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PurposeEvidence supports the role of prescribed exercise for cancer survivors, yet few are advised to exercise by a healthcare practitioner (HCP). We sought to investigate the gap between HCPs' knowledge and practice from an international perspective.MethodsAn online questionnaire was administered to HCPs working in cancer care between February 2020 and February 2021. The questionnaire assessed knowledge, beliefs, and practices regarding exercise counselling and referral of cancer survivors to exercise programs.ResultsThe questionnaire was completed by 375 participants classified as medical practitioners (42%), nurses (28%), exercise specialists (14%), and non-exercise allied health practitioners (16%). Between 35 and 50% of participants self-reported poor knowledge of when, how, and which cancer survivors to refer to exercise programs or professionals, and how to counsel based on exercise guidelines. Commonly reported barriers to exercise counselling were safety concerns, time constraints, cancer survivors being told to rest by friends and family, and not knowing how to screen people for suitability to exercise (40-48%). Multivariable logistic regression models including age, gender, practitioner group, leisure-time physical activity, and recall of guidelines found significant effects for providing specific exercise advice (χ2(7) = 117.31, p

PurposeTo examine the perspectives of medical and nursing health professionals concerning their roles and responsibilities in providing dietary and exercise advice to cancer survivors, and referrals to allied health professionals.MethodsAn integrative review. PubMed, CINAHL, PsycINFO, Embase, Web of Science databases, and bibliographies of relevant studies were searched from December 2011 to June 2021. All studies were eligible for inclusion. The Mixed-Methods Appraisal Tool (MMAT) was used to critically appraise included studies. Data were extracted and synthesised regarding the perspectives of medical and nursing health professionals on their roles, responsibilities, barriers, and facilitators.ResultsTwenty-one studies involving 3401 medical and nursing health professionals and 264 cancer survivors of diverse cancer types were included. Ten quantitative, nine qualitative, and two mixed-methods studies were eligible. All included studies met at least 80% of the quality criteria in the MMAT. Major findings include the following: (1) medical and nursing health professionals were unclear on their roles in providing dietary and exercise advice to cancer survivors but agreed they play a key role in referrals to dietitians and exercise professionals; (2) most cancer survivors valued the involvement of their general practitioner when receiving dietary and exercise advice.ConclusionAlthough medical and nursing health professionals understand that referrals to allied health professionals form part of their role, there is a lack of clarity regarding their roles to provide dietary and exercise advice to cancer survivors. Future studies should address barriers and facilitators of dietary and exercise advice and referral by medical and nursing health professionals.

The efficacy of immune checkpoint inhibitors (immunotherapy) is increasingly recognized to be linked to the composition the gut microbiome. Given the high rates of resistance, interventions targeting the gut microbiome are now being investigated for its ability to improve the efficacy of immunotherapy. In light of recently published data demonstrating a strong correlation between the efficacy and toxicity of immunotherapy, there is a risk that efforts to enhance immunotherapy efficacy may be undermined by increases in immune-related adverse events (IrAEs) This is particularly important for microbial interventions aimed at increasing immunotherapy efficacy, with many microbes implicated in tumour response also linked to IrAEs, especially colitis. IrAEs have a profound impact on patient quality of life, causing physical, psychosocial, and financial distress. Here, we outline strategies at the discovery, translational, and clinical research phases to ensure the impact of augmenting immunotherapy efficacy is approached in a manner that considers adverse implications. Adopting these strategies will ensure that our ongoing efforts to overcome immunotherapy resistance are not impacted by unacceptable toxicity.

Racial discrimination is a salient and chronic stressor for ethnic minority parents that can negatively impact their parenting. The present study used a short-term longitudinal design to examine the link between Chinese American mothers' stressful experiences of racial discrimination and their authoritarian parenting practices, the mediating role of mothers' depressive symptoms, and the moderating role of their behavioral acculturation toward American and Chinese cultures in these associations (i.e., behavioral participation in the American culture and behavioral maintenance of Chinese culture). Participants were 143 first-generation Chinese American mothers (M[subscript age] = 38.0 years) with preschool-age children (M[subscript age] = 4.6 years; 50% girls). Mothers reported their racial discrimination stress, depressive symptoms, American and Chinese behavioral acculturation, and authoritarian parenting across two time points over a 6-month interval. A moderated mediation model was conducted using structural equation modeling to test the hypothesized associations. Chinese American mothers' depressive symptoms mediated the association between racial discrimination stress and authoritarian parenting. The path between racial discrimination stress and depressive symptoms and the indirect effect of racial discrimination stress on authoritarian parenting were buffered by mothers' behavioral acculturation toward American culture and exacerbated by their behavioral acculturation toward Chinese culture. This study provides the first longitudinal evidence linking Chinese American mothers' experiences of racial discrimination and their negative parenting over time as well as mediating and moderating factors underlying this process. Our findings highlight the need for systemic efforts addressing racial inequalities and fostering positive development in Asian Americans and other marginalized families.

