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Use machine learning to characterize the content of endometriosis online community posts and comments. Retrospective Descriptive Study. Endometriosis online health communities (OHCs) on the platform Reddit. Users of the endometriosis OHCs r/Endo and r/endometriosis. Machine learning was used to analyze thousands of posts made to endometriosis OHCs. Content of posts and comments was interpreted using topic modeling, persona identification, and intent labeling. Measurements included baseline characteristics of users, posts, and comments to the OHCs. Machine-learning techniques; topic modeling, intent labeling, and persona identification were used to identify the most common topics of conversation, the intents behind the posts, and the subjects of people discussed in posts. System performance was assessed via accuracy at F 1 -score. A total of 34 715 posts and 353 162 comments responding to posts were evaluated. The topics most likely to be a subject of a post were menstruation (8%), sharing symptoms (8%), medical appointments (8%), medical story (9%), and empathy (7%). The majority of posts were written with the intent of seeking information about endometriosis (49%) or seeking the experiences of others with endometriosis (29%). Users expressed a strong preference for surgeons performing excision rather than ablation of endometriosis. Endometriosis OHCs are mostly used to learn about symptoms of endometriosis and share one's medical experiences. Posts and comments from users highlight the need for more empathy in the clinical care of endometriosis and easier access for patients to high-quality information about endometriosis. [ABSTRACT FROM AUTHOR]

Treatment options for patients with metastatic castration-resistant prostate cancer include use of radioligand therapy with 177Lu-PSMA-617. 177Lu-PSMA-617 is used to target prostate cancer cells selectively by targeting prostate specific membrane antigen (PSMA); however, PSMA is also expressed on lacrimal glands among other tissues. Herein, we report on a case of a Common Terminology Criteria for Adverse Events version 5 grade 3 dry eye event with concomitant blepharitis after administration of 177Lu-PSMA-617. The patient was managed with neomycin-polymyxin-dexamethasone 3.5-10000-0.1 ophthalmic suspension, artificial tears, lubricating ointments, lid scrubs, and oral antihistamines. [ABSTRACT FROM AUTHOR]

Skin denervation has been shown to cause remission of psoriatic lesions in patients, which can reappear if reinnervation occurs. This effect can be induced by the activation of dendritic cells through sensory innervation. However, a direct effect of nerves on the proliferation of keratinocytes involved in the formation of psoriatic plaques has not been investigated. We developed, by tissue engineering, a model of psoriatic skin made of patient skin cells that showed increased keratinocyte proliferation and epidermal thickness compared to healthy controls. When this model was treated with CGRP, a neuropeptide released by sensory neurons, an increased keratinocyte proliferation was observed in the psoriatic skin model, but not in the control. When a sensory nerve network was incorporated in the psoriatic model and treated with capsaicin to induce neuropeptide release, an increase of keratinocyte proliferation was confirmed, which was blocked by a CGRP antagonist while no difference was noticed in the innervated healthy control. We showed that sensory neurons can participate directly to keratinocyte hyperproliferation in the formation of psoriatic lesions through the release of CGRP, independently of the immune system. Our unique tissue-engineered innervated psoriatic skin model could be a valuable tool to better understand the mechanism by which nerves may modulate psoriatic lesion formation in humans. This study shows that keratinocytes extracted from patients' psoriatic skin retain, at least in part, the disease phenotype. Indeed, when combined in a 3D model of tissue-engineered psoriatic skin, keratinocytes exhibited a higher proliferation rate, and produced a thicker epidermis than a healthy skin control. In addition, their hyperproliferation was aggravated by a treatment with CGRP, a neuropeptide released by sensory nerves. In a innervated model of tissue-engineered psoriatic skin, an increase in keratinocyte hyperproliferation was also observed after inducing neurons to release neuropeptides. This effect was prevented by concomitant treatment with an antagonist to CGRP. Thus, this study shows that sensory nerves can directly participate to affect keratinocyte hyperproliferation in psoriasis through CGRP release. [Display omitted] [ABSTRACT FROM AUTHOR]

To evaluate dose volume histogram (DVH) construction differences across 8 major commercial treatment planning systems (TPS) and dose reporting systems for clinically treated plans of various anatomic sites and target sizes. Dose files from 10 selected clinically treated plans with a hypofractionation, stereotactic radiation therapy prescription or sharp dose gradients such as head and neck plans ranging from prescription doses of 18 Gy in 1 fraction to 70 Gy in 35 fractions, each calculated at 0.25 and 0.125 cm grid size, were created and anonymized in Eclipse TPS, and exported to 7 other major TPS (Pinnacle, RayStation, and Elements) and dose reporting systems (MIM, Mobius, ProKnow, and Velocity) systems for comparison. Dose-volume constraint points of clinical importance for each plan were collected from each evaluated system (D0.03 cc [Gy], volume, and the mean dose were used for structures without specified constraints). Each reported constraint type and structure volume was normalized to the value from Eclipse for a pairwise comparison. A Wilcoxon rank-sum test was used for statistical significance and a multivariable regression model was evaluated adjusting for plan, grid size, and distance to target center. For all DVH points relative to Eclipse, all systems reported median values within 1.0% difference of each other; however, they were all different from Eclipse. Considering mean values, Pinnacle, RayStation, and Elements averaged at 1.038, 1.046, and 1.024, respectively, while MIM, Mobius, ProKnow, and Velocity reported 1.026, 1.050, 1.033, and 1.022, respectively relative to Eclipse. Smaller dose grid size improved agreement between the systems marginally without statistical significance. For structure volumes relative to Eclipse, larger differences are seen across all systems with a range in median values up to 3.0% difference and mean up to 10.1% difference. Large variations were observed between all systems. Eclipse generally reported, at statistically significant levels, lower values than all other evaluated systems. The nonsignificant change resulting from lowering the dose grid resolution indicates that this resolution may be less important than other aspects of calculating DVH curves, such as the 3-dimensional modeling of the structure. [ABSTRACT FROM AUTHOR]

Iodinated contrast medium (ICM) is available in single- and multiuse vials of varying sizes, but CT departments often preferentially stock only a single or a limited number of vial sizes. The aims of this study were to assess actual ICM waste at a large safety-net hospital and to compare with estimated waste if single-use vials in a variety of vial sizes or multiuse vials were used. ICM administrations were retrospectively reviewed for all CT examinations performed in 2021 in a department that stocked only 100-mL ICM vials. Administered ICM dose, opened ICM volume and number of vials, and wasted ICM were compared with hypothetical models using optimally sized single-use vials and multiuse vials. Contrast use was also compared by patient class. In total, 40,393 ICM administrations over 49,670 CT examinations among 26,028 patients were reviewed, totaling 4,168,335 mL of contrast media. The mean dose was 103 mL, with mode of 100 mL. Exclusive use of 100-mL vials resulted in 1,006,165 mL waste (mean waste, 26 mL/administration). Optimally sized single-use vials resulted in 436,515 mL waste (mean waste, 11 mL/administration). Multiuse vials resulted in 537,074 mL waste (mean waste, 13 mL/administration). The distribution of optimal single-use vial size differed significantly by patient class (P <.001), with inpatient examinations more amenable to the use of smaller single-use vials. Optimizing ICM inventory can reduce contrast waste by 50% to 59%. Regular monitoring of contrast use may help optimize inventory selection across care settings. This retrospective review supports scrutiny of ICM inventory management to reduce waste, save costs, and mitigate the impacts of supply-chain disruptions. [Display omitted] [ABSTRACT FROM AUTHOR]

