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Background: Patients with multiple sclerosis (MS) have to deal with a variable disease trajectory often associated with disability and productivity loss., Objective: This study aimed to assess illness-related uncertainty and associated correlates in patients with relapsing-remitting multiple sclerosis (RRMS) beyond the near diagnosis phase., Methods: We conducted a multicenter, non-interventional study including patients diagnosed with RRMS (2017 revised McDonald criteria) and a disease duration of 3 to 8 years. Perceived uncertainty was measured using the Mishel Uncertainty of Illness Scale (MUIS). Associations between the MUIS and different patient-based outcome measures were analyzed using Spearman's rank correlation., Results: A total of 201 patients were studied (mean age (standard deviation): 38.7 (8.4) years, 71.4 % female). The median disease duration (interquartile range) was 6.0 (4.0-7.0) years and the median EDSS score was 1.0 (0.0-2.0). The mean MUIS score was 38.2 (10.8). Perceived uncertainty was positively correlated with fatigue (p < 0.001), symptom severity (p < 0.001), anxiety (p < 0.001), depressive symptoms (p < 0.001), and a threatening illness perception (p < 0.001), and negatively correlated with self-management (p < 0.001), self-efficacy (p < 0.001), processing speed (p < 0.001), knowledge of MS (p = 0.006), and quality of life (p < 0.001)., Conclusion: Illness-related uncertainty was common in a population of mid-stage RRMS. Identifying uncertainty and its associated factors may be useful for implementing preventive strategies to help patients cope with the disease throughout life., Competing Interests: Declaration of competing interest J.S. received honoraria for lecturing, consulting or travel expenses from Biogen, Merck, Teva, Novartis, BMS, Janssen, Almirall, Roche and Sanofi. J.M-M. served on scientific advisory boards and/or received speaking honoraria, research funding and support to attend scientific meetings from Biogen, Merck, Novartis, Roche and Teva. F.B. received compensation for consulting services and speaking honoraria from Almirall, Biogen, Genzyme, Merck, Novartis, Roche, Sanofi and Teva. A.A. received compensation for consulting services from Biogen, BMS, Sanofi, Roche, Janssen and Novartis; and speaking honoraria from Biogen, BMS, Sanofi, Roche, Janssen, Merck, Almirall and Novartis. J.S-M. received support to attend scientific meetings from Novartis, Merck, and Biogen; speaking honoraria from Biogen, Novartis, Sanofi, Merck, Almirall, Bayer and Teva; and participated in clinical trials of Biogen, Merck and Roche. L.B. received compensation for consulting services, speaking honoraria and support to attend scientific meetings from Bayer, Celgene, Biogen, Sanofi, Merck, Novartis, Roche, Almirall and Teva. M. G-G. received honoraria as speaker from Biogen, BMS, Janssen, Merck, Mylan, Novartis, Roche, Sanofi and Bial. S.E. received consulting fees and lecture honoraria from Biogen, Novartis, Sanofi, Merck, Roche and Almirall. C.C. received compensation for consulting services, speaking honoraria and support to attend scientific meetings and courses from Merck, Teva, Sanofi, Novartis, Biogen, Roche, and BMS. E.F-D. received honoraria and travel expenses for participation in scientific meetings and advisory boards from Almirall, Biogen, Merck, Roche and Sanofi. O.C. received honoraria for speaker services and advisory boards from Sanofi, Roche, Janssen and Merck. A.O. received research grants, travel support, advisory activities or honoraria for speaking engagements from Almirall, Biogen, BMS, Merck, Mylan, Novartis, Roche, Sanofi, and Teva. A.L-R. received speaker and consultation fees, and congress travel support from Biogen, Janssen, Merck, Novartis, Roche and Sanofi. A. M. received research grants, travel support or honoraria for speaking engagements from Biogen, Merck, Novartis, Roche, Sanofi, and Teva. E.A. received speaking honoraria from Roche, Novartis, Merck, Sanofi and Biogen. E.S. and J.M. are employees of Roche Farma Spain. The rest of the authors declared no potential conflicts of interest., (Copyright © 2024. Published by Elsevier B.V.)

Climate warming poses major threats to temperate forests, but the response of tree root metabolism has largely remained unclear. We examined the impact of long-term soil warming (>14 years, +4°C) on the fine root metabolome across three seasons for 2 years in an old spruce forest, using a liquid chromatography-mass spectrometry platform for primary metabolite analysis. A total of 44 primary metabolites were identified in roots (19 amino acids, 12 organic acids and 13 sugars). Warming increased the concentration of total amino acids and of total sugars by 15% and 21%, respectively, but not organic acids. We found that soil warming and sampling date, along with their interaction, directly influenced the primary metabolite profiles. Specifically, in warming plots, concentrations of arginine, glycine, lysine, threonine, tryptophan, mannose, ribose, fructose, glucose and oxaloacetic acid increased by 51.4%, 19.9%, 21.5%, 19.3%, 22.1%, 23.0%, 38.0%, 40.7%, 19.8% and 16.7%, respectively. Rather than being driven by single compounds, changes in metabolite profiles reflected a general up- or downregulation of most metabolic pathway network. This emphasises the importance of metabolomics approaches in investigating root metabolic pathways and understanding the effects of climate change on tree root metabolism., (© 2024 John Wiley & Sons Ltd.)

Introduction: The meningeal lymphatic vessels have been described as a pathway that transports cerebrospinal fluid and interstitial fluid in a unidirectional manner towards the deep cervical lymph nodes. However, these vessels exhibit anatomical and molecular characteristics typical of initial lymphatic vessels, with the absence of surrounding smooth muscle and few or absent valves. Given its structure, this network could theoretically allow for bidirectional motion. Nevertheless, it has not been assessed as a potential route for nanoparticles to travel from peripheral tissues to the brain., Methods: We employed superparamagnetic iron oxide nanoparticles (SPIONs), exosomes loaded with SPIONs, gold nanorods, and Chinese ink nanoparticles. SPIONs were prepared via chemical coprecipitation, while exosomes were isolated from the B16F10 melanoma cell line through the Exo-Spin column protocol and loaded with SPIONs through electroporation. Gold nanorods were functionalized with polyethylene glycol. We utilized C57BL/6 mice for post-mortem and in vivo procedures. To evaluate the retrograde directional flow, we injected each nanoparticle solution in the deep cervical lymph node. The head and neck were fixed for magnetic resonance imaging and histological analysis., Results: Here we show that extracellular vesicles derived from the B16F10 melanoma cell line, along with superparamagnetic iron oxide nanoparticles, gold nanorods, and Chinese ink nanoparticles can reach the meningeal lymphatic vessels and the brain of C57BL/6 mice after administration within the deep cervical lymph nodes post-mortem and in vivo, exclusively through lymphatic structures., Discussion: The functional anatomy of dural lymphatics has been found to be conserved between mice and humans, suggesting that our findings may have significant implications for advancing targeted drug delivery systems using nanoparticles. Understanding the retrograde transport of nanoparticles through the meningeal lymphatic network could lead to novel therapeutic approaches in nanomedicine, offering new insights into fluid dynamics in both physiological and neuropathological contexts. Further research into this pathway may unlock new strategies for treating neurological diseases or enhancing drug delivery to the brain., Competing Interests: The authors declare no competing interests in this work., (© 2024 Ramos-Zaldívar et al.)

The ambulatory diagnostic process is potentially complex, resulting in faulty communication, lost information, and a lack of team coordination. Patients and families have a unique position in the ambulatory diagnostic team, holding privileged information about their clinical conditions and serving as the connecting thread across multiple healthcare encounters. While experts advocate for engaging patients as diagnostic team members, operationalizing patient engagement has been challenging. The team science literature links improved team performance with shared mental models, a concept reflecting the team's commonly held knowledge about the tasks to be done and the expertise of each team member. Despite their proven potential to improve team performance and outcomes in other settings, shared mental models remain underexplored in healthcare. In this manuscript, we review the literature on shared mental models, applying that knowledge to the ambulatory diagnostic process. We consider the role of patients in the diagnostic team and adapt the five-factor model of shared mental models to develop a framework for patient-clinician diagnostic shared mental models. We conclude with research priorities. Development, maintenance, and use of shared mental models of the diagnostic process amongst patients, families, and clinicians may increase patient/family engagement, improve diagnostic team performance, and promote diagnostic safety., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

Dynamic teaming is required whenever people must coordinate with one another in a fluid context, particularly when the fundamental structures of a team, such as membership, priorities, tasks, modes of communication, and location are in near-constant flux. This is certainly the case in the contemporary ambulatory care diagnostic process, where circumstances and conditions require a shifting cast of individuals to coordinate dynamically to ensure patient safety. This article offers an updated perspective on dynamic teaming commonly required during the ambulatory diagnostic process. Drawing upon team science, it clarifies the characteristics of dynamic diagnostic teams, identifies common risk points in the teaming process and the practical implications of these risks, considers the role of providers and patients in averting adverse outcomes, and provides a case example of the challenges of dynamic teaming during the diagnostic process. Based on this, future research needs are offered as well as clinical practice recommendations related to team characteristics and breakdowns, team member knowledge/cognitions, teaming dynamics, and the patient as a team member., (© 2024 the author(s), published by De Gruyter, Berlin/Boston.)

