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The degree to which walleye pollock (Gadus chalcogrammus , hereafter pollock) move between the US and Russian zones of the Bering Sea is a key source of uncertainty for fisheries management. To study transboundary migrations across the US–Russia maritime boundary and explore how climate variability might influence these migrations, four seafloor-mounted echosounder moorings were deployed from July 2019 to August 2020 in the northwestern Bering Sea. The observations indicated that a substantial amount of pollock moves between the US and Russia seasonally, with a period of southeast movement into the US as winter as sea ice forms and northwest movement into Russia in early summer as waters warm. Over the deployment period, 2.3-times more pollock backscatter moved into the US zone in fall and winter than exited the subsequent spring and summer. We hypothesize that the difference in the net movement between regions was driven by pollock moving farther into Russia during the historically warm conditions at the start of deployment period and reduced northwest return migration the following summer when temperatures were relatively cooler. This supports the hypothesis that temperature affects pollock distribution, and that continued warming will lead to a larger proportion of the stock in Russian waters. [ABSTRACT FROM AUTHOR]

Background: Caustic ingestions are relatively uncommon, but remain a significant source of morbidity. Patients with caustic injury often undergo an urgent EGD, although it is not clear if an EGD is routinely needed in an asymptomatic patient. The study has two primary objectives; 1) to determine the utility of routine EGD in asymptomatic suicidal caustic ingestions; 2) to determine if asymptomatic unintentional acidic ingestions can be managed with observation alone, similar to basic ingestions. Methods: This retrospective study, which took place at 14 hospitals in three countries evaluated all patients who presented with a caustic ingestion between 2014–2020. The presence of symptoms and esophageal injury, demographic information, pH of ingested substance, reason for the ingestion, and outcome were recorded. Results: 409 patients were identified; 203 (46.9%) were male. The median (IQR) age was 18 (4–31) years; overall range 10 months to 78 years. Suicidal ingestions accounted for 155 (37.9%) of cases. Dysphagia or dysphonia were more likely in those with significant esophageal injury compared to those without (59.3% vs. 12.6% respectively; OR 10.1; 95% CI 4.43–23.1). Among 27 patients with significant esophageal injury, 48% were found in suicidal patients, compared with 51.9% in non-suicidal patients (p = NS). On multivariate regression, there was no difference in the rate of significant esophageal injury among suicidal vs. non suicidal patients (aOR 1.55; p = 0.45, 95% CI 0.45–5.33). Most ingestions involved basic substances (332/409; 81.2%). Unknown or mixed ingestions accounted for 25 (6.11%) of the ingestions. Significant esophageal burns were found in 6/52 (11.5%) of acid ingestions, compared with 21/332 (6.3%) of basic ingestions. Of the 42 cases of acidic ingestions without dysphagia or odynophagia, 2 (4.8%; 0.58–16.1%) had significant esophageal burns, compared with 9 (3.2%; 95% CI 1.4–5.9%) of the 284 basic ingestions; p = 0.64). On multivariate logistic regression, patients with acidic ingestions were not more likely to experience a significant burn (aOR 1.7; p = 0.11, 95% CI 0.9–3.1) compared to those with basic ingestions. No patient with significant esophageal burns was asymptomatic. Conclusion: In this study, there was no statistical differences in the rates of significant burns between acidic and basic caustic ingestions. There were no significant esophageal injuries noted among asymptomatic patients. [ABSTRACT FROM AUTHOR]

Since the 1980's, the growing involvement of private consultancy firms in the public sector worldwide has instigated concerns about the outsourcing of public policy advising to market-driven actors. Although these firms participate in spreading policy ideas, their roles have not received sustained attention, despite being observed by a few scholars. Against this background, the aim of this paper is threefold. First, from established policy concepts relating to policy diffusion, we identify the potential roles that consultancy firms may take on in spreading policy ideas. Second, we use a systematic literature review to collect and distil what is currently known about what different roles consultancy firms fulfil, and what kinds of tensions arise in their interactions with both clients and other actors. Third, we draft an agenda for future research on consultancy firms' impact in governance processes. To focus our study, our review hones in on environmental governance, more specifically water governance, a significant area of activity for such firms where they play an important in-between role in providing policy ideas. We found indications that consultancy firms possess six types of capabilities (trusted facilitators, reactors to environmental policies, shapers of environmental policies, market drivers, interest navigators, and managers of public participation), and face various dilemmas around biases, decontextualized global practices, market interests, and manipulative practices. We conclude that more attention should be given to empirically refining capabilities involved in shaping policies and markets and to further highlighting how consultancy firms impact the diffusion of governance ideas in and beyond the water and environmental sectors. [ABSTRACT FROM AUTHOR]

For two centuries, academics and their universities have competed for prominence and vied to demonstrate that their institutions are at the center of the scholarly world. Scientific advances in particular fields, reciprocal academic visits and conferences, impressive physical architecture, and publishing in shared venues and a lingua franca are among the many dimensions in which universities seek prestige in a relational status system. We call this system competitive emulation and theorize it as a mode of rivalry neither fully captured by imaginaries of economic and political competition nor eclipsed by third-party ranking schemes. By nuancing university competition this way, we emphasize its fragility, dynamism, and relationality, and suggest how this special form of competition might be leveraged for strategic action in our current times. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Hospital at home (HaH) delivers hospital‐level care to acutely ill patients at home as a substitute for brick‐and‐mortar hospital care. The clinician and program characteristics of HaH programs worldwide are relatively unknown. We sought to describe the world's HaH clinicians and their programs' characteristics.We analyzed a survey administered to all attendees of the 2023 World Hospital at Home Congress. Clinician characteristics included age, years worked in HaH, profession, burnout, and experience. Program characteristics included location, daily census, types of care delivery, and clinical capabilities.Of 670 attendees, about 305 were clinicians and 129 responded (42% response rate for clinicians). The majority of clinicians were 30–49 years old (65.1%), new to the field (70.5% worked less than 10 years), and part‐time (18% dedicated >74% effort to HaH). Clinicians reported overall satisfaction with their job and low burnout. About half of programs were in Europe (52.1%), newly operational (44.7% less than 5 years), mostly operated in urban environments (87.2%), and mostly had a daily census of less than 25 patients (62.8%). Most programs operated 7‐days per week (88.3%), performed intermittent or continuous remote monitoring (81.4%), used video communication (63.8%), and had some advanced capabilities such as in‐home imaging (47.9%) and advanced procedures (23.4%). Visit frequencies to the patient's home were variable: most programs had physicians visit the home, nearly all had nurses visit the home, and fewer performed virtual visits.HaH clinicians and programs have significant similarities but also a fair number of divergent practices, much like brick‐and‐mortar hospital care. Further standardization of the care model will help to unify the field across the globe. [ABSTRACT FROM AUTHOR]