PurposeExercise can help cancer survivors manage sequela, treatment side effects, improve overall quality of life, and is recommended for most. The purpose of this study was to investigate exercise behavior and factors influencing exercise engagement among cancer survivors at the National Cancer Centre, Singapore (NCCS).MethodsThis cross-sectional study was inclusive of survivors of all cancer types and stages who were at least 21 years of age and had undergone chemotherapy at the NCCS. Surveys were utilized to assess survivor barriers and facilitators to exercise and to retrospectively assess physical activity and exercise behaviors at 4 cancer-related time periods (pre-diagnosis and post-diagnosis before, during, or after chemotherapy).ResultsA total of 102 cancer survivors were enrolled; 60% were diagnosed with stage IV cancer. Predominant cancer types included lower gastrointestinal tract (25.5%) and breast cancer (21.6%). Prior to cancer diagnosis, 90.2% of participants reported aerobic activity satisfying NCCN guidelines. Significant reductions in reported exercise, and physical activity, were observed following cancer diagnosis that persisted during chemotherapy. Key exercise facilitators included the desire to remain healthy (86.3%) and to improve sleep and mental well-being (73.5%). Key barriers included side effects of treatment (52.0%). Only 46.1% of survivors reported receiving exercise guidance from healthcare professionals following diagnosis.ConclusionOverall, even among this notably active cohort of Singaporean survivors, opportunities for increased exercise engagement throughout the survivorship continuum remain. Increased education regarding the benefits of exercise to survivors as well as guidance regarding exercise modalities including resistance training is greatly needed as well.

Multiple studies have shown that transgender individuals routinely face increased levels of hostility and discrimination in the workplace compared to their cisgender peers; this is also true for transgender educators, who are often marginalized or silenced for expressing their gender diversity. Exploring the experiences of transgender teachers can provide much-needed information for school and district leaders seeking to support and affirm transgender individuals as valued members of the school community. The workplace experiences of six transgender educators in various teaching roles were examined in this qualitative study. The researchers utilized semistructured interviews to explore participants' professional lives, focusing on factors that affected decisions to reveal or conceal their gender identities, the climate of the schools in which they worked, and their support for LGBTQ students. Findings suggest that while support for LGBTQ teachers is growing, heteronormativity persists in troubling ways, particularly for transgender educators. Implications of these findings for school and district leaders are discussed.

Given the critical impact of their decisions and of the community's perception of their performance, it is reasonable that school superintendents would seek to understand the factors that influence their decisions and the processes used to make them. The researcher in this study used a qualitative approach, interviewing 13 school superintendents about the factors that affected their decisions and the extent to which they utilized a rational or intuitive decision-making model. The results show that superintendents' decisions are influenced by the belief that they must safeguard the interests of students, by their perceptions about community acceptance of their decisions, and by the advice of trusted consultants. Their responses suggested that superintendents blend a rational approach with their intuition when making decisions, a strategy that mimics dual process approaches.