• What is the primary question addressed by this study? What are the components and outcomes of a mentoring program to promote independence and scientific leadership and to improve the likelihood of research funding? • What is the main finding of this study? The Advanced Research Institute (ARI) in Mental Health and Aging participants had sustained research activity, scientific service, and among NIMH Career Development awardees, ARI participants were 3.2 times more likely to achieve R01 funding than nonparticipants. • What is the meaning of the finding? With outside mentors, methodology support, and an expanded network, the ARI mentoring program can support the growth of researchers building independence. The Advanced Research Institute (ARI) in Mental Health and Aging is a NIMH-funded mentoring network to help transition early-career faculty to independent investigators and scientific leaders. Since 2004, ARI has enrolled 184 Scholars from 61 institutions across 34 states. We describe the ARI components and assess the impact and outcomes of ARI on research careers of participants. Outcomes of ARI graduates (n = 165) came from NIH Reporter, brief surveys, and CVs: 87.3% remained active researchers, 83.6% performed scientific service, and 80.6% obtained federal grants. A population-based analysis examined NIMH mentored K awardees initially funded from 2002–2018 (n = 1160): in this group, 77.1% (47/61) of ARI participants versus 49.5% (544/1099) of nonparticipants obtained an R01. Controlling for time, ARI participants were 3.2 times more likely to achieve R01 funding than nonparticipants. Given the struggle to reduce attrition from the research career pipeline, the effectiveness of ARI model could be relevant to other fields. [ABSTRACT FROM AUTHOR]

We propose the use of monoclonal antibodies that target MMP-26—a potential endometriosis biomarker—as platforms for the delivery of radionuclides and fluorophores to endometriosis tissue for PET imaging and intraoperative fluorescence imaging. Human endometrial stromal cells (SHT290) and human endometrial epithelial cells (12Z) were used as a model of endometriosis, while human primary ovarian epithelial cells (H6036) and human uterine microvascular endothelial cells (HUtMEC) were representative of healthy tissue. Western blotting and immunocytochemical (ICC) staining for MMP-26 were performed on all cell lines. Subcutaneous 12Z and SHT290 xenografts grown in mice and patient-derived endometriosis tissue were both excised and stained for MMP-26. A small library of MMP-26-targeting monoclonal antibodies were radiolabeled with [89Zr]Zr4+ or modified with the near-infrared fluorophore IR800CW. All immunoconjugates were purified via gel filtration, and the purity and serum stability of the radioimmunoconjugates were evaluated via iTLC and SE-HPLC. N/A. 6 patients with confirmed endometriosis were enrolled and consented to tissue banking. N/A. 12Z and SHT290 cells abundantly express MMP-26, and estrogen increases this expression significantly. Endometriosis xenograft tissue and patient endometriosis tissue both express MMP-26, while healthy ovarian and uterine cells show little to no expression—emphasizing the potential of MMP-26 as an endometriosis biomarker. MMP-26-targeting antibodies showed specific binding to only MMP-26 and, when labeled with IR800CW, displayed a degree-of-labeling of 3.7 IR800CW/mAb. The 89Zr-labeled probes were synthesized in >98% purity and proved >85% stable in human serum over 5 days. The evaluation of these probes in murine models is underway. We have validated the specific expression of MMP-26 by endometriosis tissue in comparison with healthy ovarian and uterine cells. MMP-26-targeting immunoconjugates hold promise for the PET and fluorescent imaging of endometriosis. [ABSTRACT FROM AUTHOR]

The mitochondrial enzyme L-2-hydroxyglutarate dehydrogenase (L2HGDH) regulates the abundance of L-2-hydroxyglutarate (L-2HG), a potent signaling metabolite capable of influencing chromatin architecture, mitochondrial metabolism, and cell fate decisions. Loss of L2hgdh activity in humans induces ectopic L-2HG accumulation, resulting in neurodevelopmental defects, altered immune cell function, and enhanced growth of clear cell renal cell carcinomas. To better understand the molecular mechanisms that underlie these disease pathologies, we used the fruit fly Drosophila melanogaster to investigate the endogenous functions of L2hgdh. L2hgdh mutant adult male flies were analyzed under normoxic and hypoxic conditions using a combination of semi-targeted metabolomics and RNA-seq. These multi-omic analyses were complemented by tissue-specific genetic studies that examined the effects of L2hgdh mutations on the Drosophila renal system (Malpighian tubules; MTs). Our studies revealed that while L2hgdh is not essential for growth or viability under standard culture conditions, L2hgdh mutants are hypersensitive to hypoxia and expire during the reoxygenation phase with severe disruptions of mitochondrial metabolism. Moreover, we find that the fly renal system is a key site of L2hgdh activity, as L2hgdh mutants that express a rescuing transgene within the MTs survive hypoxia treatment and exhibit normal levels of mitochondrial metabolites. We also demonstrate that even under normoxic conditions, L2hgdh mutant MTs experience significant metabolic stress and are sensitized to aberrant growth upon Egfr activation. These findings present a model in which renal L2hgdh activity limits systemic L-2HG accumulation, thus indirectly regulating the balance between glycolytic and mitochondrial metabolism, enabling successful recovery from hypoxia exposure, and ensuring renal tissue integrity. • Drosophila L2hgdh is not essential for growth or viability under standard culture conditions. • L2hgdh mutants are hypersensitive to hypoxia and expire during the reoxygenation phase with severe disruptions of mitochondrial metabolism. • The Drosophila renal system is a key site of L2hgdh activity. • L2hgdh mutant MTs experience significant metabolic stress and are sensitized to aberrant growth upon Egfr activation. [ABSTRACT FROM AUTHOR]

Although medical, interventional, and surgical treatment options for fibroids have expanded over the last decade, many patients are not thoroughly counseled about all available therapies. Patients desire a more comprehensive approach with shared decision-making tailored to their health goals. The aim of this study is to assess patient knowledge regarding treatment options before and after consultation with a multidisciplinary fibroid center. Prospective survey study. Academic medical center in New York, NY. Patients who presented for initial consultation with a multidisciplinary fibroid program from July 2021 through January 2022. Patients were offered same-day office consultation with a minimally invasive gynecologic surgeon (MIGS) followed by a telemedicine visit with an interventional radiologist (IR) within 3 weeks of the appointment request. Collaborative discussions were held between providers regarding patient care. Patients were asked to complete the survey following both appointments. Data was collected regarding demographics, prior evaluation of fibroids, knowledge about treatment options, and overall experience. A total of 102 patients completed the survey (response rate 77%). A majority (55.9%) had known about their fibroids for at least 2 years. Most patients sought out the fibroid program for a 2nd (28.4%), 3rd (22.5%) or 4th (7.8%) opinion. Notably, 35.3% of patients who had previously been seen by an obstetrician-gynecologist (OB/GYN) were not offered any treatment. Of those who had been offered treatment, 24.5% were counseled on medical management with oral contraceptives, 28.4% on surgical options, and 5.9% on uterine artery embolization. Nearly all patients (86.3%) endorsed that they would not have sought 2 separate consultations had it not been for the program. Patients were overall well-informed after their experience, with 95.1% reporting they were more knowledgeable about their options and none reporting the 2 separate consults created more confusion for them. Many patients with symptomatic fibroids seeking secondary opinions have not been adequately counseled on fibroid management options. A collaborative approach to fibroid management better educates patients, provides an opportunity to be thoroughly counseled by the specialists performing either surgical or interventional procedures, and increases patient knowledge about fibroid treatment options. [ABSTRACT FROM AUTHOR]

Objectives: Lonely and socially isolated homebound older participants of a randomized trial comparing behavioral activation (BA) versus friendly visiting, both delivered by lay counselors using tele-videoconferencing, were reassessed at 1-year to determine whether benefits at 12 weeks were maintained over time.Methods: The study reinterviewed 64/89 (71.9%) participants.Results: The positive 12-week impact of tailored BA on 3 indicators of social connectedness (loneliness, social interaction and satisfactions with social support) was maintained, albeit to a lesser degree, over 1 year. The positive impact on depressive symptoms and disability was also maintained.Conclusions: The intervention's potential reach and scalability are suggested by several factors: participants were recruited by home delivered meals programs during routine assessments; the intervention was brief and delivered by lay counselors; care delivery by tele-videoconferencing is increasingly common. The 1 year outcomes indicate that brief BA delivered by tele-video conferencing can have an enduring impact on social connectedness. [ABSTRACT FROM AUTHOR]