Background: The assessment of serum neurofilament light chain (sNfL) concentration in multiple sclerosis (MS) is a useful tool for predicting clinical outcomes and assessing treatment response. However, its use in clinical practice is still limited. We aimed to assess how measurement of sNfL influences neurologists' treatment decisions in MS., Methods: We conducted a cross-sectional, web-based study in collaboration with the Spanish Society of Neurology. Neurologists involved in MS care were presented with different simulated case scenarios of patients experiencing either their first demyelinating MS event or a relapsing-remitting MS. The primary outcome was therapeutic inertia (TI), defined as the absence of treatment initiation or intensification despite elevated sNfL levels. Nine cases were included to estimate the TI score (range 0-9, where higher values represented a higher degree of TI)., Results: A total of 116 participants were studied. Mean age (standard deviation-SD) was 41.9 (10.1) years, 53.4 % male. Seventy-eight (67.2 %) were neurologists fully dedicated to the care of demyelinating disorders. Mean (SD) TI score was 3.65 (1.01). Overall, 92.2 % of participants (n = 107) presented TI in at least 2/9 case scenarios. The lack of full dedication to MS care (p = 0.014), preference for taking risks (p = 0.008), and low willingness to adopt evidence-based innovations (p = 0.009) were associated with higher TI scores in the multivariate analysis after adjustment for confounders., Conclusion: TI was a common phenomenon among neurologists managing MS patients when faced with the decision to initiate or escalate treatment based on elevated sNfL levels. Identifying factors associated with this phenomenon may help optimize treatment decisions in MS care., Competing Interests: Declaration of competing interest Gustavo Saposnik received consulting fees from Roche Farma Spain and is supported by the University of Toronto Scientific Merit award. He also receives a modest stipend from the World Stroke Organization as the Editor in Chief of the World Stroke Academy. Enric Monreal reported receiving research grants, travel support, or honoraria for speaking engagements from Almirall, Merck, Roche, Sanofi, Bristol Myers Squibbb, Biogen, Janssen, and Novartis. Jose M García-Domínguez received honoraria as speaker, advisor and researcher from Almirall, Bristol Myers Squibb, Biogen, Janssen, Merck, Novartis, Roche, Teva, and Sanofi. Jose E Meca-Lallana received honoraria as a consultant, chairman and lecturer in meetings and participated in clinical trials and other research projects promoted by Alexion, Biogen, Bristol Myers Squibb, Janssen, Merck, Novartis, Roche, and Sanofi. Lamberto Landete received honoraria for participating in advisory boards and scientific and educational activities from Almirall, Bayer, Biogen, Bristol Myers Squibb, Sanofi, Merck, Novartis, UCB, Roche, and Teva. Virginia Meca-Lallana received consulting and speaking fees from Almirall, Biogen, Genzyme, Janssen, Merck, Novartis, Roche, Terumo, Sanofi, Teva, and Bristol Myers Squibb. Luis Querol received speaker honoraria from Merck, Sanofi, Roche, Biogen, Grifols and CSL Behring; provided expert testimony for Grifols, Johnson & Johnson, Annexon Pharmaceuticals, Sanofi, Novartis, Takeda, and CSL-Behring; and received research funds from Roche, UCB, and Grifols. Eduardo Agüera received speaking honoraria from Roche, Novartis, Merck, Sanofi, and Biogen. Sergio Martínez-Yélamos received honoraria for participating on advisory boards and for collaborations as consultant and scientific communications; they also received research support as well as funding for travel and congress expenses from Roche, Biogen Idec, Novartis, TEVA, Merck, Genzyme, Sanofi, Bayer, Almirall, and Bristol Myers Squibb. Luisa M Villar reported receiving research grants and personal fees from Merck, Roche, Sanofi, Bristol Myers Squibb, Biogen, and Novartis. Ana B Caminero received courses and honoraria for her participation as speaker/meeting moderator/symposia organizer from Alter, Almirall, Bayer, Bial, Biogen, Bristol Myers Squibb, Lilly, Merck, Mylan, Novartis, Roche, Sanofi-Genzyme, Teva, and UCB; and support to attend scientific meetings from Biogen, Bial, Merck-Serono, Novartis, Roche, Sanofi, and Teva. Rocío Gómez-Ballesteros, Elisa Salas, Nicolas Medrano, Elena García-Arcelay, and Jorge Maurino are employees of Roche Farma Spain., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Context: Resilience Catalysts (RC) in Public Health provides local health departments (LHDs) with a process and technical assistance (TA) to operationalize the Community Health Strategist (CHS) role, foster equity, and support community resilience through policy, practice, and program change across multiple sectors., Objectives: This evaluation sought to (1) identify essential elements of the RC process and TA that help LHDs address the systemic drivers of adversity and inequity, and (2) expand understanding of RC's preliminary impact and inform implications for theory, practice, and funding in the post-COVID context., Design: The mixed-methods evaluation incorporated online surveys and semi-structured interviews. Key themes and takeaways were identified using framework analysis, constant comparison analysis, and descriptive statistics., Setting: The evaluation was conducted in 12 cities and counties across the United States, including California, Colorado, Florida, Iowa, Kentucky, Maryland, Massachusetts, New Jersey, North Carolina, Ohio, Tennessee, and Washington., Participants: Survey participants consisted of 29 representatives of 11 RC sites. Interview participants included 33 individuals: 19 representatives of 9 RC sites and 14 individuals representing RC TA providers and funders., Main Outcome Measures: The evaluation measured outcomes related to collaborative engagement, addressing inequity, systems change, knowledge change, ability to work within a local political and community context, sustainability, and scalability., Results: Evaluation results demonstrate outcomes related to community engagement, expansion of system-level thinking, advancing health and racial equity, clarity and understanding of RC process, building LHD and partners' capacity and skills needed to embody the CHS role., Conclusions: The RC process prepared LHDs to operationalize the CHS role by providing the knowledge, skills, and capacities needed to understand root causes of adversity and inequity, address structural racism as a public health issue, and develop collaborative plans for addressing root causes., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc.)

Purpose: Since wounds are a primary source of infection, it is desirable to have a wound dressing that prevents infectious processes during the tissue regeneration phase. In this regard, silver nanoparticles, oregano essential oil, and chitosan have been utilized due to their antimicrobial activity. This work focused on the preparation of a composite containing these three components, intended to provide protection for wounds, especially by exerting antimicrobial effects., Methods: A composite based on chitosan nanoparticles loaded with oregano essential oil (OEO) and silver nanoparticles was fabricated through the casting-solvent evaporation method. The films were prepared from a suspension of chitosan nanoparticles. The nanoparticles were characterized by size and entrapment efficiency. The surface of the films was observed by SEM, and the mechanical resistance, occlusive capacity, and antimicrobial activity against S. aureus, E. coli, and P. aeruginosa were evaluated. The release of OEO from the films was studied using Franz-type cells., Results: A composite was successfully prepared from a dispersion of OEO-loaded chitosan nanoparticles (147.8 nm, PDI = 0.35; entrapment efficiency = 80.9 %; loading capacity = 38 %) and silver nanoparticles (19.6 nm, PDI = 0.4). A film could be formed that made the composite by pouring the chitosan nanoparticle dispersion directly into molds. The composite presented advantageous characteristics, such as being semi-occlusive (occlusion factor ~ 40 % and reduction in TEWL of 18 %), allowing the sustained release of OEO (about 0.2 mgCm-2 h-1 during 8 h), and having antimicrobial activity for the three strains evaluated., Conclusion: The prepared composite can be considered a potential candidate for dressing materials intended to prevent and treat wound infections., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Endometriosis, defined as the presence of endometrial-like tissue outside of the uterus, is one of the most prevalent gynecological disorders. Although different theories have been proposed, its pathogenesis is not clear. Novel studies indicate that the gut microbiome may be involved in the etiology of endometriosis; nevertheless, the connection between microbes, their dysbiosis, and the development of endometriosis is understudied. This case-control study analyzed the gut microbiome in women with and without endometriosis to identify microbial targets involved in the disease., Methods: A subsample of 1000 women from the Estonian Microbiome cohort, including 136 women with endometriosis and 864 control women, was analyzed. Microbial composition was determined by shotgun metagenomics and microbial functional pathways were annotated using the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. Partitioning Around Medoids (PAM) algorithm was performed to cluster the microbial profile of the Estonian population. The alpha- and beta-diversity and differential abundance analyses were performed to assess the gut microbiome (species and KEGG orthologies (KO)) in both groups. Metagenomic reads were mapped to estrobolome-related enzymes' sequences to study potential microbiome-estrogen metabolism axis alterations in endometriosis., Results: Diversity analyses did not detect significant differences between women with and without endometriosis (alpha-diversity: all p-values > 0.05; beta-diversity: PERMANOVA, both R 2  < 0.0007, p-values > 0.05). No differential species or pathways were detected after multiple testing adjustment (all FDR p-values > 0.05). Sensitivity analysis excluding women at menopause (> 50 years) confirmed our results. Estrobolome-associated enzymes' sequence reads were not significantly different between groups (all FDR p-values > 0.05)., Conclusions: Our findings do not provide enough evidence to support the existence of a gut microbiome-dependent mechanism directly implicated in the pathogenesis of endometriosis. To the best of our knowledge, this is the largest metagenome study on endometriosis conducted to date., (© 2024. The Author(s).)

