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Abstract Background Colorectal cancer (CRC) screening decision aids can inform patients about CRC screening benefits, costs, and procedures. Patients who receive the decision aid report wanting to share the information with their families and friends. We evaluated a CRC screening decision aid on Hispanic patients’ communication to their alters and whether patient-alter communication leads to alters’ CRC screening intention. Methods We conducted a one-arm pre/post study of Hispanic patients and their alters; patients (n = 42) and their alters (n = 19) were recruited from a clinic site in Yakima County, Washington State. Patients viewed a CRC screening decision aid at the clinic site. Survey data from patients and alters were collected via telephone including patients’ communication with their alters about CRC screening after viewing the decision aid and alters’ intention to be screened for CRC after talking to the patient. Results Most participants reported sharing CRC information with their alters after viewing the decision aid, and most alters confirmed they had received CRC information from participants (68%). The decision aid was associated with participants' own intention to undergo CRC screening and with alters' intention to be screened for CRC using a fecal occult blood test (p = 0.014) and sigmoidoscopy (p = 0.011). Conclusions Patient decision aids have the potential to increase CRC screening behavior beyond the decision aid recipients to their social network. Trial registration Trials Registration Number: NCT04444232 “Retrospectively registered.”

Patient focus groups can be invaluable for facilitating user-centered design of medical devices and new technologies, effectively capturing the richness and depth of patient experiences to help thoroughly assess feasibility, tolerance, and usability. While the metaverse holds promise for healthcare applications, its use in patient focus groups remains unexplored. In this Perspective we discuss the potential of the metaverse for conducting focus groups with patients. The theme of the focus group was the design and development of a therapeutic virtual reality application for patients with chronic low back pain. We carried out a pilot study comparing a focus group in a shared virtual space versus a physical location. This experience was positively received by patients, researchers, and clinicians, suggesting the metaverse is a viable medium for conducting these meetings and has potential advantages for remotely located participants, opening the doors for future expansion beyond focus groups to encompass all kinds of patient support and information groups. This approach fosters patient-centered healthcare by helping to facilitate patient voices directly into the design process, which may help lead to improved healthcare delivery, patient satisfaction, and treatment outcomes.

Abstract Chronic pain alters the experience of owning a body and leads to disturbances in bodily perception. We tested whether women with fibromyalgia (FM) are receptive to bodily illusions of owning a visible and progressively invisible body in immersive virtual reality (VR), and what modulates this experience. Twenty patients participated in two experimental sessions; each session included two conditions in a counterbalanced order. We found that patients with FM could indeed experience virtual embodiment. Sentiment analysis revealed significantly more positive reactions to the progressively invisible body, yet twice as many patients declared they preferred the illusion of a visible virtual body. A linear mixed model revealed that the strength of embodiment was positively associated with body perception disturbances and negatively associated with FM symptoms intensity. No effect of pain during the VR experience nor interoception awareness on embodiment was found. The results indicated that patients with FM are receptive to virtual bodily illusions and that the impact of the embodiment depends on affective reactions, the level of cognitive body distortions, and the intensity of symptoms. Importantly, there is a large variation among patients which should be considered in future VR-based interventions.

Stimulant-use disorders can present with long-term cognitive and mental health deficits. Little is known about the underlying molecular mechanisms perpetuating sex differences in cognitive and behavioral deficits in preclinical models of addiction to stimulants such as methamphetamine (MA). The current study investigated the neurochemical shifts underlying sex disparities in MA-induced working memory deficits and an addictive phenotype following abstinence from chronic MA abuse. We used our previously reported mouse model of voluntary oral methamphetamine administration (VOMA) consisting of an acquisition phase (days 1–14) characterized by escalating doses of MA and a binge phase (days 14–28) characterized by static doses. Female VOMA mice exhibited sustained MA consumption during the binge phase, demonstrating sex-specific vulnerabilities to the maintenance of MA addiction. The 8-arm radial maze was used to test spatial working memory performance following abstinence from VOMA. Results indicate working memory deficits correlated to higher MA consumption in females only. Hippocampal and accumbal tissue were collected and analyzed by immunoblotting. Female VOMA mice had decreased GluA1, but not GluA2, in the hippocampus, which may perpetuate synaptic destabilization and working memory deficits. Female-specific increases in GluA1 and p-GSK3β expression in accumbal tissue suggest vulnerability toward abstinence-induced drug craving and heightened downstream neurotoxicity. Our study reveals female-specific neurochemical shifts in hippocampal and accumbal AMPA receptor signaling following abstinence from chronic MA consumption that may perpetuate female susceptibility to MA-induced cognitive deficits. These data demonstrate a novel molecular pathway that would exacerbate memory deficits and perpetuate an addictive phenotype in female populations following MA abuse.

