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School readiness during early childhood is crucial for future academic success. Existing guidelines recommend a comprehensive approach. This concurrent validation study developed a School Readiness Index (SRI) with five readiness domains: early learning skills, approach to learning, cognitive skills, socioemotional development, and physical health. Through a cross-sectional comparative design, the school readiness skills of 119 Puerto Rican children (63 males, 56 females) aged 54–65 months were assessed using standardized tests (e.g., Batería IV Woodcock-Muñoz and NIH Toolbox Cognition Battery), parental questionnaires (e.g., Ages and Stages Questionnaire-3), and physical health assessments. Each measure was scored and classified using a binary coding system (0 and 1) based on participant abilities (e.g., 1 for expected performance, 0 if below expectations). A composite SRI score was calculated using 25 indicators. Discriminant validity was assessed by comparing children’s registration status in the special education program (SEP). Sex, household income, and maternal education are key determinants of school readiness. Children registered in the SEP had significantly lower composite scores than those not registered, supporting the SRI’s discriminant validity. The SRI is a reliable tool for identifying Hispanic children from Puerto Rico who may benefit from additional support. Inclusive and multidisciplinary assessment strategies are essential.

Serum albumin measurement is an important parameter routinely evaluated in clinical biochemistry within the livestock industry. It plays a crucial role in assessing the nutritional and health status of animals, as well as in aiding the diagnosis of various pathological conditions as a complementary tool. Several laboratory methods are available for albumin measurement; however, some methods have been documented to overestimate the concentration of serum albumin versus the proposed gold standard of serum protein electrophoresis. The primary aim of the study was to analyze the agreement between albumin measurement in bovine serum samples by the capillary zone electrophoresis (CZE), agarose gel electrophoresis (AGE), bromocresol green (BCG), and purple (BCP) methods. In addition, AGE and CZE methods were also compared for quantitation of globulin fractions. Lastly, reference intervals were established using all methods using the American Society for Veterinary Clinical Pathology (ASVCP) guidelines. Serum samples from 55 clinically normal Brangus cattle (5 ± 1.5 years old) were examined by the four methods. For the albumin method comparison, all methods were significantly correlated ( r  = 0.55–0.91, p  < 0.0001) and the bias between methods ranged from 0.01–0.22 g/dL. For AGE and CZE methods, all protein fractions were significantly correlated ( r  = 0.85–0.91, p  < 0.0001) except for the alpha 1 fraction ( r  = 0.21, p  = 0.12). Five fractions were quantitated using AGE method: albumin, alpha 1, alpha 2, beta, and gamma globulins. For the CZE method, six fractions were resolved with the sub fractionation of beta 1 and beta 2 globulin fractions. The evaluated methods showed good agreement in determining albumin levels in cattle. Although CZE offers higher resolution, it requires careful interpretation and precise definition of fractions. Therefore, methodological choice and consideration of analyzer-specific reference intervals are essential for accurate results.

Background In order to address disparities in preventable chronic diseases, we adapted a nutrition and lifestyle-focused shared medical appointment (SMA) program to be delivered in an underserved community setting. The objective was to evaluate a community-based nutrition and lifestyle-focused SMA as it relates to acceptability and health and behavior-related outcomes. Methods A mixed-methods study was performed to evaluate pre-post changes in wellness indices, biometrics, self-efficacy, and trust in medical researchers as part of a community-based SMA. To understand program acceptability including barriers and facilitators for implementation and scalability, we conducted two participant focus groups and five stakeholder interviews and used content analysis to determine major themes. Results Fifteen participants attended 10 weekly sessions. The majority were older adult, African American women. There were pre-post improvements in mean [SD] systolic (-10.5 [7.7] mmHg, p  = 0.0001) and diastolic (-4.7 [6.7] mmHg, p  = 0.17) blood pressures and weight (-5.7 [6.3] pounds, p  = 0.003) at 3 months though these were not significant at 6 months. More individuals reported improvements in health status, daily fruit and vegetable intake, and sleep than at baseline. There were no significant pre-post changes in other wellness indices, self-efficacy, trust in medical researchers, hemoglobin A1c, insulin, or LDL cholesterol. Participants discussed positive health changes as a result of the SMA program, program preferences, and facilitators and barriers to continuing program recommendations in focus groups. SMA implementation was facilitated by clinical staff who adjusted content to a low health literacy group and partnership with a trusted community partner. Sustainability barriers include heavy personnel time and in-kind resources to deliver the program. Conclusions Nutrition and lifestyle-focused SMAs in a resource-challenged community setting may be an acceptable intervention for underserved patients.

