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Introduction: The Accreditation Council for Graduate Medical Education (ACGME), a U.S. nonprofit organization setting educational standards for safe and high-quality medical care, recently expanded its requirements for resident well-being, emphasizing self-care. However, little research exists on this topic. This study aimed to assess the types and frequency of mindful self-care behaviors, defined as intentional practices that promote awareness of internal needs and external demands. It also examined the relationship between self-care, well-being, burnout, distress, and depression, and whether self-care can protect residents from depression linked to burnout and distress. Methods: A cross-sectional survey was conducted with medical residents at a Northeastern U.S. medical school over three months. Residents in their first four years of surgical and non-surgical specialties received an email with a survey link and informed consent. Mindful self-care was assessed using the Mindful Self-Care Scale (MSCS), distress with the Physician Well-Being Index (PWBI), depression with the Patient Health Questionnaire-9 (PHQ-9), and wellness with the Brief Resident Wellness Profile (BRWP). Data were analyzed using SPSS, with moderation analyses performed to explore self-care’s role in mitigating depression linked to distress. Results: A total of 104 residents participated (15.95% response rate). Self-care positively correlated with resident well-being (r = .62, p < .0001) and negatively correlated with resident distress (r = -.50, p < .0001) and resident depression (r = -.56, p < .0001). Burned-out residents had significantly less self-care than those not burned out (F (1,97) = 15.69, p < .0001). Moderation analyses evidenced that mindful self-care is protective for residents against developing depression related to burnout and distress. Discussion: This research shows that resident self-care is strongly linked to well-being and is associated with lower distress, depression, and burnout. It highlights that self-care can protect against poor health outcomes during residency and emphasizes that self-care can involve changing one’s approach rather than requiring additional resources like time or money.

Background: Feeding difficulties and subsequent malnutrition are common in children with cerebral palsy (CP).Objectives: A study was undertaken to determine the current practices and challenges of South African registered dietitians (SA RD) regarding the nutritional management of children with CP, to compare these practices with international guidelines and to compare the practices of private- and public-sector dietitians.Design: This was a cross-sectional descriptive study with an analytical component.Subjects and outcome measures: The SA RDs completed an online questionnaire, which was developed according to the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines. Participant answers were scored to assess their management of children with CP.Results: Of the 87 SA RDs who participated, 78 had work experience in CP (40 public and 38 private sector). Over two-thirds (n = 62/87, 71.2%) received training on the management of CP at university, albeit inadequate (n = 42/62, 67.7%). Common challenges that affect RDs’ management are poor caregiver compliance (n = 72; 92.2%) and poor networking between healthcare professionals (HCPs) (n = 60; 77.0%). The SA RD (n = 78) management of children with CP was significantly different from the ESPGHAN guidelines (p

To estimate the effect of neighborhood-level modification on the efficacy of the MyPEEPS Mobile intervention on the reduction of condomless anal sex acts among same-sex attracted adolescent men.A series of generalized linear mixed model was used to examine if the effect of the MyPEEPS Mobile intervention on condomless anal sex acts was moderated by neighborhood-level factors using data from the 2019 American Community Survey US Census Bureau. “The magnitudes of intervention were significantly smaller at both 6- and 9-month follow-up among adolescents living in neighborhood with high proportions of Hispanic or Latino residents (IRR6M = 1.02, 95 % CI: 1.01, 1.02; IRR9M = 1.03, 95 % CI: 1.01, 1.05) and high proportions of families with income below the poverty level (IRR6M = 1.07, 95 % CI: 1.01, 1.12; IRR9M = 1.05, 95 % CI: 1.01, 1.10), which indicated that living in communities with a higher concentration of residents living under poverty or of Hispanic/and Latino ethnicity significantly modified the effective of program intervention on condomless sex among adolescent MSM. Understanding how neighborhood characteristics modify the effect of HIV prevention interventions may be useful in better targeting delivery and tailoring content of interventions based on neighborhood level characteristics such as the ones identified in this study.

Professional literature presents evidence that foster care agencies, foster parents, and educators are unprepared to meet the distinctive educational needs of foster youth. Although there is a general lack of evidence on specific interventions developed for foster youth, some studies have addressed the impact of tutoring. This paper studies the impact of a pilot program that paired 15 teacher candidates with 15 foster youth for virtual reading tutoring as part of a college course. Data were collected from youth, parents, and teacher candidates through surveys and focus groups. The results of this study suggested that the tutoring relationship produced several academic and emotional benefits for both foster youth and tutors. Participants all saw evidence of increases in the tutees' skill level and content knowledge, and tutors overwhelmingly reported feelings of fulfillment. The establishment of a strong, supportive relationship between tutor and tutee was also seen as a primary factor in success. Finally, the study presented evidence that diverse instructional resources and methods are important for youth engagement and that tutors need in-depth, thorough training on how to locate and properly use these types of resources. Suggestions for future research are proposed.

