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Background The promise of precision medicine could be stymied if people do not accept the legitimacy of personalized risk information. We tested 4 explanations for skepticism of personalized diabetes risk information. Method We recruited participants ( N = 356; Mage = 48.6 [ s = 9.8], 85.1% women, 59.0% non-Hispanic white) from community locations (e.g., barbershops, churches) for a risk communication intervention. Participants received personalized information about their risk of developing diabetes and heart disease, stroke, colon cancer, and/or breast cancer (women). Then they completed survey items. We combined 2 items (recalled risk, perceived risk) to create a trichotomous risk skepticism variable (acceptance, overestimation, underestimation). Additional items assessed possible explanations for risk skepticism: 1) information evaluation skills (education, graph literacy, numeracy), 2 ) motivated reasoning (negative affect toward the information, spontaneous self-affirmation, information avoidance); 3) Bayesian updating (surprise), and 4) personal relevance (racial/ethnic identity). We used multinomial logistic regression for data analysis. Results Of the participants, 18% believed that their diabetes risk was lower than the information provided, 40% believed their risk was higher, and 42% accepted the information. Information evaluation skills were not supported as a risk skepticism explanation. Motivated reasoning received some support; higher diabetes risk and more negative affect toward the information were associated with risk underestimation, but spontaneous self-affirmation and information avoidance were not moderators. For Bayesian updating, more surprise was associated with overestimation. For personal relevance, belonging to a marginalized racial/ethnic group was associated with underestimation. Conclusion There are likely multiple cognitive, affective, and motivational explanations for risk skepticism. Understanding these explanations and developing interventions that address them will increase the effectiveness of precision medicine and facilitate its widespread implementation.

Background. Physical activity promotion is an essential intervention for the prevention of chronic disease by reducing the risk of cardiovascular disease, Type 2 diabetes, and certain types of cancers, as well as improving brain health. Previous approaches that emphasized physical fitness did not meet the needs of the larger population due to not incorporating integration of movement into daily life. Changes that result in the addition of even small amounts of physical activity, such as through active transportation, can make a big difference in quality of life and longevity. Innovative Approach. To increase opportunities for active transportation, Utah agencies are working across sectors to incorporate physical activity into routine, day-to-day activities that may help to address this challenging public health problem. Human-powered travel is a key component of community design supporting health and healthy behaviors. The Utah Department of Health and Human Services (DHHS) built relationships with partners in order to promote active transportation. Lessons Learned & Recommendations. This article will demonstrate ways in which public health, transportation, and planning agencies can better engage to provide opportunities for all people to be physically active. DHHS addresses the importance of sharing public health data among state agencies, inclusion of under-represented populations in community feedback, and engaging in shared projects that will support the involvement of public health in transportation planning.

Together with research teams from around the world, the Anthropocene Working Group (AWG) has been meticulously quantifying and scrutinizing the global stratigraphic imprint of human activities, the results of which are gathered in this thematic collection of papers in The Anthropocene Review. How can such empirical research, which so impressively articulates the end of a relatively stable Earth System in the mid-20th century, inform our ways of understanding and responding to the planetary crisis that the geological samples quietly represent? In this afterword to the collection we report and reflect on the joint undertaking of the AWG, Haus der Kulturen der Welt and the Max Planck Institute for the History of Science to bring geoscientific evidence, cultural experimentation and historical contextualization together in a shared public framework.

We review and compare proposals for 12 reference sections submitted to the Anthropocene Working Group of the International Subcommission on Quaternary Stratigraphy, of which one will be recommended as the Global boundary Stratotype Section and Point (GSSP) to define the base of the Anthropocene as a series within the Geological Time Scale. The sites span five continents and are located in diverse environments, with all but one sampled by coring. Many sites show annually resolved laminae (here considered optimal for GSSP selection) that can be independently dated radiometrically to confirm a complete succession over the critical interval. An extensive range of proxies, documenting profound human modification of the Earth System at around the mid-20th century interval, has been analysed. Airborne signals (e.g. radioisotopes, fly ash, stable carbon and nitrogen isotopes) provide the most widespread and near-isochronous proxies, applicable across most environments. Additional means of correlation include the appearance of microplastics and persistent organic pollutants, and shifts in heavy metal concentrations and lead isotope ratios. Assemblage changes of microfossils (and some macrofossils) in marine, estuarine and lake settings reflect environmental changes and biological introductions. These systematic and comprehensive datasets, with correlation established between sections, provide the basis for a proposal to formalize the Anthropocene.

