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Purpose: The purpose of the study was to describe differences in non-Hispanic Black (NHB) and non-Hispanic White (NHW) parents’ perceptions of factors that influence the use of diabetes technology. Methods: Focus groups were conducted with parents of NHB and NHW children at a pediatric diabetes center in the Northeast United States. Kilbourne’s health disparities framework informed the focus group guide and a priori coding for directed content analysis. Further analysis allowed subcategories to emerge inductively. Results: Twenty-one parents participated. Five subcategories emerged, describing differences in NHB and NHW parent decisions regarding diabetes technology: (1) child’s choice, (2) shame versus pride, (3) pros and cons of technology, (4) time frame, and (5) blood glucose indications of readiness. NHB parents feared technology malfunction, worried that visible devices could worsen experienced stigma of diabetes diagnosis, and described the diabetes team as gatekeepers, who changed eligibility criteria for diabetes technology use for their research purposes. In contrast, NHW parents reported diabetes team expectation of diabetes technology use and did not report provider-related barriers. Conclusion: This study adds to existing literature advancing our understanding of the patient and provider mechanisms underlying racial disparities in diabetes technology use. This understanding may guide development of interventions focused on patients, providers, and structural factors to improve equity in use of diabetes technology by youth with type 1 diabetes.

J. S. Bach’s Well-Tempered Clavier II is well known for the complexity of its source situation, and its vast array of variant readings. The current article uses techniques of phylogenetic analysis, developed in the biological sciences, to deepen our understanding of the complex relationships between the primary sources. The computer algorithm NeighborNet is used to analyse data comprising the textual variants for the Prelude in A, bwv888 and the Prelude in C, bwv870. The resultant grouping of sources reflects the differences in revision practice between the two preludes. While Bach saw little need to revise the Prelude in A, the Prelude in C underwent a process of continued revision that can be discerned in the results of the phylogenetic analysis. The analyses also highlight the uncertain relationship of the manuscript DD70 with the other sources of the Prelude in C and the implications for 18th-century performance practice.

This chapter describes how textual scholars have applied computer programs from evolutionary biology to differences among versions of a manuscript text to infer the copying history of those versions (depicted diagrammatically as a ‘stemma’). The chapter presents the similarities between copying of texts and the copying of DNA sequences, and then describes how computer programs used for inferring the evolutionary history of DNA or protein sequences can also be used to infer the copying history of sets of texts. This approach is often referred to as ‘phylomemetics’. The history of phylomemetic analysis of texts is reviewed briefly, along with the steps involved in an analysis of textual material. The chapter discusses tests of the phylomemetic approach, and some of the criticisms that have been made of the approach, or difficulties encountered with it, although these criticisms and difficulties typically apply to conventional textual scholarship as well.

Accurate forecasts can inform response to outbreaks. Most efforts in influenza forecasting have focused on predicting influenza-like activity, but fewer on influenza-related hospitalizations. We conducted a simulation study to evaluate a super learner’s predictions of three seasonal measures of influenza hospitalizations in the United States: peak hospitalization rate, peak hospitalization week, and cumulative hospitalization rate. We trained an ensemble machine learning algorithm on 15,000 simulated hospitalization curves and generated weekly predictions. We compared the performance of the ensemble (weighted combination of predictions from multiple prediction algorithms), the best-performing individual prediction algorithm, and a naive prediction (median of a simulated outcome distribution). Ensemble predictions performed similarly to the naive predictions early in the season but consistently improved as the season progressed for all prediction targets. The best-performing prediction algorithm in each week typically had similar predictive accuracy compared to the ensemble, but the specific prediction algorithm selected varied by week. An ensemble super learner improved predictions of influenza-related hospitalizations, relative to a naive prediction. Future work should examine the super learner’s performance using additional empirical data on influenza-related predictors (e.g., influenza-like illness). The algorithm should also be tailored to produce prospective probabilistic forecasts of selected prediction targets.