Objective: To describe our modification of Behavioral Activation to address social isolation and loneliness: Brief Behavioral Activation for Improving Social Connectedness. Our recent randomized clinical trial demonstrated the effectiveness of the intervention, compared to friendly visit, in alleviating loneliness, reducing depressive symptoms, and increasing social connectedness with lonely homebound older adults receiving home-delivered meals.Methods: We modified Brief Behavioral Activation Treatment for Depression to address social isolation and loneliness by addressing each of its key elements: Psychoeducation; intervention rationale; exploration of life areas, values and activities; and activity monitoring and planning. The intervention consisted of six weekly sessions, up to 1 hour each. Interventionists were bachelor's-level individuals without formal clinical training who participated in an initial 1-day training as well as ongoing supervision by psychologists and social workers trained in BA throughout the study delivery period.Results: We provide three case examples of participants enrolled in our study and describe how the intervention was applied to each of them.Conclusions: Our preliminary research suggests that Behavioral Activation modified to address social connectedness in homebound older adults improves both social isolation and loneliness. This intervention has potential for scalability in programs that already serve homebound older adults. Further research is needed to solidify the clinical evidence base, replicate training and supervision procedures, and demonstrate the sustainability of Brief Behavioral Activation for Improving Social Connectedness for homebound and other older adults. [ABSTRACT FROM AUTHOR]

Background: Influenza has been an acknowledged cause of respiratory disease for decades. However, considerable related, and often unappreciated, disease burden stems from cardiovascular complications, exacerbations of underlying medical conditions and secondary respiratory complications, with the highest burden in the elderly. This novel study combines the gold standard method of a randomized controlled trial with real-world data collection through national registries, to assess the relative effectiveness of high-dose (QIV-HD) vs standard-dose quadrivalent influenza vaccine (QIV-SD) in preventing cardio-respiratory hospitalizations in a large cohort of adults aged ≥65 years.Methods and Results: This trial (NCT04137887) is a Phase III/IV, modified double-blinded, randomized, registry-based trial, conducted by the Finnish Institute for Health and Welfare (THL). Participants (n>120 000) are being enrolled over multiple influenza seasons and randomized (1:1) to receive QIV-HD or QIV-SD. Participant follow-up is based on data collection up to 11 months post-vaccination using Finnish national health registries. The primary objective is to demonstrate the relative superior effectiveness of QIV-HD over QIV-SD in preventing cardio-respiratory hospitalizations up to 6 months post-vaccination. Safety will be assessed using automated online tools throughout the study, with causality assessed using statistical and probabilistic methods; serious adverse reactions and adverse events of special interest will be investigated individually.Conclusion: This large, real-world, randomized study will provide valuable insight into the contribution of influenza in causing severe cardio-respiratory events, and the role of vaccination with QIV-HD in reducing these outcomes compared to the current standard of care.Funding: Sanofi Pasteur. [ABSTRACT FROM AUTHOR]

There is currently a clinical dilemma in treating acute pain in patients receiving long-term buprenorphine products. This is a retrospective cohort review involving patients receiving long-term buprenorphine therapy who either underwent a surgical procedure or presented to an emergency department (ED) for acute pain between January 1, 2012 and January 1, 2022. Patients were excluded if opioids were prescribed 30 days before the index date. Chart reviews were conducted to characterize buprenorphine treatment strategies and the addition of new pain medications. Chart review revealed (1) incidence of opioid use disorder (OUD) relapse, (2) hospital re-presentation for pain or OUD, (3) fatal and non-fatal overdose, and (4) all-cause mortality and suicidality. Descriptive statistics were used to analyze results. A total of 70 of 259 screened patients met inclusion criteria. The mean (±SD) age was 50.3 ± 13 years, 92.9% male, 64.3% White, and 78.6% had an OUD diagnosis. While 84.3% presented to the ED, 15.7% underwent surgical procedures. For the primary endpoint, the total daily dose of buprenorphine or buprenorphine/naloxone from index date to discharge was continued in 90.0%, increased in 2.9%, decreased in 1.4%, and discontinued in 5.7% of cases. At discharge, 46.2% were prescribed an additional pain medication. A total of 7.1% re-presented for pain or OUD relapse, 15.7% experienced an OUD relapse, 1.4% experienced new-onset suicidality, and 1.4% experience all-cause mortality within 90 days of the index date. No fatal or non-fatal opioid overdoses were observed. The most commonly observed practice was continuing buprenorphine doses in patients with acute or postsurgical pain, which was effective and safe. Although further data is necessary to fully elucidate these findings, the data herein may suggest that clinicians can safely continue buprenorphine doses in the acute pain setting in patients receiving these products chronically. [ABSTRACT FROM AUTHOR]

To document the process by which healthcare professionals (HCPs) support people living with and beyond hematological cancer and detail how they learned from their personal and clinical experience. Using a narrative approach, we conducted nine semi-structured interviews with HCPs, including nurses, from a specialized care centre who support patients with hematological cancer. Interviews aimed to capture experiential learning gained from their practice. We performed a hybrid inductive/deductive content analysis on data using a framework based on sociological and educational models of experiential learning. Among healthcare professionals, analysis revealed the need to provide care and support that is 'humane' and adapted to each patient. Learning to provide this type of care proved to be challenging. Over the course of their clinical experience, healthcare professionals learned to adapt the support they provided by straddling a boundary between sympathy and empathy. Learning outcomes were associated with personal-professional development among participants. Our findings bring to light an overlooked facet of patient support in the context of cancer care, which is the acquisition of the soft skills required to deliver humanistic care and support. This learning process requires time and involves navigating between the realms of sympathy and empathy. Experiential learning is intertwined with the complexity of the often long-term patient-professional relationship that characterizes hemato-oncology. This unique relationship offers rewards for healthcare professionals on both personal and professional fronts. • Learning journey for HCPs in managing relationships, navigating between empathy and sympathy. • Personal and professional experiences shape the empathetic approaches of HCPs in cancer care. • Accumulation of experiences serves as benchmarks for refining humanistic care • Acknowledging informal encounters among professional groups to enhance experiential learning • Suggestions include implementing internships focused on relationship building in diverse situations. [ABSTRACT FROM AUTHOR]

Objective: This review seeks to establish the incidence of adverse outcomes associated with minimally invasive tissue extraction at the time of surgical procedures for myomas.Data Sources: Articles published in the following databases without date restrictions: PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews and Trials. Search was conducted on March 25, 2020.Methods Of Study Selection: Included studies evaluated minimally invasive surgical procedures for uterine myomas involving morcellation. This review did not consider studies of nonuterine tissue morcellation, studies involving uterine procedures other than hysterectomy or myomectomy, studies involving morcellation of known malignancies, nor studies concerning hysteroscopic myomectomy. A total of 695 studies were reviewed, with 185 studies included for analysis.Tabulation, Integration, and Results: The following variables were extracted: patient demographics, study type, morcellation technique, and adverse outcome category. Adverse outcomes included prolonged operative time, morcellation time, blood loss, direct injury from a morcellator, dissemination of tissue (benign or malignant), and disruption of the pathologic specimen.Conclusion: Complications related to morcellation are rare; however, there is a great need for higher quality studies to evaluate associated adverse outcomes. [ABSTRACT FROM AUTHOR]

Study Objective: To review pregnancy outcomes after laparoscopic myomectomy with the use of barbed suture.Design: Retrospective cohort study and follow-up survey.Setting: Single, large academic medical center.Patients: Patients who underwent laparoscopic myomectomy with the use of barbed suture for myometrial closure between 2008 and 2016.Intervention: Laparoscopic myomectomy and a follow-up survey regarding pregnancy outcome.Measurements and Main Results: A total of 486 patients met inclusion criteria and underwent a laparoscopic myomectomy between 2008 and 2016. Of the 428 with viable contact information, 240 agreed to participate (56%). Of those who responded to the survey, 101 (42%) attempted to get pregnant, and there were 4 unplanned pregnancies. There were 110 pregnancies among 76 survey respondents. In total, of the women attempting a postoperative pregnancy, 71% had at least 1 pregnancy. Comparing the women who did and did not conceive postoperatively, the group who got pregnant was on average younger, 33.8 ± 4.5 years vs 37.5 ± 6.5 years (p = .001); had fewer myomas removed, median = 2 (range 1-9) vs median = 2 (range 1-16) myomas (p = .038); and had a longer follow-up period, 30 months ( vs 30 (11-93 months) ± 20 (p <.001). The mean time to first postoperative pregnancy was 18.0 months (range 2-72 months). Of the 110 reported postoperative pregnancies, there were 60 live births (55%), 90% by means of cesarean section. The mean gestational age at birth was 37.8 weeks. In the cohort, there were 8 preterm births, 3 cases of abnormal placentation, 2 cases of fetal growth restriction, 3 cases of hypertensive disorders of pregnancy, and 2 cases of myoma degeneration requiring hospitalization for pain control. There were no uterine ruptures reported.Conclusion: According to our findings, pregnancy outcomes after laparoscopic myomectomy with barbed suture are comparable with available literature on pregnancy outcomes with conventional smooth suture. [ABSTRACT FROM AUTHOR]

