Midwestern Sites Research Articles

Abstract OT2-06-01: Breast Cancer Cohort of the Comprehensive Outcomes for After Cancer Health (COACH) Study: Study Protocol

Abstract Background: Women with breast cancer account for the largest cohort (23%) of over 18 million cancer survivors in the United States. Of the nearly 4 million breast cancer survivors, many, including individuals with metastatic breast cancer, will require lifelong treatment for chronic conditions. As part of a multi-site study including diverse tumor types, breast cancer survivors are being recruited to explore the feasibility and outcomes of a digital health coaching (DHC) program following the completion of primary therapy to support self-management of symptoms and general wellness. Trial design: A randomized-wait list control design will evaluate outcomes related to engagement in a DHC program following completion of primary therapy. Participants will be enrolled in a 6-month DHC program delivering evidence-based content via weekly calls, text, and email, in addition to usual support from their respective healthcare teams. The intervention group will receive coaching upon enrollment. The control group will receive coaching after a 6-month monitoring period. Twelve months of longitudinal clinical, patient-reported outcomes, activity tracking (via Fitbit), and microbiome data will be collected from both groups. Eligibility criteria: The breast cancer cohort will consist of individuals with both localized and metastatic disease within 1 year of completion of primary therapy, defined as treatment of curative intent, first-line or later, from which the individual is advancing to active surveillance or follow-up, with or without maintenance therapy. All study participants must be >18 years old, able to read and speak English, have access to mobile technology, and agree to wear and have data collected from an activity tracker. Specific aims: 1) Assess the feasibility and acceptability of a DHC program and its effect on participant health self-efficacy; 2) characterize associations between participant symptoms, physical/psychosocial well-being, and health self-management and gut microbiota changes; and 3) explore patient-generated health data outcomes among participants (patient reported and wearable biometrics outcomes). Statistical methods: Feasibility and acceptability will be assessed through descriptive statistics. Feasibility for this study is defined as a retention rate ≥70%, and acceptability is defined as ≤20% scoring “not at all helpful.” Secondary aims will be assessed using linear mixed models. Cross-cohort analysis of physical function, measured by the PROMIS Physical Function 10a, will be conducted. Assuming a power of 0.8 and significance level of .05, we will be able to detect a 2.51 difference in PROMIS score means between the control and intervention group (SD 10) with a sample of 500 total participants. Sub-group analysis will be conducted with the anticipated 250 participants in the breast cancer cohort with a focus on feasibility, acceptability, and descriptive and exploratory endpoints for this population as a whole and comparing early stage and metastatic participants. Target and present accruals: 500 individuals with diverse tumor types will be enrolled across 5 collaborating sites, of which 4 ill include individuals with breast cancer. An estimated 250 breast cancer participants (approximately 50% of the total study population), including 150 with de novo or progressive metastatic breast cancer, are planned to be recruited. To date, 1 Midwestern site has enrolled the first 7 breast cancer survivors. Two additional sites plan to enroll in July 2022, with the remaining 2 sites to begin enrollment by the end of 2022. Citation Format: Robin M. Lally, Rachael L. Schmidt, Gisele Tlusty, Elizabeth K. Arthur, Laura K. Flora, Jessica L. Krok-Schoen, Jessica T. Jones, Meagan Whisenant, Abbey Kaler, Debu Tripathy, Leorey Saligan, Marilyn Hammer, Austin Barr, Lindsey Jackson, Jennifer Loftis, Kelly J. Brassil. Breast Cancer Cohort of the Comprehensive Outcomes for After Cancer Health (COACH) Study: Study Protocol [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT2-06-01.