Background: Implementation of new practices in team-based settings requires teams to work together to respond to new demands and changing expectations. However, team constructs and team-based implementation approaches have received little attention in the implementation science literature. This systematic review summarizes empirical research examining associations between teamwork and implementation outcomes when evidence-based practices and other innovations are implemented in healthcare and human service settings., Methods: We searched MEDLINE, CINAHL, APA PsycINFO and ERIC for peer-reviewed empirical articles published from January 2000 to March 2022. Additional articles were identified by searches of reference lists and a cited reference search for included articles (completed in February 2023). We selected studies using quantitative, qualitative, or mixed methods to examine associations between team constructs and implementation outcomes in healthcare and human service settings. We used the Mixed Methods Appraisal Tool to assess methodological quality/risk of bias and conducted a narrative synthesis of included studies. GRADE and GRADE-CERQual were used to assess the strength of the body of evidence., Results: Searches identified 10,489 results. After review, 58 articles representing 55 studies were included. Relevant studies increased over time; 71% of articles were published after 2016. We were unable to generate estimates of effects for any quantitative associations because of very limited overlap in the reported associations between team variables and implementation outcomes. Qualitative findings with high confidence were: 1) Staffing shortages and turnover hinder implementation; 2) Adaptive team functioning (i.e., positive affective states, effective behavior processes, shared cognitive states) facilitates implementation and is associated with better implementation outcomes; Problems in team functioning (i.e., negative affective states, problematic behavioral processes, lack of shared cognitive states) act as barriers to implementation and are associated with poor implementation outcomes; and 3) Open, ongoing, and effective communication within teams facilitates implementation of new practices; poor communication is a barrier., Conclusions: Teamwork matters for implementation. However, both team constructs and implementation outcomes were often poorly specified, and there was little overlap of team constructs and implementation outcomes studied in quantitative studies. Greater specificity and rigor are needed to understand how teamwork influences implementation processes and outcomes. We provide recommendations for improving the conceptualization, description, assessment, analysis, and interpretation of research on teams implementing innovations., Trial Registration: This systematic review was registered in PROSPERO, the international prospective register of systematic reviews., Registration Number: CRD42020220168., (© 2024. The Author(s).)

The beneficial effects of physical activity (PA) on gut microbiome have been reported, nevertheless the findings are inconsistent, with the main limitation of subjective methods for assessing PA. It is well accepted that using an objective assessment of PA reduces the measurement error and also allows objective assessment of sedentary behavior (SB). We aimed to study the associations between accelerometer-assessed behaviors (i.e., SB, light-intensity physical activity [LPA] and moderate-to-vigorous physical activity [MVPA]) with the gut microbiome using compositional data analysis, a novel approach that enables to study these behaviors accounting for their inter-dependency. This cross-sectional study included 289 women from the Northern Finland Birth Cohort 1966. Physical activity was measured during 14 days by wrist-worn accelerometers. Analyses based on the combined effect of MVPA and SB, and compositional data analyses in association with the gut microbiome data were performed. The microbial alpha- and beta-diversity were not significantly different between the MVPA-SB groups, and no differentially abundant microorganisms were detected. Compositional data analysis did not show any significant associations between any movement behavior (relative to the others) on microbial alpha-diversity. Butyrate-producing bacteria such as Agathobacter and Lachnospiraceae CAG56 were significantly more abundant when reallocating time from LPA or SB to MVPA (γ = 0.609 and 0.113, both p-values = 0.007). While PA and SB were not associated with microbial diversity, we found associations of these behaviors with specific gut bacteria, suggesting that PA of at least moderate intensity (i.e., MVPA) could increase the abundance of short-chain fatty acid-producing microbes., (© 2024 The Author(s). Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Importance: Assessing nontechnical skills in operating rooms (ORs) is crucial for enhancing surgical performance and patient safety. However, automated and real-time evaluation of these skills remains challenging., Objective: To explore the feasibility of using motion features extracted from surgical video recordings to automatically assess nontechnical skills during cardiac surgical procedures., Design, Setting, and Participants: This cross-sectional study used video recordings of cardiac surgical procedures at a tertiary academic US hospital collected from January 2021 through May 2022. The OpenPose library was used to analyze videos to extract body pose estimations of team members and compute various team motion features. The Non-Technical Skills for Surgeons (NOTSS) assessment tool was employed for rating the OR team's nontechnical skills by 3 expert raters., Main Outcomes and Measures: NOTSS overall score, with motion features extracted from surgical videos as measures., Results: A total of 30 complete cardiac surgery procedures were included: 26 (86.6%) were on-pump coronary artery bypass graft procedures and 4 (13.4%) were aortic valve replacement or repair procedures. All patients were male, and the mean (SD) age was 72 (6.3) years. All surgical teams were composed of 4 key roles (attending surgeon, attending anesthesiologist, primary perfusionist, and scrub nurse) with additional supporting roles. NOTSS scores correlated significantly with trajectory (r = 0.51, P = .005), acceleration (r = 0.48, P = .008), and entropy (r = -0.52, P = .004) of team displacement. Multiple linear regression, adjusted for patient factors, showed average team trajectory (adjusted R2 = 0.335; coefficient, 10.51 [95% CI, 8.81-12.21]; P = .004) and team displacement entropy (adjusted R2 = 0.304; coefficient, -12.64 [95% CI, -20.54 to -4.74]; P = .003) were associated with NOTSS scores., Conclusions and Relevance: This study suggests a significant link between OR team movements and nontechnical skills ratings by NOTSS during cardiac surgical procedures, suggesting automated surgical video analysis could enhance nontechnical skills assessment. Further investigation across different hospitals and specialties is necessary to validate these findings.

