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Abstract Background There are limited longitudinal data regarding nutrient intake, nutritional status and physical function in community-dwelling ethnically diverse older adults. This study explored these variables and their relationship at baseline (n = 100) and 8-months’ follow-up (n = 81) among community-dwelling ethnically diverse older adults (≥60 years) in Birmingham, United Kingdom. Methods Multiple-pass 24-h dietary recalls and the Mini Nutritional Assessment-Short Form assessed nutritional intake and status, respectively. Short Physical Performance Battery (SPPB) and handgrip strength measured physical function. Linear and multinomial regressions were used to predict relationships between physical function, nutritional status and nutrient intake. Results Complete data were collected at baseline (n = 100) and 8-months’ follow-up (n = 81). Mean (SD) age was 70 (8.1) years (60% male), with 62% being obese. Statistically significant decreases in intakes of vitamin B6, vitamin B1, iron, folate, and magnesium occurred over time. Daily intake of all micronutrients except vitamin B12, phosphorus and manganese were below the Recommended Nutrient Intakes (RNI). SPPB (Z = -4.01, p

Abstract Background The United Kingdom population is ageing and becoming increasingly diverse; thus, it is vital to develop and implement interventions supporting this population shift. Social networks (SN) significantly impact health outcomes in later life, however relatively little is known about SN of community-dwelling ethnically diverse older adults. This study aimed to: 1) profile SN and changes in SN in this population over 8 months; 2) examine associations between SN, dietary intake, nutritional status, and physical function. Methods SN were assessed using the Wenger Practitioner Assessment of Network Type. Energy and nutrient intakes were measured using multiple-pass 24-h recalls. The Mini Nutritional Assessment-Short Form (MNA-SF) assessed nutritional status. Physical function was measured using the Short Physical Performance Battery (SPPB) and handgrip strength. Data were collected at baseline and 8-months. Correlation and regression analyses examined relationships between SN, physical function, nutrient intake and nutritional status. Semi-structured interviews were conducted at baseline (n = 92) and follow-up (n = 81) to identify potential influences of SN. Interviews were transcribed verbatim and analysed using directed content analysis. Results Quantitative data were obtained from 100 participants at baseline and 81 at follow-up. Mean (SD) age was 70.8 (8.1) years (59% male), comprising African/Caribbean (60%), South Asian (34%), and other ethnicities (6%). Five SN typologies were identified under two broad areas: integrated-SN consisting of locally integrated (44%) and wider community (8%); and non-integrated-SN consisting of family dependent (25%), local self-contained (17%), and private restricted (6%). At follow-up, 37% remained in non-integrated networks, 19% transitioned to non-integrated networks, 11% transitioned to, and 33% remained in, integrated networks. Participants within integrated networks at baseline had higher SPPB scores at follow-up. Compared to the private restricted, local self-contained SN significantly predicted zinc, riboflavin and vitamin B6 intakes. Participants remaining in, or transitioning to, non-integrated networks had low MNA-SF scores. Qualitative findings indicate that participants with reductions in SN perceived it as causing poorer physical function and eating behaviours. Conclusion In the present study, integrated SN were associated with higher physical function and nutritional status at 8-month’s follow-up. These results can inform the design of interventions to improve social networks, physical function and healthy nutrition within this population.

We examine the coseismic influence of the 5 July 2019, MW7.1 Ridgecrest and the 24 June 2020 MW5.8 Owens Lake earthquakes on rockfall distributions in two undisturbed high-altitude areas of the southern Sierra Nevada Mountains, California, USA. These events occurred within the geologically recent (2), the significantly lower magnitude Owens Lake event produced nearly twice as many (102) mappable rockslides as the significantly stronger Ridgecrest event (58), a difference likely due to slope oversteepening in the formerly glaciated area. Significant seismic amplification by topography and reactivation of preexisting failures was apparent for both areas. Inclusion of these factors may improve failure predictions and rockfall probability estimation.

Interprofessional education (IPE) is essential to prepare healthcare students to work collaboratively once they enter the mental health workforce. However, there is limited research exploring IPE for students in a mental health service context. This study aimed to explore stakeholder experiences of a work-integrated learning (WIL) placement model with embedded IPE opportunities for clinical psychology and occupational therapy students in a youth mental health service in Australia. Students (n=9), staff (n=12) and clients (n=10) involved in the model participated in semi-structured interviews. A template thematic analysis derived five themes from the data: placement model valuable for all stakeholders, students' interprofessional learning, the role of the clinical educators, contrasting expectations of students' workload, and challenges of piloting new models of care. The findings from this research highlight the value and challenges of WIL placements featuring IPE in mental health settings, providing useful future directions to organizations hoping to implement similar models.

Preparing students enrolled in healthcare programs for industry is paramount. While providing administrative and clinical education is essential, students must understand the health literacy levels of the population they serve and work diligently to ensure the population understands and comprehends the health information. Adults with low or limited health literacy levels need help understanding health information and making informed decisions. Research shows that improvements in health literacy result in decreased ER visits, medication errors, increased patient satisfaction, and better health outcomes. Health literacy is an issue throughout the world. This reflection seeks to provide a narrative comparing health literacy concerns in the United States and Spain. The objective is to shed light on the need for all colleges and universities to teach students about health literacy and how to determine patients' health literacy levels. Increasing students' understanding can improve the comprehension and awareness of patients and the population that they serve, thus leading to more appropriate health decisions and outcomes.

Although assessment of student learning remains a thorny area for co-creation in education, a growing number of researchers and practitioners advocate and enact partnership in formative and summative assessment as part of equity work. In this case study, we join these efforts in reflecting on students' and our own experiences of the midterm conversation that we use as a key formative assessment structure and process across three co-facilitated courses. The midterm conversation--a partnership among students and instructors as co-teachers--is embedded in course design and curriculum with the goal of advancing, informing, and sustaining our pedagogical commitments. This case illustrates how we practice assessment as dialogue and as emergent understanding. This practice is based on an expectation of diverse learning goals and outcomes and on trust in students' capacities to direct their learning with reference to their own interests and standards for their work.

