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Abstract Developments in long-term space exploration necessitate advancements in countermeasures against microgravity-induced skeletal muscle loss. Astronaut data shows considerable variation in muscle loss in response to microgravity. Previous experiments suggest that genetic background influences the skeletal muscle response to unloading, but no in-depth analysis of genetic expression has been performed. Here, we placed eight, male, inbred founder strains of the diversity outbred mice (129S1/SvImJ, A/J, C57BL/6J, CAST/EiJ, NOD/ShiLtJ, NZO/HILtJ, PWK/PhJ, and WSB/EiJ) in simulated microgravity (SM) via hindlimb unloading for three weeks. Body weight, muscle morphology, muscle strength, protein synthesis marker expression, and RNA expression were collected. A/J and CAST/EiJ mice were most susceptible to SM-induced muscle loss, whereas NOD/ShiLtJ mice were the most protected. In response to SM, A/J and CAST/EiJ mice experienced reductions in body weight, muscle mass, muscle volume, and muscle cross-sectional area. A/J mice had the highest number of differentially expressed genes (68) and associated gene ontologies (328). Downregulation of immunological gene ontologies and genes encoding anabolic immune factors suggest that immune dysregulation contributes to the response of A/J mice to SM. Several muscle properties showed significant interactions between SM and mouse strain and a high degree of heritability. These data imply that genetic background plays a role in the degree of muscle loss in SM and that more individualized programs should be developed for astronauts to protect their skeletal muscles against microgravity on long-term missions.

A 39-year-old woman presented with cushingoid features was worked up and diagnosed to have ACTH-independent Cushing’s syndrome. Computed tomography of the whole abdomen revealed a left adrenal mass. She was scheduled for elective laparoscopic left adrenalectomy, however, a few days prior to the surgery, the patient had hematochezia. Colonoscopy revealed multiple ulcers on the terminal ileum, to which biopsy revealed Mycobacterium tuberculosis infection. The patient underwent laparoscopic left adrenalectomy on the same admission, which revealed adrenal adenoma on histopathology.

Negative emotions are typically high, and typically stay high over time, in caregivers of children with autism. The severity of autism-related symptoms on the other hand tends to improve over time, reducing as the child gets older. Why caregivers' negative emotions continue to be high at a time when autism symptom severity is improving remains puzzling. This exploratory study asks whether prevalence-induced concept change (PICC) might provide one plausible explanation. A sample of N = 34 participants, of which 17 were caregivers of children with autism and 17 were non-caregiving controls, completed questionnaires assessing negative emotions. PICC was assessed via an online paradigm; participants were shown a face on screen for 500ms and asked, following its disappearance, whether it conveyed a negative (i.e., sad) or a neutral expression. Neutral faces mistaken for sad faces, as our outcome variable of interest, were summed across trials. The prevalence of negative faces was gradually reduced across four experimental blocks (50 trials per block). Mixed ANOVA yielded a significant main effect of block. That is, neutral faces were more likely to be mistaken for sad faces as sad faces became less prevalent across blocks. This pattern of change varied by group; caregivers were more likely to mistake neutral faces for sad faces as sad faces reduced in prevalence across blocks. Errors made by the control group did not vary across blocks. Caregivers' concept of 'negative, therefore, seems sensitive to change, redefining its parameters as negative events become less prevalent. PICC might explain why caregivers' negative emotions remain high when autism symptom severity, as one well-known predictor of those negative emotions, is reducing in prevalence. The implications of these findings for caregivers' psychological well-being and, by association, care recipient quality of life are considered., Author(s): B Lovell [sup.1] , G Horan-Anderson [sup.1] , K McCarty [sup.1] , Mark A. Wetherell [sup.1] Author Affiliations: (1) https://ror.org/049e6bc10, grid.42629.3b, 0000 0001 2196 5555, Department of Psychology, Northumbria [...]

The recent advances in hardware and software related to distributed smart sensing have opened unprecedented opportunities for building effective solutions to applications, such as object detection, tracking and recognition for surveillance, mobile medical imaging, distributed video monitoring/retrieval, gesture recognition, etc.