Purpose: Shared decision-making is critical in multiple sclerosis (MS) due to the uncertainty of the disease trajectory over time and the large number of treatment options with differing efficacy, safety and administration characteristics. The aim of this study was to assess patients' decisional conflict regarding the choice of a disease-modifying therapy and its associated factors in patients with mid-stage relapsing-remitting multiple sclerosis (RRMS)., Methods: A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS (2017 revised McDonald criteria) and disease duration of 3 to 8 years were included. The level of uncertainty experienced by a patient when faced with making a treatment choice was assessed using the 4-item Decisional Conflict Scale. A battery of patient-reported and clinician-rated measures was administered to obtain information on symptom severity, illness perception, illness-related uncertainty, regret, MS knowledge, risk taking behavior, preferred role in the decision-making process, cognition, and self-management. Patients were recruited during routine follow-up visits and completed all questionnaires online using electronic tablets at the hospital. A multivariate logistic regression analysis was conducted., Results: A total of 201 patients were studied. Mean age (Standard deviation) was 38.7 (8.4) years and 74.1% were female. Median disease duration (Interquartile range) was 6.0 (4.0-7.0) years. Median EDSS score was 1.0 (0-2.0). Sixty-seven (33.3%) patients reported a decisional conflict. These patients had lower MS knowledge and more illness uncertainty, anxiety, depressive symptoms, fatigue, subjective symptom severity, a threatening illness perception, and poorer quality of life than their counterparts. Lack of decisional conflict was associated with MS knowledge (Odds ratio [OR]=1.195, 95% CI 1.045, 1.383, p=0.013), self-management (OR=1.049, 95% CI 1.013, 1.093, p=0.018), and regret after a healthcare decision (OR=0.860, 95% CI 0.756, 0.973, p=0.018) in the multivariate analysis., Conclusion: Decisional conflict regarding the selection of a disease-modifying therapy was a common phenomenon in patients with mid-stage RRMS. Identifying factors associated with decisional conflict may be useful to implement preventive strategies that help patients better understand their condition and strengthen their self-management resources., Competing Interests: Julia Sabin received honoraria for lecturing, consulting or travel expenses from Biogen, Merck, Teva, Novartis, BMS, Janssen, Almirall, Roche and Sanofi. Jesús Martín-Martínez served on scientific advisory boards and/or received speaking honoraria, research funding and support to attend scientific meetings from Biogen, Merck, Novartis, Roche and Teva. Francisco Javier Barrero received compensation for consulting services and speaking honoraria from Almirall, Biogen, Genzyme, Merck, Novartis, Roche, Sanofi and Teva. Ana Alonso received compensation for consulting services from Biogen, BMS, Sanofi, Roche, Janssen and Novartis; and speaking honoraria from Biogen, BMS, Sanofi, Roche, Janssen, Merck, Almirall and Novartis. José Luis Sánchez-Menoyo received support to attend scientific meetings from Novartis, Merck, and Biogen; speaking honoraria from Biogen, Novartis, Sanofi, Merck, Almirall, Bayer and Teva; and participated in clinical trials from Biogen, Merck and Roche. Laura Borrega received compensation for consulting services, speaking honoraria and support to attend scientific meetings from Bayer, Celgene, Biogen, Sanofi, Merck, Novartis, Roche, Almirall and Teva. Monserrat Gómez-Gutiérrez received honoraria as speaker from Biogen, BMS, Janssen, Merck, Mylan, Novartis, Roche, Sanofi and Bial. Sara Eichau received consulting fees and lecture honoraria from Biogen, Novartis, Sanofi, Merck, Roche and Almirall. Carmen Calles received compensation for consulting services, speaking honoraria and support to attend scientific meetings and courses from Merck, Teva, Sanofi, Novartis, Biogen, Roche, and BMS. Eva Fernández-Díaz received honoraria and travel expenses for participation in scientific meetings and advisory boards from Almirall, Biogen, Merck, Roche and Sanofi. Olga Carmona received honoraria for speaker services and advisory boards from Sanofi, Roche, Janssen and Merck. Aida Orvíz received research grants, travel support, advisory activities or honoraria for speaking engagements from Almirall, Biogen, BMS, Merck, Mylan, Novartis, Roche, Sanofi, and Teva. Ana López-Real received speaker and consultation fees, and congress travel support from Biogen, Janssen, Merck, Novartis, Roche and Sanofi. Amelia Mendoza received research grants, travel support or honoraria for speaking engagements from Biogen, Merck, Novartis, Roche, Sanofi, and Teva. Eduardo Agüera received speaking honoraria from Roche, Novartis, Merck, Sanofi and Biogen. Elisa Salas and Jorge Maurino are employees of Roche Farma Spain. The authors report no other conflicts of interest in this work., (© 2024 Sabin et al.)

Microbial necromass carbon (MNC) accounts for a large fraction of soil organic carbon (SOC) in terrestrial ecosystems. Yet our understanding of the fate of this large carbon pool under long-term warming is uncertain. Here, we show that 14 years of soil warming (+4°C) in a temperate forest resulted in a reduction in MNC by 11% (0-10 cm) and 33% (10-20 cm). Warming caused a decrease in the content of MNC due to a decline in microbial biomass carbon and reduced microbial carbon use efficiency. This reduction was primarily caused by warming-induced limitations in available soil phosphorus, which, in turn, constrained the production of microbial biomass. Conversely, warming increased the activity of soil extracellular enzymes, specifically N-acetylglucosaminidase and leucine aminopeptidase, which accelerated the decomposition of MNC. These findings collectively demonstrate that decoupling of MNC formation and decomposition underlie the observed MNC loss under climate warming, which could affect SOC content in temperate forest ecosystems more widespread., (© 2024 John Wiley & Sons Ltd.)

Team coaching has been found to increase group effort, improve interpersonal processes, and increase team knowledge and learning. However, the team coaching literature is renowned for its inability to define team coaching itself-making it difficult to solidify its place in the world of team science. So far, there is no consensus on what specific training would serve internal leaders best, and how they would connect to the team coaching literature. We know leadership and team training are effective in improving organizational outcomes, but the gap in the literature lies in identifying what specific competencies internal team coaches need, and what training could fulfill these. In this piece, we seek to (1) identify what competencies internal team leaders need based on the outcomes we know team coaching yields, (2) identify specific behaviors that can fulfill these competencies, and (3) integrate the literature to form an evidence-based guide on what training to provide to internal team coaches. By doing so, we hope to provide a definitive understanding of what internal team coaches need to be successful.

Purpose: Breast cancer mortality rates in Latin America (LA) are higher than those in the United States, possibly because of advanced disease presentation, health care disparities, or unfavorable molecular subtypes. The Latin American Cancer Research Network was established to address these challenges and to promote collaborative clinical research. The Molecular Profiling of Breast Cancer Study (MPBCS) aimed to evaluate the clinical characteristics and treatment outcomes of LA participants with locally advanced breast cancer (LABC)., Patients and Methods: The MPBCS enrolled 1,449 participants from Argentina, Brazil, Chile, Mexico, and Uruguay. Through harmonized procedures and quality assurance measures, this study evaluated clinicopathologic characteristics, neoadjuvant chemotherapy response, and survival outcomes according to residual cancer burden (RCB) and the type of surgery., Results: Overall, 711 and 480 participants in the primary surgery and neoadjuvant arms, respectively, completed the 5-year follow-up period. Overall survival was independently associated with RCB (worse survival for RCBIII-adjusted hazard ratio, 8.19, P < .001, and RCBII [adjusted hazard ratio, 3.69, P < .008] compared with RCB0 [pathologic complete response or pCR]) and type of surgery (worse survival in mastectomy than in breast-conserving surgery [BCS], adjusted hazard ratio, 2.97, P = .001). The hormone receptor-negative-human epidermal growth factor receptor 2-positive group had the highest proportion of pCR (48.9%). The analysis of the ASCO Quality Oncology Practice Initiative breast module revealed high compliance with pathologic standards but lower adherence to treatment administration standards. Notably, compliance with trastuzumab administration varied widely among countries (33.3%-88.7%)., Conclusion: In LABC, we demonstrated the survival benefit of BCS and the prognostic effect of the response to available neoadjuvant treatments despite an important variability in access to key treatments. The MPBCS represents a significant step forward in understanding the real-world implementation of oncologic procedures in LA.

A multicenter study involving 204 adults with relapsing-remitting multiple sclerosis (RRMS) assessed the dimensionality and item characteristics of the Mishel-Uncertainty of Illness Scale (MUIS), a generic self-assessment tool. Mokken analysis identified two dimensions in the MUIS with an appropriate item and overall scale scalability after excluding nonclassifiable items. A refined 12-item MUIS, employing a grade response model, effectively discriminated uncertainty levels among RRMS patients (likelihood ratio test p -value = .03). These findings suggest the potential value of the 12-item MUIS as a reliable measure for assessing uncertainty associated with the course of illness in RRMS., Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: ES and JM are employees of Roche Farma Spain. JS received honoraria for lecturing, consulting, or travel expenses from Biogen, Merck, Teva, Novartis, BMS, Janssen, Almirall, Roche, and Sanofi. JMM served on scientific advisory boards and/or received speaking honoraria, research funding and support to attend scientific meetings from Biogen, Merck, Novartis, Roche, and Teva. FJB received compensation for consulting services and speaking honoraria from Almirall, Biogen, Genzyme, Merck, Novartis, Roche, Sanofi, and Teva. AA received compensation for consulting services from Biogen, BMS, Sanofi, Roche, Janssen, and Novartis; and speaking honoraria from Biogen, BMS, Sanofi, Roche, Janssen, Merck, Almirall, and Novartis. JLSM received support to attend scientific meetings from Novartis, Merck, and Biogen; speaking honoraria from Biogen, Novartis, Sanofi, Merck, Almirall, Bayer, and Teva; and participated in clinical trials from Biogen, Merck, and Roche. LB received compensation for consulting services, speaking honoraria, and support to attend scientific meetings from Bayer, Celgene, Biogen, Sanofi, Merck, Novartis, Roche, Almirall, and Teva. MGG received speaking honoraria from Biogen, BMS, Janssen, Merck, Mylan, Novartis, Roche, Sanofi, and Bial. SE received consulting fees and lecture honoraria from Biogen, Novartis, Sanofi, Merck, Roche, and Almirall. CC received compensation for consulting services, speaking honoraria and support to attend scientific meetings and courses from Merck, Teva, Sanofi, Novartis, Biogen, Roche, and BMS. EFD received honoraria and travel expenses for participation in scientific meetings and advisory boards from Almirall, Biogen, Merck, Roche, and Sanofi. OC received honoraria for speaker services and advisory boards from Sanofi, Roche, Janssen, and Merck. AO received research grants, travel support, advisory activities, and honoraria for speaking from Almirall, Biogen, BMS, Merck, Mylan, Novartis, Roche, Sanofi, and Teva. ALR received speaker and consultation fees, and congress travel support from Biogen, Janssen, Merck, Novartis, Roche, and Sanofi. AM received research grants, travel support or honoraria for speaking engagements from Biogen, Merck, Novartis, Roche, Sanofi, and Teva. EA received speaking honoraria from Roche, Novartis, Merck, Sanofi, and Biogen. The rest of the authors declared no potential conflicts of interest. The abstract of this article was presented at the European Congress of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) as a poster presentation with interim findings (PCR178; Copenhagen, Denmark; November 14, 2023)., (© The Author(s), 2024.)

