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The intestinal parasite, Cryptosporidium, is a major contributor to global child mortality and causes opportunistic infection in immune deficient individuals. Innate resistance to Cryptosporidium, which specifically invades enterocytes, is dependent on the production of IFN-γ, yet whether enterocytes contribute to parasite control is poorly understood. In this study, utilizing a mouse-adapted strain of C. parvum, we show that epithelial-derived IL-18 synergized with IL-12 to stimulate innate lymphoid cell (ILC) production of IFN-γ required for early parasite control. The loss of IFN-γ-mediated STAT1 signaling in enterocytes, but not dendritic cells or macrophages, antagonized early parasite control. Transcriptional profiling of enterocytes from infected mice identified an IFN-γ signature and enrichment of the anti-microbial effectors IDO, GBP, and IRG. Deletion experiments identified a role for Irgm1/m3 in parasite control. Thus, enterocytes promote ILC production of IFN-γ that acts on enterocytes to restrict the growth of Cryptosporidium.

Introduction: It is unclear whether the timing of meals relative to sleep impacts cardiometabolic risk factors (e.g., weight gain). This cohort study aimed to detect and describe the association of the timing of caloric intake and dietary patterns (e.g., skipping breakfast) with weight trajectory over 2 years among participants who used the Daily24 mobile application to record their timing of eating and sleeping. Hypothesis: We hypothesized that skipping breakfast or consuming 50% or more of daily calories in the latter half of the day is associated with greater weight gain over 2 years. Methods: We conducted a secondary data analysis from a multi-site, electronic health record-based cohort study of adults from 3 healthcare systems in PCORnet’s PaTH Clinical Research Network. Of the 1017 participants enrolled in the study, N=407 patients downloaded and used the Daily24 mobile application for at least 2 weekdays and 1 weekend day over 6 months. We calculated the median of each participant’s daily eating and sleeping intervals. Participants’ weights were extracted from electronic health records available for up to 10 years prior to until 10 months after baseline. Weight trajectories were calculated over 2 years of this data. Participants completed online surveys about demographics and behavioral characteristics at baseline and after 4 months. We constructed multivariate linear regression models with weight trajectory as the dependent variable and breakfast skipping (i.e., not eating anything within 3 hours of waking), having a medium or large meal within 3 hours of sleep, ≥50% caloric consumption in the latter half of the day (after 12 pm), and ≥90% caloric consumption after 7 pm as independent variables. Additional independent variables included age, sex, race, days of application use, and body mass index (BMI) category. Results: Mean (SD) baseline age was 50.8 (15.0) years, 75.7% had a BMI≥25 kg/m 2 , 78.1% were women, and 84.0% were white. The average number of recorded Daily24 application days was 55.9 (53.5), significantly greater than the 3-day minimum inclusion criterion. The mean of participants’ median intervals from first to last meal was 11.2 (2.0) hours. Although not statistically significant, consuming 50% of daily calories in the latter half of the day and skipping breakfast were associated with an increasing weight trajectory (0.03 and 0.25 kg/year; 95% CI -0.39 to 0.45 and -0.32 to 0.82, respectively). Conclusions: Timing of eating (e.g., skipping breakfast or eating most calories later in the day) may be associated with very small weight increases over time. Our app-based approach may not have had enough observations to establish this association. Further research is needed to understand the clinical importance of circadian dietary patterns related to cardiometabolic health.

