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To develop a Theory of Change (ToC) pathway to facilitate the development of a multi-component intervention package supporting pressure Ulcer (PU) risk identification and management, in partnership with people with Long Term Neurological Conditions (LTNC) who self-manage care and live at home, their informal carers and PAs. A participatory approach, with extensive input from those whose lives are the focus of the research, was used throughout the 4 interlinked work packages (WP): • WP1 – Development of two co-operative Inquiry Groups (CIGs) • WP2 - Semi-structured interviews and/or app participation • WP3– Professional and strategic stakeholder engagement • WP4–Systems mapping and Theory of Change (ToC pathway development Iterative data analysis was undertaken with emerging findings from each WP informing subsequent stages of the study. Overall, 74 participants contributed across the 4 WPs, incorporating 31 Service Users (SU), 8 carers, 9 Personal Assistants (PAs) and 26 professional stakeholders. We identified 8 key themes related to PU prevention, incorporating, learning, safe routines, third sector and peer support, navigating complex systems, adapting and reacting to change, perceptions of risk, risk negotiation and supporting roles. The findings indicate systemic and professional barriers which hamper people's ability to self-care and seek help. The study highlights the complexities and impact of managing PU prevention activities at home for people with LTNC and areas of learning for health professionals and systems. By understanding these complexities we developed a systems map, identified resource requirements and illustrated a Theory of Change (ToC) pathway, to underpin future work to develop and user test an interactive, multi-component intervention. • People with Long-Term Neurological Conditions (LTNCs) are at increased risk of Pressure Ulcer (PU) development. • People with LTNCs often manage multiple needs and changing risks across complex health conditions and busy lives. • There is a gap in support, resources, and training for people with LTNCs and their carers, who manage PU risk at home. • Complex health and social care services, and gaps in provision, hamper people's ability to escalate care when needed. • Healthcare Professionals and service users sometimes have different perceptions of PU risk. [ABSTRACT FROM AUTHOR]

Manufacturing and construction (M&C) companies cause significant environmental impacts and are under pressure to act. Despite research analysing the relationship between environmental impact mitigation (EIM) and economic performance (EP), findings remain inconclusive. Acknowledging the longevity of the M&C sector, and the uptake of ISO 14001 in UK companies, there is a lack of research analysing this relationship. Research has predominantly used dichotomous measurements for EIM, yet this fails to consider the substantiveness of the approach. This paper develops a multifaceted scoring system to measure the substantiveness of a company's approach to EIM. Using a sample of 58 UK-based publicly-listed M&C companies, the measurement analyses how a substantive approach to EIM affects EP. Correlational tests showed a medium, positive relationship. This implies companies may not need to choose between EIM and profit. The findings and the multifaceted measurement developed have implications for research, stakeholders, and high-level leadership teams. [ABSTRACT FROM AUTHOR]