Objective: To test the acceptability and effectiveness of a lay-coach-facilitated, videoconferenced, short-term behavioral activation (Tele-BA) intervention for improving social connectedness among homebound older adults.Methods: We employed a two-site, participant-randomized controlled trial with 89 older adults (averaging 74 years old) who were recipients of, and initially screened by, home-delivered meals programs. All participants reported loneliness; many reported being socially isolated and/or dissatisfaction with social support. Participants received five weekly videoconference sessions of either Tele-BA or Tele-FV (friendly visits; active control). Three primary outcomes were social interaction (Duke Social Support Index [DSSI] Social Interaction Subscale), subjective loneliness (PROMIS Social Isolation Scale), and DSSI Satisfaction with Social Support Subscale. Depression severity (PHQ-9) and disability (WHODAS 2.0) were secondary outcomes. Mixed-effects regression models were fit to evaluate outcomes at 6- and 12-weeks follow-up.Results: Compared to Tele-FV participants, Tele-BA participants had greater increase in social interaction (t [81] = 2.42, p = 0.018) and satisfaction with social support (t [82] = 2.00, p = 0.049) and decrease in loneliness (t [81] = -3.08, p = 0.003), depression (t [82] = -3.46, p = 0.001), and disability (t [81] = -2.29, p = 0.025).Conclusion: A short-term, lay-coach-facilitated Tele-BA is a promising intervention for the growing numbers of homebound older adults lacking social connectedness. The intervention holds promise for scalability in programs that already serve homebound older adults. More research is needed to solidify the clinical evidence base, cost-effectiveness and sustainability of Tele-BA delivered by lay coaches for homebound and other older adults. [ABSTRACT FROM AUTHOR]

Vascular Ehlers-Danlos syndrome (vEDS) is a rare disorder and 1 of 13 types of EDS. The syndrome results in aortic and arterial aneurysms and dissections at a young age. Diagnosis is confirmed with molecular testing via skin biopsy or genetic testing for COL3A1 pathogenic variants. We describe a multi-institutional experience in the diagnosis of vEDS from 2000 to 2015. This is a multi-institutional cross-sectional retrospective study of individuals with vEDS. The institutions were recruited through the Vascular Low Frequency Disease Consortium. Individuals were identified using the International Classification of Diseases -9 and 10-CM codes for EDS (756.83 and Q79.6). A review of records was then performed to select individuals with vEDS. Data abstraction included demographics, family history, clinical features, major and minor diagnostic criteria, and molecular testing results. Individuals were classified into two cohorts and then compared: those with pathogenic COL3A1 variants and those diagnosed by clinical criteria alone without molecular confirmation. Eleven institutions identified 173 individuals (35.3% male, 56.6% Caucasian) with vEDS. Of those, 11 (9.8%) had nonpathogenic alterations in COL3A1 and were excluded from the analysis. Among the remaining individuals, 86 (47.7% male, 68% Caucasian, 48.8% positive family history) had pathogenic COL3A1 variants and 76 (19.7% male, 19.7% Caucasian, 43.4% positive family history) were diagnosed by clinical criteria alone without molecular confirmation. Compared with the cohort with pathogenic COL3A1 variants, the clinical diagnosis only cohort had a higher number of females (80.3% vs 52.3%; P <.001), mitral valve prolapse (10.5% vs 1.2%; P =.009), and joint hypermobility (68.4% vs 40.7%; P <.001). Additionally, they had a lower frequency of easy bruising (23.7% vs 64%; P <.001), thin translucent skin (17.1% vs 48.8%; P <.001), intestinal perforation (3.9% vs 16.3%; P =.01), spontaneous pneumothorax/hemothorax (3.9% vs 14%, P.03), and arterial rupture (9.2% vs 17.4%; P =.13). There were no differences in mortality or age of mortality between the two cohorts. This study highlights the importance of confirming vEDS diagnosis by testing for pathogenic COL3A1 variants rather than relying on clinical diagnostic criteria alone given the high degree of overlap with other forms genetically triggered arteriopathies. Because not all COL3A1 variants are pathogenic, the interpretation of the genetic testing results by an individual trained in variant assessment is essential to confirm the diagnosis. An accurate diagnosis is critical and has serious implications for lifelong screening and treatment strategies for the affected individual and family members. [ABSTRACT FROM AUTHOR]

The vitality of geriatric mental health research requires an ongoing infusion of new investigators into the career pipeline. This report examines outcomes of the NIMH-funded, Advanced Research Institute (ARI) in Geriatric Mental Health, a national mentoring program supporting the transition of early career researchers to independent investigators. Outcome data for 119 ARI Scholars were obtained from the NIH Reporter database, CVs, and PubMed: 95.0% continue in research, 80.7% had obtained federal grants, and 45.4% had achieved an NIH R01. Among all NIMH mentored K awardees initially funded 2002-2014 (n=901), 60.4% (32/53) of ARI participants vs. 42.0% (356/848) of nonparticipants obtained an R01. Controlling for funding year, ARI participants were 1.9 times more likely to achieve R01 funding than nonparticipants. These data suggest that ARI has helped new generations of researchers to achieve independent funding, become scientific leaders, and conduct high impact research contributing to public health and patient care. [ABSTRACT FROM AUTHOR]

Background: In the United States, opioids are commonly prescribed to treat knee pain after total knee arthroplasty (TKA). While surgery leads to decreased pain in most patients, a sizable minority continue to experience severe pain and consume opioids chronically after TKA. We sought to determine the population-level effect of TKA on opioid consumption by detailing the pattern of opioid prescriptions before and after surgery.Methods: We retrospectively identified US Veterans Health Administration TKA patients from 2010 to 2015. Outpatient opioid prescriptions were identified from 18 months before to 18 months after surgery, and mean daily opioid doses were calculated. Our primary end point was the achievement of opioid-freedom, defined as a period of at least 6 months without opioids. We compared the percentage of patients who were opioid-free preoperatively to the percentage who were opioid-free 18 months after surgery (no prescriptions after postoperative month 12). We identified factors associated with opioid-freedom.Results: In a cohort of 33,927 patients, 41% were opioid-free in the month before surgery compared to 54% 18 months after surgery (P < .001). Preoperative freedom from opioids (odds ratio, 4.59; 95% confidence interval, 4.34 to 4.85; P < .001) was more strongly associated with postoperative freedom from opioids than patient medical and social factors.Conclusion: TKA was associated with an increase in postoperative freedom from opioids. Low preoperative dose of opioids was more strongly associated with postoperative opioid-freedom than patient characteristics, suggesting that opioid prescription patterns are a chief driver of opioid use after surgery.Level Of Evidence Iii: Retrospective cohort study. [ABSTRACT FROM AUTHOR]

Abstract The Northwest Atlantic Fisheries Organization (NAFO) Roadmap is the general framework aimed toward implementing an Ecosystem Approach to Fisheries (EAF) in NAFO. The core principles are: a) the approach has to be objective-driven, b) it should consider long-term ecosystem sustainability, c) it must be place-based, and d) the consequences of trade-offs in managing human activities have to be explicitly defined. The Roadmap is not a fixed plan; it evolves as different components are developed, refined, and implemented. Core elements of the Roadmap include the identification of ecosystem-based management units, a hierarchical approach to define exploitation rates by considering ecosystem, multispecies, and stock level sustainability, and the integration of impacts on benthic communities. The modular design of the plan has allowed NAFO to start implementing some components (e.g. closures to bottom fishing for the protection of Vulnerable Marine Ecosystems), while work on others is still ongoing (e.g. multispecies modelling). Even though the Roadmap is far from being fully implemented, NAFO has made important progress towards EAF over the last decade. This paper summarizes the Roadmap structure and the current level of implementation, describes some of the challenges faced, and examines those still ahead. [ABSTRACT FROM AUTHOR]