Summary Introduction Gestational weight gain (GWG) and postpartum weight retention (PPWR) are significant, potentially modifiable, contributors to women's future weight and health trajectories. There is a need for feasible and patient‐centered (i.e., convenient, remotely‐delivered, technology‐enhanced, and accessible through the prenatal care setting) behavioural interventions that limit GWG and PPWR. This study tests the feasibility and acceptability of a remotely‐delivered behavioural health coaching intervention to limit gestational weight gain and postpartum weight retention. Methods Pregnant women (11–16 weeks gestation) were recruited from two prenatal clinics and randomized to the active intervention or health education comparison group. Completion of the program was monitored and perceived helpfulness was rated (0–100). Results Twenty‐six women were randomized (n = 13 per arm; mean age = 31.6 years, SD = 3.6; mean BMI = 26.7 kg/m2, SD = 7.4). Participants completed a median of 18 coaching calls and 16/19 learning activities during pregnancy, and a median of 6 calls and 5/6 learning activities postpartum. They logged weights at least once/week for a median of 36/38 expected weeks and tracked daily calories and exercise for a median of 154/266 days and 72/266 days, respectively. Median (Q1, Q3) helpfulness ratings of the program during pregnancy were 80 (64, 91) and 62 (50, 81) postpartum; helpfulness ratings of coaching calls were 85 (58, 98). At 37 weeks gestation, 77% of participants achieved IOM weight gain recommendations compared to 54% in the comparison group. Conclusions This study provides evidence for the feasibility and acceptability of a remotely‐delivered behavioural weight control intervention in pregnancy and postpartum.

Transportation is a lifeline. Without access to transportation, opportunities for people to thrive and prosper are limited. However, traditional approaches to transportation planning largely ignore the social dimensions of travel, which contribute to transportation injustice. In the United States, federal legislation introduced public involvement into the regional transportation planning process, paving the way for local communities to participate in decision-making—but a mismatch persists. Despite the intent for public involvement that allows for inclusive and meaningful participation, in reality this involvement is often reactive and superficial without direct influence on final outcomes. Re-envisioning public involvement can help advance transportation justice by addressing procedural inequities in transportation planning. The human-centered mobility (HCM) paradigm embodies a more expansive view of transportation that acknowledges the heterogeneity of travelers and focuses on lived experiences with the transportation system. Design thinking, which like HCM is grounded in the human-centered framework, offers a problem-solving approach that first seeks to understand the end users’ needs to inform the development of solutions. This qualitative study explored to what extent the use of design thinking as a public involvement strategy could yield inclusive and meaningful participation to address transportation challenges in three U.S. metropolitan regions through systems mapping and in-depth interviews. This study suggests that a human-centered approach to public involvement can achieve progress towards transportation equity by gathering input from diverse perspectives rooted in lived experiences. However, procedural and political barriers exist that can impede the realization of meaningful outcomes related to improved transportation access.

Background and Objectives: Primary care clinicians are in a unique position to address intimate partner violence (IPV) in routine clinical practice. The purpose of this study was to improve clinician readiness to identify and manage IPV in four family medicine residency practice sites on the west side of Chicago by partnering with a local domestic violence organization. Methods: Practice sites included three federally qualified health centers and one hospital-based office. Eligible clinicians included resident and faculty physicians, nurse practitioners, and certified nurse midwives. We assessed readiness using the validated Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS). We used initial survey results (n=53, 73%) to develop a targeted clinician educational intervention by a community organization. We administered the PREMIS tool postintervention at 1 and 6 months, measuring perceived and actual knowledge, preparedness, and practice issues. We performed comparison statistics to assess aggregate change. Results: PREMIS response rates were n=53 (72%), n=32 (47%), and n=36 (49%), for preintervention, 1, and 6 months postintervention, respectively. Mean clinician preparedness score improved significantly at 1 and 6 months (P

Background: Small pilot and randomized controlled studies suggest that time-restricted feeding may decrease body weight. However, the role of meal timing and intervals, measured using mobile applications, has not been examined in larger population-based studies. The objective of this study is to evaluate the association between meal intervals and weight trajectories among adults from a population-based clinical cohort. Methods: Multi-site prospective cohort study of adults recruited from three health systems. Over the 6-month study period, 547 participants downloaded and used the Daily24 mobile application to record the timing of meals and sleep for at least one day. Intervals were calculated as the average of all available daily entries for each participant. We obtained information on weight and comorbidities at each outpatient visit from electronic health records available for up to 10 years prior to until 10 months after baseline. We used mixed linear regression to model weight trajectories. Results: The mean (SD) baseline (at consent) age was 51.1 (15.0) years and body mass index (BMI) 30.8 (7.8) kg/m 2 ; 77.9% were women and 77.5% were White. Average time in the cohort was 5.9 years prior to and 0.3 years after baseline. The mean interval from first to last meal was 11.5 (2.3) hours. The associations between meal intervals and weight trajectories are shown in the Table . The number of meals per day was positively associated with weight change before baseline, and number of snacks and drinks per day was inversely associated with weight change after baseline. Each additional occasion of snacks and drinks was associated with a 3.20 kg weight decrease (95% CI 1.41 to 4.99). None of the other associations were statistically significant. Conclusions: Number of daily meals was positively associated with weight change in previous periods, while the number of daily snacks and drinks was inversely associated with weight trajectory. The intervals from first to last meal was not associated with weight change.

