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The Impact of Ethanol and Adolescent Social Isolation Stress on Nucleus Accumbens Medium Spiny Neurons Integration of Prefrontal Cortex and Basolateral Amygdala Inputs
No full textDrug addiction, including alcohol use disorder (AUD), hijacks the brain’s reward system and promotes drug-seeking behavior. Medium spiny neurons (MSNs) in the nucleus accumbens (NAc), a key reward center, receive glutamatergic input from the medial prefrontal cortex (mPFC) and basolateral amygdala (BLA), both of which are affected by alcohol. However, the cellular mechanisms by which the NAc integrates these inputs, and their relevance to AUD, remain poorly understood. Additionally, the effects of stress on glutamatergic signaling in the NAc are not well characterized. Using ex vivo electrophysiology and optogenetics, I found that under alcohol-naïve conditions, the NAc prioritizes mPFC and BLA inputs in an age- and sex-dependent manner. Adolescent males favor mPFC input more than females, but this difference disappears in adulthood, when females instead show greater BLA input than males. After two weeks of binge drinking, adolescent mice exhibit no changes in input prioritization. In contrast, adult males show a shift toward BLA input relative to controls. Social stress in alcohol-naïve adolescent mice enhances BLA input in both sexes compared to non-isolated females. Acute alcohol (50 mM) strengthens BLA input in non-isolated males and isolated females. These findings suggest that both stress and alcohol dynamically modulate BLA and mPFC input to the NAc in a sex-specific manner. This work enhances our understanding of how stress and alcohol interact to influence reward circuitry and highlights the importance of considering sex differences in addiction vulnerability and relapse risk.NeuroscienceNo embarg
The Implementation of Dynamic Appraisal of Situational Aggression Score at Emergency Department Triage
No full textStudy objective: Violence in health care settings is a growing threat to patients and clinicians. This study's objective was to describe the demographic distribution of the Dynamic Appraisal of Situational Aggression (DASA) score at emergency department (ED) triage, identifying patterns in score variability across different patient groups and exploring associations with demographic factors.
Methods: From January 11, 2023 to December 31, 2023, patients aged 18 years and older were assigned a DASA score during triage at 5 EDs as part of a systemwide strategy to mitigate increasing workplace violence. Scores were used to stratify patients into established risk categories of aggressive behavior (low, moderate, high, or imminent). Subjects' DASA scores and demographic characteristics were abstracted from the electronic health record. Findings were reported descriptively with 95% confidence intervals for counts and proportions.
Results: There were 192,947 ED encounters during the study period, of which 159,154 (80.3%) had a DASA score assigned at triage (mean age, 51.5 years; 53.5% women). The data set comprised 98,751 unique patients. Male sex, younger age, high-acuity Emergency Severity Index, and arrival with police, by ambulance, or by aircraft were most associated with a high-risk DASA score assignment.
Conclusion: The use of the DASA instrument score at ED triage was highly adopted by staff. The demographic makeup of patients with a high-risk DASA score was concordant with prior literature describing patients at risk for committing violence against health care workers. Further research should investigate the predictive value of triage DASA assessment for aggressive patient behavior.No embarg
Employment Outcomes among People with Disabilities: Health-Related Determinants
No full textA systematic scoping review of research published between 2000 and 2020 on employment of people with disabilities, that was funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), was conducted by CeKTER researchers. All papers comparing people with disabilities to those without were excluded from the systematic scoping review. Among over 100 publications reviewed there was a wide and very disparate array of findings with numerous variables used and varying research questions. This result belies summative findings. There are numerous ways of organizing the disparate findings. This brief is part of a series of findings from CeKTER's systematic scoping review. In this brief we report on findings about a range of health-related determinants impacting the employment of people with disabilities, including disability characteristics, health challenges, and lifestyle related determinants. Please note that all comparisons are always about corresponding peers with disabilities.The contents of this product were funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Grant #90DPEM0004. NIDILRR is a Center within the Administration for Community Living (ACL). ACL is an agency in the Department of Health and Human Services (HHS). The contents of this product do not necessarily represent the policy of NIDILRR, ACL, or HHS and you should not assume endorsement by the Federal Government.No embarg
“My life, my choice, my happiness, my voice:” A qualitative study of home dwelling adults 85 years and older
No full textPURPOSE: This study explored the meaning and experience of aging in place for adults 85 years and older residing in the community.
SPECIFIC AIMS: 1) to explore the meaning of home and aging in place to older adults; 2) to explore how older adults experience power personally within their environment and in relationships with others, power-as-freedom or power-as-control; and 3) to explore human-environment health patterning modalities older adults engage in to enhance their wellbecoming.
FRAMEWORK: Elizabeth Barrett’s theory of power as knowing participation in change undergirded this study.