The Coronavirus (COVID-19) pandemic and its associated health restrictions have harmed the population psychologically. We aimed to compare the post-traumatic stress disorder (PTSD) symptoms and Quality of Life (QoL) in older French patients with cancer to the younger ones. This longitudinal multicenter study named COVIPACT began in April 2020 during the first French lockdown and has included 579 outpatients receiving treatment for a solid or hematological malignancy. Data were collected every three months, namely at the first release period (M3), at the second lockdown (M6), at the second release period (M9), and finally at the last curfew period (M12) in France. Standardized validated self-questionnaires were used to assess PTSD symptoms (using the Event Scale–Revised self-questionnaire), insomnia (through the Insomnia Severity Index questionnaire), QoL (using the Functional Assessment of Cancer Therapy - General questionnaire), and cognitive complaints (through the Functional Assessment of Cancer Therapy – Cognition questionnaire). Student (or Wilcoxon) tests and Chi-squared tests were used for continuous or discrete variables, respectively. We conducted linear mixed model to study the change during follow-up. Out of 579 included patients, 157 (27%) were ≥ 70 years old at baseline, of whom 104 participated in the longitudinal study. At baseline, older patients reported fewer PTSD symptoms (17% versus 23%, p =.06), insomnia (17% versus 27%, p =.02), and cognitive complaint (3% versus 16%, p <.01) than younger patients. QoL at baseline was similar between age subgroups. We observed no significant difference in the trajectory of PTSD symptoms, insomnia, or emotional well-being between both groups during the follow-up. Cognitive complaints were lower at baseline in older patients but steadily increased during the follow-up and reached the same level as younger patients at one year. One in five older patients reported PTSD symptoms, evolving similarly to younger patients during the first year of the COVID-19 pandemic. While cognitive complaints tend to recover in a bell-shaped curve at one year in younger patients, the trend is increasing in older ones. Screening for PTSD symptoms and late cognitive impairment should be given special attention in older patients. Trial Registration: Clinicaltrials.gov identifier: NCT04366154 [ABSTRACT FROM AUTHOR]

While research investigating the potential benefits of yoga for eating disorders (EDs) has expanded, a systematic approach examining how yoga has been implemented for this cohort has not yet been conducted. This research therefore aimed to synthesize the current understanding of how yoga has been implemented for individuals with EDs, with regards to the feasibility, acceptability, and safety of yoga for this cohort. This study utilised mapping review technology. The following electronic databases were searched within the month of September 2021 and December 2022: PsycINFO, MEDLINE, CINAHL, and Embase. Articles that applied and documented the use of yoga for the EDs were selected. The review identified ten unique studies. Details regarding the application, feasibility, acceptability, and safety of these yoga programs were extracted. This resulted in an evidence map or visual summary of how yoga has been applied for the EDs. While limited, the current literature suggests that yoga is a safe, acceptable, and feasible transdiagnostic intervention for EDs. These findings provide pragmatic support for safely applying yoga for the EDs into clinical practice to support ED recovery. • This review identified and categorized research detailing the implementation of yoga for eating disorders (EDs). • Findings suggest that yoga is a safe, acceptable, and feasible transdiagnostic intervention for EDs. • Common adaptations to yoga for EDs utilised across the literature have been highlighted in this review. [ABSTRACT FROM AUTHOR]

Hydraulic limitations in dominant trees may play a role in the growth decline that is commonly observed in aging forest stands. We hypothesized that hydraulic limitations affect dominant trees but not non-dominant trees in aging forests, resulting in changes in growth dominance during stand development. To test this hypothesis, we used a 1067-year-long post-fire chronosequence that was established in the eastern Canadian boreal forest. Within each stand, we estimated transpiration of different sized trees using direct (stem sap flow) and indirect (leaf isotope composition) measurements, which were combined with tree and stand growth estimates (growth dominance coefficient, GD). Stem sap flow measurements indicated that transpiration rate per unit leaf area (E L ) of dominant trees indeed decreased with increasing stand age and, based upon temporal changes in leaf C and O isotope ratios, was related to an increase in stomatal closure. These results suggest that hydraulic limitation of dominant trees increased with stand age. Also, the slope of the relationship between E L and tree diameter that was calculated for each stand decreased with decreasing GD, implying that hydraulic limitation was responsible for the shift in stand growth dominance that was observed over time. Therefore, hydraulic limitation in dominant trees clearly contributes to reverse growth dominance of old-growth boreal forests, and could be involved in age-related declines in forest productivity. [ABSTRACT FROM AUTHOR]

Purpose: To retrospectively analyze adverse events (AE) in patients with hepatocellular carcinoma (HCC) treated with yttrium-90 radioembolization in the setting of angiographically apparent arterioportal shunts (APSs).Materials and Methods: Thirty-two patients with HCC underwent radioembolization with APSs from January 2011 to September 2016, totaling 34 administrations using resin (6) and glass (28) microspheres. APSs were graded angiographically as segmental (9), ipsilobar (15), contralobar (7), or main portal (2), according to portal perfusion. Tumors were categorized as solitary (9), multifocal (7), or infiltrative (16). Both unilobar (25) and bilobar (7) disease was treated. Child Pugh Score was A (22), B (10), or C (2), with a median Model for End-Stage Liver Disease (MELD)/Na-MELD of 8/8.5. Median procedure dose was 132.6 Gy. AEs were graded using Combined Terminology Criteria for Adverse Events (CTCAE) version 4.0. Tumor response was assessed using the modified Response Evaluation Criteria in Solid Tumors (mRECIST).Results: CTCAE grade ≥3 AEs were observed in 22% of patients. Barcelona Clinic Liver Cancer (BCLC) C patients with nonsegmental shunts who received lobar administrations had a grade ≥3 AE rate of 38% compared with the remaining cohort, which was 12% (P = .076). No events were reported in patients with segmental shunts (P = .023). Imaging analysis revealed mRECIST complete response (17), partial response (13), stable disease (3), and progressive disease (1). Overall survival at 6 months and 12 months was 72% and 57%, respectively.Conclusions: Radioembolization in the setting of APS may have a higher AE profile than reported literature when BCLC-C patients with nonsegmental shunts receive lobar administrations. Segmental shunts are generally well tolerated. [ABSTRACT FROM AUTHOR]

Abstract Clinical nursing leadership is critical for quality care. All nurses including students should receive clinical nursing leadership education. Research pertaining to educational strategies on clinical leadership for nursing students remains sparse. The aim of this paper is to report the qualitative evaluation of a co-constructed educational intervention on clinical nursing leadership, developed for 1st year preregistration nursing students. The research question was "what are the components of an educational intervention that support the development of clinical nursing leadership in 1st year nursing students?". The intervention included videos, brainstorming, journal entries on students' clinical leadership paired with the observation of a nurse's clinical leadership. A research and development model guided the study. Focus groups and individual interviews were conducted with 23 students and 6 educators who tested the intervention. Thematic analysis revealed three intervention components that supported learning: visual examples at the student's level, observation of role models and animated discussions in small groups. Visual examples and observation of role models supported learning by expanding student's initial views of nursing beyond a technical role to one that is embedded with clinical nursing leadership. Animated discussions in small groups helped students learn to speak up and be open to other's opinions. Highlights • Clinical nursing leadership is critical for improving care and patient safety. • An early educational intervention on clinical nursing leadership is evaluated. • The strategies used were videos, role models, journal entries, and brainstorming. • Videos helped students expand their perception of nursing and clinical leadership. • Journal entries and brainstorming need additional evaluation. [ABSTRACT FROM AUTHOR]