Matrix metalloproteinases (MMPs) are significant drivers of many diseases, including cancer, and are established targets for drug development. Tissue inhibitors of metalloproteinases (TIMPs) are endogenous MMP inhibitors and are being pursued for the development of anti-MMP therapeutics. TIMPs possess many attractive properties for drug candidates, such as complete MMP inhibition, low toxicity, low immunogenicity, and high tissue permeability. However, a major challenge with TIMPs is their rapid clearance from the bloodstream due to their small size. This study explores a method for extending the plasma half-life of the N-terminal domain of TIMP2 (N-TIMP2) by appending it with a long, intrinsically unfolded tail containing Pro, Ala, and Thr (PATylation). We designed and produced two PATylated N-TIMP2 constructs with tail lengths of 100 and 200 amino acids (N-TIMP2-PAT100 and N-TIMP2-PAT200). Both constructs demonstrated higher apparent molecular weights and retained high inhibitory activity against MMP-9. N-TIMP2-PAT200 significantly increased plasma half-life in mice compared to the non-PATylated variant, enhancing its therapeutic potential. PATylation offers distinct advantages for half-life extension, such as fully genetic encoding, monodispersion, and biodegradability. It can be easily applied to N-TIMP2 variants engineered for high affinity and selectivity toward individual MMPs, creating promising candidates for drug development against MMP-related diseases.

Background: Researchers have established that the preterm neonate is born with an immature gastrointestinal tract. The preterm neonate is thus susceptible to various complications often seen in the neonatal intensive care unit, e.g., feeding intolerances, necrotizing enterocolitis, and hospital-acquired bloodstream infections. These complications can be life-threatening, and if survived, can have an unfavorable effect on the neonate’s growth and development. Aim: The aims of this narrative review article were to provide an in-depth understanding of the various factors contributing to the development of the preterm neonatal microbiome. Further, we reviewed gastrointestinal microbiome dysbiosis and its potential role in the development of feeding intolerances, necrotizing enterocolitis, and hospital-acquired bloodstream infections. Lastly, we described the potential role of probiotics in this vulnerable population. Methods: A PubMed database search was conducted identifying articles that describe the development and function of the neonatal microbiome, the role of gastrointestinal dysbiosis, and the development of neonatal complications as well as the role of probiotics in gastrointestinal dysbiosis. Results: Various maternal, neonatal, and environmental factors play a role in the development of gastrointestinal dysbiosis in the preterm neonate. This can lead to feeding intolerances, necrotizing enterocolitis, and hospital-acquired bloodstream infections. Discussion: The pathogenesis of the development of short-term complications in the preterm neonate can be linked to the immaturity of the host immune system as well as alterations seen in the intestinal microbiome. There is a growing body of evidence that probiotics can play a role in preventing dysbiosis and thus complications observed in the preterm neonate. However, the optimal combination of probiotic strains and dosage still needs to be identified.

This article shares development of a mentor teacher training program to support teacher candidates in their student teaching internship. The mentor teacher training program includes three parts: (a) online training on internship processes and procedures, co-teaching, and a department developed Framework for Extended Oral and Written Feedback, (b) face-to-face orientation session to clarify co-teaching and feedback framework, and (c) co-observation of intern candidates by faculty supervisor and mentor teacher. The goal of the mentor teacher training program is to orient mentor teachers to the internship and to train them in providing high quality, actionable feedback that leads the teacher candidate to improved practice.

