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Introduction: There is a paucity of evidence on the effectiveness of physical interventions for chronic musculoskeletal pain affecting adolescents. This study explored adolescent and parent experiences and perceived effectiveness of physical intervention for chronic musculoskeletal pain in the UK. Methods: Using semi‐structured interviews, 21 young people receiving treatment for chronic musculoskeletal pain and 21 parents were interviewed regarding their healthcare experiences. Data regarding experiences of physical interventions were analysed in this secondary qualitative analysis using inductive reflexive thematic analysis. Results: Three themes that captured why adolescents and parents perceived physical interventions to be effective or not were (1) feeling in control, (2) the right person and an explanation that makes sense and (3) make a difference to me not my foot. Discussion: Core concepts that appeared to influence the perceived effectiveness of physical interventions from the perspectives of adolescents and parents included facilitating adolescent autonomy, establishing a therapeutic alliance on the basis of trust and focusing physiotherapy treatment on meaningful participation in life. Conclusion: There were no ideal physical interventions. The themes convey the importance of therapeutic alliance, intervention context and the need for personalised care. [ABSTRACT FROM AUTHOR]

Objective Development and test of a culturally sensitive intervention for rheumatology healthcare professionals (HCPs). Methods Using a before and after study design, 15 HCPs were recruited to undertake the bespoke intervention from four National Health Service sites across England, in areas serving a diverse population. The intervention was evaluated using two validated outcomes: (i) Patient Reported Physician Cultural Competency (PRPCC); and (ii) Patient Enablement Instrument (PEI), measuring patients' perceptions of their overall healthcare delivery. Additionally, HCPs completed the COM-B questionnaire for capability (C), opportunity (O) and motivation (M) to perform behaviour (B), measuring behaviour change. Results Two hundred patients were recruited before HCPs undertook the intervention (cohort 1), and 200 were recruited after (cohort 2) from 15 HCPs; after exclusions 178 patients remained in cohort 1 and 186 in cohort 2. Sixty percent of patients identified as white in both recruited cohorts, compared with 29% and 33% of patients (cohorts 1 and 2, respectively) who identified as being of South Asian origin. After the intervention, the COM-B scores indicated that HCPs felt more skilled and equipped for consultations. No significant differences were noted in the average overall cultural competency score between the two cohorts in white patients (57.3 vs 56.8, P  = 0.8), however in the South Asian cohort there was a statistically significant improvement in mean scores (64.1 vs 56.7, P  = 0.014). Overall, the enablement score also showed a statistically significant improvement following intervention (7.3 vs 4.3, P  < 0.001) in the white patients and in the South Asian patients (8.0 vs 2.2, P  < 0.001). Conclusion This novel study provides evidence for improving cultural competency and patient enablement in rheumatology settings. [ABSTRACT FROM AUTHOR]

The article explores the issue of impaired functional sympatholysis during exercise in patients with heart failure with preserved ejection fraction (HFpEF) and its impact on exercise intolerance. HFpEF is a condition characterized by diastolic dysfunction and reduced exercise tolerance. The study reveals that individuals with HFpEF experience a lack of localized reduction in sympathetic-mediated vasoconstriction in the blood vessels supplying working muscle tissue. The authors suggest that chronic overactivation of the sympathetic nervous system and endothelial cell dysfunction may contribute to this impairment. The findings shed light on potential explanations for exercise intolerance in HFpEF patients and may aid in the development of clinical strategies to manage this condition. [Extracted from the article]

Purpose: To explore women's mental health in India's rapidly changing society. Participants and Methods: A convenience sample of low-income women (N = 286) in a medium-sized city in South-India participated in a mixed-methods, exploratory study in 2022. Institutional Review Board (IRB) approval was received from Loma Linda University in the US, and Christian Medical College-Vellore in India, in accordance with the declaration of Helsinki, prior to data collection. All study materials were forward and back translated for Tamil, the local language. Phase 1(n = 25) involved audio recorded key-informant interviews and focus groups. Verbatim transcripts were inductively coded, and emerging themes identified. Phase 2 (n = 261) entailed a quantitative survey including demographics, health history, and validated scales measuring mental health symptoms, coping strategies, social support, living situation, and life satisfaction. Data collectors were gender and language matched, research trained, community health nurses. Results: Qualitative themes included: 1) benefits of living in the city, 2) double duty for women doing household work and paid work, 3) challenges of living in the urban environment, 4) advantages of living in the village, 5) struggles associated with village life. Quantitative results: the average Hopkins Symptoms Checklist (HSCL) score of 1.82 (SD = 0.70) exceeded the 1.65 cut-off score for anxiety and depression symptomology. Among participants with elevated HSCL scores (n = 129) the average was markedly elevated (M = 2.39, SD = 0.56). These women were more likely to rely on wishful thinking, religious coping, and reported more post-migration living difficulties, less social support, and less satisfaction with life. Regression analysis further explored variables associated with participant HSCL scores. Conclusion: In this sample of low-income urban-dwelling women depression and anxiety symptomology was elevated. Given the limited mental health workforce and cultural stigmatization of mental health issues, further attention is required. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to elucidate characteristics of vaccine-hesitant nurses at two large Southern California medical centers where rates of COVID-19 vaccination were lower than expected. Methods: This study is a secondary analysis of nurse participants in a cross-sectional study conducted at the two medical centers. Participants completed an online survey regarding their demographics; work setting and role characteristics; influenza vaccination history; COVID-19 knowledge and beliefs; and personal history of COVID-19 exposure, diagnosis, and disease impact (infection or death) on those closest to them. Results: Of 869 nurse participants, most (78.6%) were vaccinated and 21.4% were unvaccinated; more than half of the unvaccinated participants reported being unwilling to be vaccinated ("vaccine hesitant"). The χ2 comparisons revealed no significant differences between vaccinated and vaccine-hesitant nurses in terms of education, contact with COVID-19 patients, work environment, or having friends and family impacted by COVID-19. Binary logistic regression showed that nurses who had no history of recent influenza vaccination were 10 times more likely to be vaccine hesitant, those who had inaccurate knowledge about COVID-19 vaccines were seven times more likely to be vaccine hesitant, and younger nurses and those with a prior COVID-19 diagnosis were approximately three times more likely to be vaccine hesitant. Furthermore, 17.3% of all participants were unwilling to recommend COVID-19 vaccination to others. Conclusion: The findings offer a nuanced understanding of vaccine hesitancy among nurses and will be useful to the planning and development of policies, campaigns, and interventions aimed at increasing vaccination rates among nurses. Changing attitudes is essential, and particular attention must be paid to nurses who are unwilling to recommend vaccination to others. Effective interventions are needed. This study aimed to elucidate the characteristics of vaccine-hesitant nurses at two large medical centers where rates of COVID-19 vaccination were lower than expected, and to understand the reasons for such hesitancy. [ABSTRACT FROM AUTHOR]

