Search

Introduction: Diagnosis of urinary tract infection (UTI) in the elderly population is challenging as they commonly present with atypical signs and symptoms. Prevalence of asymptomatic bacteriuria in the elderly population is high. Hence, urine dipstick and urine culture are no longer diagnostic tests. UTI is over-diagnosed and overtreated in the elderly, resulting in poor antimicrobial stewardship. This project was carried out to assess and improve the current practices in the diagnosis and treatment of UTI in the Department of Medicine of the Elderly. Methods: We reviewed current Scottish Intercollegiate Guidelines Network (SIGN) and National Institute for health and Care Excellence (NICE) guidelines on management of UTI and defined indications for performing urine dipstick and sending urine culture. We then collected and assessed data on all urine dipsticks performed, urine cultures sent, and use of antibiotics in treating UTI and asymptomatic bacteriuria in three Medicine of the Elderly wards in Aberdeen Royal Infirmary. We carried out intervention by means of presenting and discussing findings of Plan-Do- Study-Act (PDSA) cycles in departmental multi-disciplinary Quality Improvement (QI) meetings followed by educational sessions. Results: Our baseline data showed 77% of urine dipsticks were performed without clinical indication and 18% of patients had urine cultures sent without clinical indication. After presenting our initial findings and carrying out an educational intervention session, 25% of patients had urine dipstick done without clinical indication, and 0% of patients had urine cultures sent without clinical indication. However, over the course of four subsequent PDSA cycles, practices in investigation of UTI fluctuated but were overall consistently better than the initial practice with further interventions. In all PDSA cycles, no patients were treated for asymptomatic bacteriuria. Conclusions: Multidisciplinary team involvement in discussion of this QI project findings and educational sessions proved to be an effective form of intervention for improving current practice. [ABSTRACT FROM AUTHOR]

Objective: We conducted a systematic scoping review to characterize the landscape of communication scholarship within racial health equity in and through the patient-provider interaction., Methods: We employed three waves of data collection to identify relevant articles (N = 454) about racial equity within provider-patient interactions. We iteratively developed a codebook concerning article characteristics, coding for journal names, data source, descriptive characteristics for the study samples, and presence of theory and equity in sections of the manuscripts., Results: This search identified studies (N = 206) that were published in 76 peer-reviewed scientific journals. The majority of studies reported primary data analyses and used survey and interview methodology. Many studies examined participants as patients generally rather than in reference to particular health conditions. Among those with a specific health condition, the largest proportion focused on cancer control. Very few studies included samples with Native American and Pacific Island heritage. Most studies included cisgender men and/or women, but none included transgender men or women. The vast majority of research focused on the patient experience; few centered on providers' and caregivers' experiences. The body of scholarship was largely atheoretical; the most frequently noted constructs were patient-provider communication (including patient-centered communication and patient-centered care), implicit/explicit racial bias, shared decision-making. There was wide variation in the extent to which equity was woven through the manuscripts. Equity is typically mentioned in the literature review, and racial identity in the sample may serve as a marker of racialized experiences., Conclusion: This study demonstrates the need for the development of theory that elevates the centrality of health equity to attend to the bi- or multi-directional flow of communication that shapes the quality of these interactions., Practice Implications: These insights can serve as a strong foundation for the development of interventions to address equity in clinical interactions., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: An increase in pandemics of zoonotic origin has led to a growing interest in using statistical prediction to identify hotspots of zoonotic emergence. However, the rare nature of pathogen emergence requires modellers to impose simplifying assumptions, which limit the model's validity. We present a novel approach to hotspot mapping that aims to improve validity by combining model-based insights with expert knowledge., Methods: We conducted a systematic literature review to identify predictors for zoonotic emergence events in three priority virus families (Filoviridae, Coronaviridae, and Paramyxoviridae). We searched PubMed, Web of Science, Agricola, medRxiv, bioRxiv, Embase, CAB Global Health, and Google Scholar on Oct 14-28, 2021, with no restrictions on language or the date of publication. Articles suggested by subject matter experts and those identified by a review of reference lists were also included. We used regularised regression to fit a model to the data extracted from the literature and produced maps of ranked risk. In a series of workshops in five countries (Kenya, Peru, Senegal, Thailand, and Viet Nam), experts in zoonotic diseases produced qualitative hotspot maps based on their expertise, which were compared with the model-derived maps., Findings: 425 articles were analysed, from which 19 predictors and 1068 outcome events were identified. The in-sample misclassification error was 0·365, and 89% of participant-selected zones were ranked as moderate or high risk by the model. Participant-selected zones were too large to be actionable without further refinement. Discordance was probably due to missing predictors for which no valid data exist, and homogeneity imposed by our global model., Interpretation: Concordance between the two sets of maps supports the validity of each. Because model-based and participatory strategies have non-overlapping limitations, the results can be harmonised to minimise bias, and model-based results could be used to refine participant-selected zones. This approach shows potential for refining deployment of countermeasures to prevent future pandemics., Funding: US Agency for International Development., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC 4.0 license.)

