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Attention-Deficit/Hyperactivity Disorder (ADHD) poses challenges for affected individuals in varied functional arenas and life domains. Research on specialized ADHD coaching demonstrates benefit across the age span. However, studies of ADHD coaching for adults have only focused on group coaching. We engaged eight expert coaches in an iterative process over five focus group meetings to develop components of a manualized intervention for a coaching engagement for individual adults with ADHD. The resultant guidelines, “ADHD Coaching Engagement: Manualized Intervention” (ACE-MI) offers both best practice guidance for coaching adults with ADHD and a consistent approach to a coaching engagement useful in supporting quality research in the field.

This pre-post exploratory feasibility study examined a 6-week, multifaceted, self-guided positive psychology intervention to support the well-being of health and wellness coaches during the COVID-19 pandemic. Nearly 40% of 634 participants completed the post-intervention survey, using the interventions on 60% of possible days, a majority finding the intervention helpful or very helpful. Regressions demonstrated improvements post-intervention in anxiety, depression, and life satisfaction for participants whose initial scores were not optimal. The intervention appears well-received, feasible, and supportive of coach well-being. Future research might find this cost-effective, flexible, and convenient intervention useful in supporting well-being more broadly, including during future health crises.

Assistenzsysteme helfen, managementrelevante und administrative Arbeiten auf landwirtschaftlichen Betrieben effizienter zu gestalten und Ressourcen zu schonen. Bereits jetzt sind eine Vielzahl von Assistenzsystemen in der Landwirtschaft im Einsatz. Dennoch gibt es unseres Wissens momentan im landwirtschaftlichen Kontext keinen Modellansatz für Assistenzsysteme, der sowohl die technischen Aspekte des Entscheidungsprozesses einschließlich des Controllings als auch die Bedeutung für die Akteure bei der Anwendung ausreichend darstellt. Die Verknüpfung dieser beiden Gesichtspunkte ist jedoch wichtig, um den Nutzwert von Assistenzsystemen in der Nutztierhaltung darzustellen und die zukünftigen Entwicklungen auch unter ethischen Aspekten voranzutreiben. Ein bereits bestehendes Modell zu Assistenzsystemen berücksichtigt vor allem technische Aspekte und behandelt den Bereich der Entscheidungsvorgänge nicht tiefergehend. Die Entscheidungsvorgänge sind gerade im Dreiklang der Mensch-Tier-Maschine-Interaktion aus ethischer Sicht jedoch von besonderer Bedeutung. Mithilfe einer exemplarischen Darstellung wird das bereits vorhandene Modell daher erweitert und die Unterstützung zur Entscheidungsfindung und die Rolle des Menschen im Prozess aufgezeigt.

Relative to their typically developing peers, college students with Attention Deficit/Hyperactivity Disorder (ADHD) often have poorer adjustment to college, higher rates of class withdrawal and academic probation, and lower rates of retention. Supportive services for these students are still being researched and developed. ADHD coaching--increasingly recognized as an important component of multimodal treatment for individuals with ADHD--may be a useful support for college students. To examine this question, the authors conducted a comprehensive descriptive literature review of studies examining ADHD coaching outcomes. Nineteen quantitative and qualitative studies of coaching outcomes were identified. Of these, 10 focus specifically on college students. All 19 studies indicate that coaching supports improved ADHD symptoms and executive functioning. The majority of quantitative studies report statistically significant benefits; several report positive trends. Additionally, six studies report improved participant well-being; three demonstrate maintenance of gains; five document high participant satisfaction with coaching. The authors provide: a description of ADHD coaching, a general overview of research on ADHD coaching, a detailed description of research on ADHD coaching for college students, implications for educational institutions, and suggestions for future study.