This paper aims to further explore the impact of need and culture as they relate to orientation, training, development, and administrative policies on regional university adjunct faculty. The use of adjunct faculty has risen considerably over recent years making their university experience more relevant in today's higher education climate. Adjunct faculty express the desire for orientation, training, and professional development. In addition, adjunct faculty find administrative policies extremely isolating in nature as they struggle to develop more meaningful relationships with other faculty, administrators, and students. While adjunct faculty have vast industry experience, they often lack extensive experience in higher education. Considering that adjunct faculty have such a tremendous impact on college students, how they feel about their higher education experience is of great concern. Adjunct faculty effectiveness suffers when they do not receive adequate orientation, training, and development. When adjunct faculty are isolated from the university due to the structure of administrative policy, they become less committed to the overarching goals of the organization and thus less committed to students.

In this study, we aimed to determine the role of parental praise and child affect in the neural processes underlying parent-child interactions, utilizing functional near-infrared spectroscopy (fNIRS) hyperscanning. We characterized the dynamic changes in interpersonal neural synchrony (INS) between parents and children (4-6 years old, n = 40 dyads) during a cognitively challenging task. We then examined how changes in parent-child INS are influenced by parental feedback and child affect. Parent-child INS showed a quadratic change over time, indicating a decelerated decline during the interaction period. The relationship of parental praise, in the form of positive feedback, to change in INS was contingent upon the child's positive affect during the task. The highest levels of INS were observed when praise was present and child affect was positive. The left temporo-parietal regions of the child and the right dorsolateral prefrontal and right temporo-parietal regions of the parent demonstrated the strongest INS. The dynamic change in INS during the interaction was associated with children's independent performance on a standardized test of visuospatial processing. This research, leveraging fNIRS hyperscanning, elucidates the neural dynamics underlying the interaction between parent praise and child positive affect, thereby contributing to our broader understanding of parent-child dynamics.

Anxiety is commonly experienced by autistic people and impacts on quality of life and social participation. New anxiety interventions are required to effectively meet the needs of autistic people. Personalised Anxiety Treatment-Autism (PAT-A©) is a bespoke, modular approach to treating anxiety in up to 12 sessions. This study explored the feasibility and acceptability of delivering PAT-A© in the UK National Health Service (NHS). A single-blind randomised controlled trial design. Thirty-four autistic adults were recruited via clinical services and randomised to receive either PAT-A© or enhanced treatment as usual (CCSP). Outcome assessments relating to anxiety, quality of life and related constructs were completed at baseline, immediately post intervention; and at 3 and 12 months. Seventy-one percent of the PAT-A© group and 65% of the CCSP met diagnostic threshold for at least three anxiety disorders. Retention was good across both groups, with 82% (N = 14/17) completing the full course of PAT-A© and 71% (N = 12/17) attending both psychoeducational sessions in CCSP. 94% in PAT-A© and 82% in CCSP completed some follow up assessment 3 months post-intervention. Thematic analysis of interview data revealed that many participants valued the personalised approach, developed transferable skills and experienced positive changes to their anxiety. Participants were willing to be recruited and randomised, PAT-A© was feasible to deliver in the NHS and the trial methods and materials were acceptable. Our findings indicate that a fully powered clinical and cost-effectiveness trial of PAT-A© is warranted.

Sustained motivation for Daily Mile participation at higher physical activity intensities may contribute to the attainment of children's daily moderate-to-vigorous physical activity (MVPA) targets and long-term health benefits. However, individual variability exists in the amount of MVPA accumulated by children during the Daily Mile. The current study explored children's motivation for participating in the Daily Mile at MVPA intensity, using a theory of planned behaviour framework. Twenty-five children (mean age = 10.07 ± 0.60 years) from the Northwest of England were recruited to the study; 52% were female and 88% were White. Participants completed a questionnaire, with an open-ended response format, probing behavioural, control, and normative beliefs for participation in the Daily Mile at MVPA intensity. Template analysis was conducted independently by two researchers to identify main themes and subthemes. Findings showed that children possessed a range of behavioural, control, and normative beliefs about MVPA participation during the Daily Mile. Prominent behavioural beliefs included fitness enhancement, implications for concentration and learning, positive affective states, and pain and discomfort. Key control beliefs included weather, space and health restrictions, and distractions from peers. Finally, peers and parents were salient normative beliefs. Children possessed a range of modal beliefs in relation to MVPA participation during the Daily Mile. Implications of the findings, and methods for practitioners seeking to maximise the contribution of the Daily Mile to children's daily MVPA targets are discussed.

Objective: This paper describes several automation tools and software that can be considered during evidence synthesis projects and provides guidance for their integration in the conduct of scoping reviews. Study Design and Setting: The guidance presented in this work is adapted from the results of a scoping review and consultations with the JBI Scoping Review Methodology group. Results: This paper describes several reliable, validated automation tools and software that can be used to enhance the conduct of scoping reviews. Developments in the automation of systematic reviews, and more recently scoping reviews, are continuously evolving. We detail several helpful tools in order of the key steps recommended by the JBI's methodological guidance for undertaking scoping reviews including team establishment, protocol development, searching, de-duplication, screening titles and abstracts, data extraction, data charting, and report writing. While we include several reliable tools and software that can be used for the automation of scoping reviews, there are some limitations to the tools mentioned. For example, some are available in English only and their lack of integration with other tools results in limited interoperability. Conclusion: This paper highlighted several useful automation tools and software programs to use in undertaking each step of a scoping review. This guidance has the potential to inform collaborative efforts aiming at the development of evidence informed, integrated automation tools and software packages for enhancing the conduct of high-quality scoping reviews.

