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ABSTRACTTrait mindfulness confers emotional benefits and encourages skillful emotion regulation, in part because it helps people more deliberately attend to internal experiences and external surroundings. Such heightened attentional control might help skillfully deploy one's attention towards certain kinds of stimuli, which may in turn help regulate emotions, but this remains unknown. Testing how trait mindful people deploy attention when regulating their emotions could help uncover the specific mechanisms of mindfulness that confer its emotional benefits. The present study aimed to determine whether high trait mindfulness is associated with sustained attention biases to (i.e. longer gaze at) emotional scenes, when all participants are given the emotion regulation goal of staying in a positive mood. To measure this, we used eye tracking to assess selective attention to positive, neutral, and negative photographs. Higher trait mindfulness was associated with both a stronger attention bias for positive (vs. neutral and vs. negative) images, as well as greater success staying in a positive mood during viewing. Surprisingly, this attention bias towards the positive images did not mediate the relationship between mindfulness and maintenance of positive mood. Future work should compare visual attention to other emotion regulation strategies that may maximise positive affect for mindful people.

IntroductionDigital tomosynthesis (DTS) has broad non-orthopaedic applications and has seen limited use within orthopaedics for imaging of the wrist. The utility of DTS for assessing reduction and hardware placement following operative treatment of pelvic ring injuries and acetabular fractures has not previously been investigated.MethodsAll operatively treated acetabular fractures and pelvic ring injuries that underwent surgical fixation within a one-year time span received both a computed tomography (CT) scan and a DTS scan as part of their routine postoperative imaging workup. Three orthopaedic traumatologists independently reviewed the images for face-value clinical utility. Radimetrics and PCXMC software were utilized on a subset of the study population's DTS and CT studies to calculate the effective and organ radiation doses delivered.Results52 patients (22 acetabular fractures, 22 pelvic ring injuries, 7 pelvic ring and acetabular fractures, 2 femoral head & acetabular fractures) were included. DTS was considered adequate to assess reduction 83% of the time, hardware position 83% of the time, and sufficient to replace the CT scan 67% of the time. DTS was associated with an 8.3 times lower effective radiation dose than CT. All organ doses were lower for DTS than CT.DiscussionDTS appears to have face-value clinical utility for assessing reduction and hardware position following surgical treatment of acetabular fractures and pelvic ring injuries. Given that DTS is associated with significantly lower radiation doses to patients, further study utilizing more objective criteria is warranted.

As national literary imaginaries become more global, so too do the possibilities for exploring young adult literature in its representation of transnational youth identities, representations reflecting youth often thrown into the tension of navigating multiple homelands. In carrying out a critical content analysis grounded in theories and concepts of transnationalism to Emiko Jean’s Tokyo Ever After (2021), I consider how readers might engage with the text and become aware of, and connected with, the lives of transnational youth through themes such as dichotomous selfhood, with the view that such awareness may encourage transformations of power. I argue for the use of transnational critical literacy of young adult literature as one approach to develop in youth audiences a better understanding of transnationalism and its influence on adolescent identity formation.

Abstract Left ventricular noncompaction cardiomyopathy (LVNC) is a structural heart defect that has been associated with generation of arrhythmias in the population and is a cause of sudden cardiac death with severe systolic dysfunction and fatal arrhythmias. LVNC has gained increasing acknowledgment with increased prevalence. We conducted a systematic review of reported electrocardiogram (ECG) results for pediatric LVNC patients. EMBASE database query was performed, yielding 4531 articles related to LVNC between 1990 and December 2023. Patient age ranged from prenatal to 18 years of age. Qualitative analyses were performed to characterize individual arrhythmias, and summative interpretation of ECG evaluations was gathered for the entire cohort. Systematic review of 57 LVNC cases and ECG presentation revealed many waveform consistencies, including abnormal left ventricular, atrioventricular node, and interventricular septal patterns, and specifically a high incidence of Mobitz type II and Wolff–Parkinson–White waveforms. This review of ECG analysis reinforces the clinical and etiologic significance of pediatric LVNC. While LVNC in pediatric populations may not always present as acute clinical cases, further investigation into the electrophysiology of the disease supports the need for further evaluation and risk stratification for patients with suspected LVNC and/or ventricular arrhythmia.

Abstract Remote monitoring is beneficial for the management of patients with cardiovascular implantable electronic devices by impacting morbidity and mortality. With increasing numbers of patients using remote monitoring, keeping up with higher volume of remote monitoring transmissions creates challenges for device clinic staff. This international multidisciplinary document is intended to guide cardiac electrophysiologists, allied professionals, and hospital administrators in managing remote monitoring clinics. This includes guidance for remote monitoring clinic staffing, appropriate clinic workflows, patient education, and alert management. This expert consensus statement also addresses other topics such as communication of transmission results, use of third‐party resources, manufacturer responsibilities, and programming concerns. The goal is to provide evidence‐based recommendations impacting all aspects of remote monitoring services. Gaps in current knowledge and guidance for future research directions are also identified.

