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Abstract Background Cancer-related financial hardship is an increasingly recognized concern for patients, families, and caregivers. Many Native American (NA) patients are at increased risk for cancer-related financial hardship due to high prevalence of low income, medical comorbidity, and lack of private health insurance. However, financial hardship screening (FHS) implementation for NA patients with cancer has not been reported. The objective of this study is to explore facilitators and barriers to FHS implementation for NA patients. Methods We conducted key informant interviews with NA patients with cancer and with clinical staff at an academic cancer center. Included patients had a confirmed diagnosis of cancer and were referred to the cancer center through the Indian Health Service, Tribal health program, or Urban Indian health program. Interviews included questions regarding current financial hardship, experiences in discussing financial hardship with the cancer care and primary care teams, and acceptability of completing a financial hardship screening tool at the cancer center. Clinical staff included physicians, advanced practice providers, and social workers. Interviews focused on confidence, comfort, and experience in discussing financial hardship with patients. Recorded interviews were transcribed and thematically analyzed using MAXQDA® software. Results We interviewed seven patients and four clinical staff. Themes from the interviews included: 1) existing resources and support services; 2) challenges, gaps in services, and barriers to care; 3) nuances of NA cancer care; and 4) opportunities for improved care and resources. Patients identified financial challenges to receiving cancer care including transportation, lodging, food insecurity, and utility expenses. Patients were willing to complete a FHS tool, but indicated this tool should be short and not intrusive of the patient’s financial information. Clinical staff described discomfort in discussing financial hardship with patients, primarily due to a lack of training and knowledge about resources to support patients. Having designated staff familiar with I/T/U systems was helpful, but perspectives differed regarding who should administer FHS. Conclusions We identified facilitators and barriers to implementing FHS for NA patients with cancer at both the patient and clinician levels. Findings suggest clear organizational structures and processes are needed for financial hardship to be addressed effectively.

BackgroundSurvivorship care plans (SCPs) are provided at the completion of cancer treatment to aid in the transition from active treatment to long-term survivorship. They describe the details of a patient’s diagnosis and treatment and offer recommendations for follow-up appointments, referrals, and healthy behaviors. The plans are currently paper-based and become outdated as soon as a patient’s health status changes. There is a need to digitize these plans to improve their accessibility, modifiability, and longevity. With current technology, SCPs can be linked to mobile devices and activity trackers so that patients can track health behaviors and compare them to their clinical goals, taking charge of their own health. ObjectiveA mobile app, POSTHOC (POST-Treatment Health Outcomes of Cancer Survivors), that digitizes the SCP was developed, with goals of integrating it with wearable technologies and electronic medical records. Herein, we are conducting a randomized controlled trial that evaluates the POSTHOC app versus the traditional SCP on total symptom burden in the early posttreatment period. MethodsWe will recruit 54 patients who have recently completed curative therapy for cancer (any type) in person and remotely. They will be randomized 2:1, POSTHOC:usual care (unblinded). Those randomized to the POSTHOC group will receive their SCP via the app and will choose to focus on nutrition or exercise for the duration of the study based on their individual plan and personal preferences. Those randomized to the control group will get a paper-based plan. At baseline, 6 weeks, and 12 weeks, we will evaluate patient-reported outcomes, including total symptom burden (web-based questionnaire), diet (24-hour Automated Self-Administered [ASA24]), and physical activity (Fitbit Charge 6 [Google LLC]). We will also collect quantitative and qualitative feedback on the usability of the app from those in the POSTHOC arm to improve the app for future implementation studies, with a specific focus on patient-provider communication. For feasibility, we will calculate the percentage of patients who used the POSTHOC app at least 3 times per week. We will use linear mixed models to evaluate the effects of the POSTHOC app versus those of usual care on other outcomes at weeks 6 and 12. ResultsThis trial is open to accrual in the University of Maryland Medical System as of March 2024, and as of July 3, 2024, a total of 20 participants have consented. ConclusionsThis study is among the first to digitize the SCP in a mobile app and test the effects of a mobile health–delivered behavioral health intervention on symptom burden in cancer survivors. Our results will provide evidence about the effects of health self-management on symptoms. This knowledge will be integral to larger randomized controlled studies, integration with the electronic medical record, and nationwide implementation. Trial RegistrationClinicalTrials.gov NCT05499663; https://clinicaltrials.gov/ct2/show/NCT05499663 International Registered Report Identifier (IRRID)DERR1-10.2196/59222