During disuse, mechanical unloading causes extensive bone loss, decreasing bone volume and strength. Variations in bone mass and risk of osteoporosis are influenced by genetics; however, it remains unclear how genetic variation affects the skeletal response to unloading. We previously found that genetic variation affects the musculoskeletal response to 3 weeks of immobilization in the 8 Jackson Laboratory J:DO founder strains: C57Bl/6J, A/J, 129S1/SvImJ, NOD/ShiLtJ, NZO/HlLtJ, CAST/EiJ, PWK/PhJ, and WSB/EiJ. Hindlimb unloading (HLU) is the best model for simulating local and systemic contributors of disuse and therefore may have a greater impact on bones than immobilization. We hypothesized that genetic variation would affect the response to HLU across the eight founder strains. Mice of each founder strain were placed in HLU for 3 weeks, and the femurs and tibias were analyzed. There were significant HLU and mouse strain interactions on body weight, femur trabecular BV/TV, and femur ultimate force. This indicates that unloading only caused significant catabolic effects in some mouse strains. C57BL/6 J mice were most affected by unloading while other strains were more protected. There were significant HLU and mouse strain interactions on gene expression of genes encoding bone metabolism genes in the tibia. This indicates that unloading only caused significant effects on bone metabolism genes in some mouse strains. Different mouse strains respond to HLU differently, and this can be explained by genetic differences. These results suggest the outbred J:DO mice will be a powerful model for examining the effects of genetics on the skeletal response to HLU. [ABSTRACT FROM AUTHOR]

Developments in long-term space exploration necessitate advancements in countermeasures against microgravity-induced skeletal muscle loss. Astronaut data shows considerable variation in muscle loss in response to microgravity. Previous experiments suggest that genetic background influences the skeletal muscle response to unloading, but no in-depth analysis of genetic expression has been performed. Here, we placed eight, male, inbred founder strains of the diversity outbred mice (129S1/SvImJ, A/J, C57BL/6J, CAST/EiJ, NOD/ShiLtJ, NZO/HILtJ, PWK/PhJ, and WSB/EiJ) in simulated microgravity (SM) via hindlimb unloading for three weeks. Body weight, muscle morphology, muscle strength, protein synthesis marker expression, and RNA expression were collected. A/J and CAST/EiJ mice were most susceptible to SM-induced muscle loss, whereas NOD/ShiLtJ mice were the most protected. In response to SM, A/J and CAST/EiJ mice experienced reductions in body weight, muscle mass, muscle volume, and muscle cross-sectional area. A/J mice had the highest number of differentially expressed genes (68) and associated gene ontologies (328). Downregulation of immunological gene ontologies and genes encoding anabolic immune factors suggest that immune dysregulation contributes to the response of A/J mice to SM. Several muscle properties showed significant interactions between SM and mouse strain and a high degree of heritability. These data imply that genetic background plays a role in the degree of muscle loss in SM and that more individualized programs should be developed for astronauts to protect their skeletal muscles against microgravity on long-term missions. [ABSTRACT FROM AUTHOR]

Background: The positive relationship between problem behaviours of children with additional complex needs and psychological distress in their caregivers has been widely evidenced. Fewer studies, however, have assessed the relationship between care recipients' problem behaviours and key physiological processes, relevant for the physical health status of their care providers. This study examined the psychological, endocrine and health corollaries of child problem behaviours in caregivers of children with autism and attention deficit hyperactivity disorder. Methods: Caregivers (n?=?18) completed self-report measures of psychological distress, child problem behaviours and incidences of commonly occurring ailments. To capture important parameters of the basal diurnal cortisol pattern, caregivers collected saliva samples at waking, 30?min post waking, 1200?h and 2200?h on two consecutive weekdays. Results: Data revealed a positive relationship between caregivers' perceived levels of stress and problems with child conduct behaviours. In addition, caregivers who reported more problems with child emotional and hyperactivity behaviours displayed atypical cortisol patterns characterised by flatter diurnal cortisol slopes and reduced cortisol awakening response magnitude. Subjective reports of commonly occurring ailments were also greater in caregivers experiencing more problems with child emotional behaviours. Conclusions: These findings have implications for interventions that aim to improve the psychophysiological well-being of the caregiver by targeting problem behaviours of the care recipient.

