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Background: Hip fracture in the aged is a major health problem, especially considering the increasing proportion of the elderly in the population. This study examines changes in circulating levels of hormones, which are purported to affect bone metabolism, in response to hip fracture in postmenopausal women.Methods: Patients consisted of women ages 65 and older who had surgery within 2 days of fracture. Serum samples were obtained at 3, 10, 60, 180, and 360 days postfracture. Healthy women without hip fractures from the same age range served as a control group (n = 17). Hormones were determined by radioimmunoassay. Subjects with fractures in the neck region of the femur (n = 78) were compared to subjects with fractures in the trochanteric region (n = 88).Results: Estrone concentration (47.6 +/- 5.7 pg/mL; mean +/- SEM) at 3 days postfracture was elevated (p < .001) compared to control levels of 20.7 +/- 4.6 pg/mL. By 2 months, levels had declined to control levels. Androstenedione and the adrenal hormones, DHEAS and cortisol, displayed similar responses. Parathyroid hormone (PTH) levels were not significantly different from the control concentration at 3 days following fracture, but increased (p < .001) during the year following fracture. Calcitonin concentrations were much higher (p < .001) 3 days postfracture (42.1 +/- 3.7 pg/mL) compared to controls without fracture (9.8 +/- 3 pg/mL). Except for testosterone, no differences could be attributed to fracture location. Only PTH, with concentrations higher in the older age groups (p < .001), showed an age-related response.Conclusions: Following hip fracture, there are some dramatic responses in hormones that purportedly are mechanistically important in bone metabolism. These changes include transient increases in steroid hormones, chronic elevations in calcitonin, and rising levels of PTH during the year after fracture. [ABSTRACT FROM AUTHOR]

Adolescent suicide and mental illness have increased at alarming rates. Healthcare professionals report a lack of skill and confidence in obtaining adolescent histories and managing confidential care due to limited training in residency. Nursing professional development practitioners face challenges of adequately preparing interdisciplinary healthcare providers to assess, identify, and intervene at all points of contact with adolescents. To increase the confidence in clinical communication skills and clinical competency, and to increase the number of social work referrals related to modifiable risk factors for adolescent patients, a Texas pediatric tertiary care center utilized standardized patient (SP) methodology to supplement traditional clinical experiences with communication-focused education based on the Home, Education, Eating, Activities, Drugs, Sexuality, Suicidality, and Safety (HEEADSSS) interviewing. This quality improvement (QI) pilot demonstrated the benefits of utilizing standardized patient methodology in communication-focused education based on the HEEADSSS interviewing. Following the SP simulations, confidence in clinical communication skills increased by 13%, clinical competency in performing comprehensive psychosocial interviews increased by 11%, use of HEEADSSS increased by 64%, and social work referrals increased by 89%. This interdisciplinary SP interviewing simulation pilot was beneficial in improving the 36 physician and nursing residents' ability to conduct psychosocial assessments for risk factors of suicidality among adolescents.

Practice readiness continues to be a challenge in healthcare. This was especially evident during the COVID-19 pandemic. This focused descriptive-correlational study examined nurses' perceived preparedness for practice during the pandemic. One hundred and eighty-four registered nurses (RN) responded to Qualtrics survey questions addressing the competencies they perceived they had and the competencies they felt they needed that would have better prepared them to care for patients during the COVID-19 pandemic. The results demonstrated that although these nurses felt competent in certain areas, they perceived that they needed more education in those same areas to feel better prepared. Bivariate correlations and linear regression analysis indicated that institutional competency development, education, and work experience influenced perceived competency.