The Fulbright Scholar Program offers numerous awards, presenting nurse practitioners with opportunities to interact with colleagues around the world. As increasing acceptance of the nurse practitioner role is gaining acceptance and being defined in various countries across the world, with expanding role definitions, this represents a trailblazing opportunity to influence global representation. The recent completion of a Fulbright award experience in India is provided as an exemplar of the Fulbright opportunity. Nurse practitioner program development and continuing education are key to enhancing patient care and access to care among patients who need it most. To be a part of the effort to prepare nurse practitioners everywhere expands the reach beyond that of an individual nurse practitioner. We can learn from each other, share strategies for implementation across settings, and together address barriers to practice. [ABSTRACT FROM AUTHOR]

Black men have the highest rate of prostate cancer (PCa) morbidity and mortality in the US, and often receive delayed and/or poorer-quality treatment. This inequity has led many to turn to complementary and alternative medicine/therapies (CAM). However, little is known about the use of these therapies within the Black community. The purpose of this study was to describe types of CAM therapies used, and the reasons behind their use for overall health and PCa treatment and prevention among three groups of Black males, namely African Americans, Caribbean Immigrants and African Immigrants. This study used a mixed-methods design with a quantitative phase (n = 575) followed by a qualitative phase (n = 61) with participants recruited from various parts of the country. Results revealed differences among subgroups in CAM use for overall health and PCa, as well as differences in the types of CAM therapies used and differences in the reasons behind their use. The findings of this study reveal a prevalence of CAM use for overall health and PCa within three different groups of Black men and identifies the specific CAM used. There were significant differences in the types of CAM used by each subgroup for both overall health and PCa. This study also shows that there is value in looking at Black subgroups distinctively, for their rates of CAM use and reasons for use, are distinctly different. [ABSTRACT FROM AUTHOR]

Background: India has the highest number of stillbirths and the highest neonatal death rate in the world. In the context of its pronatalist society, women who experience perinatal loss often encounter significant social repercussions on top of grief. Furthermore, even when pregnancy outcomes were favorable, adverse life circumstances put some women at risk for postnatal depression. Therefore, perinatal loss and postnatal depression take a heavy toll on women's mental health. The purpose of this study is to assess mental health among a sample of Mumbai slum-dwelling women with a history of recent childbirth, stillbirth, or infant death, who are at risk for perinatal grief, postnatal depression, or mental health sequelae.Methods: We conducted a mixed method, cross-sectional study. A focus group discussion informed the development of a comprehensive survey using mainly internationally validated scales. After rigorous forward and back-translation, surveys were administered as face-to-face structured interviews due to low literacy and research naiveté among our respondents. Interviews were conducted by culturally, linguistically, gender-matched, trained research assistants.Results: Of our reproductive age (N = 260) participants, 105 had experienced stillbirth, 69 had a history of infant death, and 25 had experienced both types of loss. Nearly half of the sample met criteria for postnatal depression, and 20% of these women also met criteria for perinatal grief. Anxiety and depression varied by subgroup, and was highest among women desiring an intervention.Conclusions: Understanding factors contributing to women's suffering related to reproductive challenges in this pronatalist context is critically important for women's wellbeing. [ABSTRACT FROM AUTHOR]

Purpose: Given the pressures surrounding women's reproductive role in India, and persistent high rates of perinatal death, the purpose of this study is to describe and compare poor rural and urban Indian women's experiences of perinatal grief. Participants and Methods: Two cross-sectional studies were compared on shared quantitative variables. Poor rural (N = 217) and urban, slum-dwelling (N = 149) Central Indian women with a history of stillbirth, and/or infant death were recruited with the aid of local community health workers. Trained, local, gender, and linguistically matched research assistants conducted the structured interviews. Shared quantitative variables include demographics, Social Provision Scale, Shortened Ways of Coping-Revised, Perinatal Grief Scale, social norms and autonomy. Results: While similar with respect to SES, age, number of living sons and perinatal loss experiences, these samples of poor women differed significantly across many variables, most notably women's household position, joint family living, number of live daughters, religious coping, autonomy, and degrees of perinatal grief. While perinatal grief was significantly associated with many variables bi-variably, most lost their relative influence in our stepwise multivariable modeling within site (rural/urban), with only social norms and social support remaining significant for rural (31% of variance) and wishful thinking and social norms for urban participants (38.4% of variance). In the combined sample household position, social support and social norms remained significant and explained 53.6% of the adjusted variance. Conclusion: In both samples, perinatal grief was high following perinatal loss. Both groups of women with perinatal loss have increased risk of mental health sequelae. Notably, the context affected how they experienced perinatal grief, with rural women's grief being higher and more affected by their societal pressures and isolation. Such nuances are important considerations for much-needed tailored approaches to future interventions. [ABSTRACT FROM AUTHOR]

Objective: To review the currently available research into romantic partner involvement during oncology consultations.Methods: Studies were identified via database searches plus hand-searching. A narrative review was performed using the principles of Thematic, and Framework syntheses. The search strategy was performed according to the principles of PRISMA.Results: From 631 results, 18 studies were included. The findings indicate that romantic partners are most valued by patients when they provide emotional, practical, and informational support. It is also indicated that psychosocial and sexual concerns are rarely discussed. Couples' self-reported satisfaction with consultations appear related to the extent of romantic partner involvement, the roles that they enacted, and the extent to which psychosocial and sexual concerns were addressed.Conclusion: This review indicates that romantic partner involvement during clinical consultations enhances the couple's experience. However, there are methodological limitations to this body of research, which are discussed in this review.Practice Implications: Research to date has yet to offer an exploration of the social practices and conversational actions relating to romantic partner involvement during triadic oncology consultations. Future studies that draw upon recordings of these consultations, using methods capable of analysing situated social practices can address this gap. [ABSTRACT FROM AUTHOR]

Background: Infertility is a global problem, with high prevalence in India. As a pronatalist society, infertility is particularly problematic in India, causing stigma, shame, and blame especially for women. Infertility consequences for women include discrimination, social exclusion, and abandonment, putting them at high risk for mental health distress. Furthermore, mental health is highly stigmatized and specialized care is largely unavailable. Despite the cultural importance of childbearing, research on infertility distress and resulting mental health sequelae is lacking, particularly among low-income women. The purpose of this study is to assess mental health, using validated scales, among Mumbai slum-dwelling women with a history of infertility. Methods: We conducted a mixed-method, cross-sectional study. A focus group discussion with community health workers (n = 7) informed the development of a comprehensive survey. The survey consisted of validated scales whenever possible, in addition to questions pertaining to women's sociodemographic and reproductive history. After rigorous forward and back translation, the surveys were conducted as face-to-face structured interviews due to low literacy levels and the research naiveté of our respondents. Interviews were conducted by culturally, linguistically, gender-matched, trained research assistants. Results: Mumbai slum-dwelling women of reproductive age suffering from infertility (N = 74) participated. Most (85%) women and their husbands (66%) reported previous infertility testing. Participants had elevated mental health distress (anxiety and depression symptomology) largely explained by general health, length of marriage, and coping strategy employed. Conclusion: Women facing the double stigma of mental health and infertility need innovative programs to address their challenges. [ABSTRACT FROM AUTHOR]