Key Points: Question: What is the relative effectiveness of grief-focused cognitive behavior therapy compared with mindfulness-based cognitive therapy to reduce prolonged grief? Findings: In this randomized clinical trial of 100 adults with prolonged grief disorder, both interventions were associated with reduced grief severity, and grief-focused cognitive behavior therapy demonstrated greater reduction in prolonged grief symptoms 6 months after treatment compared to mindfulness-based cognitive therapy. Meaning: The findings indicate that both interventions may be considered for treating prolonged grief symptoms; with consideration of all relevant factors, grief-focused cognitive behavior therapy appeared to be more effective in reducing grief severity. This randomized clinical trial evaluates the efficacy of grief-focused cognitive behavior therapies vs mindfulness-based cognitive therapy in individuals with prolonged grief disorder. Importance: Although grief-focused cognitive behavior therapies are the most empirically supported treatment for prolonged grief disorder, many people find this treatment difficult. A viable alternative for treatment is mindfulness-based cognitive therapy. Objective: To examine the relative efficacies of grief-focused cognitive behavior therapy and mindfulness-based cognitive therapy to reduce prolonged grief disorder severity. Design, Setting, and Participants: A single-blind, parallel, randomized clinical trial was conducted among adults aged 18 to 70 years with prolonged grief disorder, as defined in the International Classification of Diseases, 11th Revision, and assessed by clinical interview based on the Prolonged Grief−13 (PG-13) scale. Those with severe suicidal risk, presence of psychosis, or substance dependence were excluded. Between November 2012 and November 2022, eligible participants were randomized 1:1 to eleven 90-minute sessions of grief-focused cognitive behavior therapy or mindfulness-based cognitive therapy at a traumatic stress clinic in Sydney, Australia, with follow-up through 6 months. Interventions: Both groups received once-weekly 90-minute individual sessions for 11 weeks. Grief-focused cognitive behavior therapy comprised 5 sessions of recalling memories of the deceased, plus cognitive restructuring and planning future social and positive activities. Mindfulness-based cognitive therapy comprised mindfulness exercises adapted to tolerate grief-related distress. Main Outcomes and Measures: The primary outcome was change in prolonged grief disorder severity measured by the PG-13 scale assessed at baseline, 1 week posttreatment, and 6 months after treatment (primary outcome time point), as well as secondary outcome measures of depression, anxiety, grief-related cognition, and quality of life. Results: The trial included 100 participants (mean [SD] age, 47.3 [13.4] years; 87 [87.0%] female), 50 in the grief-focused cognitive behavior therapy condition and 50 in the mindfulness-based cognitive therapy condition. Linear mixed models indicated that at the 6-month assessment, participants in the grief-focused cognitive behavior therapy group showed greater reduction in PG-13 scale score relative to those in the mindfulness-based cognitive therapy group (mean difference, 7.1; 95% CI, 1.6-12.5; P =.01), with a large between-group effect size (0.8; 95% CI, 0.2-1.3). Participants in the grief-focused cognitive behavior therapy group also demonstrated greater reductions in depression as measured on the Beck Depression Inventory than those in the mindfulness-based cognitive therapy group (mean difference, 6.6; 95% CI, 0.5-12.9; P =.04) and grief-related cognition (mean difference, 14.4; 95% CI, 2.8-25.9; P =.02). There were no other significant differences between treatment groups and no reported adverse events. Conclusions and Relevance: In this study, grief-focused cognitive behavior therapy conferred more benefit for core prolonged grief disorder symptoms and associated problems 6 months after treatment than mindfulness-based cognitive therapy. Although both treatments may be considered for prolonged grief disorder, grief-focused cognitive behavior therapy might be the more effective choice, taking all factors into consideration. Trial Registration: anzctr.org.au Identifier: ACTRN12612000307808 [ABSTRACT FROM AUTHOR]

This paper describes the innovative approach of using liberating structures to the development of the AUR 2023 strategic plan, and lessons learned in their application. The 2023 strategic plan built on the results and approach of the prior 2015 plan. Similar to the 2015 strategic plan, traditional tools such as a SWOT analysis and strategic retreat were used. In addition, the 2023 process included tools called liberating structures and was iteratively co-produced through a series of virtual meetings over 18 months. Advantages of liberating structures included increased creativity and speed in moving through meeting tasks, increased number of meaningful contributions from AUR members and increased engagement from participants during discussions and meetings. The 2023 AUR strategic plan is provided along with examples of completed goals and those under early implementation. Lessons learned from using these tools for strategic planning can be applied to other society and group meetings. Moving forward, the 2023 strategic plan will be a living document, which will be reviewed at each Board of Directors meeting and periodically adapted. [ABSTRACT FROM AUTHOR]

Three radiologists representing unique career stages and paths have reflected on tips for achieving personal and career satisfaction that are relevant to their respective stage. Using published resources to lend support to these tips, this review article concludes by offering tangible tools that academic radiology departments can utilize to help customize faculty development to their staff at the various career stages. [ABSTRACT FROM AUTHOR]

The article discusses three models of change in relation to the field of radiology. Topics discussed include the transtheoretical model of change which is based on the assumption that behavioral change progresses through different stages, the diffusion of innovation model wherein certain set of characteristics determines the different rates of adoption of innovation, and the Plan-Do-Study-Act (PDSA) model which is use to improve health care quality.