Eastern gamagrass (Tripsacum dactyloides) is a highly productive, highly palatable native grass tolerant to both drought and flooding. It has frequently shown great response to nitrogen (N) applications, but the responses of southern native ecotypes in upland and bottomland sites have yet to be reported. The objectives were to measure the responses of long-established eastern gamagrass with different N application rates in two bottomland hay pastures and two upland grazed sites, and to measure the N responses for six diverse ecotypes in a common garden. A randomized block design was used with ecotype as the main block and fertilizer rate as the subplot. In the long-established sites, 75 N peak yields were not statistically different to those of 0 N, while upland yields across the season were consistently higher for 150 N but varied for the bottomland. The common garden ecotypes had no significant difference in yield between treatments when averaged across years. Roaring Springs showed the most consistent and greatest benefit to additional N, more than doubling the dry weight of the control. All remaining ecotypes, however, had more modest responses. Eastern gamagrass responds inconsistently to applications of 75 N, whereas most applications of 150 N generally result in higher yield, though significant increases are not guaranteed.

Eastern gamagrass (Tripsacum dactyloides) is highly palatable, ideal for grazing and hay production in the United States. It is deep rooted and resilient, tolerant of flooding and drought. Objectives of this study were to develop plant parameters for different ecotypes of this grass. Data collected in field plots of diverse ecotypes included biomass, leaf area index (LAI), light extinction coefficient (k), and radiation use efficiency (RUE). Average LAI was 1.06 and average k was −1.05. The power response of k to LAI offers a new approach to simulating light interception at very low LAI values and throughout the range of LAI values of these ecotypes and similar grass species. The RUE values, which ranged from 1.16 to 4.31 g/MJ, highlight the immense diversity of eastern gamagrass. The high RUE values for the most productive ecotypes emphasizes the importance of this grass species for hay and grazing. While not as large as switchgrass (Panicum virgatum) values, it is still a prominent forage species that even is comparable to maize (Zea mays L.) in productivity when expressed as radiation use efficiency. These results are an important step in developing relationships and parameters to simulate the different ecotypes of this grass with process-based models.

Climate-sensitive hazards, including extreme heat, wildfire smoke, flooding, and rising sea levels, can jeopardize the health of all populations. However, certain population groups are more vulnerable to harm from these hazards. While youth–particularly those from historically marginalized groups and communities–are among those at the highest risk, their abilities may be underutilized in local climate adaptation efforts. This exploratory research aimed to identify opportunities for youth involvement in climate and environmental solutions in their historically marginalized communities. Specifically, this study (1) investigated youth risk perceptions and impacts of various climate-sensitive hazards (e.g. extreme heat, wildfire smoke, flooding, and sea level rise); (2) examined current barriers, resource needs, and opportunities for youth to engage in climate and environmental solution work; and (3) explored current methods and spaces where youth and community leaders can support youth-led climate-related initiatives. Through focus group discussions with youth and in-depth interviews with community leaders who are directly with youth, this study identified opportunities to leverage youth experiences, perceptions, and assets to promote a healthy and resilient community in the face of various compounding climate-related threats. Results showed that while youth recognize the changing climate and associated health impacts, they require more financial resources and support from local decision-makers to maintain their engagement and promote community resilience. Engaging youth in climate action and community resilience involves more than just centering youth voices and perspectives–it requires intentional collaboration, capacity-building, organizing, granting decision-making power, and other strategies to produce inclusive, intersectional, and sustainable solutions.