ABSTRACT In Parable of the Sower, Octavia Butler (1993) wrote: “Any Change may bear seeds of benefit. Seek them out. Any Change may bear seeds of harm. Beware” (p. 116). In this paper, we apply this command to a speculative examination of the consequences of text‐based generative AI (GAI) for adolescent writers, framing this examination within a socially situated “Writers‐in‐Community” model of writing (Graham, 2018), which considers writing as both an act of individual cognition and as situated within concentric circles representing nested social, material, and cultural contexts for writing. Through the lens of this model, we discuss representations of language‐related technologies in works by several well‐known authors of 20th‐century speculative fiction and contrast these speculative scenarios with examples from our recent research into student writers' use of ChatGPT and other GAI tools. Finally, we discuss (a) the limitations of these tools as lacking the ability to set goals and use these goals to compose a written work, which is a key component of an effective writing process and (b) what would be required to supporting students to write agentively in collaboration with these tools, despite these limitations. This discussion focuses on three principles: (1) centering human writers in collaborations with GAI; (2) setting writer goals to address historical, political, institutional, and social influences; and (3) critical agency in literacy with GAI. [ABSTRACT FROM AUTHOR]

Towards a better characterization of the increasing blast overpressure threat, person-borne sensors are being considered for large military population segments potentially subjected to explosive blast and firing of crew served weapons. Training and field data, tracked longitudinally across a soldier's entire career, can help with the diagnosis of blast injuries and the improvement of standard operating procedures for both explosive forced entry and large weapons firing. However, a current challenge with person-born blast dosimeters resides with the position of the overpressure sensors themselves. Often, the sensors are not fully exposed to the blast locally, resulting in pressure measurements not representative of the blast conditions surrounding an individual. While fielding multiple individual and uncoupled dosimeter units around the body increases the likeliness of catching the representative blast exposure, issues arise from differences in internal clock, potential partial triggering, and the complexity of merging data from different sources. Instead, integrating multiple overpressure sensors pointing in different directions, within a single device that captures and records all data simultaneously, proves highly beneficial for data analysis and interpretation. This paper presents algorithms that combine the overpressure data collected from such multiple coupled sensors for each blast event to minimize the effect of blast directionality. In particular, an algorithm estimating the equivalent side-on blast overpressure is presented, facilitating injury estimates from existing established blast injury models adapted for the outputs from the blast dosimeters. An algorithm is also presented that estimates the orientation or provenance of an explosive blast relative to the soldier. [ABSTRACT FROM AUTHOR]

Intoduction: Diffuse leptomeningeal glioneuronal tumors (DLGNTs) pose a rare and challenging entity within pediatric central nervous system neoplasms. Despite their rarity, DLGNTs exhibit complex clinical presentations and unique molecular characteristics, necessitating a deeper understanding of their diagnostic and therapeutic nuances. Methods: This review synthesizes contemporary literature on DLGNT, encompassing epidemiology, clinical manifestations, pathological features, treatment strategies, prognostic markers, and future research directions. To compile the existing body of knowledge on DLGNT, a comprehensive search of relevant databases was conducted. Results: DLGNT primarily affects pediatric populations but can manifest across all age groups. Its diagnosis is confounded by nonspecific clinical presentations and overlapping radiological features with other CNS neoplasms. Magnetic resonance imaging (MRI) serves as a cornerstone for DLGNT diagnosis, revealing characteristic leptomeningeal enhancement and intraparenchymal involvement. Histologically, DLGNT presents with low to moderate cellularity and exhibits molecular alterations in the MAPK/ERK signalling pathway. Optimal management of DLGNT necessitates a multidisciplinary approach encompassing surgical resection, chemotherapy, radiotherapy, and emerging targeted therapies directed against specific genetic alterations. Prognostication remains challenging, with factors such as age at diagnosis, histological subtypes, and genetic alterations influencing disease progression and treatment response. Long-term survival data are limited, underscoring the need for collaborative research efforts. Conclusion: Advancements in molecular profiling, targeted therapies, and international collaborations hold promise for improving DLGNT outcomes. Harnessing the collective expertise of clinicians, researchers, and patient advocates, can advance the field of DLGNT research and optimize patient care paradigms. [ABSTRACT FROM AUTHOR]

Purpose: To examine the differential effect of non- and anthracycline-based chemotherapy on fatigue over 12 months post-diagnosis among breast cancer survivors. Methods: This study is based on a prospective Wake Forest NCI Community Oncology Research Program (NCORP) multicenter cohort study (WF-97415) of women with stage I to III breast cancer and non-cancer controls. Analyses compared those: 1) receiving, or 2) not receiving anthracycline chemotherapy, 3) receiving aromatase inhibitors (AIs) without chemotherapy, with 4) a comparator group without a history of cancer. In-person clinic assessments were conducted at: baseline (prior to chemotherapy or start of AI therapy), and 3 and 12 months after baseline. The Functional Assessment of Chronic Illness Therapy-Fatigue scale was the primary outcome. Estimated least squares means by group using mixed models with a random subject effect, fixed effects of time and group, and the interaction between time and group was used to compare groups across time, controlling for age, comorbidities, and treatment variables. Results: Among 284 women (mean age = 53.4 years, sd 11.9 years), there was a significant (p < 0.0001) group by time interaction, with a sharp increase in fatigue at 3 months in the two chemotherapy groups in comparison to the non-chemotherapy and non-cancer controls. The two chemotherapy groups did not significantly differ in fatigue at any time point. Conclusion: Women with breast cancer who receive non- or anthracycline-based chemotherapy experience similar trends in and levels of fatigue within the first year of treatment and greater fatigue than women receiving AIs alone or women without breast cancer. [ABSTRACT FROM AUTHOR]

Bacteria possess diverse classes of signaling systems that they use to sense and respond to their environments and execute properly timed developmental transitions. One widespread and evolutionarily ancient class of signaling systems are the Hanks‐type Ser/Thr kinases, also sometimes termed "eukaryotic‐like" due to their homology with eukaryotic kinases. In diverse bacterial species, these signaling systems function as critical regulators of general cellular processes such as metabolism, growth and division, developmental transitions such as sporulation, biofilm formation, and virulence, as well as antibiotic tolerance. This multifaceted regulation is due to the ability of a single Hanks‐type Ser/Thr kinase to post‐translationally modify the activity of multiple proteins, resulting in the coordinated regulation of diverse cellular pathways. However, in part due to their deep integration with cellular physiology, to date, we have a relatively limited understanding of the timing, regulatory hierarchy, the complete list of targets of a given kinase, as well as the potential regulatory overlap between the often multiple kinases present in a single organism. In this review, we discuss experimental methods and curated datasets aimed at elucidating the targets of these signaling pathways and approaches for using these datasets to develop computational models for quantitative predictions of target motifs. We emphasize novel approaches and opportunities for collecting data suitable for the creation of new predictive computational models applicable to diverse species. [ABSTRACT FROM AUTHOR]