Objective We explored patients' experiences of using Internet-based self-management support for low back pain (LBP) in primary care, with and without physiotherapist telephone guidance. Design Exploratory descriptive qualitative study using thematic analysis, nested within a randomized feasibility trial. Methods Patients with LBP who participated in a feasibility trial of the SupportBack Internet intervention (ISRCTN: 31034004) were invited to take part in semistructured telephone interviews after the three-month intervention period (a convenience sample from within the trial population). Fifteen participants took part (age range = 36–87 years, 66.7% female, characteristics representative of the trial population). Data were analyzed thematically. Results Analysis resulted in the development of six themes (subthemes in parentheses): Perceptions of SupportBack's design (Clarity and ease of use, Variety and range of information provided, Need for specificity and flexibility), Engaging with the SupportBack intervention, Promoting positive thought processes (Reassurance, Awareness of self-management), Managing behavior with SupportBack (Motivation and goal setting, Using activity as a pain management strategy, Preferences for walking or gentle back exercises), Feeling supported by telephone physiotherapists (Provision of reassurances and clarity, Physiotherapists are motivating), Severity and comorbidity as barriers (Preexisting condition or severity acting as a barrier, Less useful for mild low back pain). Conclusions The Internet intervention SupportBack appeared to feasibly support self-management of LBP. Reassurance and ongoing support to implement behavioral changes were central to reported benefits. The addition of physiotherapist telephone support further enhanced the patient experience and the potential utility of the intervention. [ABSTRACT FROM AUTHOR]

Preceptors are essential to nurse practitioner (NP) students' transition from being a student to competent entry-level NP graduate. The literature is replete with data pertaining to the benefits of and barriers to preceptors engaging in the clinical education of NP students, and little has changed in the last two decades in this regard. Therefore, faculty solicited preceptor input to enhance curriculum revision and clinical training preparation. This qualitative inquiry project derived data from interviews with 13 preceptors in a variety of clinical settings. Interviews were audiorecorded, transcribed verbatim, and analyzed using a content analysis method. Recruiting, training, and retaining qualified, willing preceptors are of paramount importance to NP programs. This article describes preceptor expectations of NP students' knowledge, skills, and attitudes for optimal clinical rotation experiences. The results have important implications for innovative NP educational models, developing trust in NP education programs and promoting competency development of the NP student using entrustable professional activities. [ABSTRACT FROM AUTHOR]

Background: Many parents of children with developmental delays (DDs) experience high levels of parental stress, and young children with DDs are likely to exhibit clinical levels of behavioral problems. The reciprocal relationship between the two issues makes these families vulnerable to stress-related health risks. To address this, the current study aims to investigate the effectiveness of mindfulness-based stress reduction (MBSR) at reducing parent stress, as measured by both psychological self-report and a physiological biomarker. Method: A pretest–posttest design with a 6-month follow-up assessment was used to establish effectiveness with analyses of within-subject effects. Parents (N = 47) of children (2.5–5 years of age) with DDs participated in a standard 8-week MBSR intervention. Measures included the Parenting Daily Hassles, a self-report measure of perceived frequency and intensity of parenting stress, and salivary samples for measurement of the cortisol awakening response (CAR), a biological marker of stress response. Results: Both self-reported parenting stress and CAR decreased following MBSR for parents of children with DDs. The greatest difference in means over time was between baseline and follow-up, where changes in effect size were even stronger for biological markers than for self-report measures. Conclusion: The MBSR intervention reduced both perceived and physiologic stress. Health-care professionals caring for these families might consider encouraging parents to participate in MBSR as both treatment and prevention of parenting stress. [ABSTRACT FROM AUTHOR]

Background: Evaluating the impact of communication during clinical encounters is complex. One behaviour, largely ignored in clinical practice and training, is interruptions in verbal communication. Two types exist: an 'overlap' (an error projecting when a turn ends); and an 'interruption' (when an individual starts talking before the speaker's turn is complete). This paper reports the prevalence of these behaviours during initial consultations involving physiotherapists and patients with back pain. Method: 25 initial back pain consultations were observed, audio-recorded, transcribed verbatim, analysed thematically and managed using a Framework approach. Results: The data set comprised 15,489 turns: 7659 by patients; 7647 by clinicians; and 183 by others (patients' spouse or clinical colleagues). Clinicians were 7 times more likely to interrupt than patients (284 and 39 respectively), however overlaps were 1.5 times more prevalent among patients (n = 582) compared to clinicians (n = 385). The main functions for interruptions by clinicians and patients were to 'seek' or 'give' additional information respectively. A trend was noted that female physiotherapists were 3 times more likely to interrupt than male clinicians and overall, the prevalence of interruptions in same-sex consultations was twice as likely as in mixed-sex encounters, however the small sample size precluded secondary analyses. Conclusion: Alongside measuring the prevalence of interruptions in back pain consultations, this study identified differences in the nature of interruptions made by physiotherapists and patients. It highlights the complexity of clinical encounters and that being aware of interruptions is important to optimize rapport and clinician-patient relationships. [ABSTRACT FROM AUTHOR]

Empathy is considered essential to creating a positive clinician-patient relationship, along with improving patient experience and adherence to treatment. It is not clear how physiotherapists acquire their empathic skills. This study explored physiotherapists’ perceptions of empathy during musculoskeletal clinical encounters. Seventeen participants attended three focus groups separated by clinical employment grade. The definition of empathy, its acquisition and impact on a clinical encounter were discussed, audio-recorded, transcribed verbatim and analysed thematically. Six key themes and 48 sub-themes were identified. Empathy was defined similarly in all three focus groups. There was divergence on its acquisition and the extent to which it can be taught, however participants agreed that empathy is an innate characteristic. Senior physiotherapists placed greater emphasis on the importance of empathic communication than student physiotherapists, whilst student and junior physiotherapists considered limited clinical experience to be a barrier in delivering empathic communication, anticipating this to improve over time. This study identified a mismatch between the perceived importance of empathic communication in the literature and by clinicians, compared with the time spent acquiring and developing these skills. Clinicians need to place a greater emphasis on enhancing their empathic communication skills throughout their career to help create a positive patient experience and enhance clinician-patient relationships. [ABSTRACT FROM PUBLISHER]