Background/Aims Intestinal pseudo-obstruction (IpsO) is an uncommon gastrointestinal manifestation of systemic lupus erythematosus (SLE) and is largely underrecognized. Only 13 cases of lupus-related IpsO were reported in Asia and none so far has been published in the Philippines. IpsO has a possible association with ureterohydronephrosis and bile duct dilatation. The co-manifestation of these three dilated hollow viscera is a rare occurrence with only four reported cases in the past. The objective of this case report is to document IpsO as a recognized clinical manifestation of SLE and to establish its apparent association with ureterohydronephrosis and bile duct dilatation, a rare clinical entity termed as visceral muscle dysmotility syndrome or generalized megaviscera of lupus, as documented in previous case reports. Methods We present a case report of a 39-year-old female patient, known to have SLE who presented with persistent diarrhea, vomiting and abdominal distention. Results Imaging studies showed dilated bowel loops on SFA, diffuse colonic wall thickening, dilatation of the common bile duct and ureterohydronephrosis with no evidence of mechanical obstruction on whole abdominal CT scan with triple contrast. Colonoscopy revealed internal hemorrhoids and nonspecific colitis only. She eventually underwent exploratory laparotomy which showed dilated small and large bowels but no evidence of mechanical obstruction was noted. Cyclophosphamide pulse therapy was initiated which resulted to rapid resolution of patient's symptoms. Conclusions Awareness and high index of suspicion is important in the diagnosis of IpsO secondary to SLE. Early recognition of this disease entity is crucial to avoid complications, unnecessary surgical intervention and repeated invasive procedures. Immunosuppressive therapy is still the initial and first-line treatment for IpsO secondary to SLE. Co-manifestation of dilatation of 3 hollow viscera especially in patient known to have SLE, should lead to suspicion of generalized auto-immune smooth muscle/enteric nerve injury. [ABSTRACT FROM AUTHOR]

Background/Aims Small duct primary sclerosing cholangitis is a rare clinical condition that may remain unrecognized. Diagnosis rests on clinical, biochemical, and histologic features consistent with primary sclerosing cholangitis but with normal cholangiogram findings. We report here a case of small duct primary sclerosing cholangitis in a patient who presented with jaundice. Methods Clinical Presentation. A 22-year-old Filipino gentleman with no known comorbids came in due to a 2-week history of jaundice with elevated transaminases, bilirubin and alkaline phosphatase. No other symptoms were noted. Hepatitis markers were all normal. Physical examination was unremarkable except for jaundice. Results Management. Magnetic resonance cholangiopancreatography was normal with no evidence of dilated intra- and extrahepatic ducts. Liver biopsy showed intrahepatic cholestasis with periductal fibrosis. Ursodeoxycholic acid was started which showed significant decrease in jaundice with improvement in biochemistries. Conclusions Recommendation. Small duct primary sclerosing cholangitis appears to have a more favorable prognosis than classic primary sclerosing cholangitis. However, further studies with long-term follow up are recommended to determine disease progression. [ABSTRACT FROM AUTHOR]

Background/Aims Tuberculosis (TB) remains one of the world's most problematic and fatal communicable diseases. Pulmonary tuberculosis is the most common manifestation, however, extrapulmonary infection may occur and the gastrointestinal tract may be involved 1% of the time. Disseminated tuberculosis, involving 2 or more noncontiguous sites, may occur in compromised immune systems but rarely in the immunocompetent host. We report here two cases of disseminated TB presenting as massive gastrointestinal bleeding and small bowel obstruction in the immunocompetent host. Results A 34-year old Filipino male with no known comorbids presented with jaundice, diarrhea, melena, fever and weight loss. Laboratories showed elevated transaminases (4x), elevated alkaline phosphatase (5x), and conjugated hyperbilirubinemia. Hepatitis and human immunodeficiency virus screening were all negative. MRCP showed hilar stricture for which ERCP (endoscopic retrograde cholangiopancreatography) with stenting was done. EGD (esophagogastroduodenoscopy) only showed erosive gastritis. Colonoscopy revealed ileocecal ulcers suggestive of tuberculosis (Fig. 1). The patient was started on Anti-koch's medication, however, massive gastrointestinal bleeding occurred which led to his demise. Postmortem studies revealed disseminated TB involving the lungs, liver, pancreas, spleen, and gastrointestinal tract particularly the ileum with transmural ulcerations and caseation necrosis. A 43-year old Filipino male with no known comorbids presented with billous vomiting, abdominal pain and distention. Initial SFA was unremarkable. The patient deteriorated before other workups could have been done. Post-mortem studies showed caseation necrosis and Langhans type giant cells consistent with tuberculosis in the lungs, urinary system, and the entire gastrointestinal tract. Examination of the abdomen showed tan, white plaques of tuberculous implants on the serosa of all intestinal segments with multiple adhesions. Conclusions Disseminated TB is rare in the immunocompetent host but should always be considered in the differential diagnosis of gastrointestinal diseases since timely initiation of treatment results in excellent prognosis while a delay may lead to catastrophic complications. [ABSTRACT FROM AUTHOR]