Food for thought: Examining the relationship between low calorie density foods in Instagram feeds and disordered eating symptoms among undergraduate women

BackgroundAmple studies have tested how viewing bodies on social media impacts eating disorder symptoms; however, the relationship between viewing food images on social media and disordered eating remains understudied. This study investigated whether viewing images of healthy, palatable food on Instagram impacted disordered eating attitudes across two samples of undergraduate women. MethodsThis pre-registered online study was conducted at two sites. Participants identifying as female (study 1 n = 222; study 2 n = 214) were randomly assigned to view one of two Instagram feeds – either a feed featuring low calorie, aesthetically pleasing foods or a control condition featuring travel images. Participants completed state measures of disordered eating intentions, self-esteem, and body image before and after viewing the feeds. ResultsA main effect of condition on disordered eating intentions was found at the Midwestern site, but not the Southeastern site. ConclusionsViewing healthy palatable food images on Instagram could increase risk for disordered eating behaviors among college females. If findings are replicated, individuals vulnerable to disordered eating may benefit from removing these types of feeds from their social media. Further research is needed to determine whether other forms of visual content on Instagram may be associated with disordered eating.

Stressed Mothers Receiving Infant Mental Health-Based Early Head Start Increase in Mind-Mindedness.

Maternal mind-mindedness is a characteristic of supportive parenting and contributes to many positive social–emotional outcomes in early childhood. However, there is limited knowledge of mind-mindedness among parents experiencing parenting stress from low-income settings. This is a critical gap in evidence given the robust role of supportive parenting in children’s development and the capacity of home-based interventions to improve children’s outcomes through enhancing supportive parenting. This study examined: (1) maternal mind-mindedness, operationalized as mothers’ appropriate mind-related comments (MRC), across toddlerhood in mothers of toddlers who participated in infant mental health (IMH) based Early Head Start (EHS) services; and (2) whether parenting stress moderated EHS program effects on appropriate MRC over time. Data from a primarily White midwestern site in the United States were collected at study enrollment and when toddlers were 14-, 24-, and 36-months of age (N = 152; mothers Mage = 22.4 years, SD = 5.1; toddlers Mage = 14.4 months, SD = 1.3; 51% females). Data included parent-completed questionnaires and observed parent–child interactions, which were coded for MRC. Although there were no main effects of EHS programming on mothers’ appropriate MRC over time, multilevel growth curve modeling indicated that parenting stress moderated EHS effects on mothers’ appropriate MRC over time. Among mothers with greater parenting stress, those who received IMH-based EHS services demonstrated greater proportions of MRC over time as compared to mothers with greater stress in the control group. IMH-based parenting interventions that target parenting stress may promote appropriate MRC in low-income populations during toddlerhood.

Differences in Sensorimotor Development Among U.S. Infants Receiving Breastmilk and/or Formula in the First 6-Months From the PediaTrac™ Project

ObjectivesAchieving sensorimotor (SEM) milestones is one measure of early infant brain development promoted through higher docosahexaenoic acid (DHA) levels. Both breastmilk and formula contain DHA, with a global level of 0.32% in breastmilk and many formula brands. However, a 2017 study of Midwestern U.S. mothers found significantly lower breastmilk DHA levels. It was thus hypothesized that infants fed formula would have higher SEM scores. The objective of this study was to measure differences in SEM development between infants fed breastmilk, formula, or a combination in participants of the PediaTrac™ Project. PediaTrac is a web-based measure providing longitudinal, real time, multidomain data on infant and toddler growth and development at time periods corresponding to well child visits. MethodsUsing PediaTrac, data were collected from 548 caregiver-infant dyads across multiple Midwestern sites. Caregivers reported the primary nutrition source as breastfeeding, formula or combination. Their responses to gross and fine motor function questions were used to create a SEM composite, Percent of Maximum Possible (POMP) score at newborn (NB), 2-, 4- and 6-months. Data were analyzed via ANOVA and Tukey test using SPSS. ResultsInfants fed formula had statistically higher mean SEM scores at NB (M = 0.618Formula, M = 0.590Breast, p = 0.017), 2- (M = 0.706Formula, M = 0.680Breast, p = 0.006) and 6-months (M = 0.727Formula, M = 0.696Breast, p = 0.014) compared to breastfed infants. Mean SEM scores of combination fed infants were higher than breastfed infants at 2- (M = 0.701Combination, M = 0.680Breast, p = 0.184), 4- (M = 0.684Combination, M = 0.673Breast, p = 0.573) and 6-months (M = 0.704Combination, M = 0.696Breast, p = 0.895), despite no significant differences between scores. ConclusionsFormula fed infants showed consistently higher SEM scores than breastfed infants in the first 6-months. These findings contradict previous research, indicating a need for further investigation into variables contributing to these discrepancies such as maternal breastmilk DHA concentrations, socioeconomic factors, site specific confounds, accuracy of parent reports of motor development, etc. Funding SourcesEunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health. EMU College of Health & Human Services Research Support Award.

