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The human leukocyte antigen (HLA) system comprises cell-surface proteins responsible for the presentation of peptide antigens. HLAs play an essential role in the regulation of the human immune system, and their studies have been crucial to its understanding. To create a sustainable model for the investigation of HLAs, we successfully generated the human iPSC line MURAi003-A derived from the peripheral blood mononuclear cells of a donor with homozygous Class I and Class II HLAs (A*11:01, B*46:01; C*01:02; DRB1*09:01; DQB1*03:03) using non-integrative reprogramming episomes. MURAi003-A exhibited pluripotent stem cell characteristics with consistent demonstrations of pluripotency and expression of stem cell-associated markers.

Abstract Background People with lived experience of health and illness are increasingly being involved in research. Knowing what creates interest in becoming involved in health research may help identify appropriate ways of facilitating meaningful involvement. The study aimed to investigate why people became public collaborators in health research and what helped sustain their commitment to staying involved. Methods Semistructured individual qualitative interviews were conducted with 11 Norwegian public collaborators recruited from patient organisations. To enhance the quality and relevance of this study, three public collaborators were involved in framing the study and in the data analysis. One of them is a coauthor of this paper. The interviews were analysed through reflexive thematic analysis, and two themes were generated. Results The first theme, ‘research as a vehicle to impact’ showed how interest in becoming involved in research was founded on the possibility of impacting healthcare through research. Other inspiring factors were how they appraised the relevance of the research, in addition to the public collaborators’ own sense of moral duty to advocate for research related to their own as well as others, illnesses or diseases. The second theme, ‘‘Acknowledgement and accessibility’, framed how the participants perceived appreciation of experiential knowledge as crucial for maintaining motivation in their role as public collaborators. Other promoters of sustained involvement presented were training for both public collaborators and researchers, adequate allowance as a means for visualising and valuing PPI, and accessible language. Conclusions This study contributes to the understanding of how to facilitate meaningful and sustainable PPI, which requires a safe space for collaboration and attention to accessibility. Facilitating meaningful involvement may, in turn, increase the potential impact and sustainability of PPI.

Abstract Background Patient and public involvement (PPI) is increasingly considered an integral part of health research, and the focus has shifted from why we need PPI to how users can be involved in a meaningful way. The rationale for investigating experiences with PPI from the perspective of occupational therapy (OT)‐trained researchers' originates in the interrelationship between the inclusive approach to knowledge production, and participation and inclusion as core tenets of OT. The aim of this study was to explore PPI in health research from the perspective of OT‐trained researchers. Method Semi‐structured individual interviews were conducted online with nine Norwegian researchers. The interviews were analysed using reflexive thematic analysis. Results Professional background and clinical experience from person‐centred OT formed the foundation for how these researchers approached and facilitated PPI in their research. Valuing experiential knowledge and facilitating PPI to be meaningful for public collaborators were highlighted as essential for PPI to have an impact. The need to balance mutual expectations, requirements for research, and what might be possible to achieve within a research study were found to be vital. Conclusion Collaborative clinical experience constituted a sound foundation for implementing PPI in research. The occupational perspective underlines the importance of acknowledging experiential knowledge as essential to facilitating meaningful PPI. Challenges related to requirements for research and culture for implementing PPI were addressed by clarifying roles and expectations. Patient or Public Contribution Three public collaborators were involved in developing the aims, the interview guide, and the data analysis. They all had previous experience being involved in research.