The healthcare industry is inadvertently a teamwork industry - and yet - little time is devoted to improving teamwork on the field. As a response to this issue, team development intervention (TDI) tools have flourished. Findings suggest the capability for TDIs to better team competencies, and potentially mitigate prominent healthcare problems. However, team coaching has been excluded as a potential TDI for healthcare. For this reason, we seek to 1) discuss existing team coaching models, integrating findings across the literature, 2) highlight the advantages of Hackman and Wageman (2005)'s model over others, 3) display its empirically-corroborated propositions, and finally, 4) provide general guidance on how to move forward. We move beyond extant literature by providing an outline on what outcomes team coaching can and cannot yield, accumulating evidence from fields outside of healthcare and incorporating team coaching into the TDI literature. By doing so, we hope empirical research on team coaching is incentivized, resulting in an efficient and accessible TDI for healthcare professionals and the field of interprofessional care.

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Background: The most common age-related musculoskeletal disorder is sarcopenia. Sarcopenia is the progressive and generalized loss of muscle mass, strength, and function. The causes of sarcopenia can include insufficient nutritional status, which may be due to protein-energy malnutrition, anorexia, limited food access and eating ability, or malabsorption. In the United States, 15.51% of older adults have been diagnosed with sarcopenia. Culinary medicine (CM) is a novel evidence-based medical field that combines the science of medicine with food and cooking to prevent and treat potential chronic diseases. CM helps individuals learn and practice culinary skills while tasting new recipes. Therefore, this program could successfully reduce barriers to protein intake, enabling older adults to enhance their diet and muscle quality., Objective: This study aimed to examine how a web-based CM intervention, emphasizing convenient ways to increase lean red meat intake, could improve protein intake with the promotion of physical activity to see how this intervention could affect older adults' muscle strength and mass., Methods: A 16-week, single-center, parallel-group, randomized controlled trial was conducted to compare a web-based CM intervention group (CMG) with a control group (CG) while monitoring each group's muscle strength, muscle mass, and physical activity for muscle quality. The CMG received weekly web-based cooking demonstrations and biweekly nutrition education videos about enhancing protein intake, whereas the CG just received the recipe handout. Anthropometrics, muscle mass, muscle strength, dietary habits, physical activity, and cooking effectiveness were established at baseline and measured after the intervention. The final number of participants for the data analysis was 24 in the CMG and 23 in the CG., Results: No between-group difference in muscle mass (P=.88) and strength (dominant P=.92 and nondominant P=.72) change from the prestudy visit was detected. No statistically significant difference in protein intake was seen between the groups (P=.50). A nonsignificant time-by-intervention interaction was observed for daily protein intake (P=.08). However, a statistically significant time effect was observed (P≤.001). Post hoc testing showed that daily protein intake was significantly higher at weeks 1 to 16 versus week 0 (P<.05). At week 16, the intake was 16.9 (95% CI 5.77-27.97) g higher than that at the prestudy visit., Conclusions: This study did not affect protein intake and muscle quality. Insufficient consistent protein intake, low physical activity, intervention adherence, and questionnaire accuracy could explain the results. These studies could include an interdisciplinary staff, different recruitment strategies, and different muscle mass measurements. Future research is needed to determine if this intervention is sustainable in the long term and should incorporate a follow-up to determine program efficacy on several long-term behavioral and health outcomes, including if the participants can sustain their heightened protein intake and how their cooking skills have changed., Trial Registration: ClinicalTrials.gov NCT05593978; https://clinicaltrials.gov/ct2/show/NCT05593978., (©Emily Salas-Groves, Michelle Alcorn, Allison Childress, Shannon Galyean. Originally published in JMIR Formative Research (https://formative.jmir.org), 13.02.2024.)

Objective: To explore how Accountable Communities of/for Health (ACHs), a type of health-focused multisector collaborative, are developing strategies to address health equity with diverse partners., Data Sources and Study Setting: Interview and focus group participants were recruited from a purposive sample of 22 ACH participant organizations in Washington (n = 9 ACHs) and California (n = 13 ACH)., Study Design: Interview and focus group data were thematized using constant comparison analysis., Data Collection: Interviews were conducted to learn how each ACH's system context, collaboration processes, and goals influence its progress toward health equity. Focus groups were conducted to gain a deeper understanding of how local context and power dynamics influence an ACH's ability to make progress toward health equity. There were 22 focus group participants and 65 interview participants., Principal Findings: Results indicate that ACHs advance health equity across the social-ecological spectrum of health with approaches targeting the individual, community, and societal levels. Specific approaches used by ACHs to collaboratively address health equity include providing equity education to participating organizations and community groups; including diverse community voices in collaborative decision-making; changing practices in their participant's daily operations; improving existing services and developing new services; and actively promoting a culture of keeping equity at the center of ACH efforts., Conclusions: This study identifies strategies for advancing health equity in multisector collaboratives. ACHs in Washington and California are devoting resources to ensure health equity is central to their work. The numerous approaches ACHs use to advance health equity are important to ensure everyone can reach their full health potential. While current literature argues that multisector health initiatives are integral for advancing health equity, there is a lack of research on how these initiatives advance equity in practice. Thus, this paper provides generalizable strategies that can be further investigated to optimize progress toward health equity., (© 2023 The Authors. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.)

Given the demanding nature of its mission, the collective units of the Army, not just individual Soldiers, need to be able to withstand and adapt to a wide range of challenges. Therefore, it is important to be able to effectively assess resilience at the team-level and to understand the factors that can enable or diminish it. This article describes the development of a construct valid and psychometrically-sound measure of team resilience - the Team Resilience Scale (TRS). A theoretical framework of team resilience and related constructs is introduced. We then summarize the procedures for developing the TRS and related constructs, providing evidence of the content validity of the TRS. Finally, we assess the psychometric soundness and construct validity of the TRS in two Army field studies. Our analyses support the convergent validity of items and indicate that the measure can be used to examine three first-order dimensions of resilience (i.e., physical, affective, and cognitive) or as a single overall resilience composite. Results show the TRS was positively related to team performance in both samples and it co-varied with stressors and team actions. Practical recommendations for use of the measure and suggestions for future research are offered.

Malaria is a devastating infectious disease that affects large swathes of human populations across the planet's tropical regions. It is caused by parasites of the genus Plasmodium, with Plasmodium falciparum being responsible for the most lethal form of the disease. During the intraerythrocytic stage in the human hosts, malaria parasites multiply and degrade hemoglobin (Hb) using a battery of proteases, which include two cysteine proteases, falcipains 2 and 3 (FP-2 and FP-3). Due to their role as major hemoglobinases, FP-2 and FP-3 have been targeted in studies aiming to discover new antimalarials and numerous inhibitors with activity against these enzymes, and parasites in culture have been identified. Nonetheless, cross-inhibition of human cysteine cathepsins remains a serious hurdle to overcome for these compounds to be used clinically. In this article, we have reviewed key functional and structural properties of FP-2/3 and described different compound series reported as inhibitors of these proteases during decades of active research in the field. Special attention is also paid to the wide range of computer-aided drug design (CADD) techniques successfully applied to discover new active compounds. Finally, we provide guidelines that, in our understanding, will help advance the rational discovery of new FP-2/3 inhibitors., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Soil microbial necromass is an important contributor to soil organic matter (>50%) and it is largely composed of microbial residues. In soils, fragmented cell wall residues are mostly found in their polysaccharide forms of fungal chitin and bacterial peptidoglycan. Microbial necromass biomarkers, particularly amino sugars (AS) such as glucosamine (GlcN) and muramic acid (MurA) have been used to trace fungal and bacterial residues in soils, and to distinguish carbon (C) found in microbial residues from non-microbial organic C. Neutral sugars (NS), particularly the hexose/pentose ratio, have also been proposed as tracers of plant polysaccharides in soils. In our study, we extended the range of biomarkers to include AS and NS compounds in the biomass of 120 species belonging to archaea, bacteria, fungi, or plants. GlcN was the most common AS found in all taxa, contributing 42-91% to total AS content, while glucose was the most common NS found, contributing 56-79% to total NS. We identified talosaminuronic acid, found in archaeal pseudopeptidoglycan, as a new potential biomarker specific for Euryarchaeota. We compared the variability of these compounds between the different taxonomic groups using multivariate approaches, such as non-metric multidimensional scaling (NMDS) and partial least squares discriminant analysis (PLS-DA) and statistically evaluated their biomarker potential via indicator species analysis. Both NMDS and PLS-DA showcased the variability in the AS and NS contents between the different taxonomic groups, highlighting their potential as necromass residue biomarkers and allowing their extension from separating bacterial and fungal necromass to separating microbes from plants. Finally, we estimated new conversion factors where fungal GlcN is converted to fungal C by multiplying by 10 and MurA is converted to bacterial C by multiplying by 54. Conversion factors for talosaminuronic acid and galactosamine are also proposed to allow estimation of archaeal or all-microbial necromass residue C, respectively., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