Mobile learning has gained significant recognition for its beneficial effects on learning across various dimensions. Nonetheless, ensuring consistent learner acceptance of mobile learning remains a critical factor to address. This meta-analysis study is the first comprehensive examination of critical antecedents impacting learners' perceived usefulness and perceived ease of use of mobile learning within the Technology Acceptance Model. This study undertook a comprehensive analysis of prior research conducted in both English and Chinese languages during the last 22 years. The aim was to build the Integrated Mobile Learning Acceptance Model utilizing a one-stage meta-analysis structural equation model. Five major antecedents of perceived usefulness and perceived ease of use were identified, and the moderating effects of education level, region, and culture were revealed. The resulting model provides a cohesive framework for understanding the factors that influence learners' intention to use mobile learning across various contexts. At the same time, the results of the study contribute to the advancement of theory in mobile learning acceptance and have practical implications for the design and evaluation of mobile learning.

Embedding musicians' occupational health training in music education curricula is widely recommended due to the well-documented high prevalence of performance-related health problems (PRHPs) among musicians across their lifespan. A scoping review was conducted to examine the range of evidence from implementations of musicians' health education programs, regarding the maintenance of hearing, musculoskeletal, psychological, and vocal health, as well as injury prevention strategies to minimize the risk of PRHP. Eligible sources of evidence included published and unpublished studies reporting occupational health education programs (which may have incorporated information on physical or psychological health, exercise, or somatic movement training) implemented with pre-tertiary and tertiary music students and teachers. Studies reporting stand-alone psychological health education were excluded. Key characteristics from included studies were extracted and charted. Data charts outline commonalities across the reported results, including physical, psychological, educational, and behavioral change outcome measures. Out of 46 records included for data extraction, 35 reported programs with tertiary-aged music students, seven reported programs with pre-tertiary-aged music students, two reported programs with music teachers, and two reported systematic reviews. Reported benefits from this research with both pre-tertiary and tertiary music students suggest that musicians' health education and injury prevention strategies reduce self-reported playing-related pain and music performance anxiety. However, future implementation studies need to address identified challenges such as effective behavior change and the enablers and barriers to the long-term adoption of strategies for optimal music performance and health outcomes. This review highlights the need for further research into designing and embedding musicians' health education into all music training settings, including more implementations with pre-tertiary music students, as well as training to support the professional development needs of instrumental and vocal teachers.

Responses to the COVID-19 pandemic globally disrupted lives and contributed to the exacerbation of pre-existing inequalities. Women in research were also affected. The prominent role that women played in professional and personal care duties had a detrimental effect on their research outputs, potentially hindering their career progression. Moreover, the challenges faced by women academics during the pandemic, including job loss, increased mental health issues, and the intersection of gender with other socio-demographic traits exacerbated existing gender disparities within academia. By systematically scoping the qualitative literature on the experiences of women researchers during the pandemic, this study sought to explore how women experienced and reacted to the challenges generated by the COVID-19 pandemic. A qualitative meta synthesis of the included studies revealed three themes: gendered professional expectations, colliding identities and coping strategies. These themes show how gendered roles such as teaching and professional care work, associated with the hierarchical and gendered division of tasks both at home and in the workplace, made women feel unsupported and alienated as relevant agents in the academic context. The study reveals the importance of pastoral care, teaching and service work as the essential backbone of the academic infrastructure, especially in times of crises. It also exposes how productivity-focused researcher assessment criteria, rewarding mainly individual results and unrewarding of care and service work, can be viewed as perpetuating structural inequalities based on gender, parenting situations, contractual situations and background. In conclusion, this study exposes the need to proactively address the gendered practices and implicit biases which reproduce inequalities within academia and highlights how paying attention to the experiences and needs of women researchers is essential for improving the resilience and crises preparedness of academic the system.

Objectives: Community sites, including schools, are important settings for interventions to promote children and young people's mental health and wellbeing. A central provision to support mental health in the UK is school- and community-based counselling services. However, the evidence-base for school counselling services is limited by weak evaluation designs, lack of understanding of different counselling approaches in use, and a failure to conceptualise counselling services as part of a wider complex system. To address the last point, this article takes a complex system-focused perspective to explore how a 'system disruption', that is counselling service implementation, can be optimised in the Welsh education system. Design: The approach used in this study is a mixed-method qualitative design. Setting: Participants were recruited from school and community settings. They included children and young people, parents, carers, school staff, counsellors and stakeholders from health and education. Method: Consultations, key system stakeholder interviews and school case studies were conducted. All stakeholders were asked about their experiences of local authority-funded school- and community-based counselling services in Wales. Interview and consultation data were analysed using a thematic analysis approach. Results: Data converged into three main themes focusing on the specifics of counselling sessions, counselling services as part of universal mental health provision and a whole education system approach. These three themes are brought together into a complex systems-focused model of an optimised school- and community-based counselling service. Conclusion: The model offers an opportunity to address issues with current counselling services in Wales and improve outcomes and sustainability by increasing the likelihood they will become embedded in the whole education system.

The notions of indigenous knowledge and cultural philosophies are becoming ubiquitous in many social inquiries, and evaluation is no exception. Nonetheless, the pursuit to embed relevant indigenous philosophies in contemporary evaluation has yet to succeed. In this article, we discuss indigenous relational philosophies, approaches, and practices as they relate to evaluation. Using qualitative research approaches, we interviewed 43 Indigenous development leaders and other local representatives in three local government areas in Ghana. Utilizing evidence synthesis approaches through a triangulation process, we conclude that indigenous knowledge and other cultural ethos were distinct in community-based development evaluation processes. There was an elusive intersection between indigenous and contemporary evaluation paradigms. Indigenous evaluation has principles such as community spirit, mutual trust, self-organization, relational patterns or networks, "ubuntu" ideals, consensus building, and collective action that can complement contemporary evaluation for the effective and efficient evaluation of community development programs and social policies. We identify key indigenous elements and other indigenous relational assessment patterns to aid in the design of an indigenously driven relational evaluation framework. The evaluative competencies embedded in indigenous philosophies are vast, thus, a call for future research is proposed.

