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Chronicles the life of a former slave to James and Dolley Madison, tracing his early years on their plantation, his service in the White House household staff and post-emancipation achievements as a memoirist.

Purpose of Review We evaluated the impact of digital mental health interventions (DMHIs) for college students. We organized findings using the RE-AIM framework to include reach, effectiveness, adoption, implementation, and maintenance. Recent Findings We conducted a systematic literature review of recent findings from 2019–2024. Our search identified 2,701 articles, of which 95 met inclusion criteria. In the reach domain, student samples were overwhelmingly female and White. In the effectiveness domain, over 80% of DMHIs were effective or partially effective at reducing their primary outcome. In the adoption domain, studies reported modest uptake for DMHIs. In the implementation and maintenance domains, studies reported high adherence rates to DMHI content. While recruitment methods were commonly reported, adaptations and costs of implementation and maintenance were rarely reported. Summary DMHIs for college students are effective for many psychological outcomes. Future work should address diversifying samples and considering implementation in a variety of college settings.

Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) is one of the most widely used computerized neurocognitive assessment batteries in athletics and serves as both a baseline and postinjury assessment. It has become increasingly popular to administer the ImPACT baseline test in an unsupervised remote environment; however, whether the lack of supervision affects the test-retest reliability is unknown. To establish the minimal detectable change (MDC) of composite scores from the ImPACT test when administered to National Collegiate Athletic Association Division I student-athletes in an unsupervised remote environment before 2 consecutive athletic seasons. Cross-sectional study. Participants were provided with a unique link and detailed written instructions on how to complete the ImPACT test at home. Division I student-athletes. Remote baseline ImPACT results from the 2020-2021 and 2021-2022 athletic seasons were analyzed. The MDC was calculated at the 95%, 90%, and 80% CIs for each of the ImPACT composite scores as well as the average and SD. The MDC at the 95% CI was 18.6 for the verbal memory composite score, 24.44 for visual memory, 8.76 for visual motor, 0.14 for reaction time, and 6.13 for impulse control. One-way repeated-measures multivariate analysis of variance, repeated-measures analysis of variance, and Wilcoxon signed ranks tests suggested no difference in the composite scores and impulse control between time points. The ImPACT composite scores and impulse control did not change between the 2 remote testing time points when administered approximately 1 year apart. Our study suggests that the MDC serves as a clinician's guide for evaluating changes in ImPACT baseline scores and in making clinical judgments on sport-related concussion when the test is administered at home.

The influence of the menstrual cycle (MC) on the acute responses to endurance training remains unclear. This study aimed to investigate the effect of the MC on the physiological and perceptual responses to standardized low‐intenstiy continuous (LIT) and high‐intensity interval sessions (HIT). Naturally menstruating endurance‐trained women performed a standardized LIT (n = 23) and/or HIT (n = 23) session during the early‐follicular (EFP), ovulatory (OP), and mid‐luteal (MLP) phases of 2 MCs. Physiological (i.e., oxygen uptake (V˙$\\dot{V}$ O2), heart rate (HR), and blood lactate concentration (BLa)) and perceptual variables (i.e., rating of perceived exertion (RPE) and mood state) were measured. MC phases were determined using urinary ovulation kits and verified with serum hormone analysis. Non‐eumenorrheic MCs were excluded from analysis. During LIT and HIT, ventilation (VE) was higher in MLP than OP (p < 0.001) and BLa was slightly higher in EFP than OP (LIT, p = 0.004, HIT, p = 0.001). During HIT, V˙$\\dot{V}$ O2 (p = 0.025) and HR (p = 0.036) were slightly higher during MLP than OP. RPE was slightly higher in EFP than OP in the LIT (p = 0.036) and HIT (p < 0.001). Vigor (p < 0.001) and tension (p = 0.036) were highest in EFP. No phase by time interactions were observed for any of the outcome variables throughout either session type (p > 0.05). MC phase had a modest effect on several physiological and perceptual measures during LIT and HIT. However, the between‐phase differences were small and no clear trends emerged across variables to indicate that the overall demands of a LIT or HIT session would be substantially altered in any one particular MC phase. Highlights Several minor physiological and perceptual fluctuations were observed across the menstrual during the LIT and HIT sessions, including higher minute ventilation and/or oxygen uptake during the midluteal phase and higher ratings of perceived exertion during the early follicular phase. The magnitude of the between‐phase fluctuations observed across the menstrual cycle were small, directionally inconsistent, and unlikely to notably influence the overall demands of typical LIT and HIT sessions on a group level. The physiological and perceptual outcomes observed during both session types were misaligned, wherein slightly greater physiological demands appeared to emerge during the midluteal phase, whereas slightly greater perceptual effort was reported in the early follicular phase. It is unlikely that general endurance training recommendations need to be adjusted according to menstrual cycle phase, as the overall physiological/perceptual demands associated with these sessions do not appear to be substantially altered at the group‐level in any one specific phase. Individualized training modifications should be considered when necessary.