Abstract Background The Low Energy Availability in Females Questionnaire (LEAF-Q) is a screening tool developed to detect endurance athletes and dancers at risk for development of persistent low energy availability (LEA) and the female athlete triad (Triad). This study investigated the applicability of the LEAF-Q in a cohort of sixty professional female football players. Methods The participants were classified as at risk (≥ 8) or not at risk (< 8) for persistent LEA and the Triad according to their LEAF-Q score, before being compared. Receiver operating curves were then conducted to examine the ability of the overall LEAF-Q and subcategories to correctly determine the presence of clinically defined markers of the Triad. Additionally, Youden’s index was calculated to determine the best fitting cut-off values. Results Thirty-two percent of participants were classified as at risk by the LEAF-Q. We found no statistically significant differences between the two groups for any markers associated with persistent LEA. Except for acceptable accuracy in determining menstrual status, all other LEAF-Q components exhibited poor accuracy and predictive values. Youden’s index scores imply that increasing the overall and injury cut-off values to ≥ 10 and ≥ 5 respectively, would yield increased performance. Conclusions Our findings do not support the use of the LEAF-Q for the purpose of detecting LEA and Triad conditions among female football players.

ABSTRACTPatients with coronary heart disease need timely treatment for survival and optimum prognosis. There is limited research exploring patients’ experience regarding distance to percutaneous coronary intervention. The aim was to explore patients’ experiences of aspects contributing to safety and quality of care regarding health services following percutaneous coronary intervention in Northern Norway. A qualitative explorative design was used, and 15 patients participated in individual semi-structured interviews 9–16 months after treatment. The reflexive thematic analysis revealed two main themes: (1) being part of a safe system and (2) adapting to new everyday life. Feeling safe and experiencing quality care depended on whether the participants were heard within the system upon first contact, whether help was available when needed, the travel time for treatment, sufficient information, the competency of care provided by healthcare professionals, and how follow-up services were organised when adapting to everyday life. To conclude, patients undergoing percutaneous coronary intervention in an arctic context perceived healthcare services as safe when the system delivered continuous care throughout all levels. Consistent optimisation of transport time and distance to treatment, especially for rural patients, and extensively focusing on follow-up services, can contribute to improving safety and quality of care.

Background Health professionals are responsible for implementing patient involvement (PI) in the choice of treatment approach. Previous studies within the field of substance use disorder (SUD) treatment have shown positive patient experiences with PI. However, little is known about challenges experienced by health professionals in converting principles of PI into clinical practice. Aims To explore challenges with PI in the treatment of SUD. Method Five health professionals working in a Norwegian institution for inpatient treatment of SUD were included and took part in a semi-structured interview. Data were analysed using a systematic text condensation approach. Results PI in SUD was perceived as challenging due to conceptual unclarities as well as treatment dilemmas that may challenge the notion of PI as a universal and unified ideological foundation of substance use treatment. Conclusions The findings point to a need to critically examine the PI concept and to take a flexible approach in adjusting PI principles to good clinical practice. A framework is launched, allowing the reported challenges in implementing PI in clinical practice to be accepted, acknowledged, and recognized by clinicians as well as by administrators and heads of clinical units.

IntroductionPositive social interactions with farm animals may have therapeutic benefits on humans by increasing brain oxytocin secretion, as inferred from circulating oxytocin levels. The aim of this observational study was to investigate acute changes in human plasma oxytocin levels and state anxiety associated with interactions with dairy cows.MethodsData were collected from 18 healthy female nursing students who performed stroking and brushing of an unfamiliar cow for 15 min. Blood samples were drawn before entering the cowshed (T1, baseline), and after 5 (T2) and 15 (T3) min of interaction with a cow. At T1 and T3, the students filled out the Norwegian version of the Spielberger State-Trait Anxiety Inventory-State Subscale (STAI-SS).ResultsAcross participants, no significant changes in average plasma oxytocin concentration were detected between time points (p>0.05). There was, however, a modest decline in the STAI-SS scores between T1 and T3 (p=0.015) and a positive correlation between the change in individual level of state anxiety between T1 and T3 and the change in OT concentration of the same individual between T2 and T3 (p = 0.045).DiscussionThe results suggest that friendly social interactions with cows are beneficial in lowering state anxiety, but any relationship with release of OT into the circulation was complex and variable across individuals. The acute reduction in state anxiety lends support to the value of interacting with farm animals in the context of Green Care for people with mental health challenges.