Background: Mindfulness-based stress reduction (MBSR) alleviates depression and anxiety in adults with autism spectrum disorder (ASD); however, underlying therapeutic neural mechanisms and mindfulness-specific effects have yet to be elucidated., Methods: We randomly assigned adults with ASD to MBSR or social support/education (SE). They completed questionnaires that assessed depression, anxiety, mindfulness traits, autistic traits and executive functioning abilities as well as a self-reflection functional MRI task. We used repeated-measures analysis of covariance (ANCOVA) to evaluate behavioural changes. To identify task-specific connectivity changes, we performed a generalized psychophysiological interactions (gPPI) functional connectivity (FC) analysis on regions of interest (ROIs; insula, amygdala, cingulum and prefrontal cortex [PFC]). We used Pearson correlations to explore brain-behaviour relationships., Results: Our final sample included 78 adults with ASD - 39 who received MBSR and 39 who received SE. Mindfulness-based stress reduction uniquely improved executive functioning abilities and increased mindfulness traits, whereas both MBSR and SE groups showed reductions in depression, anxiety and autistic traits. Decreases specific to MBSR in insula-thalamus FC were associated with anxiety reduction and increased mindfulness traits, including the trait "nonjudgment;" MBSR-specific decreases in PFC-posterior cingulate connectivity correlated with improved working memory. Both groups showed decreased amygdala-sensorimotor and medial-lateral PFC connectivity, which corresponded with reduced depression., Limitations: Larger sample sizes and neuropsychological evaluations are needed to replicate and extend these findings., Conclusion: Together, our findings suggest that MBSR and SE are similarly efficacious for depression, anxiety and autistic traits, whereas MBSR produced additional salutary effects related to executive functioning and mindfulness traits. Findings from gPPI identified shared and distinct therapeutic neural mechanisms, implicating the default mode and salience networks. Our results mark an early step toward the development of personalized medicine for psychiatric symptoms in ASD and offer novel neural targets for future neurostimulation research., Clinical Trial Registration: ClinicalTrials.gov identifier NCT04017793., Competing Interests: Competing interests: B. Pagni received support for article processing charges from the ASU Graduate Program Student Association’s Publication Grant. M. Walsh receives funding from the National Institute of Mental Health ( NIMH F31MH122107). M. Dixon received payment for execution of the program as part of this study. L. Ballard declares having received honoraria for facilitation of guided mind-fulness medications and educational presentations on mindfulness meditation., (© 2023 CMA Impact Inc. or its licensors.)

The male preponderance in autism spectrum disorder (ASD) led to the hypothesis that aspects of female biology are protective against ASD. Females with ASD (ASD-F) report more compensatory behaviors (i.e. "camouflaging") to overcome ASD-related social differences, which may be a mechanism of protection. No studies have examined sex-related brain pathways supporting camouflaging in ASD-F, despite its potential to inform mechanisms underlying the ASD sex bias. We used functional connectivity (FC) to investigate "sex-atypical" and "sex-typical" FC patterns linked to camouflaging in adults with ASD and examined multimodal coherence of findings via structural connectometry. Exploratory associations with cognitive/emotional functioning examined the adaptive nature of FC patterns. We found (i) "sex-atypical" FC patterns linked to camouflaging in the hypothalamus and precuneus and (ii) "sex-typical" patterns in the right anterior cingulate and anterior parahippocampus. Higher hypothalamic FC with a limbic reward cluster also correlated with better cognitive control/emotion recognition. Structural connectometry validated FC results with consistent brain pathways/effect patterns implicated in ASD-F. In summary, "male-typical" and "female-typical" brain connectivity patterns support camouflaging in ASD-F in circuits implicated in reward, emotion, and memory retrieval. "Sex-atypical" results are consistent with fetal steroidogenic/neuroinflammatory hypotheses. However, female genetics/biology may contribute to "female-typical" patterns implicated in camouflaging., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permission@oup.com.)