A recent floristic survey in the Pacific slope of the Talamanca Mountain (Costa Rica), has revealed a new species of Rhodospatha , characterised by a bracteolate inflorescence. We describe and fully illustrate Rhodospatha rubrinervis from the Cloudbridge Nature Reserve. A detailed taxonomic description, as well as its distribution, ecology, phenology and conservation assessment are provided, along with a comparative discussion of its morphological affinities with R. forgetii and R. wendlandii . In addition, we present a brief discussion on the presence of a bracteole in Rhodospatha , a morphological character that, although illustrated by H.W. Schott 160 years ago, has not previously been described in detail.

ObjectiveTo compare outcomes and costs associated with functional medicine-based care delivered in a shared medical appointment (SMA) to those delivered through individual appointments.DesignA retrospective cohort study was performed to assess outcomes and cost to deliver care to patients in SMAs and compared with Propensity Score (PS)-matched patients in individual appointments.SettingA single-centre study performed at Cleveland Clinic Center for Functional Medicine.ParticipantsA total of 9778 patients were assessed for eligibility and 7323 excluded. The sample included 2455 patients (226 SMAs and 2229 individual appointments) aged ≥18 years who participated in in-person SMAs or individual appointments between 1 March 2017 and 31 December 2019. Patients had a baseline Patient-Reported Outcome Measurement Information System (PROMIS) Global Physical Health (GPH) score and follow-up score at 3 months. Patients were PS-matched 1:1 with 213 per group based on age, sex, race, marital status, income, weight, body mass index, blood pressure (BP), PROMIS score and functional medicine diagnostic category.Primary and secondary outcome measuresThe primary outcome was change in PROMIS GPH at 3 months. Secondary outcomes included change in PROMIS Global Mental Health (GMH), biometrics, and cost.ResultsAmong 213 PS-matched pairs, patients in SMAs exhibited greater improvements at 3 months in PROMIS GPH T-scores (mean difference 1.18 (95% CI 0.14 to 2.22), p=0.03) and PROMIS GMH T-scores (mean difference 1.78 (95% CI 0.66 to 2.89), p=0.002) than patients in individual appointments. SMA patients also experienced greater weight loss (kg) than patients in individual appointments (mean difference −1.4 (95% CI −2.15 to −0.64), p<0.001). Both groups experienced a 5.5 mm Hg improvement in systolic BP. SMAs were also less costly to deliver than individual appointments.ConclusionSMAs deliver functional medicine-based care that improves outcomes more than care delivered in individual appointments and is less costly to deliver.

New alternative laboratory means are needed to improve the options for antemortem diagnosis of avian aspergillosis. In this study, 3-hydroxybutyrate was measured in plasma samples collected from a cohort of African penguins (Spheniscus demersus) maintained under human care. Results were interpreted in combination with those of protein electrophoresis and compared with anti-Aspergillus antibody and galactomannan antigen detection. Overall, 3-hydroxybutyrate levels were found significantly increased in Aspergillus-diseased cases versus the control penguin group (P = 0.002). Mean absolute concentration of β-globulins was increased >20% in samples from infected birds, and α2-globublins were also found to be significantly increased versus clinically normal controls (P < 0.001 and P = 0.001 respectively). Of note, the α2-globulins were also significantly increased versus penguins with inflammatory (non-aspergillosis) diseases (P = 0.001). The specificity of 3-hydroxybutyrate, β-globulins, and α2-globulins for aspergillosis was 78.6%, 79.6%, and 92.2%, respectively. Using these measures in tandem resulted in high specificity (>90%) and negative predictive value (≥80%). In contrast, anti-Aspergillus antibody and galactomannan antigen did not distinguish between infected cases and controls (P > 0.05). This study demonstrates that basic testing in tandem with the new biomarker 3-hydroxybutyrate may provide reliable evidence for the diagnosis of aspergillosis in penguins.