Objective Studies indicate an inverse association between sleep duration and psychological distress. We aimed to explore associations between changes in sleep duration and changes in psychological distress in girls and boys.Methods The Fit Futures Study is a broad adolescent study providing data from 373 girls and 294 boys aged 15–18 years collected in 2010/2011 (FF1) and 2012/2013 (FF2). Psychological distress was measured by the Hopkins Symptom Checklist (HSCL-10) and sleep duration was self-reported. Change score variables were calculated as the change between baseline and follow-up for sleep duration and HSCL-10, respectively. Associations between changes in sleep duration and changes in HSCL-10 were explored by linear regressions, in gender-stratified analyses.Results At FF1, girls and boys slept on average 6.93 (SD = 1.08) and 7.05 (SD = 1.20) hours per night respectively, and correspondingly, 6.83 (SD = 1.19) and 6.85 (SD = 1.21) at FF2. At FF1, 22.8% of the girls and 25.8% of the boys slept ≤ 6 h per night, and correspondingly 28.0% and 28.2% at FF2. In girls and boys, one unit increase (30 min) in sleep duration was associated with a decrease in HSCL-10 score of B [95% CI] = −0.090 [−0.131, −0.048], p

BackgroundMany individuals with intellectual disability (ID) have a sedentary lifestyle. Few interventions aimed at increasing their level of physical activity (PA) have shown lasting effects.AimTo assess the feasibility and acceptability of a pilot intervention study using innovative mobile health (mHealth) support systems to encourage PA in individuals with ID.MethodsNine individuals with ID and a low level of PA, aged 16–36 years, were included in the present convergent triangulation mixed method design. Two mHealth support systems (apps) were developed and tested. PA was measured with a Fitbit smartwatch, accelerometer, the International Physical Activity Questionnaire—Short Form (IPAQ-S), and Goal attainment scaling. Data were collected through online pre-, mid- (4 weeks), and post-intervention (12 weeks) questionnaires and activity trackers. Semi-structured qualitative interviews with participants and/or a family or staff member were held after the 12-week follow-up. Data were analyzed using conventional nonparametric statistics and thematic analyses.ResultsThe response rate and retention to the trial were 16% and 100%, respectively. Data quality was high, except for missing data from Fitbit activity trackers of approximately 30% from the 4- and 12-week follow-up stages. The feasibility challenges with activity trackers include rashes, size, non-acceptance, and loss of motivation. Participants and family members/staff reported interest in the study theme and were pleased with the data collection method. All but one participant achieved their PA goals. Most participants reported being satisfied with the apps as they were enjoyable or provided a reminder for performing physical and other activities. Social support for PA among family members also increased. However, app support from staff and family members was needed, and apps were not used regularly. Two of nine participants (22%) had increased their PA measured as steps per day with Fitbit at the 12-week follow-up.ConclusionsThe acceptability and feasibility of using tailored mobile applications in natural settings to increase PA among adults with ID are promising. This study aligns with previous studies in showing the challenges to increasing PA, which requires the inclusion of family members, staff, and stakeholders. The intervention requires modifications before a randomized controlled trial can be conducted.

PurposeTo examine high school students’ disclosure of sexual harassment and abuse (SHA), and awareness of reporting systems and support mechanisms in school among students, leaders, and coaches.MethodNorwegian 17-year-old high school elite athletes (n = 630), recreational athletes (n = 307), and reference students (n = 263) responded to an online questionnaire at two measurement points, 1 year apart (T1 and T2). Leaders and coaches (n = 249) at the participating high schools responded to an adapted version of the questionnaire at T1. Data were analyzed using ANOVA or Welch test, Pearson Chi-Square test, and McNemar test.ResultsIn total, 11.4 and 34.0% of the adolescents were aware of reporting systems and support mechanisms, respectively, in their schools. Nearly all the leaders, and half of the coaches were aware of these resources. Among the adolescents with lifetime experience of SHA, 20.1% had disclosed their experiences to someone. Girls disclosed more frequently than boys. The elite- and recreational athletes disclosed less often compared with the reference students. A negative change from T1 to T2 was found in disclosure of SHA and awareness of support mechanisms. At T2, 6.5% of the adolescents reported that their school had implemented measures against SHA during the last 12 months.ConclusionThe results emphasize a need for institutional effort to improve information about available report- and support resources and increase the relevance of use of such systems for adolescents.