Background:Millennium Development Goal 4, to reduce child mortality, can only be achieved by reducing stillbirths globally. A confluence of medical and sociocultural factors contribute to the high stillbirth rates in India. The psychosocial aftermath of stillbirth is a well-documented public health problem, though less is known of the experience for men, particularly outside of the Western context. Therefore, men's perceptions and knowledge regarding reproductive health, as well as maternal-child health are important.Methods:Key informant interviews (n = 5) were analyzed and 28 structured interviews were conducted using a survey based on qualitative themes.Results:Qualitative themes included men's dual burden and right to medical and reproductive decision making power. Wives were discouraged from expressing grief and pushed to conceive again. If not successful, particularly if a son was not conceived, a second wife was considered a solution. Quantitative data revealed that men with a history of stillbirths had greater anxiety and depression, perceived less social support, but had more egalitarian views towards women than men without stillbirth experience. At the same time fathers of stillbirths were more likely to be emotionally or physically abusive. Predictors of mental health, attitudes towards women, and perceived support are discussed.Conclusions:Patriarchal societal values, son preference, deficient women's autonomy, and sex-selective abortion perpetuate the risk for future poor infant outcomes, including stillbirth, and compounds the already higher risk of stillbirth for males. Grief interventions should explore and take into account men's perceptions, attitudes, and behaviors towards reproductive decision making. [ABSTRACT FROM AUTHOR]

Asian-Indians, one of the fastest growing US immigrant groups, experience depression and anxiety, particularly among women. In this mixed-methods study, quantitative (n = 217) and qualitative (n = 36) data explored egalitarian vs. traditional views regarding women's roles and rights. Bicultural integration, family planning decision-making ability, and anxiety were associated with more egalitarian views, while Punjabi language preference, depression, and more births were associated with traditional views. Health care professionals serving this population need to be aware of the potential cultural values conflicts and gender role expectations that influence decisions around reproductive health and mental health care for Asian-Indian immigrant women. [ABSTRACT FROM AUTHOR]

Commonalities are presented from the experiences of U.S. nurse researchers who conducted studies in India, Jordan, Aotearoa/New Zealand, and Trinidad and Tobago. While planning research, it is important to engage collaborators who are members of the culture to be studied to understand what are culturally appropriate aims and methods. It is also vital to observe cultural etiquette, especially while gaining entrée and collecting data. Issues related to data collection include timing it around local holidays and events, and adapting individualist methods for obtaining consent and data to be more respectful for those in a collectivist culture. Care must be taken to give back, to sharing findings, and insure sustainability for future research in the host culture. Based on these and other reflections, recommendations are offered to support investigators planning research in a culture that is not their own. [ABSTRACT FROM AUTHOR]

Concepts of patient-centredness and shared decision-making inform expectations that clinicians should display sensitivity to patients' expressed preferences. This study examines the organisation of treatment-related preferences expressed by patients and their partners during clinical consultations for people with localised prostate cancer. A conversation analysis of twenty-eight diagnosis and treatment consultations was conducted with data recorded from four clinical sites across England. When clinicians disaligned from expressions of preference such as directing talk away from expressions, or moving to redress perceived misunderstandings, it caused discordance in the unfolding interaction. This led to couples silencing themselves. Two deviant cases were identified that did not feature the misalignment found in all other collected cases. In these two cases, the interaction remained collaborative. These findings highlight the immediate consequences of expressions of preference being resisted, rejected, and dismissed in a context where clinicians are expected to explore expressed preferences in service of SDM. The deviant case analysis offers an alternative practice to the pattern observed across the collection, offering a comparison between misaligned sequences, and cases where social solidarity was maintained. By acknowledging couple's expressions as valid contributions, rather than acting to inform or correct them, clinicians can create opportunity spaces for discussion around treatment preferences. • Couples regularly expressed treatment-related preferences during consultations. • Clinician disalignment from expressions of preference caused interactional discordance. • This led to couples silencing themselves, indicative of conflict management. • Clinicians inhibited exploration of couples' preferences and viewpoints. [ABSTRACT FROM AUTHOR]

This research examines how partners contribute to clinical consultations for people with prostate cancer. It highlights a social practice where a partner responds to talk that addresses a patient. A conversation analysis of twenty-eight prostate cancer treatment and diagnostic consultations was carried out using data collected from four clinical sites across England. The analysis demonstrated that this practice was prosocial and patient enabling. Partners oriented to the patient's primary rights to take their turn as the selected next speaker, only initiating after a substantial delay from the clinician's turn-at-talk. Consequently, the partner consistently opened an opportunity space that the patient took to elaborate upon, or collaborate with the partners' turn as they regularly took up a unified stance resisting the individualised configuration of the encounter. This research highlights the social and clinical utility of partners during these consultations, as they served as important, yet underutilised interactional and informational resources for clinicians and patients. This research indicates a need to reconsider the configuration of these consultations and sanction partners as formal participants. Absent of this, partners will continue to have to work to insert their contributions into consultations while resisting the dyadic structure of these interactions. • Partners were rarely addressed by clinicians and patients and worked to insert their contributions into the consultation. • Partners oriented to the patient's primary rights to respond to talk explicitly addressing patients. • Partners served as an important, yet under-used informational and interactional resource for patient and clinician. • This paper argues for a need to reconsider what it means to enact patient centredness in triadic healthcare encounters. [ABSTRACT FROM AUTHOR]

Stillbirth is a significant global health problem that frequently results in perinatal grief with compound negative psychosocial impact. In low-resource settings with exceedingly high stillbirth rates, such as rural Chhattisgarh, India, it is vital to utilize low-cost, effective interventions. Mindfulness-based stress reduction is an evidence-based intervention utilized for a broad range of physical and mental health problems, and is adaptable to specific populations. The objective of this study was to explore the sustained effectiveness of a shortened, culturally adapted mindfulness-based intervention (MBI) designed to address complex grief after stillbirth. We used an observational, mixed-methods pre-post study design with 6-week and 12-month follow-up assessments among women with a history of stillbirth (N = 22). Analyses explored study outcomes and continued use of mindfulness skills. Pretest results showed elevated psychological symptoms and high levels of perinatal grief. General linear modeling repeated measures was used to explore 6-week and 12-month follow-up changes from baseline, controlling for significantly correlated demographic variables. Longitudinal results indicated significant reductions in perinatal grief and psychological symptoms; four of the five facets of mindfulness changed in the desired direction; and resilience scores indicated thriving. The shortened, culturally adapted, MBI pilot brought about sustained, significant reductions of perinatal grief and mental health symptoms, and participants reported use of mindfulness skills in day-to-day life. This study shows that the significant mental health needs among rural women of various castes and ethnicities in Chhattisgarh following stillbirth were successfully addressed by a promising MBI with potential scalability and sustainability. [ABSTRACT FROM PUBLISHER]

