Captive rhesus macaques sometimes exhibit undesirable abnormal behaviors, such as motor stereotypic behavior (MSB) and self-abuse. Many risk factors for these behaviors have been identified but the list is far from comprehensive, and large individual differences in rate of behavior expression remain. The goal of the current study was to determine which experiences predict expression of MSB and self-biting, and if individual differences in personality can account for additional variation in MSB expression. A risk factor analysis was performed utilizing data from over 4,000 rhesus monkeys at the California National Primate Research Center. Data were analyzed using model selection, with the best fitting models evaluated using Akaike Information Criterion. Results confirmed previous research that males exhibit more MSB and self-biting than females, MSB decreases with age, and indoor reared animals exhibit more MSB and self-biting than outdoor reared animals. Additionally, results indicated that animals exhibited less MSB and self-biting for each year spent outdoors; frequency of room moves and number of projects positively predicted MSB; pair separations positively predicted MSB and self-biting; pair housed animals expressed less MSB than single housed and grate paired animals; and that animals expressed more MSB and self-biting when in bottom rack cages, or cages near the room entrance. Based on these results we recommend limiting exposure to these risk factors when possible. Our results also demonstrated a relationship between personality and MSB expression, with animals low on gentle temperament, active in response to a human intruder, and high on novel object contact expressing more MSB. From these results we propose that an animal’s MSB is related to its predisposition for an active personality, with active animals expressing higher rates of MSB.

The human intruder test is a testing paradigm designed to measure rhesus macaques’ behavioral responses to a stressful and threatening situation. In the test, an unfamiliar human positions him/herself in various threatening positions relative to a caged macaque. This paradigm has been utilized for over twenty years to measure a variety of behavioral constructs, including fear and anxiety, behavioral inhibition, emotionality, and aggression. To date there have been no attempts to evaluate comprehensively the structure of the behavioral responses to the test. Our first goal was to identify the underlying latent factors affecting the different responses among subjects, and our second goal was determine if rhesus reared in different environments respond differently in this testing paradigm. To accomplish this, we first performed exploratory and confirmatory factor analyses on the behavioral responses of 3–4 month-old rhesus macaques, utilizing data from over 2,000 separate tests conducted between 2001–2007. Using the resulting model, we then tested to see whether early rearing experience affected responses in the test. Our first analyses suggested that most of the variation in infant behavioral responses to the human intruder test could be explained by four latent factors: “Activity,” “Emotionality,” “Aggression,” and “Displacement.” Our second analyses revealed a significant effect of rearing condition for each factor score (P < 0.001); most notable socially-reared animals had the lowest Activity score (P < 0.001), indoor mother-reared animals had the highest Displacement score (P < 0.001), and nursery-reared animals had the highest Emotionality (P < 0.001) and lowest Aggression scores (P < 0.001). These results demonstrate that this standardized testing paradigm reveals multiple patterns of response, which are influenced by an animal’s rearing history.

Rhesus macaques (Macaca mulatta) housed indoors experience many routine husbandry activities on a daily basis. The anticipation of these events can lead to stress, regardless of whether the events themselves are positive or aversive in nature. The specific goal of this study was to identify whether increasing the predictability of husbandry events could decrease stress and anxiety in captive rhesus macaques. This study was conducted on 39 single-housed subjects in four indoor rooms at the Oregon National Primate Research Center. Temporal and signaled predictability were added to four daily husbandry events: morning and afternoon feeding, enrichment distribution, and room cleaning. Temporally predictable husbandry events occurred reliably at the same time daily, while signaled predictable husbandry events were preceded by a distinct event-specific signal in the form of a doorbell. Informal tests prior to study onset found the doorbells not to be aversive to the subjects. Subjects received each of four treatments: unpredictable events, temporally predictable events, signaled predictable events, and temporally and signaled predictable events. Change in stress was evaluated by monitoring changes in motor stereotypies and displacement behaviors. Our results showed that subjects displayed less stress and anticipatory behaviors related to feeding and enrichment events when the events were temporally predictable (P < 0 .0001). When husbandry events were preceded by a reliable signal, subjects vocalized less prior to the event and were less responsive to activity outside of the room (P < 0 .01). However this may have come at a cost as the animals were extremely reactive to the doorbell signals and showed a heightened stress response during the actual husbandry events (P < 0 .01). Similar to temporal predictability alone, when temporal predictability was combined with signaled predictability subjects displayed less stress and anticipatory behaviors related to feeding and enrichment events (P < 0 .0001). In addition, when both forms of predictability were combined subjects showed less stress behaviors while waiting for daily room cleaning (P < 0 .01). When signaled predictability was paired with temporal predictability subjects no longer had the negative response to the doorbell signal, as they were able to predict and anticipate when the events would occur. Because these results are not necessarily applicable to animals that are given control over their environment or housed in a group setting, the management recommendation that can be made from this study is that temporal predictability of feeding reduces stress and anxiety and is thus beneficial to captive indoor single-housed rhesus macaques.

A patient-centered health system needs precise computable measurements to derive value. While validated patient-reported outcomes (PROs) are increasingly used in trials, their adoption in care remains limited and generally separated from the medical record. Further, absence of systematic processes for patient-led data submission excludes valuable data from digital devices that can potentially aid in contextualizing health status. With prior experience in developing apps for the Patient-Reported Outcomes Measurement Information System (PROMIS), we sought to make collecting patient-generated health data (PGHD) a fundamental property of health information technology at scale, and in an interoperable, standards-compliant fashion. We build upon the open SMART on FHIR (Fast Health Interoperability Resources) specification to create SMART Markers-a mobile device software framework encapsulating functionality needed for rapid deployment of both patient-and practitioner-facing PGHD apps. We refactored previously developed PROMIS apps to use SMART Markers for handling PGHD-request creation, on-device administration, and generation of a variety of PGHD types and submission of results to a FHIR server. Validation and conformance tests were performed on the generated output and app-reusability was demonstrated across two demo servers. App developers can import SMART Markers into their existing or new apps to readily leverage an interoperable PGHD capturing functionality out of the box, without having to reinvent the wheel. Our approach enables the creation of health system integrated, context-specific experiences for both patients and practitioners.