Research studying aging in adults with autism spectrum disorder (ASD) is growing, but longitudinal work is needed. Autistic adults have increased risk of dementia, altered hippocampal volumes and fornix integrity, and verbal memory difficulties compared with neurotypical (NT) adults. This study examined longitudinal aging in middle-age adults with ASD versus a matched NT group, and compared findings with cross-sectional age effects across a broad adult age range. Participants were 194 adults with (n = 106; 74 male) and without (n = 88; 52 male) ASD, ages 18-71. Participants (n = 45; 40-70 age range) with two visits (2-3 years apart) were included in a longitudinal analysis. Hippocampal volume, fornix fractional anisotropy (FA), and verbal memory were measured via T1-weighted MRI, diffusion tensor imaging, and the Rey Auditory Verbal Learning Test, respectively. Longitudinal mixed models were used for hippocampal system variables and reliable change index categories were used for Auditory Verbal Learning Test analyses. Multivariate regression was used for cross-sectional analyses. Middle-age adults with ASD had greater longitudinal hippocampal volume loss and were more likely to show clinically meaningful decline in short-term memory, compared with NT. In contrast, cross-sectional associations between increasing age and worsening short-term memory were identified in NT, but not autistic adults. Reduced fornix FA and long-term memory in ASD were found across the broad cross-sectional age range. These preliminary longitudinal findings suggest accelerated hippocampal volume loss in ASD and slightly higher rates of clinically-meaningful decline in verbal short-term memory. Contradictory cross-sectional and longitudinal results underscore the importance of longitudinal aging research in autistic adults. LAY SUMMARY: Autistic adults have increased risk of dementia, differences in brain memory structures, and difficulty with memory compared with neurotypical (NT) adults. However, there are no publications that follow the same middle-age autistic adults over time to see how their brain and memory change. Our preliminary findings in a small middle-age autism sample suggest a key memory brain structure, the hippocampus, may shrink faster over 2-3 years compared with NT, and short-term memory may become more challenging for some. Across a broad adult range, autistic adults also had reduced integrity of connections to the hippocampus and greater challenges with long-term memory. In our larger sample across a broad age range, the results did not hint at this aforementioned pattern of accelerated aging. This underscores the importance of more aging research in autism, and especially research where people are followed over time., (© 2022 International Society for Autism Research and Wiley Periodicals LLC.)

Background: Reconceptualized nursing education can prepare registered nurses to practice at the full scope of licensure on interprofessional teams across care continua while enhancing the quality of health care systems., Problem: Traditional nursing programs minimally address primary care competencies. Rapidly changing managed care models demand nurses develop knowledge, skills, and attitudes to effectively deliver population health, primary care, care coordination, and disease prevention/management services across care continua., Approach: A faculty team built an innovative concept and competency-based accelerated bachelor of science in nursing primary care-focused curriculum integrating behavioral health, aesthetic knowing, and technology., Outcomes: The curriculum was implemented twice, with the third cohort mid-program. Program evaluation is ongoing., Conclusion: A paradigm shift in nursing education may improve population-based biobehavioral wellness, disease prevention, and chronic disease management. Future research should focus on how this innovative curricular approach builds essential nursing competencies and enhances digital fluency, observation, communication, empathy, and critical thinking skills., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Adults with autism spectrum disorder (ASD) consistently report worse functional health and well-being, compared to neurotypical (NT) peers. In a series of studies, we aimed to elucidated the effects of sex, age, and their interaction on health-related quality of life (HRQoL) and evaluated the effectiveness of mindfulness-based stress reduction (MBSR) for improving health-, disability-, and autism-related QoL, with possible sex and age outcome moderators, in adults with ASD., Methods: Study 1 used the 36-Item Short Form Survey to compare mental and physical HRQoL composite scores in adults with ASD (n = 67) and matched NT adults (n = 66). Study 2 was a randomized pilot evaluation of the effect of MBSR, compared to an active control intervention with social support and relaxation education (support/education; n = 56), on the World Health Organization QoL BREF, Disability, and Autism-Specific scales in adults with ASD., Results: In Study 1, we replicated findings that mental HRQoL is worse in both men and women with ASD, compared to NT counterparts, but physical HRQoL is only worse in women with ASD. We present novel findings that older age is associated with better mental HRQoL in women with ASD only. In Study 2, MBSR improved disability-related QoL in adults with ASD over and above the support/education intervention, but both interventions improved mental HRQoL. Lastly, both interventions were more effective for HRQoL improvements in women with ASD., Conclusion: Findings encourage precision medicine approaches tailored to age and sex groups for best HRQoL outcomes in adults with ASD., Clinicaltrials: gov Identifier: NCT04017793., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Purpose: The aim of this quality improvement (QI) project was to assess a shadowing experience with a certified WOC nurse (CWOCN) on 4 interprofessional collaborative practice domains: interprofessional communication, role awareness and responsibilities, teams and teamwork, and values and ethics for interprofessional practice., Participants and Setting: Forty-nine physician residents in Family and Internal Medicine participated in this project set at a health system in Chicago, Illinois., Approach: Residents spent 16 hours shadowing a CWOCN and completed the Interprofessional Education Collaborative Competency Self-Assessment Tool (IPESAT) pre- and postshadowing that measured 4 interprofessional education (IPE) domains: interprofessional communication, role awareness and responsibilities, teams and teamwork, and values and ethics for interprofessional practice. Paired t tests were performed to determine differences in IPESAT scores before and after the shadowing experience., Outcomes: Residents demonstrated significant improvement in their overall knowledge of IPE (P = .000) as well as knowledge within each of the 4 domains (P = .000). After the shadowing experience, the overall ranking improved by 7.5%; the greatest gain (10.8%) occurred in the teamwork domain., Implications for Practice: We found that even a comparatively brief shadowing experience with a CWOCN improved knowledge in IPE competencies. The shadowing experience is now permanently part of the Internal Medicine Residency program, and based on these IPE outcomes, other residency programs in our setting, such as the Rehabilitation and Family Medicine program, have increased their requests to shadow with the CWOCN., Competing Interests: The authors explicitly stated no conflicts of interest, including financial, consultant, institutional, and/or other relationships., (Copyright © 2022 by the Wound, Ostomy and Continence Nurses Society.)