Digital technologies and the instructional contexts in which they are embedded can increase students' access to meaningful learning opportunities. Although there is a tradition of designing and integrating digital tools in secondary-grades project-based science instruction to enhance learners' access to disciplinary learning, the elementary grades have received less attention. This has left classroom teachers with limited guidance for leveraging affordances of digital tools in project-based learning (PBL) with younger learners. In this article, we describe the design and integration of digital tools in Multiple Literacies in Project-based Learning, a recent elementary-grade project-based science curriculum that integrates literacy and mathematics. We use the principles of Universal Design for Learning to characterize the affordances of these digital tools, with attention to how the interplay of the tools and the PBL environment in which they were embedded enhanced access to learning opportunities for all students.

Youth with attention problems are at increased risk for school disengagement (Booster et al., JAD 16:179-189, 2012; DuPaul & Langberg, in: Barkley (ed), Attention-deficit/hyperactivity disorder: A handbook for diagnosis and treatment, Guilford, New York, 2014), which portends risk for poor outcomes (Bond et al., JAH 40:357.e9-357, 2007; Carter et al., JA 30:51-62, 2007; Fredricks et al., RER 74:59-109, 2004). Interventions that target school engagement may benefit from peer delivery because peers are widely available in schools and potentially more credible than adults. In this study, a peer-supported school-based school engagement intervention for middle school students with attention problems, Together Engaging and Achieving Meaningfully (TEAM) was developed with educators and students. In initial development (Study One), community development team meetings with partners (N = 9 school staff and students) were conducted. Thematic analysis was used to identify themes used to refine TEAM. In Study Two, a single-case pilot with one student with attention problems and one peer coach was conducted. Measures of fidelity, attendance, acceptability, and satisfaction were collected. Results were used to refine TEAM. Then in pilot implementation (Study Three), a non-randomized pilot was conducted with 10 fifth- through seventh-grade students with attention problems (n = 6 in the intervention group) and six eighth-grade coaches. Measures of fidelity, attendance, acceptability, satisfaction, and clinician-required time for implementation were collected. Cohen's d mean difference effect sizes were calculated between and within groups over implementation. Feedback from partners highlighted barriers and aspects that were acceptable and feasible. Results from implementation suggested high attendance, high coach fidelity with revised implementation support, and low clinician-required time. Lessons learned and avenues for future development and research are discussed.

This study compared parenting across four non-Western cultures to test cross-cultural commonality and specificity principles in three aspects: measurement properties, parenting normativeness, and their associations with child outcomes. Both mothers and fathers (N = 1509 dyads) with preschool-aged children (M = 5.00 years; 48% girls) from urban areas of four countries (Malaysia, N = 372; China, N = 441; Turkey, N = 402; and Japan, N = 294) reported on four parenting constructs (authoritative, authoritarian, group harmony socialization, and intrusive control) and their sub-dimensions using modified culturally relevant measures. Teachers reported on children's internalizing, externalizing, and prosocial behaviors. The commonality principle was supported by two sets of findings: (1) full measurement invariance was established for most parenting constructs and sub-dimensions, except that intrusive control only reached partial scalar invariance, and (2) no variations were found in associations between parenting and any child outcomes across cultures or parent gender at the construct level for all four parenting constructs and at the sub-dimensional level for authoritarian and intrusive control sub-dimensions. The specificity principle was supported by the other two sets of findings: (1) cross-cultural differences in parenting normativeness did not follow the pattern of economic development but yielded culture-specific patterns, and (2) at the sub-dimensional level, the authoritative parenting and group harmony socialization sub-dimensions were differently associated with child outcomes across cultures and/or parent gender. The findings suggested that examining specific dimensions rather than broad parenting constructs is necessary to reflect cultural specificities and nuances. Our study provided a culturally-invariant instrument and a three-step guide for future parenting research to examine cross-cultural commonalities/specificities.

Due to its haptic and interactive nature, virtual anatomy provides an opportunity for small-group learning, enabling students to develop their group work skills before they graduate. However, there is currently little practical guidance supported by pedagogic principles detailing how to incorporate it into curricula. Anatomy educators at the University of Plymouth conducted action research aiming to capture students' overall perceptions of the virtual anatomy platform Anatomage. Questioning the benefits and challenges students face while interacting with Anatomage prompted the creation of evidence-based interventions to be later evaluated. Although a plethora of themes were identified, this report specifically examines those relating to group work. Thematic analysis of initial focus group data found group size and group dynamics impacted students' experience with the platform. Following the implementation of interventions to resolve these issues, a questionnaire and second series of focus groups were conducted to determine whether they were successful. Additional subthemes found from these data included facilitation, social pressure, peer learning and working with friends. This study contributed to the improvement of small group learning and integration of virtual anatomy into curricula based on student and staff feedback. As such, these data support the development of effective group working skills which are fundamental for healthcare professionals and widely recognized by regulators such as the General Medical Council and Health and Care Professions Council. In this report, the authors provide practical advice informed by pedagogy and principles from management and psychology to provide a multidisciplinary perspective.

