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This essay argues that Jessie Redmon Fauset's debut novel There is Confusion sets the terms by which Black women would go on to challenge the formidable color line of twentieth-century dance. The 1924 text dramatizes the exercise of feminine performance to arbitrate between competing doctrines of race essentialism by centering on the figure of the aloof yet laboring ballerina of color. Fauset ultimately presents her heroine's thinking as a kind of body to emphasize the conditions of mental work Black women have been forced to endure in the modernist period as in our own. [ABSTRACT FROM AUTHOR]

Reservation-dwelling American Indian adolescents are at exceedingly high risk for cannabis use. Prevention initiatives to delay the onset and escalation of use are needed. The risk and promotive factors approach to substance use prevention is a well-established framework for identifying the timing and targets for prevention initiatives. This study aimed to develop predictive models for the usage of cannabis using 22 salient risk and promotive factors. Models were developed using data from a cross-sectional study and further validated using data from a separate longitudinal study with three measurement occasions (baseline, 6-month follow-up, 1-year follow-up). Application of the model to longitudinal data showed an acceptable performance contemporaneously but waning prospective predictive utility over time. Despite the model's high specificity, the sensitivity was low, indicating an effective prediction of non-users but poor performance in correctly identifying users, particularly at the 1-year follow-up. This divergence can have significant implications. For example, a model that misclassifies future adolescent cannabis use could fail to provide necessary intervention for those at risk, leading to negative health and social consequences. Moreover, supplementary analysis points to the importance of considering change in risk and promotive factors over time. [ABSTRACT FROM AUTHOR]

Despite providing essential ecosystem services, wetlands are one of the most threatened ecosystems worldwide. Revegetation of wetlands is a critical aspect of restoring ecosystem services, yet little is known about common practices, the challenges managers face, or what resources they require to improve revegetation outcomes. We assessed current revegetation practices, obstacles, and potential solutions by surveying wetland managers in the Intermountain West of the United States, a vast, ecologically diverse region containing hundreds of millions of hectares of public lands. Survey results indicate that managers revegetate wetlands for erosion control, invasion resistance, enhanced wildlife habitat, and improved water quality despite small budgets and limited personnel. Drought, invasive species, and the timing and availability of water are the biggest ecological challenges that managers face and point to the need to prioritize wetland revegetation research to improve revegetation practices in a changing climate with dwindling water resources. Additionally, access to genetically‐ and species‐diverse native plant materials is a concern for many managers. To address these challenges, managers need additional financial and human resources, accessible information relating to revegetation methods, and greater collaboration with research institutions and native plant vendors. Our findings underscore the need for funding entities to prioritize money for wetland revegetation efforts, a natural resource management area that has been neglected relative to many other ecosystems. The results of this study provide insight into challenges and potential solutions for wetland revegetation in regions of the world, such as the western United States, where increasing water scarcity threatens wetlands and their restoration. [ABSTRACT FROM AUTHOR]

As the U.N. Decade on Restoration progresses, the demand for genetically and species‐diverse native plant materials for restoration is expected to increase. However, little is known about the availability of plant materials for restoration, particularly in wetlands, which have lagged behind in restoration research. Given the crucial role wetlands play in providing ecosystem services, particularly in semi‐arid regions worldwide, it is important to understand the availability of wetland plant materials for restoration. We surveyed plant material vendors in the Intermountain West of the United States, a vast region containing hundreds of millions of hectares of private working lands and protected areas. We sought to determine the breadth and diversity of species and materials available for restoration, the practices used by vendors, and the challenges they face. We found far lower availability of aquatic, emergent, and meadow wetland species compared to riparian and terrestrial species. To improve species availability, vendors need financial incentives to produce new or difficult‐to‐propagate species and clearer feedback from customers on what species meet their restoration goals. Market fluctuations are the biggest challenge that vendors face, and creating consistent demand is the most important way to overcome this challenge. Overall, vendors follow best practices for obtaining and maintaining genetic diversity in their seed and plant collections, a critical component to meeting restoration goals. However, there are still some opportunities to improve best practices. The results add to the understanding of the challenges in meeting plant material demand for restoration in wetlands regionally and globally. [ABSTRACT FROM AUTHOR]

We are beginning to accept and address the role that medicine as an institution played in legitimizing scientific racism and creating structural barriers to health equity. There is a call for greater emphasis in medical education on explaining our role in perpetuating health inequities and educating learners on how bias and racism lead to poor health outcomes for historically marginalized communities. Diversity, equity, and inclusion (DEI; also referred to as EDI) and antiracism are key parts of patient care and medical education as they empower health professionals to be advocates for their patients, leading to better health care outcomes and more culturally and socially humble health care professionals. The Liaison Committee on Medical Education has set forth standards to include structural competency and other equity principles in the medical curriculum, but medical schools are still struggling with how to specifically do so. Here, we highlight a stepwise approach to systematically developing and implementing medical educational curriculum content with a DEI and antiracism lens. This article serves as a blueprint to prepare institution leadership, medical faculty, staff, and learners in how to effectively begin or scale up their current DEI and antiracism curricular efforts. [ABSTRACT FROM AUTHOR]

The links between chronic kidney disease (CKD) and cardiac conditions such as coronary heart disease or valvular disease are well established in the literature. However, the relationship between hypertrophic cardiomyopathy (HCM) and CKD is not as frequently described or researched. HCM is the most common form of inherited cardiac disease. It is mainly transmitted in an autosomal dominant fashion and caused by mutations in genes encoding sarcomere proteins. HCM is estimated to affect 0.2% of the general population and has an annual mortality rate of between approximately 0.5 and 1%. Our review article aims to summarize the genetics of HCM; discuss the potential clinical mimics that occur concurrently with HCM and CKD, potential interlinks that associate between these two conditions, the role of renal dysfunction as a poor prognostic indicator in HCM; and based on currently available evidence, recommend a management approach that may be suitable when clinicians are faced with this clinical scenario. [ABSTRACT FROM AUTHOR]

This article discusses a case of relapsed membranous nephropathy (MN) in a 63-year-old woman who had previously been treated with rituximab. MN is a kidney disease characterized by the presence of autoantibodies against the phospholipase A2 receptor (PLA2R). Typically, relapse is indicated by a rise in PLA2R autoantibody titers, but in this case, the patient experienced a relapse without an increase in PLA2R autoantibodies. The authors suggest that rituximab may have "masked" the patient's PLA2R response and emphasize the importance of repeat kidney biopsies in relapsed MN cases. Further research is needed to better understand this unusual scenario. [Extracted from the article]

The article focuses on the surge of medical misinformation, disinformation, and mal-information exacerbated by the COVID-19 pandemic, prompting a critical examination of physicians' roles both within and outside healthcare settings. Topics include the impact of misinformation on public health behaviors, challenges posed by artificial intelligence and social media influencers in spreading inaccurate health information.