Abstract Background Inflammatory markers have been associated with depression and anxiety disorder in adolescents. Less is known about the association between inflammation and subclinical symptoms in the form of psychological distress. We investigated prevalence of psychological distress and examined the associations between common pro-inflammatory markers and psychological distress in an adolescent population sample. Methods The study was based on data from 458 girls and 473 boys aged 15–17 years from the Fit Futures Study, a large-scale study on adolescent health, conducted in Northern Norway. Psychological distress was measured with the Hopkins Symptom Checklist (HSCL-10). Serum-levels of the following low-grade inflammatory markers were measured: C-reactive protein (CRP), interleukin 6 (IL-6), transforming growth factor-alpha (TGF-α), tumor necrosis factor alpha variant 1 (TRANCE) and tumor necrosis factor alpha variant 2 (TWEAK). Associations between quartiles of inflammatory markers and HSCL-10 were examined by logistic regression and adjusted for potential confounders in sex-stratified analyses. Results The proportion of psychological distress above cutoff were 26.9% and 10.8% among girls and boys, respectively. In both girls and boys, crude analysis showed positive associations between all inflammatory markers and HSCL-10, except for TWEAK and TRANCE in boys. However, none of these associations were statistically significant. Further, there were no significant findings in the adjusted analyses. Conclusion There was a higher prevalence of psychological distress in girls compared to boys. Pro-inflammatory markers were not significantly associated with psychological distress in data from healthy adolescents aged 15–17 years.

Objective: To assess prevalence and factors associated with depression, anxiety and stress among adolescents experiencing lockdown during the 2019 coronavirus disease 2019 (COVID-19) in both Asian and Western countries. Material and Methods: From May-June 2020, secondary school students were enrolled in an online cross-sectional survey, through social media; including, but not limited to, Instagram, Snapchat, WhatsApp and LINE. We assessed the presence and severity of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder Scale-7) and stress (Perceived Stress Scale-10) within the last month, and assessed significant associations with demographics, degree of social distancing, and other associated issues using univariate and multivariate logistic regression analyses. Results: From 392 respondents (56.4% male, 43.1% female), from Thailand (59.2%), the United Kingdom (26.5%) and other countries (14.3%), we identified depressive symptoms in 58.7%, anxiety in 40.3% and high levels of stress in 9.7%. By multivariate analysis, we found significant associations between being female and depression and anxiety, being in late secondary school years and depression, and changes in patterns of substance use and anxiety and stress. Participants not located in Thailand had increased risk of depression. Conclusion: Our study demonstrated depression, anxiety and stress in six, four and one out of ten adolescents, respectively, who were experiencing lockdowns due to the COVID-19 pandemic. We found female gender, older school years, and changes in substance use patterns to be significantly associated with these mental health conditions.

Objectives To quantify energy expenditure and intake in professional female footballers playing on a national and/or international level. Second, to determine the prevalence of low energy availability among these players, defined as