We developed a low-cost method for the production of Illumina-compatible sequencing libraries that allows up to 14 times more libraries for high-throughput Illumina sequencing to be generated for the same cost. We call this new method Hackflex. The quality of library preparation was tested by constructing libraries from Escherichia coli MG1655 genomic DNA using either Hackflex, standard Nextera Flex (recently renamed as Illumina DNA Prep) or a variation of standard Nextera Flex in which the bead-linked transposase is diluted prior to use. In order to test the library quality for genomes with a higher and a lower G+C content, library construction methods were also tested on Pseudomonas aeruginosa PAO1 and Staphylococcus aureus ATCC 25923 , respectively. We demonstrated that Hackflex can produce high-quality libraries and yields a highly uniform coverage, equivalent to the standard Nextera Flex kit. We show that strongly size-selected libraries produce sufficient yield and complexity to support de novo microbial genome assembly, and that assemblies of the large-insert libraries can be much more contiguous than standard libraries without strong size selection. We introduce a new set of sample barcodes that are distinct from standard Illumina barcodes, enabling Hackflex samples to be multiplexed with samples barcoded using standard Illumina kits. Using Hackflex, we were able to achieve a per-sample reagent cost for library prep of A$7.22 (Australian dollars) (US $5.60; UK £3.87, £1=A$1.87), which is 9.87 times lower than the standard Nextera Flex protocol at advertised retail price. An additional simple modification and further simplification of the protocol by omitting the wash step enables a further price reduction to reach an overall 14-fold cost saving. This method will allow researchers to construct more libraries within a given budget, thereby yielding more data and facilitating research programmes where sequencing large numbers of libraries is beneficial.

Background: The World Health Organization report that an estimated 793,000 people died by suicide in 2016 globally. The use of digital technology has been found to be beneficial in the delivery of Web-based suicide prevention interventions. Research on the integration of digital technology within mental health services has indicated that despite the proliferation of technology, engagement by patients and professionals in adopting such technology can be poor., Objectives: The current study aims to explore the experiences of 15 mental health professionals involved in integrating mobile health technology into their practice. A secondary aim was to identify the drivers and barriers to the adoption of such technology by mental health professionals, and to consider what theoretical models could best account for the data., Methods: Semi-structured interviews, conducted from July to October 2019, were used to explore the experiences of mental health professionals engaged in the adoption of mobile health technology within mental health services. Mental Health professionals and clinician managers working in HSE Child and Adolescent Mental Health, Adult Mental Health, and Primary Care Psychology services were recruited for the study. Qualitative interview data was transcribed and analysed using NVivo. Thematic Analysis was used to identify themes., Results: Four major themes were identified: Accessibility, 'Transitional Object', Integration, and Trust. Within these 4 major themes, a total of 9 subthemes were identified: Service Accessibility, Immediate Access, Client Engagement, Adjunct-to-therapy, Therapeutic Relationship, Infrastructural Support, Enhancing Treatment, Trust in the Technology, Trust in the Organisation., Conclusions: Overall, Diffusion of Innovation Theory provides a useful theoretical framework which is consistent with and can adequately account for many of the Major and Subthemes identified in the data. In addition, 'Transitional Objects', a key concept within Object Relations Theory, could offer a means of better understanding how patients and professionals engage with digital technology within mental health services particularly., (© 2021. The Author(s).)