We reported that an acquired miR-142 deficit transforms chronic phase (CP) chronic myeloid leukemia (CML) leukemic stem cells (LSCs) into blast crisis (BC) LSCs. Given the role of miR-142 in the development and activity of the immune system, we postulated that this deficit also promotes LSC immune escape. Herein, we report on IL-6-driven miR-142 deficit occurring in T cells during BC transformation. In CML murine models, miR-142 deficit impairs thymic differentiation of lymphoid-primed multipotent progenitors (LMPP) into T cells and prevents T cells' metabolic reprogramming, thereby leading to loss of T cells and leukemia immune escape. Correcting miR-142 deficit with a miR-142 mimic compound (M-miR-142), alone or in combination with immune checkpoint antibodies, restores T cell number and immune activity, leading to LSC elimination and prolonged survival of BC CML murine and patient-derived xenograft models. These observations may open new therapeutic opportunities for BC CML and other myeloid malignancies., Competing Interests: Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Recent studies suggest that proteomic cargo of extracellular vesicles (EVs) may play a role in metabolic improvements following lifestyle interventions. However, the relationship between changes in liver fat and circulating EV-derived protein cargo following intervention remains unexplored., Methods: The study cohort comprised 18 Latino adolescents with obesity and hepatic steatosis (12 males/6 females; average age 13.3 ± 1.2 y) who underwent a six-month lifestyle intervention. EV size distribution and concentration were determined by light scattering intensity; EV protein composition was characterized by liquid chromatography tandem-mass spectrometry., Results: Average hepatic fat fraction (HFF) decreased 23% by the end of the intervention (12.5% [5.5] to 9.6% [4.9]; P = 0.0077). Mean EV size was smaller post-intervention compared to baseline (120.2 ± 16.4 nm to 128.4 ± 16.5 nm; P = 0.031), although the difference in mean EV concentration (1.1E+09 ± 4.1E+08 particles/mL to 1.1E+09 ± 1.8E+08 particles/mL; P = 0.656)) remained unchanged. A total of 462 proteins were identified by proteomic analysis of plasma-derived EVs from participants pre- and post-intervention, with 113 proteins showing differential abundance (56 higher and 57 lower) between the two timepoints (adj-p <0.05). Pathway analysis revealed enrichment in complement cascade, initial triggering of complement, creation of C4 and C2 activators, and regulation of complement cascade. Hepatocyte-specific EV affinity purification identified 40 proteins with suggestive (p < 0.05) differential abundance between pre- and post-intervention samples., Conclusions: Circulating EV-derived proteins, particularly those associated with the complement cascade, may contribute to improvements in liver fat in response to lifestyle intervention., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Depression scores in caregivers of autistic children often fall in the clinical range. The attention of clinically depressed individuals tends to be biased toward negatively toned information. Whether caring for an autistic child might also be characterized by a negative attentional bias was explored here., Methods: A sample of N  = 98 (57 caregivers and 41 controls) completed questionnaires assessing depressive symptoms. Orienting attention to (i.e., vigilance), and shifting attention away from (i.e., disengagement), negative information was assessed via an online version of the emotional face dot probe task., Results: Mean depression scores in caregivers, falling in the borderline clinical range, were significantly higher compared with controls. Groups, however, were indistinguishable with respect to vigilance and disengagement, and these attentional indices were unrelated to depression scores., Conclusion: Caring for an autistic child, while associated with borderline clinical depression scores, was not characterized by a negative attentional bias. Findings are discussed in the context of methodological shortcomings and recommendations for future research., 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 Lovell, McCarty, Penfold and Wetherell.)