Children and adolescents (henceforth "children") with both attention-deficit/hyperactivity disorder (ADHD) and anxiety experience greater difficulties than children with either alone, though qualitative methodologies are yet to be used to understand the challenges this population experiences. We aimed to explore parent-reported daily impacts of co-occurring anxiety in children with ADHD (ages 8-13 years). Participants were enrolled in an Australian trial evaluating an adapted anxiety intervention and were eligible if their child met diagnostic criteria for ADHD plus separation, social, and/or generalized anxiety disorder. A baseline measure of life impacts associated with child anxiety captured situations parents reported were difficult, due to their child's anxiety. Reflexive thematic analysis of free-text responses (N = 203) facilitated new insights via inductively generating key themes. Three overarching themes highlighted (1) child difficulties with everyday situations and processes due to their anxiety; (2) the nature of the child's anxiety being pervasive and unrelenting; and (3) the strain placed on the child's family system. This study enhances understanding of daily impacts associated with co-occurring anxiety and ADHD and may contribute to an improved understanding of support needs. Results reiterate the need to identify co-occurring difficulties in children with ADHD and support both children and their families.

We examined the prevalence of self-reported motivations and barriers to helping intoxicated peers among emerging adults (N = 377; M[subscript age] = 18.64; 75% women, 88% White) attending a Southeastern university and whether motivations and barriers differed by age, gender, race, and class standing. Respondents aged 19-24 were more likely to endorse the motivation item "Because it was your "turn" to be the helper/designated driver (DD) that night" than eighteen-year-olds. Race differences were also reported for the motivation item, "Because the person was your friend", where White participants were more likely to endorse this item than non-White participants. Men also reported more Burden/Hassles-related barriers than did women.

Background: This study investigated differences in the clinical and demographic characteristics of individuals with intellectual disabilities delayed in assessment and treatment hospitals versus individuals who were not delayed. The study further investigated the clinical outcomes of the individuals whose discharge from the hospital was delayed. Method: This was a cohort study using secondary data collected from patient records. Variables included age, ethnicity, levels of deprivation, areas of origin, diagnoses, and the provision of a care and treatment review. A comparison was made between individuals who became delayed despite being clinically ready for discharge and those who were discharged on time. Findings: Individuals with severe intellectual disabilities were more likely to experience delayed discharge from hospital (p = 0.001). Similarly, people who were admitted to hospitals away from their home areas were also more likely to experience delayed discharge (p < 0.001). There were no significant differences between the delayed and nondelayed groups for other factors such as age, deprivation or ethnicity. Individuals who experienced a delay in discharge did not experience an increased rate of adverse incidents compared to the period of active treatment and clinical improvements were maintained during the period of delay. There were low rates of completion of care and treatment reviews before admission, although people who were delayed were more likely to have received a review during admission (78.8% vs. 27.1%). Conclusion: It is important for clinicians and service development leads to be aware that people who are admitted away from their home area and people with severe intellectual disabilities may be at higher risk of experiencing significantly delayed discharge from the hospital. More broadly, many people remained in hospital for a substantial length of time after being assessed as clinically ready for discharge. Due to the low rates of completion before admission, the expansion of community-based care and treatment reviews should also be explored. While people did not suffer increased rates of adverse incidents during their extended stay, their liberty was still restricted, hence there should be a focus on effective community provision. The current model of relying on the willingness of independent providers to support the care of complex individuals requires significant reform.

Background: This study determined awareness and occupational exposures to needlestick injuries (NSIs) and its associated risk factors among healthcare workers (HCWs) in the Kumasi Metropolis, Ghana. Materials and Methods: A descriptive cross-sectional study was conducted among a total of 540 HCWs from three selected tertiary hospitals in the Kumasi Metropolis, Ghana. Data were collected using a structured questionnaire and analyzed. Results: All the study participants were aware of NSI and NSI-associated hepatitis B virus (HBV), hepatitis C virus, or human immunodeficiency virus (HIV) acquisition. Most of them (63.6%) were trained on the safety use of sharps devices and the majority of them preferred safety-engineered devices (79.8%). A greater proportion of the participants has had HBV vaccination (85.9%). The prevalence of NSIs was approximately 47%. NSIs were highly ranked to occur at patient's bedside (28.5%) and clinical laboratories (24.6%). Handling of needles/sharp objects before usage (27.7%) and during usage (34.0%) ranked the second and first cause of NSIs among health workers, respectively. Compared with those with less than 5 years working experience, having worked at the health facility between 5 and 10 years (prevalence rate ration [PRR] = 2.07 [1.39–3.11], p = 0.0004), 11–15 years (PRR = 4.32 [2.14–8.73], p < 0.0001), and >15 years (PRR = 5.73 [2.40–13.70], p < 0.0001) were associated with increased events of NSI. Conclusion: Despite the high awareness of NSIs and its perceived risk of infection acquisition, the prevalence of NSIs was high among HCWs. There is, therefore, the need for employers to enforce the universal precaution practices, provide regular training and education, and ensure adherence of HCWs to safety precaution of needle usage disease.

Macrophages contribute to the induction and resolution of inflammation and play a central role in chronic low-grade inflammation in cardiovascular diseases caused by atherosclerosis. Human milk oligosaccharides (HMOs) are complex unconjugated glycans unique to human milk that benefit infant health and act as innate immune modulators. Here, we identify the HMO 3'sialyllactose (3'SL) as a natural inhibitor of TLR4-induced low-grade inflammation in macrophages and endothelium. Transcriptome analysis in macrophages revealed that 3'SL attenuates mRNA levels of a selected set of inflammatory genes and promotes the activity of liver X receptor (LXR) and sterol regulatory element binding protein-1 (SREBP1). These acute antiinflammatory effects of 3'SL were associated with reduced histone H3K27 acetylation at a subset of LPS-inducible enhancers distinguished by preferential enrichment for CCCTC-binding factor (CTCF), IFN regulatory factor 2 (IRF2), B cell lymphoma 6 (BCL6), and other transcription factor recognition motifs. In a murine atherosclerosis model, both s.c. and oral administration of 3'SL significantly reduced atherosclerosis development and the associated inflammation. This study provides evidence that 3'SL attenuates inflammation by a transcriptional mechanism to reduce atherosclerosis development in the context of cardiovascular disease.