Abstract: Although initial therapy of mantle cell lymphoma (MCL) is not standardized, bendamustine plus rituximab (BR) is commonly used in older patients. Rituximab (R) maintenance after induction is often used. Thus, the open-label, randomized phase 2 ECOG-ACRIN Cancer Research Group E1411 trial was designed to test 2 questions: (1) does addition of bortezomib to BR induction (BVR) and/or (2) addition of lenalidomide to rituximab (LR) maintenance improve progression-free survival (PFS) in patients with treatment-naïve MCL? From 2012 to 2016, 373 previously untreated patients, 87% aged ≥60 years, were enrolled in this trial. At a median follow-up of 7.5 years, there is no difference in the median PFS of BR compared with BVR (5.5 vs 6.4 years; hazard ratio [HR], 0.90; 90% confidence interval [CI], 0.70-1.16). There were no unexpected additional toxicities with BVR treatment compared with BR, with no impact on total dose/duration of treatment received. Independent of the induction treatment, addition of lenalidomide did not significantly improve PFS, with median PFS in R vs LR (5.9 vs 7.2 years; HR, 0.84; 90% CI, 0.62-1.15). Most patients completed the planned 24 cycles of LR at the scheduled dose. In summary, adding bortezomib to BR induction does not prolong PFS in treatment-naïve MCL, and LR maintenance was not associated with longer PFS compared with R alone after BR. Nonetheless, the >5-year median PFS outcomes in this prospective cooperative group trial indicate the efficacy of BR followed by R maintenance as highly effective initial therapy for older patients with MCL. This trial was registered at www.clinicaltrials.gov as #NCT01415752., (© 2024 American Society of Hematology. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Background: Preconception lifestyle intervention holds potential for reducing gestational diabetes mellitus, but clinical trial data are lacking., Objective: This study aimed to determine the effects of a prepregnancy weight loss intervention on gestational diabetes mellitus recurrence in women with overweight/obesity and previous gestational diabetes mellitus., Study Design: A 2-site, randomized controlled trial comparing a prepregnancy lifestyle intervention with educational control was conducted between December 2017 and February 2022. A total of 199 English- and Spanish-speaking adults with overweight/obesity and previous gestational diabetes mellitus were randomized to a 16-week prepregnancy lifestyle intervention with ongoing treatment until conception or educational control. The primary outcome was gestational diabetes mellitus recurrence. Analyses excluded 6 participants who conceived but did not have gestational diabetes mellitus ascertained by standard methods., Results: In the 63 (33%) women who conceived and had gestational diabetes mellitus ascertained (Ns=38/102 [37%] intervention vs 25/91 [28.0%] control; P=.17), those in the intervention group had significantly greater weight loss at 16 weeks compared with controls (4.8 [3.4-6.0] vs 0.7 [-0.9 to 2.3] kg; P=.001) and a greater proportion lost ≥5% of body weight (50.0% [17/34] vs 13.6% [3/22]; P=.005). There was no significant difference in the incidence of gestational diabetes mellitus recurrence between the intervention (57.9% [ns=23/38]) and the control group (44.0% [ns=11/25]; odds ratio, 1.8 [0.59-5.8]). Independent of group, greater prepregnancy weight loss predicted 21% lower odds of gestational diabetes mellitus recurrence (odds ratio, 0.79 [0.66-0.94]; P=.008). A ≥5% weight loss before conception reduced the odds of gestational diabetes mellitus recurrence by 82% (odds ratio, 0.18 [0.04-0.88]; P=.03)., Conclusion: Lifestyle intervention produced considerable prepregnancy weight loss but did not affect gestational diabetes mellitus rates. Given that the conception rate was 50% lower than expected, this study was underpowered., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Significant health disparities exist for trans and gender-nonconforming patients, in part caused by a reduced likelihood of seeking health care due to experienced discrimination in health care settings. Increasing inclusivity in patient-provider interactions can decrease barriers to care seeking for these patients, but such advice to providers must be simple to implement and account for potential backlash among certain patient subgroups., Methods: In 3 studies, we use online samples to experimentally test patient reactions to 2 methods of provider inclusivity signaling: verbal sharing of the provider's pronouns and request for the patient's pronouns (a method frequently suggested in the literature) and the provider wearing a pin indicating their pronouns without verbal sharing or requesting that the patient share their pronouns., Results: Study 1 finds that political orientation significantly moderated the effect of pronoun request on patient satisfaction with the visit, P = .003; satisfaction with the doctor, P = .003; and willingness to return to the provider, P = .007, with politically liberal participants being more satisfied and more likely to return when pronouns were requested and politically conservative participants less satisfied and less likely to return. Study 2 replicated these findings and demonstrated that such backlash among conservative