Grateful caregivers report lower levels of psychological distress. Social support, engendered by gratitude and buffering against stress, might mediate this effect. Here we explored whether the protective psychological effect of dispositional gratitude might be mediated by increased social support. A sample of 126 caregivers of autistic children completed questionnaires assessing dispositional gratitude, social support and psychological distress. Gratitude inversely predicted psychological distress, as did social support after adjusting for gratitude. Gratitude positively predicted social support. Gratitude no longer predicted psychological distress after adjusting for social support. Indirect effects analysis revealed the gratitude-distress relationship occurred indirectly via social support. Grateful caregivers reported higher levels of social support, and this predicted lower psychological distress. Gratitude, relatively stable as a disposition, has a state component that is sensitive to change, and healthcare professionals might do well to recommend gratitude enhancing interventions for caregivers of autistic children.

Cognitively empathic caregivers are able to take the perspective of their autistic child(ren) without experiencing vicarious distressing emotions, and typically report lower psychological distress. Taking the perspective of the autistic child might, through fostering cognitive empathy, might relieve caregivers' psychological distress. Here we explored whether autism perspective taking videos developed by the National Autistic Society (NAS), intended to raise public awareness about autism, might be effective, packaged as an intervention, for increasing caregivers' cognitive empathy and reducing their psychological distress. A sample of 24 caregivers of autistic children completed questionnaires capturing psychological distress and cognitive empathy at baseline. For three consecutive days, for two-three minutes per day, caregivers watched perspective taking videos. Follow up assessments were collected 7, 14, and 21 days post intervention. Psychological distress was lower after seven days, and stayed lower 14 and 21 days post intervention compared with baseline. Cognitive empathy was higher after 14 days, and remained higher 21 days post intervention compared with baseline. Taking the perspective of the autistic child, achieved here with publically available NAS videos, seems to be effective for increasing caregivers' cognitive empathy and reducing their psychological distress for up to three weeks. Future research might use more rigorous methodologies, incorporating control groups and larger samples, to explore moderators of intervention efficacy., Competing Interests: Conflict of interest Authors declare no conflict of interest., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Caregivers of children with autism spectrum disorder self-report more physical health problems than controls. Sleep disturbances are also more prevalent in caregivers, and are positively associated with physical health problems. The negative impact of caring for a child with ASD on physical health therefore, might occur indirectly via poorer sleep., Methods: Participants, of which n = 43 were caregivers and n = 17 were controls, completed self-report measures of physical health problems and, to capture objective measures of sleep, wore an actigraphy device., Results: Physical health problems were greater in caregivers, as were subjective reports of disturbed sleep. Objectively, waking after sleep onset (WASO) and average number of awakenings were higher, as was sleep latency, and sleep efficiency was poorer, in caregivers. Total sleep time however, was greater in caregivers, as was time in bed. Physical health problems, while unrelated to actigraphy measures, were positively associated with self-reported sleep disturbances. Caregivers' increased risk for physical health problems occurred indirectly via greater self-reports of disturbed sleep., Conclusions: Interventions that help alleviate caregivers' sleep disturbances might be effective, by reducing physical health problems, for improving quality of provided care, and this might be explored in future research., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Introduction: We evaluated a simulation-based training day for medical registrars to define the hidden curriculum of the training., Methods: We interviewed participants to explore their reflections about the day, what they had learned and how it had influenced their practice. Interviews were conducted iteratively and analysed in accordance with content thematic analysis., Results: We established four themes: sharing (collaborative learning), sensing (comparing one's practice against peers'), transforming (development or change in practice based on learning from the day), and endorsing (appreciating authenticity in the simulation and psychological safety in debriefing)., Conclusion: This evaluation furthered our understanding of the self-reported learning outcomes of our participants. We encourage other institutions to perform similar evaluations to build a collaborative understanding of simulationbased education for medical registrars.