Purpose Camouflaging, or the use of strategies by autistic people to minimize the visibility of their autistic traits in social situations, is associated with stress, autistic burnout, depression, and suicidality among autistic adults. However, little is known about how autistic children and adolescents experience camouflaging, limiting our understanding of its onset and development. The present study filled this knowledge gap by examining camouflaging behaviour among autistic children and adolescents using a photo-elicitation approach.Methods Eight autistic children and adolescents aged 10 to 14 years (M = 11.88, SD = 1.89) attended an orientation session and were given two to three weeks to take photographs on the topic of camouflaging. Individual interviews were conducted with each participant about their photos. Inductive thematic analysis and an interpretive engagement framework were used to identify major themes within participant interviews and images.Results Qualitative analysis identified 12 themes reflecting motivations to camouflage (as a response to negative social experiences, as a learned habit), contexts of camouflaging (e.g., the audience), strategies and behaviours used to camouflage (suppressing autistic stimming behaviour, hiding the self), and perceived consequences of camouflaging (internal conflict, stress, needing time to recharge).Conclusion Results highlight that autistic children and adolescents as young as 10 years old engage in camouflaging behaviour which can be pervasive and automatic, and that this can be a stressful, confusing, and energetically draining experience. Better understanding of the development and experience of camouflaging in childhood can inform prevention of mental health concerns in adulthood.

Bone loss associated with the systemic skeletal disease osteoporosis results in weakened or fragile bone, the most serious consequence of which is fracture. A 67-year-old post-menopausal Caucasian woman presented with a diagnosis of osteoporosis by FRAX and DXA and a history of a fragility hip fracture. The patient was classified according to the latest guidance document for treating patients with post-menopausal osteoporosis from the International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis. The patient was at very high risk for major osteoporotic fracture, including hip fracture. This case report describes the use of a minimally invasive surgical procedure to address bone loss in the proximal femur associated with osteoporosis. Local osteo-enhancement procedure (LOEP), a minimally invasive surgical procedure, was performed using a triphasic calcium-based implant material, AGN1. LOEP was carried out under general anesthesia and fluoroscopic navigation. The area of bone loss in the proximal femur, the enhancement site, was identified, debrided, and irrigated to prepare it for low-pressure filling with AGN1 implant material. The patient recovered from the procedure without incident and was discharged without activity limitations after an overnight stay. X-ray imaging and DXA scans were used to evaluate implant material resorption and replacement with bone over a 3.25-year follow up. A significant and sustained increase in femoral neck and total hip BMD was observed (pre vs 3.25 years post-procedure: 0.546 vs 1.031 gm/cm2 and 0.628 vs 0.96 gm/cm2, respectively), which corresponded to a change in the patient’s T-score from the osteoporosis range to normal. Based on the use of T-scores to measure the risk of fragility fractures, and acknowledging the well-published limitations of doing so, the hip fracture risk of this patient was reduced from very high to low. This case report documents the use of this minimally invasive, targeted procedure to address hip fragility fracture (the most serious issue in the systemic disease osteoporosis), with AGN1 implant material used to replace bone lost in the proximal femur.

Selection bias remains a subject of controversy. Existing definitions of selection bias are ambiguous. To improve communication and the conduct of epidemiologic research focused on estimating causal effects, we propose to unify the various existing definitions of selection bias in the literature by considering any bias away from the true causal effect in the referent population (the population before the selection process), due to selecting the sample from the referent population, as selection bias. Given this unified definition, selection bias can be further categorized into two broad types: type 1 selection bias owing to restricting to one or more level(s) of a collider (or a descendant of a collider) and type 2 selection bias owing to restricting to one or more level(s) of an effect measure modifier. To aid in explaining these two types-which can co-occur-we start by reviewing the concepts of the target population, the study sample, and the analytic sample. Then, we illustrate both types of selection bias using causal diagrams. In addition, we explore the differences between these two types of selection bias, and describe methods to minimize selection bias. Finally, we use an example of "M-bias" to demonstrate the advantage of classifying selection bias into these two types.