The article focuses on the impact of recent Supreme Court rulings on race-conscious admissions in higher education, highlighting the implications for Historically Black Colleges and Universities (HBCUs) in fostering diversity within the medical profession. Topics include the role of HBCUs in addressing underrepresentation in medicine, the importance of financial support to enhance their educational offerings.

BACKGROUND: High cannabis use rates among American Indian (AI) adolescents necessitate the identification of factors that protect against early cannabis initiation. METHODS: Data collected from 279 AI middle school students attending reservation‐based schools in 2018 and 2019 were analyzed. Three waves of data, with approximately 6 months between each, were used. A repeated measures latent class analysis examined a school‐related protective factor index over three waves. The predictive power of lifetime cannabis use on school protection class membership was estimated, along with differences in past month cannabis use at follow‐up 2 across school protection classes while holding baseline use constant. RESULTS: Four school protection classes were identified: high, moderate, low, and declining protection. Abstinence at baseline was associated with an increased odds of membership in the high protection class compared to the moderate and low protection classes. Students with consistent and high school protection throughout middle school were significantly less likely to report past month cannabis use at follow‐up 2 compared to other classes. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Maintaining a high level of school protection throughout middle school substantially lowers the odds of cannabis use among AI adolescents. CONCLUSIONS: Interventions to promote school‐related protective factors in this population are essential and should be designed and tested. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the effectiveness of a self-administered naming treatment for one individual, B.N., presenting with semantic variant primary progressive aphasia (svPPA) and a history of traumatic brain injury (TBI). Method: Naming treatment included components of Lexical Retrieval Cascade Treatment and was self-administered using an adaptive spaced retrieval software, Anki. Using a multiple-baseline, single-case experimental design, naming accuracy probes were taken during pretreatment, treatment, posttreatment, and follow-up (through 12 months) for 60 trained words and 10 untrained words. Item-level Bayesian generalized mixed-effects models were used to estimate (a) the treatment effect for trained words, (b) change in untrained words, and (c) maintenance of treatment effects from posttreatment to each subsequent follow-up. Results: Statistical analyses revealed that a gain of 35 out of 60 trained words (35.3; 90% CI [30.6, 39.5]) was directly attributable to treatment. Following treatment, evidence of generalization to untrained words was not observed. During the follow-up period, there was gradual decline in naming accuracy of trained items. Conclusions: The positive treatment results reported here support the use of self-administered naming treatments for those with svPPA and a history of TBI. Although the utility of this treatment approach is constrained by patient factors including motivation, self-administered naming treatments represent a unique opportunity to expand access to speech-language intervention for people with svPPA, including those with concomitant diagnoses. [ABSTRACT FROM AUTHOR]

Summary: Cognitive behavioural therapy (CBT) is the recommended first‐line treatment for insomnia. However, guideline care is very seldom available and most patients receive no treatment, or less effective second‐line pharmacotherapy or sleep hygiene, neither of which are evidence‐based for chronic insomnia. The primary challenge for CBT has been supply. There are not enough therapists to meet the enormous demand. We must accelerate clinician training, but this approach can never be sufficient, even with abbreviated, efficient therapies. Fortunately, however, the treatment landscape has also changed dramatically. Fully‐automated digital CBT (dCBT) has emerged as a safe, effective, and scalable treatment delivery format. dCBT is software only, so it can be disseminated as readily and widely as sleep medication. Moreover, dCBT can be integrated into services. Just as medications can be delivered through health professionals and health systems, approved dCBT programmes can be the same. However, an ecosystem of psychologically‐based care should not necessitate a medical prescription model. Our proposed stepped care framework, comprises both population health and clinical health service initiatives, enabling universal access to guideline care for insomnia. The diverse ways in which CBT may be delivered (in‐person, face‐to‐face, using telehealth, group therapy, digitally) can operate congruently and efficiently to optimise treatment for people at all levels of complexity and need. With safe and clinically effective dCBT products now set to become established as treatments, clearly differentiated from wellness apps, there is potential to rapidly transform insomnia services and, for the first time, to deliver clinical guideline care at international scale. [ABSTRACT FROM AUTHOR]

Considerable comorbidity exists between insomnia and anxiety, and evidence shows that the benefits of CBT for insomnia extend to anxiety. Using data from two large trials of digital CBT (dCBT) for insomnia, we evaluated whether improving sleep is an effective treatment target to reduce both insomnia and anxiety symptoms in individuals with insomnia and clinically significant anxiety. This was a controlled sub-analysis combining individual participant data from two previous randomised controlled trials of dCBT for insomnia (Sleepio). Participants (N = 2172) with insomnia disorder and clinically significant anxiety symptoms were included in this sub-analysis and received either dCBT or control (usual care or sleep hygiene education). Assessments were evaluated at baseline, post-intervention (week 8 or 10), and follow-up (week 22 or 24). Mediation was evaluated using structural equation models. dCBT for insomnia was superior to control at reducing both insomnia (Hedges' g range = 0.77–0.81; both p < 0.001) and anxiety symptoms (Hedges' g range = 0.39–0.44; both p < 0.001) at all time points. Baseline insomnia symptoms moderated the effects of dCBT on insomnia, however no variables moderated treatment effects on anxiety. Reductions in anxiety symptoms at follow-up were mediated by improvements in sleep at post-intervention (% mediated = 84 %), suggesting a causal pathway. Participants did not have a formal anxiety disorder diagnosis and so the effects of dCBT for insomnia on anxiety may differ by anxiety disorder. Addressing sleep using dCBT for insomnia may serve as a treatment target from which to improve anxiety in individuals with insomnia and clinically significant comorbid anxiety. Digital Insomnia therapy to Assist your Life as well as your Sleep (DIALS) - ISRCTN60530898 http://www.isrctn.com/ISRCTN60530898. Oxford Access for Students Improving Sleep (OASIS) - ISRCTN61272251 http://www.isrctn.com/ISRCTN61272251. • Digital CBT for insomnia led to benefits in both insomnia and anxiety. • Improvements in sleep significantly mediated benefits to anxiety symptoms. • Sleep may be a transdiagnostic treatment target in those with insomnia and anxiety. • No variables moderated the effects of digital CBT for insomnia on anxiety. [ABSTRACT FROM AUTHOR]