participants did not occur when inclusivity was indicated via the provider wearing a pin indicating their pronouns. Study 3 showed that while pronoun pins may be subtle enough to not cause backlash, they are noticed by the target community and increase satisfaction and willingness to return among participants who identify as trans, nonbinary, and genderqueer., Limitations: These studies were hypothetical scenario studies run online rather than field studies., Conclusions: These results suggest that recommendations for increasing inclusivity should account for potential negative impacts on the practice from more politically conservative patients and that more subtle methods of indicating an inclusive health care environment are likely to be more implementable for practitioners in the field while still positively affecting the target population., Highlights: Increasing inclusivity in health care settings by verbally sharing and requesting pronouns can cause backlash and aggression among politically conservative patients.More subtle methods of inclusivity signaling such as providers wearing pins sharing their own pronouns do not have this type of backlash effect and increase satisfaction and willingness to return among non-cisgender patients.Recommendations for increasing inclusivity in health care settings should consider negative reactions from other patient subgroups to ensure recommendations are those providers are likely to be willing and able to implement long term.

Neurons require large amounts of energy, but whether they can perform glycolysis or require glycolysis to maintain energy remains unclear. Using metabolomics, we show that human neurons do metabolize glucose through glycolysis and can rely on glycolysis to supply tricarboxylic acid (TCA) cycle metabolites. To investigate the requirement for glycolysis, we generated mice with postnatal deletion of either the dominant neuronal glucose transporter (GLUT3cKO) or the neuronal-enriched pyruvate kinase isoform (PKM1cKO) in CA1 and other hippocampal neurons. GLUT3cKO and PKM1cKO mice show age-dependent learning and memory deficits. Hyperpolarized magnetic resonance spectroscopic (MRS) imaging shows that female PKM1cKO mice have increased pyruvate-to-lactate conversion, whereas female GLUT3cKO mice have decreased conversion, body weight, and brain volume. GLUT3KO neurons also have decreased cytosolic glucose and ATP at nerve terminals, with spatial genomics and metabolomics revealing compensatory changes in mitochondrial bioenergetics and galactose metabolism. Therefore, neurons metabolize glucose through glycolysis in vivo and require glycolysis for normal function., Competing Interests: Declaration of interests M.G.V.H. discloses that he is a scientific advisor for Agios Pharmaceuticals, iTeos Therapeutics, Sage Therapeutics, Faeth Therapeutics, DRIOA Ventures, and Auron Therapeutics. Y.H. discloses that he is a co-founder and scientific advisory board member of GABAeron., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Due to immunosuppression and underlying comorbidities, transplant recipients represent a vulnerable population following emergency general surgery (EGS) operations. The present study sought to evaluate clinical and financial outcomes of transplant patients undergoing EGS., Methods: The 2010-2020 Nationwide Readmissions Database was queried for adults (≥18 years) with non-elective EGS. Operations included bowel resection, perforated ulcer repair, cholecystectomy, appendectomy and lysis of adhesions. Patients were classified by transplant history ( Non-transplant , Kidney/Pancreas , Liver , Heart/Lung ). The primary outcome was in-hospital mortality while perioperative complications, resource utilization and readmissions were secondarily considered. Multivariable regression models evaluated the association of transplant status on outcomes. Entropy balancing was employed to obtain a weighted comparison to adjust for intergroup differences., Results: Of 7,914,815 patients undergoing EGS, 25,278 (0.32 %) had prior transplantation. The incidence of transplant patients increased temporally (2010: 0.23 %, 2020: 0.36 %, p < 0.001) with Kidney/Pancreas comprising the largest proportion (63.5 %). Non-transplant more frequently underwent appendectomy and cholecystectomy while transplant patients more commonly received bowel resections. Following entropy balancing , Liver was associated with decreased odds of mortality (AOR: 0.67, 95 % CI: 0.54-0.83, Reference: Non-transplant ). Incremental hospitalization duration was longer in Liver and Heart/Lung compared to Non-transplant . Odds of acute kidney injury, readmissions and costs were higher in all transplant types., Conclusion: The incidence of transplant recipients undergoing EGS operations has increased. Liver was observed to have lower mortality compared to Non-transplant . Transplant recipient status, regardless of organ, was associated with greater resource utilization and non-elective readmissions. Multidisciplinary care coordination is warranted to mitigate outcomes in this high-risk population., Competing Interests: P.B. is a surgical proctor for Atricure Inc. (Irvine, CA) and received consulting fees unrelated to the present work. All other authors have no disclosures., (© 2023 The Authors.)