Objective: This systematic review and meta-analysis aimed to quantify the relationship between resilience resources at the individual (e.g., optimism), interpersonal (e.g., social support), and neighborhood (e.g., social environment) levels, and cardiovascular outcomes among adults in the United States. Method: On 9/25/2020, electronic databases (PubMed, Embase, CINAHL, PsycINFO) were systematically searched for randomized controlled trials, nonrandomized intervention studies, and prospective cohort studies that examined the relationship between resilience resources at the individual, interpersonal, or neighborhood level and cardiovascular outcomes. Studies that met the eligibility criteria were summarized narratively and quantitatively. Because relevant search results yielded only observational studies, risk of bias was assessed using an adapted version of the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool. Results: From 4,103 unique records, 13 prospective cohort studies with a total of 310,906 participants met the eligibility criteria, and six of these studies were included in the meta-analyses. Most relevant studies found that higher levels of individual-level resilience resources were associated with lower incidence of adverse cardiovascular outcomes, with point estimates ranging from .46 to 1.18. Interpersonal-level resilience resources (i.e., social network) were associated with a lower coronary heart disease risk (risk ratio, .76; 95% CI [.56, 1.02]). Neighborhood-level resilience resources (i.e., perceived social cohesion and residential stability) were associated with a lower odds of stroke (odds ratio, .92; 95% CI [.84, 1.01]). Conclusions: Evidence suggests that higher levels of resilience resources are associated with better cardiovascular outcomes. However, more prospective studies with diverse populations are needed to strengthen the evidence. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

OBJECTIVES: Globally, there is growing evidence of a double burden of malnutrition with obesity coexisting alongside micronutrient deficiencies across the life course. An emergent double burden poses a threat to health during childhood in Samoa: among 2–4-year-olds with overweight/obesity, 42.9% were anemic. Previous research suggests that obesity-related inflammation may increase the risk of iron deficiency or anemia in children. To test this hypothesis, we examined whether overweight/obesity at 2–4 is associated with anemia at 3.8–6 years old among Samoan children. METHODS: Data were obtained from the Ola Tuputupua’e “Growing Up” cohort study. Overweight/obesity at 2–4 years old was classified by body mass index-for-age Z-score > +2 SD. Anemia was defined as hemoglobin < 110 g/L for under 5-year-olds and < 115 g/L for 5–6-year-olds. Prevalence ratios (PRs) for anemia at 3.8–6 years old were estimated by fitting modified Poisson regression models. RESULTS: In our sample of 197 children, 16.24% (n = 32) were affected by overweight/obesity at 2–4 years old and 26.90% (n = 53) had anemia at 3.8–6 years old. After covariate adjustment, the prevalence of anemia was 18% lower among children with overweight/obesity at 2–4 years old compared to those without (PR:0.82; 95% CI:0.42–1.63); however, the corresponding confidence interval was imprecise and inclusive of a higher prevalence. CONCLUSIONS: There was not strong evidence to support a relationship between overweight/obesity and anemia in Samoan children, suggesting that obesity-related inflammation may not be related to iron deficiency nor anemia in this setting. Further investigation of the antecedents of overweight/obesity and anemia is critical to inform integrated action to improve health in Samoa.

The purpose of this article is to summarize the opinions of the surgical oncology leaders from the Global Forum of Cancer Surgeons (GFCS) about the global impact of COVID-19 pandemic on cancer surgery.A panel session (virtual) was held at the annual Society of Surgical Oncology 2021 International Conference on Surgical Cancer Care to address the impact of COVID-19 on cancer surgery globally. Following the virtual meeting, a questionnaire was sent to all the leaders to gather additional opinions. The input obtained from all the leaders was collated and analyzed to understand how cancer surgeons from across the world adapted in real-time to the impact of COVID-19 pandemic.The surgical oncology leaders noted that the COVID-19 pandemic led to severe disruptions in surgical cancer care across all domains of clinical care, education, and research. Several new changes/protocols associated with increased costs were implemented to deliver safe care. Leaders also noted that preexisting disparities in care were exacerbated, and the pandemic had a detrimental effect on well-being and financial status.The COVID-19 pandemic has led to severe disruptions in surgical cancer care globally. Leaders of the GFCS opined that new strategies need to be implemented to prepare for any future catastrophic events based on the lessons learned from the current events. The GFCS will embark on developing such a roadmap to ensure that surgical cancer care is preserved in the future regardless of any catastrophic global events.