Health-risk behaviors have an unclear etiology and college students have elevated risk for engagement. Emotion dysregulation and several personality dimensions have been implicated in health-risk behaviors, but these constructs have rarely been studied together. Further, it is unknown if different types of health-risk behaviors have distinct etiologies. 2077 college students completed a cross-sectional survey. Latent profile analysis discerned classes of participants from emotion dysregulation and personality dimensions. Differential engagement in self-injury, suicidality, disordered eating, substance misuse, and unprotected sex was evaluated across classes. Three classes were identified, which were primarily distinguished by emotion dysregulation, urgency, and neuroticism. Health-risk behaviors generally increased across classes with increasing emotion-related constructs. Self-injury and suicidality demonstrated different patterns than other health-risk behaviors. Results elucidate heterogeneity in health-risk behavior engagement. Focusing on emotional difficulties may be more important for reducing self-injury and suicidality than disordered eating, substance misuse, and risky sex. [ABSTRACT FROM AUTHOR]

Chimeric antigen receptor (CAR) T‐cell therapy is a novel adoptive T‐cell immunotherapy for haematological malignancies. First introduced into clinical practice in 2017, CAR T‐cell therapy is now finding its place in the management of lymphoid malignancies, primarily of B‐cell lineage, including lymphoblastic leukaemia, non‐Hodgkin lymphoma and plasma cell myeloma, with remarkable therapeutic outcomes. CAR T‐cells are a customised therapeutic product for each patient. Manufacture commences with collection of autologous T‐cells, which are then genetically engineered ex vivo to express transmembrane CARs. These chimeric proteins consist of an antibody‐like extracellular antigen‐binding domain, to recognise specific antigens on the surface of tumour cells (e.g. CD19), linked to the intracellular co‐stimulatory signalling domains of a T‐cell receptor (e.g. CD137). The latter is required for in vivo CAR T‐cell proliferation, survival, and durable efficacy. Following reinfusion, CAR T‐cells harness the cytotoxic capacity of a patient's immune system. They overcome major mechanisms of tumour immuno‐evasion and have potential to generate robust cytotoxic anti‐tumour responses. This review discusses the background to CAR T‐cell therapies, including their molecular design, mechanisms of action, methods of production, clinical applications and established and emerging technologies for CAR T‐cell evaluation. It highlights the need for standardisation, quality control and monitoring of CAR T‐cell therapies, to ensure their safety and efficacy in clinical management. [ABSTRACT FROM AUTHOR]

Primary progressive aphasia (PPA) is a language-prominent dementia that fundamentally impacts the lives of not only the person with the diagnosis, but also their family members. While assuming a caregiving role, care partners are vulnerable to negative health and psychosocial consequences of their own. Support groups are one way to meet the needs of care partners, providing opportunities for individuals with common experiences to socialize, obtain knowledge about disorders, and learn coping strategies. Given that PPA is rare and that in-person support groups are sparse in the United States, there is a need for alternative meeting modalities, to overcome the limitations imposed by relative scarcity of potential participants, lack of appropriately-trained clinical professionals, and the logistical demands faced by overburdened care providers. Telehealth-based support groups provide care partners with opportunities to connect virtually with other care partners; however, research regarding their feasibility and benefit is limited. This pilot study investigated whether a telehealth-based support group for care partners of persons with PPA is feasible and yields benefits in psychosocial functioning. Ten care partners of persons with PPA (7 females; 3 males) participated in a group intervention comprising psychoeducation about relevant topics, followed by group discussion. Meetings were held twice monthly for four months via teleconference. All participants completed pre- and post-intervention measures to examine support group satisfaction as well as psychosocial functioning, including quality of life, coping, mood, and caregiving perception. Consistent group member participation across study phases supports the feasibility of this intervention model. Quantitative results from paired-samples permutation tests indicate no significant changes from pre- to post-intervention on psychometrically-validated psychosocial measures. Qualitatively, results from an in-house Likert-type survey indicate positive outcomes in quality of life, social support, caregiving skills, and psychoeducation. Relatedly, post-intervention themes derived from a thematic analysis of written survey responses included: Enhancing knowledge about PPA, feeling connected and mutually supported, and desire for more time together. Consistent with existing literature evaluating virtually-delivered care partner support groups in dementia and other acquired medical conditions, findings from this study support the feasibility and benefit of telehealth-based support groups for care partners of persons with PPA. [ABSTRACT FROM AUTHOR]

Membranous nephropathy (MN) is the most prevalent cause of nephrotic syndrome amongst the non-diabetic adult population. A fifth of idiopathic nephrotic syndrome cases can be attributed to MN, rising to more than 40% in older patients over 60 years. Most MN cases are classified as being of a primary cause, where there is absence of a secondary disease process explaining its manifestation. Traditionally, the standard approach of diagnosing MN involves performing a kidney biopsy as histological evaluation offers not only conclusive evidence of the diagnosis but also provides valuable information regarding disease chronicity and the presence of any other kidney histopathological features. Nevertheless, kidney biopsy is an invasive procedure which poses risks for the patient including bleeding and pain and bears greater costs for the health system. The identification of the phospholipase A2 receptor (PLA2R) antigen in 2009 was a landmark discovery, one which has evolved our understanding of the disease processes in MN and subsequently our management approach of this condition. Antibodies against PLA2R (PLA2RAb) have since emerged as an attractive non-invasive test option to be applied for the diagnosis and prognostication of primary MN. However, much debate and unknowns remain about the accuracy and reliability of testing for PLA2RAb across various primary MN scenarios. We provide a review summarizing the historical journey of PLA2R in relation to its significance in primary MN and, more importantly, evidence emerging over the years which contemplated the role of PLA2RAb as a diagnostic and prognostic tool in primary MN. [ABSTRACT FROM AUTHOR]