Key Clinical Message: While orbital encephaloceles secondary to orbital roof fractures, in the setting of gunshot wound injuries, are rare, it is important to discuss diagnosis, treatment, and outcomes. This comprehensive manuscript aims to accomplish these objectives. [ABSTRACT FROM AUTHOR]

The rising incidence of trans youth throughout the world and the new policy of many European countries and 25 US states that psychotherapy should be the first therapeutic response to Gender Dysphoria have made a reexamination of a comprehensive psychiatric evaluation (CPE) urgently relevant. Two conflicting views of the purpose of the CPE exist based on etiologic beliefs and convictions about the best therapeutic approach. This paper provides one clinician's synthesis of the elements, processes, goals, values, benchmarks of CPE and its usual recommendation for psychotherapy. The CPE recommended herein provides cogent hypotheses about the origins of the intrapsychic creation of a trans identity that are to be strengthened, weakened, or supplanted by explanations that emerge from psychotherapy. It also strengthens familial bonds and clarifies the intention to improve the mental health, social function, and autonomy of the minor. The inescapable ethical tensions that surround trans minor health care are discussed. The recommended CPE does not prevent subsequent medical interventions. [ABSTRACT FROM AUTHOR]

Individual characteristics of neighborhood context, like concentrated socioeconomic disadvantage, are associated with children's cognitive development, including their academic skill development and executive functions. However, questions remain regarding how neighborhood structural, process, and physical features uniquely predict children's cognitive skills when measuring neighborhoods more holistically. Exploiting within-child changes in neighborhood conditions over time in a nationally representative sample of children followed from kindergarten through fifth grade (N ≈ 13,550), this study examined unique associations between structural (i.e., concentrated disadvantage), process (i.e., violent crime, learning resources, and aspects of school quality), and physical (i.e., green space and pollution) characteristics of neighborhoods and children's achievement skills and executive functions. Fixed-effects models demonstrated that increases in neighborhood violent crime and pollution predicted decreases in children's reading and math skills, while increases in neighborhood school quality, learning resources, and green space predicted increases in reading and math. Children's executive functions were better when neighborhood pollution was lower and when school quality was better. Our results suggest that improving neighborhood structure, processes, and physical conditions may foster children's cognitive skill development, especially academic achievement. Educational Impact and Implications Statement: This study documented how neighborhood structural, process, and physical characteristics related to change in children's academic and executive function skills from kindergarten through fifth grade. Specifically, utilizing a representative sample of U.S. elementary school students and rigorous analytic methods that reduce selection bias, we found that increased pollution and violent crime related to declines in academic skills while more learning resources, green space, and higher school-level average achievement related to better academic skills. Executive functions were less mutable by neighborhood conditions; only pollution and school quality predicted children's executive functions (negatively and positively, respectively). [ABSTRACT FROM AUTHOR]

How terrestrial ecosystems will accumulate carbon as the climate continues to change is a major source of uncertainty in projections of future climate. Under growth‐stimulating environmental change, time lags inherent in population and community dynamic processes have been posed to dampen, or alternatively amplify, short‐term carbon gain in terrestrial vegetation, but these outcomes can be difficult to predict. To theoretically frame this problem, we developed a simple model of vegetation dynamics that identifies the stage‐structured demographic and competitive processes that could govern the timescales of carbon storage and loss. We show that demographic lags associated with growth‐stimulating environmental change can allow a rapid increase in population‐level carbon storage that is lost back to the atmosphere in later years. However, this transient carbon storage only emerges when environmental change increases the transition of adult individuals into a larger size class that suffers markedly higher mortality. Otherwise, demographic lags simply slow carbon accumulation. Counterintuitively, an analogous tradeoff between maximum adult size and survivorship in two‐species models, coupled with environmental change‐driven replacement, does not generate the transient carbon gain seen in the single‐species models. Instead lags in competitive replacement slow the approach to the eventual carbon trajectory. Together, our results suggest that time lags inherent in demographic and compositional turnover tend to slow carbon accumulation in systems responding to growth‐stimulating environmental change. Only under specific conditions will lagged demographic processes in such systems drive transient carbon accumulation, conditions that investigators can examine in nature to help project future carbon trajectories. [ABSTRACT FROM AUTHOR]

Background and Aim Methods Results Conclusions Colorectal cancer (CRC) is the fourth leading cause of cancer death globally. CRC surveillance is a common indication for colonoscopy, representing a considerable burden for endoscopy services. Accurate identification of high‐risk patients who would benefit from more intensive surveillance, as well as low‐risk patients suitable for less frequent follow‐up, could improve the effectiveness of surveillance protocols and resource use. Our aim was to identify and critically appraise published risk models for the occurrence of metachronous advanced colorectal neoplasia (ACN), defined here as CRC or advanced adenomas detected during surveillance colonoscopy.We searched PubMed and EMBASE for primary research studies reporting the development and/or validation of multivariable models that predict metachronous ACN risk. Screening of studies for inclusion, data extraction, and risk of bias assessment were conducted by two researchers independently.We identified nine studies describing nine risk models. Six models were internally validated and two were externally validated. No model underwent both internal and external validation. Good model discrimination (concordance index > 0.7) was reported for two models during internal validation and for one model during external validation. Calibration was acceptable when assessed (n = 4). Methodological limitations and a high risk of bias were observed for all studies.Several published models predicting metachronous ACN risk showed some promise. However, adherence to methodological standards was limited, and only two models were externally validated. Head‐to‐head comparisons of existing models using populations independent from model development cohorts should be prioritized to identify models suitable for use in clinical practice. [ABSTRACT FROM AUTHOR]