As innovative endeavors have become more complex and time-intensive, there has become an increasing reliance on expert teams in organizations. Expert innovation teams are comprised of team members with extensive experience and mastery in a particular discipline. These teams utilize fluid membership that expands the available knowledge of the team but creates challenges for effective teamwork. We argue that the mechanism for creating an enduring impact and developing a product to fruition requires the cognitive and social integration of fluid team members. This article focuses on how teams effectively integrate knowledge with diverse, and possibly fluid, team members and how teams can organize knowledge through planning and reflection to implement the idea successfully. Knowledge integration and team reflexivity are considered in tandem to emphasize the multi-faceted nature of generating and implementing innovative solutions and the conflicting teamwork processes that hinder innovative efforts. To understand how these competing teamwork processes required for successful innovation interact, we developed a framework that considers resilience as the factor that elicits team creative performance. In doing so, we discuss how innovation teams build resilience over time and how creative failure can lead to greater levels of innovation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Linhardt and Salas.)

Apple ( Malus domestica Borkh) is an appreciated source of polyphenols. Phenolic compounds are known as natural antioxidants and have a wide range of applications in different industries. Apple pomace has the potential of being an alternative source of polyphenols. To determine the polyphenolic profile of apple pomace, samples from the skin at two different stages of ripening were extracted with 80-20% EtOH-water/acetic acid 5% (S1) and 20-80% EtOH-water/acetic acid 5% (S2) in order to determine the solvent system. Ripe skins extracted with S1 showed a higher total polyphenol content or TPC (1.21 g of polyphenols per 100 g of fresh weight (FW)) than unripe apple skin, being the most effective system tested and a mean degree of polymerization of 2.47. Commercial apple pomace was extracted with S1, resulting in a TPC of 0.5615 ± 0.007 g of polyphenols per 100 g of FW. Meanwhile, the RP-HPLC-MS analysis led to the tentative identification of several polyphenolic compounds., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Among broad-spectrum anticancer agents, paclitaxel (PTX) has proven to be one of the most effective against solid tumors for which more specific treatments are lacking. However, drawbacks such as neurotoxicity and the development of resistance reduce its therapeutic efficacy. Therefore, there is a need for compounds able to improve its activity by synergizing with it or potentiating its effect, thus reducing the doses required. We investigated the interaction between PTX and tannins, other compounds with anticancer activity known to act as repressors of several proteins involved in oncological pathways. We found that both tannic acid (TA) and ethyl gallate (EG) strongly potentiate the toxicity of PTX in Hep3B cells, suggesting their utility in combination therapy. We also found that AT and EG promote tubulin polymerization and enhance the effect of PTX on tubulin, suggesting a direct interaction with tubulin. Biochemical experiments confirmed that TA, but not EG, binds tubulin and potentiates the apparent binding affinity of PTX for the tubulin binding site. Furthermore, the molecular docking of TA to tubulin suggests that TA can bind to two different sites on tubulin, one at the PTX site and the second at the interface of α and β-tubulin (cluster 2). The binding of TA to cluster 2 could explain the overstabilization in the tubulin + PTX combinatorial assay. Finally, we found that EG can inhibit PTX-induced expression of pAkt and pERK defensive protein kinases, which are involved in resistance to PXT, by limiting cell death (apoptosis) and favoring cell proliferation and cell cycle progression. Our results support that tannic acid and ethyl gallate are potential chemotherapeutic agents due to their potentiating effect on paclitaxel.

Fluid teams, characterized by frequent changes in team membership, are vital in the neonatal intensive care unit (NICU) due to high patient acuity and the need for a wide range of specialized providers. However, many challenges can hinder effective teamwork in this setting. This article reviews the challenges related to fluid teamwork in the NICU and discusses recommendations from team science to address each challenge. Drawing from the current literature, this paper outlines three challenges that can hinder fluid teamwork in the NICU: incorporating patient families, managing hierarchy among team members, and facilitating effective patient handoffs. The review concludes with recommendations for managing NICU teamwork differently using strategies from team science., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Bell, Rufrano, Traylor, Ohning and Salas.)

The impact of social networks on people's daily lives is worrisome, particularly in adolescents and young people, who seem to exceed the limits of normal use. Constant excessive use can lead to pathological behaviors linked to social media addiction (SMA). Our objectives were to 1) adapt the Bergen Social Media Addiction Scale (BSMAS) to Spanish and 2) evaluate its psychometric properties in a young population. The BSMAS was adapted to Spanish, involving experts on social media addiction and people from the target population during the adaptation process. For the psychometric evaluation, 650 Peruvian college students responded to the Spanish version (53.5 % women aged 18 to 40, M = 21.5 SD = 2.7). The one-dimensional measurement model proposed for the original BSMAS was confirmed for our version (X 2 (9)  = 23.9315, CFI = 0.994, TLI = 0.990, SRMR = 0.032, RMSEA = 0.061). The reliability was good (α = 0.863; 95 % CI: 0.848-0.870; ω = 0.864; 95 % CI: 0.846-0.844), and the measurement invariance was confirmed for sex and age by fitting models. The concurrent validity with external social media addiction and mental health indicators was also confirmed. This study provides new and relevant information on the BSMAS validity and allows its application to Spanish-speaker college students from Peru and similar countries., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Effective teamwork is critical to the mission of Child Advocacy Center (CAC) multidisciplinary teams. Team interventions designed to fit the unique cross-organizational context of CAC teams may improve teamwork in CACs., Methods: A collaborative, community-engaged approach was used to adapt TeamSTEPPS, an evidence-based team training for healthcare, for CAC multidisciplinary teams. The adapted training was piloted with one team and evaluated using mixed methods. Team members completed pre-training (n = 26) and follow-up surveys (n = 22) and participated in qualitative interviews (n = 9)., Results: The adaptation process resulted in the creation of TeamTRACS (Team Training in Roles, Awareness, Communication, and Support). Participants rated TeamTRACS as highly acceptable, appropriate, feasible, relevant, and useful for CAC teams. They identified positive and negative aspects of the training, ideas for improvement, and future uses for TeamTRACS., Conclusions: TeamTRACS is a feasible approach to team training in CACs, and team members find the content and skills relevant and useful. Additional research is needed to test the effectiveness of TeamTRACS and identify appropriate implementation strategies to support its use., Competing Interests: Declarations of interest: None.

Microorganisms are important due to their widespread presence and multifaceted roles across various domains of life, ecology, and industries. In humans, they underlie the proper functioning of multiple systems crucial to well-being, including immunological and metabolic functions. Emerging research addressing the presence and roles of microorganisms within human reproduction is increasingly relevant. Studies implementing new methodologies (e.g., to investigate vaginal, uterine, and semen microenvironments) can now provide relevant insights into fertility, reproductive health, or pregnancy outcomes. In that sense, cutting-edge sequencing techniques, as well as others such as meta-metabolomics, culturomics, and meta-proteomics, are becoming more popular and accessible worldwide, allowing the characterization of microbiomes at unprecedented resolution. However, they frequently involve rather complex laboratory protocols and bioinformatics analyses, for which researchers may lack the required expertise. A suitable pipeline would successfully enable both taxonomic classification and functional profiling of the microbiome, providing easy-to-understand biological interpretations. However, the selection of an appropriate methodology would be crucial, as it directly impacts the reproducibility, accuracy, and quality of the results and observations. This review focuses on the different current microbiome-related techniques in the context of human reproduction, encompassing niches like vagina, endometrium, and seminal fluid. The most standard and reliable methods are 16S rRNA gene sequencing, metagenomics, and meta-transcriptomics, together with complementary approaches including meta-proteomics, meta-metabolomics, and culturomics. Finally, we also offer case examples and general recommendations about the most appropriate methods and workflows and discuss strengths and shortcomings for each technique., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: We describe a methodology that provides a nonobtrusive means of detecting stress and related deficits through the assessment of spontaneous verbal output in ongoing communications., Background: In high-demand environments, operational personnel are exposed to an array of environmental, task, and interpersonal stressors that can negatively impact performance as well as jeopardize safety and well-being. In these settings, the requirement exists to assess cognitive and emotional state "at a distance" and without interfering with ongoing performance., Method: We describe a lexical approach to assessing stress effects from ongoing or spontaneous verbal output. This approach is examined in a spaceflight analog setting., Results: We assess stress effects in terms of five core dimensions and develop lexical indicators of these core stress dimensions and relevant sub-facets. We establish the proof-of-concept of this approach by presenting representative data from a spaceflight analog., Conclusion: This approach provides an unobtrusive means to evaluate ongoing task communications at the individual and team level in order to assess cognitive/emotional states such as workload, negative affect, attentional focus, anxiety, and team orientation., Application: There are many high-demand settings in which it is valuable to monitor the potential negative effects of stress on operational personnel. These environments include spaceflight, the military, aviation, law enforcement, and medicine.