Patient-reported outcomes (PROs) in randomized controlled trials pertaining to inflammatory bowel disease are important in identifying patients’ perspective of treatment. Incompletely reported PROs within trials could misrepresent information for clinicians and may contribute to treatment which lacks accommodation of patient input. Our study evaluates completeness of reporting of PROs and risk of bias (RoB) to identify how well trialists are adhering to known resources for trials. We used MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify eligible trials from 2006 to 2020 with at least 1 PRO measure related to inflammatory bowel disease. The trials were screened in duplicate using Rayyan. We then compared trial completion of reporting to the Consolidated Standards of Reporting Trials (CONSORT)-PRO adaptation, and assessed RoB using the Cochrane Collaboration RoB 2.0 tool. To measure trial and reporting characteristics, we performed bivariate regression analyses. Among a sample of 29 trials, the mean completion percentage for CONSORT-PRO was 46.77%. We found PROs as a secondary outcome had significantly lower CONSORT-PRO reporting (p

The purpose of this study was to examine the efficacy of a teacher-implemented professional development program to increase the fidelity with which paraeducators use evidence-based practices (EBPs) in instruction for children with autism. Employing a modified multiple-probe design, investigators implemented the Autism Focused Intervention Resources and Modules for Paraprofessionals (AFP) program in four special education and four inclusive classrooms enrolling students with autism. As the teacher initiated features of the AFP program focusing on individual EBPs, level changes in paraeducators’ EBP fidelity increased markedly, with replications across paraeducators demonstrating experimental control. Statistical analyses produced large effect sizes, Goal Attainment Scale scores indicated student progress, and participants’ ratings reflected strong social validity. School closure due to the COVID-19 pandemic prevented the completion of the study, but the pattern of effects suggests the efficacy of the AFP program as a program of professional development for paraeducators providing instruction for children with autism.

Study design Systematic Review Objectives Vertebral Artery Injury (VAI) is a potentially serious complication of cervical spine fractures. As many patients can be asymptomatic at the time of injury, the identification and diagnosis of VAI can often prove difficult. Due to the high rates of morbidity and mortality associated with VAI, high clinical suspicion is paramount. The purpose of this review is to elucidate incidence, diagnosis, treatment and outcomes of VAI associated with cervical spine injuries. Methods A systematic search of electronic databases was performed using ‘PUBMED’, ‘EMBASE’,‘Medline (OVID)’, and ‘Web of Science, for articles pertaining to traumatic cervical fractures with associated VAI. Results 24 studies were included in this systematic review. Data was included from 48 744 patients. In regards to the demographics of the focus groups that highlighted information on VAI, the mean average age was 46.6 (32.1-62.6). 75.1% (169/225) were male and 24.9% (56/225) were female. Overall incidence of VAI was 596/11 479 (5.19%). 190/420 (45.2%) of patients with VAI had fractures involving the transverse foramina. The right vertebral artery was the most commonly injured 114/234 (48.7%). V3 was the most common section injured (16/36 (44.4%)). Grade I was the most common (103/218 (47.2%)) injury noted. Collective acute hospital mortality rate was 32/226 (14.2%), ranging from 0-26.2% across studies. Conclusion VAI secondary to cervical spine trauma has a notable incidence and high associated mortality rates. The current available literature is limited by a low quality of evidence. In order to optimise diagnostic protocols and treatment strategies, in addition to reducing mortality rates associated with VAI, robust quantitative and qualitative studies are needed.

Voriconazole is an antifungal with known side effects of phototoxicity and photocarcinogenesis. We present a case of HPV-related multifocal squamous cell carcinoma in a 68-year-old man with HIV, due to accelerated photocarcinogenesis associated with long-term use of voriconazole. Histology confirmed SCC with HPV-related features and he was found to have metastases. Multifocal SCC is unusual in association with voriconazole and HIV infection and only one other case has been reported. It is important for clinicians to be aware of the photocarcinogenic effects of voriconazole, especially in patients with HIV.