Kilovoltage radiotherapy dose calculations are generally performed with manual point dose calculations based on water dosimetry. Tissue heterogeneities, irregular surfaces, and introduction of lead cutouts for treatment are either not taken into account or crudely approximated in manual calculations. Full Monte Carlo (MC) simulations can account for these limitations but require a validated treatment unit model, accurately segmented patient tissues and a treatment planning interface (TPI) to facilitate the simulation setup and result analysis. EGSnrc was used in this work to create a model of Xstrahl kilovoltage unit extending the range of energies, applicators, and validation parameters previously published. The novel functionality of the Python-based framework developed in this work allowed beam modification using custom lead cutouts and shields, commonly present in kilovoltage treatments, as well as absolute dose normalization using the output of the unit. 3D user-friendly planning interface of the developed framework facilitated non-co-planar beam setups for CT phantom MC simulations in DOSXYZnrc. The MC models of 49 clinical beams showed good agreement with measured and reference data, to within 2% for percentage depth dose curves, 4% for beam profiles at various depths, 2% for backscatter factors, 0.5 mm of absorber material for half-value layers, and 3% for output factors. End-to-end testing of the framework using custom lead cutouts resulted in good agreement to within 3% of absolute dose distribution between simulations and EBT3 GafChromic film measurements. Gamma analysis demonstrated poor agreement at the field edges which was attributed to the limitations of simulating smooth cutout shapes. Dose simulated in a heterogeneous phantom agreed to within 7% with measured values converted using the ratio of mass energy absorption coefficients of appropriate tissues and air., (© 2022 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine.)

Purpose: Accurate measurement of out-of-field dose in radiotherapy directly impacts beam data modeling in treatment planning systems, verification of implanted electronic devices/lens/fetus dose, secondary cancer risk estimation, and organ-at-risk dose reporting. When performing out-of-field dosimetry, it is therefore imperative that the response of the detector has been well characterized. Due to the softening of the radiation beam out-of-field, many detectors will exhibit energy dependence. This study investigated the energy dependence of a range of clinical available detectors over typical energies experienced out-of-field., Methods: The response of detectors to photon beams from 70 kV to 6 MV was measured. The relative change in response from 6 MV down to 70 kV highlighted the expected deviation in the response of detectors that would typically be calibrated in-field for use out-of-field., Results: The Pinpoint detector displayed the most energy-independent response over the energy range investigated. The Micro-Lion detector was the only detector to show an under-response to all low-energy beams relative to 6 MV. The diode-type detectors showed the largest energy dependence., Conclusions: When considering detectors for use in out-of-field dose measurements, it is important that the energy dependence is investigated over a low-energy range as out-of-field the energy spectra comprise a larger component of photons in the 50-100-keV range. This study highlights the variation in response of a range of clinically available detectors to low-energy radiation beams relative to 6 MV for out-of-field dosimetry. The Pinpoint detector was the most energy-independent detector with a response close to unity over the entire energy range investigated., (© 2022 American Association of Physicists in Medicine.)