Objective: Propose areas of future space human factors research., Background: Deep space, long-duration human spaceflight missions to the Moon and Mars still require advances in space human factors research. Key drivers relate to astronauts living and working in isolation, new novel technologies required to accomplish exploration missions, and the longer durations of these., Results: Three areas of research are proposed for methods and techniques: (1) to enable more autonomous astronauts; (2) to monitor crew and improve ground team situation awareness; and (3) to detect and support changes in long-duration team coordination., Conclusions: Future human exploration missions will benefit from advances in space human factors research., Application: Human factors researchers can contribute to human spaceflight by prioritizing these research topics.

The development of oocytes occurs over a broad time frame, starting at the earliest stages of embryogenesis and continuing into adulthood. Conditional knockout technologies such as the Cre/loxP recombination system are useful for analyzing oocyte development at specific stages, but not every time frame has appropriate Cre drivers, for instance, during oocyte meiotic initiation through early prophase I in the embryo. Here, we generated a novel knockin mouse line that produces a bicistronic transcript from the endogenous Stra8 locus that includes a "self-cleaving" 2A peptide upstream of cre. This allows for high efficiency cleavage and production of both proteins individually and results in expression of cre in both male and female gonads at the biologically relevant stage. Fluorescent reporter analysis confirms that this line recapitulates endogenous Stra8 expression in both sexes and does not affect fertility of heterozygous nor homozygous mice. This line, named Stra8P2Acre, adds to the repertoire of germ-cell specific cre driver lines and, importantly, allows for deletion of target genes during key embryonic oocyte developmental stages, including early events in meiosis. Summary Sentence Generation of a novel cre recombinase knockin to the Stra8 locus allows production of Stra8 and cre without affecting fertility., (© The Author(s) 2023. Published by Oxford University Press on behalf of Society for the Study of Reproduction. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: Prostate cancer disproportionately affects Black men. Physical activity protects long-term health and quality of life outcomes in prostate cancer survivors. This study aimed to identify sociocultural factors related to physical activity among Black prostate cancer survivors to inform culturally tailored intervention development., Methods: This secondary analysis included data from 257 men who identified as Black or African American and were diagnosed with prostate cancer between 2013 and 2018. Participants completed validated self-report measures of perceived history of racial discrimination, religiosity, fatalism, sociodemographic (e.g., age, ethnicity, income) and clinical characteristics (e.g., years since diagnosis, comorbidity burden), and leisure-time physical activity. Regression analyses were conducted to examine the associations between sociocultural factors and mild, moderate, and vigorous physical activity., Results: Participants were on average 68.7 years old (SD = 7.7), and most were non-Hispanic (97.3%), married (68.9%), reported an annual household income above $50,000 (57.1%), received at least some college education (74.1%), and were overweight or had obesity (78.5%). Participants reported on average 88.1 (SD = 208.6) min of weekly mild physical activity, and most did not meet guidelines for weekly moderate (80.5%) or vigorous (73.0%) physical activity. After adjusting for covariates, older age and greater religiosity were associated with mild physical activity (ps ≤ 0.05). Higher levels of fatalism were associated with lower odds of meeting guidelines for moderate physical activity (OR = 0.87, 95% CI = 0.77-0.99)., Conclusions: Sociocultural factors such as religiosity and fatalism may be associated with some forms of physical activity in Black prostate cancer survivors. These findings suggest that incorporating faith-based practices into health behavior interventions may be appropriate for this population., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This scoping review investigates the volume of evidence for home-based exercise and nutrition programs and their effect on muscle quality among senior adults to inform implementation and future research. It aims to answer the research question: What are the evidence, challenges, and needs for research regarding a home-based exercise and nutrition intervention program to improve muscle outcomes in senior adults? This scoping review was conducted following the PRISMA extension for Scoping Review. The following databases were searched: PubMed, Scopus, MEDLINE, CINAHL, EMBASE, and the Cochrane Library. Applied filters were used to help condense the research articles. A total of 13 studies met the inclusion criteria for this scoping review. Most exercise interventions were either resistance or multi-component exercise programs. The nature of the nutrition intervention varied between different supplements, foods, education, or counseling. Muscle outcomes included muscle mass in nine studies, muscle function in all the studies, muscle strength in ten studies, and biochemical analyses in two studies. Two studies found improvements in muscle mass; two studies revealed improvements in all their muscle function tests; and three studies revealed improvements in muscle strength. Muscle biopsy in a study revealed enhanced muscle fibers, but both studies did not reveal any biomarker improvements. The scoping review findings revealed mixed results on the effectiveness of a home-based exercise and nutrition program. However, the current evidence does have many gaps to address before recommending this form of intervention for senior adults as an effective way to prevent and manage sarcopenia. Since this review identified multiple knowledge gaps, strengths, and limitations in this growing field, it can be a starting point to help build future study designs and interventions in this population., Competing Interests: The authors report no conflicts of interest in this work., (© 2023 Salas-Groves et al.)

Background: During active transcription, SARS-CoV-2 generates subgenomic regions of viral RNA. While standard SARS-CoV-2 RT-PCR amplifies region(s) of genomic RNA, it cannot distinguish active infection from remnant viral genomic material. However, screening for subgenomic RNA (sgRNA) by RT-PCR may aid in the determination of actively transcribing virus., Objectives: To evaluate the clinical utility of SARS-CoV-2 sgRNA RT-PCR testing in a pediatric population., Study Design: Retrospective analysis was performed on inpatients from February-September 2022 positive for SARS-CoV-2 by RT-PCR with a concomitant order for sgRNA RT-PCR. Chart abstractions were conducted to determine clinical outcomes, management, and infection prevention and control (IPC) practices., Results: Of 95 SARS-CoV-2 positive samples from 75 unique patients, 27 (28.4%) were positive by sgRNA RT-PCR. A negative sgRNA RT-PCR test allowed for de-isolation in 68 (71.6%) patient episodes. Regardless of age or sex, a positive sgRNA RT-PCR result significantly correlated with disease severity (P = 0.007), generalized COVID-19 symptoms (P = 0.012), hospitalization for COVID-19 (P = 0.019), and immune status (P = 0.024). Moreover, sgRNA RT-PCR results prompted changes in management in 28 patients (37.3%); specifically, therapeutic escalation in 13/27 (48.1%) positives and de-escalation in 15/68 (22.1%) negatives., Conclusions: Taken together, these findings underscore the clinical utility of sgRNA RT-PCR testing in a pediatric population as we report significant associations between sgRNA RT-PCR results and clinical parameters related to COVID-19. These findings align with the proposed use of sgRNA RT-PCR testing to guide patient management and IPC practices in the hospital setting., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Introduction: The female reproductive tract harbours unique microbial communities (known as microbiota) which have been associated with reproductive functions in health and disease. While endometrial microbiome studies have shown that the uterus possesses higher bacterial diversity and richness compared to the vagina, the knowledge regarding the composition of the Fallopian tubes (FT) is lacking, especially in fertile women without any underlying conditions., Methods: To address this gap, our study included 19 patients who underwent abdominal hysterectomy for benign uterine pathology, and 5 women who underwent tubal ligation as a permanent contraceptive method at Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA). We analyzed the microbiome of samples collected from the FT and endometrium using 16S rRNA gene sequencing., Results: Our findings revealed distinct microbiome profiles in the endometrial and FT samples, indicating that the upper reproductive tract harbors an endogenous microbiome. However, these two sites also shared some similarities, with 69% of the detected taxa Being common to both. Interestingly, we identified seventeen bacterial taxa exclusively present in the FT samples, including the genera Enhydrobacter, Granulicatella, Haemophilus, Rhizobium, Alistipes , and Paracoccus , among others. On the other hand, 10 bacterial taxa were only found in the endometrium, including the genera Klebsiella, Olsenella, Oscillibacter and Veillonella (FDR <0.05). Furthermore, our study highlighted the influence of the endometrial collection method on the findings. Samples obtained transcervically showed a dominance of the genus Lactobacillus, which may indicate potential vaginal contamination. In contrast, uterine samples obtained through hysterescopy revealed higher abundance of the genera Acinetobacter, Arthrobacter, Coprococcus, Methylobacterium, Prevotella, Roseburia, Staphylococcus , and Streptococcus ., Discussion: Although the upper reproductive tract appears to have a low microbial biomass, our results suggest that the endometrial and FT microbiome is unique to each individual. In fact, samples obtained from the same individual showed more microbial similarity between the endometrium and FT compared to samples from different women. Understanding the composition of the female upper reproductive microbiome provides valuable insights into the natural microenvironment where processes such as oocyte fertilization, embryo development and implantation occur. This knowledge can improve in vitro fertilization and embryo culture conditions for the treatment of infertility., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Canha-Gouveia, Pérez-Prieto, Rodríguez, Escamez, Leonés-Baños, Salas-Espejo, Prieto-Sánchez, Sánchez-Ferrer, Coy and Altmäe.)