Objective The contemporary practice of testing for genetically triggered aortic and arterial aneurysms and dissections is not well described. This study aimed to describe this practice at a tertiary care academic center and to ascertain the yield of testing in establishing the diagnosis in patients referred on the basis of clinical suspicion. Methods This is a retrospective cohort study of patients referred for vascular genetic testing at an academic medical center between 2010 and 2015. Patients were identified by Current Procedural Terminology diagnostic codes 81405, 81408, and 81479 for genetic testing (Marfan syndrome, Loeys-Dietz syndrome, aneurysms-osteoarthritis syndrome, COL3A1 , and familial thoracic aortic aneurysm panel [ ACTA2 , COL3A1 , TGFBR1 , TGFBR2 , SMAD3 , TGFB2 , MYLK , MYH11 , and PRKG1 genes]) and by review of the collagen vascular laboratory database for genetic testing results. Data abstracted included demographics, clinical history, reason for referral, family history, referring provider type, and outcomes of genetic testing. Results Ninety-six patients (44.3% male; median age, 40.8 years) were referred for suspected genetic vascular disease. Genetic testing was performed in 75 cases thought to have heritable mutations related to aortic or arterial aneurysms and dissections. The most common reason for genetic testing was a personal history of aortic or arterial aneurysms and dissections (62.3%; mean age, 45.8 ± 11.1 years), followed by a family history of aortic or arterial aneurysms and dissections without a personal history (26.6%; age, 28.8 ± 17.9 years). The most common genetic testing performed was a familial thoracic aortic aneurysm gene panel (44%), followed by single gene testing for vascular Ehlers-Danlos syndrome (33.3%). Genetic testing identified a pathogenic mutation in 36% of the cases. The highest likelihood of identifying a pathogenic mutation was in those who had a family history with an already diagnosed mutation (57.1%), followed by patients with aortic root and ascending aortic aneurysm or dissection (42.3%). Conclusions In patients with suspected genetically triggered vascular disease, the yield of clinical vascular genetic testing is reasonable when selective genetic testing is performed on the basis of personal or family history. These tests should be obtained with appropriate expertise in genetic counseling and interpretation of genetic testing results. Negative genetic test results in the setting of a positive family history demonstrate the limits of testing and known mutations leading to genetically triggered aortic and arterial aneurysms and dissections and support the need for novel gene discovery. [ABSTRACT FROM AUTHOR]

Recently, the role which fisheries play in the provision of marine ecosystem services has been more widely acknowledged, largely as a result in recent years of fisheries management organisations developing and adopting more ecosystem-based approaches to fisheries management (EAFM). Accordingly, several important management and science challenges have been identified. We argue that these challenges represent a number of important steps which underpin effective science based fisheries management, and when taken together and integrated, offer a logical framework by which to best achieve an EAFM. The challenges, or steps of the framework, identified and described are, i. defining appropriate spatial management units based upon significant and coherent ecosystem production processes, ii. assessing multi-species stock dynamics, iii. developing mixed fisheries management approaches, and iv. assessing the impacts of fisheries on non-target species and ecosystem components. The paper considers how the knowledge gained from research on these challenges can be applied to a risk-based management framework as an essential step towards the achievement of the Sustainable Development Goal (SDG) 14 with respect to the conservation and sustainable use of marine resources for sustainable development. [ABSTRACT FROM AUTHOR]

People with visible differences are often confronted with negative observer responses, including stares, disgust, and avoidance. Characteristics of negative observer responses are well-documented, but less is known about associated factors. We conducted a scoping review to map what is known about factors associated with negative observer responses. Web of Science, PubMed, PsycINFO, and CINAHL databases were searched, and 16 articles met inclusion criteria. Two general categories of factors were identified: (1) observer characteristics, including age, sex, and socioeconomic status, experiences with disfigurements, and personal beliefs or attitudes related to visible differences; and (2) evolved internal mechanisms, including threat-detection, disgust, and disease avoidance. Additionally, there was evidence that lack of anonymity influences lower reporting of observer reactions. Efforts that increase exposure to individuals with visible differences may ameliorate adverse reactions; however, due to the limited nature of evidence reviewed, further research is needed before more concrete recommendations can be made. [ABSTRACT FROM AUTHOR]

Objective Breakthroughs in HIV treatment, especially combination antiretroviral therapy (ART), have massively reduced AIDS-associated mortality. However, ART administration amplifies the risk of non-AIDS defining illnesses including obesity, diabetes, and cardiovascular disease, collectively known as metabolic syndrome. Initial reports suggest that ART-associated risk of metabolic syndrome correlates with socioeconomic status, a multifaceted finding that encompasses income, race, education, and diet. Therefore, determination of causal relationships is extremely challenging due to the complex interplay between viral infection, ART, and the many environmental factors. Methods In the current study, we employed a mouse model to specifically examine interactions between ART and diet that impacts energy balance and glucose metabolism. Previous studies have shown that high-fat feeding induces persistent low-grade systemic and adipose tissue inflammation contributing to insulin resistance and metabolic dysregulation via adipose-infiltrating macrophages. Studies herein test the hypothesis that ART potentiates the inflammatory effects of a high-fat diet (HFD). C57Bl/6J mice on a HFD or standard chow containing ART or vehicle, were subjected to functional metabolic testing, RNA-sequencing of epididymal white adipose tissue (eWAT), and array-based kinomic analysis of eWAT-infiltrating macrophages. Results ART-treated mice on a HFD displayed increased fat mass accumulation, impaired glucose tolerance, and potentiated insulin resistance. Gene set enrichment and kinomic array analyses revealed a pro-inflammatory transcriptional signature depicting granulocyte migration and activation. Conclusion The current study reveals a HFD-ART interaction that increases inflammatory transcriptional pathways and impairs glucose metabolism, energy balance, and metabolic dysfunction. [ABSTRACT FROM AUTHOR]

Many associations between ocular disorders and obstructive sleep apnea (OSA) have been studied, such as nonarteritic anterior ischemic optic neuropathy, glaucoma, papilledema, retinal vein occlusion, eyelid hyperlaxity, lower-eyelid ectropion and recurrent corneal erosions. The objective of this review is to synthetize the possible vascular disorders of the retina and the optic nerve associated with sleep apnea patients and to discuss the underlying pathophysiological hypotheses. Main mechanisms involved in the ocular complications of OSA are related to intermittent hypoxia, sympathetic system activation, oxidant stress, and deleterious effects of endothelin 1. The main evidence-based medicine data suggest that OSA should be screened in patients with ischemic optic neuropathy and diabetic retinopathy. The effect of OSA treatment and emerging therapies are discussed. [ABSTRACT FROM AUTHOR]

This article reports on new research that finds certain messages reduce fear of sharks, key to promoting conservation-minded responses to shark bites. Here it is argued that the sophistication in public feelings toward these highly emotional events has allowed new actors to mobilize and given rise to the ‘Save the Sharks’ movement. In a unique experiment coupling randomly assigned intent-based priming messages with exposure to sharks in a ‘shark tunnel’, a potential path to reduce public fear of sharks and alter policy preferences is investigated. Priming for the absence of intent yielded significant fear extinction effects, providing a viable means of increasing support for non-lethal policy options following shark bite incidents. High levels of pride and low levels of blame for bite incidents are also found. In all, this article provides a step towards improving our understanding of fear and fear reduction in public policy. [ABSTRACT FROM AUTHOR]