This review describes recent developments in online and mobile mental health applications, including a discussion of patient portals to support mental health care. These technologies are rapidly evolving, often before there is systematic investigation of their effectiveness. Though there are some reviews of the effectiveness of mental health mobile apps, perhaps the more significant development is innovation in technology evaluation as well as new models of interprofessional collaboration in developing behavioural health technologies. Online mental health programs have a strong evidence base. Their role in population health strategies needs further exploration, including the most effective use of limited clinical staff resources. Patient portals and personal health records serve to enhance mental health treatment also, though concerns specific to mental health must be addressed to support broader adoption of portals. Provider concerns about sharing psychiatric notes with patients hinder support for portals. Health information exchange for mental health information requires thoughtful consent management strategies so mental health patients can benefit. Finally, the broad array of health information technologies may overwhelm patients. User-friendly, well-designed, patient-centred health information technology homes may integrate these functions to promote a holistic approach to care plans and overall wellness. Such technology homes have special security needs and require providers and patients to be well informed about how best to use these technologies to support behavioural health interventions. [ABSTRACT FROM PUBLISHER]

Mindfulness-based stress reduction (MBSR) interventions are popular as a treatment strategy for myriad diagnoses in various settings, and may be beneficial for parents of children with developmental delays (DD). However, prior research suggests extreme levels of stress and extraordinary demands on time among these parents, making the feasibility of effectively implementing MBSR with this population questionable. This study examined the feasibility of administering standard MBSR to a diverse community-based sample of parents of young children with DD. The potential impact of MBSR interventions includes improvement in parents’ mental health, and collateral benefits for the family environment, including improved child behavior. Nurses may have an integral role in interdisciplinary teams providing MBSR. [ABSTRACT FROM AUTHOR]

Constitutive activation of the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) axis is fundamental to the molecular pathogenesis of a host of hematological disorders, including acute leukemias and myeloproliferative neoplasms (MPN). We demonstrate here that the major JAK2 mutation observed in these diseases (JAK2V617F) enforces Mcl-1 transcription via STAT3 signaling. Targeting this lesion with JAK inhibitor I (JAKi-I) attenuates STAT3 binding to the Mcl-1 promoter and suppresses Mcl-1 transcript and protein expression. The neutralization of Mcl-1 in JAK2V617F-harboring myelodyssplastic syndrome cell lines sensitizes them to apoptosis induced by the BH3-mimetic and Bcl-xL/Bcl-2 inhibitor, ABT-263. Moreover, simultaneously targeting JAK and Bcl-xL/-2 is synergistic in the presence of the JAK2V617F mutation. These findings suggest that JAK/Bcl-xL/-2 inhibitor combination therapy may have applicability in a range of hematological disorders characterized by activating JAK2 mutations. [ABSTRACT FROM AUTHOR]

We explored the concept of using a Mindfulness-based intervention to reduce perinatal grief among Indian women. Data were collected using mixed methods to explore concept acceptability, receptivity, modality, and feasibility of the intervention. The intervention was piloted and evaluated with measures of perinatal grief, psychosocial wellbeing, religious coping, perceived social provision of support, and mindfulness. The intervention was well received and effective in teaching skills to help women deal with high levels of grief and subsequent mental health challenges. To overcome attendance barriers modification is necessary. Partnership with a local nursing school is critical to enhance sustainability of the intervention. [ABSTRACT FROM AUTHOR]

Background Substantial progress has been made in the identification of sequence elements that control mRNA splicing and the genetic variants in these elements that alter mRNA splicing (referred to as splicing quantitative trait loci - sQTLs). Genetic variants that affect mRNA splicing in trans are harder to identify because their effects can be more subtle and diffuse, and the variants are not co-located with their targets. We carried out a transcriptome-wide analysis of the effects of a mutation in a ubiquitous splicing factor that causes retinitis pigmentosa (RP) on mRNA splicing, using exon microarrays. Results Exon microarray data was generated from whole blood samples obtained from four individuals with a mutation in the splicing factor PRPF8 and four sibling controls. Although the mutation has no known phenotype in blood, there was evidence of widespread differences in splicing between cases and controls (affecting approximately 20% of exons). Most probesets with significantly different inclusion (defined as the expression intensity of the exon divided by the expression of the corresponding transcript) between cases and controls had higher inclusion in cases and corresponded to exons that were shorter than average, AT rich, located towards the 5' end of the gene and flanked by long introns. Introns flanking affected probesets were particularly depleted for the shortest category of introns, associated with splicing via intron definition. Conclusions Our results show that a mutation in a splicing factor, with a phenotype that is restricted to retinal tissue, acts as a trans-sQTL cluster in whole blood samples. Characteristics of the affected exons suggest that they are spliced co-transcriptionally and via exon definition. However, due to the small sample size available for this study, further studies are required to confirm the widespread impact of this PRPF8 mutation on mRNA splicing outside the retina. [ABSTRACT FROM AUTHOR]

Background. Communication in clinical encounters is vital in ensuring a positive experience and outcome for both patient and clinician. Objective. The purpose of this study was to measure verbal communication between physical therapists and patients with back pain during their initial consultation and trial management of the data using a novel, Web-based application. Design. A cross-sectional study was conducted. Methods. Nine musculoskeletal physical therapists and 27 patients with back pain participated in this study. Twenty-five initial consultations were observed, audio recorded, and categorized using the Medical Communications Behavior System. Data were managed using Synote, a freely available application enabling synchronization of audio recordings with transcripts and coded notes. Results. In this sample, physical therapists spoke for 49.5% of the encounter and patients for 33.1%. Providers and patients spent little time overtly discussing emotions (1.4% and 0.9%, respectively). More-experienced clinicians used more "history/ background probes," more "advice/suggestion," and less "restatement" than less-experienced staff, although they demonstrated a greater prevalence of talking concurrently and interrupting patients (7.6% compared with 2.6%). Limitations. Although studies measuring actual behavior are considered to be the gold standard, audio recordings do not enable nonverbal behaviors to be recorded. Conclusion. This study investigated a method for measuring the verbal content of clinical encounters in a physical therapy outpatient setting. The study has directly contributed to developing a research-friendly version of the application (ie, Synote Researcher). Given the pivotal role of communication in ensuring a positive experience and outcome for both patient and provider, investing time in further developing communication skills should be an on-going priority for providers. Further work is needed to explore affective behaviors and the prevalence of interrupting patients, considering differences in sex and provider experience. [ABSTRACT FROM AUTHOR]