PurposePrevious studies have shown that individuals living in areas with persistent poverty (PP) experience worse cancer outcomes compared to those living in areas with transient or no persistent poverty (nPP). The association between PP and melanoma outcomes remains unexplored. We hypothesized that melanoma patients living in PP counties (defined as counties with ≥ 20% of residents living at or below the federal poverty level for the past two decennial censuses) would exhibit higher rates of incidence-based melanoma mortality (IMM).MethodsWe used Texas Cancer Registry data to identify the patients diagnosed with invasive melanoma or melanoma in situ (stages 0 through 4) between 2000 and 2018 (n = 82,458). Each patient’s PP status was determined by their county of residence at the time of diagnosis.ResultsAfter adjusting for demographic variables, logistic regression analyses revealed that melanoma patients in PP counties had statistically significant higher IMM compared to those in nPP counties (17.4% versus 11.3%) with an adjusted odds ratio of 1.35 (95% CI 1.25–1.47).ConclusionThese findings highlight the relationship between persistent poverty and incidence-based melanoma mortality rates, revealing that melanoma patients residing in counties with persistent poverty have higher melanoma-specific mortality compared to those residing in counties with transient or no poverty. This study further emphasizes the importance of considering area-specific socioeconomic characteristics when implementing place-based interventions to facilitate early melanoma diagnosis and improve melanoma treatment outcomes.

Introduction School policy can encourage sun safe habits, such as wearing hats and applying sunscreen. However, sun safety policies (SSP) have not been formally assessed for Texas independent school districts (ISDs), particularly in counties with the highest melanoma incidence relative risk (RR). This study aims to assess the presence, strength, and intent of SSPs across Texas ISDs located in counties with the highest and lowest melanoma incidence. We also identify factors correlated with stronger SSP. Methods Eleven components of SSPs from 102 ISDs were evaluated in this cross-sectional study by examining school district websites, official documents, social media, media appearances, statements by school officials, and the Texas Education Agency’s online database. Coders were trained to score each policy’s content, presence, and strength. Results Policies for sunscreen use and hats existed in 94% (n = 96) and 92% (n = 94) of ISDs, respectively. In counties with the highest melanoma incidence RR, 30% (n = 15) and 44% (n = 22) of ISDs allocated resources for sun safety and outdoor shade, compared to 2% (n = 1) and 3% (n = 2) in low-risk counties. No ISDs had SSPs on UV protective clothing, accountability, or modeling sun safety behaviors. SSP strength was positively correlated with percentage of school nurses (ρ = 0.564, P < 0.001), community median household income (ρ = 0.431, P < 0.001), percentage of female students (ρ = 0.461, P < 0.001), and tax rate (ρ = 0.366, P = 0.0002). Negative correlations were found with percentage of central staff administration (ρ = −0.523, P < 0.001) and graduation rates (ρ = −0.335, P < 0.001). Conclusion Our findings underscore the need for interventions to strengthen SSPs across Texas. Plain Language Summary Schools can play an important role in protecting students from the sun by allowing sunscreen use, permitting hats, and providing shade. However, Texas schools have not been formally evaluated for sun safety policies, especially in areas with the highest melanoma rates. In this study, we reviewed sun safety policies from 102 school districts in Texas, focusing on counties with the highest and lowest melanoma risk. We examined school websites, official documents, and other sources to assess the strength of these policies. We found that nearly all districts allowed sunscreen and hats, but very few provided resources for sun safety or outdoor shade. No schools had policies on UV-protective clothing, ensuring sun safety accountability, or modeling good sun protection behaviors. Stronger sun safety policies were correlated to factors like a higher percentage of school nurses, higher household income, and more female students. Weaker policies were associated with more central staff administrators and higher graduation rates. Our results highlight the need for better sun safety policies in Texas schools.