BACKGROUND: Although mindfulness-based interventions (MBIs) are widely used in clinical and nonclinical settings, there has been little systematic study of their potential risks. To address this gap, we examined differences in psychological and physical worsening among participants in the usual care and intervention conditions of a 3-group, randomized pragmatic trial (Learning to Apply Mindfulness to Pain [LAMP]) that tested the effectiveness of 2 approaches to delivering MBIs to patients with chronic pain. METHODS: The sample consisted of 374 male and 334 female patients with chronic pain enrolled in the LAMP trial who completed a 10-week follow-up survey, 61% of whom had a mental health diagnosis. Psychological and physical worsening was assessed by a checklist asking whether participants experienced specific symptoms since beginning the study. We used multivariable logistic regression models with imputed data to determine whether predicted probabilities of increased symptoms differed between usual care and the 2 MBIs. RESULTS: Participants in usual care were more likely to report experiencing increased psychological and physical worsening than were those in the MBIs, including an increase in disturbing memories; sadness, anxiousness, and fatigue; isolation and loneliness; and feeling more upset than usual when something reminded them of the past. CONCLUSIONS: MBIs do not appear to cause harm, in terms of increased symptoms, for this population of patients with chronic pain and high levels of mental health comorbidities. CLINICAL TRIAL REGISTRATION: Preregistration with an analysis plan at www.ClinicalTrials.gov: NCT04526158. Patient enrollment began December 4, 2020.

Human mobility is strongly associated with the spread of SARS-CoV-2 via air travel on an international scale and with population mixing and the number of people moving between locations on a local scale. However, these conclusions are drawn mostly from observations in the context of the global north where international and domestic connectivity is heavily influenced by the air travel network; scenarios where land-based mobility can also dominate viral spread remain understudied. Furthermore, research on the effects of nonpharmaceutical interventions (NPIs) has mostly focused on national- or regional-scale implementations, leaving gaps in our understanding of the potential benefits of implementing NPIs at higher granularity. Here, we use Chile as a model to explore the role of human mobility on disease spread within the global south; the country implemented a systematic genomic surveillance program and NPIs at a very high spatial granularity. We combine viral genomic data, anonymized human mobility data from mobile phones and official records of international travelers entering the country to characterize the routes of importation of different variants, the relative contributions of airport and land border importations, and the real-time impact of the countrys mobility network on the diffusion of SARS-CoV-2. The introduction of variants which are dominant in neighboring countries (and not detected through airport genomic surveillance) is predicted by land border crossings and not by air travelers, and the strength of connectivity between comunas (Chiles lowest administrative divisions) predicts the time of arrival of imported lineages to new locations. A higher stringency of local NPIs was also associated with fewer domestic viral importations. Our analysis sheds light on the drivers of emerging respiratory infectious disease spread outside of air travel and on the consequences of disrupting regular movement patterns at lower spatial scales.

BACKGROUND: Vaccine development against Chlamydia, a prevalent sexually transmitted infection (STI), is imperative due to its global public health impact. However, significant challenges arise in the production of effective subunit vaccines based on recombinant protein antigens, particularly with membrane proteins like the Major Outer Membrane Protein (MOMP). METHODS: Cell-free protein synthesis (CFPS) technology is an attractive approach to address these challenges as a method of high-throughput membrane protein and protein complex production coupled with nanolipoprotein particles (NLPs). NLPs provide a supporting scaffold while allowing easy adjuvant addition during formulation. Over the last decade, we have been working toward the production and characterization of MOMP-NLP complexes for vaccine testing. RESULTS: The work presented here highlights the expression and biophysical analyses, including transmission electron microscopy (TEM) and dynamic light scattering (DLS), which confirm the formation and functionality of MOMP-NLP complexes for use in animal studies. Moreover, immunization studies in preclinical models compare the past and present protective efficacy of MOMP-NLP formulations, particularly when co-adjuvanted with CpG and FSL1. CONCLUSION: Ex vivo assessments further highlight the immunomodulatory effects of MOMP-NLP vaccinations, emphasizing their potential to elicit robust immune responses. However, further research is warranted to optimize vaccine formulations further, validate efficacy against Chlamydia trachomatis, and better understand the underlying mechanisms of immune response.

The family of Ras-like GTPases consists of over 150 different members, regulated by an even larger number of guanine exchange factors (GEFs) and GTPase-activating proteins (GAPs) that comprise cellular switch networks that govern cell motility, growth, polarity, protein trafficking, and gene expression. Efforts to develop selective small molecule probes and drugs for these proteins have been hampered by the high affinity of guanosine triphosphate (GTP) and lack of allosteric regulatory sites. This paradigm was recently challenged by the discovery of a cryptic allosteric pocket in the switch II region of K-Ras. Here, we ask whether similar pockets are present in GTPases beyond K-Ras. We systematically surveyed members of the Ras, Rho, and Rab family of GTPases and found that many GTPases exhibit targetable switch II pockets. Notable differences in the composition and conservation of key residues offer potential for the development of optimized inhibitors for many members of this previously undruggable family.

Coccidioidomycosis is a disease caused by soil fungi of the genus Coccidioides, divided genetically into Coccidioides immitis (California isolates) and Coccidioides posadasii (isolates outside California). Coccidioidomycosis is transmitted through the inhalation of fungal spores, arthroconidia, which can cause disease in susceptible mammalian hosts, including humans. Coccidioidomycosis is endemic to the western part of the United States of America, including the central valley of California, Arizona, New Mexico, and parts of western Texas. Cases have been reported in other regions in different states, and endemic pockets are present in these states. The incidence of reported cases of coccidioidomycosis has notably increased since it became reportable in 1995. Clinically, the infection ranges from asymptomatic to fatal disease due to pneumonia or disseminated states. The recognition of coccidioidomycosis can be challenging, as it frequently mimics bacterial community-acquired pneumonia. The diagnosis of coccidioidomycosis is frequently dependent on serologic testing, the results of which can take several days or longer to obtain. Coccidioidomycosis continues to present challenges for clinicians, and suspected cases can be easily missed. The challenges of coccidioidomycosis disease, from presentation to diagnosis to treatment, remain a hurdle for clinicians, and further research is needed to address these challenges.