Associations between parental involvement and school readiness for children enrolled in Head Start and other early education programs

This study investigates the relations among low-income parents’ perceptions of their child’s teacher, parental school involvement, and children’s pre-academic skills and aggressive behaviors by program type: Head Start or other early childhood education (ECE) programs. The data were collected at two Midwestern sites as a part of the Early Head Start Research and Evaluation Pre-Kindergarten Follow-up Study. Findings indicate that when Head Start parents attended more school activities, their child scored higher on early literacy skills and lower in aggressive behavior. When Head Start parents perceived their child’s teacher as responsive, their child scored higher on early math skills. For children enrolled in other ECE programs, however, these relationships were not found. This study suggests that parents’ perceptions of their child’s teacher and their level of school involvement may be linked differentially to pre-academic skills and aggressive behaviors depending on program type. These findings call for research to further elucidate these links and suggest the need for additional support for low-income families and more professional development for early childhood teachers regarding ways to promote children’s school readiness through enhancing home-school connections.

Living Independent From Tobacco reduces cigarette smoking and improves general health status among long-term tobacco users with disabilities

BackgroundPeople with disabilities disproportionately use tobacco and suffer associated negative health consequences. Research is needed to explore tobacco cessation programming for people with disabilities to counter these health disparities. ObjectiveWe evaluated the impact of Living Independent From Tobacco on tobacco use, knowledge and attitudes about tobacco use, coping skills, and perceived health status among people with disabilities. We also assessed participants’ subjective impressions at post-test. MethodsLiving Independent From Tobacco was evaluated via train the trainer model at three Midwestern sites serving people with disabilities. Outcomes were assessed at four time points: pre- and post-test (n = 30), and again at 1-month (n = 26) and 6-months (n = 13). ResultsLong-term tobacco users with disabilities significantly reduced tobacco use from pre-test to post-test (p = 0.003), and, compared to baseline, this reduction continued to be significant 1-month after the intervention (p = 0.02). From pre-test to post-test, perceived health status significantly improved (p = 0.0001). No significant changes were observed across time points for knowledge and attitudes about tobacco use nor for coping skills. Qualitative data revealed the importance of coping skills to mitigate the negative effects of nicotine withdrawal. Peer accountability was also noted as an important source of motivation for tobacco cessation. ConclusionsData from the present study provide evidence for the short-term effectiveness of Living Independent From Tobacco to reduce tobacco use and improve health status among people with disabilities. Qualitative data revealed the importance of coping skills and peer accountability to support tobacco cessation. Implications for tobacco cessation programming for people with disabilities are discussed.

Factors associated with genetic testing in a cohort of breast cancer survivors.

We examined factors associated with self-reported use of genetic testing among breast cancer survivors based on a 2015 cross-sectional survey at eight Midwestern sites. Genetic testing was reported in 39% of our 1235 study participants, with higher utilization among those aged <50 and with a triple-negative cancer. Bilateral mastectomy, having relatives with breast cancer, and younger age were associated with increased genetic testing use. Increasing income, in interaction with age, was associated with use of genetic testing among younger but not older patients. Rural residency emerged as a possible barrier for genetic testing among women with triple-negative cancer.