IntroductionPreliminary evidence supports the beneficial role of physical activity on prostate cancer outcomes. This phase III randomised controlled trial (RCT) is designed to determine if supervised high-intensity aerobic and resistance exercise increases overall survival (OS) in patients with metastatic castrate-resistant prostate cancer (mCRPC).Methods and analysisParticipants (n=866) must have histologically documented metastatic prostate cancer with evidence of progressive disease on androgen deprivation therapy (defined as mCRPC). Patients can be treatment-naïve for mCRPC or on first-line androgen receptor-targeted therapy for mCRPC (ie, abiraterone or enzalutamide) without evidence of progression at enrolment, and with no prior chemotherapy for mCRPC. Patients will receive psychosocial support and will be randomly assigned (1:1) to either supervised exercise (high-intensity aerobic and resistance training) or self-directed exercise (provision of guidelines), stratified by treatment status and site. Exercise prescriptions will be tailored to each participant's fitness and morbidities. The primary endpoint is OS. Secondary endpoints include time to disease progression, occurrence of a skeletal-related event or progression of pain, and degree of pain, opiate use, physical and emotional quality of life, and changes in metabolic biomarkers. An assessment of whether immune function, inflammation, dysregulation of insulin and energy metabolism, and androgen biomarkers are associated with OS will be performed, and whether they mediate the primary association between exercise and OS will also be investigated. This study will also establish a biobank for future biomarker discovery or validation.Ethics and disseminationValidation of exercise as medicine and its mechanisms of action will create evidence to change clinical practice. Accordingly, outcomes of this RCT will be published in international, peer-reviewed journals, and presented at national and international conferences. Ethics approval was first obtained at Edith Cowan University (ID: 13236 NEWTON), with a further 10 investigator sites since receiving ethics approval, prior to activation.Trial registration numberNCT02730338.

The rumen is a complex ecosystem composed of anaerobic bacteria, protozoa, fungi, methanogenic archaea and phages. These microbes interact closely to breakdown plant material that cannot be digested by humans, whilst providing metabolic energy to the host and, in the case of archaea, producing methane. Consequently, ruminants produce meat and milk, which are rich in high-quality protein, vitamins and minerals, and therefore contribute to food security. As the world population is predicted to reach approximately 9.7 billion by 2050, an increase in ruminant production to satisfy global protein demand is necessary, despite limited land availability, and whilst ensuring environmental impact is minimized. Although challenging, these goals can be met, but depend on our understanding of the rumen microbiome. Attempts to manipulate the rumen microbiome to benefit global agricultural challenges have been ongoing for decades with limited success, mostly due to the lack of a detailed understanding of this microbiome and our limited ability to culture most of these microbes outside the rumen. The potential to manipulate the rumen microbiome and meet global livestock challenges through animal breeding and introduction of dietary interventions during early life have recently emerged as promising new technologies. Our inability to phenotype ruminants in a high-throughput manner has also hampered progress, although the recent increase in "omic" data may allow further development of mathematical models and rumen microbial gene biomarkers as proxies. Advances in computational tools, high-throughput sequencing technologies and cultivation-independent "omics" approaches continue to revolutionize our understanding of the rumen microbiome. This will ultimately provide the knowledge framework needed to solve current and future ruminant livestock challenges.

Purpose: Teacher ratings were used to compare children with developmental language disorders (DLD) and their typically developing peers on 2 subtypes of social withdrawal (shyness and unsociability). Measurement invariance analysis was utilized to determine if teachers rated the 2 groups using the same underlying construct for each of the rating scale items that have been designed to assess withdrawn behavior. Method: The Teacher Behavior Rating Scale (TBRS; C. H. Hart & Robinson, 1996) was administered to the teachers of 173 children with DLD and 182 typically developing children (age range: 5;0-12;11 years;months) to compare 2 subtypes of withdrawal, shyness and unsociability. Measurement invariance analysis was used to establish an appropriate basis for comparing the latent group means and other structural parameters, and partial invariance models were used to compare the groups. Results: For the TBRS, shyness and unsociability were measured by 4 and 5 items, respectively. The measurement invariance analysis indicated that classroom teachers approached 1 item on each of these scales using a different underlying construct when rating the 2 groups of children. Taking this into account, the groups were compared. Teachers rated children with DLD as significantly more withdrawn on both shyness and unsociability in comparison with typically developing children. Age and gender were not significant factors. Conclusions: When conducting assessments, it should not be assumed that teachers or other raters approach even commonly used rating scale items using the same underlying perception for typically developing children and children with disorders. However, the analysis of invariant items on the TBRS reconfirmed that children with DLD are at risk for social withdrawal as operationalized by assessments of both shyness and unsociability.

Researchers examined the relationship between superintendent longevity and district variables on standardized test scores for students in North Carolina. The authors used hierarchical multiple regression to understand if superintendent-specific variables explained variance in student performance over and above district-based variables documented in the research literature. The continuous predictors were the percentage of students who receive free or reduced lunch (FRL), school size, and superintendents' levels of experience. This study illustrates that the issue of whether superintendents affect student achievement is not an all or nothing proposition. While superintendents can influence student achievement, particularly as their in-state experience increases, there are district predictors that must be considered.