The aim of our study was to investigate short- and medium-term survival in patients with sudden cardiac death (SCD) after resuscitation. We continued a retrospective study at the University of Pécs from April 2018 to December 2019. 192 patients with SCD were selected. Exclusion criteria were incomplete documentation and unstable rhythm, after which we continued the study with 181 patients. Our data were obtained from documents recorded by the Emergency Department. The study population was divided into two groups, with proven shockable (I) and non-shockable (II) initial rhythm, and their data were compared at hospital discharge, at 1 month, and at 3 months. The main endpoint was the mortality between the two groups. Our results already showed that hospital survival was significantly higher in the shockable rhythm group than in the non-shockable group (62% vs. 38%, P=0.002). We also obtained similar results for 1-month survival (54% vs. 16%, P=0.004). When risk factors were examined, there was a significant difference in the survival of diabetic (P=0.001) and hypertensive patients (P=0.001). Patients with shockable rhythm have significantly better survival rates.

Introduction Type 2 diabetes mellitus (T2DM) is a powerful risk factor for cardiovascular disease (CVD), conferring a greater relative risk in women than men. We sought to examine sex differences in cardiometabolic risk factors and management in the contemporary cohort represented by the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE).Research design and methods GRADE enrolled 5047 participants (1837 women, 3210 men) with T2DM on metformin monotherapy at baseline. The current report is a cross-sectional analysis of baseline data collected July 2013 to August 2017.Results Compared with men, women had a higher mean body mass index (BMI), greater prevalence of severe obesity (BMI≥40 kg/m2), higher mean LDL cholesterol, greater prevalence of low HDL cholesterol, and were less likely to receive statin treatment and achieve target LDL, with a generally greater prevalence of these risk factors in younger women. Women with hypertension were equally likely to achieve blood pressure targets as men; however, women were less likely to receive ACE inhibitors or angiotensin receptor blockers. Women were more likely to be divorced, separated or widowed, and had fewer years of education and lower incomes.Conclusions This contemporary cohort demonstrates that women with T2DM continue to have a greater burden of cardiometabolic and socioeconomic risk factors than men, particularly younger women. Attention to these persisting disparities is needed to reduce the burden of CVD in women.Trial registration number ClinicalTrials.gov (NCT01794143)

Abstract Identifying biomarkers associated with disease progression and drug resistance are important for personalized care. We investigated the expression of 121 curated genes, related to immunomodulatory drugs (IMiDs) and proteasome inhibitors (PIs) responsiveness. We analyzed 28 human multiple myeloma (MM) cell lines with known drug sensitivities and 130 primary MM patient samples collected at different disease stages, including newly diagnosed (ND), on therapy (OT), and relapsed and refractory (RR, collected within 12 months before the patients’ death) timepoints. Our findings led to the identification of a subset of genes linked to clinical drug resistance, poor survival, and disease progression following combination treatment containing IMIDs and/or PIs. Finally, we built a seven‐gene model (MM‐IMiD and PI sensitivity‐7 genes [IP‐7]) using digital gene expression profiling data that significantly separates ND patients from IMiD‐ and PI‐refractory RR patients. Using this model, we retrospectively analyzed RNA sequcencing (RNAseq) data from the Mulltiple Myeloma Research Foundation (MMRF) CoMMpass (n = 578) and Mayo Clinic MM patient registry (n = 487) to divide patients into probabilities of responder and nonresponder, which subsequently correlated with overall survival, disease stage, and number of prior treatments. Our findings suggest that this model may be useful in predicting acquired resistance to treatments containing IMiDs and/or PIs.