BackgroundSeveral studies have shown that individuals with intellectual disabilities (IDs) have low levels of physical activity (PA), and intervention studies on PA suggest inconsistent evidence. The use of technology as a means of motivation for PA has yet to be extensively explored and needs to be further investigated. ObjectiveWe aim to assess the feasibility and acceptability of procedures for an intervention arm in a future trial on mobile health (mHealth) to support PA for individuals with IDs. In addition, we aim to examine how the use of technology can influence motivation for PA among participants, their caregivers, and staff members. MethodsA mixed methods pilot study of an intervention arm will be carried out in a planned randomized controlled trial (RCT). Ten participants with ID and their caregivers or a staff member will be included. Information will always be provided by a caregiver or a staff member, or participants with ID if possible. Assessments will be carried out at baseline, follow-up after 4 weeks, and 12 weeks, and include questionnaires on PA, social support, self-efficacy, and challenging behavior. PA will be measured with 2 different activity trackers (Fitbit and Axivity) for 1 week at all assessments. Feasibility will be assessed as recruitment and adherence rate, missing data, usability of the motivational mHealth tool, and estimates of effectiveness. Acceptability of study procedures, activity measures, and motivation for participation in PA will be additionally assessed with qualitative methods at the end of the intervention. ResultsEnrollment commenced in May 2021. Data collection was completed in March 2022. ConclusionsThis pilot study will evaluate the feasibility and acceptability of study procedures of the intervention arm of a planned RCT to address feasibility issues, improve study procedures, and estimate effectiveness of the study measures. How the use of technology can influence motivation for PA will also be examined, which can help guide and improve future PA interventions involving the use of technology. Trial RegistrationClinicalTrials.gov NCT04929106; https://clinicaltrials.gov/ct2/show/NCT04929106 International Registered Report Identifier (IRRID)DERR1-10.2196/37849

This research paper explores the integration of ChatGPT as a tool for interactive learning of numerical methods in a differential equations (DEs) course. DE course is crucial for engineering students to model real-world phenomena. However, many DE courses focus only on analytical solutions and neglect important numerical solutions. To overcome this gap, an active learning approach was adopted, where students were asked to select a real-life phenomenon in their field of interest, find an appropriate model to describe it using DEs, and subsequently solve DE numerically using various numerical methods. The authors allowed students to use ChatGPT to generate codes and learn how to adapt them to their personalized learning needs. The findings derived from the students' survey responses demonstrated that ChatGPT significantly enhanced their interests and improved their coding skills. Students reported increased engagement and excitement in their learning journey with the integration of ChatGPT. By sharing this experience, we aim to inspire other educators to explore the potential of innovative technologies and instructional methods to enhance their own courses.

This paper considers the impact of technological processes on human thought, specifically the implications of artificial intelligence (AI) on writing instruction. The main purpose of this paper is to present instructional considerations that will elevate human voice and reduce student temptations to turn to AI unreasonably to produce a piece of writing while still providing responsible options for the incorporation of AI in the writing process.

This quantitative study is designed to help educational institutions and instructors make informed decisions regarding the use of online proctoring software. The researchers studied the impact of proctoring software in online courses by comparing the final grades of two groups of online, undergraduate students who took the same online course with the same professor who administered virtually the same content, with and without proctoring software. The overall sample included 252 students in six different undergraduate courses. When regressing all six courses together, the data did not show that the addition of proctoring software created a significantly lower course grade. The researchers then regressed the data of each individual undergraduate course, with the addition of independent variables, which had a mixed-bag of results. Interestingly, an undergraduate business course showed that the use of proctoring software reduced course grades while other courses produced interesting significant findings relative to gender and attendance status.

BackgroundMediation analysis is important to test the theoretical framework underpinning an intervention. We therefore aimed to investigate if the healthy body image (HBI) intervention’s effect on eating disorder (ED) symptomatology and use of muscle building supplements was mediated by the change in risk and protective factors for ED development and muscle building supplement use.MethodsThis study used data from the HBI intervention: a cluster randomized controlled universal intervention aiming to promote positive body image and embodiment and reduce the risk for ED development including 30 schools in Norway. A total of 1,713 (37% boys) participants were included in the analyses. Conditional latent growth curve analyses were performed to test for indirect effects on ED symptomatology and weekly frequency of protein and creatine supplement use measured at the 12-month follow-up via change in the proposed mediators.ResultsIn girls, the reduction in ED symptomatology was mediated by positive changes in protective factors (self-esteem and body image flexibility) and reductions in risk factor scores (perceived media pressure and thin appearance internalization). Comparable changes in protective and risk factors among boys played no mediating role.ConclusionInterventions aiming to reduce the risk of ED development in girls may benefit from aiming to enhance self-esteem and body image flexibility and reduce perceived media pressure and thin appearance internalization. Future studies should investigate the casual relationship between muscle building supplement use and risk and protective factors for ED development in both girls and boys.