Background: Androgen deprivation therapy (ADT) inhibits prostate cancer growth. However, ADT causes loss of bone mineral density (BMD) and an increase in fracture risk; effective interventions for ADT‐induced bone loss are limited. Methods: A phase 2 randomized controlled trial investigated the feasibility, safety, and preliminary efficacy of high‐dose weekly vitamin D (HDVD, 50,000 IU/week) versus placebo for 24 weeks in patients with prostate cancer receiving ADT, with all subjects receiving 600 IU/day vitamin D and 1000 mg/day calcium. Participants were ≥60 years (mean years, 67.7), had a serum 25‐hydroxyvitamin D level <32 ng/mL, and initiated ADT within the previous 6 months. At baseline and after intervention, dual‐energy x‐ray absorptiometry was used to assess BMD, and levels of bone cell, bone formation, and resorption were measured. Results: The HDVD group (N = 29) lost 1.5% BMD at the total hip vs. 4.1% for the low‐dose group (N = 30; p =.03) and 1.7% BMD at the femoral neck vs. 4.4% in the low‐dose group (p =.06). Stratified analyses showed that, for those with baseline 25‐hydroxyvitamin D level <27 ng/mL, the HDVD group lost 2.3% BMD at the total hip vs 7.1% for the low‐dose group (p <.01). Those in the HDVD arm showed significant changes in parathyroid hormone (p <.01), osteoprotegerin (p < 0.01), N‐terminal telopeptide of type 1 collagen (p < 0.01) and C‐terminal telopeptide of type 1 collagen (p < 0.01). No difference in adverse events or toxicity was noted between the groups. Conclusions: HDVD supplementation significantly reduced hip and femoral neck BMD loss, especially for patients with low baseline serum 25‐hydroxyvitamin D levels, although demonstrating safety and feasibility in prostate cancer patients on ADT. Patients with prostate cancer on androgen deprivation therapy often suffer rapid bone loss during the initiation of treatment. Supplementation with high‐dose vitamin D (50,000 IU/week plus 800 IU/day) significantly and safely decreased the amount of bone loss compared with vitamin D supplementation using the recommended daily allowance (800 IU/day). [ABSTRACT FROM AUTHOR]

Background: Research suggests that quantitative metric reports can improve the clinical performance of emergency physicians; however, few studies have examined their effects on physicians in training. The primary study objective was to assess the effects of providing emergency medicine (EM) residents with individualized throughput metrics with regard to emergency department (ED) disposition times. Methods: We performed a single‐center, retrospective, observational study from January 2021 to December 2022 examining ED disposition times before and after providing upper‐level EM residents individualized throughput metrics. Residents received monthly reports of three specific metrics averaged over the preceding 6 months: (1) median time from room to discharge order (Rm2Dc), (2) median time from return of all results to discharge order (Rlts2Dc), and (3) median time from room and to consult order for hospitalization (Rm2Hosp). Overall mean values of the three metrics before and during metric sharing were compared via independent t‐test and stratified by level of training and time of year. Adjusted analysis was performed to control for temporal differences between study periods. Testing was conducted at α = 0.05 level of significance. Results: A total of 35 unique residents were included in the analysis. Overall, mean disposition times were not significantly different before and during reporting of metrics: Rm2Dc (154.8 min vs. 148.9 min, p = 0.109), Rslt2Dc (46.5 min vs. 45.1 min, p = 0.522), and Rm2Hosp (141.7 min vs. 135.7 min, p = 0.257). Subgroup analysis yielded similar results, aside from a significant decrease in mean Rm2Hosp in the postgraduate year‐3 (PGY‐3) group (145.8 min vs. 124.1 min, p = 0.004). Analysis with adjusted means yielded results similar to those observed with unadjusted data. Conclusions: Overall, individualized throughput metrics were not correlated with decreased average times to ED disposition for upper‐level EM residents; however, in the subset of hospitalized patients seen by PGY‐3 residents, we observed a mean decrease of 21.7 min to consultation. [ABSTRACT FROM AUTHOR]

Eastern gamagrass (Tripsacum dactyloides) is a highly productive, highly palatable native grass tolerant to both drought and flooding. It has frequently shown great response to nitrogen (N) applications, but the responses of southern native ecotypes in upland and bottomland sites have yet to be reported. The objectives were to measure the responses of long-established eastern gamagrass with different N application rates in two bottomland hay pastures and two upland grazed sites, and to measure the N responses for six diverse ecotypes in a common garden. A randomized block design was used with ecotype as the main block and fertilizer rate as the subplot. In the long-established sites, 75 N peak yields were not statistically different to those of 0 N, while upland yields across the season were consistently higher for 150 N but varied for the bottomland. The common garden ecotypes had no significant difference in yield between treatments when averaged across years. Roaring Springs showed the most consistent and greatest benefit to additional N, more than doubling the dry weight of the control. All remaining ecotypes, however, had more modest responses. Eastern gamagrass responds inconsistently to applications of 75 N, whereas most applications of 150 N generally result in higher yield, though significant increases are not guaranteed. [ABSTRACT FROM AUTHOR]