Objectives The Bronchiolitis Endotracheal Surfactant Study (BESS) is a randomised controlled trial to determine the efficacy of endo-tracheal surfactant therapy for critically ill infants with bronchiolitis. To explore acceptability of BESS, including approach to consent within a limited time frame, we explored parent and staff experiences of trial involvement in the first two bronchiolitis seasons to inform subsequent trial conduct.Design A mixed-method embedded study involving a site staff survey, questionnaires and interviews with parents approached about BESS.Setting Fourteen UK paediatric intensive care units.Participants Of the 179 parents of children approached to take part in BESS, 75 parents (of 69 children) took part in the embedded study. Of these, 55/69 (78%) completed a questionnaire, and 15/69 (21%) were interviewed. Thirty-eight staff completed a questionnaire.Results Parents and staff found the trial acceptable. All constructs of the Adapted Theoretical Framework of Acceptability were met. Parents viewed surfactant as being low risk and hoped their child’s participation would help others in the future. Although parents supported research without prior consent in studies of time critical interventions, they believed there was sufficient time to consider this trial. Parents recommended that prospective informed consent should continue to be sought for BESS. Many felt that the time between the consent process and intervention being administered took too long and should be ‘streamlined’ to avoid delays in administration of trial interventions. Staff described how the training and trial processes worked well, yet patients were missed due to lack of staff to deliver the intervention, particularly at weekends.Conclusion Parents and staff supported BESS trial and highlighted aspects of the protocol, which should be refined, including a streamlined informed consent process. Findings will be useful to inform proportionate approaches to consent in future paediatric trials where there is a short timeframe for consent discussions.Trial registration number ISRCTN11746266.

Aim:Hospital acquired bloodstream infection (HA-BSI) is a major contributor to morbidity and mortality in preterm, very low birthweight infants, especially in low-to-middle- income countries.Materials and Methods:We conducted a double-blind, placebo-controlled, randomized clinical trial to investigate the effect of a multi-strain probiotic formulation (LabinicTM) on the incidence and severity of HA-BSI in preterm neonates.Results:Two hundred neonates (100 per arm) were included in this trial. Fifteen neonates developed HA-BSI events (2 in the probiotic arm and 13 in the placebo arm). The median day of life at HA-BSI onset for the probiotic group was 10.5±3.5, and for the placebo group, it was 11.2±6.4. The incidence of HA-BSI in neonates receiving the probiotic was significantly lower compared to those receiving the placebo [0.93 versus 5.99 HA-BSI events/1,000 neonate-days; incidence rate ratio (IRR) of 0.156 [95% confidence interval (CI): 0.017 to 0.691], p=0.0046]. Calculating the incidence rate of the combined outcome (sepsis/death) was also lower in the probiotic group versus the placebo group [2.34 versus 6.45 events/1,000 neonate days; IRR 0.33 (95% CI: 0.11 to 0.97), p=0.043].Conclusion:The use of a multi-strain probiotic significantly reduced HA-BSI incidence in this cohort of preterm neonates.

Abstract Objectives Microtia and aural atresia are congenital ear anomalies with a wide‐ranging spectrum of phenotypes and varied functional and psychosocial consequences for patients. This study seeks to analyze the management of microtia‐atresia patients at our center over a 20‐year period and to propose recommendations for advancing microtia‐atresia care at a national level. Methods We performed a retrospective analysis of data from patients presenting to the Massachusetts Eye and Ear (Boston, MA) for initial otolaryngology consultation for congenital microtia and/or aural atresia between 1999 and 2018. Results Over the 20‐year study period, 229 patients presented to our microtia‐atresia center at a median age of 7 years. The severity of microtia was most commonly classified as grade III (n = 87, 38%), 61% (n = 140) of patients had complete atresia, the median Jahrsdoerfer grading scale score was 6 (range 0–10), and 81 patients (35%) underwent surgery for microtia repair. For hearing rehabilitation, 30 patients (64%) underwent bone conduction device implantation and 17 patients (36%) underwent atresiaplasty. The implementation of an interdisciplinary, longitudinal care model resulted in an increase in patient (r = 0.819, p

The study of protein-protein interactions (PPIs) and the engineering of protein-based inhibitors often employ two distinct strategies. One approach leverages the power of combinatorial libraries, displaying large ensembles of mutant proteins, for example, on the yeast cell surface, to select binders. Another approach harnesses computational modeling, sifting through an astronomically large number of protein sequences and attempting to predict the impact of mutations on PPI binding energy. Individually, each approach has inherent limitations, but when combined, they generate superior outcomes across diverse protein engineering endeavors. This synergistic integration of approaches aids in identifying novel binders and inhibitors, fine-tuning specificity and affinity for known binding partners, and detailed mapping of binding epitopes. It can also provide insight into the specificity profiles of varied PPIs. Here, we outline strategies for directing the evolution of tissue inhibitors of metalloproteinases (TIMPs), which act as natural inhibitors of matrix metalloproteinases (MMPs). We highlight examples wherein design of combinatorial TIMP libraries using structural and computational insights and screening these libraries of variants using yeast surface display (YSD), has successfully optimized for MMP binding and selectivity, and conferred insight into the PPIs involved.