Ecosystem services of poplar at long‐term phytoremediation sites in the Midwest and Southeast, United States

AbstractShort rotation woody crops (SRWCs) including Populus species and their hybrids (i.e., poplars) are ideal for incorporating biomass production with phytotechnologies such as phytoremediation. To integrate these applications, 15 poplar plantings from nine long‐term phytoremediation installations were sampled from 2012 to 2013 in the Midwest (Illinois, Iowa, Wisconsin) and Southeast (Alabama, Florida, North Carolina) United States. In this review, we report summary results of this sampling and how performance at each site compared with comparable phytoremediation systems in the literature. We review significant genotypic differences from each planting within the context of provisioning (i.e., biomass production) and regulating (i.e., carbon sequestration) ecosystem services and how they relate to the need for a cleaner environment during times of accelerated ecological degradation. Overall, the contaminated poplar sites provided these ecosystem services comparable to noncontaminated poplar sites used for bioenergy and biofuels feedstock production. For example, phytoremediation trees at the Midwestern sites had biomass values ranging from 4.4 to 15.5 Mg ha−1 y−1, which was ~20% less relative to bioenergy trees (p = .0938). Results were similar for diameter and carbon, with some genotype × environment interactions resulting in phytoremediation trees exhibiting substantially greater growth and productivity (i.e., +131% at one site). As illustrated in the current review, phytoremediation success can be increased with the identification and deployment of genotypes tailored to grow well and tolerate a broad diversity of contaminants (generalists) (i.e., ‘DN34’, ‘NM6’, ‘7300501’) versus those that significantly outperform their counterparts under unique site conditions (specialists) (i.e., ‘220‐5’, ‘51‐5’, ‘S13C20’).This article is categorized under: Concentrating Solar Power &gt; Climate and Environment Bioenergy &gt; Economics and Policy Bioenergy &gt; Science and Materials

2057. Predictors for Gastrointestinal Protozoa Detection in U.S. Children Presenting with Acute Diarrhea

BackgroundThough more often associated with persistent diarrhea, protozoal gastroenteritis may also present as an acute illness. Suspicion for gastrointestinal protozoal infection is historically based on travel or recreational water exposure and duration of illness, which can delay diagnosis and effective treatment. The use of multiplex PCR panels has the potential to improve diagnosis of protozoal illness. To better understand when testing for protozoa is warranted, we examined predictors of protozoal gastroenteritis within a prospective multicenter study of U.S. children presenting to emergency departments with acute gastroenteritis (AGE).MethodsThe analysis utilized data from the IMPACT study, a prospective trial of the clinical impact of a multiplex PCR panel for detecting GI pathogens in AGE in five pediatric hospitals across the United States. From these data, we evaluated 72 potential predictors, including patient demographics, medical histories, exposures, symptoms, and vital signs. Using Random Forest Algorithm, 10 variables were selected based on variable importance measure. These were then entered into a Stepwise logistic regression model.ResultsOut of 962 patients there were 41 (4.3%) patients with protozoal detections, including 18 for Giardia and 24 for Cryptosporidium. Of these, 21 (51%) were male and the median age was 4.3 years old. Detection rates varied by site with 76% (31) of cases at two Midwestern sites. In 23 (56%) of cases protozoa was the sole pathogen detected. Logistic regression modeling of the top 10 variables identified by Random Forest showed the strongest predictor was living in a household with a child 5 years old or younger, followed by study site and younger age (table). Notably, travel, recreational water exposure, and duration of diarrhea were not in the top 10 variables identified. ConclusionOur analysis suggests that age and household exposure predict higher likelihood of protozoal infection in children with AGE. Classic epidemiologic exposures including travel and recreational water exposure were not predictive. These data could improve appropriate test selection. Future studies are still needed for external validation of this model.Disclosures A. Pavia, BioFire Dx: Investigator, Research support.