Background: Primary healthcare, particularly Indigenous-led services, are well placed to deliver services that reflect the needs of Indigenous children and their families. Important characteristics identified by families for primary health care include services that support families, accommodate sociocultural needs, recognise extended family child-rearing practices, and Indigenous ways of knowing and doing business. Indigenous family-centred care interventions have been developed and implemented within primary healthcare services to plan, implement, and support the care of children, immediate and extended family and the home environment. The delivery of family-centred interventions can be through environmental, communication, educational, counselling, and family support approaches., Objectives: To evaluate the benefits and harms of family-centred interventions delivered by primary healthcare services in Canada, Australia, New Zealand, and the USA on a range of physical, psychosocial, and behavioural outcomes of Indigenous children (aged from conception to less than five years), parents, and families., Search Methods: We used standard, extensive Cochrane search methods. The latest search date was 22 September 2021., Selection Criteria: We included randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, controlled before-after studies, and interrupted time series of family-centred care interventions that included Indigenous children aged less than five years from Canada, Australia, New Zealand, and the USA. Interventions were included if they met the assessment criteria for family-centred interventions and were delivered in primary health care. Comparison interventions could include usual maternal and child health care or one form of family-centred intervention versus another., Data Collection and Analysis: We used standard Cochrane methods. Our primary outcomes were 1. overall health and well-being, 2. psychological health and emotional behaviour of children, 3. physical health and developmental health outcomes of children, 4. family health-enhancing lifestyle or behaviour outcomes, 5. psychological health of parent/carer. 6. adverse events or harms. Our secondary outcomes were 7. parenting knowledge and awareness, 8. family evaluation of care, 9. service access and utilisation, 10. family-centredness of consultation processes, and 11. economic costs and outcomes associated with the interventions. We used GRADE to assess the certainty of the evidence for our primary outcomes., Main Results: We included nine RCTs and two cluster-RCTs that investigated the effect of family-centred care interventions delivered by primary healthcare services for Indigenous early child well-being. There were 1270 mother-child dyads and 1924 children aged less than five years recruited. Seven studies were from the USA, two from New Zealand, one from Canada, and one delivered in both Australia and New Zealand. The focus of interventions varied and included three studies focused on early childhood caries; three on childhood obesity; two on child behavioural problems; and one each on negative parenting patterns, child acute respiratory illness, and sudden unexpected death in infancy. Family-centred education was the most common type of intervention delivered. Three studies compared family-centred care to usual care and seven studies provided some 'minimal' intervention to families such as education in the form of pamphlets or newsletters. One study provided a minimal intervention during the child's first 24 months and then the family-centred care intervention for one year. No studies had low or unclear risk of bias across all domains. All studies had a high risk of bias for the blinding of participants and personnel domain. Family-centred care may improve overall health and well-being of Indigenous children and their families, but the evidence was very uncertain. The pooled effect estimate from 11 studies suggests that family-centred care improved the overall health and well-being of Indigenous children and their families compared no family-centred care (standardised mean difference (SMD) 0.14, 95% confidence interval (CI) 0.03 to 0.24; 2386 participants). We are very uncertain whether family-centred care compared to no family-centred care improves the psychological health and emotional behaviour of children as measured by the Infant Toddler Social Emotional Assessment (ITSEA) (Competence domain) (mean difference (MD) 0.04, 95% CI -0.03 to 0.11; 2 studies, 384 participants). We assessed the evidence as being very uncertain about the effect of family-centred care on physical health and developmental health outcomes of children. Pooled data from eight trials on physical health and developmental outcomes found there was little to no difference between the intervention and the control groups (SMD 0.13, 95% CI -0.00 to 0.26; 1961 participants). The evidence is also very unclear whether family-centred care improved family-enhancing lifestyle and behaviours outcomes. Nine studies measured family health-enhancing lifestyle and behaviours and pooled analysis found there was little to no difference between groups (SMD 0.16, 95% CI -0.06 to 0.39; 1969 participants; very low-certainty evidence). There was very low-certainty evidence of little to no difference for the psychological health of parents and carers when they participated in family-centred care compared to any control group (SMD 0.10, 95% CI -0.03 to 0.22; 5 studies, 975 parents/carers). Two studies stated that there were no adverse events as a