Human emissions of greenhouse gases have caused a predictable rise of 1.2 °C in global temperatures. Over the last 70 years, the rise has occurred at a geologically unprecedented speed and scale. To avoid a worsening situation, most developed nations are turning to renewable sources of power to meet their climate commitments, including the UK, Norway, Denmark and The Netherlands. The North Sea basin offers many advantages in the transition from fossil fuels by virtue of its natural resources, physical setting, offshore infrastructure and skilled workforce. Nonetheless, the magnitude of the up-front costs and the scale required to achieve net zero emissions are rarely acknowledged. In addition, some of the technologies being planned are commercially immature. In particular, the current cost of the capture, transport and disposal of carbon dioxide is problematic as a large-scale solution to industrial emissions. Repurposing the North Sea to meet a low-carbon future will require substantial collaboration between governments and industrial sectors. There are nonetheless significant opportunities for companies prepared to switch from the traditional oil and gas business to renewable energy production and other sustainable activities.

Introduction: Enamel hypoplasia causes a reduction in the thickness of affected enamel and is one of the most common dental anomalies. This defect is caused by environmental and/or genetic factors that interfere with tooth formation, emphasizing the importance of investigating enamel hypoplasia on an epidemiological and genetic level. Methods: A genome-wide association of enamel hypoplasia was performed in multiple cohorts, overall comprising 7,159 individuals ranging in age from 7 to 82 years. Mixed models were used to test for genetic association while simultaneously accounting for relatedness and genetic population structure. Meta-analysis was then performed. More than 5 million single-nucleotide polymorphisms were tested in individual cohorts. Results: Analyses of the individual cohorts and meta-analysis identified association signals close to genome-wide significance (p < 5 × 10–8), and many suggestive association signals (5 × 10–8 < p < 5 × 10–6) near genes with plausible roles in tooth/enamel development. Conclusion: The strongest association signal (p = 1.57 × 10–9) was observed near BMP2K in one of the individual cohorts. Additional suggestive signals were observed near genes with plausible roles in tooth development in the meta-analysis, such as SLC4A4 which can influence enamel hypoplasia. Additional human genetic studies are needed to replicate these results and functional studies in model systems are needed to validate our findings.

Supplementary Tables 1-3 from Sirolimus Therapy for Angiomyolipoma in Tuberous Sclerosis and Sporadic Lymphangioleiomyomatosis: A Phase 2 Trial

SUPPLEMENTARY TABLES, FIGURES AND FIGURE LEGENDS

One of the greatest barriers to curative treatment of neuroblastoma is its frequent metastatic outgrowth prior to diagnosis, especially in cases driven by amplification of the MYCN oncogene. However, only a limited number of regulatory proteins that contribute to this complex MYCN-mediated process have been elucidated. Here we show that the growth arrest-specific 7 (GAS7) gene, located at chromosome band 17p13.1, is preferentially deleted in high-risk MYCN-driven neuroblastoma. GAS7 expression was also suppressed in MYCN-amplified neuroblastoma lacking 17p deletion. GAS7 deficiency led to accelerated metastasis in both zebrafish and mammalian models of neuroblastoma with overexpression or amplification of MYCN. Analysis of expression profiles and the ultrastructure of zebrafish neuroblastoma tumors with MYCN overexpression identified that GAS7 deficiency led to (i) downregulation of genes involved in cell–cell interaction, (ii) loss of contact among tumor cells as critical determinants of accelerated metastasis, and (iii) increased levels of MYCN protein. These results provide the first genetic evidence that GAS7 depletion is a critical early step in the cascade of events culminating in neuroblastoma metastasis in the context of MYCN overexpression.Significance:Heterozygous deletion or MYCN-mediated repression of GAS7 in neuroblastoma releases an important brake on tumor cell dispersion and migration to distant sites, providing a novel mechanism underlying tumor metastasis in MYCN-driven neuroblastoma.See related commentary by Menard, p. 2815