Predicting fractures in glacially related fine-grained materials and a synthetic soil of bentonite and sand using soil texture

Scientists and engineers from many disciplines have been studying the formation of fractures in fine-grained natural geologic materials and fill. Naturally occurring fractures in the fine-grained materials can create preferential flow paths, which can allow water to infiltrate quickly, resulting in recharge to underlying aquifers but also allowing contaminants to pass through to aquifers, potentially threatening ground water drinking water sources. They can also create zones of weakness that allow piping in dams and slip zones in fill materials. Glacially related fine-grained materials are widely distributed across the northern hemisphere, including the U.S. states of Minnesota, Wisconsin, Michigan, Iowa, Illinois, Indiana, and Ohio; Canada; and much of Northern Europe. It has been difficult to predict the presence of these fractures. The objective of this research was to analyze soil textures of fractured soils and determine boundary conditions for predicting the likelihood of fractures in similar materials, graphically representing the predictive model on the USDA soil texture ternary diagram. An extensive Midwestern U.S. data set (275 data points) including Ohio, Iowa, Michigan, and Wisconsin soil samples was studied. The texture data of those glacially related fine-grained materials containing fractures indicate that those with <79% sand and >6.5% clay can be predicted to support fractures. An auxiliary experiment using bentonite suggests that this predictive model may be applicable beyond the clay mineralogies common to the U.S. Midwest. This is a promising method of predicting which soil textures are most likely to form fractures, and can be a useful field tool for engineering geologists, soil scientists, and other environmental professionals. It is immediately applicable to the U.S. Midwestern sites, and with additional analyses using other soils, could be used more widely across glaciated North America and Northern Europe.

Genetic structure of winter populations of the endangered Indiana bat (Myotis sodalis) prior to the white nose syndrome epidemic: implications for the risk of disease spread

The spread of white nose syndrome raises serious concerns about the long-term viability of affected bat species. Here we examine the geographic distribution of genetic variation, levels of population connectivity that may influence the spatial spread of WNS, and the likelihood that recent population declines in regions affected by WNS have led to the loss of unique genetic variation for the endangered Indiana bat (Myotis sodalis). We amplified a fragment of the mitochondrial control region for 375 individuals and genotyped 445 individuals at 10 microsatellite loci from 18 sampling sites distributed across the majority of the species' range. Analysis of mitochondrial DNA indicated the presence of at least five distinct matrilineal clusters, with the most pronounced differences between northeastern sites and those in the rest of the range. The majority of individuals in the Ozark- Central, Midwest, and Appalachian recovery units fell into a single cluster. Significant differentiation also was observed between one Appalachian and one Midwestern site and the majority of other sites. However, using nuclear microsatellites we observed the absence of differentiation and widespread gene flow among all hibernacula, suggesting the occurrence of extensive gene flow through dispersal and mating. The absence of genetically distinct populations within the range of Indiana bats indicates a lack of barriers to WNS transmission, and it is unlikely that significant portions of the hibernating population of Indiana bats will remain disease free into the future. Further, while matrilineal gene flow was restricted among some sites and regions, we found no genetic evidence to support the division of Indiana bats into separate recovery units.

Gun crime incident reviews as a strategy for enhancing problem solving and information sharing

Over the last several decades, police departments and other criminal justice agencies have seen a shift toward a proactive problem-solving response to crime problems. This problem-solving orientation has often included an emphasis on expanded partnerships across criminal justice agencies as well as with a variety of community stakeholders, including researchers. This manuscript uses the issue of gun violence as a lens through which to examine the organizational and inter-organizational changes necessary to apply a data-driven, proactive, and strategic policing-led response to gun homicides and non-fatal shootings in four Midwestern sites. Each site adapted a unique data collection process and incident review. The data collection, incident reviews, and the varying models developed across the four cities, provide a reflection on corresponding organizational and inter-organizational changes that illuminate the movement toward this proactive, data-driven, problem-solving model of criminal justice. Fulfilling the promise of the incident reviews, however, requires internal organizational and cross-agency inter-organizational collaboration to align people, systems, and resources with this proactive, problem-solving model. Additionally, effectively implementing these organizational and inter-organizational changes appears dependent on commitment and leadership, collaboration and partnerships, data quality and availability, and training and communication within and across organizational boundaries.