DESIGN: The unitary biographical narrative method informed by Ricoeur and Rogerian science was used to reveal the plot of meaning present in storied lives people shared.
RESULTS: Fifteen older adults participated in interviews. Findings reveal that these adults desire to make their own choices and decisions demonstrating power-as-freedom and use human-environmental health patterning modalities to promote wellbecoming. A difference exists between Home and home. Home is grounded in familiarity, comfort, land, memories, connections, and love in this world and beyond.
CONCLUSION: Through mutual process with the participants and expanding awareness, their collective stories reveal that Home is the manifestation of unitary synthesis with the universe and the participants’ perceptions of time passing. Home is deeply rooted in love and cannot simply be replicated elsewhere. It is where these participants feel the power of love and where love-power resonance is the primary human-environment health patterning modality used to create opportunities to enhance wellbecoming.
KEYWORDS: aging in place, older adults, biographical narrative, home6 months2025-11-1
Facilitators of COVID-19 vaccination among pregnant and lactating refugee women: A qualitative study using a community-based approach
No full textIntroduction: The coronavirus disease of 2019 (COVID-19) vaccination has reduced the severity of illness and hospitalization rates associated with the virus. However, pregnant and lactating refugee women often have lower vaccination rates, which are influenced by limited access to healthcare, cultural barriers, and misinformation. This study, guided by the Positive Deviance Framework, examines the factors that promoted COVID-19 vaccination among pregnant and lactating refugee women.
Methods: Cultural Health Navigators conducted in-depth interviews with pregnant and lactating refugee women recruited from a large federally qualified health center who received COVID-19 vaccines.
Results: This qualitative study included 30 participants, stratified by language groups and representing diverse educational backgrounds and lengths of residence in the United States. Thematic analysis of the interviews revealed factors such as fear of COVID-19, emotional relief following vaccination, trust in healthcare providers and scientific evidence, and support from family and Cultural Health Navigators.
Discussion: The findings highlight the importance of culturally sensitive communication and trust-building in promoting vaccination rates among pregnant and lactating refugee women. Trust in healthcare providers, scientific evidence, and support from family and Cultural Health Navigators played a key role in overcoming vaccination barriers. Tailored strategies and supportive interventions can enhance COVID-19 vaccination uptake in this population. Further research in larger, diverse populations is needed to identify additional strategies for improving vaccination rates among refugee women.No embarg
A Flexible Framework for Urgent Public Health Climate Action
No full textClimate change poses profound threats to human safety, health, and well-being. Public health agencies, especially state, territorial, local, and Tribal health departments, can play an essential role in climate change adaptation and mitigation. Public health climate action can protect health, promote health equity, and increase climate change resilience. The Centers for Disease Control and Prevention has updated its original climate and health framework for practitioners and expanded its utility by developing practical guidance. The revised framework, Building Resilience Against Climate Effects, supports health departments and their partners by providing an accessible approach that can be tailored to different contexts. The framework has been updated to center justice, equity, and belonging; integrate climate change mitigation or reduction of greenhouse gas emissions that cause climate change; and address agency capacity. The Building Resilience Against Climate Effects framework also emphasizes collaboration, especially cross-sectoral and community partnerships, communication, and evaluation. Framework elements, key tactics, and guiding principles are presented in a pragmatic, step-by-step implementation guide. The implementation guide can be used by state, territorial, local, and Tribal health departments to galvanize or expand their engagement with public health climate action, which grows more urgent each year. (. Published online ahead of print May 22, 2025:e1-e12. https://doi.org/10.2105/AJPH.2025.308061).No embarg
The prevalence and burden of chronic kidney disease, patterns of anticoagulation prescribing, and major bleeding risk in older adults with atrial fibrillation
Get PDFBACKGROUND: In older adults with atrial fibrillation (AF), the presence of comorbid chronic kidney disease (CKD) may be more challenging for optimal disease management, influence stroke prophylaxis with oral anticoagulation, and impact bleeding risk. We examined the prevalence and burden of CKD in older patients with AF, patterns of anticoagulation prescribing according to CKD stage, and major bleeding events.
METHODS: Patients aged 65 years and older with AF were enrolled in a cohort study from clinics in Massachusetts and Georgia between 2016 and 2018. Kidney function was assessed with estimated glomerular filtration rate (GFR) values at study enrollment. Anticoagulation therapy with direct acting oral anticoagulation therapy (DOAC) or warfarin; and major bleeding events were ascertained from medical records. Cox proportional hazards model was used to estimate the multivariable adjusted risk of two-year major bleeding events.