Background: The mother-child relationship is extremely important, and for mothers experiencing incarceration, this relationship has unique challenges. There is limited evidence currently available to identify the type and content of parenting education that would best suit women who are incarcerated., Objective: This study aims to design and evaluate a parent education program for women experiencing incarceration in South Australia. The program must meet the specific needs of incarcerated women and considers the cultural needs of Aboriginal and or Torres Strait Islanders and migrant women. Hereafter Aboriginal and/or Torres Strait Islander peoples will be referred to as Aboriginal; the authors acknowledge the diversity within Aboriginal cultures., Methods: This study will utilize a mixed methods approach, including six phases framed by a community-based theoretical model. This methodology provides a collaborative approach between the researcher and the community to empower the women experiencing incarceration, allowing their parenting education needs to be addressed., Results: A scoping review was undertaken to inform this study protocol. This paper describes and discusses the protocol for this mixed methods study. Recruiting commenced in December 2019, results will be published in 2020, and the project will be completed by August 2022. This project has been supported by a Research Training Scholarship from the Australian Government., Conclusions: The scoping review highlighted a lack of rigorous evidence to determine the most appropriate parenting education program to suit women experiencing incarceration specifically, and there was little consideration for the cultural needs of women. It also became clear that when quantitative and qualitative data are utilized, the women's voices can assist in the determination of what works, what will not work, and what can be improved. The data collected and analyzed during this study, as well as the current evidence, will assist in the development of a specific parenting education program to meet the needs of women experiencing incarceration in South Australia and will be implemented and evaluated as part of the study., International Registered Report Identifier (irrid): PRR1-10.2196/18992., (©Belinda Lovell, Mary Steen, Adrian Esterman, Angela Brown. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 13.08.2020.)

Caregivers of children with ASD often find benefits associated with their caregiving role, and benefit finding predicts lower distress. Child problematic behaviours (CPB), which positively predict caregivers' distress, are perceived to be being less problematic, or more manageable, by caregivers who find benefits. Benefit finding therefore might mitigate the negative psychological impact of CPB. A sample of n = 158 caregivers of children with ASD completed an online survey assessing benefit finding, CPB, and psychological distress. CPB positively, and benefit finding negatively, predicted caregivers' distress. Moderation effects however were not observed. Findings implicate increased CPB and lower benefit finding as risk factors for caregivers' psychological distress. Findings provide clearly definable targets for intervention.

Background: Affiliate stigma negatively predicts social support, and positively predicts psychological distress, in caregivers of children with ASD. Whether the affiliate stigma-distress relationship occurs indirectly via social support however has not been explored., Methods: A correlational design was used. A sample of n = 124 caregivers of children with ASD completed an online survey assessing affiliate stigma, perceived support from family, friends and significant others, and perceived stress., Results: The relationship between greater affiliate stigma and increased perceived stress occurred indirectly via lower perceived support from family, but not from friends or significant others., Conclusions: These findings underscore the importance of increasing caregivers' perceived family support. Whether interventions that alleviate affiliate stigma are beneficial for reducing perceived stress, and whether this effect is mediated by increased perceived availability of support, might be the subject of future research., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Since 2007, Gaza Palestine has been subject to blockade affecting over 1.9 million people. This denies health professionals access to continuing professional development (CPD). In Gaza, family physicians are scarce, and their level of training does not meet the needs of United Nations Relief and Works Agency's (UNRWA) Family Health Team (FHT) model for better population health., Aim: This study sought to develop a postgraduate training programme for Gazan doctors via a Diploma in Family Medicine (FM PG), and evaluate its impact on physicians and patients., Design & Setting: A mixed-methods evaluation of a postgraduate diploma in Gaza Palestine., Method: The programme was delivered over 1 year, to 15 primary care doctors. The impact was evaluated through focus group discussions and patient feedback questionnaire survey comparing FM PG graduate doctors and doctors without the FM PG Diploma., Results: All participating doctors graduated successfully and found the experience extremely positive. Trainees felt that the Diploma helped them take more individualised approach to patients; have a better understanding of psychosocial elements affecting patient health; feel more inclined towards team-working and collaborative approaches to health care; and more insight into non-verbal communication such as active listening and tactile gestures. Statistical analysis of patients' feedback showed significantly improved patient-reported outcomes and satisfaction when treated by course diplomates compared to non-diplomates., Conclusion: Where there are limited training opportunities, investment in a structured postgraduate diploma training programme can improve quality of health service delivery. UNRWA's experience in Gaza demonstrates the value of a scalable model in resource-limited settings., (Copyright © 2019, The Authors.)