Educators and researchers are interested in ways that ChatGPT and other generative AI tools might move beyond the role of “cheatbot” and become part of the network of resources students use for writing. We studied how high school students used ChatGPT as a writing support while writing arguments about topics like school mascots. We asked: What did students prompt ChatGPT to do? And how did students take up ChatGPT's responses to those prompts? We used Flower and Hayes' writing model to analyze screencasts of students interacting with ChatGPT and one another as they planned, drafted, and reviewed their arguments. Our data show that while planning and drafting, students primarily asked ChatGPT for ideas and then built upon those ideas to develop their own arguments. While reviewing, they generally used ChatGPT as they might use Grammarly or other editing tools. Students also compared their writing with that of ChatGPT, which allowed them to identify their unique writing voices and build meta‐level understandings of rhetorical choices and effects. Our study indicates that ChatGPT can become a part of a social, distributed model of writing, and that students can use ChatGPT as a resource for writing without sidestepping the processes of planning, drafting, and reviewing. [ABSTRACT FROM AUTHOR]

While climate models broadly agree on the changes expected to occur over the Arctic with global warming on a pan-Arctic scale (i.e. polar amplification, sea ice loss, and increased precipitation), the magnitude and patterns of these changes at regional and local scales remain uncertain. This limits the usability of climate model projections for risk assessments and their impact on human activities or ecosystems (e.g. fires and permafrost thawing). Whereas any single or ensemble mean projection may be of limited use to stakeholders, recent studies have shown the value of the storyline approach in providing a comprehensive and tractable set of climate projections that can be used to evaluate changes in environmental or societal risks associated with global warming. Here, we apply the storyline approach to a large ensemble of the Coupled Model Intercomparison Project Phase 6 (CMIP6) models with the aim of distilling the wide spread in model predictions into four physically plausible outcomes of Arctic summertime climate change. This is made possible by leveraging strong covariability in the climate system associated with well-known but poorly constrained teleconnections and local processes; specifically, we find that differences in Barents–Kara sea warming and lower-tropospheric warming over polar regions among CMIP6 models explain most of the inter-model variability in pan-Arctic surface summer climate response to global warming. Based on this novel finding, we compare regional disparities in climate change across the four storylines. Our storyline analysis highlights the fact that for a given amount of global warming, certain climate risks can be intensified, while others may be lessened, relative to a "middle-of-the-road" ensemble mean projection. We find this to be particularly relevant when comparing climate change over terrestrial and marine areas of the Arctic which can show substantial differences in their sensitivity to global warming. We conclude by discussing the potential implications of our findings for modelling climate change impacts on ecosystems and human activities. [ABSTRACT FROM AUTHOR]

There is scant understanding of what supports African emerging adults who are not in employment, education or training (i.e., NEET) to show resilience to NEET‐related challenges. This article narrows that gap by reporting an iterative phenomenological study with nine African emerging adults (mean age: 23.44; 66% female) who were NEET for the 18‐month duration of the study and living in a resource‐constrained community in South Africa. We interviewed each young person three times (June 2021; December 2021; June 2022). A reflexive thematic analysis of these interview transcripts showed that being NEET is a multifaceted challenge. Supported by a mix of personal, relational and environmental resources, young people managed this challenge by resisting or recuperating from destructive coping mechanisms and believing in a successful future self. These findings point to the importance of young people and their social ecologies (families, peers, service providers and policymakers) recognising and enacting their co‐responsibility for resilience to the compound challenges of being NEET. [ABSTRACT FROM AUTHOR]

The Hospital at Home model, called Hospital-in-Home (HIH) in the Department of Veterans Affairs, delivers coordinated, high-value care aligned with older adult and caregiver preferences. Documenting implementation barriers and corresponding strategies to overcome them can address challenges to widespread adoption. To evaluate HIH implementation barriers and identify strategies to address them, we conducted interviews with 8 HIH staff at 4 hospitals between 2010 and 2013. We utilized qualitative directed content analysis guided by the Consolidated Framework for Implementation Research (CFIR) and mapped identified barriers to possible strategies using the CFIR-Expert Recommendations for Implementing Change (ERIC) Matching Tool. We identified 11 barriers spanning 5 CFIR domains. Three implementation strategies – identifying and preparing champions, conducting educational meetings, and capturing and sharing local knowledge – achieved high expert endorsement for each barrier. A mix of strategies targeting resources, organizational readiness and fit, and leadership engagement should be considered to support the sustainability and spread of HIH. [ABSTRACT FROM AUTHOR]

This document is a compilation of various scientific papers and preprints covering a wide range of topics, including protein folding, cell migration, machine learning, deep neural networks, neural scaling laws, representations and generalization in artificial and brain neural networks, and the neuron as a direct data-driven controller. The papers discuss different aspects of these subjects, providing a comprehensive overview of the current research in these fields. This document can be a valuable resource for library patrons conducting research on these topics, particularly in the fields of neuroscience and artificial intelligence. [Extracted from the article]

Management of immune thrombocytopenia (ITP) in dogs and cats is evolving, but there are no evidence‐based guidelines to assist clinicians with treatment decisions. Likewise, the overall goals for treatment of ITP have not been established. Immunosuppressive doses of glucocorticoids are the first line treatment, but optimal treatment regimens beyond glucocorticoids remain uncertain. Additional options include secondary immunosuppressive drugs such as azathioprine, modified cyclosporine, and mycophenolate mofetil, usually selected based on clinician preference. Vincristine, human IV immunoglobulin (hIVIg), and transfusion of platelet or red blood cell–containing products are often used in more severe cases. Splenectomy and thrombopoietin receptor agonists are usually reserved for refractory cases, but when and in which patient these modalities should be employed is under debate. To develop evidence‐based guidelines for individualized treatment of ITP patients, we asked 20 Population Intervention Comparison Outcome (PICO) format questions. These were addressed by 17 evidence evaluators using a literature pool of 288 articles identified by a structured search strategy. Evidence evaluators, using panel‐designed templates and data extraction tools, summarized evidence and created guideline recommendations. These were integrated by treatment domain chairs and then refined by iterative Delphi survey review to reach consensus on the final guidelines. In addition, 19 non‐PICO questions covering scenarios in which evidence was lacking or of low quality were answered by expert opinion using iterative Delphi surveys with panelist integration and refinement. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The rigorous consensus process identified few comparative treatment studies, highlighting many areas of ITP treatment requiring additional studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Diagnosis of Immune Thrombocytopenia in Dogs and Cats. [ABSTRACT FROM AUTHOR]