RESULTS: Participants' (n = 1,244) mean age was 75 years; 48% were women, and 86% were White. Overall, 25% had a normal GFR, 44%, 28%, and 3% had mild, moderate, and severe CKD/kidney failure, respectively. Patients with severe CKD/kidney failure were more likely to be the oldest participants, dependent in their instrumental activities of daily living, and had the highest burden of frailty, multimorbidity, and polypharmacy. Approximately 44% of patients with normal GFR and 39% of those with mild CKD were prescribed a DOAC, while a majority of those with severe CKD/kidney failure (69%) were prescribed warfarin. Overall, 8% (n = 105) experienced a major bleeding event over the 2-year follow-up. After adjusting for sociodemographic, psychosocial, geriatric, and clinical variables, patients with severe CKD/kidney failure (HR: 2.81 [95% CI:1.10-7.17]) had a higher bleeding risk than those with a normal GFR.
CONCLUSIONS: In managing older patients with AF and comorbid CKD, healthcare providers should be increasingly aware of the increased burden of frailty, dependence for care, multimorbidity, polypharmacy, and the high risk of major bleeding especially among those with severely impaired kidney function. This finding emphasizes the need for a more holistic and multidisciplinary approach to stroke prophylaxis in older adults with AF and comorbid CKD.No embarg
Navigating Complexities: A Comprehensive Stakeholder Analysis for Opioid Crisis Strategies in Boston
No full textThis article presents a comprehensive stakeholder analysis within the context of opioid overdose prevention in Boston, showcasing the development and application of an integrated framework designed to address the complex dynamics of the opioid crisis. Utilizing a modified Agency for Healthcare Research and Quality stakeholder analysis tool, this study categorized key stakeholders into four main groups: healthcare providers, law enforcement officers, health policy officials, and community leaders. Through in-depth, semistructured interviews with 15 stakeholders recruited from Boston's Mayor's Task Force for Opioid Remediation, we synthesized insights to map out strategic intelligence essential for policy formulation and enhanced stakeholder engagement. The analysis highlighted the necessity of multisector collaboration and identified critical leverage points that could influence future interventions. The findings underscored the potential of tailored interventions that consider the unique needs and contributions of different stakeholder groups, advocating for policy reforms that support comprehensive public health strategies. The integrated framework represents a proposed implementation model for Boston, demonstrating adaptability for other urban settings. The framework introduces innovative strategies for continuous improvement and adaptation, informed by stakeholder feedback. This research contributes to the field by demonstrating the effectiveness of stakeholder analysis in developing actionable and sustainable public health policies, providing a replicable model for other urban settings facing similar public health challenges.No embarg
Adulting Shorts: Let’s Talk About Getting Your Teen Ready for a Job
Get PDFPre-ETS, or Pre-Employment Transition Services, are a set of services designed to help students with disabilities, including those with mental health conditions, typically aged 14-22, prepare for post-secondary education or employment. These services offer an early start on career exploration and skill development, often preceding or supplementing traditional Vocational Rehabilitation (VR) services. This comic is used to increase the awareness of Pre-ETS.The contents of this comic were supported in part under grants with funding from the National Institute on Disability, Independent Living, and Rehabilitation Research, (NIDILRR), United States Departments of Health and Human Services (NIDILRR grant numbers 90RTE0012 and 90RTEM0005, The Learning and Working RRTC). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this comic do not necessarily represent the policy of NIDILRR, ACL, or HHS and you should not assume endorsement by the Federal Government.No embarg
An Emerging Long Non‐coding RNA Regulates Synaptogenesis in Drosophila
No full textIt is widely accepted that synaptogenesis and synaptic plasticity are the foundation of learning and memory and is implicated in many neurological and psychiatric diseases. Our lab previously described the ViSyToR (Viral Synaptic Transfer of RNA) pathway required for synaptogenesis at the Drosophila larval neuromuscular junction (NMJ), which involves two key components: darc1, a retrotransposon-like capsid gene, and copia, a retrotransposon. Both dArc1 and Copia proteins form capsid-like structures, bind to their own RNAs, and are transferred across the NMJ from presynaptic neurons to postsynaptic muscles. dArc1 is a positive regulator of synaptogenesis, while Copia is a negative regulator of synaptogenesis. They compete to maintain the proper synaptic growth at the NMJ. Using RNA immunoprecipitation, we found that the long non-coding RNA statera (stae, originally CR34335) associates with Copia proteins. stae is highly expressed in neurons and muscles of Drosophila. stae mutants show a decrease of bouton numbers at the NMJ, suggesting that stae is a positive regulator of synaptogenesis. Strikingly, stae knockout leads to upregulation of copia expression, with an increase of copia RNA stability and transposition activity, suggesting that stae is a repressor of copia elements. We further showed by bioinformatic analysis that stae is an emerging lncRNA during Drosophila evolution. Taken together, our results point to an unexpected role of a long non-coding RNA in regulating synaptogenesis by repressing a retrotransposon.Interdisciplinary Graduate Program2 years2027-08-2