Chromosomal instability (CIN) is the persistent reshuffling of cancer karyotypes via chromosome mis-segregation during cell division. In cancer, CIN exists at varying levels that have differential effects on tumor progression. However, mis-segregation rates remain challenging to assess in human cancer despite an array of available measures. We evaluated measures of CIN by comparing quantitative methods using specific, inducible phenotypic CIN models of chromosome bridges, pseudobipolar spindles, multipolar spindles, and polar chromosomes. For each, we measured CIN fixed and timelapse fluorescence microscopy, chromosome spreads, six-centromere FISH, bulk transcriptomics, and single-cell DNA sequencing (scDNAseq). As expected, microscopy of tumor cells in live and fixed samples significantly correlated (R = 0.72; P < 0.001) and sensitively detect CIN. Cytogenetics approaches include chromosome spreads and 6-centromere FISH, which also significantly correlate (R = 0.76; P < 0.001) but had limited sensitivity for lower rates of CIN. Bulk genomic DNA signatures and bulk transcriptomic scores, CIN70 and HET70, did not detect CIN. By contrast, scDNAseq detects CIN with high sensitivity, and significantly correlates with imaging methods (R = 0.82; P < 0.001). In summary, single-cell methods such as imaging, cytogenetics, and scDNAseq can measure CIN, with the latter being the most comprehensive method accessible to clinical samples. To facilitate the comparison of CIN rates between phenotypes and methods, we propose a standardized unit of CIN: Mis-segregations per Diploid Division. This systematic analysis of common CIN measures highlights the superiority of single-cell methods and provides guidance for measuring CIN in the clinical setting. [ABSTRACT FROM AUTHOR]

Educational contexts are often seen as constraints in school settings. We propose a framework to analyze how teachers draw on their contexts to find resources to support their learning. Following five preservice elementary teachers into their first years of teaching, we draw on interviews, surveys, artifacts, and videorecords. We apply this framework to identify the resources available in elementary science teaching. Our findings show how some resources can cascade from higher levels (e.g., state standards and mistrust of science) and impact classroom opportunities. Our analysis highlights the importance of teacher education and school leadership in illuminating contextual resources available to teachers. [ABSTRACT FROM AUTHOR]

Eastern gamagrass (Tripsacum dactyloides) is highly palatable, ideal for grazing and hay production in the United States. It is deep rooted and resilient, tolerant of flooding and drought. Objectives of this study were to develop plant parameters for different ecotypes of this grass. Data collected in field plots of diverse ecotypes included biomass, leaf area index (LAI), light extinction coefficient (k), and radiation use efficiency (RUE). Average LAI was 1.06 and average k was −1.05. The power response of k to LAI offers a new approach to simulating light interception at very low LAI values and throughout the range of LAI values of these ecotypes and similar grass species. The RUE values, which ranged from 1.16 to 4.31 g/MJ, highlight the immense diversity of eastern gamagrass. The high RUE values for the most productive ecotypes emphasizes the importance of this grass species for hay and grazing. While not as large as switchgrass (Panicum virgatum) values, it is still a prominent forage species that even is comparable to maize (Zea mays L.) in productivity when expressed as radiation use efficiency. These results are an important step in developing relationships and parameters to simulate the different ecotypes of this grass with process-based models. [ABSTRACT FROM AUTHOR]

The social inclusion of military women is negatively affected by dominant masculine norms. Often, military organizations try to promote inclusion through top-down policies. However, little is known about solutions military personnel themselves propose, and what is needed to implement those. Drawing on an action research project in the Netherlands Armed Forces, we identify four systemic collaborative requirements to implement initiatives aimed at improving inclusion: (a) awareness and recognition of women’s (negative) experiences, (b) a safe environment for dialogue and joint ownership, (c) organizational trust, support and mandate, and (d) the implementation of interventions in the organizational structure. We discuss two paradoxes we identified (a) addressing inclusion in unsafe workplaces requires safety and (b) creating awareness about women’s social inclusion without putting women in the spotlight. Our results show that a dialogic and collaborative approach is promising, especially to address the complexities that arise when trying to strengthen inclusion. [ABSTRACT FROM AUTHOR]