This paper gives a general framework for the computation of several classes of partial differential equations (PDEs) on hypersurfaces. The approach is to work in a sufficiently thin narrow band, surrounding the surface, in the embedding Euclidean space and appropriately extend the differential operators so that the solutions on the narrow band and surface are equivalent. The solutions in the narrow band are equivalent to the solutions on the surface as in the former are constant along surface normal extensions of the latter. Consequently, it is possible to use existing (high order) numerical methods developed on grids in Euclidean space to solve PDEs on surfaces, with narrow bands whose widths are a small constant multiple of uniform Cartesian grid spacing. We apply the formulation to PDEs that originate from variational principles defined on surfaces as well as Hamilton-Jacobi-Bellman equations on surfaces that are derived from optimal control problems. This framework also provides a systematic way for solving PDE's on the unstructured point clouds that are sampled from the surface.

BACKGROUND Collecting data on daily habits across a population of individuals is challenging. Mobile-based circadian ecological momentary assessment (cEMA) is a powerful frame for observing the impact of daily living on long-term health. OBJECTIVE In this paper, we (1) describe the design, testing, and rationale for specifications of a mobile-based cEMA app to collect timing of eating and sleeping data and (2) compare cEMA and survey data collected as part of a 6-month observational cohort study. The ultimate goal of this paper is to summarize our experience and lessons learned with the Daily24 mobile app and to highlight the pros and cons of this data collection modality. METHODS Design specifications for the Daily24 app were drafted by the study team based on the research questions and target audience for the cohort study. The associated backend was optimized to provide real-time data to the study team for participant monitoring and engagement. An external 8-member advisory board was consulted throughout the development process, and additional test users recruited as part of a qualitative study provided feedback through in-depth interviews. RESULTS After ≥4 days of at-home use, 37 qualitative study participants provided feedback on the app. The app generally received positive feedback from test users for being fast and easy to use. Test users identified several bugs and areas where modifications were necessary to in-app text and instructions and also provided feedback on the engagement strategy. Data collected through the mobile app captured more variability in eating windows than data collected through a one-time survey, though at a significant cost. CONCLUSIONS Researchers should consider the potential uses of a mobile app beyond the initial data collection when deciding whether the time and monetary expenditure are advisable for their situation and goals.

In this paper, we present a new multiscale domain decomposition algorithm for computing solutions of static Eikonal equations. The new method is an iterative two-scale method that uses a parareal-like update scheme in combination with standard Eikonal solvers. The purpose of the two scales is to accelerate convergence and maintain accuracy. We adapt a weighted version of the parareal method for stability, and the optimal weights are studied via a model problem. Numerical examples are given to demonstrate the method., 27 pages, 18 figures

Timing of eating relative to sleep and endogenous circadian rhythm impacts weight and cardiometabolic health. We used qualitative methods to explore what influences the “when” of eating and sleeping. We conducted 37 one-on-one semi-structured interviews among participants with a body mass index (BMI) ≥ 25 kg/m2 recruited from three internal medicine clinics affiliated with an urban academic hospital. Participants (70.3% Female; 51.4% White; Age range: 21–83 years old) completed measures of social jetlag, physical activity, eating habits, and mobile application use and participated in interviews following a guide developed by the study team. Responses were recorded, transcribed and coded sequentially by two trained researchers using editing-style analysis to identify themes. We identified two main themes, each with subthemes: 1) influences on the “when” of eating and sleeping, with subthemes including social jetlag and being overscheduled, and 2) contextualizing beliefs and perceptions about the “when” of eating and sleeping, with subthemes including perceived recommendations for timing of eating and sleeping, and alignment of behaviors with perceived recommendations. Many participants noted being more flexible in their eating and sleeping times on work-free vs work days. The themes this study identified should be considered when designing interventions that influence the timing of eating and sleeping for weight management.