Immune thrombocytopenia (ITP) is the most common acquired primary hemostatic disorder in dogs. Immune thrombocytopenia less commonly affects cats but is an important cause of mortality and treatment‐associated morbidity in both species. Immune thrombocytopenia remains a diagnosis of exclusion for which diagnostic guidelines are lacking. Primary, or non‐associative, ITP refers to autoimmune platelet destruction. Secondary, or associative, ITP arises in response to an underlying disease trigger. However, evidence for which comorbidities serve as ITP triggers has not been systematically evaluated. To identify key diagnostic steps for ITP and important comorbidities associated with secondary ITP, we developed 12 Population Evaluation/Exposure Comparison Outcome (PECO) format questions. These questions were addressed by evidence evaluators utilizing a literature pool of 287 articles identified by the panelists using a structured search strategy. Evidence evaluators, using panel‐designed templates and data extraction tools, summarized evidence and created guideline recommendations that then were integrated by diagnosis and comorbidity domain chairs. The revised PECO responses underwent a Delphi survey process to reach consensus on final guidelines. A combination of panel expertise and PECO responses were employed to develop algorithms for diagnosis of ITP in dogs and cats, which also underwent 4 iterations of Delphi review. Comorbidity evidence evaluators employed an integrated measure of evidence (IME) tool to determine evidence quality for each comorbidity; IME values combined with evidence summaries for each comorbidity were integrated to develop ITP screening recommendations, which also were subjected to Delphi review. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The final consensus statement provides clinical guidelines for the diagnosis of, and underlying disease screening for, ITP in dogs and cats. The systematic consensus process identified numerous knowledge gaps that should guide future studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Treatment of Immune Thrombocytopenia. [ABSTRACT FROM AUTHOR]

Objective: To investigate the value of the sonographic identification of deep infiltrating endometriosis (DIE) in women presenting with complaints suggestive of DIE. Sonography findings were correlated with subsequent surgical exploration, and histologic verification. Methods: A retrospective observational case series was investigated to document the ability of the use of sonography to accurately detect the presence of deep infiltrating endometriosis. The clinical observations were performed consistent with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations for observational studies. Recognizing the real‐world office setting for this may introduce the importance of the practical clinical aspects of diagnostic procedures in general. Results: Three‐dimensional transvaginal sonography was able to accurately identify deep invasive endometriosis in 92% of the 100 women subjectively complaining of the associated symptoms of endometriosis, who underwent sonography, surgical exploration, and pathologic analysis. Additional sonographic evidence of pelvic pathology was found during the course of this investigation, perhaps complementing other means for diagnosing endometriosis. Conclusion: Three‐dimensional transvaginal sonography is a diagnostic tool that can effectively identify deep infiltrating endometriosis, which may otherwise go undetected and untreated. These findings should encourage the use of sonography for the detection of this subtype of endometriosis. Synopsis: A series of cases is described of sonographically detected deep infiltrating endometriosis with three‐dimensional transvaginal sonography, which were all surgically explored and histologically examined. [ABSTRACT FROM AUTHOR]

Purpose: In a learning health system (LHS), data gathered from clinical practice informs care and scientific investigation. To demonstrate how a novel data and analytics platform can enable an LHS at a regional cancer center by characterizing the care provided to breast cancer patients. Methods: Socioeconomic information, tumor characteristics, treatments and outcomes were extracted from the platform and combined to characterize the patient population and their clinical course. Oncologists were asked to identify examples where clinical practice guidelines (CPGs) or policy changes had varying impacts on practice. These constructs were evaluated by extracting the corresponding data. Results: Breast cancer patients (5768) seen at the Juravinski Cancer Centre between January 2014 and June 2022 were included. The average age was 62.5 years. The commonest histology was invasive ductal carcinoma (74.6%); 77% were estrogen receptor‐positive and 15.5% were HER2 Neu positive. Breast‐conserving surgery (BCS) occurred in 56%. For the 4294 patients who received systemic therapy, the initial indications were adjuvant (3096), neoadjuvant (828) and palliative (370). Metastases occurred in 531 patients and 495 patients died. Lowest‐income patients had a higher mortality rate. For the adoption of CPGs, the uptake for adjuvant bisphosphonate was very low, 8% as predicted, compared to 64% for pertuzumab, a HER2 targeted agent and 40.2% for CD4/6 inhibitors in metastases. During COVID‐19, the provincial cancer agency issued a policy to shorten the duration of radiation after BCS. There was a significant reduction in the average number of fractions to the breast by five fractions. Conclusion: Our platform characterized care and the clinical course of breast cancer patients. Practice changes in response to regulatory developments and policy changes were measured. Establishing a data platform is important for an LHS. The next step is for the data to feedback and change practice, that is, close the loop. [ABSTRACT FROM AUTHOR]

Understanding how diversity is maintained in plant communities requires that we first understand the mechanisms of competition for limiting resources. In ecology, there is an underappreciated but fundamental distinction between systems in which the depletion of limiting resources reduces the growth rates of competitors and systems in which resource depletion reduces the time available for competitors to grow, a mechanism we call 'competition for time'. Importantly, modern community ecology and our framing of the coexistence problem are built on the implicit assumption that competition reduces the growth rate. However, recent theoretical work suggests competition for time may be the predominant competitive mechanism in a broad array of natural communities, a significant advance given that when species compete for time, diversity‐maintaining trade‐offs emerge organically. In this study, we first introduce competition for time conceptually using a simple model of interacting species. Then, we perform an experiment in a Mediterranean annual grassland to determine whether competition for time is an important competitive mechanism in a field system. Indeed, we find that species respond to increased competition through reductions in their lifespan rather than their rate of growth. In total, our study suggests competition for time may be overlooked as a mechanism of biodiversity maintenance. [ABSTRACT FROM AUTHOR]

AbstractThis article invites middle and high school social studies teachers and students to address the question, “Is the United States Exceptional?” We define American exceptionalism as the belief that the United States is qualitatively different from other nations based upon having some special virtue, ideology, or mission that makes it an outlier. We identify four themes or components of American exceptionalism: democracy, individual liberty, opportunity, optimism. We then call for letting students decide for themselves whether, when, and how the United States has been an exceptional nation while studying U.S. and world history. We close considering the advantages of allowing students to explore America as an exceptional nation in the current moment. Inquiring into American exceptionalism positions students studying U.S. and world history to construct their own nuanced understandings, to see from multiple perspectives, and to consider the United States in a global context. [ABSTRACT FROM AUTHOR]

Hyperalgesic priming is a preclinical model of the transition from acute to chronic pain characterized by a leftward shift in the dose-response curve for and marked prolongation of prostaglandin E2 (PGE2)-induced mechanical hyperalgesia, in vivo. In vitro, priming in nociceptors is characterized by a leftward shift in the concentration dependence for PGE2-induced nociceptor sensitization. In the present in vitro study we tested the hypothesis that a mu-opioid receptor (MOR) agonist opioid analgesic, morphine, can produce priming by its direct action on nociceptors. We report that treatment of nociceptors with morphine, in vitro, produces a leftward shift in the concentration dependence for PGE2-induced nociceptor sensitization. Our findings support the suggestion that opioids act directly on nociceptors to induce priming. [ABSTRACT FROM AUTHOR]