The United States is the third largest producer of cotton and the largest exporter of cotton globally. Fusarium wilt, caused by the soilborne fungal pathogen Fusarium oxysporum f. sp. vasinfectum (Fov), was estimated to cause a $21 million cotton yield loss in 2022. Historically, Alabama was an important producer of cotton in the Southeastern United States and was the first state in which Fusarium wilt on cotton was described. To assess the genetic diversity of Fov field isolates in Alabama, 118 field isolates were collected from six counties across the state from 2014 to 2016. Phylogenetic analysis using TEF1 and RPB2 placed the Fov field isolates into 18 haplotypes. Upon profiling the Tfol transposon insertion in the NAT gene, it was determined that no race 4 isolates were recovered in Alabama. Representatives of all field isolate haplotypes caused disease on Upland cotton variety Rowden in a hydroponic test tube assay. Two haplotype A isolates were the most aggressive isolates recovered, and haplotype A isolate TF1 was more aggressive than the race 4 isolate 89-1A on Upland cotton and had similar symptom severity on Pima cotton. Karyotype profiling indicted an abundance of small chromosomes characteristic of karyotypes that include accessory chromosomes, with considerable variability between isolates. Collectively, our study indicates that Fov isolates from Alabama are genetically diverse, which may have been promoted by its persistence in cotton fields. [ABSTRACT FROM AUTHOR]

Background and Objectives: The utility of oral 5-aminolevulinic acid (5-ALA)/protoporphyrin fluorescence for the resection of high-grade gliomas is well documented, but the problem of false-negative observations remains. This study compares high-grade glioma visualization with low/standard dose 5-ALA (<30 mg/kg) to high-dose 5-ALA (>40 mg/kg) to see if by using this higher dose, it is possible to reduce the rate of false-negative observations without increasing the rate of false-positive (FP) observations and therefore increase the sensitivity., Methods: This is a prospective study of consecutive patients with radiological evidence of presumed high-grade glioma. We reviewed the data from patients who received preoperative low/standard doses and patients who received a preoperative high dose of 5-ALA. Adverse events, dose to observation time, intensity of tumor fluorescence, and results of biopsies in areas of tumor and tumor bed under deep blue light were recorded., Results: A total of 22 patients with high-grade glioma received a dose >40 mg/kg (high-dose) and 9 patients received <30 mg/kg (low/standard dose). There were no serious adverse events related to 5-ALA in any subject. There was a very high sensitivity and specificity of 5-ALA for the presence of tumor in both groups. There were no FP observations (fluorescence with no tumor) in either group. The specificity and the positive predictive value were 100% in both groups. The sensitivity and the negative predictive value were 53.3% and 30.0% in the low/standard dose group and 59.5% and 31.8% in the high-dose group, respectively., Conclusion: High-dose oral 5-aminolevulinic/protoporphyrin fluorescence is a safe and effective aid to the intraoperative detection of high-grade gliomas with high sensitivity and specificity. False-negative observations with a high dose do not seem to be less than that with a low/standard dose. The rate of FP observations with both groups remains very low., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Background: Survivorship care plans (SCPs) are provided at the completion of cancer treatment to aid in the transition from active treatment to long-term survivorship. They describe the details of a patient's diagnosis and treatment and offer recommendations for follow-up appointments, referrals, and healthy behaviors. The plans are currently paper-based and become outdated as soon as a patient's health status changes. There is a need to digitize these plans to improve their accessibility, modifiability, and longevity. With current technology, SCPs can be linked to mobile devices and activity trackers so that patients can track health behaviors and compare them to their clinical goals, taking charge of their own health., Objective: A mobile app, POSTHOC (POST-Treatment Health Outcomes of Cancer Survivors), that digitizes the SCP was developed, with goals of integrating it with wearable technologies and electronic medical records. Herein, we are conducting a randomized controlled trial that evaluates the POSTHOC app versus the traditional SCP on total symptom burden in the early posttreatment period., Methods: We will recruit 54 patients who have recently completed curative therapy for cancer (any type) in person and remotely. They will be randomized 2:1, POSTHOC:usual care (unblinded). Those randomized to the POSTHOC group will receive their SCP via the app and will choose to focus on nutrition or exercise for the duration of the study based on their individual plan and personal preferences. Those randomized to the control group will get a paper-based plan. At baseline, 6 weeks, and 12 weeks, we will evaluate patient-reported outcomes, including total symptom burden (web-based questionnaire), diet (24-hour Automated Self-Administered [ASA24]), and physical activity (Fitbit Charge 6 [Google LLC]). We will also collect quantitative and qualitative feedback on the usability of the app from those in the POSTHOC arm to improve the app for future implementation studies, with a specific focus on patient-provider communication. For feasibility, we will calculate the percentage of patients who used the POSTHOC app at least 3 times per week. We will use linear mixed models to evaluate the effects of the POSTHOC app versus those of usual care on other outcomes at weeks 6 and 12., Results: This trial is open to accrual in the University of Maryland Medical System as of March 2024, and as of July 3, 2024, a total of 20 participants have consented., Conclusions: This study is among the first to digitize the SCP in a mobile app and test the effects of a mobile health-delivered behavioral health intervention on symptom burden in cancer survivors. Our results will provide evidence about the effects of health self-management on symptoms. This knowledge will be integral to larger randomized controlled studies, integration with the electronic medical record, and nationwide implementation., Trial Registration: ClinicalTrials.gov NCT05499663; https://clinicaltrials.gov/ct2/show/NCT05499663., International Registered Report Identifier (irrid): DERR1-10.2196/59222., (©Kaitlin H Chung, Shari M Youngblood, Carin L Clingan, Dana C Deighton, Virginia A Jump, Thushini Manuweera, Nicolette M McGeorge, Cynthia L Renn, Paula Y Rosenblatt, Aaron T Winder, Shijun Zhu, Ian R Kleckner, Amber S Kleckner. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 05.09.2024.)