result of the intervention. No additional data were provided. No studies reported from the health service providers perspective or on outcomes for family's evaluation of care or family-centredness of consultation processes., Authors' Conclusions: There is some evidence to suggest that family-centred care delivered by primary healthcare services improves the overall health and well-being of Indigenous children, parents, and families. However, due to lack of data, there was not enough evidence to determine whether specific outcomes such as child health and development improved as a result of family-centred interventions. Seven of the 11 studies delivered family-centred education interventions. Seven studies were from the USA and centred on two particular trials, the 'Healthy Children, Strong Families' and 'Family Spirit' trials. As the evidence is very low certainty for all outcomes, further high-quality trials are needed to provide robust evidence for the use of family-centred care interventions for Indigenous children aged less than five years., (Copyright © 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Irradiation of the tumour site during treatment for cancer with external-beam ionising radiation results in a complex and dynamic series of effects in both the tumour itself and the normal tissue which surrounds it. The development of a spectral model of the effect of each exposure and interaction mode between these tissues would enable label free assessment of the effect of radiotherapeutic treatment in practice. In this study Fourier transform Infrared microspectroscopic imaging was employed to analyse an in-vitro model of radiotherapeutic treatment for prostate cancer, in which a normal cell line (PNT1A) was exposed to low-dose X-ray radiation from the scattered treatment beam, and also to irradiated cell culture medium (ICCM) from a cancer cell line exposed to a treatment relevant dose (2 Gy). Various exposure modes were studied and reference was made to previously acquired data on cellular survival and DNA double strand break damage. Spectral analysis with manifold methods, linear spectral fitting, non-linear classification and non-linear regression approaches were found to accurately segregate spectra on irradiation type and provide a comprehensive set of spectral markers which differentiate on irradiation mode and cell fate. The study demonstrates that high dose irradiation, low-dose scatter irradiation and radiation-induced bystander exposure (RIBE) signalling each produce differential effects on the cell which are observable through spectroscopic analysis., Competing Interests: The authors declare no conflict of interest.

The Caribbean has long been an under-represented geographical region in the field of genomics research. Such under-representation may result in Caribbean people being underserved by precision medicine and other public health benefits of genomics. A collaboration among regional and international researchers aims to address this issue through the H3ECaribbean project (Human Heredity, Environment, and Health in the Caribbean), which builds on the lessons and success of H3Africa. The Caribbean project aims to target issues of social justice by encouraging the inclusion of diverse Caribbean communities in genomics research. This paper explores a framework for the ethical and socially acceptable conduct of genomics research in the Caribbean, taking account of the cultural peculiarities of the region. This is done in part by exploring research ethics issues identified in indigenous communities in North America, Small Island Developing States, and similar endeavours from the African continent. The framework provides guidance for interacting with local community leaders, as well as detailing steps for obtaining informed consent of all participants. Specifically, the authors outline the methods to ensure effective interaction and enforce full transparency with study participants to combat historical neglect when working with under-represented communities in the Caribbean., Competing Interests: All authors declare no competing interests., (© 2022 The Authors.)

Psychosocial stressors are determinants of increases in adiposity. Both psychosocial stressors and adiposity are higher among African Americans (AAs). Therefore, clarifying the stress-obesity link in AAs is important. The stress associated with goal striving is particularly relevant to AAs because opportunity for upward mobility is not always equal. Goal-striving stress (GSS) has not been assessed with adiposity, a potential result of GSS. Therefore, the objective of this study was to determine whether GSS would be associated with repeated measures of adiposity [body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHR)] in AAs. Linear mixed models were used to assess the relationship between GSS with repeated measures of adiposity across three exam periods among 2902 AAs, and sex was assessed as a moderator. Models were adjusted for demographics, health behaviours, morbidities, and daily discrimination. GSS was positively associated with repeated measures of adiposity in women but not men: WC [estimate (standard error) p-value] [0.003 (0.001) p < 0.01] and WHR [0.003 (0.0007) p < 0.01]. This suggests that high stress due to goal striving may contribute to greater increases in adiposity in AA women over time. Community-based interventions should continue to consider focused support group models as viable options for goal-striving related stress reduction., (© 2021 John Wiley & Sons Ltd.)