Background Prenatal exposure to the Zika virus can lead to microcephaly and adverse developmental outcomes, even in children without evident birth defects. The social environment plays a crucial role in infant health and developmental trajectories, especially during periods of heightened brain plasticity. The study aimed to assess socioenvironmental factors as predictors of developmental outcomes of 36-month-old children exposed to Zika virus prenatally. Study design This cross-sectional study included 53 mothers and 55 children enrolled in the Pediatric Outcomes of Prenatal Zika Exposure cohort study in Puerto Rico. The study performs follow-up developmental assessments of children born to mothers with confirmed and probable Zika virus infection during pregnancy. Mothers completed socioenvironmental questionnaires (e.g., Perceived Neighborhood Scale and US Household Food Insecurity Survey). Children’s developmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development: Third Edition, the Ages and Stages Questionnaires: Third Edition, the Ages and Stages Questionnaire-Socioemotional: Second Edition, and the Child Adjustment and Parent Efficacy Scale. Results Linear regression models, adjusting for a child’s sex and age and maternal education, revealed that early life exposure to food insecurity and maternal pregnancy stressors were significantly associated with poorer developmental outcomes in Zika virus-exposed children at 36 months of age. Maternal resilience representation of adaptive ability was associated with the preservation of adequate developmental outcomes in children. Conclusions Pregnancy and early childhood are critical life periods for ensuring optimal brain development in children. While the mechanisms in the interaction of children with their environment are complex, the risk and protective factors identified in the study are modifiable through public policy and preventive initiatives. Implementation of comprehensive strategies that improve access to social support programs, educational and nutritional interventions, and mental health services during pregnancy and early childhood can enhance the developmental potential of vulnerable children.

Previous studies support the possible application of galactomannan, a major antigen of Aspergillus sp., to aspergillosis diagnosis in avian and other animal species. An assay is commercially available for use with human serum and bronchoalveolar lavage fluid samples. In the current study, galactomannan results from plasma samples were compared between birds with histologically confirmed aspergillosis and those that were clinically normal presumptively non-Aspergillus infected birds per submitting practitioners' responses to a questionnaire. It was observed that infected birds demonstrated a 2.6-fold increase in galactomannan over birds without evidence of aspergillosis. With the use of a galactomannan index of 0.5 as a cutoff, the sensitivity and specificity of the test were found to be 67% and 73%, respectively. In addition, plasma samples were analyzed for abnormalities in protein electrophoretic patterns. Infected birds had a higher incidence of increased beta and/or gamma globulin concentrations. Test sensitivity and specificity were 73% and 70%, respectively. If the 2 tests were used as a panel, then the sensitivity was 89% and specificity was 48%. These data indicate that both galactomannan and protein electrophoresis may be valuable tools in the diagnosis of avian aspergillosis.

The acute phase response is an important component of the early reaction of the immune system to insults including infection, inflammation, trauma, neoplasia, and stress. Acute phase proteins are valuable prognostic indicators in many mammalian species but have been poorly studied in reptiles thus far. This study examined 18 paired samples from loggerhead sea turtles (Caretta caretta) for changes observed during the rehabilitation period. Analyses performed included packed cell volume (PCV), hemoglobin binding protein, and plasma protein electrophoresis. Significant differences were observed in all of the protein electrophoresis values. Notably, the concentration of hemoglobin binding protein (as determined by a haptoglobin assay) increased in conjunction with rising total protein (by refractometry) and PCV. The results indicate that this assay may have the potential to be a useful tool in assessing the health of sea turtles.

PurposeBardet-Biedl Syndrome (BBS) is an autosomal recessive disorder characterized by pleiotropism that affects multiple organ systems. The primary features of BBS include rod-cone dystrophy, renal anomalies, post axial polydactyly, and neurologic deficits. The clinical picture of BBS is extensively heterogenous, with inter and intra familial patients varying in levels of syndromic manifestations and severity of symptoms. MethodsIn this study we examined a monocular BBS patient who was compound heterozygous for mutations in the ARL6 (BBS3) gene.ResultsThe patient reported visual complaints consistent with a clinical picture of cone or cone-rod dystrophy. Fundus imaging showed retinal mottling on color photos and a parafoveal hyperfluorescent ring on short wave autofluorescence (SW-AF). Full field electroretinogram (ffERG) revealed normal scotopic step tracings and diminished amplitudes in the photopic steps.ConclusionThis rod-sparing result was consistent with cone-dystrophy and is the first known case of a rod-sparing ffERG phenotype in a BBS patient with mutations in the ARL6 gene. This contributes to the existing phenotype and may potentially contribute to furthering our understanding of BBS pathophysiology.