Atmospheric amines and ammonia measured with a chemical ionization mass spectrometer (CIMS)

Abstract. We report measurements of ambient amines and ammonia with a fast response chemical ionization mass spectrometer (CIMS) in a southeastern US forest and a moderately polluted midwestern site during the summer. At the forest site, mostly C3-amines (from pptv to tens of pptv) and ammonia (up to 2 ppbv) were detected, and they both showed temperature dependencies. Aerosol-phase amines measured thermal-desorption chemical ionization mass spectrometer (TDCIMS) showed a higher mass fraction in the evening with cooler temperatures and lower in the afternoon with warmer temperatures, a trend opposite to the gas-phase amines. Concentrations of aerosol-phase primary amines measured with Fourier transform infrared spectroscopy (FTIR) from micron and submicron particles were 2 orders of magnitude higher than the gas-phase amines. These results indicate that gas to particle conversion is one of the major processes that control the ambient amine concentrations at this forest site. Temperature dependencies of C3-amines and ammonia also imply reversible processes of evaporation of these nitrogen-containing compounds from soil surfaces in daytime and deposition to soil surfaces at nighttime. During the transported biomass burning plume events, various amines (C1–C6) appeared at the pptv level, indicating that biomass burning is a substantial source of amines in the southeastern US. At the moderately polluted Kent site, there were higher concentrations of C1- to C6-amines (pptv to tens of pptv) and ammonia (up to 6 ppbv). C1- to C3-amines and ammonia were well correlated with the ambient temperature. C4- to C6-amines showed frequent spikes during the nighttime, suggesting that they were emitted from local sources. These abundant amines and ammonia may in part explain the frequent new particle formation events reported from Kent. Higher amine concentrations measured at the polluted site than at the rural forested site highlight the importance of constraining anthropogenic emission sources of amines.

Tomography-measured Macropore Parameters to Estimate Hydraulic Properties of Porous Media

A critical hydraulic parameter for geomedia is the saturated hydraulic conductivity. This property is needed in models for predicting water infiltration into soils and water runoff from landscapes. The objective of this study was to use computed tomography (CT)-measured macropore data to predict saturated hydraulic conductivity at four sites from several soil depths and multiple treatments. These core samples were removed from four Midwestern sites. Some study sites included soils developed in loess and glacial till as well as soils developed in deep loess. The four sites included treatments which evaluated different soil management relative to conservation programs with vegetative grasses and agroforestry treatments as well as restored and native prairies. The samples (76mm diam. by 76mm long) were scanned using a computed tomography scanner with 0.19 by 0.19 by 0.5mm resolution. CT-measured pore parameters included macroporosity (> 1000 μm diam.), coarse mesoporosity (200 to 1000 μm diam.), number of pores, circularity of pores, and fractal dimension of macroporosity. The log-transformed saturated hydraulic conductivity was best estimated using the logarithm of number of pores (r2 = 0.69). Results indicate that CT methods can be used as a characterization tool to assess soil pore properties for prediction of saturated hydraulic conductivity.

Differences in CAHPS Reports and Ratings of Health Care Provided to Adults and Children

Consumer assessment of health care is an important metric for evaluating quality of care. These assessments can help purchasers, health plans, and providers deliver care that fits patients' needs. To examine differences in reports and ratings of care delivered to adults and children and whether they vary by site. This observational study compares adult and child experiences with care at a large west coast medical center and affiliated clinics and a large mid-western health plan using Consumer Assessment of Healthcare Providers and Systems Clinician & Group 1.0 Survey data. Office staff helpfulness and courtesy was perceived more positively for adult than pediatric care in the west coast site. In contrast, more positive perceptions of pediatric care were observed in both sites for coordination of care, shared decision making, overall rating of the doctor, and willingness to recommend the doctor to family and friends. In addition, pediatric care was perceived more positively in the mid-west site for access to care, provider communication, and office staff helpfulness and courtesy. The differences between pediatric care and adult care were larger in the mid-western site than the west coast site. There are significant differences in the perception of care for children and adults with care provided to children tending to be perceived more positively. Further research is needed to identify the reasons for these differences and provide more definitive information at sites throughout the United States.