Background: Clinical practice is a core component of nurse education. It is believed that nursing students' clinical placement experiences can affect their learning outcomes, satisfaction, as well as influence their choice of future career. To examine nursing students' perception of clinical learning environment and mentoring in hospital where they perform their clinical placement and the connection of these factor with intention to work as a nurse once graduated., Methods: Nursing students enrolled in clinical practice at least 6 months in hospitals in China were surveyed between January-March 2021. Percentages, frequencies, mean, standard deviation, t-test, ANOVA, and regression analysis were used to analyse the data., Results: Of the five scales in the CLES+T, 'Leadership style of the ward manager' scored the highest mean while 'Pedagogical atmosphere at the ward' scored the lowest. Nursing students with lower educational level, those supervised by fixed preceptor, and those intent to be a nurse in the future were significantly more satisfied with the CLES+T. Most of the nursing students are intent to work as a nurse in the future. CLES+T total scores and sub-dimensions (Premises of nursing on the ward) have significantly effectiveness on the intention to be a nurse in the future., Conclusions: Given the significant correlation of between learning environments and nursing students intention to be a nurse in the future, ward managers need to build a good clinical teaching atmosphere and promote opportunities for theoretical and practical connections among students through effective feedback mechanisms, which can enable students to experience a better clinical learning environment and meaningful experiences to build their professional roles and competencies, thus helping to enhance students' willingness to pursue nursing careers in the future., (© 2022. The Author(s).)

Root exudation is one of the primary processes that mediate interactions between plant roots, microorganisms, and the soil matrix, yet the mechanisms by which exudation alters microbial metabolism in soils have been challenging to unravel. Here, utilizing distinct sorghum genotypes, we characterized the chemical heterogeneity between root exudates and the effects of that variability on soil microbial membership and metabolism. Distinct exudate chemical profiles were quantified and used to formulate synthetic root exudate treatments: a high-organic-acid treatment (HOT) and a high-sugar treatment (HST). To parse the response of the soil microbiome to different exudate regimens, laboratory soil reactors were amended with these root exudate treatments as well as a nonexudate control. Amplicon sequencing of the 16S rRNA gene illustrated distinct microbial diversity patterns and membership in response to HST, HOT, or control amendments. Exometabolite changes reflected these microbial community changes, and we observed enrichment of organic and amino acids, as well as possible phytohormones in the HST relative to the HOT and control. Linking the metabolic capacity of metagenome-assembled genomes in the HST to the exometabolite patterns, we identified microorganisms that could produce these phytohormones. Our findings emphasize the tractability of high-resolution multiomics tools to investigate soil microbiomes, opening the possibility of manipulating native microbial communities to improve specific soil microbial functions and enhance crop production. IMPORTANCE Decrypting the chemical interactions between plant roots and the soil microbiome is a gateway for future manipulation and management of the rhizosphere, a soil compartment critical to promoting plant fitness and yields. Our experimental results demonstrate how soil microbial community and genomic diversity is influenced by root exudates of differing chemical compositions and how changes in this microbiome result in altered production of plant-relevant metabolites. Together, these findings demonstrate the tractability of high-resolution multiomics tools to investigate soil microbiomes and provide new information on plant-soil environments useful for the development of efficient and precise microbiota management strategies in agricultural systems.

Background: Distressing preoccupation with the circumstances of the death, experiential avoidance, and yearning often manifest in pathological forms of grief following the sudden or unexpected death of a loved one. Traumatic distress-the emotional distress linked to circumstances or reminders of a death-often leads to avoidance behaviors, whereas yearning has been conceptualized as an emotional state which leads to proximity-seeking behaviors following bereavement. A gap exists in the literature explaining how these variables may interact and perpetuate one another., Aims: The present study aims to examine the role of experiential avoidance in the relationship between traumatic distress and yearning in a sample of suddenly and unexpectedly bereaved young adults. Results suggest that the association between traumatic distress and yearning may be partially mediated by experiential avoidance. Implications of these findings for theoretical models of grief and yearning are discussed., Materials & Methods: Data include a sample of 606 bereaved young adults (Mage = 21.25; 77.4% female) who participated in a larger, online survey study conducted at two universities in the United States exploring the prevalence of trauma exposure in college students., Results: Mediation analysis demonstrated experiential avoidance as partially mediating the relationship between traumatic distress and yearning (ab = .21, SE = .10, 95% CI [.02, .40]) when controlling for presence at the scene of death or injury. This indirect effect accounted for 11.67% of the total effect. An additional moderated mediation analysis indicated this indirect effect was present across all levels of prolonged grief disorder (PGD) symptom severity., Discussion: Results indicate that the association between traumatic distress and yearning may be partially mediated by experiential avoidance across all levels of PGD symptom severity., Conclusion: Findings suggest that bereaved individuals experiencing recurrent, death-related intrusive thoughts, imagery, and/or other memories related to the circumstances of the death may be more likely to experience intense yearning for the deceased in part due to attempts to avoid painful internal experiences associated with such cues., (© 2021 Wiley Periodicals LLC.)