OBJECTIVE: To compare the effect of Healthy for Two/Healthy for You (H42/H4U), a health coaching program, in prenatal care clinics that serve a racially and economically diverse population, on total gestational weight gain (GWG) (vs. usual care). We hypothesize that compared to usual prental care, intervention participants will have lower GWG and lower rates of gestational diabetes mellitus (GDM). METHODS: We report the rationale and design of a pragmatic, parallel arm randomized clinical trial with 380 pregnant patients < 15 weeks gestation with overweight or obesity from one of 6 academic and community-based obstetrics practices, randomized to either H42/H4U or usual prenatal care in a 1:1 ratio. The study duration is early pregnancy to 6 months postpartum. The primary outcome is total GWG, calculated as the difference between first clinic-assessed pregnancy weight and the weight at 37 weeks gestation. Key maternal and infant secondary outcomes include GDM incidence, weight retention at 6 months postpartum, infant weight, maternal health behaviors and wellness. CONCLUSIONS: This pragmatic clinical trial embeds a pregnancy health coaching program into prenatal care to allow parallel testing compared to usual prenatal care on the outcome of total GWG. The real-world design provides an approach to enhance its sustainability beyond the trial with the goal to ultimately improve maternal/child health outcomes and reduce future obesity. TRIAL REGISTRATION: The study was first registered at clinicaltrials.gov on 1/26/21 (NCT04724330).

Background Pregnancy provides an opportunity to promote healthy lifestyle behaviors. This study’s aim was to explore the perspectives of pregnant and postpartum women and obstetric providers around behavioral lifestyle changes in pregnancy and postpartum. Methods We conducted a qualitative study with pregnant and postpartum patients recruited from 2 prenatal care clinics at an urban, academic hospital in the United States. In-depth interviews with 23 pregnant or postpartum women and 11 obstetric providers were completed between October 2015–April 2016. Interviews were audio-recorded and transcribed verbatim. We coded transcripts for thematic content and applied the PRECEDE-PROCEED framework for results to directly inform program development. Results Six themes highlighted the predisposing, enabling and reinforcing factors that enable and sustain health behavior changes in pregnancy and postpartum: 1) “Motivation to have a healthy baby” during pregnancy and to “have my body back” after delivery, 2) Pre-pregnancy knowledge and experiences about pregnancy and the postpartum period, 3) Prioritizing wellness during pregnancy and postpartum, 4) The power of social support, 5) Accountability, 6) Integration with technology to reinforce behavior change. Conclusions In this qualitative study, pregnant and postpartum women and obstetric providers described themes that are aimed at encouraging lifestyle changes to promote healthy weight gain in pregnancy and can directly inform the development of a behavioral weight management intervention for pregnant and postpartum women that is patient-centered and tailored to their needs.

Treatment with combination antiretroviral therapy (cART) regimens with a high capacity to penetrate the blood-brain barrier has been associated with lower levels of human immunodeficiency virus (HIV) in the central nervous system (CNS). This study examined neurocognitive performance among a sample of 118 HIV+ substance dependent individuals (SDIs) and 310 HIV− SDIs. HIV+ participants were prescribed cART regimens with varying capacity to penetrate the CNS as indexed by the revised CNS penetration effectiveness (CPE) scale. Participants completed the Rotary Pursuit Task (RPT) and the Weather Prediction Task (WPT)--two measures of procedural learning (PL) with known sensitivity to HIV infection--and a control task of sustained attention. HIV+ SDIs prescribed cART with relatively high CNS penetrance performed significantly more poorly on both tasks than HIV− controls. Task performance of HIV+ SDIs prescribed cART with relatively low CNS penetrance did not differ significantly from either HIV− controls or the HIV+/High CPE group, although a trend towards lower RPT performance relative to HIV− participants was observed. Between-group differences were not seen on a control task of motor impulsivity (Immediate Memory Task), indicating that the observed deficits among HIV+/High CPE SDIs may have some specificity.