OBJECTIVE: To determine whether the relationship between average glucose (AG) levels and hemoglobin A1c (HbA1c) differs across racial/ethnic groups. RESEARCH DESIGN AND METHODS: We performed a prospective substudy of GRADE, a comparative effectiveness randomized trial conducted in 36 centers in the U.S. A total of 1,454 of the 5,047 participants in the GRADE cohort, including 534 non-Hispanic White (NHW), 389 non-Hispanic Black (NHB), and 327 Hispanic White patients and 204 patients of other racial/ethnic backgrounds, were included in the substudy. Continuous glucose monitoring (CGM) performed for 10 days was used to calculate AG10. Immediately after CGM, HbA1c and glycated albumin were measured. Fasting plasma glucose (FPG) and glucose area under the curve (AUC) were derived from a 75-g oral glucose tolerance test. RESULTS: The relationship between AG10 and HbA1c was significantly different for NHB compared with NHW patients and those of other racial/ethnic groups. HbA1c levels were 0.2–0.6 percentage points higher in NHB than in NHW patients for AG10 levels from 100 to 250 mg/dL. For an HbA1c of 7%, AG10 was 11 mg/dL higher for NHW than for NHB patients. Similar findings were observed across races for relationships of FPG and AUC with HbA1c and for glucose measurements with glycated albumin levels. Differences in the relationship between AG10 and HbA1c across racial groups remained after adjustments for any demographic or other differences between racial/ethnic subgroups. CONCLUSIONS: The relationship between several measures of glucose with HbA1c and glycated albumin consistently differed across races. These findings should be considered in setting treatment goals and diagnostic levels. [ABSTRACT FROM AUTHOR]

Beat-up little seagull On a marble stair Tryin' to find the ocean Lookin' everywhere ... ... Get my sister Sandy And my little brother Ray Buy a big old wagon [...]

ObjectiveTo compare the effectiveness of two interventions to reduce diabetes distress (DD) and improve glycemic control among adults with type 1 diabetes (T1D).Research design and methodsIndividuals with T1D (n = 301) with elevated DD and HbA1c were recruited from multiple settings and randomly assigned to OnTrack, an emotion-focused intervention, or to KnowIt, an educational/behavioral intervention. Each group attended a full-day workshop plus four online meetings over 3 months. Assessments occurred at baseline and 3 and 9 months. Primary and secondary outcomes were change in DD and change in HbA1c, respectively.ResultsWith 12% attrition, both groups demonstrated dramatic reductions in DD (effect size d = 1.06; 78.4% demonstrated a reduction of at least one minimal clinically important difference). There were, however, no significant differences in DD reduction between OnTrack and KnowIt. Moderator analyses indicated that OnTrack provided greater DD reduction to those with initially poorer cognitive or emotion regulation skills, higher baseline DD, or greater initial diabetes knowledge than those in KnowIt. Significant but modest reductions in HbA1c occurred with no between-group differences. Change in DD was modestly associated with change in HbA1c (r = 0.14, P = 0.01), with no significant between-group differences.ConclusionsDD can be successfully reduced among distressed individuals with T1D with elevated HbA1c using both education/behavioral and emotion-focused approaches. Reductions in DD are only modestly associated with reductions in HbA1c. These findings point to the importance of tailoring interventions to address affective, knowledge, and cognitive skills when intervening to reduce DD and improve glycemic control.

Purpose Selinexor, a first-in-class, oral, selective exportin 1 (XPO1) inhibitor, induces apoptosis in cancer cells through nuclear retention of tumor suppressor proteins and the glucocorticoid receptor, along with inhibition of translation of oncoprotein mRNAs. We studied selinexor in combination with low-dose dexamethasone in patients with multiple myeloma refractory to the most active available agents. Patients and Methods This phase II trial evaluated selinexor 80 mg and dexamethasone 20 mg, both orally and twice weekly, in patients with myeloma refractory to bortezomib, carfilzomib, lenalidomide, and pomalidomide (quad-refractory disease), with a subset also refractory to an anti-CD38 antibody (penta-refractory disease). The primary end point was overall response rate (ORR). Results Of 79 patients, 48 had quad-refractory and 31 had penta-refractory myeloma. Patients had received a median of seven prior regimens. The ORR was 21% and was similar for patients with quad-refractory (21%) and penta-refractory (20%) disease. Among patients with high-risk cytogenetics, including t(4;14), t(14;16), and del(17p), the ORR was 35% (six of 17 patients). The median duration of response was 5 months, and 65% of responding patients were alive at 12 months. The most common grade ≥ 3 adverse events were thrombocytopenia (59%), anemia (28%), neutropenia (23%), hyponatremia (22%), leukopenia (15%), and fatigue (15%). Dose interruptions for adverse events occurred in 41 patients (52%), dose reductions occurred in 29 patients (37%), and treatment discontinuation occurred in 14 patients (18%). Conclusion The combination of selinexor and dexamethasone has an ORR of 21% in patients with heavily pretreated, refractory myeloma with limited therapeutic options.