Purpose: A growing body of research suggests that the brain is implicated in cognitive impairment, fatigue, neuropathy, pain, nausea, sleep disturbances, distress, and other prevalent and burdensome symptoms of cancer and its treatments. Despite anecdotal evidence of difficulties using gold-standard magnetic resonance imaging (MRI) to study the brain, no studies have systematically reported reasons that patients with cancer do or do not complete research MRI scans, making it difficult to understand the role of the brain related to these symptoms. The goal of this study was to investigate these reasons and to suggest possible solutions., Methods: We analyzed data from 72 patients with cancer (mostly breast and gastrointestinal) from 3 studies: MRI was mandatory in Study 1; MRI was optional in Studies 2-3. Patients provided reasons for completing or not completing optional research MRI scans., Results: The percentage of scans completed when MRI was mandatory was 76%, and when optional, it was 36%. The most common reasons for not completing optional scans were claustrophobia (40%), safety contraindications (11%), discomfort (5%), a busy MRI schedule (5%), and the scanner being too far away (4%). Older patients were more likely to complete at least one scan (log(odds) = 0.09/year, p = 0.02)., Conclusion: Although brain MRI is feasible for many patients with cancer, it can be difficult or not feasible for patients with claustrophobia, safety issues, busy schedules, or transportation issues. Improving communication, comfort, and access to a scanner may help. Reducing inequities related to study participation can improve research supportive care research.