Abstract Background Rural Latino children have higher rates of obesity compared to non-Latino Whites. Schools are in a unique position to address rural childhood obesity through policies. While evidence exists on factors that promote or impede school-based physical activity (PA) and nutrition policies, only a fraction has been in rural communities. This study seeks to understand 1) the knowledge and perceptions of school nutrition and PA policies and 2) barriers and facilitators to their implementation among rural school stakeholders from Washington State. Methods We conducted 20 semi-structured, in-depth interviews with school stakeholders (e.g., principals and school nutrition directors) from four K–12 school districts in the Lower Yakima Valley of Eastern Washington State. Thematic analysis was conducted using inductive, constant comparison approach to identify themes around knowledge and perceptions of policies and barriers and facilitators of policy implementation. Results Three main themes were identified: perceptions and knowledge of school PA and nutrition policies, barriers to policy implementation, and facilitators of policy implementation. The majority of stakeholders were supportive of school-based policies promoting PA and a healthy diet, even when lacking a specific understanding of these policies. Four subthemes were identified as barriers to policy implementation: viewing PA as a low priority, misuse of recess time, funding constraints, and lack of strong leadership. Facilitators of implementation included strong leadership at the district level, creating healthy norms through school-community linkages and pooling community resources to improve nutrition and PA among children. Conclusions Schools provide a unique setting to promote healthy diet and PA behaviors among children and their families. Study findings show that while knowledge of specific nutrition and PA policies may vary, support for such policies were high among rural stakeholders. Study findings can inform policy development and support strategies for policy implementation in rural settings. Future studies may want to examine whether implementation of strategies addressing the barriers and enhancing facilitators lead to success in rural school settings.

Los micronegocios son las unidades económico-sociales más frecuentes en Colombia; no obstante, estos usualmente cuentan con condiciones adversas para su desarrollo y sostenibilidad. Así pues, por medio de este trabajo se busca identificar los principales aspectos de fortalecimiento para la reactivación y competitividad de los micronegocios en la ciudad más poblada del país, Bogotá. Para lograrlo, se utilizó un enfoque metodológico cuantitativo estadístico de análisis de conglomerados mixto, aplicado a una muestra de 1.197 micronegocios, recolectada durante el primer semestre del 2021. Se evidenció que los micronegocios se pueden tipificar en tres grandes grupos: el primero (43%), de competitividad media; el segundo (24%), de competitividad baja, y el trcero (33%), de competitividad alta. Por otra parte, dado que los métodos para la obtención de la muestra no fueron totalmente aleatorizados, esta investigación tiene implicaciones para la generalización de los resultados. Sin embargo, debido a que existen muy pocos estudios focalizados en este tipo de unidades económicas, la presente investigación contribuye a la comprensión y visibilización de esta población. Finalmente, se exponen conclusiones y recomendaciones que pueden servir como insumo para la formulación de futuros proyectos o políticas públicas.

Abstract Background Rural Latino children and adults are less active than urban and non-Latino counterparts. We examined physical activity (PA) patterns of rural Latino children and their parents, and explored parental beliefs about and reported barriers of Latino family physical activity. Latino families in a rural area in eastern Washington state, with children in grades 3–5 were included. Methods We used mixed methods. Children (n = 27) and parents (n = 25) wore an accelerometer for 5 days; parents (n = 31) participated in a semi-structured interview and completed a demographic survey. Parent and child activity levels were compared using paired t-tests; interviews were analyzed with qualitative content analysis. Results Although 100% children and 46% parents met physical activity guidelines, parents and children spent most of the day in sedentary behaviors. Parent-reported PA barriers included their long work hours, lack of transportation, and their child’s screen-time. Conclusion Addressing barriers and reducing sedentary time could increase PA of rural Latino families.

Contexto: Los micropilotes son utilizados como elementos de refuerzo del suelo o de recalce, dicha función es comprobada y analizada por diferentes autores. En Colombia el uso de esta técnica está limitado a conceptos propios del geotecnista que involucran conocimientos empíricos y experiencias exitosas. En consecuencia, es necesaria la compilación de variables clave y metodologías analíticas y numéricas para la mejor comprensión de esta técnica. Método: En este documento se presenta un estado del arte sustentado en artículos e investigaciones que tienen como objeto el análisis y la evaluación del comportamiento de los micropilotes como elementos recuperadores de capacidad de carga en grupos de pilotes que presentan defectos. Resultados: Los hallazgos identificados en los documentos consultados logran ser sintetizados como un soporte teórico que se convierte en un punto de partida para futuras investigaciones en este campo de la ingeniería geotécnica. Conclusiones: Se logra evidenciar que los micropilotes tienen una influencia positiva en la recuperación de carga de fundaciones existentes, demostrando la importancia de efectuar ensayos y análisis de campo directamente en Colombia, considerando los estratos de suelos específicos que se encuentran en el país.