This Essay surfaces an obstacle to decarceration hiding in plain sight: progressives' continued support for the carceral system. Despite progressives' increasingly prevalent critiques of criminal law, there is hardly a consensus on the left in opposition to the carceral state. Many left-leaning academics and activists who may critique the criminal system writ large remain enthusiastic about criminal law in certain areas-- often areas in which defendants are imagined as powerful and victims as particularly vulnerable. In this Essay, we offer a novel theory for what animates the seemingly conflicted attitude among progressives toward criminal punishment--the hope that the criminal system can be used to redistribute power and privilege. We examine this redistributive theory of punishment via a series of case studies: police violence, economic crimes, hate crimes, and crimes of gender subordination. It is tempting to view these cases as one-off exceptions to a general opposition to criminal punishment. Instead, we argue that they reflect a vision of criminal law as a tool of redistribution--a vehicle for redistributing power from privileged defendants to marginalized victims. Ultimately, we critique this redistributive model of criminal law. We argue that the criminal system can't redistribute in the egalitarian ways that some commentators imagine. Even if criminal law somehow could advance some of the redistributive ends that proponents suggest, our criminal system would remain objectionable. The oppressive and inhumane aspects of the carceral state still would be oppressive and inhumane, even if the identity of the defendants or the politics associated with the institutions shifted. [ABSTRACT FROM AUTHOR]

Personal secrets are a ubiquitous fact of group life, but the conditions under which they are revealed have not been explored. In five studies, we assessed secret disclosure in groups governed by four models of human sociality (Communal Sharing, Equality Matching, Authority Ranking, Market Pricing; Fiske). In Studies 1a and 1b, participants indicated their willingness to disclose secrets in hypothetical groups governed by the models. In Studies 2a and 2b, participants rated how much a group in which they disclosed secrets or nonsecrets is governed by the models. In Study 3, participants indicated their disclosure of various types of secrets in Communal Sharing and Equality Matching groups to which they belonged. Across studies, disclosure was most strongly associated with Communal Sharing, followed by Equality Matching. Study 3 further showed that identity fusion predicted disclosure in these two kinds of groups. Implications for understanding disclosure of personal secrets in group contexts were discussed. [ABSTRACT FROM AUTHOR]

Anecdotal evidence has suggested that rater-based measures (e.g., parent report) may have strong across-trait/within-individual covariance that detracts from trait-specific measurement precision; rater measurement-related bias may help explain poor correlation within Autism Spectrum Disorder (ASD) samples between rater-based and performance-based measures of the same trait. We used a multi-trait, multi-method approach to examine method-associated bias within an ASD sample (n = 83). We examined performance/rater-instrument pairs for attention, inhibition, working memory, motor coordination, and core ASD features. Rater-based scores showed an overall greater methodology bias (57% of variance in score explained by method), while performance-based scores showed a weaker methodology bias (22%). The degree of inter-individual variance explained by method alone substantiates an anecdotal concern associated with the use of rater measures in ASD. [ABSTRACT FROM AUTHOR]

The article discusses the varying responses of Latin American leaders to the war in Gaza and calls for cutting military and commercial ties with Israel. While some leaders have taken actions such as cutting diplomatic ties or recalling ambassadors, others have strengthened their ties to Israel. Public opinion in countries like Brazil and Chile has shown support for Israel, despite large Arab and Arab-descendant populations. The article also highlights the historical ties between Israel and Latin America, including military support during Cold War conflicts and recent controversies involving Israeli-made surveillance software. Activists are pushing for progressive leaders to take stronger actions, but concrete steps to divest from Israel have been limited. [Extracted from the article]

Early integrated palliative care (EIPC) for patients with advanced cancers requires the involvement of family doctors (FDs) and oncologists. We compared attitudes between patients and their providers regarding the delivery of EIPC. Patients with newly diagnosed incurable gastrointestinal (GI) cancer at a tertiary cancer centre in Ontario, Canada, were surveyed using a study-specific instrument regarding the importance of and preferences for accessing support across eight domains of palliative care. Physicians within the circle of care completed a parallel survey for each patient. The concordance between patient and physician responses was analyzed. A total of 66 patients were surveyed (median age 69, 35% female). All had an oncologist, 12% had a specialist palliative care provider (SPC), and 97% had an FD, but only 41% listed the FD as part of the care team. In total, 95 providers responded (oncologist = 68, FD = 21, SPC = 6; response rate 92%; 1–3 physician responses per patient). Disease management and physical concerns were most important to patients. Patients preferred to access care in these domains from oncologists or SPCs. For all other domains, most patients attributed primary responsibility to self or family rather than any healthcare provider. Thus, concordance was poor between patient and physician responses. Across most domains of palliative care, we found low agreement between cancer patients and their physicians regarding responsibilities for care, with FDs appearing to have limited involvement at this stage. [ABSTRACT FROM AUTHOR]

The harms that occur to patients in the hospital are relatively well documented. In contrast, less information is available about the harms that occur to outpatients, even though the amount of health care being delivered in outpatient settings and the complexity of that care are increasing. This article describes the frequency and types of harm that occurred at 11 outpatient sites in Massachusetts during 1 year. Visual Abstract. The Safety of Outpatient Health Care: The harms that occur to patients in the hospital are relatively well documented. In contrast, less information is available about the harms that occur to outpatients, even though the amount of health care being delivered in outpatient settings and the complexity of that care are increasing. This article describes the frequency and types of harm that occurred at 11 outpatient sites in Massachusetts during 1 year. Background: Despite considerable emphasis on delivering safe care, substantial patient harm occurs. Although most care occurs in the outpatient setting, knowledge of outpatient adverse events (AEs) remains limited. Objective: To measure AEs in the outpatient setting. Design: Retrospective review of the electronic health record (EHR). Setting: 11 outpatient sites in Massachusetts in 2018. Patients: 3103 patients who received outpatient care. Measurements: Using a trigger method, nurse reviewers identified possible AEs and physicians adjudicated them, ranked severity, and assessed preventability. Generalized estimating equations were used to assess the association of having at least 1 AE with age, sex, race, and primary insurance. Variation in AE rates was analyzed across sites. Results: The 3103 patients (mean age, 52 years) were more often female (59.8%), White (75.1%), English speakers (90.8%), and privately insured (70.4%) and had a mean of 4 outpatient encounters in 2018. Overall, 7.0% (95% CI, 4.6% to 9.3%) of patients had at least 1 AE (8.6 events per 100 patients annually). Adverse drug events were the most common AE (63.8%), followed by health care–associated infections (14.8%) and surgical or procedural events (14.2%). Severity was serious in 17.4% of AEs, life-threatening in 2.1%, and never fatal. Overall, 23.2% of AEs were preventable. Having at least 1 AE was less often associated with ages 18 to 44 years than with ages 65 to 84 years (standardized risk difference, −0.05 [CI, −0.09 to −0.02]) and more often associated with Black race than with Asian race (standardized risk difference, 0.09 [CI, 0.01 to 0.17]). Across study sites, 1.8% to 23.6% of patients had at least 1 AE and clinical category of AEs varied substantially. Limitation: Retrospective EHR review may miss AEs. Conclusion: Outpatient harm was relatively common and often serious. Adverse drug events were most frequent. Rates were higher among older adults. Interventions to curtail outpatient harm are urgently needed. Primary Funding Source: Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions. [ABSTRACT FROM AUTHOR]