Stillbirth is a globally significant public health problem with many medical causes. There are also indirect causal pathways including social and cultural factors which are particularly salient in India's traditional society. The purpose of this study was to explore women's perceptions of stillbirth and to determine how issues of gender and power, social support, coping efforts, and religious beliefs influence perinatal grief outcomes among poor women in rural Chhattisgarh, India. Structured interviews were done face-to-face in 21 randomly selected villages among women of reproductive age ( N = 355) who had experienced stillbirth ( n = 178) and compared to those who had not ( n = 177), in the Christian Hospital, Mungeli catchment area. Perinatal grief was significantly higher among women with a history of stillbirth. Greater perinatal grief was associated with lack of support, maternal agreement with social norms, and younger maternal age. These predictors must be understood in light of an additional finding-distorted sex ratios, which reflect gender discrimination in the context of Indian society. The findings of this study will allow the development of a culturally appropriate health education program which should be designed to increase social support and address social norms, thereby reducing psychological distress to prevent complicated perinatal grief. Perinatal grief is a significant social burden which impacts the health women. [ABSTRACT FROM AUTHOR]

Double subgenomic Sindbis virus (dsSINV) vectors are widely used for the expression of proteins, peptides, and RNA sequences. These recombinant RNA viruses permit high level expression of a heterologous sequence in a wide range of animals, tissues, and cells. However, the alphavirus genome structure and replication strategy is not readily amenable to the expression of more than one heterologous sequence. The Rhopalosiphum padi virus (RhPV) genome contains two internal ribosome entry site (IRES) elements that mediate cap-independent translation of the virus nonstructural and structural proteins. Most IRES elements that have been characterized function only in mammalian cells but previous work has shown that the IRES element present in the 5′ untranslated region (UTR) of the RhPV genome functions efficiently in mammalian, insect, and plant systems. To determine if the 5′ RhPV IRES element could be used to express more than one heterologous sequence from a dsSINV vector, RhPV 5′ IRES sequences were placed between genes for two different fluorescent marker proteins in the dsSINV, TE/3′2J/mcs. While mammalian and insect cells infected with recombinant viruses containing the RhPV sequences expressed both fluorescent marker proteins, only single marker proteins were routinely observed in cells infected with dsSINV vectors in which the RhPV IRES had been replaced by a luciferase fragment, an antisense RhPV IRES, or no intergenic sequence. Thus, we report development of a versatile tool for the expression of multiple sequences in diverse cell types. [ABSTRACT FROM AUTHOR]

Abstract: Formalin-fixed paraffin-embedded (FFPE) tissue samples are a potentially valuable resource of expression information for medical research, but are under-utilized due to degradation and modification of the RNA. Using a random primer-based RNA amplification strategy, we have evaluated multiple protocols for the extraction and isolation of RNA from FFPE samples. We found that the RecoverAll RNA isolation procedure with three or four slices (ten-microns in thickness), supplemented with additional DNAse, gave optimal results. RNA integrity as assessed by Agilent Bioanalyzer, and amplification of the 28S ribosomal RNA, were predictive for the number of genes detected on Affymetrix arrays. We obtained expression data for colon and lung tumor and normal FFPE samples and matched frozen samples and found a high correlation between frozen and matched FFPE samples (R 2 between 0.82 and 0.89), while the signature sets in tumor versus normal comparisons were also quite similar. QPCR confirmed all 16 of the differential expression results from the microarrays that we tested. Differentially expressed signature genes from tumor versus matched normal FFPE tissue from colon and lung were identified as cancer-related, with 95 colon tumor and 67 lung tumor genes identified, respectively. [Copyright &y& Elsevier]

Abstract: Translation initiation on the majority of cellular mRNAs is mediated by a cap structure on the 5′ end of the mRNA and involves the binding of initiation factors to the cap, followed by recruitment of the 40S ribosomal subunit. However, a number of viral mRNAs are translated using an alternative mechanism, termed internal initiation. In this case, initiation factors and the 40S subunit bind to an internal ribosome entry site (IRES) structure within the 5′ untranslated region (UTR) of the mRNA. Although there is no common feature amongst all viral IRES elements, most are believed to contain extensive secondary structure and some of these structures are important for their function. However, an IRES element from the 5′ UTR of the genome of Rhopalosiphum padi virus, a Dicistrovirus, challenges this paradigm. This IRES has been shown to function in a number of different translation systems. Intriguingly, the functional region of this IRES element is largely unstructured, and multiple regions from within the 5′ UTR function as efficiently as the full-length sequence. This review compares and contrasts the features of this atypical IRES element with other IRES elements and discusses its possible mechanism of action. [Copyright &y& Elsevier]

Abstract: Eukaryotic translation initiation factor 4E (eIF4E) is perhaps best known for its function in the initiation of protein synthesis on capped mRNAs in the cytoplasm. However, recent studies have highlighted that eIF4E has many additional functions, which include the nuclear export of specific mRNAs as well as roles in ageing and the translation of some uncapped viral RNAs. This review aims to update the reader on recent developments, including the potential of eIF4E as a therapeutic target. [Copyright &y& Elsevier]

Background and Purpose Communication is the most important aspect of practice that health care professionals have to master. The purpose of this study was to measure the content and prevalence of verbal and nonverbal communications between physical therapists and patients with back pain. Subjects Seven physical therapists and 21 patients with back pain participated in this study. Methods The first interaction following the initial assessment was recorded with a video camera. The outcome measures were the Medical Communications Behavior System (verbal communication) and frequencies of nonverbal behaviors (affirmative head nodding, smiling, eye gaze, forward leaning, and touch). Semistructured interviews were undertaken with the physical therapists to determine the perceived influence of the video camera. Results A total of 2,055 verbal statements were made. Physical therapists spent approximately twice as much time talking as patients, with content behaviors (such as taking history and giving advice) comprising 52% of verbal communications. The most prevalent nonverbal behaviors were touch by physical therapists (54%) and eye gaze by patients (84%). Discussion and Conclusion The prevalence and content of communication can be measured with video analysis and validated tools. Communication is an extremely important but underexplored dimension of the patient-therapist relationship, and the methods described here could provide a useful model for further research and reflective practice. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of timing of verbal disclosure of a disability on employment interview ratings of applicants with nonvisible disabilities. Study Design: Participants (56 college students) viewed 2 videotaped employment interviews: 1 involving an applicant who disclosed a nonvisible disability (transverse myelitis), either early or late in the interview, and 1 with an applicant who did not disclose a disability. Outcome Measures: Qualifications/hiring, liking, and comfort with disability disclosure scales. Results: Applicants with nonvisible disabilities who chose to disclosure their disability were rated as more qualified and likeable when disclosing early in an interview. Conclusion: Individuals who wish to disclose an externally caused nonvisible disability (similar to transverse myelitis) should consider doing so early in an interview rather than at the end. [ABSTRACT FROM AUTHOR]

