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This study compared the effectiveness of comic-based with text-based concussion discharge instructions on improving caregiver knowledge. This study also examined the role of social determinants of health on comprehension instructions.This was an observational study of the caregivers of pediatric concussion patients. Caregivers' health literacy and demographics related socioeconomic factors were obtained. After the patients' evaluation in the emergency department, caregivers were given printed comic-based concussion discharge instructions. Caregivers were contacted 3 days later and tested overall knowledge of discharge instructions' content. These survey results were compared with historical controls who received text-based instructions.A total of 120 participants were recruited, and 86 participants completed follow-up procedures. When comparing the caregivers' recall ability with a comic-based vs traditional text-based instructions, caregivers with comic-based content were more likely to accurately recall overall discharge instructions (77.5% vs 44%, P.001), particularly physical rest and activity restrictions (86.5% vs 63%, P.001). Caregivers also were less likely to misidentify a red flag symptom (7.5% vs 19%, P.04). Comic-based instructions did not increase recall of cognitive rest instructions or postconcussive symptoms. When examining demographic factors, caregivers who could not recall 3 postconcussive symptoms were more likely to be Hispanic or Black, less likely to be college educated, and more likely to have low health literacy.Novel methods should be explored to adequately prepare caregivers for continuing postconcussive care at home. Discharge instructions must be tailored to address caregivers' baseline health literacy and how caregivers digest and retain information.

According to the “relative income hypothesis,” decision makers derive positive utility from identifying with a group that performs more poorly than they do. We hypothesize that decision makers simultaneously derive negative utility from identifying with such a group. The reason is that decision makers aspire toward status, and thus prefer to identify with a group that is more successful than they are. We call such proposed reason the “aspirational income hypothesis.” If the aspirational income effect dominates the relative income effect, decision makers would prefer to join groups with higher rank than their own. We report data from an experiment that supports the aspirational income hypothesis. It shows that the hypothesis holds (at a weaker intensity) even when it is costly to join a higher ranking group.

Systemic immunoglobulin light-chain (AL) amyloidosis is characterized by deposition of amyloid fibrils of light chains produced by clonal CD38+ plasma cells. Daratumumab, a human CD38-targeting antibody, may improve outcomes for this disease.We randomly assigned patients with newly diagnosed AL amyloidosis to receive six cycles of bortezomib, cyclophosphamide, and dexamethasone either alone (control group) or with subcutaneous daratumumab followed by single-agent daratumumab every 4 weeks for up to 24 cycles (daratumumab group). The primary end point was a hematologic complete response.A total of 388 patients underwent randomization. The median follow-up was 11.4 months. The percentage of patients who had a hematologic complete response was significantly higher in the daratumumab group than in the control group (53.3% vs. 18.1%) (relative risk ratio, 2.9; 95% confidence interval [CI], 2.1 to 4.1; P0.001). Survival free from major organ deterioration or hematologic progression favored the daratumumab group (hazard ratio for major organ deterioration, hematologic progression, or death, 0.58; 95% CI, 0.36 to 0.93; P = 0.02). At 6 months, more cardiac and renal responses occurred in the daratumumab group than in the control group (41.5% vs. 22.2% and 53.0% vs. 23.9%, respectively). The four most common grade 3 or 4 adverse events were lymphopenia (13.0% in the daratumumab group and 10.1% in the control group), pneumonia (7.8% and 4.3%, respectively), cardiac failure (6.2% and 4.8%), and diarrhea (5.7% and 3.7%). Systemic administration-related reactions to daratumumab occurred in 7.3% of the patients. A total of 56 patients died (27 in the daratumumab group and 29 in the control group), most due to amyloidosis-related cardiomyopathy.Among patients with newly diagnosed AL amyloidosis, the addition of daratumumab to bortezomib, cyclophosphamide, and dexamethasone was associated with higher frequencies of hematologic complete response and survival free from major organ deterioration or hematologic progression. (Funded by Janssen Research and Development; ANDROMEDA ClinicalTrials.gov number, NCT03201965.).