Apply it!: By reading this article, the health and fitness professional will learn: • Physical activity guidelines emphasize the performance of aerobic exercise for health and often indicate that resistance exercise can be beneficial; however, emerging evidence shows that resistance exercise is often as effective as aerobic for many aspects of health. • Resistance exercise participation can benefit several health aspects: cardiorespiratory health, vascular health, muscle oxidative capacity, mental health, muscle hypertrophy, strength, and power. • To support clients in sticking to their program, use strategies like monitoring (you and your client keeping track of how much resistance exercise they are doing), action planning (scheduling when, where, and how they will do their resistance exercise), and highlighting the health and emotional benefits of resistance exercise that are relevant to your client. [ABSTRACT FROM AUTHOR]

Building upon decades of scholarship in critical archive studies, particularly work informed by critical race theory, this article closely examines the racialized power of one specific archival initiative, the Digital Transgender Archive (DTA). Presented as an extended case study of the DTA, this article reveals the white supremacist logics that can operate even within projects devoted to seeking archival justice for oppressed communities. Beginning at the broadest level, the article opens with a discussion of archival appraisal and collecting as racial power. Next, the project's commitment to open access is challenged by evaluating the harm to BIPOC communities that may result from unfettered and undifferentiated access. The subsequent two sections take a practical turn as the author discusses the DTA's approach to handling racist content and the projectwide steps that are being taken to address the white supremacist logics that undermine the mission of the project. [ABSTRACT FROM AUTHOR]

Background and Purpose: Few persons with Parkinson disease (PD) appear to engage in moderate-intensity walking associated with disease-modifying health benefits. How much time is spent walking at lower, yet still potentially beneficial, intensities is poorly understood. The purpose of this exploratory, observational study was to describe natural walking intensity in ambulatory persons with PD. Methods: Accelerometer-derived real-world walking data were collected for more than 7 days at baseline from 82 participants enrolled in a PD clinical trial. Walking intensity was defined according to the number of steps in each active minute (1-19, 20-39, 40-59, 60-79, 80-99, or ≥100 steps). Daily minutes of walking and duration of the longest sustained walking bout were calculated at each intensity. Number of sustained 10 to 19, 20 to 29, and 30-minute bouts and greater at any intensity also were calculated. Values were analyzed in the context of physical activity guidelines. Results: Most daily walking occurred at lower intensities (157.3 ± 58.1 min of 1-19 steps; 81.3 ± 32.6 min of 20-39 steps; 38.2 ± 21.3 min of 40-59 steps; 15.1 ± 11.5 min of 60-79 steps; 7.4 ± 7.0 min of 80-99 steps; 7.3 ± 9.6 min of ≥100 steps). The longest daily sustained walking bout occurred at the lowest intensity level (15.9 ± 5.2 min of 1-19 steps). Few bouts lasting 20 minutes and greater occurred at any intensity. Discussion and Conclusions: Despite relatively high daily step counts, participants tended to walk at remarkably low intensity, in bouts of generally short duration, with relatively few instances of sustained walking. The findings reinforced the need for health promotion interventions designed specifically to increase walking intensity. Video Abstract available for more insight from authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A426). [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has caused much uncertainty and disruption in healthcare resulting in many challenges for strategic planning. Scenario planning is a tool that allows healthcare leaders to plan healthcare delivery strategies by incorporating the uncertainties into the analysis and planning process. Variables were identified which will have major impact on the future, but whose future direction is uncertain. The extremes of these drivers were used to generate multiple scenarios. A subset of scenarios was used to evaluate potential tactics to determine which may be high yield in the face of uncertainty. Unlike traditional strategic planning, scenario planning does not develop a single future with a path to that future. Scenario planning evaluates tactics to determine which would be helpful in specific scenarios, multiple different futures or under specific conditions. We present a scenario planning model which can be used to determine specific tactics to accommodate the uncertainty due to variable healthcare delivery needs in the COVID-19 era. [ABSTRACT FROM AUTHOR]