In this manuscript, we consider a finite multivariate nonparametric mixture model where the dependence between the marginal densities is modeled using the copula device. Pseudo expectation–maximization (EM) stochastic algorithms were recently proposed to estimate all of the components of this model under a location-scale constraint on the marginals. Here, we introduce a deterministic algorithm that seeks to maximize a smoothed semiparametric likelihood. No location-scale assumption is made about the marginals. The algorithm is monotonic in one special case, and, in another, leads to "approximate monotonicity"—whereby the difference between successive values of the objective function becomes non-negative up to an additive term that becomes negligible after a sufficiently large number of iterations. The behavior of this algorithm is illustrated on several simulated and real datasets. The results suggest that, under suitable conditions, the proposed algorithm may indeed be monotonic in general. A discussion of the results and some possible future research directions round out our presentation. [ABSTRACT FROM AUTHOR]

How analytic uncertainty is presented can affect critical policymaker decisions. Analysts are told to offer separate: (1) assessments of the likelihood an analytic statement is true and (2) confidence statements that express how strongly analysts believe their assessments. The distinction between likelihood and confidence sounds clear but is not. The IC defines confidence poorly. Most intelligence products fail to distinguish likelihood from confidence and use the terms interchangeably to mean probability. The IC should abandon its confusing shorthand confidence descriptions. Instead, analysts should provide explanations of the nature and strength of evidence, and the reasoning behind analytic judgments. [ABSTRACT FROM AUTHOR]

Background Management of hypertension, dyslipidemia, diabetes and other modifiable factors may mitigate the cardiovascular disease (CVD) risk in people with human immunodeficiency virus (HIV, PWH) compared with people without HIV (PWoH). Methods This was a retrospective cohort study of 8285 PWH and 170 517 PWoH from an integrated health system. Risk factor control was measured using a novel disease management index (DMI) accounting for amount/duration above treatment goals (0% to 100% [perfect control]), including 2 DMIs for hypertension (diastolic and systolic blood pressure), 3 for dyslipidemia (low-density lipoprotein, total cholesterol, triglycerides), and 1 for diabetes (HbA1c). CVD risk by HIV status was evaluated overall and in subgroups defined by DMIs, smoking, alcohol use, and overweight/obesity in adjusted Cox proportional hazards models. Results PWH and PWoH had similar DMIs (80%–100%) except for triglycerides (worse for PWH) and HbA1c (better for PWH). In adjusted models, PWH had an elevated risk of CVD compared with PWoH (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.07–1.31). This association was attenuated in subgroups with controlled dyslipidemia and diabetes but remained elevated for PWH with controlled hypertension or higher total cholesterol. The strongest HIV status association with CVD was seen in the subgroup with frequent unhealthy alcohol use (HR, 2.13; 95% CI, 1.04–4.34). Conclusions Control of dyslipidemia and diabetes, but not hypertension, attenuated the HIV status association with CVD. The strong association of HIV and CVD with frequent unhealthy alcohol use suggests enhanced screening and treatment of alcohol problems in PWH is warranted. [ABSTRACT FROM AUTHOR]

Pruritis, the sensation of itch, is produced by multiple substances, exogenous and endogenous, that sensitizes specialized sensory neurons (pruriceptors and pruri-nociceptors). Unfortunately, many patients with acute and chronic pruritis obtain only partial relief when treated with currently available treatment modalities. We recently demonstrated that the topical application of high molecular weight hyaluronan (HMWH), when combined with vehicles containing transdermal transport enhancers, produce potent long-lasting reversal of nociceptor sensitization associated with inflammatory and neuropathic pain. In the present experiments we tested the hypothesis that the topical formulation of HMWH with protamine, a transdermal transport enhancer, can also attenuate pruritis. We report that this topical formulation of HMWH markedly attenuates scratching behavior at the nape of the neck induced by serotonin (5-hydroxytryptamine, 5-HT), in male and female rats. Our results support the hypothesis that topical HMWH in a transdermal transport enhancer vehicle is a strong anti-pruritic. [ABSTRACT FROM AUTHOR]

Objective: Subtle changes in memory, attention, and spatial navigation abilities have been associated with preclinical Alzheimer disease (AD). The current study examined whether baseline AD biomarkers are associated with self- and informant-reported decline in memory, attention, and spatial navigation. Method: Clinically normal (Clinical Dementia Rating Scale (CDR®) = 0) adults aged 56–93 (N = 320) and their informants completed the memory, divided attention, and visuospatial abilities (which assesses spatial navigation) subsections of the Everyday Cognition Scale (ECog) annually for an average of 4 years. Biomarker data was collected within (±) 2 years of baseline (i.e., cerebrospinal fluid (CSF) p-tau181/Aβ42 ratio and hippocampal volume). Clinical progression was defined as CDR > 0 at time of final available ECog. Results: Self- and informant-reported memory, attention, and spatial navigation significantly declined over time (p s <.001). Baseline AD biomarkers were significantly associated with self- and informant-reported decline in cognitive ability (p s <.030), with the exception of p-tau181/Aβ42 ratio and self-reported attention (p =.364). Clinical progression did not significantly moderate the relationship between AD biomarkers and decline in self- or informant-reported cognitive ability (p s >.062). Post-hoc analyses indicated that biomarker burden was also associated with self- and informant-reported decline in total ECog (p s <.002), and again clinical progression did not significantly moderate these relationships (p s >.299). Conclusions: AD biomarkers at baseline may indicate risk of decline in self- and informant-reported change in memory, attention, and spatial navigation ability. As such, subjectively reported decline in these domains may have clinical utility in tracking the subtle cognitive changes associated with the earliest stages of AD. [ABSTRACT FROM AUTHOR]