Abstract Background Hispanics bear some of the highest burden of the obesity epidemic and the disparities gap is bigger among Hispanics in rural communities. This mixed methods study examined the objective and subjective assessment of food availability and food access in four rural, agricultural, and predominantly Hispanic communities. Methods In this convergent parallel mixed methods study, we used the Nutrition Environment Measures Survey (NEMS) of Food Stores and Restaurants to objectively assess 57 food stores and 69 restaurants in four rural agricultural communities in Washington State. To complement the objective assessment findings, we conducted semi-structured interviews with 32 community residents. The data were collected from 2013 to 2014. Frequencies and means were calculated for quantitative data and content analysis conducted for interview data. Results Participants (n = 32) had a mean age of 35.6 (SD 6.2) years, were mostly women, uninsured, low income, and had less than a high school education. Grocery and convenience stores had low NEMS composite scores indicating low overall availability of food items, low quality, and high food prices. Composite scores for sit-down restaurants, fast casual restaurants, and fast-food restaurants were similarly low in all four towns indicating limited availability of healthier options. Semi-structured interviews revealed participants perceived high availability and accessibility of quality fresh produce. Most participants reported eating out regularly several times a week, frequenting restaurant chains that serve buffets or fast foods, and allowing children to make decisions regarding their own food choices. Conclusions Community members’ perception of food availability and food access may be different from the objective assessment of food environment. This information can be used to inform community-wide interventions to address food environment in these rural communities.

It is well known that young organisms do not maintain memories as long as adults, but the mechanisms for this ontogenetic difference are undetermined. Previous work has revealed that the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAr) subunits are trafficked into the synaptic membrane following memory retrieval in adults. Additionally, phosphorylated PSD-95-pS295 promotes AMPAr stabilization at the synapse. We investigated these plasticity related proteins as potential mediators in the differential contextual stress memory retrieval capabilities observed between adult and juvenile rats. Rats were assigned to either pedestal stress (1 h) or no stress control (home cage). Each animal was placed alone in an open field for 5 min at the base of a 6 × 6 sq inch pedestal (4ft high). Stress subjects were then placed on this pedestal for 1hr and control subjects were placed in their home cage following initial exploration. Each animal was returned to the open field for 5 min either 1d or 7d following initial exposure. Freezing postures were quantified during the memory retrieval test. The 1d test shows adult (P90) and juvenile (P26) stressed rats increase their freezing time compared to controls. However, the 7d memory retrieval test shows P90 stress rats but not P26 stress rats freeze while in the fear context. Twenty minutes after the memory retrieval test, hippocampi and amygdala were micro-dissected and prepared for western blot analysis. Our results show that 1d fear memory retrieval induced an upregulation of PSD-95 and pS295 in the adult amygdala but not in the juvenile. However, the juvenile animals upregulated PKMζ, PI3K and GluA2/3, GluA1-S845 in the dorsal hippocampus (DH), but the adults did not. Following the 7d memory retrieval test, adults upregulated GluA2 in the amygdala but not the juveniles. In the DH, adults increased PSD-95 and pS295 but not the juveniles. The adults appear to preferentially increase amygdala-driven processing at 1d and increase DH-driven context specific processing at 7d. These data identify molecular processes that may underlie the reduced fear-memory retrieval capability of juveniles. Together these data provide a potential molecular target that could be beneficial in treatment of anxiety disorders and PTSD. Keywords: Stress, Fear, Memory, Amygdala, Hippocampus, Plasticity, AMPA receptor, PSD-95, Development

Viral infections represent significant morbidity and mortality factors in kidney transplant recipients, with CMV, EBV, and BKV infections being most common. Desensitization (DES) with IVIg and rituximab with/without plasma exchange followed by kidney transplantation with alemtuzumab induction increased successful transplant rates in HLA-sensitized patients but may represent an increased risk for viral infections due to severe lymphocyte depletion. Here, we report on the posttransplant viral infection status in 372 DES versus 538 non-DES patients. CMV and EBV viremia were significantly lower in DES patients, while BKV viremia was similar. This trend was observed primarily in CMV sero(−), EBV sero(+), and sero(−) patients. No patient developed PTLD. The incidence of BKAN, allograft, and patient survival was similar in both groups. These viral infections were not associated with subsequent allograft rejection which occurred within 6 months after the infection. Conclusions. The IVIg + rituximab desensitization combined with alemtuzumab induction with triple immunosuppression maintenance does not increase the risk for CMV, EBV, and BKV infections. Possible factors include, in addition to posttransplant antiviral prophylaxis and PCR monitoring, presence of memory T cells and antibodies specific to CMV and likely EBV, NK cell-mediated ADCC despite lymphocyte depletion, elimination of EBV and CMV reservoirs by rituximab and alemtuzumab, and use of IVIg with antiviral properties.