Frontline nurse leaders direct staff and unit systems while ensuring that quality, safe patient care is provided. It is unknown if frontline nurse leaders oriented with only on-the-job-training are competent and if a professional development program will improve their competencies. This project's purpose was to measure self-assessed competencies, using the Nurse Manager Inventory Tool, of 38 frontline nurse leaders. This project used a quasi-experimental design and utilized pre- and postsurvey for evaluation purposes of a leadership development curriculum.

Understanding the genetic basis for a phenotype is a central goal in biological research. Much has been learnt about bacterial genomes by creating large mutant libraries and looking for conditionally important genes. However, current genome-wide methods are largely unable to assay essential genes which are not amenable to disruption. To overcome this limitation, we developed a new version of "TraDIS" (transposon directed insertion-site sequencing) that we term "TraDIS-Xpress" that combines an inducible promoter into the transposon cassette. This allows controlled overexpression and repression of all genes owing to saturation of inserts adjacent to all open reading frames as well as conventional inactivation. We applied TraDIS-Xpress to identify responses to the biocide triclosan across a range of concentrations. Triclosan is endemic in modern life, but there is uncertainty about its mode of action with a concentration-dependent switch from bacteriostatic to bactericidal action unexplained. Our results show a concentration-dependent response to triclosan with different genes important in survival between static and cidal exposures. These genes include those previously reported to have a role in triclosan resistance as well as a new set of genes, including essential genes. Novel genes identified as being sensitive to triclosan exposure include those involved in barrier function, small molecule uptake, and integrity of transcription and translation. We anticipate the approach we show here, by allowing comparisons across multiple experimental conditions of TraDIS data, and including essential genes, will be a starting point for future work examining how different drug conditions impact bacterial survival mechanisms., (© 2020 Yasir et al.; Published by Cold Spring Harbor Laboratory Press.)

Aim: In this interprofessional education Art Applications Workshop, 104 medicine, nursing and psychology students apply skills developed through visual arts observations that enhance students' collaboration, communication, and observational skills to standardized patient encounters. Students observe two-dimensional images, write case reports on the paintings' subjects, and apply principles to complete assessment notes on standardized patients. This descriptive paper's goal is to disseminate this interprofessional curriculum and share experiences in implementing this workshop., Background: Visual arts education in healthcare programs expand students' visual, tactile and oral expression, especially in collaborative team settings., Methods: In session 1, student teams analyze paintings and learn visual assessment techniques. In session 2, student teams observe paintings in a museum setting and write observations in case notes. In session 3, student teams apply visual assessment techniques to standardized patient interviews, write patient histories, assessment notes, and finally, complete post-survey self-evaluations., Results: In the standardized patient assessment 73% of students made accurate diagnosis with supporting evidence in patient histories and notes. In post-survey results, 91% of students agreed/strongly agreed they improved their visual observation skills, 92% agreed/strongly agreed they improved their communication skills in listening and encouraging the ideas and opinions of other team members, 91% agreed/strongly agreed they are more confident in communicating with students from different disciplines, and 97% agreed/strongly agreed they are more confident in collaborating with students from different disciplines., Conclusions: This Workshop demonstrates enhanced self-reported perceptions of collaboration, observation, and communication skills in case notes and standardized patient assessment notes., (Copyright © 2019 Elsevier Inc. All rights reserved.)