Simple Summary: There are an increasing number of older people living with kidney cancer and/or cancer and kidney disease worldwide, sparking a wider discussion on the impact of frailty and the clinical significance of conducting frailty assessments for this patient population. We provide an update on the current evidence related to frailty assessment in onconephrology and identify areas where further research efforts are anticipated to address knowledge gaps within this topic. Onconephrology has emerged as a novel sub-specialty of nephrology dedicated to the intersection between the kidney and cancer. This intersection is broad and includes a number of important areas of focus, including concurrent chronic kidney disease (CKD) and cancer, acute kidney complications of cancer, and cancer-treatment-induced nephrotoxicity. The importance of onconephrology is even more evident when considering the global growth in the population of older adults, many of whom are living with some degree of frailty. Furthermore, a considerable proportion of older adults have CKD (some of whom eventually progress to kidney failure) and are at high risk of developing solid tumour and hematologic malignancies. Specific to kidney disease, the association between frailty status and kidney disease has been explored in depth, and tools to capture frailty can be used to guide the management and prognostication of older adults living with kidney failure. Whilst there is emerging data regarding the assessment and impact of frailty in onconephrology, there remains a relative paucity of knowledge within this topic. In this article, we evaluate the definition and operationalization of frailty and discuss the significance of frailty within onconephrology. We review evidence on current approaches to assessing frailty in onconephrology and discuss potential developments and future directions regarding the utilization of frailty in this patient population. A greater awareness of the intersections and interactions between frailty and onconephrology and further efforts to integrate frailty assessment in onconephrology to optimize the delivery of realistic and goal-directed management strategies for patients is needed. [ABSTRACT FROM AUTHOR]

There is a rising demand for dialysis in the older population given the increased numbers of older adults living with chronic kidney disease (CKD) progressing to kidney failure. Home dialysis, i.e. peritoneal dialysis (PD) and home hemodialysis (HHD), has been available for decades, but more recently there has been a rapid increase in home dialysis utilization as patients and clinicians consider its practical and clinical advantages. For older adults, incident home dialysis utilization more than doubled and prevalent home dialysis growth nearly doubled over the past decade. Whilst its advantages and recent rise in popularity are evident, there are numerous barriers and challenges that are important to consider prior to initiating older adults on home dialysis. Some nephrology healthcare professionals do not view home dialysis as an option for older adults. Successful delivery of home dialysis for older adults may be made even more difficult by physical or cognitive limitations, concerns around dialysis adequacy, and treatment-related complications, as well as challenges relating to caregiver burnout and patient frailty that are unique to home dialysis and older adults. Ultimately, it would be important for clinicians, patients and their caregivers to define what constitutes a 'successful therapy' to ensure treatment goals are aligned towards each individual's priorities of care, considering the complex challenges that surround an older adult receiving home dialysis. In this review, we evaluate some of the key challenges surrounding the delivery of home dialysis to older adults and propose potential solutions based on updated evidence to overcome these challenges. [ABSTRACT FROM AUTHOR]

Peritoneal dialysis (PD)‐associated peritonitis secondary to Ralstonia infection is very rare. Ralstonia pickettii is an organism that can grow in contaminated saline, water, chlorhexidine, and other medical products used in laboratories and the clinical setting. Infective endocarditis, prosthetic joint, and severe chest infections are previously reported with R. pickettii infection. We report a novel series of three cases diagnosed with PD‐associated peritonitis caused by R. pickettii, where the cases appeared consecutively to our unit during a span of 4 weeks. During the COVID‐19 pandemic, there were increased uses of non‐sterile gloves by clinical staff as a form of personal protective equipment throughout patient interaction and PD exchange, as recommended by local hospital policy for all staff attending to patient care. A multidisciplinary team root cause analysis of our cases suggested non‐sterile gloves being the likely source of environmental contamination, leading to PD‐associated peritonitis caused by R. pickettii in this scenario. [ABSTRACT FROM AUTHOR]

The article discusses the emergence of Medicare Advantage (MA) "affinity plans" tailored to specific populations like LGBTQ+ communities, women, and racial and ethnic minorities. The study identified 61 MA affinity plans between 2020 and 2024, with enrollment growing over 122% in the last 2 years, particularly among Asian American beneficiaries. Affinity plans generally had lower contract star ratings compared to non-affinity plans, indicating a need for further research on their value to beneficiaries. The study highlights the importance of understanding the characteristics and impact of MA affinity plans on diverse populations. [Extracted from the article]

This study aimed to evaluate the efficacy of 18-month 0.01% atropine in 61 myopic children (aged 7–10) and the relationship with central retinal response (by multifocal electroretinogram [mfERG]) in a double-masked randomized placebo-controlled clinical trial. Global-flash mfERG was measured at baseline, while cycloplegic spherical equivalent refraction (SER) and axial length (AL) were measured at baseline and at 6-month intervals. Annualized change in SER and AL were compared between atropine and control groups, and the relationships with baseline mfERG were evaluated. Changes in SER (−0.70 ± 0.39D vs. −0.66 ± 0.41D, p = 0.63) and AL (0.32 ± 0.16 mm vs. 0.30 ± 0.22 mm, p = 0.52) were similar in atropine and control groups. Interestingly, in the placebo group, mfERG amplitude was negatively correlated with axial elongation (Rp = −0.44, p = 0.03) as in our previous study. However, in the atropine group, an opposite trend was observed that axial elongation was positively correlated with mfERG amplitude (Ra = 0.37, p = 0.04). Annualized myopia progression demonstrated similar opposite effect between atropine and placebo groups but did not reach statistical significance. An ERG screening protocol may be warranted to identify suitable candidates to reduce the likelihood of an unfavorable treatment response by 0.01% atropine. [ABSTRACT FROM AUTHOR]

Reservation-dwelling American Indian adolescents are at exceedingly high risk for cannabis use. Prevention initiatives to delay onset and escalation of use are needed. School engagement and student's positive experiences at school have been identified as key promotive factors against cannabis use in the general population of adolescents, but little work has examined these factors among American Indian youth. Seven school-related promotive factors were examined as predictors of past 30-day cannabis use (measured 6 months later), controlling for previous onset of cannabis use as well as a set of relevant potential confounders. Models were tested using 280 adolescents in 6th or 7th grade at the start of the study from two reservation-based schools in the US. Students were surveyed three times, with 6 months in between each survey. The average age at the start of the study was 11.99 years (SD = 0.87) and 54% of participants were female. Using a cumulative logit model to predict past 30-day use, American Indian youth who reported greater school bonding, academic aspirations, proclivity to endeavor in their studies, and interest in school at Wave 2 reported less 30-day cannabis use at Wave 3 (controlling for onset of cannabis at Wave 1 and several other control variables). No evidence of an effect of self-reported grades, perceived safety, or participation in school-related extracurricular activities was found. Given substantial deterioration of these school-related promotive factors over time, and the effect of the school-related promotive factors on subsequent cannabis use, efforts to design and test interventions to promote school engagement as a protective measure against cannabis use is warranted. [ABSTRACT FROM AUTHOR]