Supplementary Figure 2 from Migratory and Antigen Presentation Functions of IFN-Producing Killer Dendritic Cells

Supplementary Figure 1 from Migratory and Antigen Presentation Functions of IFN-Producing Killer Dendritic Cells

Supplementary Figure Legends 1-2 from Migratory and Antigen Presentation Functions of IFN-Producing Killer Dendritic Cells

Background Down syndrome (DS) is one of the most common genetic causes of intellectual disability, and it is associated with an increased incidence of numerous co-occurring conditions. Autism spectrum disorder (ASD) is common in persons with DS, with rates reported as high as 39%. However, little is known regarding co-occurring conditions in children with both DS and ASD. Methods A single-center retrospective review of prospective longitudinally collected clinical data was performed. Any patient with a confirmed diagnosis of DS evaluated at a large, specialized Down Syndrome Program in a tertiary pediatric medical center between March 2018 and March 2022 was included. A standardized survey which included demographic and clinical questions was administered during each clinical evaluation. Results In total, 562 individuals with DS were included. The median age was 10 years (IQR: 6.18–13.92). Of this group, 72 (13%) had a co-occurring diagnosis of ASD (DS+ASD). Individuals with DS+ASD were more likely to be male (OR 2.23, CI 1.29–3.84) and had higher odds of a current or prior diagnosis of constipation (OR 2.19, CI 1.31–3.65), gastroesophageal reflux (OR 1.91, CI 1.14–3.21), behavioral feeding difficulties (OR 2.71, CI 1.02–7.19), infantile spasms (OR 6.03, CI 1.79–20.34) and scoliosis (OR 2.73, CI 1.16–6.40). There were lower odds of congenital heart disease in the DS+ASD group (OR 0.56, CI 0.34–0.93). There was no observed difference in prematurity or Neonatal Intensive Care Unit complications between groups. Individuals with DS+ASD had similar odds of having a history of congenital heart defect requiring surgery to those with DS only. Furthermore, there was no difference in rates of autoimmune thyroiditis or celiac disease. There was also no difference in rates of diagnosed co-occurring neurodevelopmental or mental health conditions in this cohort, including anxiety disorders and attention-deficit/hyperactivity disorder. Conclusions This study identifies a variety of medical conditions which are more frequent in children with DS+ASD than DS alone, providing important information for the clinical management of these patients. Future research should investigate the role of some of these medical conditions in the development of ASD phenotypes, and whether there may be distinct genetic and metabolic contributions towards these conditions.

Many eukaryotes acquired chloroplasts by endosymbiotic acquisition of photosynthetic bacteria or already-domesticated chloroplasts from other eukaryotes. However, the ciliate Mesodinium rubrum acquires the nucleus of a photosynthetic eukaryote, as well as its chloroplast, resulting in dramatic metabolic remodelling in the ciliate.