IncHI2-ST1 plasmids play an important role in co-mobilizing genes conferring resistance to critically important antibiotics and heavy metals. Here we present the identification and analysis of IncHI2-ST1 plasmid pSPRC-Echo1, isolated from an Enterobacter hormaechei strain from a Sydney hospital, which predates other multi-drug resistant IncHI2-ST1 plasmids reported from Australia. Our time-resolved phylogeny analysis indicates pSPRC-Echo1 represents a new lineage of IncHI2-ST1 plasmids and show how their diversification relates to the era of antibiotics., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Aim: This article describes a job-shadowing project that partnered second-year medical and third-year pharmacy students with an advanced practice nurse (APN) for a four-hour job- shadowing experience., Background: In order to address the Interprofessional Education Collaborative (IPEC) Expert Panel core competencies of interprofessional communication, teamwork, and roles/responsibilities, this project implemented a job-shadowing experience to increase students' knowledge of APN roles and interprofessional collaborative team practices., Methods: Forty volunteer medical and pharmacy students were paired together and completed the job-shadowing activity with an APN. Assessment of knowledge was measured by pre- and post-project surveys., Results: Pre- and post-job-shadowing differences demonstrated statistical significance in the interprofessional domains of role awareness, collaboration and communication. These results suggest that an APN job-shadowing experience is effective in developing medical and pharmacy students' competencies in interprofessional collaborative practice., Conclusion: Specific recommendations include creating enhanced job-shadowing experiences within the curriculums of medicine, pharmacy, and nursing students, and assessing for evidence of enhanced IPEC competencies as a result of these learning experiences., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Hyponatremic hypertensive syndrome (HHS) is an uncommon disorder usually encountered in the adult population with unilateral renal artery stenosis and is under-recognized in the pediatric population., Case Diagnosis/treatment: A 19-month-old male presented with new-onset status epilepticus associated with neurological sequelae, and hypertension to a high of 248/150 mmHg. Lab work revealed significant hyponatremia, elevated peripheral renin activity, and increase in aldosterone and ADH levels. A diagnosis of HHS was made. Initial analysis revealed a high-grade proximal renal artery stenosis by magnetic resonance imaging (MRI) and angiogram. Electroencephalogram and an MRI of the brain demonstrated characteristic abnormalities of the left temporal-parietal regions consistent with posterior reversible leukoencephalopathy syndrome (PRES). The patient responded to right renal artery balloon dilation and stent placement. Since intervention and close blood pressure control with Amlodipine, the patient has been free of seizures and is neurologically intact., Conclusion: We report a case of malignant hypertension in a 19-month-old male secondary to renal artery stenosis with associated HHS and PRES. Prognosis of PRES in children with renal disease is excellent. Prompt intervention may offer near complete resolution of physiologic and symptomatic effects of HHS and PRES due to high-grade renal artery stenosis. This report was written with parental consent for de-identified case presentation and radiographs for the educational benefit of other medical professionals.

The recent development of cell biology techniques for bacteria to allow visualization of fundamental processes in time and space, and their use in synchronous populations of cells, has resulted in a dramatic increase in our understanding of cell division and its regulation in these tiny cells. The first stage of cell division is the formation of a Z ring, composed of a polymerized tubulin-like protein, FtsZ, at the division site precisely at midcell. Several membrane-associated division proteins are then recruited to this ring to form a complex, the divisome, which causes invagination of the cell envelope layers to form a division septum. The Z ring marks the future division site, and the timing of assembly and positioning of this structure are important in determining where and when division will take place in the cell. Z ring assembly is controlled by many factors including negative regulatory mechanisms such as Min and nucleoid occlusion that influence Z ring positioning and FtsZ accessory proteins that bind to FtsZ directly and modulate its polymerization behavior. The replication status of the cell also influences the positioning of the Z ring, which may allow the tight coordination between DNA replication and cell division required to produce two identical newborn cells.

Using an estimation of CLDL, 522 sera from 311 men and 211 women were studied. Lipoprotein phenotyping was done with and without knowledge of CLDL. Two hundred sixty-four of the 522 patients were considered abnormal without knowledge of CLDL. Interpretation was changed in 70 cases when CLDL was considered. Thirty-four were reclassified from 11B to IV because CLDL was not elevated. Thirty-three were reclassified from 11A to "slightly elevated cholesterol without other evidence of hyperlipoproteinemia" because CLDL was not elevated. Three were reclassified from normal to 11A because of elevated CLDL associated with borderline normal cholesterol.