Background: Phosphine is a valuable fumigant to control pest populations in stored grains and grain products. However, recent studies indicate a substantial increase in phosphine resistance in stored product pests worldwide. Results: To understand the molecular bases of phosphine resistance in insects, we used RNA-Seq to compare gene expression in phosphine-resistant and susceptible laboratory populations of the red flour beetle, Tribolium castaneum. Each population was evaluated as either phosphine-exposed or no phosphine (untreated controls) in triplicate biological replicates (12 samples total). Pairwise analysis indicated there were eight genes differentially expressed between susceptible and resistant insects not exposed to phosphine (i.e., basal expression) or those exposed to phopshine (>8-fold expression and 90 % C.I.). However, 214 genes were differentially expressed among all four treatment groups at a statistically significant level (ANOVA, p< 0.05). Increased expression of 44 cytochrome P450 genes was found in resistant vs. susceptible insects, and phosphine exposure resulted in additional increases of 21 of these genes, five of which were significant among all treatment groups (p < 0.05). Expression of two genes encoding anti-diruetic peptide was 2- to 8-fold reduced in phosphine-resistant insects, and when exposed to phosphine, expression was further reduced 36- to 500-fold compared to susceptible. Phosphine-resistant insects also displayed differential expression of cuticle, carbohydrate, protease, transporter, and many mitochondrial genes, among others. Gene ontology terms associated with mitochondrial functions (oxidation biological processes, monooxygenase and catalytic molecular functions, and iron, heme, and tetrapyyrole binding) were enriched in the significantly differentially expressed dataset. Sequence polymorphism was found in transcripts encoding a known phosphine resistance gene, dihydrolipoamide dehydrogenase, in both susceptible and resistant insects. Phosphine-resistant adults also were resistant to knockdown by the pyrethroid deltamethrin, likely due to the increased cytochrome P450 expression. Conclusions:Overall, genes associated with the mitochondria were differentially expressed in resistant insects, and these differences may contribute to a reduction in overall metabolism and energy production and/or compensation in resistant insects. These data provide the first gene expression data on the response of phosphine-resistant and -susceptible insects to phosphine exposure, and demonstrate that RNA-Seq is a valuable tool to examine differences in insects that respond differentially to environmental stimuli.

Novel technologies, such as ecological momentary assessment (EMA) and wearable biosensor wristwatches, are increasingly being used to assess outcomes and mechanisms of change in psychological treatments. However, there is still a dearth of information on the feasibility and acceptability of these technologies and whether they can be reliably used to measure variables of interest. Our objectives were to assess the feasibility and acceptability of incorporating these technologies into dialectical behavior therapy and conduct a pilot evaluation of whether these technologies can be used to assess emotion regulation processes and associated problems over the course of treatment. A total of 20 adults with borderline personality disorder were enrolled in a 6-month course of dialectical behavior therapy. For 1 week out of every treatment month, participants were asked to complete EMA 6 times a day and to wear a biosensor watch. Each EMA assessment included measures of several negative affect and suicidal thinking, among other items. We used multilevel correlations to assess the contemporaneous association between electrodermal activity and 11 negative emotional states reported via EMA. A multilevel regression was conducted in which changes in composite ratings of suicidal thinking were regressed onto changes in negative affect. On average, participants completed 54.39% (SD 33.1%) of all EMA (range 4.7%-92.4%). They also wore the device for an average of 9.52 (SD 6.47) hours per day and for 92.6% of all days. Importantly, no associations were found between emotional state and electrodermal activity, whether examining a composite of all high-arousal negative emotions or individual emotional states (within-person r ranged from -0.026 to -0.109). Smaller changes in negative affect composite scores were associated with greater suicidal thinking ratings at the subsequent timepoint, beyond the effect of suicidal thinking at the initial timepoint. Results indicated moderate overall compliance with EMA and wearing the watch; however, there was no concurrence between EMA and wristwatch data on emotions. This pilot study raises questions about the reliability and validity of these technologies incorporated into treatment studies to evaluate emotion regulation mechanisms.