Despite early interest, the evidence linking fatty acids to cardiovascular diseases remains controversial. We used Mendelian randomization to explore the involvement of polyunsaturated (PUFA) and monounsaturated (MUFA) fatty acids biosynthesis in the aetiology of several cardiovascular disease endpoints in up to 1,153,768 European and 212,453 East Asian ancestry individuals. As instruments, we selected single nucleotide polymorphisms (SNP) mapping to genes with well-known roles in PUFA (i.e. FADS1/2 and ELOVL2) and MUFA (i.e. SCD) biosynthesis. Our findings suggest that higher PUFA biosynthesis rate (proxied by rs174576 near FADS1/2) is related to higher odds of multiple cardiovascular diseases, particularly ischemic stroke, peripheral artery disease and venous thromboembolism, whereas higher MUFA biosynthesis rate (proxied by rs603424 near SCD) is related to lower odds of coronary artery disease among Europeans. Results were unclear for East Asians as most effect estimates were imprecise. By triangulating multiple approaches (i.e. uni-/multi-variable Mendelian randomization, a phenome-wide scan, genetic colocalization and within-sibling analyses), our results are compatible with higher low- density lipoprotein (LDL)-cholesterol (and possibly glucose) being a downstream effect of higher PUFA biosynthesis rate. Our findings indicate that genetically-determined PUFA and MUFA biosynthesis are involved in the aetiology of cardiovascular diseases and suggest LDL-cholesterol as a potential mediating trait between PUFA biosynthesis and cardiovascular diseases risk.

To examine the relative importance of client change language subtypes as predictors of alcohol use following motivational interviewing (MI).Participants were 164 heavy drinkers (57.3% female,Among GBIAS change language subtypes, higher sustain talk (ST) around change planning was ranked the most important predictor of drinks per week (Results challenge the assumption that all ST during MI is a negative prognostic indicator and highlight the importance of the context in which change language emerges. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Loss of long-term haematopoietic stem cell function (LT-HSC) hampers the success ofex vivoHSC gene therapy and expansion procedures, but the kinetics and the mechanisms by which this occurs remain incompletely characterized. Here through time-resolved scRNA-Seq, matchedin vivofunctional analysis and the use of a reversiblein vitrosystem of early G1arrest, we define the sequence of transcriptional and functional events occurring during the firstex vivodivision of human LT-HSCs. We demonstrate that contrary to current assumptions, loss of long-term repopulation capacity during culture is independent of cell cycle progression. Instead it is a rapid event that follows an early period of adaptation to culture, characterised by transient gene expression dynamics and constrained global variability in gene expression. Cell cycle progression however contributes to the establishment of differentiation programmes in culture. Our data have important implications for improving HSC gene therapy and expansion protocols.

Background: Down syndrome (DS) is one of the most common genetic causes of intellectual disability. Autism spectrum disorder (ASD) is common in persons with DS with rates reported as high as 39%. However, little is known regarding risk factors for the development of ASD in persons with DS. Methods: A single-center retrospective review of prospective longitudinally collected clinical data was performed. Any patient with a confirmed diagnosis of DS evaluated at a large, specialized Down Syndrome Program in a tertiary pediatric medical center between March 2018 - March 2022 was included. A standardized survey which included demographic and clinical questions was administered during each clinical evaluation. Results: In total, 562 individuals with DS were included. The median age was 10 years (IQR: 6.18-13.92). Of this group, 72 (13%) had a co-occurring diagnosis of ASD (DS+ASD). Individuals with DS+ASD were more likely to be male (OR 2.23, CI 1.29-3.84) and had higher odds of a current or prior diagnosis of constipation (OR 2.19, CI 1.31-3.65), gastroesophageal reflux (OR 1.91, CI 1.14-3.21), behavioral feeding difficulties (OR 2.71, CI 1.02-7.19), infantile spasms (OR 6.03, CI 1.79-20.34) and scoliosis (OR 2.73, CI 1.16-6.40). There were lower odds of congenital heart disease in the DS+ASD group (OR 0.56, CI 0.34-0.93). There was no observed difference in prematurity or Neonatal Intensive Care Unit complications between groups. Individuals with DS+ASD had similar odds of having a history of congenital heart defect requiring surgery to those with DS only. Furthermore, there was no difference in rates of autoimmune thyroiditis or celiac disease. There was also no difference in rates of diagnosed co-occurring neurodevelopmental or mental health conditions in this cohort, including anxiety disorders and attention-deficit/hyperactivity disorder. Conclusions: This study identifies a variety of medical conditions which are more frequent in children with DS+ASD than DS alone, providing important information for clinical management of these patients. Future research should investigate the role of some of these medical conditions in the development of ASD phenotypes, and whether there may be distinct genetic and metabolic contributions towards these conditions. Trial registration: n/a