Perioperative handoffs are high-risk events for miscommunications and poor care coordination, which cause patient harm. Extensive research and several interventions have sought to overcome the challenges to perioperative handoff quality and safety, but few efforts have focused on teamwork training. Evidence shows that team training decreases surgical morbidity and mortality, and there remains a significant opportunity to implement teamwork training in the perioperative environment. Current perioperative handoff interventions face significant difficulty with adherence which raises concerns about the sustainability of their impact. In this perspective article, we explain why teamwork is critical to safe and reliable perioperative handoffs and discuss implementation challenges to the five core components of teamwork training programs in the perioperative environment. We outline evidence-based best practices imperative for training success and acknowledge the obstacles to implementing those best practices. Explicitly identifying and discussing these obstacles is critical to designing and implementing teamwork training programs fit for the perioperative environment. Teamwork training will equip providers with the foundational teamwork competencies needed to effectively participate in handoffs and utilize handoff interventions. This will improve team effectiveness, adherence to current perioperative handoff interventions, and ultimately, patient safety., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Paquette, Kilcullen, Hoffman, Hernandez, Mehta, Salas and Greilich.)

Based on the activity of 23 TSCs on CZ taken from the literature, we have developed a QSAR model for predicting the activity of TSCs. New TSCs were designed and then tested against CZP, resulting in inhibitors with IC 50 values in the nanomolar range. The modelling of the corresponding TSC-CZ complexes by molecular docking and QM/QM ONIOM refinement indicates a binding mode compatible with what was expected for active TSCs, according to a geometry-based theoretical model previously developed by our research group. Kinetic experiments on CZP suggest that the new TSCs act by a mechanism that involves the formation of a reversible covalent adduct with slow association and dissociation kinetics. These results demonstrate the strong inhibitory effect of the new TSCs and the benefit of the combined use of QSAR and molecular modelling techniques in the design of new and potent CZ/CZP inhibitors., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: Yellow-fleshed potatoes biofortified with iron have been developed through conventional breeding, but the bioavailability of iron is unknown., Objectives: Our objective was to measure iron absorption from an iron-biofortified yellow-fleshed potato clone in comparison with a nonbiofortified yellow-fleshed potato variety., Methods: We conducted a single-blinded, randomized, crossover, multiple-meal intervention study. Women (n = 28; mean ± SD plasma ferritin 21.3 ± 3.3 μg/L) consumed 10 meals (460 g) of both potatoes, each meal extrinsically labeled with either 58 Fe sulfate (biofortified) or 57 Fe sulfate (nonfortified), on consecutive days. Iron absorption was estimated from iron isotopic composition in erythrocytes 14 d after administration of the final meal., Results: Mean ± SD iron, phytic acid, and ascorbic acid concentrations in iron-biofortified and the nonfortified potato meals (mg/per 100 mg) were 0.63 ± 0.01 and 0.31 ± 0.01, 39.34 ± 3.04 and 3.10 ± 1.72, and 7.65 ± 0.34 and 3.74 ± 0.39, respectively (P < 0.01), whereas chlorogenic acid concentrations were 15.14 ± 1.72 and 22.52 ± 3.98, respectively (P < 0.05). Geometric mean (95% CI) fractional iron absorption from the iron-biofortified clone and the nonbiofortified variety were 12.1% (10.3%-14.2%) and 16.6% (14.0%-19.6%), respectively (P < 0.001). Total iron absorption from the iron-biofortified clone and the nonbiofortified variety were 0.35 mg (0.30-0.41 mg) and 0.24 mg (0.20-0.28 mg) per 460 g meal, respectively (P < 0.001)., Conclusions: TIA from iron-biofortified potato meals was 45.8% higher than that from nonbiofortified potato meals, suggesting that iron biofortification of potatoes through conventional breeding is a promising approach to improve iron intake in iron-deficient women. The study was registered at www., Clinicaltrials: gov as Identifier number NCT05154500., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: Venous thromboembolism (VTE) is a leading cause of death among patients with cancer. The Khorana score was developed for assessing the risk of VTE in outpatients with cancer receiving chemotherapy, but its accuracy in identifying patients at high risk has been questioned. The aim of this study was to develop and validate a clinical-genetic score that improves the assessment of VTE risk in oncology outpatients within 6 months of diagnosis., Methods: The new score was developed using the data of 364 outpatients belonging to the Spanish ONCOTHROMB 12-01 population. In this cohort, clinical data associated with the risk of VTE were collected at the time of diagnosis, including the Khorana score. These patients were also genotyped for the 51 genetic variants known to be associated with VTE. Multivariate logistic regression was performed to determine the weight of each genetic and clinical variable in relation to VTE risk, allowing a clinical-genetic risk score (the ONCOTHROMB score) to be developed. The Khorana and the ONCOTHROMB scores were then compared via the area under the receiver operating characteristic curve (AUC), calibration, and the number of patients needed to treat. The new score was then validated in a study of 263 patients in the Vienna Cancer and Thrombosis Study population., Results: Nine genetic variants, tumor site, TNM stage, and a body mass index of > 25 kg/m 2 were found to be associated with VTE and were used to build the ONCOTHROMB score, which better predicted the overall risk of VTE than did the Khorana score (AUC, 0.781 v 0.580; P < .001). Similar AUC results were recorded in the validation study the Vienna Cancer and Thrombosis Study cohort involving patients with the same type of tumor (AUC for the ONCOTHROMB score v the Khorana score: 0.686 v 0.577; P < .001) and with all type of tumors (AUC for the ONCOTHROMB score v the Khorana score: 0.720 v 0.561; P < .0001)., Conclusion: The ONCOTHROMB score for VTE risk in outpatients with cancer, which takes into account both clinical and genetic variables, better identifies patients who might benefit from primary thromboprophylaxis than does the Khorana score.

Background: Handoffs are ubiquitous in modern healthcare practice, and they can be a point of resilience and care continuity. However, they are prone to a variety of issues. Handoffs are linked to 80% of serious medical errors and are implicated in one of three malpractice suits. Furthermore, poorly performed handoffs can lead to information loss, duplication of efforts, diagnosis changes and increased mortality., Methods: This article proposes a holistic approach for healthcare organisations to achieve effective handoffs within their units and departments., Results: We examine the organisational considerations (ie, the facets controlled by higher-level leadership) and local drivers (ie, the aspects controlled by the individuals working in the units and providing patient care)., Conclusion: We propose advice for leaders to best enact the processes and cultural change necessary to see positive outcomes associated with handoffs and care transitions within their units and hospitals., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Sleep is an essential element for patients' recovery during a period of hospitalisation. Hospital Clínic de Barcelona has developed the ClíNit project to promote patients' sleep by identifying elements that affect the quality of sleep and implementing actions to improve rest at night., Objective: Our aim is to select actions to improve sleep quality., Methods: The study population included night-shift nurses from two clinical units where the pilot actions were to be carried out (n: 14). The nurses prioritised actions to improve sleep quality using the methodology proposed by Fogg: clarification, magic wand, crispification, and the focus-mapping technique., Results: Two sessions were organised for each unit and 32 actions considered high impact and easy to implement were proposed, of which 43.75% (14/32) were directly dependent on nurses. It was then agreed to implement four of these pilot studies., Conclusions: One aspect worth highlighting is that using prioritization techniques such as the Fogg technique is a good strategy to implement the general objectives of intervention programmes in large organizations in an easy way.

In this effort we draw from the literature on interprofessional teamwork in high reliability organizations from different fields of study, including healthcare, industrial/organizational psychology, and management. We combine this literature with our collective experience to offer five observations on future needs for the field of team science research and practice. These themes include: (1) exploration of nonclinical teams, (2) evaluation of multi-team systems in healthcare, (3) the study of dyad leadership of teams, (4) the proliferation of virtual healthcare teams, and (5) the continuing integration of organizational and team science into the study of interprofessional teams. By presenting these observations, we argue why each is critical to the overall understanding of interprofessional teamwork in healthcare and provide areas for future scholarly advancement that will inform healthcare practice.