Search

Mindfulness witnessed a substantial popularity surge in the past decade, especially as digitally self-administered interventions became available at relatively low costs. Yet, it is uncertain whether they effectively help reduce stress. In a preregistered (OSF https://doi.org/10.17605/OSF.IO/UF4JZ ; retrospective registration at ClinicalTrials.gov NCT06308744 ) multi-site study (nsites = 37, nparticipants = 2,239, 70.4% women, Mage = 22.4, s.d.age = 10.1, all fluent English speakers), we experimentally tested whether four single, standalone mindfulness exercises effectively reduced stress, using Bayesian mixed-effects models. All exercises proved to be more efficacious than the active control. We observed a mean difference of 0.27 (d = -0.56; 95% confidence interval, -0.43 to -0.69) between the control condition (M = 1.95, s.d. = 0.50) and the condition with the largest stress reduction (body scan: M = 1.68, s.d. = 0.46). Our findings suggest that mindfulness may be beneficial for reducing self-reported short-term stress for English speakers from higher-income countries.

Abstract Background Within the Open Biological and Biomedical Ontology (OBO) Foundry, many ontologies represent the execution of a plan specification as a process in which a realizable entity that concretizes the plan specification, a “realizable concretization” (RC), is realized. This representation, which we call the “RC-account”, provides a straightforward way to relate a plan specification to the entity that bears the realizable concretization and the process that realizes the realizable concretization. However, the adequacy of the RC-account has not been evaluated in the scientific literature. In this manuscript, we provide this evaluation and, thereby, give ontology developers sound reasons to use or not use the RC-account pattern. Results Analysis of the RC-account reveals that it is not adequate for representing failed plans. If the realizable concretization is flawed in some way, it is unclear what (if any) relation holds between the realizable entity and the plan specification. If the execution (i.e., realization) of the realizable concretization fails to carry out the actions given in the plan specification, it is unclear under the RC-account how to directly relate the failed execution to the entity carrying out the instructions given in the plan specification. These issues are exacerbated in the presence of changing plans. Conclusions We propose two solutions for representing failed plans. The first uses the Common Core Ontologies ‘prescribed by’ relation to connect a plan specification to the entity or process that utilizes the plan specification as a guide. The second, more complex, solution incorporates the process of creating a plan (in the sense of an intention to execute a plan specification) into the representation of executing plan specifications. We hypothesize that the first solution (i.e., use of ‘prescribed by’) is adequate for most situations. However, more research is needed to test this hypothesis as well as explore the other solutions presented in this manuscript.

Invasive species represent a significant threat to native biodiversity. The Himalayan Balsam Impatiens glandulifera is an annual plant, which is invasive in Europe and often inhabits the riparian zone. It produces several secondary metabolites causing, for example, growth inhibition of terrestrial plants and invertebrates. One of these metabolites is the quinone 2-methoxy-1,4-naphthoquinone (2-MNQ). The compound gets washed out from the above-ground parts of the plant during precipitation and may then leach into nearby waterbodies. Despite some evidence for the allelopathic effect of plant secondary metabolites on terrestrial invertebrates, little is known about how 2-MNQ affects the survival or development of aquatic dipteran larvae, despite the importance of this functional group in European freshwaters. Here, we investigated the effects of 2-MNQ on larvae of the river keystone species Chironomus riparius in acute and chronic scenarios. The toxicity of 2-MNQ towards the first and the fourth larval stage was determined in a 48-hour acute exposure assay. We show that 2-MNQ has a negative impact on the development, growth and survival of C. riparius. The LC50 of 2-MNQ was 3.19 mg/l for the first instar and 2.09 mg/l for the fourth instar. A ten-day chronic exposure experiment, where the water was spiked with 2-MNQ, revealed that 2-MNQ had a significantly negative impact on larval body size, head capsule size, body weight, development and survival. These results demonstrate the negative impact of the secondary metabolite 2-MNQ from the terrestrial plant I. glandulifera on a crucial macroinvertebrate inhabiting the adjacent stream ecosystem in riverine ecosystems. This may lead to a decline in population size, resulting in cascading effects on the food web.