Melanoma currently ranks as the fifth leading cancer diagnosis and is projected to become the second most common cancer in the United States by 2040. Melanoma detected at earlier stages may be treated with less-risky and less-costly therapeutic options. This study aims to analyze temporal and spatial trends in melanoma incidence by stage at diagnosis (overall, early, and late) in Texas from 2000 to 2018, focusing on demographic and geographic variations to identify high-risk populations and regions for targeted prevention efforts. We used melanoma incidence data from all 254 Texas counties from the Texas Cancer Registry (TCR) from 2000 to 2018, aggregated by county and year. Among these, 250 counties reported melanoma cases during the period. Counties with no cases reported in a certain year were treated as having no cases. Melanoma cases were classified by SEER Summary Stage and stratified by the following four key covariates: age, sex, race and ethnicity, and stage at diagnosis. Incidence rates (IRs) were calculated per 100,000 population, and temporal trends were analyzed using joinpoint regression to determine average annual percentage changes (AAPCs) with 95% CIs for the whole time period (2000-2018), the most recent 10-year period (2009-2018), and the most recent 5-year period (2014-2018). Heat map visualizations were developed to assess temporal trends by patient age, year of diagnosis, stage at diagnosis, sex, and race and ethnicity. Spatial cluster analysis was conducted using Getis-Ord Gi* statistics to identify county-level geographic clusters of high and low melanoma incidence by stage at diagnosis. A total of 82,462 melanoma cases were recorded, of which 74.7% (n=61,588) were early stage, 11.3% (n=9,352) were late stage, and 14% (n=11,522) were of unknown stage. Most cases were identified as males and non-Hispanic White individuals. Melanoma IRs increased from 2000 to 2018, particularly among older adults (60+ years; AAPC range 1.20%-1.84%; all P values were <.001), males (AAPC 1.59%; P<.001), and non-Hispanic White individuals (AAPC of 3.24% for early stage and 2.38% for late stage; P<.001 for early stage and P = .03 for late state). Early-stage diagnoses increased while the rates of late-stage diagnoses remained stable for the overall population. The spatial analysis showed that urban areas had higher early-stage incidence rates (P=.06), whereas rural areas showed higher late-stage incidence rates (P=.05), indicating possible geographic-based differences in access to dermatologic care. Melanoma incidence in Texas increased over the study time period, with the most-at-risk populations being non-Hispanic White individuals, males, and individuals aged 50 years and older. The stable rates of late-stage melanoma among racial and ethnic minority populations and rural populations highlight potential differences in access to diagnostic care. Future prevention efforts may benefit from increasing access to dermatologic care in areas with higher rates of late-stage melanoma at diagnosis.

The wide availability of web-based sources, including social media (SM), has supported rapid, widespread dissemination of health information. This dissemination can be an asset during public health emergencies; however, it can also present challenges when the information is inaccurate or ill-informed. Of interest, many SM sources discuss cancer, specifically cutaneous melanoma and keratinocyte cancers (basal cell and squamous cell carcinoma). Through a comprehensive and scoping review of the literature, this study aims to gain an actionable perspective of the state of SM information regarding skin cancer diagnostics, prognostics, and prevention. We performed a scoping literature review to establish the relationship between SM and skin cancer. A literature search was conducted across MEDLINE, Embase, Cochrane Library, Web of Science, and Scopus from January 2000 to June 2023. The included studies discussed SM and its relationship to and effect on skin cancer. Through the search, 1009 abstracts were initially identified, 188 received full-text review, and 112 met inclusion criteria. The included studies were divided into 7 groupings based on a publication's primary objective: misinformation (n=40, 36%), prevention campaign (n=19, 17%), engagement (n=16, 14%), research (n=12, 11%), education (n=11, 10%), demographics (n=10, 9%), and patient support (n=4, 3%), which were the most common identified themes. Through this review, we gained a better understanding of the SM environment addressing skin cancer information, and we gained insight into the best practices by which SM could be used to positively influence the health care information ecosystem.