This study examines how intellectual disability nurses employed in residential living services for persons with intellectual disabilities, in Norway, deal with medication management for these individuals. Using a qualitative study, a total of 18 intellectual disability nurses were interviewed as part of four focus groups. The results demonstrate six main challenges: First, Being alone with the responsibility of medication management - a challenge; Second, The need for further competence development; Third, Teaching and supervising unskilled colleagues in safe medication management; Fourth, Interpreting residents with little or only nonverbal communication; Fifth, The need to act as advocates when residents require hospitalization; Sixth, Deficient systems for medication management on several levels. The findings point to several major flaws in the system of medication management, which necessitates the need for highly qualified intellectual disability nurses. Managers must ensure that there is a secure system to mitigate errors and promote patient safety.

ObjectiveThe scarcity of research on associations between inflammatory markers and symptoms of depression and anxiety during adolescence has yielded inconsistent results. Further, not all studies have controlled for potential confounders. We explored the associations between baseline inflammatory markers and psychological distress including moderators at follow-up in a Norwegian adolescent population sample.MethodsData was derived from 373 girls and 294 boys aged 15–18 years at baseline, in the Fit Futures Study, a large-scale 2-year follow-up study on adolescent health. Baseline data was gathered from 2010 to 2011 and follow-up data from 2012 to 2013. Psychological distress was measured with Hopkins Symptom Checklist (HSCL-10). Serum levels of the following inflammatory markers were measured: C-reactive protein (CRP), Interleukin 6 (IL-6), Transforming growth factor alpha (TGF-α), Tumor necrosis factor alpha variant 1 (TRANCE), and variant 2 (TWEAK). Independent associations between baseline inflammatory markers and HSCL-10 at follow-up were explored by linear regressions, in sex-stratified analyses.ResultsIn girls, analyses showed positive associations between all inflammatory markers and HSCL-10, except for TRANCE. However, all associations were non-significant in crude as well as in adjusted analyses. In boys, CRP (p = 0.03) and TGF-α (p

IntroductionTau-positron emission tomography (PET) outcome data of patients with Alzheimer's disease (AD) cannot currently be meaningfully compared or combined when different tracers are used due to differences in tracer properties, instrumentation, and methods of analysis.MethodsUsing head-to-head data from five cohorts with tau PET radiotracers designed to target tau deposition in AD, we tested a joint propagation model (JPM) to harmonize quantification (units termed "CenTauR" [CTR]). JPM is a statistical model that simultaneously models the relationships between head-to-head and anchor point data. JPM was compared to a linear regression approach analogous to the one used in the amyloid PET Centiloid scale.ResultsA strong linear relationship was observed between CTR values across brain regions. Using the JPM approach, CTR estimates were similar to, but more accurate than, those derived using the linear regression approach.DiscussionPreliminary findings using the JPM support the development and adoption of a universal scale for tau-PET quantification.HighlightsTested a novel joint propagation model (JPM) to harmonize quantification of tau PET. Units of common scale are termed "CenTauRs". Tested a Centiloid-like linear regression approach. Using five cohorts with head-to-head tau PET, JPM outperformed linearregressionbased approach. Strong linear relationship was observed between CenTauRs values across brain regions.

When forensic interviewers reject children's "Don't know" responses, either by repeating questions or pressuring the children to provide different responses, children may change their subsequent responses. The primary objective of the current study was to examine interviewer reactions following preschool-aged alleged abuse victims' "Don't know" responses in 114 forensic interviews and the children's responses to these rejections. Interviewer reactions were dichotomously coded as either interviewer acceptance (i.e., transitioning to the next logical question or formulating questions focusing on previously mentioned details) or interviewer rejection (i.e., repeating questions or making negative remarks about recall ability). The results showed that the interviewers accepted the children's "Don't know" responses 75.3% of the time and rejected them 24.7% of the time. When interviewers rejected the children's "Don't know" responses, 75.9% of the subsequent responses contradicted the children's initial responses. These results suggest that interviewer rejections following preschool-aged children's "Don't know" responses may be suggestive.