During my first week on a male orthopaedic ward I participated in a drug round while being supervised by my mentor.

Background:Stress urinary incontinence is a debilitating condition which occurs in 10-20% of females. Surgical management of stress urinary incontinence is increasingly common. Suburethral slings are most efficacious in treatment of stress urinary incontinence. Graft materials in these procedures can be synthetic or biologic. Common reported complications include bladder perforation, hematoma, vaginal extrusion of implant, de novo urgency symptoms, urinary tract infections and voiding dysfunction. Case:A 43-year-old para 5 woman presented to our department with complaint of a left suprapubic growing mass. Her medical history was significant for stage III cervical cancer treated with chemoradiation three years prior. Her past surgical history included a retropubic porcine dermis Pelvilace sling (Bard Medical, Covington GA) placement and cystoscopy 10 months prior to presentation. The clinical presentation was highly suggestive of local reaction to porcine dermis suburethral sling, however the diagnosis of recurrence of cervical cancer could not be excluded. The patient underwent definitive management with incision and drainage of a large pocket of pus, suprapubic exploration and resection of an indurated mass. The pathology report revealed poorly formed granuloma and no evidence of cancerous cells. The patient had an uncomplicated postoperative course and remains continent and asymptomatic 24 months post operatively. Conclusion:We present a rare case of granuloma formation secondary to reaction to porcine dermis graft that presented as a suprapubic mass.

Overactive bladder (OAB) in women is highly prevalent. It can be very bothersome and affect quality of life. Treatment differs significantly depending on the clinical presentation, and includes behavioural modification, medicinal therapies and surgical procedures. New treatment options have become available in recent years, and can offer great benefit to patients with persistent, bothersome OAB.First-line management for OAB consists of lifestyle and behavioural therapy, followed by antimuscarinic therapy or oral beta-3 agonists. Sacral neuromodulation, onabotulinumtoxinA and posterior tibial nerve stimulation are additional well tolerated and efficacious treatment options that should be considered in carefully selected, refractory OAB patients. These recent advances in OAB therapy are discussed in this review.The treatment of OAB is often complex, and can require trials of multiple different treatment modalities. Although the treatment advances discussed in this review have augmented treatment of OAB, the condition continues to negatively impact quality of life for our ageing female population. Clinical trials and development of novel therapies continue to be paramount.

We present an extensive data set for color research that has been made available online (www.cs. sfu.ca/∼colour/data). The data are especially germane to research into computational color constancy, but we have also aimed to make the data as general as possible, and we anticipate a wide range of benefits to research into computational color science and computer vision. Because data are useful only in context, we provide the details of the collection process, including the camera characterization, and the data used to determine that characterization. The most significant part of the data is 743 images of scenes taken under a carefully chosen set of 11 illuminants. The data set also has several standardized sets of spectra for synthetic data experiments, including some data for fluorescent surfaces. © 2002 Wiley Periodicals, Inc. Col Res Appl, 27, 147–151, 2002; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/col.10049

This report documents successful practices in the United States and Canada, and presents information on efforts employed to achieve optimal bus fleet size and effective spare bus ratios. The objective is to update the findings of TCRP Synthesis 11: System-Specific Spare Bus Ratios, as significant changes have occurred in the transit industry since 1995. This synthesis provides valuable guidance to transit agencies on how various factors may affect optimal fleet size. The intended audience for this synthesis can be bus transit management, operations, and all supporting staffs and stakeholders. A literature review, a survey of selected transit agencies with an 80% response rate, and four case examples report on agency bus fleets with numerous unique attributes, service demands, environmental factors, and maintenance issues.