"Teach For All" is a global network of state-based organizations that translate "Teach For America's" market model of school reform into moral projects of nation-building abroad. Referring to this challenge as one of "scaling" the organization, its leaders elaborate a theory of change that hinges on replicability: in order to effect a global education revolution, "Teach For All" must reproduce inspiring instances of change in classrooms around the world. In service of this goal, the organization marshals an impressive archive of transformational stories. Each supports its "shared problems, shared solutions" philosophy and attains status as evidence, suggesting that "Teach For All's" brand of transformative teaching can eradicate educational inequity despite the contingencies of place. "Teach For All's" use of stories to "sell" this brand of reform is itself nothing new. But what is so peculiar about "Teach For All's" project is that tales of individual conversion--of situated transformation--come to serve as sites for "scalability." By exploring stories as technologies of scale, tracing the ways in which they travel the globe and operate on different audiences, and interrogating the work they do within "Teach For All's" ideological apparatus, this article explores the relationship between storytelling "shared solutions" and scaling global reform, and the generic subject that such a relationship produces.

Abstract Tyrosine kinase inhibitors (TKIs) targeting BCR::ABL1 have turned chronic myeloid leukaemia (CML) from a fatal disease into a manageable condition for most patients. Despite improved survival, targeting drug‐resistant leukaemia stem cells (LSCs) remains a challenge for curative CML therapy. Aberrant lipid metabolism can have a large impact on membrane dynamics, cell survival and therapeutic responses in cancer. While ceramide and sphingolipid levels were previously correlated with TKI response in CML, the role of lipid metabolism in TKI resistance is not well understood. We have identified downregulation of a critical regulator of lipid metabolism, G0/G1 switch gene 2 (G0S2), in multiple scenarios of TKI resistance, including (1) BCR::ABL1 kinase‐independent TKI resistance, (2) progression of CML from the chronic to the blast phase of the disease, and (3) in CML versus normal myeloid progenitors. Accordingly, CML patients with low G0S2 expression levels had a worse overall survival. G0S2 downregulation in CML was not a result of promoter hypermethylation or BCR::ABL1 kinase activity, but was rather due to transcriptional repression by MYC. Using CML cell lines, patient samples and G0s2 knockout (G0s2−/−) mice, we demonstrate a tumour suppressor role for G0S2 in CML and TKI resistance. Our data suggest that reduced G0S2 protein expression in CML disrupts glycerophospholipid metabolism, correlating with a block of differentiation that renders CML cells resistant to therapy. Altogether, our data unravel a new role for G0S2 in regulating myeloid differentiation and TKI response in CML, and suggest that restoring G0S2 may have clinical utility.

Multimodal care, including Attention deficit/hyperactivity disorder (ADHD) coaching, is considered optimal in ADHD treatment. Still, little research has explored the topic of interprofessional communication and collaboration for this population. Following COREQ guidelines, this report of focus group research identifies attitudes and experiences of ADHD coaches regarding communication and collaboration with other professionals in support of their clients. Key themes in the data suggest a perception that collaboration is important but that there are barriers to overcome. Interprofessional learning opportunities, training in collaborative approaches, and research on varied professionals’ perspectives related to collaboration might all enhance optimal support for individuals with ADHD.