Abstract Background Recently, there has been increasing evidence that reducing burnout in healthcare providers requires significant organizational efforts that include the integration of leadership strategies. Methods Focus groups were conducted across four health systems within the University of Colorado Department of Medicine in four affinity groups (administrative staff, medical trainees, research faculty, and clinical faculty). Authentic leadership theory was used for analysis to advance the understanding of the role of leadership style upon participants’ work experiences and preferences, and to identify opportunities for translation of site-specific results to other academic medical settings. Results Study participants from each affinity group believed their clinical leaders lacked objectivity with decision-making (lacking “balancing processing”), which contributed to their overall feeling of powerlessness. The experience of increasing work demands was salient throughout all twelve focus groups, and participants identified leadership that interacted in a more open and self-disclosing manner (“relational transparency”) as alleviating at least some of this burden. Strong preference discernable alignment between their leaders’ decision-making and their internal moral compass of values (demonstrating “internalized moral perspective”) was described, as was clinical leaders demonstrating “self-awareness” (having a self-reflective process that informs the leader’s decision-making). Comparing affinity group experiences within each authentic leadership theory construct identified the relevance of contextual factors, such as work setting and roles, upon employees’ perceptions and expectations of their leaders. Conclusions Use of authentic leadership theory advanced the understanding of the association between leadership traits and experiences of burnout amongst a large group of academic clinicians, researchers, trainees, and administrative staff. Leadership styles that promoted relationship transparency, openness, and support were preferred and fostering these traits may help address the demands in academic medicine, including symptoms of burnout.

Primary open-angle glaucoma (POAG) is a leading cause of irreversible vision loss, yet much of the genetic risk remains unaccounted for, especially in African-Americans who have a higher risk for developing POAG. We conduct a multiethnic genome-wide association study (GWAS) of POAG in the GERA cohort, with replication in the UK Biobank (UKB), and vice versa, GWAS in UKB with replication in GERA. We identify 24 loci (P

Background: Emotion regulation flexibility is a person's tendency to shift their use of emotion regulation strategies in response to contextual demands. A lack of flexibility is thought to underlie affective disorders, yet conceptualizations of “flexibility” vary widely, and few studies have empirically assessed flexibility. In this study, we outline methods for measuring emotion regulation flexibility and then examine evidence for inflexibility in people with a common affective disorder: social anxiety disorder (SAD). Methods: Participants were community adults diagnosed with SAD and a psychologically healthy control group who completed a 14-day experience-sampling study. Participants recorded their most anxiety-provoking event each day, how they evaluated contextual demands (i.e., perceived controllability, emotional intensity) of these events, and their use of seven emotion regulation strategies to manage anxiety. Hypotheses and analyses were preregistered with the Open Science Framework (https://osf.io/s7kqj/). Results: Participants with SAD demonstrated some evidence of inflexibility. They used three disengagement strategies (rumination, thought suppression, expressive suppression) more often than controls and did so independently of contextual demands (specifically, perceived controllability). Nonetheless, participants with SAD largely demonstrated similar regulatory patterns as controls, most notably in their use of engagement strategies (acceptance, cognitive, reappraisal, problem-solving). Limitations: We measured two of many possible contextual demands, did not compare to a mixed clinical group or other affective disorders (e.g., depression), and did not assess temporal sequences of strategy use. Conclusions: People with SAD demonstrate some inflexibility in their use of disengagement regulation strategies.

Knowledge management has the potential to develop strategic advantage and enhance the performance of an organization in terms of productivity and business process efficiency. For this reason, organizations are contributing significant resources to knowledge management; investing in information location and implementing knowledge management processes and systems. However, most of these processes and systems focus only on knowledge management and omit the critical element of value. This paper examines intellectual capital and knowledge management within the not-for-profit environment of higher education. The research is focused on intellectual capital and is framed by the perspective of the strategic importance of knowledge. It is argued that the understanding and application of knowledge management within institutions of higher education is underdeveloped which resulted in a model and framework being proposed.