Caregivers of children with autism spectrum disorder (ASD) self-report more prospective memory (PM) failures compared with controls. Subjective and objective measures of PM, however, tend to be poorly correlated. This study therefore explored the cognitive impact of caring for a child with ASD using the Cambridge Prospective Memory Test (CAMPROMPT), a more objective, performance-based assessment of PM failures. Whether atypical cortisol secretion patterns might mediate caregivers' compromised cognition was also explored. A sample of n = 23 caregivers of children with ASD and n = 11 parent controls completed time- and event-cued PM tasks with CAMPROMPT. Diurnal cortisol indices, the cortisol-awakening response, diurnal cortisol slope, and mean diurnal output were estimated from saliva samples on multiple days. Results indicated objectively assessed event- but not time-cued PM failures were greater in caregivers compared with controls. Variations in cortisol secretion patterns, however, did not mediate the group effect. In conclusion, caring for a child with ASD was associated with greater deficits in event-cued PM. Future studies might examine the influence of caregivers' event-cued PM failures on quality of provided care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Acute physicians make patient-centred decisions at the start of the patient's hospital journey. Dozens more decisions are made by the individual members of the MDT (and, of course, by the patient) during the in-patient period. Decisions are made at every level of seniority and experience and range widely in scope and impact. The original articles in this issue are connected by a common thread: phenomena that inform and influence the decisions made by acute physicians.

Affiliate stigma is one risk factor for psychological distress in familial caregivers. Few studies however, and none involving caregivers in the UK and US, have explored caregivers' characteristics and family constellation variables as risk and protective factors for affiliate stigma. This study aimed to fill this gap. Moreover, we believe this study is only second to explore these relationships among caregivers of children with autism spectrum disorder (ASD), a group particularly vulnerable to affiliate stigma. A sample of n = 192 caregivers of children with ASD completed an online survey assessing caregivers' characteristics and family factors, and affiliate stigma. Non-partnered caregivers were more likely to report affiliate stigma, as were caregivers with shorter sleep duration. These findings might help clinicians and other health professionals identify caregivers at risk for affiliate stigma and concomitant psychological distress., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Context: Coaching has been employed successfully in the competitive sports, professional music, and business and corporate worlds. It is now emerging as a training modality in medical education., Objectives: This paper reviews the current evidence on coaching strategies for doctors and medical students., Methods: An applied literature search was conducted in PubMed, MEDLINE and Web of Science. Predetermined definitions of coaching interventions and their evaluations were used to narrow 993 papers down to 21, which were included in the final review. The 21 papers were critiqued with reference to validated scoring metrics., Results: There are many papers discussing the merits of coaching in the world of medicine, but few evaluations of coaching interventions. Existing coaching methodologies can be broadly summarised into three categories: coaching for doctor/student well-being and resilience; coaching for improved non-technical skills, and coaching for technical skills. Identification of suitable papers for inclusion is complicated by theoretical uncertainty regarding coaching: many papers use the term as a synonym for teaching or mentoring. The strongest evidence for coaching lies in the teaching of technical skills., Conclusions: There is weak- to medium-strength evidence to support coaching as a method of improving doctor well-being and enhancing non-technical skills, although the evidence base is limited as a whole. This review identifies strong evidence to support coaching as a method to improve technical skills. There is great scope for further studies investigating the power of coaching in medical students and doctors., (© 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

As those working in Acute Medicine gather at SAMsterDAM2, the spring conference of the Society for Acute Medicine, the growth, reputation and global representation of the specialty continues to grow. Alongside, the traditional strongholds of the UK, Ireland, Netherlands, Denmark and Australia growth in Asia continues with an AMU now established in Pakistan among other countries.

There is a myth that Acute Physicians only work in Acute Medical Units (AMUs). In fact, they tread a constant path between the AMU, the Emergency Department (ED), ambulatory care, Intensive Care Units (ITUs) and various specialty wards within the hospital. Just as our focus is not tied to a single organ or body system, is it not solely linked to a certain geographical place. As a result, those working in Acute Medicine are invested in the pathways, problems, processes and positive attributes of departments and units outside of the AMU, because they affect our patients.