ObjectiveTo determine whether the use of continuous glucose monitoring (CGM) without confirmatory blood glucose monitoring (BGM) measurements is as safe and effective as using CGM adjunctive to BGM in adults with well-controlled type 1 diabetes (T1D).Research design and methodsA randomized noninferiority clinical trial was conducted at 14 sites in the T1D Exchange Clinic Network. Participants were ≥18 years of age (mean 44 ± 14 years), had T1D for ≥1 year (mean duration 24 ± 12 years), used an insulin pump, and had an HbA1c ≤9.0% (≤75 mmol/mL) (mean 7.0 ± 0.7% [53 ± 7.7 mmol/mol]); prestudy, 47% were CGM users. Participants were randomly assigned 2:1 to the CGM-only (n = 149) or CGM+BGM (n = 77) group. The primary outcome was time in range (70-180 mg/dL) over the 26-week trial, with a prespecified noninferiority limit of 7.5%.ResultsCGM use averaged 6.7 ± 0.5 and 6.8 ± 0.4 days/week in the CGM-only and CGM+BGM groups, respectively, over the 26-week trial. BGM tests per day (including the two required daily for CGM calibration) averaged 2.8 ± 0.9 and 5.4 ± 1.4 in the two groups, respectively (P < 0.001). Mean time in 70-180 mg/dL was 63 ± 13% at both baseline and 26 weeks in the CGM-only group and 65 ± 13% and 65 ± 11% in the CGM+BGM group (adjusted difference 0%; one-sided 95% CI -2%). No severe hypoglycemic events occurred in the CGM-only group, and one occurred in the CGM+BGM group.ConclusionsUse of CGM without regular use of confirmatory BGM is as safe and effective as using CGM with BGM in adults with well-controlled T1D at low risk for severe hypoglycemia.

OBJECTIVE: To compare the effectiveness of three interventions to reduce diabetes distress (DD) and improve HbA1c among adults with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: Individuals with T1D (n = 276) with elevated DD (a score >2 on the total Type 1 Diabetes Distress Scale) and HbA1c (>7.5%) were recruited from multiple settings and randomly assigned to one of three virtual group-based programs: 1) Streamline, an educator-led education and diabetes self-management program; 2) TunedIn, a psychologist-led program focused exclusively on emotional-focused DD reduction; or 3) FixIt, an integration of Streamline and TunedIn. Assessments of the primary outcomes of DD and HbA1c occurred at baseline and at 3, 6, and 12 months. RESULTS: All three programs demonstrated substantive and sustained reductions in DD (Cohen's d = 0.58–1.14) and HbA1c (range, −0.4 to −0.72) at 12-month follow-up. TunedIn and FixIt participants reported significantly greater DD reductions compared with Streamline participants (P = 0.007). Streamline and TunedIn participants achieved significantly greater HbA1c reductions than did FixIt participants (P = 0.006). CONCLUSIONS: DD can be successfully reduced among individuals with T1D with elevated HbA1c using both the educational/behavioral and emotion-focused approaches included in the study. Although both approaches are associated with significant and clinically meaningful reductions in DD and HbA1c, TunedIn, the emotion-focused program, had the most consistent benefits across both DD and HbA1c. The study findings suggest the overall value of group-based, fully virtual, and time-limited emotion-focused strategies, like those used in TunedIn, for adults with T1D. [ABSTRACT FROM AUTHOR]

Breakdown, trespass, seepage, degradation: this is late industrialism. Over the past decade, the term has become synonymous with collapse, describing everything from crumbling infrastructure to outmoded paradigms. But the “late” in “late industrial” carries radical potential, too. It points toward the possibility of another world taking shape within the wreckage as people retrofit broken systems, build flexible coalitions, and work creatively with time. In this collection, we train our eyes on these refashionings, asking how late industrial systems might be put to life-affirming work. Specifically, we track cases where breath, air, and atmosphere help inaugurate a “phase shift” (Choy and Zee 2015) from breakdown toward worlds otherwise. Breath has sentinel qualities: it can warn of trouble in the air. But it is also an animating force. Taking conceptual cues from this duality, contributors attend to late industrialism as it is sensed and transformed into something vital.