Despite efforts to improve patient experience (PX), little is known about the perspective of hospitalists regarding PX initiatives and priorities. A survey was distributed to hospitalist groups across the country assessing involvement in PX initiatives and their perceived effectiveness, what PX means to providers, and facilitators/barriers in improving PX. Ninety-nine percent of respondents had encountered some improvement activity around PX. The most prevalent were communication training, group Hospital Consumer Assessment of Healthcare Providers and Systems data, and interdisciplinary bedside rounding. Respondents rated most initiatives a 5 to 6 out of 10 for their effectiveness, with the perception of effectiveness increasing with respondents’ assessment of patient experience priority. Learning about others’ experiences in improving PX and learning about potential collaborations for quality improvement or research in these areas were areas of interest for future work. Qualitative work highlighted potential barriers in improving PX such as workload and staffing constraints, uncontrollable environmental factors, and unrealistic patient expectations. Improving PX is a priority, and there are many initiatives in place with perceived variable success and perceived barriers in improving PX.

Primary open-angle glaucoma (POAG) leads to progressive vision loss. Here, Choquet et al. perform genome-wide association analysis for POAG in a multi-ethnic cohort, identify a total of nine novel genetic loci and show relevant function of FMNL2 and LMX1B using cell line and mouse experiments.

Objective: Improvement in emotion regulation is a proposed transdiagnostic mechanism of change. However, treatment research is limited by disorder-specific investigations that assess a narrow number of emotion regulation strategies. Moreover, most assess pre-to-post-treatment change without examining short-term changes throughout psychotherapy that might influence treatment response. Method: To address these gaps, this study uses daily diary methodology to examine trajectories of change in use of six emotion regulation strategies during partial hospitalization psychiatric treatment. Treatment was rooted in cognitive behavioral principles and included skills adapted from empirically supported cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) manuals. Participants were adults (N = 364; Mage = 34.6 years; 60% female; 85% non-Hispanic White) with various profiles of mood, anxiety, and obsessive–compulsive disorders who completed symptom measures at baseline and discharge and daily measures of emotion regulation. Results: In the first 7 treatment days, patients increased use of engagement strategies (reappraisal, acceptance) and decreased use of disengagement (expressive suppression) and cognitive perseveration (experiential avoidance, rumination) strategies. Day-to-day trajectories found that decreased use of experiential avoidance predicted next-day changes in distraction and suppression use. In predicting treatment outcomes, steeper rates of decreased suppression use predicted reductions in anxiety, depression, and general psychopathology symptoms; similar patterns were observed for decreased rumination and experiential avoidance use and increased reappraisal use. Conclusion: Results add to a growing literature on the value of intentional, constructive engagement with emotional experiences as a mechanism of psychological health. What is the public health significance of this article?: This study suggests that successful cognitive behavioral psychotherapy increases constructive engagement with emotions. These changes can occur within the first few days of transdiagnostic treatments and be maintained at discharge. [ABSTRACT FROM AUTHOR]

Remote monitoring is beneficial for the management of patients with cardiovascular implantable electronic devices by impacting morbidity and mortality. With increasing numbers of patients using remote monitoring, keeping up with higher volume of remote monitoring transmissions creates challenges for device clinic staff. This international multidisciplinary document is intended to guide cardiac electrophysiologists, allied professionals, and hospital administrators in managing remote monitoring clinics. This includes guidance for remote monitoring clinic staffing, appropriate clinic workflows, patient education, and alert management. This expert consensus statement also addresses other topics such as communication of transmission results, use of third-party resources, manufacturer responsibilities, and programming concerns. The goal is to provide evidence-based recommendations impacting all aspects of remote monitoring services. Gaps in current knowledge and guidance for future research directions are also identified. [ABSTRACT FROM AUTHOR]

Patrick P Kneeland, Margaret C FangThe University of California, San Francisco Division of Hospital Medicine, San Francisco, CA, USAAbstract: Warfarin therapy reduces morbidity and mortality related to thromboembolism. Yet adherence to long-term warfarin therapy remains challenging due to the risks of anticoagulantassociated complications and the burden of monitoring. The aim of this paper is to review determinants of adherence and persistence on long-term anticoagulant therapy for atrial fibrillation and venous thromboembolism. We evaluate what the current literature reveals about the impact of warfarin on quality of life, examine warfarin trial data for patterns of adherence, and summarize known risk factors for warfarin discontinuation. Studies suggest only modest adverse effects of warfarin on quality of life, but highlight the variability of individual lifestyle experiences of patients on warfarin. Interestingly, clinical trials comparing anticoagulant adherence to alternatives (such as aspirin) show that discontinuation rates on warfarin are not consistently higher than in control arms. Observational studies link a number of risk factors to warfarin non-adherence including younger age, male sex, lower stroke risk, poor cognitive function, poverty, and higher educational attainment. In addition to differentiating the relative impact of warfarin-associated complications (such as bleeding) versus the lifestyle burdens of warfarin monitoring on adherence, future investigation should focus on optimizing patient education and enhancing models of physician–patient shared-decision making around anticoagulation.Keywords: anticoagulation, warfarin, adherence, persistence, thromboembolism