Diagnostic and contact tracing apps are a needed weapon to contain contagion during a pandemic. We study how the content of the messages used to promote the apps influence adoption by running a survey experiment on approximately 23,000 Mexican adults. Respondents were randomly assigned to one of three different prompts, or a control condition, before stating their willingness to adopt a diagnostic app and contact tracing app. The prompt emphasizing government efforts to ensure data privacy, which has been one of the most common strategies, reduced willingness to adopt the apps by about 4 pp and 3 pp, respectively. An effective app promotion policy must understand individuals’ reservations and be wary of unintended reactions to naïve reassurances.

While effective preventive measures against COVID-19 are now widely known, many individuals fail to adopt them. This article provides experimental evidence about one potentially important driver of compliance with social distancing: social norms. We asked each of 23,000 survey respondents in Mexico to predict how a fictional person would behave when faced with the choice about whether or not to attend a friend’s birthday gathering. Every respondent was randomly assigned to one of four social norms conditions. Expecting that other people would attend the gathering and/or believing that other people approved of attending the gathering both increased the predicted probability that the fictional character would attend the gathering by 25%, in comparison with a scenario where other people were not expected to attend nor to approve of attending. Our results speak to the potential effects of communication campaigns and media coverage of compliance with, and normative views about, COVID-19 preventive measures. They also suggest that policies aimed at modifying social norms or making existing ones salient could impact compliance.

This article examines the use of a focused educational game. The game, Behavior Breakthroughs™, was created to teach people that work with children with autism, appropriate behavior management techniques. A group of undergraduate, teacher education students played the game and provided feedback on their experiences.

Background: Chronic myeloid leukemia (CML) is a malignant disease caused by the protein coded by the Philadelphia chromosome. Imatinib mesylate (IM) is now the treatment of choice for all stages of CML. Clinicoepidemiologic information on CML from developing countries is scattered in the current literature. Patients and Methods: We report on the clincoepidemiologic features and response to therapy with IM in a cohort of patients with all stages of CML at a Mexican institution. Additionally, we describe the failure rate of standard G-banding cytogenetics, and correlate the association of successful standard cytogenetics with fluorescence in situ hybridization (FISH) to validate the results of responses in our patient population. Ninety-nine medical charts were evaluated. Fifty-seven patients were treated with IM, and a historical group consisted of 42 patients. Results: The median age was 37 years, and the median follow-up of the IM-treated cohort was 26.4 months. The correlation between cytogenetics and FISH was 0.719 (P = .01). The complete cytogenetic response was 88.1% in the IM-treated group, versus 4.8% in the historical group. Patients previously treated with interferon-α (INF-α) had a complete cytogenetic response of 58.8%, versus 77.8% of patients previously treated who were naive to INF-α. Conclusion: Our report describes a comprehensive picture of a group of patients with CML representative of the Mexican population with socioeconomic and cultural constraints. Except for median age at diagnosis, clinicoepidemiologic features and response rates are in accordance with other series. Fluorescence in situ hybridization was a reliable method for monitoring CML at our institution. However, the role of FISH in monitoring CML, where standard cytogenetic testing and the polymerase chain reaction are less reliable, needs to be clarified more thoroughly.

Sensor based on tapered optical fiber with silicon nitride thin film to increase its sensitivity. Sensing experiments on several concentrations of glycerol in deionized water reaches sensitivity of 291 nm/RIU, with high reproducibility and reversible.

Abstract This paper is based on the work performed during the design, implementation and operation of the Cascade and Chinook fields, located offshore the United States Gulf of Mexico (USGoM) - the first deployment of an FPSO in the region. It presents an overview of the reservoir rock and fluid properties, the design and construction of wells, the design and installation of the subsea system and FPSO BW Pioneer, the oil export system through shuttle tankers, the gas export through pipelines and the regulatory framework of the project. It also presents operational information about the first wells on stream in each field. The information provided in this paper is a useful reference for petroleum field operators when designing development concepts for ultra-deep water discoveries, not only in the USGoM but also worldwide. It is especially useful for the design of field development and early production systems located far from pipeline infrastructure. It is useful for contractors to identify the technologies which are most suited for application on deep wells and ultra-deep water subsea systems and production platforms. The initial phase of development, already implemented, consists of two subsea wells in Cascade and one in Chinook tied back, through a field-specific subsea system, to a Floating, Production, Storage and Offloading (FPSO) platform. Oil is transported from the FPSO in shuttle vessels to terminals of opportunity along the USGoM and gas is exported through pipeline. Wells started-up production in 2012. Future phases of development will depend on the performance of the wells.