Truth-default theory (TDT) proposes that deception is infrequent relative to honesty and that deception requires a motive. TDT further lists confessed deception as a viable method of improving deception detection accuracy. Findings from the experimental literature on false confessions conflict with TDT predictions suggesting that confessions might be an important boundary condition for the theory. Data from various versions of a cheating experiment (N = 485) were reexamined for the rates of true and false confessions and denials under different types of interrogation strategies including accusatory questioning and false evidence ploys. Frequent honest but not false confessions were observed. Demand effects, communication goals, and deception motives are proposed as potential explanations for the conflicting findings. The results are interpreted and framed within TDT. Suggestions are provided for practitioners and for future research. [ABSTRACT FROM AUTHOR]

With the republication of Adrienne Harris' classic essay, "You must remember this" (Harris, 2009), Psychoanalytic Dialogues continues our new feature, Après Coup. By putting a paper from the early years of the journal in conversation with contemporary readers and writers, we hope to dive into the ways in which psychoanalysts forge relationality in spaces of complexity and contradiction over time, as our experiences- collective, dyadic, or solitary – are always nonlinear and multiply configured. This Apres Coup includes commentaries by Cleonie White, Ph.D. Ken Corbett, Ph.D. Shubha Herlekar, Psy.D. MFT, Victor Donas, M.D. Donnel Stern, Ph.D. and Giuseppe Civitarese, M.D. Ph.D. [ABSTRACT FROM AUTHOR]

To quantify the burden of ocular injuries on deployed US service members by calculating disability-adjusted life years (DALYs). Retrospective, observational cohort study. US service members with ocular injuries sustained in combat zones from January 1, 2001 to May 19, 2020. Health states and duration of injuries were identified using data from the Defense and Veterans Eye Injury and Vision Registry. These health states were mapped to disability weights from the Global Burden of Disease (GBD) study. Average duration of injury or illness was calculated until remission or death. For the latter, life expectancy at age of sustaining injury, as identified from US Life Tables from the National Vital Statistics Reports 2020, was used. Using Defense Manpower Data Center reports capturing number of service members deployed per year, incidence rates were calculated for ocular injury and DALYs. Disability-adjusted life years of ocular injury. Seventeen thousand five hundred fifty-five patients sustained ocular injury that incurred DALYs. In total, these injuries resulted in 11 214 DALYs (average, 0.64 DALYs per included patient and 20.6 DALYs per 10 000 US service members per year). Severe impairment of distance vision (77.9%) and blindness (10.6%) were the primary contributors of DALYs. Although only 9.3% of patients sustained a permanent ocular injury, permanent disability accounted for 99.5% of total DALYs. The average yearly incidence rate of ocular injury was 32.0 cases per 10 000 US service members. Foreign body was the most frequent injury type (2754 occurrences), followed by abrasion (2419 occurrences) and multiple injury types (1429 occurrences). The most DALYs occurred in patients with multiple injury types (2485 DALYs), followed by abrasion (accounting for 725 DALYs) and foreign body (accounting for 461 DALYs). We report higher average DALYs per case ratio among US service members compared with the general population studied by the GBD study, highlighting the differences in probabilities of permanent injury between the two studies. Our study provides understanding of the impact of ocular injuries on active-duty service members and lays the groundwork for further research and interventions to mitigate their burden. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

Purpose: To identify distinct trajectories of physical health-related quality of life (HRQoL) in older women over the first two years following breast cancer diagnosis, and to examine characteristics associated with trajectory group membership. Methods: A secondary analysis of a longitudinal study of women diagnosed with stage I-III breast cancer who completed surveys within eight months of diagnosis and six, twelve, and eighteen months later that focuses on a subset of women aged ≥ 65 years (N = 145).Physical HRQoL was assessed using the Physical Component Score (PCS) of the SF-36 Health Survey. Finite mixture modeling identified distinct PCS trajectories. Multivariable logistic regression identified variables predictive of low PCS group membership. Results: Two distinct patterns of PCS trajectories were identified. The majority (58%) of women had PCS above the age-based SF-36 population norms and improved slightly over time. However, 42% of women had low PCS that remained low over time. In multivariable analyses, older age, difficulty paying for basics, greater number of medical comorbidities, and higher body mass index were associated with low PCS group membership. Cancer treatment and psychosocial variables were not significantly associated. Conclusion: A large subgroup of older women reported very low PCS that did not improve over time. Older age, obesity, multiple comorbidities, and lower socioeconomic status may be risk factors for poorer PCS in women with breast cancer. Incorporating routine comprehensive geriatric assessments that screen for these factors may help providers identify older women at risk for poorer physical HRQoL post breast cancer treatment. [ABSTRACT FROM AUTHOR]

This article explores the use of metaphorical cards in psychotherapy with anorexic patients. The cards contain symbolic images that allow patients to communicate their emotions and connect with their true selves in a nonverbal way. The article emphasizes the importance of integrating nonverbal treatments like these cards alongside other therapeutic techniques for patients with eating disorders. The use of these cards can help patients establish emotional distance from painful memories and feelings, reduce resistance, and address conflicts within therapy. Overall, these cards can be a highly effective tool in the therapeutic process for anorexic patients. [Extracted from the article]

This review of 16 prevention-related publications in Eating Disorders during 2022 is framed by three models: (1) Mental Health Intervention Spectrum: health promotion → types of prevention → case identification/referral → treatment; (2) the prevention cycle: rationale and theory, shaped by critical reviews → clarifying risk and protective factors → program innovation and feasibility studies → efficacy and effectiveness research → program dissemination; and (3) definitions of and links between disordered eating (DE) and eating disorders (EDs). Seven articles fell into the category of prevention rationale (including screening studies) and relevant reviews, while nine articles addressed correlates of/risk factors (RFs) for various aspects of DE and EDs. One implication of the 16 articles reviewed is that RF research toward construction of selective and indicated prevention programs for an expanding array of diverse at-risk groups needs to address, from a nuanced, intersectional framework, a broad range of factors beyond negative body image and internalization of beauty ideals. Another implication is that, to expand and improve current and forthcoming prevention programs, and to shape effective advocacy for prevention-oriented social policy, the field in general and Eating Disorders in particular need more scholarship in the form of critical reviews and meta-analyses; protective factor research; prevention program development and multi-stage evaluation; and case studies of multi-step activism at the local, state (province, region), and national levels. [ABSTRACT FROM AUTHOR]