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection (LRTI) in infants and young children worldwide. Using routine statutory health insurance claims data including patients from all regions of Germany, we investigated the health-care resource use and costs associated with RSV prophylaxis with palivizumab in Germany. In the database, infants from the birth cohorts 2015–2019 eligible for palivizumab immunization were identified using codes of the 10th revision of the International Classification of Diseases (ICD-10). Health-care resource use and costs related to immunization were determined by inpatient and outpatient administrations. Over the study period, only 1.3% of infants received at least one dose of palivizumab in their first year of life. The mean number of doses per immunized infant was 4.6. From a third-party payer perspective, the mean costs of palivizumab per infant who received at least one dose in the first year of life was €5,435 in the birth cohorts 2015–2019. Despite the substantial risk of severe RSV infection, we found low rates of palivizumab utilization. Novel preventive interventions, featuring broader indications and single-dose administration per season, contribute to mitigating the burden of RSV disease across a more extensive infant population.

OBJECTIVES: Medical education fellowships provide training in teaching, assessment, educational program administration, and scholarship. The longitudinal impact of this training is unknown. The objective of this study was to explore the impact of medical education fellowships on the careers of graduates. METHODS: The authors performed a qualitative study with a constructivist-interpretivist paradigm using semistructured interviews in 2021. The authors used a purposeful randomized stratified sampling strategy of graduates to ensure diversity of representation (gender, region, fellowship duration, and career stage). Two researchers independently analyzed interview transcriptions using a modified grounded theory approach. RESULTS: The authors interviewed 10 graduates and identified three overarching concepts: motivations for pursuing fellowship, benefits of training, and drivers of career development. Graduates sought training because of their desire for growth and career preparation and at the advice of mentors. Fellowships provided knowledge and skills in a structured learning environment, supported by mentors and a collaborative community. Fellowship training shaped the careers of graduates by increasing their self-efficacy, enhancing their outcome expectations, refining their goals, and influencing their professional identity formation. They acquired expertise that prepared them for jobs, developed credibility, felt competitive in the job market, anticipated successful promotion, reached for greater goals, broadened their educational worldview, and evolved their professional identity as a result of fellowship training. CONCLUSIONS: Fellowship training in medical education provides knowledge and skills, a structured learning environment, and important relationships that shape the careers of graduates by impacting their self-efficacy, outcome expectations, goal creation, and professional identity formation.

Due to the COVID-19 pandemic, educators have been forced to rapidly transition away from in-person learning environments to completely online formats. Many of these educators have had little or no training and experience teaching online, contributing to stress and anxiety. To compound this problem even further, there are a multitude of online learning technologies from which to choose that can be relatively costly and require an intensive production process. In an effort to provide immediate relief to those dealing with this problem, we detail how interteaching, an empirically supported behavioral teaching technique, can be used to cultivate an interactive online learning environment in either an asynchronous or synchronous format. Specifically, we describe some best practices and provide some examples on how to generate active student responding (ASR) as well as provide pinpointed performance-based feedback. We specifically reference the relatively easy-to-use online software Kaltura, but it is hoped that our suggestions inspire others to develop and use these strategies across a variety of platforms in effort to provide evidence-based quality education during this crisis.