A pilot study was conducted to investigate the feasibility and effectiveness of behavioral activation (BA) therapy for veterans with posttraumatic stress disorder (PTSD). Eleven veterans seeking treatment at a Veterans Administration outpatient PTSD clinic were enrolled in the study protocol, consisting of 16-weekly individual sessions of BA. Nine veterans completed the protocol, one participant completed 15 sessions, and one dropped out after one session. Clinician-rated PTSD symptom severity showed significant pre- to posttreatment improvement and was associated with a moderate effect size. A number of participants also were improved on measures of depression and quality of life, but changes did not reach statistical significance. Findings suggest that BA is a well-tolerated, potentially beneficial intervention for veterans with chronic symptoms of PTSD. [ABSTRACT FROM AUTHOR]

Abstract: Spontaneous episodes of spreading depression (SD) originating in multiple sources adjacent to a focal intracerebral hemorrhage (ICH) propagate into brain regions away from the lesion site soon after injury onset. Although these transient depolarizations have not been established in the opposite hemisphere of the swine ICH model, we have reported a diminishing of sensory responsiveness in this homotopic brain region following induction of a unilateral hemorrhage lesion. This study examined whether transient depolarizations exist in this distant brain region contralateral to the ICH site. Electrocorticographic (ECoG) recordings of brain activity were collected bilaterally from the primary somatosensory (SI) cortices of the swine brain prior to and immediately after an intracerebral injection of collagenase or saline or the insertion of the infusion pipette into the SI cortex of the right hemisphere. Transient depolarizations were present in both hemispheres of all the experimental groups. The earliest negative DC potential shifts were observed in the injured SI cortex within the first hour after collagenase injection, as compared to T = 3 h in the saline-injected group and T = 4 h in the infusion pipette only group. In contrast, transient depolarizations were first detected in the left SI cortex contralateral to the lesioned hemisphere within 2 h after collagenase infusion, by T = 4h after saline infusion and by T = 3 h in the pipette only group. Propagating waves of negative DC potential shifts continued in both brain hemispheres, particularly in the ICH group, throughout the 11-h recording period. This novel finding of recurrent depolarizing waves in the hemisphere contralateral to the injury site prompted us to examine whether corpus callosal connections may play a role in this transhemispheric phenomenon. In a separate group of animals, the corpus callosum was transected prior to acquiring DC potential recordings and collagenase injection. The onset pattern of negative DC shifts in the callosotomized + collagenase-injected group was similar to the collagenase group with an intact corpus callosum. Initial generation of SD in the callosotomized + collagenase-injected group occurred by T = 1 h in the ICH injured right hemisphere and T = 2 h in the contralateral hemisphere. These transient depolarizations also persisted throughout 11-h recording period indicating that the corpus callosal transection did not hinder these remote propagating waves of depolarization. The presence of SD in the SI cortices of both hemispheres in all experimental groups of this study suggests that a focal mechanical or hemorrhagic injury increases the susceptibility of distant ipsilateral and contralateral brain regions to depolarizing perturbations. The mechanism for these transient depolarizations in the contralateral hemisphere apparently does not involve transhemispheric propagation along corpus callosal fibers. [Copyright &y& Elsevier]

Injury to the cerebral cortex results in functional deficits not only within the vicinity of the lesion but also in remote brain regions sharing neuronal connections with the injured site. To understand the electrophysiological basis of this phenomenon, we evaluated the effects of a focal intracerebral hemorrhage (ICH) on cortical excitability in a remote, functionally connected brain region. Cortical excitability was assessed by measuring the somatic evoked potential (SEP) elicited by electrical stimulation of the swine snout, which is somatotopically represented in the rostrum area of the primary somatosensory (SI) cortex. The SEP was measured on the SI cortex ipsilateral to the site of ICH and on the contralateral SI cortex during the acute period (≤11 h) after collagenase-induced ICH. The ICH rapidly attenuated the SEP on the ipsilateral cortex as we reported earlier. Interestingly, the ICH also attenuated the SEP on the contralateral SI cortex. Evoked potentials in the contralateral SI cortex showed a gradual decrease in amplitude during this acute period of ICH. We then investigated whether the interhemispheric connections shared by the contralateral SI and the lesion cortex were responsible for the diminished evoked potentials in the uninjured hemisphere after ICH. A separate group of animals underwent corpus callosal transection prior to electrocorticography (ECoG) recordings and ICH injury. Within hours of hemorrhagic injury, a gradual but marked increase in evoked potential amplitude was observed in the homotopic SI cortex of callosotomized animals as compared to pre-injection recordings. The enhancement suggests that there are additional effects of ICH on remote areas functionally connected to the site of injury. Functional deficits were present in both SI cortices within the first several hours of a unilateral injury indicating that the cessation of brain activity in the lesioned SI is mirrored in the contralateral hemisphere. This electrophysiological depression in the uninjured SI cortex is mediated in part by the interhemispheric connections of the corpus callosum. [Copyright &y& Elsevier]

Background: Persons with co-occurring Axis I mental disorders and substance use disorders often experience multiple negative consequences as a result of their substance use. Because no existing measure adequately assesses these population-specific problems, we developed the Problems Assessment for Substance Using Psychiatric Patients (PASUPP). This paper describes the scale development and factor structure, and provides initial reliability and validity evidence for the PASUPP. Methods: An initial pool of 54 items was assembled by reviewing existing measures for relevant items and generating new items. Then, 239 patients (90% male, 61% White) with documented Axis I psychiatric and current substance use disorders rated the lifetime and last 3-month occurrence of each problem, and completed additional measures of substance use and related functioning. Results: Lifetime endorsements ranged from 31 to 95%, whereas 3-month endorsements ranged from 24 to 78%. Item analyses reduced the set to 50 items. The PASUPP is internally consistent (alpha = 0.97) and unidimensional. Scale validity was suggested by moderate correlation with other measures of substance problem severity. Conclusions: Promising psychometric properties are reported for a population-specific measure of substance use problems. Such a measure could be useful for initial assessments and outcome evaluations with substance using psychiatric patients. [Copyright &y& Elsevier]

Investigates a possible resolution for the probability heuristic model (PHM) of syllogistic reasoning. Concern to the order on the informativeness of the quantifier; Incorporation of PHM to the pragmatic phenomena causing changes in the informativeness order; Influence of the pragmatics on syllogistic reasoning.

Investigates the clinical significance of previously reported statistically significant mean reductions in drinking and related problems among college students in a randomized trial of a brief indicated preventive intervention. Alcohol-related problems and dependence; Baseline differences between high-risk and functional comparison groups.

Focuses on the arguments of Thomas Kuhn for another method of historiography based on his book `The Structure of Scientific Revolutions.' How he addressed a theory of scientific revolutions; Overview of his theory of paradigms; Discussion on the issues surrounding his theory.