In piled raft systems (PRSs), the piles are used to support load or to control settlements. These systems, when founded in soft soils that are then consolidated by loads or subsidence processes, can induce negative friction in the piles and other phenomena related to variations in the distribution of load or settlements. This paper presents the results of physical modeling in a geotechnical centrifuge capable of different distributions of piles under a raft. As a result, the influence of consolidation and extraction of water from a deep soil layer on the behavior of the PRS model was analyzed. It was determined that the processes associated with the extraction of water from the deep soil layer induce larger settlements. A separation between the raft and the soil is possible, as well as a change in the behavior of the PRS. Key words: centrifuge modelling, clays, consolidation, groundwater, subsidence, piled raft system, extraction of water from soil deep layer, settlement. Dans les systemes de radeaux sur pilotis (PRS), les pieux sont utilises pour supporter la charge ou pour maitriser les tassements. Ces systemes, lorsqu'ils sont fondes sur des sols souples qui sont ensuite consolides au moyen de charges ou de processus d'affaissement, peuvent induire une friction negative dans les pieux et d'autres phenomenes lies a des variations dans la distribution de la charge ou des tassements. Cet article montre les resultats de la modelisation physique d'une centrifugeuse geotechnique capable de differentes distributions de pieux sous un radeau. En consequence, l'influence de la consolidation et de l'extraction de l'eau d'une couche profonde du sol sur le comportement du modele PRS a ete analysee. Il a ete determine que les processus associes a l'extraction de l'eau de la couche profonde du sol induisent des tassements plus importants. Une separation entre le radeau et le sol est possible, ainsi qu'un changement dans le comportement du PRS. [Traduit par la Redaction] Mots-cles : modelisation par centrifugation, argiles, consolidation, eaux souterraines, affaissement, systeme de radeaux sur pilotis, extraction de l'eau de la couche profonde du sol, entassement., 1. Introduction A significant number of buildings are being constructed over a piled raft System (PRS) (Poulos 2001; Garcia 2015). This system can reduce the full relaxation stresses during the [...]

BackgroundDepression affects 5% of adults and it is a major cause of disability worldwide. Digital psychotherapies offer an accessible solution addressing this issue. This systematic review examines a spectrum of digital psychotherapies for depression, considering both their effectiveness and user perspectives. ObjectiveThis review focuses on identifying (1) the most common types of digital psychotherapies, (2) clients’ and practitioners’ perspectives on helpful and unhelpful aspects, and (3) the effectiveness of digital psychotherapies for adults with depression. MethodsA mixed methods protocol was developed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search strategy used the Population, Intervention, Comparison, Outcomes, and Study Design (PICOS) framework covering 2010 to 2024 and 7 databases were searched. Overall, 13 authors extracted data, and all aspects of the review were checked by >1 reviewer to minimize biases. Quality appraisal was conducted for all studies. The clients’ and therapists’ perceptions on helpful and unhelpful factors were identified using qualitative narrative synthesis. Meta-analyses of depression outcomes were conducted using the standardized mean difference (calculated as Hedges g) of the postintervention change between digital psychotherapy and control groups. ResultsOf 3303 initial records, 186 records (5.63%; 160 studies) were included in the review. Quantitative studies (131/160, 81.8%) with a randomized controlled trial design (88/160, 55%) were most common. The overall sample size included 70,720 participants (female: n=51,677, 73.07%; male: n=16,779, 23.73%). Digital interventions included “stand-alone” or non–human contact interventions (58/160, 36.2%), “human contact” interventions (11/160, 6.8%), and “blended” including stand-alone and human contact interventions (91/160, 56.8%). What clients and practitioners perceived as helpful in digital interventions included support with motivation and accessibility, explanation of task reminders, resources, and learning skills to manage symptoms. What was perceived as unhelpful included problems with usability and a lack of direction or explanation. A total of 80 studies with 16,072 participants were included in the meta-analysis, revealing a moderate to large effect in favor of digital psychotherapies for depression (Hedges g=–0.61, 95% CI –0.75 to –0.47; Z=–8.58; P