Introduction Many types of prostate cancer present minimal risk to a man’s lifespan or well-being, but existing terminology makes it difficult for men to distinguish these from high-risk prostate cancers. This study aims to explore whether using an alternative label for low-risk prostate cancer influences management choice and anxiety levels among Australian men and their partners.Methods and analysis We will run two separate studies for Australian men and Australian women with a male partner. Both studies are between-subjects factorial (3×2) randomised online hypothetical experiments. Following consent, eligible participants will be randomised 1:1:1 to three labels: ‘low-risk prostate cancer, Gleason Group 1’, ‘low-risk prostate neoplasm’ or ‘low-risk prostate lesion’. Participants will then undergo a second randomisation step with 1:1 allocation to the provision of detailed information on the benefits and harms of different management choices versus the provision of less detailed information about management choices. The required sample sizes are 1290 men and 1410 women. The primary outcome is the participant choice of their preferred management strategy: no immediate treatment (prostate-specific antigen (PSA)-based monitoring or active surveillance using PSA, MRI, biopsy with delayed treatment for disease progression) versus immediate treatment (prostatectomy or radiation therapy). Secondary outcomes include preferred management choice (from the four options listed above), diagnosis anxiety, management choice anxiety and management choice at a later time point (for participants who initially choose a monitoring strategy).Ethics and dissemination Ethics approval has been received from The University of Sydney Human Research Ethics Committee (2023/572). The results of the study will be published in a peer-reviewed medical journal and a plain language summary of the findings will be shared on the Wiser Healthcare publications page http://www.wiserhealthcare.org.au/category/publications/Trial registration numbers Australian New Zealand Clinical Trials Registry (ID 386701 and 386889).

Balancing in general and balancing alternatives and variants can be seen as a core component of the work of planners. Against the backdrop of current social challenges, the complexity of these balancing processes is increasing. From a planning science perspective, however, the question of the balancing process has only begun to be analysed. To date, there are only a few empirical studies that have explicitly focussed on balancing processes in Germany. This is where this paper starts by focusing on urban planning, investigating what planners understand by balancing alternatives and variants and how the balancing process is presented in everyday planning. To this end, 19 qualitative interviews were conducted with public and private sector planners. A qualitative content analysis was used to analyse the data. The results confirm the central role of balancing processes in everyday planning and emphasise the need for further research to understand these processes’ complexity and significance.

IntroductionDespite emergency medicine (EM) medical education fellowships increasing in number, the position of the medical education fellowship director (FD) remains incompletely defined. The goal of this study was to characterize the roles, responsibilities, support, and priorities for medical education FDs.MethodsWe adapted and piloted an anonymous electronic survey consisting of 31 single-answer, multiple-answer, and free-response items. The survey was distributed to FDs via listserv and individual emails from a directory compiled from multiple online resources. We used descriptive statistics to analyze data from items with discrete answer choices. Using a constructivist paradigm, we performed a thematic analysis of free-response data.ResultsThirty-four medical education FDs completed the survey, resulting in a response rate of 77%. Thirty-eight percent of respondents were female. Fifty-three percent earned master's degrees in education and 35% completed a medical education fellowship. Most respondents held other education leadership roles including program director (28%), associate/assistant program director (28%), and vice chair (25%). Sixty-three percent received support in their role, including clinical buy-down (90%), administrative assistants (55%), and salary (5%). There was no difference (χ2 [2, n = 32] = 1.77, p = 0.41) between availability of support and type of hospital (community, university, or public hospital). Medical education FDs dedicated a median of 12 h per month to fellowship responsibilities, include education (median 35% of time), program administration (25%), research mentorship (15%), and recruitment (10%). Medical education FDs describe priorities that can be categorized into three themes related to fellows, fellowship, and institution.ConclusionThis study provides insight into the current position and experience of medical education FDs. The results can clarify the role and responsibilities of FDs as the demand for medical education FDs increases.

Children and adolescents diagnosed with cancer can now expect an average 85% 5-year overall survival, with significant improvements in longer-term morbidity and mortality reported over the past several decades. However, the long-term impact of therapeutic agents and modalities introduced in recent years remains unclear and will require dedicated follow-up in the years ahead. The Children's Oncology Group (COG), a part of the NCI's National Clinical Trials Network, with over 200 sites across North America and beyond, enrolls more than 10,000 patients onto research protocols annually, inclusive of first-line clinical trials and nontherapeutic studies. COG provides a platform to conduct survivorship research with several unique strengths: (i) a huge catchment to ascertain relatively rare but important adverse events, (ii) study populations that are otherwise too rare to study in smaller consortia, including access to highly diverse patient populations, (iii) long-term follow-up of clinical trial populations linked to the original trial data, and (iv) a natural platform for intervention research. Enhancements in COG infrastructure facilitate survivorship research, including a COG patient registry (Project:EveryChild), availability of a long-term follow-up tracking resource, and successful deployment of various remote-based study procedures to reduce the burden on participants and participating institutions.