Abstract 164: The Impact Of Hemodynamic Factors On Stroke Risk In Moyamoya Phenomenon: A Prospective Natural History Study

Background: The natural history of moyamoya phenomenon is not well defined. Hemodynamic factors are likely involved in the risk of future stroke in these patients. The purpose of this study was to determine if severe hemodynamic impairment predicted stroke risk in patients with idiopathic moyamoya phenomenon. Methods: The study was a prospective, blindly-adjudicated, multicenter natural history study performed at five Midwestern sites. Inclusion criteria required unilateral or bilateral moyamoya phenomenon by catheter angiography and presumed idiopathic basal arterial occlusive disease. Baseline demographic and epidemiologic stroke risk factors, presenting symptoms (if any), and imaging findings were recorded on study entry. Baseline measurements of oxygen extraction fraction (OEF)were made using positron emission tomography. Hemodynamic impairment was determined by comparing the ratio of the left or right middle cerebral to cerebellar count-based OEF to normal control subjects. Those with values beyond the 95% confidence limit were considered increased. Subjects were followed for the occurrence of the primary endpoints, ischemic or hemorrhagic stroke. Follow up was done by phone interview at 6 month intervals and in person at one year. Outcome was analyzed on a per-hemisphere basis for patients with bilateral disease. The treated hemisphere was censored at the time of revascularization surgery for patients that underwent surgery. Surgery was allowed based on the discretion of treating physicians. The occurrence of stroke was adjudicated by an investigator blinded to hemodynamic status, based on records and imaging studies available at the time of the event. Results: Fifty subjects were recruited over a 5-year period and followed for a mean of 2.5 years. Mean age was 46 years. Sixteen were male. Forty had bilateral disease. Presenting symptoms were ischemic (39), hemorrhagic (5), seizure (2), headache (3) and none (2). A total of 15 patients (20 hemispheres) were censored, 4 of whom had increased OEF: 5 underwent bilateral and 10 unilateral revascularization procedures. Increased OEF was seen bilaterally in 7 (14%) and unilaterally in 8 patients (16%). Only 1 of the 15 patients with increased OEF suffered an ischemic stroke during follow-up. Two other endpoint events occurred, neither in hemispheres with increased OEF. One patient with bilateral disease and unilateral increased OEF suffered a hemorrhage one year after revascularization of the contralateral hemisphere. One patient with unilateral disease and normal OEF suffered a minor stroke 2 years after study entry. The annual risk for stroke in this cohort was 4.2%. Conclusions: The risk of stroke in this cohort of patients with moyamoya disease was very low relative to prior retrospective case series. Severe hemodynamic impairment was not associated with an increased risk of stroke.

An Analysis of Textile Fragments from the Janey B. Goode Site

Excavations at the Janey B.Goode site (11S1232), located in the American Bottom region of Illinois, yielded carbonized textile remains from two pit features dating to the Terminal Late Woodland period and from one pit feature dating to the Mississippian period. The remains comprise both twisted or braided cordage pieces and actual twined textile fragments ranging in size from 2×3 cm to over 9×9 cm. Four different twining techniques are represented: two types of compact twining and two types of space twining. All textiles appear to be constructed of bast fibers, probably from the outer part of herbaceous plant stems. The textiles are similar to those described from other Midwestern sites dating to the Woodland and Mississippian periods, reflecting the existence of a widespread fiber industry. In this paper, the textiles from the Janey B. Goode site and the production technology used to produce them are described.