STS scholars offer the atmosphere as an antidote to the homogenizing Anthropocene. They teach us that atmospheres are good to think because they are both diffuse and differential; they reflect the scale of planetary problems without forgetting that those problems manifest unevenly. The atmosphere has, then, become a useful tool for theory work. But it is also being picked up on the ground as a model for grassroots coalition building. This article follows one group we might call an atmospheric coalition, which coalesced to fight a trash incinerator proposed in south Baltimore City. That incinerator would have had a major impact on the local air, particularly due to heavy-metal toxics that land close to their source. But it also would have affected a large regional airshed and released thousands of tons of greenhouse gases. Taking a cue from these multi-scalar impacts, the coalition to stop the incinerator both used the medium of air to trouble insider/outsider dichotomies and valued an uneven distribution of power, letting youth from the frontline community lead. Participants, in other words, built a flexible alliance—and they utilized its flexibility. Sometimes it was advantageous to call the incinerator “everyone’s problem.” Sometimes it was necessary to underscore its differential effects on local people. And sometimes the transience of atmospheric claims worked to transfer jurisdiction over the plant from one group to another. In the process of exploring these maneuvers, I argue that activists used the atmosphere to define a problem-space with pliant parameters of authority and vulnerability.

Health outcomes are influenced by the ability of individuals to take an active role in the decisions and actions affecting their health and well-being. This involves a process of accessing, understanding, appraising, and using health-related information and resources to take actions that lead to positive health outcomes and an improved quality of life. Health literacy plays an integral role in the health and wellness outcomes achieved by both individuals and the healthcare delivery system as a whole, with low health literacy linked to deleterious impacts on health status and quality of life. Identifying approaches that increase health literacy is a critical component in elevating the health status of individuals and populations. This discussion investigates the relationship between health and wellness coaching (HWC) and health literacy, exploring the potential HWC has for improving health literacy. Key constructs of HWC and health literacy are shared, along with observations about their interconnectivity and the implications this has for advancing health literacy and mobilizing positive change in healthcare.

AIMS: AUGMENT-HF was an international, multi-centre, prospective, randomized, controlled trial to evaluate the benefits and safety of a novel method of left ventricular (LV) modification with alginate-hydrogel. METHODS: Alginate-hydrogel is an inert permanent implant that is directly injected into LV heart muscle and serves as a prosthetic scaffold to modify the shape and size of the dilated LV. Patients with advanced chronic heart failure (HF) were randomized (1 : 1) to alginate-hydrogel (n = 40) in combination with standard medical therapy or standard medical therapy alone (Control, n = 38). The primary endpoint of AUGMENT-HF was the change in peak VO2 from baseline to 6 months. Secondary endpoints included changes in 6-min walk test (6MWT) distance and New York Heart Association (NYHA) functional class, as well as assessments of procedural safety. RESULTS: Enrolled patients were 63 ± 10 years old, 74% in NYHA functional class III, had a LV ejection fraction of 26 ± 5% and a mean peak VO2 of 12.2 ± 1.8 mL/kg/min. Thirty-five patients were successfully treated with alginate-hydrogel injections through a limited left thoracotomy approach without device-related complications; the 30-day surgical mortality was 8.6% (3 deaths). Alginate-hydrogel treatment was associated with improved peak VO2 at 6 months-treatment effect vs. CONTROL: +1.24 mL/kg/min (95% confidence interval 0.26-2.23, P = 0.014). Also 6MWT distance and NYHA functional class improved in alginate-hydrogel-treated patients vs. Control (both P < 0.001). CONCLUSION: Alginate-hydrogel in addition to standard medical therapy for patients with advanced chronic HF was more effective than standard medical therapy alone for improving exercise capacity and symptoms. The results of AUGMENT-HF provide proof of concept for a pivotal trial. TRIAL REGISTRATION NUMBER: NCT01311791.

Little research has examined processes involved when coaching individuals with Attention-Deficit/Hyperactivity Disorder (ADHD). A mixed methods study surveyed 117 coaches who identify themselves as ‘ADHD coaches’ to explore the frequency of use and perceived effectiveness of varied communication modalities (in person, phone, video conferencing or a combination) as well as, reported here, coaches' views of the benefits and drawbacks of each. Fifteen key themes were identified in the qualitative data, including Focusing and Distraction, Managing Time, Convenience and Flexibility, and Nonverbal Observations, among others. Future research exploring client perceptions about the use of varied modalities would assist in further understanding this important aspect of coaching.