The debate about exurbanites and exurbs has ever been an Anglo-American phenomenon. Due to the limitless space for growth and the individual preferences of living in single-family homes, the exurban census tracts were the fastest growing urban type in the USA for several decades. The increase in highway infrastructure lead to an auto-centric development of land and an ongoing urban sprawl in search for natural amenities and affordable housing. This was not the case in Europe for a long time as Europeans preferred to live closer to the place of work and the historically grown structures of the urban development. However, after the COVID-19 pandemic and the restructuring of a new office culture with remote work as the new condition and growing preferences for more living space and green amenities, exurbs could also evolve in the European context. In this investigation, the authors try to identify exurbs in the German context based on a multi-criteria analysis. We find that they are mostly located in the east and north of Germany around Hamburg and Berlin, and to a minor extent to the west and south of Germany. While there has not been a significant increase of exurbs in the past years, the question remains whether the COVID-19 pandemic has influenced the exurbanisation and the related issues to a sustainable urban development according to SDG 11. Further research on the characteristics of exurbs is needed to provide additional policy recommendations and monitor the development of potential exurbs in the future.

Introduction: Globally, the health and quality of life of millions of people are negatively affected by diabetic foot ulcers (DFUs). To treat these chronic wounds, a novel injectable drug for closing DFUs composed of micronized amniotic membrane was developed. This new therapeutic drug for wound repair expands on traditional allograft therapies by allowing extracellular matrix proteins, growth factors, and cytokines to reach wound anatomies in DFUs that are difficult to treat. The aim of this study was to evaluate the components of the injectable drug. Methods: Liquid chromatography with tandem mass spectrometry and a Quantibody® human cytokine array were conducted to identify and characterize growth factors and proteins known to contribute to wound healing. In addition, hyaluronic acid was quantified and compared between the injectable and human amniotic fluid using a hyaluronan enzyme-linked immunosorbent assay. Cell proliferation, migration, angiogenesis, and viability were evaluated to assess the performance of the novel injectable in vitro. The rheometric properties of the product were evaluated by assessing it pre- and post-injection through a 22-gauge needle to measure the viscosity using a shear- and temperature-dependent viscosity protocol. Results: Liquid chromatography with tandem mass spectrometry and Quantibody® human cytokine array revealed growth factors and proteins imperative for wound healing. The quantified hyaluronic acid was compared between the injectable and human amniotic fluid, resulting in a statistically significant difference, with higher protein concentrations found in the injectable. In vitro qualitative and quantitative analysis confirmed an increase in cell viability, proliferation, and migration when treated with the drug. An evaluation of the rheometric properties of the injectable drug after passing through a 22-gauge cannula presented no alterations to the biologic drug. Conclusions: Collectively, these data present the potential of a novel injectable drug for the treatment of DFUs.

Background and Objectives: The Albumin-to-Alkaline Phosphatase ratio (AAPR) is an easily applicable and cost-effective marker investigated as an outcome predictor in solid cancers. Preliminary evidence in breast cancer suggests that a low AAPR correlates with a poor response to neoadjuvant chemotherapy (NAC) in primary tumors. However, data regarding the axillary response are lacking. This study aims to evaluate whether the AAPR can predict the axillary response in initially nodal-positive (cN+) breast cancer patients undergoing NAC. Materials and Methods: Clinical and biochemical variables of cN+ breast cancer patients undergoing NAC were collected. Pre-NAC albumin and alkaline phosphatase serum values were utilized in the AAPR calculation. Fisher’s exact test was performed to identify differences between the two groups of patients (high and low AAPR according to the cut-off reported in the literature). The primary outcome was the nodal pathologic complete response (pCR) rate in the two groups of patients. Results: Nodal pCR was achieved in 20/45 (44.4%) patients. A total of 36/45 (80%) patients had an AAPR > 0.583. Among patient and tumor characteristics, the only statistically significant difference between the two groups was the axillary pCR between the low and high AAPR groups (p-value = 0.03, OR = 0.129, 95% CI = 0.00–0.835). Conclusions: This pilot study suggests that the pre-treatment AAPR might be an early predictor of axillary response in cN+ breast cancer patients undergoing NAC. This result justifies further investigation in larger prospective trials to validate this finding.

