, C13H18O3Si (1) and C18H20O3Si (2), represent functionalizable dihydrofuranylsilanes, which permit substitution by a variety of nucleophiles. The crystal structures of 1 and 2 display weak intermolecular C—H...O hydrogen-bonding interactions (quantified by Hirshfeld surface analysis), leading to a two-dimensional supramolecular network for 1 and a one-dimensional supramolecular network for 2. The crystal structures of 1 and 2 were refined both on the basis of the independent atom model (IAM) and the Hirshfeld atom refinement (HAR) approach, and the results are comparatively discussed.

Author(s): Danika Krupp [sup.1], Yifan Hua [sup.1], Jonas Esche [sup.1], Thomas Remer [sup.1] Author Affiliations: (1) DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study Center, Department of Nutritional Epidemiology, Institute [...], Background Overweight and higher BMI are known to be related to increased blood pressure (BP) and additionally associate with lowered urine pH values even at comparable total daily acid loading. Since a reduced urine pH level at a given total acid load indicates an impaired renal net acid excretion capacity (NAEC) and renal function also relates to BP, we hypothesized that NAEC may be one mediator of the body fat-BP association. Methods Ammonium, titratable acid, pH, creatinine, and urea were measured in 24-h urine samples among 9-15-year-old adolescents of the DONALD Study. NAEC was determined as residual of the body surface area-corrected net acid excretion on urine pH (NAEC1) or body surface area-corrected ammonium excretion on urine pH (NAEC2). Markers of body fatness were determined anthropometrically and systolic and diastolic BP sphygmomanometrically. Multilinear regressions were used to examine cross-sectionally the body fat-NAEC and prospectively the NAEC1-BP associations. Results All body fat parameters were inversely associated with both NAEC1 and NAEC2 among youth (P [less than or equal to] 0.01). In a separate prospective analyses, to check for possible mediation, higher adolescent NAEC1 was significantly associated with lower systolic BP in male adults only (P = 0.04), but this association was attenuated to a trend (P = 0.07) in multivariable-adjusted models. Conclusions Independent of systemic acid load, NAEC, i.e., the kidney's function to eliminate acids is reduced with higher body fatness, and may also contribute as a mediator in the body fatness-BP relation.

Author(s): Jonas Esche [sup.1], Danika Krupp [sup.1], Gert BM Mensink [sup.2], Thomas Remer [sup.1] Author Affiliations: (1) DONALD Study Center Dortmund, IEL - Nutritional Epidemiology, University of Bonn, Dortmund, Germany [...], Background/Objective Preliminary interventional data suggest that a reduction of dietary acid load raises renal uric acid excretion and decreases serum uric acid (SUA). In line with this, in a recent cross-sectional analysis of a representative adult population sample, a higher potential renal acid load (PRAL) was found to associate with higher SUA levels. Against this background, we re-examined the relationship of the body's acid load with SUA and hyperuricemia using nutrition-derived estimates of renal net acid excretion (NAE). Subjects/Methods Cross-sectional analyses were performed in n = 6894 participants (18-79 y) of the German Health Interview and Examination Survey for Adults (DEGS1). Two different approaches were used to estimate NAE, one based on the sum of food frequency questionnaire (FFQ)-derived PRAL and body-surface area-derived organic acids (eNAE.sub.PRAL+OA) and the other based on FFQ-derived protein and potassium intake ratios (eNAE.sub.Prot/K). The associations of eNAE.sub.PRAL+OA and eNAE.sub.Prot/K with SUA were analyzed in multiple linear regression models. Multiple logistic regressions were used to calculate odds ratios (OR) for hyperuricemia comparing higher (T3) and lower (T1) tertiles of the NAE estimates. Results After adjusting for relevant confounders, eNAE.sub.PRAL+OA (p = 0.0048) and eNAE.sub.Prot/K (p = 0.0023) were positively associated with SUA. In addition, participants with a higher eNAE.sub.PRAL+OA or eNAE.sub.Prot/K had higher ORs for having hyperuricemia (OR: 1.73, 95% CI: 1.24-2.40, OR: 1.51, 95% CI: 1.10-2.08, respectively). Conclusion The results substantiate findings of a previous analysis that dietary acid load is a potential influencing factor on SUA. This implicates that a lower dietary acid load may have beneficial effects on SUA.

BackgroundHigh salt intake may be associated with pro-inflammatory changes in the immune response, and increased clinical and MRI activity in adults with relapsing-remitting multiple sclerosis.ObjectiveWe sought to determine if dietary salt intake is associated with pediatric-onset MS risk in a multicenter, case-control study.MethodsPediatric-onset CIS/MS cases within four years of onset and controls less than 22 years old recruited from 14 pediatric-MS centers were studied. Dietary sodium intake was assessed using the validated Block Kids Food Screener (NutritionQuest). Sodium intake, excess sodium, and sodium terciles were compared between cases and controls. Logistic regression models were adjusted for age, gender, ethnicity, body mass index, and socioeconomic status.ResultsAmong 170 cases (mean age=15.2±3.5) and 331 controls (mean age=14.0±3.7), no significant difference in unadjusted mean sodium intake was found between cases (2044mg/d) and controls (2030mg/d, p=0.99). The proportion of subjects consuming excess sodium, based on the adequate intake for age and gender, was similar between cases and controls (65% versus 69%, p=0.34). There were no increased odds of higher sodium intake among cases as compared to controls (for each 100mg/d increase in sodium, OR=1.00, 95% CI 0.98, 1.02; p=0.93, for excess sodium intake, OR=1.05, 95% CI 0.67, 1.64; p=0.84).ConclusionsOur results show no strong association between dietary salt intake and pediatric-onset MS risk, suggesting that salt intake may not play a prominent role in susceptibility to MS in children.