The United States is currently in the fourth wave of the overdose crisis wherein stimulants together with fentanyl are the major drivers of overdose deaths. To date, there has been limited effort outside the US Veterans Administration Health System health system to disseminate evidence-based treatment for people with stimulant use disorder. Contingency management, a behavioral intervention in which positive reinforcement is provided for a target behavior indicating treatment progress, has decades of empirical support but limited implementation in real-world, non-US Veterans Administration Health System settings. The purpose of the report is to provide an overview of contingency management, the barriers to adoption, and recommendations for overcoming these barriers. [ABSTRACT FROM AUTHOR]

Background Pressure injuries are a common healthcare problem and are associated with impaired quality of life. Objective To investigate the impact of pressure injuries on the quality of life of adults aged 18 years and older. Design Systematic review. Eligibility criteria Both quantitative and qualitative studies that report on quality of life in adults with a pressure injury from acute care, rehabilitation, long-term care and com- munity settings will be included. Methods Studies conducted between January 2009 and July 2022 and found in the Ovid Medline, Ovid Embase, CINAHL EBSCO, Scopus and Central Register of Controlled Trials databases will be identified. Two independent review authors will perform the study selection and data extraction. Methodological qual- ity will be appraised using the Critical Appraisal Skills Programme checklists. A thematic synthesis will be used to analyse qualitative evidence. A meta-analysis will be conducted for quantitative data if no signifi- cant heterogeneity is detected. Where statistical pooling is not possible, findings will be reported narratively. The Grading of Recommendations As- sessment, Development and Evaluation (GRADE) and the GRADEConfidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) tools will be used to determine confidence levels of findings from quantitative and qualitative studies. [ABSTRACT FROM AUTHOR]

Melanomas in the first 2 decades of life are uncommon and poorly understood. To assess clinicopathologic features and survival of children (≤11 years) and adolescents (12-19 years) diagnosed with melanoma. A pooled cohort of 514 patients was analyzed (397 Dutch, 117 Australian; 62 children, 452 adolescents). Pathology reports were reevaluated to determine melanoma subtypes. Multivariable Cox models were generated for recurrence-free survival (RFS) and overall survival (OS). Melanoma subtypes were conventional melanoma (superficial spreading, nodular, desmoplastic, and acral lentiginous), spitzoid melanoma, and melanoma associated with a congenital nevus in 428, 78, and 8 patients, respectively. Ten-year RFS was 91.5% (95% confidence interval [CI], 82.4%-100%) in children and 86.4% (95% CI, 82.7%-90.3%) in adolescents (P =.32). Ten-year OS was 100% in children and 92.7% (95% CI, 89.8%-95.8%) in adolescents (P =.09). On multivariable analysis possible only for the adolescent cohort due to the small number of children, ulceration status, and anatomic site were associated with RFS and OS, whereas age, sex, mitotic index, sentinel node status and melanoma subtype were not. Breslow thickness >4 mm was associated with worse RFS. Retrospective study. Survival rates for children and adolescents with melanomas were high. Ulceration, head or neck location and Breslow thickness >4 mm predicted worse survival in adolescents. [ABSTRACT FROM AUTHOR]