BACKGROUND To determine if school engagement is a viable target for early prevention of adolescent substance use, this study investigated whether school engagement in early adolescence (ages 12‐14) is a cause of alcohol and cannabis use during middle to late adolescence (ages 15‐19). METHODS: To facilitate causal inference, inverse probability of treatment weights (IPTWs), which are based on estimated probabilities of treatment selection (ie, school engagement), were created based on a robust set of potential confounders. Using the IPTWs, a cumulative link mixed model was fit to examine the impact of school engagement on alcohol and cannabis use among an ethnically diverse sample of adolescents (N = 360). RESULTS: School engagement was associated with a lower level of alcohol and cannabis use from age 15 to 18. School engagement was not associated with change in alcohol and cannabis use over time, suggesting that school engagement emits its effect early in the developmental course of substance use and offers protection throughout adolescence. CONCLUSIONS: This study supports a compensatory role of early school engagement in substance use across middle and late adolescence. School engagement is a malleable factor and thus offers an avenue for prevention efforts. [ABSTRACT FROM AUTHOR]

The 2021 National Academies of Sciences, Engineering, and Medicine (NASEM) report on Implementing High-Quality Primary Care identifies 5 high-level objectives regarding payment, access, workforce development, information technology, and implementation. Nine junior primary care leaders (3 internal medicine, 3 family medicine, 3 pediatrics) invited from broad geographies, practice settings, and academic backgrounds used appreciative inquiry to identify priorities for the future of primary care. Highlighting the voices of these early career clinicians, we propose a response to the report from the perspective of early career primary care physicians. Health equity must be the foundation of the future of primary care. Because Barbara Starfield's original 4 Cs (first contact, coordination, comprehensiveness, and continuity) may not be inclusive of the needs of under-resourced communities, we promote an extension to include 5 additional Cs: convenience, cultural humility, structural competency, community engagement, and collaboration. We support the NASEM report's priorities and its focus on achieving health equity. We recommend investing in local communities and preparatory programs to stimulate diverse individuals to serve in health care. Finally, we support a blended value-based care model with risk adjustment for the social complexity of our patients.Appeared as Annals "Online First" article. [ABSTRACT FROM AUTHOR]

Acute lymphoblastic leukaemia is the most common childhood malignancy that remains a leading cause of death in childhood. It may be characterised by multiple known recurrent genetic aberrations that inform prognosis, the most common being hyperdiploidy and t(12;21) ETV6::RUNX1. We aimed to assess the applicability of a new imaging flow cytometry methodology that incorporates cell morphology, immunophenotype, and fluorescence in situ hybridisation (FISH) to identify aneuploidy of chromosomes 4 and 21 and the translocation ETV6::RUNX1. We evaluated this new "immuno-flowFISH" platform on 39 cases of paediatric ALL of B-lineage known to have aneuploidy of chromosomes 4 and 21 and the translocation ETV6::RUNX1. After identifying the leukaemic population based on immunophenotype (i.e., expression of CD34, CD10, and CD19 antigens), we assessed for copy numbers of loci for the centromeres of chromosomes 4 and 21 and the ETV6 and RUNX1 regions using fluorophore-labelled DNA probes in more than 1000 cells per sample. Trisomy 4 and 21, tetrasomy 21, and translocations of ETV6::RUNX1, as well as gains and losses of ETV6 and RUNX1, could all be identified based on FISH spot counts and digital imagery. There was variability in clonal makeup in individual cases, suggesting the presence of sub-clones. Copy number alterations and translocations could be detected even when the cell population comprised less than 1% of cells and included cells with a mature B-cell phenotype, i.e., CD19-positive, lacking CD34 and CD10. In this proof-of-principle study of 39 cases, this sensitive and specific semi-automated high-throughput imaging flow cytometric immuno-flowFISH method has been able to show that alterations in ploidy and ETV6::RUNX1 could be detected in the 39 cases of paediatric ALL. This imaging flow cytometric FISH method has potential applications for diagnosis and monitoring disease and marrow regeneration (i.e., distinguishing residual ALL from regenerating haematogones) following chemotherapy. [ABSTRACT FROM AUTHOR]

Sleep is commonly impaired after stroke. Cognitive Behavioral Therapy for Insomnia (CBT-I) is the first-line recommended treatment for sleep difficulty. "Sleepio" is a digital CBT-I program, allowing delivery of this treatment at scale. However, Sleepio has not yet been tested specifically in people with stroke. Before doing so, we wanted to explore the experience of people with stroke using the program, and potential barriers to completion. Community dwelling survivors of stroke (n = 11, 41–78 years of age, 6 male) were given access to Sleepio. Participants discussed their experiences with the program during a semi-structured interview, which was analyzed using thematic analysis. We found four common themes: (1) positive and negative experiences impacted engagement with the program, (2) motivation to follow the program was proportional to perceived severity of sleep problem, (3) impractical advice for people with stroke, (4) difficulty operating the program. Sleepio can be used by some people at the chronic stage of stroke. However, some barriers to completion were highlighted, and not all suggestions were deemed practical for everyone. We therefore suggest possible adaptations which may make the program more easily usable and engaging for survivors of stroke with varying impairments. [ABSTRACT FROM AUTHOR]

There is a lack of research examining the relationship between religious identity and multicultural counseling competency among counselors-in-training. A correlational design was used to investigate the relationship between age, religious identity development, and multicultural counseling competency of counseling students (N = 156) from CACREP accredited programs. The results, derived from a canonical correlational analysis, indicated a significant, linear relationship between religious identity development and multicultural counseling competency. Limitations, implications, and suggestions for future research are discussed. [ABSTRACT FROM AUTHOR]

Open web resources on the Internet have become increasingly important in the scholarly community and are being cited ever more frequently in scholarly articles. Academic librarians continue to assess and collect open web resources that are of value to the academic community in order to support research. With the questions of how ARL academic libraries collect, present, and make searchable open web resources, this paper analyzes all ARL academic libraries' websites and finds that all of them are collecting valuable open web resources and presenting these on research/subject guides. This paper also finds that some ARL academic libraries implement search boxes for the collected list of open web resources, but only descriptions or titles of the resources housed on the libraries' website are being searched. None of the libraries makes the content or full text of open web resources discoverable on the academic library websites. Based on the findings, this paper proposes a solution to address the discoverability issue of collecting open web resources and how to make the content or full text of the open web resources searchable. [ABSTRACT FROM AUTHOR]