Context: Clinical practice guidelines (CPGs) are vital to establishing a standardized and evidence-based approach in medicine. These guidelines rely on the use of methodologically sound clinical trials, and the subsequent reporting of their methodology. Objective: To evaluate the completeness of randomized controlled trials (RCTs) underpinning CPGs published by the American Academy of Orthopedic Surgeons (AAOS) for management of osteoarthritis of the knee. Data Sources: We searched the most recent AAOS CPGs for surgical and nonsurgical management of osteoarthritis of the knee for RCTs. To estimate the necessary sample size, we performed a power analysis using OpenEpi 3.0 ( openepi.com ). Study Selection: Two authors independently screened the reference sections of the included CPGs. Included studies met the definition of an RCT, were retrievable in the English language, and were cited in at least one of the included CPGs. Study Design: Meta-Analysis Level of Evidence: Level 1a Data Extraction: We performed double-blind screening and extraction of RCTs included in the AAOS CPGs. We evaluated each RCT for adherence to the Consolidated Standards of Reporting Trials (CONSORT) 2010 checklist. A multiple regression analysis was conducted to assess CONSORT adherence against characteristics of included studies (ie, type of intervention, funding source, etc). Results: Our study included 179 RCTs. The overall adherence was 68.5% with significant differences between those published before and since the development of the 2010 CONSORT guidelines ( P = 0.02). We found that RCTs receiving funding from industry/private sources as well as studies that included a conflict of interest statement showed more completeness than RCTs that reported receiving no funding ( P < 0.01). Conclusion: We found suboptimal CONSORT adherence for RCTs cited in AAOS CGPs for management of osteoarthritis of the knee. Therefore, the CPGs are likely supported by outdated evidence and lack of high-quality reporting. It is important that evidence used to guide clinical decision making be of the highest quality in order to optimize patient outcomes. In order for clinicians to confer the greatest benefits to their patients, CPGs should provide the totality of evidence and emphasize emerging high-quality RCTs to ensure up-to-date, evidence-based clinical decision-making.

Mentalization refers to the capacity to understand and interpret one’s own and others mental states. There is good evidence for individualised treatments aimed at increasing this capacity with children and adolescents. However, there has been no focused synthesis of the literature concerning specifically group delivered mentalization-based parenting interventions. The current study aimed to systematically review the literature in relation to group delivered mentalization-based parenting interventions. Three databases were searched to identify N=515 studies that were screened and reported according to PRISMA guidelines. Inclusion criteria were met by N=10 studies. Interventions varied in terms of content, but often included psychoeducation, experiential group exercises and homework tasks. The length and setting of interventions did not appear to influence outcomes. Significant improvements in parental reflective functioning were found in eight of the ten studies. There was mixed evidence for the efficacy in terms of other parental and child outcomes. This may be due to the lack of high quality studies and the absence of longer-term follow-ups. There is a need for future research to conduct high quality studies with greater diversity in participating parents and long-term follow-up.

IntroductionIndividuals with dementia residing in care homes can rely heavily on care staff to access activities and meaningful interactions. Previous research suggests that care home interactions can be short, fragmented and task-orientated due to staff workload and residents’ language impairments. However, music has the potential to be an alternative communication form that remains intact in the later stages of dementia. This systematic review aims to explore how care home music interventions can facilitate social interactions.MethodsA narrative synthesis was conducted to explore the mechanisms behind how and why care home music intervention facilitate social interactions. The four-element framework guided analysis; (1) Developing a theory, (2) Developing a preliminary synthesis, (3) Exploring relationships, (4) Assessing robustness.FindingsThe final synthesis included 23 articles. The studies consisted of music therapy sessions, personalised music listening, structured music singing or instrument playing sessions and music therapeutic care. Despite the difference in music interventions, most studies reported an increase in residents’ sociable verbal and non-verbal communication and a decrease in unsociable communication. Music interventions allowed residents to reminisce, express themselves, focus and connect with others.DiscussionThe studies highlighted music interventions are accessible to all residents with dementia despite their impairments. The adaptability allows individuals to continue to connect and express themselves even when language deteriorates. More research is needed into the enablers and barriers to implementing interventions into practice, as this systematic review has highlighted that some form of music intervention for all residents can be highly beneficial. Care homes use of music could increase social interactions and meaningful activities.