A Certified Child Life Specialist (CCLS) has the knowledge, skills, and clinical training that is essential to work in the field of infant adoption. Child Life Specialists working as infant adoption specialists promote emotional support, education, and coping for the biological parent(s) and families who want to adopt a child. Using the competencies to ground the work, Child Life Specialists focus on the therapeutic relationship, attachment, and bonding while also understanding grief and loss experienced by the biological parent(s). This chapter also examines how socioeconomics, varying cultures, ethnicities, and trauma histories can affect the adoption process.

Background Psychosocial stressors increase the risks for cardiovascular disease across diverse populations. However, neighborhood level resilience resources may protect against poor cardiovascular health (CVH). This study used data from three CVH cohorts to examine longitudinally the associations of a resilience resource, perceived neighborhood social cohesion (hereafter referred to as neighborhood social cohesion), with the American Heart Association’s Life’s Simple 7 (LS7), and whether psychosocial stressors modify observed relationships. Methods We examined neighborhood social cohesion (measured in tertiles) and LS7 in the Jackson Heart Study, Multi-Ethnic Study of Atherosclerosis, and Mediators of Atherosclerosis in South Asians Living in America study. We used repeated-measures, modified Poisson regression models to estimate the relationship between neighborhood social cohesion and LS7 (primary analysis, n = 6,086) and four biological metrics (body mass index, blood pressure, cholesterol, blood glucose; secondary analysis, n = 7,291). We assessed effect measure modification by each psychosocial stressor (e.g., low educational attainment, discrimination). Results In primary analyses, adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) for ideal/intermediate versus poor CVH among high or medium (versus low) neighborhood social cohesion were 1.01 (0.97–1.05) and 1.02 (0.98–1.06), respectively. The psychosocial stressors, low education and discrimination, functioned as effect modifiers. Secondary analyses showed similar findings. Also, in the secondary analyses, there was evidence for effect modification by income. Conclusion We did not find much support for an association between neighborhood social cohesion and LS7, but did find evidence of effect modification. Some of the effect modification results operated in unexpected directions. Future studies should examine neighborhood social cohesion more comprehensively and assess for effect modification by psychosocial stressors.

The phototrophic bacterium Rhodopseudomonas palustris is emerging as a promising biotechnological chassis organism, due to its resilience to a range of harsh conditions, a wide metabolic repertoire, and the ability to quickly regenerate ATP using light. However, realization of this promise is impeded by a lack of efficient, rapid methods for genetic modification. Here, we present optimized tools for generating chromosomal insertions and deletions employing electroporation as a means of transformation. Generation of markerless strains can be completed in 12 days, approximately half the time for previous conjugation-based methods. This system was used for overexpression of alternative nitrogenase isozymes with the aim of improving biohydrogen productivity. Insertion of the pucBa promoter upstream of vnf and anf nitrogenase operons drove robust overexpression up to 4000-fold higher than wild-type. Transcript quantification was facilitated by an optimized high-quality RNA extraction protocol employing lysis using detergent and heat. Overexpression resulted in increased nitrogenase protein levels, extending to superior hydrogen productivity in bioreactor studies under nongrowing conditions, where promoter-modified strains better utilized the favorable energy state created by reduced competition from cell division. Robust heterologous expression driven by the pucBa promoter is thus attractive for energy-intensive biosyntheses suited to the capabilities of R. palustris. Development of this genetic modification toolset will accelerate the advancement of R. palustris as a biotechnological chassis organism, and insights into the effects of nitrogenase overexpression will guide future efforts in engineering strains for improved hydrogen production.