A third-grade educator and university researcher collaborated to develop an after-school virtual book club curriculum for students during the pandemic. Third-grade students were encouraged to explore social justice issues prevalent in their community first by reading relevant children's books, doing research, and collaborating to develop potential action plans to address the issues. The study examined the impact of the books, the identification with characters, and the benefit of small group pedagogy. Students were intrinsically motivated to read, research, and collaborate over social justice issues voluntarily given free choice, minimal guidance, and opportunities. The results showcased the importance of small group discussion with young children, the power of choice in research-based activities, and the desire for students to have their voices heard in important matters.

This study examines student use of and reaction to study spaces in academic libraries through the lenses of place attachment, including appropriation, affordance, and attention restoration theories. Experimenting with new methods of research (four of six methods were new), researchers identified the walking interview as the best for examining their research questions. They found that students identify the library as a study space, and they rely on the library and those within it to reinforce the discipline of study. Findings include more detailed insight into the "study ethos," noise or distraction levels, decor, and other aspects of study spaces.

Introduction Nefashot, meaning ‘Souls’ and ‘People’ in Hebrew, emerged from a local group of impassioned activists. Our core mission is to promote mental health awareness through cultural and artistic expressions, bridging gaps in open and inclusive conversations. Objectives In our early years, our primary goal was to infuse MH discussions into public spaces through art. However, as our community has evolved, so too have our objectives. Today, we recognize the profound impact of these connections and discussions, both within and beyond our dynamic community. We’ve come to understand that belonging to this community is, in itself, a catalyst for change. This shift in perspective has allowed us to fully embrace the transformative potential of community engagement and direct our activities. Methods At the heart of our approach is the nurturing of a profound sense of belonging within our diverse community. We achieve this through two vital activities: (1) Ongoing Community Communication: Within our dynamic community, which includes individuals dealing with mental health challenges, professionals, family members, friends, and allies, communication is paramount to our unity. We maintain an open and continuous dialogue through a dedicated WhatsApp group. This platform facilitates connection, sharing of experiences, and mutual support, strengthening the bonds that unite us in our shared mission. (2) Community-Driven Event Production: Beyond our annual ‘Osim Nefashot’ week, held around World Mental Health Day, we seize opportunities throughout the year to organize events or collaborate with larger events like International Women’s Day in March or Book Week in June. Encouraging active participation in event planning and execution not only amplifies the voices of our members but also deepens their sense of belonging within our ever-evolving community. Results Our hallmark is a sustainable process, welcoming new creators, forging connections, and expanding our influence while retaining core members. This renewal and continuity enable us to reach new audiences and expand mental health awareness through art and culture. Our growth is showcased, with 90 events organized last year. Conclusions Nefashot’s transformation from activists to a diverse community is an ongoing journey requiring commitment and deliberate steps. Our allocated resources and activities ensure each participant, from creators to venues to attendees, plays a vital role in advancing mental health awareness. We remain dedicated to nurturing inclusivity and promoting mental well-being through art and culture. Disclosure of Interest None Declared