Experiences occur in a continual succession, and the temporal structure of those experiences is often preserved in memory. The temporal contiguity effect of free recall reveals the temporal structure of memory: when a particular item is remembered, the next response is likely to come from a nearby list position. This effect is remarkably robust, appearing across a wide variety of methodological variations of the task. The temporal contiguity effect is also central to retrieved-context models, which propose temporal organization arises from the interaction of a temporal context representation with the contents of memory. Across six experiments, we demonstrate methodological manipulations that dramatically modulate and even eliminate temporal organization in free recall. We find that temporal organization is strongly modulated and in some cases potentially eliminated by strong semantic structure, the presence of retrieval practice, and a long list length. Other factors such as orienting task, paired-associate item structure, and retention interval duration have more subtle effects on temporal organization. In an accompanying set of simulations, we show that the modulation and elimination of the temporal organization follows lawful patterns predicted by the context maintenance and retrieval (CMR) retrieved-context model. We also find cases where CMR does not specifically predict the modulation of temporal organization, and in these cases our analysis suggests how the theory might be developed to account for these effects.

Electrical triggering of a metal-insulator transition (MIT) often results in the formation of characteristic spatial patterns such as a metallic filament percolating through an insulating matrix or an insulating barrier splitting a conducting matrix. When MIT triggering is driven by electrothermal effects, the temperature of the filament or barrier can be substantially higher than the rest of the material. Using X-ray microdiffraction and dark-field X-ray microscopy, we show that electrothermal MIT triggering leads to the development of an inhomogeneous strain profile across the switching device, even when the material does not undergo a pronounced, discontinuous structural transition coinciding with the MIT. Diffraction measurements further reveal evidence of unique features associated with MIT triggering including lattice distortions, tilting, and twinning, which indicate structural nonuniformity of both low- and high-resistance regions inside the switching device. Such lattice deformations do not occur under equilibrium, zero-voltage conditions, highlighting the qualitative difference between states achieved through increasing temperature and applying voltage in nonlinear electrothermal materials. Electrically induced strain, lattice distortions, and twinning could have important contributions in the MIT triggering process and drive the material into nonequilibrium states, providing an unconventional pathway to explore the phase space in strongly correlated electronic systems.

OBJECTIVES: Precision medicine is data-driven health care tailored to individual patients based on their unique attributes, including biologic profiles, disease expressions, local environments, and socioeconomic conditions. Emergency medicine (EM) has been peripheral to the precision medicine discourse, lacking both a unified definition of precision medicine and a clear research agenda. We convened a national consensus conference to build a shared mental model and develop a research agenda for precision EM. METHODS: We held a conference to (1) define precision EM, (2) develop an evidence-based research agenda, and (3) identify educational gaps for current and future EM clinicians. Nine preconference workgroups (biomedical ethics, data science, health professions education, health care delivery and access, informatics, omics, population health, sex and gender, and technology and digital tools), comprising 84 individuals, garnered expert opinion, reviewed relevant literature, engaged with patients, and developed key research questions. During the conference, each workgroup shared how they defined precision EM within their domain, presented relevant conceptual frameworks, and engaged a broad set of stakeholders to refine precision EM research questions using a multistage consensus-building process. RESULTS: A total of 217 individuals participated in this initiative, of whom 115 were conference-day attendees. Consensus-building activities yielded a definition of precision EM and key research questions that comprised a new 10-year precision EM research agenda. The consensus process revealed three themes: (1) preeminence of data, (2) interconnectedness of research questions across domains, and (3) promises and pitfalls of advances in health technology and data science/artificial intelligence. The Health Professions Education Workgroup identified educational gaps in precision EM and discussed a training roadmap for the specialty. CONCLUSIONS: A research agenda for precision EM, developed with extensive stakeholder input, recognizes the potential and challenges of precision EM. Comprehensive clinician training in this field is essential to advance EM in this domain.