Background: Medication overload or problematic polypharmacy is a major problem causing widespread harm, particularly to older adults. Taking multiple medications increases the risk of potentially inappropriate medications (PIMs), and residents in long-term care (LTC) are frequently prescribed 10 or more medications at once. One strategy to address this problem is for the physician and/or pharmacist to perform regular medication reviews; however, this process can be complicated and time-consuming. With a prescription review, medications may be decreased, changed, or stopped altogether. MedReviewRx is a software that runs an analysis using deprescribing rules to produce a report to guide medication reviews addressing medication overload for residents in LTC.Methods: This study will employ a mixed methods effectiveness-implementation hybrid type 2 study design. To measure effectiveness, a stepped wedge cluster randomized trial design is planned, which allows us to approximate a randomized clinical trial. Approximately 1000 residents living in LTC will be recruited from five facilities in New Brunswick. The study will begin with 3 months of baseline data on rates of deprescribing. Thereafter, every 3 months a new cluster will enter the intervention mode. The intervention consists of medication reviews augmented with the MedReviewRx software, which will be used by staff and clinicians in the facilities. The estimated study duration is 18 months and the main outcome will be the proportion of patients with one or more PIMs deprescribed (reduced/stopped or changed to a safer alternative) in the 90 days following a prescription review. The goal is to study the impact of MedReviewRx on medication overload among older adults living in LTC. In typical fashion of a stepped wedge cluster randomized trial, each cluster acts as an internal control (before and after) as well as a control for the other clusters (external control). Qualitative data collected will include resident/caregiver attitudes towards deprescribing and semi-structured interviews with staff working in the long-term care homes.Discussion: This study design addresses issues with seasonality and allows all clusters to participate in the intervention, which is an advantage when the intervention is related to quality improvement. This study will provide valuable information on PIM use, cost savings, and facilitators and challenges associated with medication reviews and deprescribing. This study represents an important step towards understanding and promoting tools to guide safe and rational reduction of PIM use among older adults.Trial Registration: NCT04762303 , Registered February 21, 2021. [ABSTRACT FROM AUTHOR]

An increasing demand for in‐center dialysis services has been largely driven by a rapid growth of the older population progressing to end‐stage kidney disease. Since the onset of the COVID‐19 pandemic, efforts to encourage home‐based dialysis options have increased due to risks of infective transmission for patients receiving hemodialysis in center‐based units. There are various practical and clinical advantages for patients receiving hemodialysis at home. However, the lack of caregiver support, cognitive and physical impairment, challenges of vascular access, and preparation and training for home hemodialysis (HHD) initiation may present as barriers to successful implementation of HHD in the older dialysis population. Assessment of an older patient's frailty status may help clinicians guide patients when making decisions about HHD. The development of an assisted HHD care delivery model and advancement of telehealth and technology in provision of HHD care may increase accessibility of HHD services for older patients. This review examines these factors and explores current unmet needs and barriers to increasing access, inclusion, and opportunities of HHD for the older dialysis population. [ABSTRACT FROM AUTHOR]

Invasive species are a major cause of biodiversity loss worldwide, but their impact on communities and the mechanisms driving those impacts are varied and not well understood. This study employs functional diversity metrics and guilds—suites of species with similar traits—to assess the influence of an invasive tree (Tamarix spp.) on riparian plant communities in the southwestern United States. We asked: (1) What traits define riparian plant guilds in this system? (2) How do the abundances of guilds vary along gradients of Tamarix cover and abiotic conditions? (3) How does the functional diversity of the plant community respond to the gradients of Tamarix cover and abiotic conditions? We found nine distinct guilds primarily defined by reproductive strategy, as well as growth form, height, seed weight, specific leaf area, drought and anaerobic tolerance. Guild abundance varied along a covarying gradient of local and regional environmental factors and Tamarix cover. Guilds relying on sexual reproduction, in particular, those producing many light seeds over a long period of time were more strongly associated with drier sites and higher Tamarix cover. Tamarix itself appeared to facilitate more shade-tolerant species with higher specific leaf areas than would be expected in resource-poor environments. Additionally, we found a high degree of specialization (low functional diversity) in the wettest, most flood-prone, lowest Tamarix cover sites as well as in the driest, most stable, highest Tamarix cover sites. These guilds can be used to anticipate plant community response to restoration efforts and in selecting appropriate species for revegetation. [ABSTRACT FROM AUTHOR]

Objective: The aims of this brief report were to examine the extent to which early onset of cannabis use by parents and their children, and intergenerational continuity in early-onset cannabis use by parents and children, differ as a function of parent age at birth of first child. Method: A total of 795 parent-child dyads (57% male parents and 49% male children) were compiled from three intergenerational studies: Oregon Youth Study-Three Generational Study (OYS-3GS), Rochester Youth Development Study and Rochester Intergenerational Study (RYDS-RIGS), and Seattle Social Development Project-The Intergenerational Project (SSDP-TIP). Parents and children identified as non-Hispanic White (29% and 22%, respectively), Black (55% and 47%), and Hispanic (8% and 11%). Early-onset cannabis use was defined as initiation at or before age 15. Time-varying effect models were fit to examine the research questions. Results: Among parents, earlier initiation of cannabis use was associated with an earlier entry into parenthood. Moreover, parents' later age at first birth was predictive of a lower prevalence of early-onset cannabis use among their children. Last, regarding intergenerational continuity, parental early onset of cannabis use increased the likelihood of child early-onset use, but only among older parents (i.e., later age at first birth). Conclusions: We provide a nuanced examination of the associations between parental and child early-onset cannabis use as a function of parents' age at first birth and describe a novel approach to incorporating parent's age at first birth into models of intergenerational continuity. [ABSTRACT FROM AUTHOR]

This article discusses the use of ultra-low dose rituximab as a treatment for relapsing adult minimal change disease (MCD). The authors present two cases where this novel approach was successful in maintaining remission. They reference two previous studies that also found favorable outcomes with ultra-low dose rituximab. The authors suggest that further research should be conducted to confirm the effectiveness of this treatment approach in relapsing MCD. [Extracted from the article]

The present study aimed to examine intra- and interpersonal associations between poor mental health and mother–daughter relationship closeness in a sample of 467 dyads. An Actor–Partner Interdependence Model was utilized to examine bidirectional processes between mothers (mean age = 42.64, SD = 6.5) and their adolescent daughters (mean age = 15.37, SD = 1.15). The independent variable was self-reported poor mental health and the dependent variable was relationship closeness. Additionally, communication satisfaction was examined as a potential interpersonal mediator of the pathway between poor mental health and relationship closeness. Daughters' self-reported poor mental health negatively predicted their own perception of closeness as well as mothers' perception of closeness. Additionally, we find evidence that perceived communication may explain (i.e., mediate) both the actor effect (one's own poor mental health on one's own perception of closeness) and the partner effect (partner's poor mental health on one's own perception of closeness). Our results suggest that when daughters' mental health is poor, relationship closeness as perceived by mother and daughter may be weakened, and that this effect may in part be explained by poor communication between mother and daughter. Strategies to promote family communication, especially for families experiencing mental health problems, may aid in the development of closer mother–daughter relationships. Further, our results suggest the importance of investigating the potential bidirectional influence of mothers' and daughters' mental health on parent-adolescent relationship quality within a dyadic unit. Highlights: We found a bidirectional relationship of poor mental health and relationship closeness within mother–daughter dyads. In mother–daughter dyads, poor communication may have the capacity to explain why poor mental health can attenuate relationship closeness. There is a need for programs highlighting family communication interventions to improve mother–daughter relationship quality, especially for families experiencing mental health problems. [ABSTRACT FROM AUTHOR]