Profound functional switch of key regulatory factors may play a major role in homeostasis and disease. Dysregulation of circadian rhythm (CR) is strongly implicated in cancer with mechanisms poorly understood. We report here that the function of REV-ERBα, a major CR regulator of the orphan nuclear receptor subfamily, is dramatically altered in tumors in both its genome binding and functional mode. Loss of CR is linked to a functional inversion of REV-ERBα from a repressor in control of CR and metabolic gene programs in normal tissues to a strong activator in different cancers. Through changing its association from NCoR/HDAC3 corepressor complex to BRD4/p300 coactivators, REV-ERBα directly activates thousands of genes including tumorigenic programs such as MAPK and PI3K-Akt signaling. Functioning as a master transcriptional activator, REV-ERBα partners with pioneer factor FOXA1 and directly stimulates a large number of signaling genes, including multiple growth factors, receptor tyrosine kinases, RASs, AKTs, and MAPKs. Moreover, elevated REV-ERBα reprograms FOXA1 to bind new targets through a BRD4-mediated increase in local chromatin accessibility. Pharmacological targeting with SR8278 diminishes the function of both REV-ERBα and FOXA1 and synergizes with BRD4 inhibitor in effective suppression of tumorigenic programs and tumor growth. Thus, our study revealed a functional inversion by a CR regulator in driving gene reprogramming as an unexpected paradigm of tumorigenesis mechanism and demonstrated a high effectiveness of therapeutic targeting such switch.

Active galactic nuclei (AGN) are prime candidate sources of the high-energy, astrophysical neutrinos detected by IceCube. This is demonstrated by the real-time multimessenger detection of the blazar TXS 0506+056 and the recent evidence of neutrino emission from NGC 1068 from a separate time-averaged study. However, the production mechanism of the astrophysical neutrinos in AGN is not well established, which can be resolved via correlation studies with photon observations. For neutrinos produced due to photohadronic interactions in AGN, in addition to a correlation of neutrinos with high-energy photons, there would also be a correlation of neutrinos with photons emitted at radio wavelengths. In this work, we perform an in-depth stacking study of the correlation between 15 GHz radio observations of AGN reported in the MOJAVE XV catalog, and 10 yr of neutrino data from IceCube. We also use a time-dependent approach, which improves the statistical power of the stacking analysis. No significant correlation was found for both analyses, and upper limits are reported. When compared to the IceCube diffuse flux, at 100 TeV and for a spectral index of 2.5, the upper limits derived are ∼3% and ∼9% for the time-averaged and time-dependent cases, respectively.

Brain aging process is influenced by various lifestyle, environmental and genetic factors, as well as by age-related and often coexisting pathologies. Magnetic resonance imaging and artificial intelligence methods have been instrumental in understanding neuroanatomical changes that occur during aging. Large, diverse population studies enable identifying comprehensive and representative brain change patterns resulting from distinct but overlapping pathological and biological factors, revealing intersections and heterogeneity in affected brain regions and clinical phenotypes. Herein, we leverage a state-of-the-art deep-representation learning method, Surreal-GAN, and present methodological advances and extensive experimental results elucidating brain aging heterogeneity in a cohort of 49,482 individuals from 11 studies. Five dominant patterns of brain atrophy were identified and quantified for each individual by respective measures, R-indices. Their associations with biomedical, lifestyle and genetic factors provide insights into the etiology of observed variances, suggesting their potential as brain endophenotypes for genetic and lifestyle risks. Furthermore, baseline R-indices predict disease progression and mortality, capturing early changes as supplementary prognostic markers. These R-indices establish a dimensional approach to measuring aging trajectories and related brain changes. They hold promise for precise diagnostics, especially at preclinical stages, facilitating personalized patient management and targeted clinical trial recruitment based on specific brain endophenotypic expression and prognosis.

PURPOSE: Nuclear protein in testis carcinoma (NC) is an underdiagnosed and aggressive squamous/poorly differentiated cancer characterized by rearrangement of the gene NUTM1 on chromosome 15q14. Co-occurring alternations have not been fully characterized. METHODS: We analyzed the genomic and immune landscape of 54 cases of NC that underwent DNA- and RNA-based NGS sequencing (Caris). RESULTS: While NC is driven by NUTM1 fusion oncoproteins, co-occurring DNA mutations in epigenetic or cell cycle pathways were observed in 26% of cases. There was no significant difference between the fusion partner of NUTM1 and co-occurring gene mutations. RNA sequencing analysis showed increased MYC pathway activity in NC compared with head and neck squamous cell carcinoma (HNSCC) and lung squamous cell carcinoma (LUSC), which is consistent with the known pathophysiology of NC. Characterization of the NC tumor microenvironment using RNA sequencing revealed significantly lower immune cell infiltration compared with HNSCC and LUSC. NC was 10× higher in patients with HNSCC and LUSC younger than 50 years than in those older than 70 years. CONCLUSION: To our knowledge, this is the first series of NC profiled broadly at the DNA and RNA level. We observed fewer intratumoral immune cells by RNA sequencing, which may be associated with anecdotal data of lack of immunotherapy benefit in NC. High MYC pathway activity in NC supports ongoing trials targeting MYC suppression. The incidence of NC among patients younger than 50 years with LUSC/HNSCC supports testing for NC in these patients. The prognosis of NCs remains dismal, and future studies should focus on improving the response to immunotherapy and targeting MYC.