• We exposed seedlings of conifer species to three realistic simulated future climates. • Seedlings of conifer species experienced high mortality (75%) induced by drought. • Conifer species are highly vulnerable at the seedling stage to future drought. • Hydraulic safety margins are good indicators of mortality risk for conifer species. The future climate of northern temperate forests is projected to be drier and warmer by the end of this century. As a result, more drought-induced forest dieback events are anticipated in northeastern North America, and assessing the vulnerability of dominant tree species to drought is critical for understanding the future composition of these forests. In a greenhouse experiment, we exposed two-year-old seedlings of Picea glauca (Moench) Voss, Picea mariana (Mill.) B.S.P. and Pinus strobus L. to three future climate treatments for southern Quebec, Canada, and evaluated their mortality, growth, and foliage water status responses to soil water availability and atmospheric drought. Using a unique approach, climate treatments emulated droughts of different frequencies, durations, and intensities. Treatments closely simulated one growing season, with changes in air temperature and relative humidity every six hours and daily adjustment in the amount of water delivered to the seedlings. The three species experienced high mortality (75%) in all water-limited treatments compared to a control treatment that provided non-limiting soil moisture (0% mortality). The biomass of the seedlings that survived was 40% lower than that of control seedlings. Our results confirmed that the hydraulic safety margins, defined as the difference between seasonal minimum water potential and xylem water potential leading to 12, 50 and 88% of hydraulic conductivity loss, were good predictors of probability of tree mortality. Therefore, hydraulic safety margins are useful functional traits that can be used to compare the vulnerability of various species to drought and then provide crucial information to practitioners and policymakers to adjust forest management to climate change. We showed that three dominant conifer species of northern temperate forests were highly vulnerable to drought in future climates. Because drought is projected to be a significant threat to forests, understanding potentially adaptive physiological responses to drought, such as hydraulic safety margins of tree seedlings, is important for predicting the response of forest regeneration and composition in warmer and drier climates. [ABSTRACT FROM AUTHOR]

Objective: To understand unmet depression needs of older adults, the current study investigates depressive symptoms, psychiatric treatment, and home- and community-based service (HCBS) use in a nationally representative sample of older adults in the United States.Methods: Participants included 5,582 adults aged 60 and over from the 2010-2012 waves of the nationally representative Health and Retirement Study. Weighted bivariate analyses were used to examine the frequency of depressive symptoms (Center for Epidemiologic Studies Depression Scale) and psychiatric treatment among HCBS recipients compared with non-HCBS recipients. Weighted logistic regression models were used to evaluate the effect of depressive symptoms on HCBS use.Results: HCBS recipients had a higher frequency of depressive symptoms compared with nonrecipients (27.5% versus 10.4%, respectively). In particular, transportation service recipients had the highest frequency of depressive symptoms (37.5%). HCBS recipients with depressive symptoms were no more likely than nonrecipients to receive psychiatric services. Depressive symptoms were associated with HCBS use, above and beyond sociodemographic and health risk factors.Conclusion: Depressive symptoms are more frequent among HCBS recipients compared with nonrecipients; however, depressed HCBS recipients are no more likely to receive psychiatric services, suggesting unmet depression needs. HCBS may be a key setting for depression detection and delivery of mental health interventions. [ABSTRACT FROM AUTHOR]

Precedence logic's consider time as the only constraint for float computation. By neglecting resource and working areas availabilities, the accuracy of the schedule is affected. The overuse of labor regardless of location may create workspace congestion, affect negatively the productivity and create an optimistic critical path. Conversely, the underuse of work locations can unnecessarily lengthen the critical path. The margin computation will inherit such optimism/pessimism. This paper explains the concept of margin calculation based on the site occupation using the Chronographical modelling. The critical path is leveled, according to the occupancy rate of the site, by relaxing or compressing the project. The rate considers the category of location (e.g. corridor or closed room) and the activity type (e.g. divisions, flooring or electrical finishing works). The method proposes five levels of layers for spaces management according to the stage of construction, namely the creation of spaces (e.g. addition of new floors); the systems (e.g. ventilation ducts); the division of spaces (e.g. partitions); the finishing (e.g. painting) and the closing of spaces (e.g. carpet laying’). Compression or relaxation could be achieved by decreasing or extending the activities durations’ by adjusting the working hours or the number of teams or peoples, or by varying the overlap rates between activities. The method thus establishes a level of risk of the completion of the project duration according to the level of criticality of the activities and locations occupation rates according to the choices made by the user. The proposed coordination method demonstrates the relevance of using other measures, including the workspace occupation rates or by freeing or blocking zones, for the scheduling calculations. The proposed chronographic logic and margin computations can then be used to simulate the project's real conditions. [ABSTRACT FROM AUTHOR]

Temporal changes in stand growth dominance, i.e. a measure of the relative contribution of different-sized trees to the total stand growth, may play a role in the commonly observed decline in forest productivity over time through a shift in resource acquisition and utilization between dominant and non-dominant trees. We hypothesized that the expected decreases in both growth dominance (GD) and relative growth rate (RGR) over time were related to decreases in leaf biomass of dominant trees or increases in allocation to leaf biomass of non-dominant trees. To better understand these potential relationships, we quantified stand growth dominance and some functional components (specific leaf area, leaf weight ratio, net assimilation rate, nitrogen per unit leaf area and nitrogen use efficiency) of the relative growth rate of dominant and non-dominant trees along forest development stages in the eastern Canadian boreal forest using a 1067-year-long post-fire chronosequence. As expected, stand growth dominance decreased with stand development, and was closely related to differences in RGR between dominant and non-dominant trees. Decline in both growth dominance and differences in RGR between 100 and 200 years after fire was related to greater biomass partitioning to leaves in non-dominant trees, coupled to better light acquisition capacity of non-dominant trees, which appeared in stands that were >75-years-old. In old-growth stands, the growth advantage of non-dominant trees over dominant trees involved other mechanisms, such as higher photosynthetic rates and better resource use efficiency in the non-dominant trees. Overall, the observed decrease in stand growth dominance with increasing age was explained mainly by declining resource acquisition and utilization in dominant trees rather than through improved resource acquisition and utilization of non-dominant trees. [ABSTRACT FROM AUTHOR]

Background Student voice posits that students' unique perspectives on teaching and learning can be used in conjunction with those of educators to create meaningful educational activities. Objective The study aimed to describe nursing students' and educators' experiences during the co-construction of educational activities involving clinical nursing leadership. Design Qualitative research and development model. Setting The study was conducted at a French-Canadian nursing faculty that provides a 3-year undergraduate program. Participants Five undergraduate nursing students, four nursing educators, and the principal investigator formed the co-construction team. Methods Data collected included all documents (written and audio) related to the co-construction process: three 2-hour team meetings, PI's fieldnotes and a focus group discussion that occurred once the co-construction process was completed. Thematic analysis was performed guided by Paillé and Muchielli's (2010) method. Results Data analysis revealed two interrelated themes: (1) unique, purposeful collaboration and (2) change that makes a difference. A space described as safe, without hierarchy and that included the “right” people helped the team achieve their objective of creating new educational activities on clinical nursing leadership. The two new learning activities developed by the team were perceived as useful for future nursing students. At the individual level, team members appreciated how co-construction helped them understand teaching and learning from new perspectives. Conclusions A structured, efficient co-construction process contributed to positive changes in the nursing program and participants. Additional research is required to enhance understanding of the factors that facilitate and hinder student-educator collaboration outside the classroom. [ABSTRACT FROM AUTHOR]

Background While reflection is a hallmark of debriefing, there is little understanding of how it contributes to nursing students' clinical judgment. Objectives The aim of this study was to describe how nursing students perceived that the Reflective dEbriefing after a PatieNt Deterioration simulation (REsPoND) fostered learning and how it contributed to their clinical judgment in patient deterioration simulations. Design A sequential explanatory mixed-methods study. Participants Nineteen students who showed the greatest clinical judgment score variation in a randomized controlled trial of the effectiveness of REsPoND. Methods Students participated in interviews on their learning experience in REsPoND. Data were subjected to thematic analysis and themes were contrasted according to students' score variations. Results Through guided exchanges with their peers, students configured a causes–observations–interventions framework that embodied their understanding of the patient's situation. They evaluated their own simulation performance based on that framework. The contribution of REsPoND to students' clinical judgment differed depending on (1) the value placed on the review of the simulation through a systematic assessment approach; (2) their focus on anticipating the situation or on performing in the simulation; and (3) their preference for who participated more in debriefing. Conclusion Clinical judgment might be improved when a systematic assessment approach is used to structure debriefing. The relationship between reflection and self-assessment during debriefing remains to be disentangled. [ABSTRACT FROM AUTHOR]