BackgroundPeople living with HIV have long life expectancy and are experiencing more comorbid conditions, being at an increased risk for developing cardiovascular disease (CVD) and diabetes, further exacerbated due to the HIV or inflammatory process. One effective intervention shown to decrease mortality and improve health outcomes related to CVD and diabetes in people living with HIV is increased regular physical activity. However, people living with HIV often fall short of the daily recommended physical activity levels. While studies show that mobile health (mHealth) can potentially help improve people’s daily activity levels and reduce mortality rates due to comorbid conditions, these studies do not specifically focus on people living with HIV. As such, it is essential to understand how mHealth interventions, such as wearables, can improve the physical activity of people living with HIV. ObjectiveThis study aimed to understand participants’ experiences wearing a fitness tracker and an app to improve their physical activity. MethodsIn total, 6 focus groups were conducted with participants who completed the control arm of a 6-month randomized controlled trial (ClinicalTrials.gov NCT03205982). The control arm received daily walk step reminders to walk at least 5000 steps per day and focused on the overall wellness of the individual. The analysis of the qualitative focus groups used inductive content analysis using the theory of planned behavior as a framework to guide and organize the analysis. ResultsIn total, 41 people living with HIV participated in the focus groups. The majority (n=26, 63%) of participants reported their race as Black or African American, and 32% (n=13) of them identified their ethnicity as Hispanic or Latino. In total, 9 major themes were identified and organized following the theory of planned behavior constructs. Overall, 2 major themes (positive attitude toward tracking steps and tracking steps is motivating) related to attitudes toward the behavior, 2 major themes (social support or motivation from the fitness tracker and app and encouragement from family and friends) related to participant’s subjective norms, 1 theme (you can adjust your daily habits with time) related to perceived behavioral control, 2 themes (reach their step goal and have a healthier lifestyle) related to participant’s intention, and 2 themes (continuing to walk actively and regularly wearing the fitness tracker) related to participant’s changed behavior. Participants highlighted how the mHealth interface with the avatar and daily step tracking motivated them to both begin and continue to engage in physical activity by adjusting their daily routines. ConclusionsFindings from this study illustrate how features of mHealth apps may motivate people living with HIV to start and continue sustained engagement in physical activities. This sustained increase in physical activity is crucial for reducing the risk of comorbid conditions such as diabetes or CVD. Trial RegistrationClinicalTrials.gov NCT03205982; https://classic.clinicaltrials.gov/ct2/show/NCT03205982

This article documents the results of a meta-analysis of available correlational validity evidence for the Social Skills Improvement System Performance Screening Guide (SSIS-PSG), which is a brief teacher-completed rating scale designed to be used as part of universal screening procedures. Article inclusion criteria included (a) published in English in a peer-reviewed journal, (b) administration of the PSG, and (c) provided validity evidence representative of the relationship between PSG scores and scores on related variables. Ten studies yielding 147 correlation coefficients met criteria for inclusion. Data were extracted following established procedures in validity generalization and meta-analytic research. Extracted coefficients were of the expected direction and magnitude with theoretically aligned constructs, thereby providing evidence of convergent validity (e.g., PSG Math and Reading items were most strongly correlated with academic performance and academic behavior variables, with effect sizes ranging from 0.708 to 0.740; PSG Prosocial Behavior and Motivation to Learn items were most strongly correlated with broadband externalizing/internalizing problems, with effect sizes ranging from -0.706 to -0.717), although Prosocial Behavior and Motivation to Learn were not as effective at discriminating among divergent constructs. These results generally support the utility of the PSG in correlating with academic and social/behavioral outcomes in the schools.

Safely opening university campuses has been a major challenge during the COVID-19 pandemic. Here, the authors describe a program of public health measures employed at a university in the United States which, combined with other non-pharmaceutical interventions, allowed the university to stay open in fall 2020 with limited evidence of transmission.

Kimberlé Crenshaw's scholarship on Black women has been the springboard for numerous education studies in which researchers use intersectionality as a theoretical framework; however, few have considered the possibilities of intersectionality as a methodological tool. In this literature synthesis, the authors (a) examined studies about Black women in higher education that had been published in the past 30 years to understand how those scholars applied intersectionality across Crenshaw's three dimensions (i.e., structural, political, and representational) and (b) advanced a set of four strategies, arguably providing a guide for engaging "intersectionality methodology," what the authors coin as "IM." Implications for higher education research and social science research broadly are also presented.