Aims: The persistence of atrial fibrillation (AF) has been associated with differential clinical outcomes, with studies showing that persistent and permanent AF results in increased morbidity and mortality when compared to the paroxysmal subtype. Given the established prognostic implications of AF subtype, we sought to discern the clinical and structural cardiac parameters associated with persistent/ permanent AF. Materials and methods: Consecutive patients admitted to our institution between January 2013 and January 2018 with a primary diagnosis of non‐valvular AF who underwent comprehensive transthoracic echocardiography were retrospectively appraised. Assessment of clinical and echocardiographic parameters was undertaken and compared according to AF subtype. Results: Of 1010 patients, 665 (mean age 66.8 ± 13.5 years, 53% men) had comprehensive transthoracic echocardiography on index admission and were included in the primary analysis. The majority of patients (n = 468; 70%) had paroxysmal AF while 197 (30%) had persistent/ permanent AF. Multivariable logistic regression analysis showed that heart failure (adjusted OR 3.135; 95% CI 2.099 to 4.682, P <.001), right atrial (RA) area ≥18 cm2 (adjusted OR 2.147; 95% CI 1.413 to 3.261, P <.001) and left atrial emptying fraction (LAEF) ≤34% (adjusted OR 2.959; 95% CI 1.991 to 4.398, P <.001) were independent predictors of persistent /permanent AF. Conclusions: The presence of heart failure, increased RA size and impaired LA function were associated with persistent/ permanent AF. These clinical and cardiac structural risk markers of AF persistence may identify a target population for early intervention to prevent adverse cardiovascular outcomes. [ABSTRACT FROM AUTHOR]

Objective: Intergenerational studies have identified relations between adolescents' and their future offspring's cannabis and alcohol use, but rarely have examined the association for other illicit drug use. Given the low prevalence of such use in community populations, we pooled data from three prospective intergenerational studies to test this link. Method: Participants were 1,060 children of 937 parents who had been repeatedly assessed since early adolescence. Children and parents reported on their use of cocaine, stimulants, hallucinogens, sedatives/tranquilizers, and opiates/narcotics from ages 10 to 18 years. Intergenerational similarities in any versus no use of these drugs were formally modeled using logistic regression. Patterns also were descriptively analyzed. Results: Parent illicit substance use was associated with significantly higher odds of child use (adjusted odds ratio [95% confidence interval] = 2.682 [1.328–5.416], p = 0.006). However, intergenerational continuity was modest; 87% of children whose parent used illicit drugs in adolescence did not use such drugs, and 77% of parents of children who used illicit drugs had not themselves used these drugs during adolescence. Conclusions: The use of illicit substances by parents during their teenage years poses a risk for their offspring's similar behaviors. However, the discontinuity of these behaviors across generations implies children are largely resilient to or protected from this risk, and conversely that other aspects of parents' and children's experiences or characteristics may be more powerful risks for children's illicit drug use than this transgenerational influence. Public Health Significance: (a) Parents' use of illicit drugs during adolescence significantly increased risk that their adolescent children would use such drugs. (b) However, most parents who used illicit drugs did not have children who used illicit drugs, and conversely, the majority of adolescents who used illicit drugs did not have parents who had used such drugs in their adolescence. (c) Distinct prevention strategies may be needed to disrupt intergenerational continuities in illicit drug use via selective prevention, and also to avert drug use by offspring of parents who abstained in adolescence through universal approaches. [ABSTRACT FROM AUTHOR]

This study protocol describes the development of the first instrument of functional communication for people living with primary progressive aphasia (PPA), with future applications to other progressive conditions, with expert validation, item-level reliability analyses, input from partners in research, and outcomes. Progressive conditions like PPA require monitoring, and as such, re-assessment. Re-assessment poses the high risk of being burdensome, destructive, and of little use to the patient. As such, there is a significant need to establish a validated and reliable measure that (1) poses minimal patient burden and (2) captures communication ability in a strengths-based manner for both clinical and research purposes. A strengths-based approach to assessment is widely recognized as the optimal way to promote patient autonomy, minimize harm, and implement functional treatment protocols and strategies. To date, there are no strengths-based assessment tools that were developed for people living with PPA nor ways to efficiently document functional communication performance. This study protocol outlines our work to address this gap in clinical practice and research. [ABSTRACT FROM AUTHOR]

Summary: Insomnia predicts the onset of depression, commonly co‐presents with depression and often persists following depression remission. However, these conditions can be challenging to treat concurrently using depression‐specific therapies. Cognitive behavioural therapy for insomnia may be an appropriate treatment to improve both insomnia and depressive symptoms. We examined the effects of a fully‐automated digital cognitive behavioural therapy intervention for insomnia (Sleepio) on insomnia and depressive symptoms, and the mediating role of sleep improvement on depressive symptoms in participants from two randomized controlled trials of digital cognitive behavioural therapy for insomnia. We also explored potential moderators of intervention effects. All participants met criteria for probable insomnia disorder and had clinically significant depressive symptomatology (PHQ‐9 ≥ 10; n = 3,352). Individuals allocated to treatment in both trials were provided access to digital cognitive behavioural therapy. Digital cognitive behavioural therapy significantly improved insomnia (p <.001; g = 0.76) and depressive symptoms (p <.001; g = 0.48) at post‐intervention (weeks 8–10), and increased the odds (OR = 2.9; 95% CI = 2.34, 3.65) of clinically significant improvement in depressive symptoms (PHQ‐9 < 10). Improvements in insomnia symptoms at mid‐intervention mediated 87% of the effects on depressive symptoms at post‐intervention. No variables moderated effectiveness outcomes, suggesting generalizability of these findings. Our results suggest that effects of digital cognitive behavioural therapy for insomnia extend to depressive symptoms in those with clinically significant depressive symptomatology. Insomnia may, therefore, be an important therapeutic target to assist management of depressive symptoms. [ABSTRACT FROM AUTHOR]