Objective: To investigate the decision-making process of women returning to work after maternity leave or parental leave and explore the influence of cultural norms and societal expectations on their choices. Additionally, we seek to understand the lived experiences of the women in this context. Introduction: Cultural norms and societal expectations significantly affect women's decisions regarding post-childbirth employment. However, a comprehensive understanding of these influences on women's experiences returning to work after parental leave is lacking. Inclusion criteria: We will include qualitative studies examining women's decision-making processes and experiences of returning to work after parental leave, with a focus on the influence of cultural norms and societal expectations. Studies from diverse cultural and geographical settings, including peer-reviewed journals and gray literature, will be considered without restrictions on publication date or language. Methods: The review will adhere to the JBI approach for qualitative systematic reviews. Major academic databases and search engines, such as CINAHL, PubMed, and Google Scholar, will be used. Study selection will involve screening titles and abstracts for relevance, followed by a full-text assessment against inclusion criteria by two independent reviewers. Critical appraisal using the JBI Critical Appraisal Checklist for Qualitative Research will evaluate study rigor. Data extraction will be conducted by two independent reviewers, using the standardized JBI data extraction tool within JBI SUMARI, to identify key themes and findings related to the women's decision-making process and lived experiences of returning to work after parental leave. The meta-aggregation approach will be utilized to synthesize findings, with confidence assessed through study quality and consistency. Any methodological deviations will be documented. Findings will be graded using the ConQual approach and presented in a summary of findings table. Discussion: By synthesizing data from different cultural contexts, this review will help bridge the gap in understanding how these factors influence women's choices. Rigor in the review will be ensured through the process of study selection, appraisal, and synthesis using the JBI approach. The findings will provide challenges faced by women and inform policies to help support their transition back to work. Systematic review registration: PROSPERO CRD42024546633. [ABSTRACT FROM AUTHOR]

Diversity in academic medicine and research enhances the quality of the science produced and the efficacy of patient care. Diversity, equity, inclusion, and accessibility (DEIA) statements have recently been suggested or required by academic job postings as a way to measure candidate's commitments to fostering DEIA in their role. In this perspective, we discuss steps to craft effective DEIA statements that convey your actions in, and commitment to, DEIA. We recognize that mandating DEIA statements may actually result in inauthentic or disingenuous statements and offer solutions to encouraging academics to arrive at a meaningful statement that represents their own perspectives on diversity. Last, we provide examples of DEIA statements from three academics at different career points. [ABSTRACT FROM AUTHOR]

Background: Inherited retinal diseases (IRDs) are a clinically and genetically heterogeneous group of disorders affecting millions worldwide. Despite the widespread adoption of next‐generation sequencing (NGS) panels, there remains a critical gap in the genetically diverse and understudied African populations. Methods: One hundred and thirty‐five South African patients affected by various IRDs underwent NGS using a custom‐targeted panel sequencing over 100 known genes. The panel was supplemented by in silico screening for a MAK‐Alu insertion and screening of seven functionally established deep intronic variants. Results: Through our combined screening strategy, we obtained a probable genetic diagnosis for 56% of the cohort. We identified 83 unique variants in 29 IRD genes underlying the disease, including 16 putative novel variants. Molecular findings prompted recommendations for clinical re‐examination in ten patients. Resolution rates varied across clinical classifications and population groups. Conclusions: This study reports the first use of a targeted NGS panel for IRDs in southern Africa, demonstrating a cost‐effective, customisable approach that optimises both diagnostic yield and resource efficiency, making it a valuable tool for IRD molecular characterisation in resource‐limited settings. Augmenting the panel by screening for variants relevant to South African patients allowed us to achieve a resolution rate in line with international studies. Our study underscores the importance of investigating diverse populations to bridge disparities in genomic research and improve diagnostic outcomes for underrepresented population groups. [ABSTRACT FROM AUTHOR]

Focuses on the development of methods for defining and determining the clinical significance of treatment effects. Conceptual definition of clinically significant change; Refinements of the methods; Examples of applications and misapplications.

Transmembrane protein 27 (TMEM27/collectrin), a glycoprotein and homolog of angiotensin-converting enzyme 2 (ACE2), is a regulator of renal amino acid uptake in the proximal tubule and may have a protective role in hypertension. Two previous reports have shown that the absence of TMEM27 expression in clear cell renal cell carcinoma (ccRCC) correlates with poorer cancer-related survival. We report our findings of TMEM27 expression in ccRCC and clinical outcomes in an independent third cohort. We conducted a retrospective analysis to identify all 321 cases of ccRCC diagnosed between 2010 and 2015 at the University of Rochester Medical Center. The intensity of TMEM27 immunostaining on tumor tissue was semi-quantitatively graded on a scale of 0, 0.5, 1, 1.5, 2, 2.5, and 3 by a single pathologist, and correlated with tumor characteristics and survival. There was evidence of metastasis at time of nephrectomy in 36 (11.2%) cases, and at the latest follow-up in 70 (21.8%) cases. As of Spring 2021, 82 (25.5%) had died. TMEM27 staining intensity correlated inversely with various tumor characteristics. Kaplan-Meier survival analysis showed worse overall all-cause mortality (p = 0.02) and disease-free survival (p = 0.028) for tumors without any TMEM27 staining (0) compared to 0.5 or higher by log-rank test. The absence of TMEM27 expression is associated with more aggressive tumor characteristics and poorer all-cause mortality and disease-free survival in ccRCC. TMEM27 may be a useful biomarker to assess cancer prognosis. Further studies are needed to better assess if TMEM27 is protective in RCC, and its potential role in active surveillance and prediction of response to target therapy. [ABSTRACT FROM AUTHOR]

Background: With increased emphasis on self-management in healthcare, clinicians need outstanding skills in offering advice and empowering patients to attain an optimal outcome. Objectives: This study explores how undergraduate physiotherapists acquire knowledge, skills, and confidence to offer advice to patients in clinical practice. Methods: Convenience sampling was used to recruit 50 BSc and MSc pre-registration physiotherapy students across all years of study in one university in southern England, UK. Semi-structured interviews were conducted for first year BSc students (n = 13). Six focus groups of mixed BSc and MSc students were conducted, three groups (n = 15 students) were mid-training, and three groups (n = 22 students) were in their final year. Results: Thematic analysis identified 6 themes: advice content; a patient-centered approach; delivery; acquisitions; perceptions; and uptake of advice. Students placed high value on advice-giving, drawing upon multiple learning opportunities, however they felt under-prepared to deliver this skill in practice. Furthermore, perceptions of their student status, and pressures to perform on graded placements were reported to influence the advice they offered to patients. Conclusions: Developing high-level skills in promoting self-management is essential in physiotherapy, this study highlights the challenges for students to develop these skills. Academic and practice educators must explicitly enable and support students to develop the knowledge and skills to confidently offer high-quality advice to patients. [ABSTRACT FROM AUTHOR]