BACKGROUND: The decisions and components of a career in medicine have changed. Historically, a career selection was often a decision between joining an institution or academic center versus the fiscal risks associated with private practice. This created a relatively simple risk versus reward equation: those in private practice made more money if it went well. The medical landscape has changed immensely, and priorities and remuneration have morphed, including concerns about promoting and sustaining well-being. METHODS: The authors performed a systematic review of scholarly databases to identify relevant resources to the topic of study. Additionally, the authors relied on their own cumulative experience in the field, including the work of Dr. Wayne Sotile of the Sotile Center for Physician Resilience. RESULTS: The first installment of this article proposes a new model in opposition to the current standard of risk versus reward where the tradeoff is instead control versus choice, where autonomy is the new risk. CONCLUSIONS: The five components that make up the majority of the ingredients in a plastic surgery career are clinical practice model, administrative duty, corporate support, academic involvement, and per diem or retainers. Much of finding or developing a practice model that suits the individual is figuring out an acceptable ratio of these ingredients. Inherent to this process is how much authority one has versus instituted control of any form, from hospital to university to insurance company.

UNLABELLED: Our study examined associations of the CXC motif chemokine ligand 9 (CXCL9), a pro-inflammatory protein implicated in age-related inflammation, with musculoskeletal function in elderly men. We found in certain outcomes both cross-sectional and longitudinal significant associations of CXCL9 with poorer musculoskeletal function and increased mortality in older men. This requires further investigation. PURPOSE: We aim to determine the relationship of (CXCL9), a pro-inflammatory protein implicated in age-related inflammation, with both cross-sectional and longitudinal musculoskeletal outcomes and mortality in older men. METHODS: A random sample from the Osteoporotic Fractures in Men (MrOS) Study cohort (N = 300) was chosen for study subjects that had attended the third and fourth clinic visits, and data was available for major musculoskeletal outcomes (6 m walking speed, chair stands), hip bone mineral density (BMD), major osteoporotic fracture, mortality, and serum inflammatory markers. Serum levels of CXCL9 were measured by ELISA, and the associations with musculoskeletal outcomes were assessed by linear regression and fractures and mortality with Cox proportional hazards models. RESULTS: The mean CXCL9 level of study participants (79.1 ± 5.3 years) was 196.9 ± 135.2 pg/ml. There were significant differences for 6 m walking speed, chair stands, physical activity scores, and history of falls in the past year across the quartiles of CXCL9. However, higher CXCL9 was only significantly associated with changes in chair stands (β =  - 1.098, p

Despite some progress, universal access to safe water, sanitation and hygiene (WASH) by 2030-a remit of Sustainable Development Goal 6-remains a distant prospect in many countries. Policy-makers and implementers of the WASH sector are challenged to track a new path. This research aimed to identify core orienting themes of the sector, as legacies of past processes, which can provide insights for its future. We reviewed global policy, science and programmatic documents and carried out 19 expert interviews to track the evolution of the global WASH sector over seven decades. We situated this evolution in relation to wider trends in global health and development over the same time period.With transnational flows of concern, expertise and resources from high-income to lower-income countries, the WASH sector evolved over decades of international institutionalisation of health and development with (1) a focus on technologies (technicalisation), (2) a search for generalised solutions (universalisation), (3) attempts to make recipients responsible for environmental health (responsibilisation) and (4) the shaping of programmes around quantifiable outcomes (metricisation). The emergent commitment of the WASH sector to these core themes reflects a pragmatic response in health and development to depoliticise poverty and social inequalities in order to enable action. This leads to questions about what potential solutions have been obscured, a recognition which might be understood as 'uncomfortable knowledge'-the knowns that have had to be unknown, which resonate with concerns about deep inequalities, shrinking budgets and the gap between what could and has been achieved.

Brain differences linked to autism spectrum disorder (ASD) can manifest before observable symptoms. Studying these early neural precursors in larger and more diverse cohorts is crucial for advancing our understanding of developmental pathways and potentially facilitating earlier identification. EEG is an ideal tool for investigating early neural differences in ASD, given its scalability and high tolerability in infant populations. In this context, we integrated EEG into an existing multi-site MRI study of infants with a higher familial likelihood of developing ASD. This paper describes the comprehensive protocol established to collect longitudinal, high-density EEG data from infants across five sites as part of the Infant Brain Imaging Study (IBIS) Network and reports interim feasibility and data quality results. We evaluated feasibility by measuring the percentage of infants from whom we successfully collected each EEG paradigm. The quality of task-free data was assessed based on the duration of EEG recordings remaining after artifact removal. Preliminary analyses revealed low data loss, with average in-session loss rates at 4.16 % and quality control loss rates at 11.66 %. Overall, the task-free data retention rate, accounting for both in-session issues and quality control, was 84.16 %, with high consistency across sites. The insights gained from this preliminary analysis highlight key sources of data attrition and provide practical considerations to guide similar research endeavors.

Ventral tegmental area (VTA) dopamine neurons regulate reward-related associative learning and reward-driven motivated behaviors, but how these processes are coordinated by distinct VTA neuronal subpopulations remains unresolved. Here, we compare the contribution of two primarily dopaminergic and largely non-overlapping VTA subpopulations, all VTA dopamine neurons and VTA GABAergic neurons of the mouse midbrain, to these processes. We find that the dopamine subpopulation that projects to the nucleus accumbens (NAc) core preferentially encodes reward-predictive cues and prediction errors. In contrast, the subpopulation that projects to the NAc shell preferentially encodes goal-directed actions and relative reward anticipation. VTA GABA neuron activity strongly contrasts VTA dopamine population activity and preferentially encodes reward outcome and retrieval. Electrophysiology, targeted optogenetics, and whole-brain input mapping reveal multiple convergent sources that contribute to the heterogeneity among VTA dopamine subpopulations that likely underlies their distinct encoding of reward-related associations and motivation that defines their functions in these contexts.