The sagebrush grasshopper, Melanoplus bowditchi Scudder (Orthoptera: Acrididae), is a phytophilous species that is widely distributed in the western United States on sagebrush species. The geographical distribution of M. bowditchi is very similar to the range of its host plants and its feeding association varies in relation to sagebrush distribution. Melanoplus bowditchi bowditchi Scudder and M. bowditchi canus Hebard were described based on their feeding association with different sagebrush species, sand sagebrush and silver sagebrush, respectively. Recently, M. bowditchi have been observed feeding on other plant species in western Nebraska. We collected adult M. bowditchi feeding on four plant species, sand sagebrush, Artemisia filifolia, big sagebrush, A. tridentata, fringed sagebrush, A. frigidus, and winterfat, Krascheninnikovia lanata. We compared the specimens collected from the four plant species for their morphological and genetic differences. We observed no consistent differences among the aedeagal parameres or basal rings among the grasshoppers collected from different host plants. Amplified Fragment Length Polymorphism markers were used to test the genetic relationships among the grasshoppers. Analysis of Molecular Variance and distance-based Unweighted Pair Group Method with Arithmetic mean dendrogram failed to reveal significant differences. Although the forms showed behavioral and minor color and size differences, the genetic data suggest all forms under study likely interbreed, which indicates they are a single species instead of four species or subspecies. These results indicate that host plant use may influence melanopline phenotype and suggest the need of further genetic analysis of subspecies recognized based on morphology, distribution, and ecology.

Mutations in the LIM-homeodomain transcription factor LMX1B cause nail-patella syndrome, an autosomal dominant pleiotrophic human disorder in which nail, patella and elbow dysplasia is associated with other skeletal abnormalities and variably nephropathy and glaucoma. It is thought to be a haploinsufficient disorder. Studies in the mouse have shown that during development Lmx1b controls limb dorsal-ventral patterning and is also required for kidney and eye development, midbrain-hindbrain boundary establishment and the specification of specific neuronal subtypes. Mice completely deficient for Lmx1b die at birth. In contrast to the situation in humans, heterozygous null mice do not have a mutant phenotype. Here we report a novel mouse mutant Icst, an N-ethyl-N-nitrosourea-induced missense substitution, V265D, in the homeodomain of LMX1B that abolishes DNA binding and thereby the ability to transactivate other genes. Although the homozygous phenotypic consequences of Icst and the null allele of Lmx1b are the same, heterozygous Icst elicits a phenotype whilst the null allele does not. Heterozygous Icst causes glaucomatous eye defects and is semi-lethal, probably due to kidney failure. We show that the null phenotype is rescued more effectively by an Lmx1b transgene than is Icst. Co-immunoprecipitation experiments show that both wild-type and Icst LMX1B are found in complexes with LIM domain binding protein 1 (LDB1), resulting in lower levels of functional LMX1B in Icst heterozygotes than null heterozygotes. We conclude that Icst is a dominant-negative allele of Lmx1b. These findings indicate a reassessment of whether nail-patella syndrome is always haploinsufficient. Furthermore, Icst is a rare example of a model of human glaucoma caused by mutation of the same gene in humans and mice.

The Bicoid morphogen gradient directs the patterning of cell fates along the anterior-posterior axis of the syncytial Drosophila embryo and serves as a paradigm of morphogen-mediated patterning. The simplest models of gradient formation rely on constant protein synthesis and diffusion from anteriorly localized source mRNA, coupled with uniform protein degradation. However, currently such models cannot account for all known gradient characteristics. Recent work has proposed that bicoid mRNA spatial distribution is sufficient to produce the observed protein gradient, minimizing the role of protein transport. Here, we adapt a novel method of fluorescent in situ hybridization to quantify the global spatio-temporal dynamics of bicoid mRNA particles. We determine that >90% of all bicoid mRNA is continuously present within the anterior 20% of the embryo. bicoid mRNA distribution along the body axis remains nearly unchanged despite dynamic mRNA translocation from the embryo core to the cortex. To evaluate the impact of mRNA distribution on protein gradient dynamics, we provide detailed quantitative measurements of nuclear Bicoid levels during the formation of the protein gradient. We find that gradient establishment begins 45 minutes after fertilization and that the gradient requires about 50 minutes to reach peak levels. In numerical simulations of gradient formation, we find that incorporating the actual bicoid mRNA distribution yields a closer prediction of the observed protein dynamics compared to modeling protein production from a point source at the anterior pole. We conclude that the spatial distribution of bicoid mRNA contributes to, but cannot account for, protein gradient formation, and therefore that protein movement, either active or passive, is required for gradient formation.