Objective: To describe musculoskeletal conditions in children with Ehlers-Danlos syndrome (EDS).Study Design: A retrospective medical record review was performed, which evaluated 205 patients with EDS (ages 6-19 years) seen in sports medicine or orthopedic clinic at a large pediatric hospital over a 5-year period.Results: Female (n = 147) and male (n = 57) patients were identified (mean age 12.7 years). The most common EDS subtype (55.6%) was hypermobility type. Patients had between 1 and 69 visits (median 4), and 764 diagnoses were recorded, most commonly laxity/instability, pain, subluxation, and scoliosis/spinal asymmetry. Nearly one-half of patients (46.8%) received a general diagnosis of pain because no more specific cause was identified, in addition to 8.3% who were diagnosed with chronic pain syndrome. The most common sites of presenting issue were knee (43.4%), back (32.2%), and shoulder (31.2%). Over three-fourths (77.1%) of patients had imaging. Most (88.1%) were prescribed physical therapy and/or other conservative measures, such as rest (40.5%), orthotics (35.6%), and medication (32.2%). Surgery was recommended to 28.8% of the study population.Conclusions: Many pediatric and adolescent patients with EDS experience joint pain, instability, and scoliosis, along with other musculoskeletal issues. Despite extensive workup, the etiology of pain may not be identified. Large numbers of office visits, imaging studies, treatment prescriptions, and specialist referrals indicate considerable use of medical resources and highlight a great need for injury prevention and additional study. [ABSTRACT FROM AUTHOR]

Purpose We evaluated the long term effectiveness of maxillomandibular advancement (MMA) for OSAS treatment patients. This retrospective study reviewed the patients treated by MMA for OSAS between 1995 and 2009. They were evaluated by complete polysomnography, cephalometry and quality of life questionnaire. The minimum follow up was 3 years. Success rate was defined by an IAH <10 with at least a 50% reduction. Material and methods 88 patients had MMA during this period. 34 accepted the evaluation (28 men, 6 women). Mean age was 52.4 ± 14. Mean follow-up was 12.5 years. Results Long term success rate was 28% for the entire group, postoperative IAH was reduced between 50 and 80% for all the patients except one. Success rate was 100% for young patients (age < 45), with BMI <25 and IAH <45 and SNB <75° and narrow retrobasinlingual space (<8 mm) and with preoperative orthodontics. Esthetic and sleep results were better with a moderate maxillary advancement and anterior impaction. There was no skeletal relapse. The major postoperative complication was inferior alveolar nerve hypoesthesia. Conclusions MMA is an effective and stable treatment of OSAS in selected patients. Preoperative orthodontics is recommended. [ABSTRACT FROM AUTHOR]

Remanufacturing serves as a key enabler for sustainable manufacturing, by closing the loop of material flow and increasing the efficiency of material usage. However, high labour intensity and inconsistency in remanufactured parts’ quality remain vital issues to address in order to increase the remanufacturing uptake across different industry sectors. This paper presents the use of advanced manufacturing techniques for the development of remanufacturing applications. The on-going world-wide 4 th Industrial revolution, related to the deployment of cyber-physical systems in industries, will be discussed in relation to its impact, opportunities and challenges for remanufacturing industries. [ABSTRACT FROM AUTHOR]

Objective We previously demonstrated that the handle-region peptide, a prorenin/renin receptor [(P)RR] blocker, reduces body weight and fat mass and may improve insulin sensitivity in high-fat fed mice. We hypothesized that knocking out the adipose tissue (P)RR gene would prevent weight gain and insulin resistance. Methods An adipose tissue-specific (P)RR knockout (KO) mouse was created by Cre-loxP technology using AP2-Cre recombinase mice. Because the (P)RR gene is located on the X chromosome, hemizygous males were complete KO and had a more pronounced phenotype on a normal diet (ND) diet compared to heterozygous KO females. Therefore, we challenged the female mice with a high-fat diet (HFD) to uncover certain phenotypes. Mice were maintained on either diet for 9 weeks. Results KO mice had lower body weights compared to wild-types (WT). Only hemizygous male KO mice presented with lower total fat mass, higher total lean mass as well as smaller adipocytes compared to WT mice. Although food intake was similar between genotypes, locomotor activity during the active period was increased in both male and female KO mice. Interestingly, only male KO mice had increased O 2 consumption and CO 2 production during the entire 24-hour period, suggesting an increased basal metabolic rate. Although glycemia during a glucose tolerance test was similar, KO males as well as HFD-fed females had lower plasma insulin and C-peptide levels compared to WT mice, suggesting improved insulin sensitivity. Remarkably, all KO animals exhibited higher circulating adiponectin levels, suggesting that this phenotype can occur even in the absence of a significant reduction in adipose tissue weight, as observed in females and, thus, may be a specific effect related to the (P)RR. Conclusions (P)RR may be an important therapeutic target for the treatment of obesity and its associated complications such as type 2 diabetes. [ABSTRACT FROM AUTHOR]

Summary Background Situation awareness may be used to operationalize nursing students' clinical judgment of patient deterioration simulation scenarios. Objectives To develop and test an instrument to measure bachelor-level nursing students' situation awareness in a patient deterioration simulation scenario, using the Situation Awareness Global Assessment Technique (SAGAT). Design Instrument development and validation. Settings A faculty of nursing of a French–Canadian university. Participants 15 critical care experts and 234 bachelor-level nursing students from a critical care course. Methods The queries were developed from evidence and guidelines regarding nurses' assessment and response to patient deterioration and an inventory of nursing diagnosis. After expert content validation, the instrument was administered to three cohorts of nursing students in a high-fidelity simulation with a scenario of hypovolemic hemorrhagic shock. Difficulty, discrimination, and fidelity indices were computed. The impact of the instrument on student's performance was assessed with a post-simulation survey. Results The instrument comprised 31 queries, which obtained high content validity indices. Most showed satisfying difficulty, discrimination, and fidelity properties. Inadequate properties of the queries may be explained by the content of the simulation scenario, the assessment practices of nursing students, and their reliance on medical assistance. Students perceived that completing the instrument helped them realize what they forgot to assess in the simulation. Conclusions This instrument appears as a promising research tool, although it still needs to be tested with other populations and in other patient deterioration simulation scenarios. [ABSTRACT FROM AUTHOR]

Evaluate referral patterns and management of symptomatic fibroids following implementation of a multidisciplinary (minimally invasive gynecologic surgery [MIGS] and interventional radiology [IR]) fibroid center. Retrospective cohort study. Academic medical center in New York, NY. Patients who presented for initial fibroid consultation between January-June 2019 and January-June 2021. Consult providers included general gynecologists (GYN), MIGS, IR and others. In September 2020, our institution established a multidisciplinary fibroid center where patients had same-day consults with both MIGS and IR providers. Data were collected before and after implementation of the program with regards to patient demographics, fibroid characteristics, prior imaging and management, referral patterns, and management after consultation. 615 patients met inclusion criteria: 273 patients in 2019 and 342 patients in 2021. Patients seen in 2021 were more likely to have previously tried medical management (30.1% vs 20.2%, p<0.01) and many had no prior treatment (53.2% vs 61.5%, p=0.04). There were more MIGS (65.5% vs 53.1%) and fewer general GYN (19.0% vs 25.6%, p=0.02) consultations in 2021. More patients presented for an additional opinion in 2021 (83.6% vs 67.0%, p<0.01), predominately with MIGS (58.8% vs 37.0%, p<0.01). General GYNs were more likely to refer to MIGS (79.3% vs 73.1%) and IR (16.0% vs 13.0%, p=0.046) in 2021. There was increased utilization of MRI imaging in 2021 among MIGS (66.5% vs 52.4%, p<0.01). Among patients who saw MIGS for consultation in 2021, more underwent uterine artery embolization (UAE) (13.8% vs 6.9%, p=0.04) and fewer underwent diagnostic hysteroscopy/dilation and curettage (11.7% vs 4.5%, p<0.01) within 1 year of consultation. Many patients with symptomatic fibroids seek specialist opinions regarding their treatment options. A multidisciplinary fibroid management program with coordinated efforts between MIGS and IR allows for comprehensive counseling and may lead to more efficient and timely care and an increase in minimally invasive procedures including UAE. [ABSTRACT FROM AUTHOR]