Natural history, loosely defined as the observational study of organisms in the habitats where they occur, is recognized at the roots of ecology. Although the centrality of natural history in ecology has shifted over time, natural history is currently in resurgence: many again consider it to be the foundation of ecological and evolutionary inquiry and advocate the value of organism‐centered approaches to address contemporary ecological challenges. Educators identify natural history as the foundational entryway into the practice of ecology, for example in the Ecological Society of America's Four‐Dimensional Ecology Education (4DEE) framework. A strong natural history foundation can help generate testable hypotheses to refine mechanistic understanding of the drivers regulating species distributions and abundances and to inform restoration and conservation efforts. Given the resurgence of natural history as the foundation for ecological knowledge and practice, it is important to recognize that natural history has a long history of racism that has impacted ecological thought and priorities. This history shapes not only who conducts ecological science but also foundational ecological concepts. For example, natural history's emphasis on pristine nature untouched by humans disregards or appropriates stewardship and knowledge of most of the world's population. Because of the legacy of chattel slavery, this exclusion is particularly strong for people of African descent. This exclusion narrows ecological inquiry, limits the capacity to find solutions to ecological problems, and risks interventions that perpetuate the relation between eugenics, ecological knowledge, and natural systems. If ecology is to become an inclusive, responsive, and resilient discipline, this knowledge gap must be addressed. We here present the colonial and racist underpinnings of natural history and offer strategies to expand inclusion in the study of nature. Natural history was steeped in racism, providing a hierarchy of cultures and a taxonomy of races. Complementing growing interest in traditional and Indigenous ecological knowledge, we focus on Black ecological knowledge, for example in the study of "maroon ecologies." Addressing the racist history of natural history is necessary for removing structural and racist barriers to diverse participation and expanding ecological knowledge bases in service of better and more just science. [ABSTRACT FROM AUTHOR]

Introduction: The opioid epidemic has evolved into a combined stimulant epidemic, with escalating stimulant and fentanyl-related overdose deaths. Primary care providers are on the frontlines grappling with patients' methamphetamine use. Although effective models exist for treating opioid use disorder in primary care, little is known about current clinical practices for methamphetamine use. Methods: Six semistructured group interviews were conducted with 38 primary care providers. Interviews focused on provider perceptions of patients with methamphetamine use problems and their care. Data were analyzed using inductive and thematic analysis and summarized along the following dimensions: (1) problem identification, (2) clinical management, (3) barriers and facilitators to care, and (4) perceived needs to improve services. Results: Primary care providers varied in their approach to identifying and treating patient methamphetamine use. Unlike opioid use disorders, providers reported lacking standardized screening measures and evidence-based treatments, particularly medications, to address methamphetamine use. They seek more standardized screening tools, Food and Drug Administration–approved medications, reliable connections to addiction medicine specialists, and more training. Interest in novel behavioral health interventions suitable for primary care settings was also noteworthy. Conclusions: The findings from this qualitative analysis revealed that primary care providers are using a wide range of tools to screen and treat methamphetamine use, but with little perceived effectiveness. Primary care faces multiple challenges in effectively addressing methamphetamine use among patients singularly or comorbid with opioid use disorders, including the lack of Food and Drug Administration–approved medications, limited patient retention, referral opportunities, funding, and training for methamphetamine use. Focusing on patients' medical issues using a harm reduction, motivational interviewing approach, and linkage with addiction medicine specialists may be the most reasonable options to support primary care in compassionately and effectively managing patients who use methamphetamines. [ABSTRACT FROM AUTHOR]

In this paper, we explore the strategies utilized by civil society organizations to improve access to medicines during the HIV/AIDS and COVID-19 health crises. In particular, we seek to illuminate why some of the successful approaches for increasing access to antiretrovirals for HIV/AIDS in the early 2000s failed in creating equitable global access to COVID-19 vaccines. While civil society has historically mobilized human rights to facilitate greater access to essential medicines, we argue that earlier strategies were not always sustainable and that civil society is now mobilizing human rights in radically different ways than previously. Instead of focusing chiefly on securing an intellectual property waiver to the TRIPS Agreement, civil society organizations are now challenging vaccine injustice, rejecting the "charity discourse" that fuels Global South dependency on Global North actors in favor of scaling up manufacture in low- and middle-income countries, and moving to embed the right to access medicines in a new World Health Organization pandemic treaty with civil society organization participation and meaningful representation from low- and middle-income countries. Such approaches, we contend, will lead to more sustainable solutions in order to avert further health care disasters, like those seen with two distinct but related struggles--the fights for equitable access to essential medicines for HIV/AIDS and for COVID-19. [ABSTRACT FROM AUTHOR]