Context: Ambulatory adverse events (AEs) affect up to 25% of the global population and cause over 7 million preventable hospital admissions around the world. Though patients and caregivers are key actors in promoting and monitoring their own ambulatory safety, healthcare teams do not traditionally partner with patients in safety efforts. We sought to identify what patients and caregivers contribute when engaged in ambulatory AE review, focusing on under-resourced care settings., Methods: We recruited adult patients, caregivers and patient advisors who spoke English, Spanish and/or Cantonese, from primary care clinics affiliated with a public health network in the USA. All had experience taking or managing a high-risk medication (blood thinners, insulin or opioid). We presented two exemplar ambulatory AEs: one involving a warfarin drug-drug interaction, and one involving delayed diagnosis of colon cancer. We conducted semistructured focus groups and interviews to elicit participants' perceptions of causal factors and potential preventative measures for similar AEs. The study team conducted a mixed inductive-deductive qualitative analysis to derive major themes., Findings: The sample included 6 English-speaking patients (2 in the focus group, 4 individual interviews), 6 Spanish-speaking patients (individual interviews), 4 Cantonese-speaking patients (2 in the focus group, 2 interviews), and 6 English-speaking patient advisors (focus group). Themes included: (1) Patients and teams have specific safety responsibilities; (2) Proactive communication drives safe ambulatory care; (3) Barriers related to limited resources contribute to ambulatory AEs. Patients and caregivers offered ideas for operational changes that could drive new safety projects., Conclusions: An ethnically and linguistically diverse group of primary care patients and caregivers defined their agency in ensuring ambulatory safety and offered pragmatic ideas to prevent AEs they did not directly experience. Patients and caregivers in a safety net health system can feasibly participate in AE review to ensure that safety initiatives include their valuable perspectives., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To examine the components of visual attention that maintain situational awareness during simulation training in undergraduate nursing students with different instruction levels., Background: Eye-tracking can provide deep insight into the nurses' attention during simulated practice. Knowing which gaze patterns promote situational awareness can significantly improve nurse instruction., Design: A comparative observational study investigated the role of visual attention on the performance quality, psychophysiological parameters (vital signs, anxiety and stress) and socioemotional competencies (cognitive workload, motivation and self-efficacy) of nursing students with various experience levels., Methods: Thirty nursing students divided into two groups according to their academic level: first cycle (n=14) and second-cycle (n=16) faced a clinical simulation scenario to resolve a cardiorespiratory arrest event. Eye tracking-based analysis required the selection of six areas of interest. The monitorization of vital signs included measuring blood pressure, heart rate, respiratory rate and oxygen saturation before and after the simulation practice. Participants completed the socioemotional questionnaire (NASA-TLX). They answered the state subscale of the State-Trait Anxiety Inventory (STAI), the Visual Analogue Scale (VAS) of stress, the Situational Motivation Scale (SIMS) and the Baessler and Schwarzer General Self-Efficacy Scale., Results: The first-cycle group displayed higher vital sign scores than the second cycle, apart from the post-simulation respiratory rate. All physiological parameters increased in mean value after the clinical simulation, except oxygen saturation. Anxiety was the only parameter in the socioemotional domain to present a statistically significant difference between the groups. First-year nursing students showed greater anxiety, stress, mental workload, identified regulation and intrinsic motivation, while second-year students showed higher levels of amotivation, external regulation and perceived self-efficacy. Eye-tracking data (revisits, gaze and duration of fixations) exhibited statistically significant differences depending on the area of interest in both groups (p =. 05). The performance outcomes showed a negative and moderate association with gaze the total number of gazes in the second-cycle group (rho = -0.640, p = 0.010)., Conclusion: Eye-tracking-based analysis can help to predict performance quality while maintaining situational awareness during nursing instruction., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: In recent years, microRNAs (miRNAs) have emerged as key players in the pathophysiology of multiple diseases including Alzheimer's disease (AD). Messenger RNA (mRNA) targeting for regulation of gene expression by miRNAs has been implicated in the annotation of disease pathophysiology as well as in the explication of their starring role in contemporary therapeutic interventions. One such miRNA is miR-153 which mediates the survival of cortical neurons and inhibits plaque formation. However, the core mRNA targets of miR-153 have not been fully illustrated. Objective: The present study aimed to elucidate the potential involvement of miR-153 in AD pathogenesis and to reveal its downstream targets. Methods: miRanda was used to identify AD-associated targets of miR-153. TargetScan, PicTar, miRmap, and miRDB were further used to validate these targets. STRING 12 was employed to assess the protein-protein interaction network while Gene ontology (GO) analysis was carried out to identify the molecular functions exhibited by these gene targets. Results: In silico analysis using miRanda predicted five important AD-related targets of miR-153, including APP, SORL1, PICALM, USF1, and PSEN1. All five target genes are negatively regulated by miR-153 and are substantially involved in AD pathogenesis. A protein interaction network using STRING 12 uncovered 30 potential interacting partners for SORL1, PICALM, and USF1. GO analysis revealed that miR-153 target genes play a critical role in neuronal survival, differentiation, exon guidance, amyloid precursor protein processing, and synapse formation. Conclusion: These findings unravel the potential role of miR-153 in the pathogenesis of AD and provide the basis for forthcoming experimental studies., 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 © 2024 Amber and Zahid.)