BackgroundEarly initiation of breast cancer screening is recommended for high-risk women, including survivors of childhood cancer treated with chest radiation. Recent studies suggest that female survivors of childhood leukemia or sarcoma treated without chest radiation are also at elevated early onset breast cancer risk. However, the potential clinical benefits and cost-effectiveness of early breast cancer screening among these women are uncertain.MethodsUsing data from the Childhood Cancer Survivor Study, we adapted 2 Cancer Intervention and Surveillance Modeling Network simulation models to reflect the elevated risks of breast cancer and competing mortality among leukemia and sarcoma survivors. Costs and utility weights were based on published studies and databases. Outcomes included breast cancer deaths averted, false-positive screening results, benign biopsies, and incremental cost-effectiveness ratios.ResultsIn the absence of screening, the lifetime risk of dying from breast cancer among survivors was 6.8% to 7.0% across models. Early initiation of annual mammography with breast magnetic resonance imaging screening between ages 25 and 40 years would avert 52.6% to 64.3% of breast cancer deaths. When costs and quality-of-life impacts were considered, screening starting at age 40 years was the only strategy with an incremental cost-effectiveness ratio below the $100 000 per quality-adjusted life-year (QALY) gained cost-effectiveness threshold ($27 680 to $44 380 per QALY gained across models).ConclusionsAmong survivors of childhood leukemia or sarcoma, early initiation of breast cancer screening at age 40 years may reduce breast cancer deaths by half and is cost-effective. These findings could help inform screening guidelines for survivors treated without chest radiation.

Learning Objectives: The goal of this study is to characterize the roles, responsibilities, and support for MedEd fellowship directors.Introduction: Despite Medical Education (MedEd) Fellowships increasing in number, the position of MedEd fellowship director remains poorly defined.Methods: We developed and piloted an anonymous electronic survey, consisting of 32 Likert-type and free response items, that we distributed via the CORD MedEd Fellowship Community of Practice listserv. We used descriptive statistics to analyze data from items with discrete answer choices. Chi-squared testing was used to evaluate differences between programs. Using a constructivist paradigm, we performed a thematic analysis of free response data.Results: Thirty-five of 44 MedEd fellowship directors (80%) completed the survey. Thirty-seven percent of respondents were female (13/35). Fifty-one percent earned Master’s degrees in education and 37% completed a MedEd fellowship. Many respondents held other education leadership roles, including program director (PD) (26%), associate/assistant PD (26%), vice chair (23%), and clerkship director (9%). Sixty-three percent (22/35) receive support, including clinical buy-down (18/22, 82%), administrative (11/22, 50%), and salary (1/22, 5%). There was no difference (X2 (2, N=33) = 2.07, p = 0.36) between support and type of hospital (community, academic, or county). Responsibilities of MedEd fellowship directors include education (median 35% of time), administration (25%), research mentorship (20%), and recruitment (14%). Priorities of MedEd fellowship directors fall into three categories, including fellow, fellowship, and institution (Table 1). Factors promoting and inhibiting success of fellowship programs are presented in Table 2.Conclusions: This study provides insight into the position of the MedEd fellowship director. We hope it will allow for role clarity as well as national and local advocacy as the demand for MedEd fellowship directors increases.

Learning Objective: Our objective was to explore the impact of medical education fellowship training on the careers of graduates.Background: Medical education fellowships in emergency medicine provide training in teaching, assessment, educational program administration, and scholarship. The longitudinal impact of this training is unknown.Objective: To explore the impact of medical education fellowships on the careers of graduates.Methods: We performed a qualitative study with a constructivist-interpretivist paradigm using semi-structured interviews. We used a purposeful randomized stratified sampling strategy of graduates to ensure diversity of representation (gender, region, fellowship duration, and career stage). Subjects were invited by email to participate in semi-structured video interviews. Interviews were recorded and transcribed. Two researchers independently analyzed the data using a modified grounded theory approach and resolved discrepancies through in-depth discussion. Inter-rater agreement was 93.7%.Results: The characteristics of the 10 participants are displayed in Table 1. Participants sought fellowship training because of their passion for education, for career preparation, and at the advice of mentors. Participants felt that fellowships provided formal training and important relationships in a supportive learning environment. Fellowship training gave fellows a community, helped them develop expertise, influenced their mindset and impacted careers in both the short and long term. Participants noted that fellowship enhanced their self-efficacy, broadened their educational world view, shaped their professional identity, validated their skill set, and prepared them for job tasks. Participants felt that fellowship increased their competitiveness in the job market, focused the direction of their career, helped develop their niche, and positively affected their career trajectory (Table 2).Conclusion: Fellowship training in medical education broadly influenced the short and long-term mindset and careers of graduates.