Objective: Students’ enrollment intensity during their first academic semester and year are highly influential in their success and decisions to persist in community college. Limited research, however, has focused on understanding how students navigate the decision-making process of determining their credit load or how institutional support services, such as academic advising, influence these decisions. Our objective was to advance knowledge on this topic by examining the implementation of a 15 to Finish campaign to promote full-time enrollment at a large, racially/ethnically diverse community college system in Texas. Methods: We interviewed 24 students and eight academic advisors to identify key factors that influence recommendations for, and selection of, course load. The collection and analysis of the data employed the critical qualitative inquiry method, and data were analyzed through low- and high-level coding processes using reconstructive analysis. Results: The factors influencing student decision-making fall into three major areas: (1) academic performance, (2) financial considerations and other costs, and (3) advising experiences, with academic performance framing students’ discussion. Academic advisors agreed with the importance of full-time enrollment for students’ success and recognized the importance of reducing time-to-degree, but believed many students were not academically prepared or had too many commitments to enroll in 15 credits each semester. Conclusion: Consequently, a “one-more-course” approach may be more attractive for both students and advisors. We outline recommendations that better enable community college students to make optimal credit load decisions, which in turn can increase their academic momentum and chances for degree completion.

The following teaching brief outlines ways for advertising and public relations educators to discuss gender pay equity in the classroom. We know that educators are asked to teach about matters of diversity; yet many faculty members do not have adequate resources to do so. Faculty can rely on data and reports, but there are few hands-on activities that allow students to directly wrestle with gender pay disparity. The following activity centers on a hypothetical scenario in which we ask students to allocate pay bonuses to employees based on performance, time on the job, and other work-related factors. Over multiple semesters, we found that students consistently award smaller percentages of the bonus pool to employees with names commonly associated with females. Thus, this exercise provides a helpful way to enlighten students about implicit bias and gender pay equity in the professions of advertising and public relations.

Nonprofit work is oftentimes viewed as inherently meaningful work, but the world of nonprofit work is changing by becoming increasingly marketized. These changes are impacting nonprofit workers’ conception and experience of meaningful work. Drawing from scholarship on neoliberal marketization, enterprise culture, and meaningful nonprofit work, this exploratory study examines how an increasingly marketized work environment is influencing nonprofit managers’ experience of meaningful work. Findings from interviews demonstrate that nonprofit managers conceive of and experience meaningful work in expected ways (e.g., through serving others). At the same time, findings indicate that their experience of meaningful work evokes elements of enterprise culture. These findings suggest that meaningful nonprofit work is becoming hybridized such that it evokes both prosocial and neoliberal market values. This in turn necessitates a reconsideration of the motivations of nonprofit workers as well as our understanding of the mechanisms by which the nonprofit sector is becoming marketized.

In response to the liberalisation and deregulation of gambling across much of the Western world, academics continue to examine gambling-related harms that result from the increased availability of gambling products and services. This paper explores the interrelationship between disordered gambling and intimate partner violence. Qualitative data were derived from interviews with 26 female research participants, illustrating how intimate partner violence perpetrated by men with gambling disorders is often instrumental in nature. The narratives of our respondents indicated that coercive and controlling practices were employed by the intimate partner with a gambling disorder to (a) access money for gambling; (b) hide their gambling behaviour from others; (c) assuage their guilt and apportion blame to the female partner for their disordered gambling and abusive behaviour. Consideration is given to how criminal justice, domestic violence, victim and gambling support agencies may best address the needs of partners and families impacted by disordered gambling.

Paraprofessionals are critical members of instructional teams for students with autism; however, little is known about their job preparation and professional development needs. This study addressed the gap in the literature by surveying 325 paraprofessionals in public school settings in the United States and Guam who reported working with students with autism. Data were gathered on paraprofessionals’ (a) roles and responsibilities, (b) applied knowledge from different types of professional development, (c) perceived barriers to professional development, and (d) types and timing of communication with their supervising teachers. The results of this study have direct implications for individuals interested in developing a model of professional development that will meet the unique needs of paraprofessionals who work with students with autism.