Background: The phenotypic heterogeneity of transthyretin amyloidosis (ATTR) familial polyneuropathy may be linked to the type of mutation and to the environmental factors. A gender difference in relation to the severity of the disease has been suspected. More than 100 different pathogenic variants of hereditary transthyretin (TTR) mutations have been reported. Objective: To describe 32 patients with confirmed TTR Ser50Arg mutation from the same geographical origin. Methods: Seven families with up to four affected generations underwent genetic testing and prospective clinical and laboratory evaluations. Results: The mutation was confirmed in seven patients from different families with clinical symptoms compatible with ATTR amyloidosis, and in 25 (62%) of the 40 direct relatives tested. Of the 32 patients with positive test results, 18 (56%) were men. Only 5 (16%) subjects were disease-free at the time of the genetic test (mean age: 20, range: 18–30-year-old). The rest developed symptoms at a young age, between ages 36 and 41. Symptomatic, histologically positive patients were older than carriers and symptomatic patients without a confirmatory biopsy. The later generation displayed symptoms at a younger age. Initial manifestations in the 27 symptomatic patients were neuropathic in 19 (70%), gastrointestinal in 6 (22%) and autonomic in 1 (4%). Significant differences were demonstrated among genders, where men had a considerably worse outcome. Conclusion: ATTR Ser50Arg mutation was associated with an early onset, an unbalanced male to female ratio, a more aggressive course in males and possibly displayed anticipation.

Objective: We aim to describe the main characteristics of patients with 3 different TTR mutations. Background Familial amyloid polyneuropathy is a late-onset inherited amyloidosis associated with a mutation on the transthyretin (TTR) gene. Marked diversity exists in clinical characteristics. Design/Methods: 33 patients from 10 different families with proven TTR mutation (27 S50A, 4 S52P, and 2 G47A) underwent prospective neurologic and autonomic examination. All evaluations were performed in a period of 12 months. Results: 19 male and 14 women were included. Age at onset was later in the patients with G47A mutation (33 vs 38 vs 42 yo). S52P had more weight loss (mean of 26kg vs 12-13kg) Initial symptoms were neuropathic in 66%, gastrointestinal in 18% and autonomic in 3%. Overall, men had a more severe form of the disease and worse prognosis. Specifically, men showed more GI (15 vs 11, p:0.001), GU (4 vs 13, p:0.17), and autonomic (13 vs 5, p:0.039) symptoms, had further weight loss (13±17 vs 8±4 kg, p:0.005), orthostatic SBP fall (26±15 vs 4.5±10 mmHg, p:0.01), and decreased NCV amplitudes (sensitive median 4.40 vs 7.20mV p:0.040, sural 2.5 vs 10.4mV p:0.000, motor median 2.4 vs 4.4mV p:0.014, and tibial 2.7 vs 5.8mV p:0.000 nerves). Three men (15.7%) and one woman (7.2%) died during the study period. The men died at a younger age (44±3.5 vs 62, p:0.049). Conclusions: S52P mutation showed a more aggressive course. Because the hereditary mode is autosomal dominant, no gender differences should be expected. However, 1-2% of plasma TTR circulates bound to high-density lipoprotein (HDL). The higher HDL levels associated with estrogen could explain these differences. Men should be considered for earlier liver transplant or pharmacologic treatment when available. It is possible that measures aimed to increase HDL may have some impact in the natural history of the disease. Disclosure: Dr. Gonzalez Duarte has nothing to disclose. Dr. Cardenas-Soto has nothing to disclose. Dr. Berenguer-Sanchez has nothing to disclose. Dr. Martinez-Banos has nothing to disclose. Dr. Estanol has nothing to disclose. Dr. Garcia-Ramos has nothing to disclose. Dr. Cantu-Brito has nothing to disclose.