A new fossil species of the genus Scutus (Scutus mirus n. sp.) is described from five Late Oligocene to Early Miocene (Waitakian to Altonian; 25.2–15.9 Ma) localities in the South Island, New Zealand. It is one of the oldest fossil species of Scutus known and probably inhabited very shallow, sub-tropical waters surrounding Zealandia during this time. The holotype of Scutus petrafixus Finlay, 1930 is re-examined; it is possibly from All Day Bay, Kakanui (Waitakian 25.2–21.7 Ma). The New Zealand species documented herein significantly expand our understanding of the fossil record of this shallow-marine molluscan lineage, and by proxy, also indicate the presence of very shallow coastal marine environments around the late Oligocene and early Miocene in southern Zealandia. [ABSTRACT FROM AUTHOR]

Objective/background: Sleep disturbance is common in individuals with psoriasis and appears to be related to both physical and psychological factors. We sought to examine whether psoriasis symptoms, night-time arousal and low mood predicted subsequent objective and self-reported sleep; and whether objective and self-reported sleep predicted next-day psoriasis symptoms and day-time functioning.Participants/methods: A total of 19 individuals (Female: 11 [57.9%], median age: 39 years) with chronic plaque psoriasis and poor sleep quality (mean Pittsburgh Sleep Quality Index, PSQI = 9.11) participated. Momentary assessments of psoriasis symptoms, mood and daytime functioning were completed at five pseudo-random intervals each day for 15 days using time-stamped digital diary entry. Objective sleep was estimated using wrist-worn actigraphy. Self-reported sleep and night-time arousal were assessed each morning using validated measures.Results and Conclusions: Two-level random intercept models showed that increased night-time arousal was associated with poorer diary-reported sleep. Neither self-reported nor objective sleep parameters were associated with daytime psoriasis symptoms in bi-directional analyses. Diary-reported sleep predicted next-day functioning, specifically sleepiness, concentration, and fatigue. Actigraphy-defined total sleep time predicted next-day fatigue. Night-time arousal is associated with poorer self-reported sleep in people with psoriasis, and sleep predicts next-day functioning. Contrary to our hypothesis, sleep disturbance does not appear to be associated with momentary assessments of psoriasis symptoms. [ABSTRACT FROM AUTHOR]

Objectives: The operational definition of early motherhood remains equivocal across the literature. In response to the tendency of using age at first birth as a categorical predictor in previous research, the time-varying relationship between maternal age at first birth and socioeconomic and parenting/home outcomes was examined using longitudinal data. Methods: Time-varying effect models were employed to examine educational attainment, home/parenting quality scores, and annual income as a function of age at first birth, controlling for race/ethnicity and presence of the father in the household during child ages 6–9. Results: Peak scores for outcomes were observed around maternal age 30 in all three models. Parenting/home quality improved with maternal age at first birth until mothers reached the late 20's, when scores appeared to level out. Highest grade completed increased until just after age 30. Total annual income increased considerably until about age 30 then leveled out, although the plateau may be due to reduced sample size at the most advanced maternal ages. Father presence in the household and race/ethnicity were associated with all three outcomes. Conclusions: Overall, later maternal age at first birth was associated with incrementally increasing parenting/home quality, greater educational attainment, and higher annual income. The results highlight the loss of information when utilizing categorical age groups to predict outcomes and suggest that optimal socioeconomic and parenting outcomes increase with age, leveling out around age 30. Researchers should consider curvilinear patterns of outcomes related to maternal age at first birth rather than rely on categorical comparisons of age groups. [ABSTRACT FROM AUTHOR]

Background: Housing is a growing challenge for US adults in an increasingly unaffordable housing market. These housing challenges can create barriers to effective management and control of Type II Diabetes. However, little is known about how housing challenges are perceived and navigated by clinicians who care for patients with Type II Diabetes.Objective: To examine how primary care clinicians perceive and navigate their patients' housing challenges in the context of Type II Diabetes management.Methods: We conducted semi-structured interviews with 18 primary care clinicians practising in four clinical settings in New Haven, Connecticut. Two investigators systematically coded the interviews. Analysis of coded data was used to determine themes.Results: Participants considered housing as significant to their patients' health and a potential barrier to optimal diabetes management. Participants sought to improve their patients' housing through advocacy, referrals and interdisciplinary collaborations. They also adjusted clinical decisions to adapt to patients' housing challenges. In making clinical adjustments, participants struggled to find a balance between what they perceived to be feasible for unstably housed patients and maintaining a standard of care. Some participants navigated this balanced by employing creative strategies and individualized care.Conclusion: In highlighting the challenges that clinicians face in maintaining a standard of care for unstably housed diabetes patients, our findings speak to the need for more guidance, resources and support to address housing in a clinical setting. [ABSTRACT FROM AUTHOR]

Photoluminescence (PL) and photoluminescence excitation (PLE) spectroscopies have been carried out at 6 K on the ∼1540 nm [sup 4]I[sub 13/2]-[sup 4]I[sub 15/2] emissions of Er[sup 3+] in Er-implanted and annealed GaN. These studies revealed the existence of multiple Er[sup 3+] centers and associated PL spectra in Er-implanted GaN films grown by metalorganic chemical vapor deposition, hydride vapor phase epitaxy, and molecular beam epitaxy. The results demonstrate that the multiple Er[sup 3+]PL centers and below-gap defect-related absorption bands by which they are selectively excited are universal features of Er-implanted GaN grown by different techniques. It is suggested that implantation-induced defects common to all the GaN samples are responsible for the Er site distortions that give rise to the distinctive, selectively excited Er[sup 3+]PL spectra. The investigations of selectively excited Er[sup 3+]PL and PLE spectra have also been extended to Er-implanted samples of Mg-doped GaN grown by various techniques. In each of these samples, the so-called violet-pumped Er[sup 3+]PL band and its associated broad violet PLE band are significantly enhanced relative to the PL and PLE of the other selectively excited Er[sup 3+]PL centers. More importantly, the violet-pumped Er[sup 3+]PL spectrum dominates the above-gap excited Er[sup 3+]PL spectrum of Er-implanted Mg-doped GaN, whereas it was unobservable under above-gap excitation in Er-implanted undoped GaN. These results confirm the hypothesis that appropriate codopants can increase the efficiency of trap-mediated above-gap excitation of Er[sup 3+] emission in Er-implanted GaN. © 2001 American Institute of Physics. [ABSTRACT FROM AUTHOR]