Effects of Sulfur Dioxide and Oxides of Nitrogen Emission Reductions on Fine Particulate Matter Mass Concentrations: Regional Comparisons

Two thermodynamic equilibrium models were applied to estimate changes in mean airborne fine particle (PM2.5)mass concentrations that could result from changes in ambient concentrations of sulfate, nitric acid, or ammonia in the southeastern United States, the midwestern United States, and central California. Pronounced regional differences were found. Southeastern sites exhibited the lowest current mean concentrations of nitrate, and the smallest predicted responses of PM2.5 nitrate and mass concentrations to reductions of nitric acid, which is the principal reaction product of the oxidation of nitrogen dioxide (NO2) and the primary gas-phase precursor of fine particulate nitrate. Weak responses of PM2.5 nitrate and mass concentrations to changes in nitric acid levels occurred even if sulfate concentrations were half of current levels. The midwestern sites showed higher levels of fine particulate nitrate, characterized by cold-season maxima, and were projected to show decreases in overall PM levels following decreases of either sulfate or nitric acid. For some midwestern sites, predicted PM2.5 nitrate concentrations increased as modeled sulfate levels declined, but sulfate reductions always reduced the predicted fine PM mass concentrations; PM2.5 nitrate concentrations became more sensitive to reductions of nitric acid as modeled sulfate concentrations were decreased. The California sites currently have the highest mean concentrations of fine PM nitrate and the lowest mean concentrations of fine PM sulfate. Both the estimated PM2.5 nitrate and fine mass concentrations decreased in response to modeled reductions of nitric acid at all California sites. The results indicate important regional differences in expected PM2.5 mass concentration responses to changes in sulfate and nitrate precursors. Analyses of ambient data, such as described here, can be a key part of weight of evidence (WOE) demonstrations for PM2.5 attainment plans. Acquisition of the data may require special sampling efforts, especially for PM2.5 precursor concentration data.

Older Adults' Perceptions of Well-Being after Intergenerational Experiences with Youth

Drawing upon Ryff's (1995) positive dimensions of well-being in older adulthood, thisstudy investigated older adults' perceptions of well-being following participation in anintergenerational program. Specifically, we examined the relationship between age, years of volunteer service, and sense of well-being among older adults (n= 46; 55 to 100 years of age) participating in intergenerational programs at 10 sites in Midwestern, agriculturally based communities. Using a mixedmethods design, results revealed that olderadults perceive a heightened sense of well-being from intergenerational interactions wit youth. Older adults reported successful aging included staying active, not worrying aboutone's problems, feeling young, and keeping up with the children and community. Adults aged 74-85 experienced significantly greater satisfaction and enjoyment than their older counterparts, particularly in anticipating working with youth and positive self-perception. No relationship emerged between years of involvement in the program and well-being. Implications for research and program development are discussed.

Recruitment and Accrual of Women in a Placebo-Controlled Clinical Pilot Study on Manual Therapy

Objective To investigate the accrual rates and recruitment processes among 3 Midwestern sites during a pilot study on manual therapy for chronic pelvic pain. Design Multisite pilot study for a randomized, placebo-controlled clinical trial. Setting Three chiropractic institutions in or near major metropolitan cities in the Midwestern United States. Subjects Thirty-nine women aged 18 to 45 with chronic pelvic pain of at least 6 months duration, diagnosed by a board certified gynecologist. Main Outcome Measures The method of recruitment was collected for each individual who responded to an advertisement and completed an interviewer-administered telephone screen. Participants who were willing and eligible after 3 baseline visits were entered into a randomized clinical trial. The number of responses and accrual rates were determined for the overall study, each of the 3 treatment sites, and each of the 5 recruitment efforts. Results In this study, 355 women were screened over the telephone and 39 were randomized, making the rate of randomization approximately 10%. The most effective recruitment methods leading to randomization were direct mail (38%) and radio advertisements (34%). However, success of the recruitment process differed by site. Conclusions Based on the accrual of this multisite pilot study, a full-scale trial would not be feasible using this study's parameters. However, useful information was gained on recruitment effectiveness, eligibility criteria, and screening protocols among the 3 metropolitan sites.