Full body repetitive behaviors, known as motor stereotypic behaviors (MSBs), are one of the most commonly seen abnormal behaviors in captive non-human primates, and are frequently used as a behavioral measure of well-being. The main goal of this paper was to examine the role of environmental factors (i.e., foraging enrichment and socialization) and intrinsic factors (i.e., temperament and origin) in the development of MSB in rhesus macaques living in cages. MSB was assessed during short annual observations in which a trained observer recorded a monkey’s behavior for 5 min, followed by a 3-min novel object test. Data were collected over 11 years, totaling 9805 observations. We compared MSB for animals with and without foraging enrichment, and across three socialization conditions: full contact pairing, protected contact socialization (partners physically separated by widely spaced bars), and single housing. In addition, we evaluated whether individual differences in response to a novel object and ancestral origin (i.e., China vs. India), predicted MSB expression during the annual observations. Data were analyzed using generalized mixed effects modeling, with the best fitting models chosen using Akaike Information Criterion. Subjects were at lowest risk for MSB when a foraging device was present (p < 0.05), and when in full contact social housing (p < 0.001). There was no statistically significant difference in MSB between subjects that were single housed and subjects housed in protected contact pairs. In addition, subjects that never touched the novel object were significantly less likely to exhibit MSB than those that touched the object immediately (p < 0.001) or within 3 min (p < 0.001). Finally, monkeys with some degree of Chinese ancestry were significantly more likely to display MSB than Indian-origin monkeys (p < 0.05). These results add to the growing body of literature on factors that can contribute to the development of MSB.

Previous studies of nonhuman primates have found relationships between health and individual differences in personality, behavior, and social status. However, despite knowing these factors are intercorrelated, many studies focus only on a single measure, for example, rank. Consequently, it is difficult to determine the degree to which these individual differences are independently associated with health. The present study sought to untangle the associations between health and these individual differences in rhesus macaques (Macaca mulatta). We studied 85 socially housed macaques at the Oregon and California National Primate Research Centers, and used veterinary records to determine the number of injuries and illnesses for each macaque. We measured personality using 12 items from a well-established primate personality questionnaire, performed focal observations of behaviors, and calculated dominance status from directional supplant data. All twelve personality questionnaire items were reliable and were used to represent five of the six personality dimensions identified in rhesus macaques-Dominance, Confidence, Openness, Anxiety, and Friendliness (also known as Sociability). Following this, we fit generalized linear mixed effects models to understand how these factors were associated with an animal's history of injury and history of illness. In the models, age was an offset, facility was a random effect, and the five personality dimensions, behavior, sex, and dominance status were fixed effects. Number of injuries and illnesses were each best represented by a negative binomial distribution. For the injury models, including the effects did improve model fit. This model revealed that more confident and more anxious macaques experienced fewer injuries. For the illness models, including the fixed effects did not significantly improve model fit over a model without the fixed effects. Future studies may seek to assess mechanisms underlying these associations.

The 21st Century Cures Act requires that certified health information technology have an application programming interface (API) giving access to all data elements of a patient’s electronic health record, “without special effort”. In the spring of 2020, the Office of the National Coordinator of Health Information Technology (ONC) published a rule—21st Century Cures Act Interoperability, Information Blocking, and the ONC Health IT Certification Program—regulating the API requirement along with protections against information blocking. The rule specifies the SMART/HL7 FHIR Bulk Data Access API, which enables access to patient-level data across a patient population, supporting myriad use cases across healthcare, research, and public health ecosystems. The API enables “push button population health” in that core data elements can readily and standardly be extracted from electronic health records, enabling local, regional, and national-scale data-driven innovation.

Reference growth studies of captive rhesus macaque infants have not accounted for diarrhea and the potential for growth stunting or growth faltering. Healthy infants without diarrhea could be used to build a standard growth chart and a tool used to detect growth faltering associated with diarrhea. We hypothesized infants who develop diarrhea during the first year of life would experience decreased linear weight gain compared to healthy infants, and we used healthy infants to establish standard growth of male and female infants. We hypothesized the lower 3rd percentile of standard growth would be cut-off criteria used in screening for diarrhea-associated growth faltering. Using a retrospective cohort of 6510 infant weight records in a multiple linear regression, daily weight gain through the first year of life was determined by sex, housing type, and health status. Male standard growth was 4.1 g/day (95% CI: 4.0 – 4.2 g/day) in corrals and 4.7 g/day (95% CI: 4.5 – 4.8 g/day) in shelter housing. Female standard growth was 4.0 g/day (95% CI: 3.8 – 4.2 g/day) in corrals and 4.4 g/day (95% CI: 4.0 – 4.7 g/day) in shelter housing. Diarrhea was significantly associated with decreased linear weight gain by up to 34% during the first year of life. Odds of growth faltering of infants, defined as those falling below the 3rd percentile of standard growth, were at least 8.9 higher given a history of diarrhea compared to healthy. The growth faltering cut-off criteria had a sensitivity of at least 53% for males and females to screen for diarrhea in infants between 6 and 12 months in shelters housing. Interinstitutional collaborations of infant rhesus macaque weight records would refine the standard growth charts and cut-off criteria, and additional morphometric data would provide a more nuanced picture of growth stunting