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We conducted a nationwide, randomized controlled trial to evaluate the impact of Healing Choices, a novel interactive education and treatment decision program rooted in the self-regulation theory framework, on decisional conflict and psychological distress at 2-month post-intervention in women with early-stage breast cancer. Patients were randomized to receive the National Cancer Institutes standard print material (control) or standard print material plus Healing Choices (the intervention). The final sample at 2-month post-intervention consisted of N = 388 participants (intervention: n = 197; control: n = 191). There were no significant differences in decisional conflict or its subscales; however, psychological distress was higher in the intervention group (16.09 ± 10.25) than in the control group (14.37 ± 8.73) at follow-up, B = 1.88, 95% CI [-0.03, 3.80], t(383) = 1.94, p = .05. Upon further examination, we found that engagement with the intervention was low-41%-prompting as-treated analyses, which showed no difference in distress between users and nonusers and a positive impact of Healing Choices on decisional conflict: decisional support subscale: users (35.36 ± 15.50) versus nonusers (39.67 ± 15.99), B = -4.31 (s.e. = 2.09), p = .04. Multiple recommendations for moving ahead stem from this work: (i) intent-to-treat analyses appeared to cause distress, cautioning against interventions that may lead to information overload; (ii) engagement with the intervention is low and future work needs to focus on increasing engagement and monitoring it throughout the study; and (iii) in studies with low engagement, as-treated analyses are critical.

A principal's leadership is a key part to the success of a school as their leadership guides both instructional and organizational outcomes. Teachers often work beyond their formal duties to see that all their students have their needs met. This is referred to as an Organizational Citizenship Behavior (i.e., when followers display behaviors that benefit the organization or its members beyond their current job requirements). This study investigated the relationship between principal's transformational leadership and teachers' Organizational Citizenship Behaviors and related motivating factors. Participants from a suburban school district completed a questionnaire based on their perceptions of their principal's leadership characteristics and reflections upon their own practices. The results showed the strongest transformational leadership practice is individualized support. This practice demonstrated positive relationships with Organizational Citizenship Behavior, Organizational Concern, and Prosocial Values. The outcomes of this study are intended to assist school leaders in promoting sound citizenship behaviors through leadership practices as well as informing leadership preparation.

BackgroundUnderserved women are at high risk for smoking relapse after childbirth due to their unique socioeconomic and postpartum stressors and barriers. Mobile text messaging technology allows delivery of relapse prevention programs targeted to their personal needs over time. ObjectiveTo describe the development of a social-cognitive theory-based and evidence-guided text messaging intervention for preventing postpartum smoking relapse among inner city women. MethodsGuided by the cognitive-social health information processing framework, user-centered design, and health communication best practices, the intervention was developed through a systematic process that included needs assessment, followed by an iterative cycling through message drafting, health literacy evaluation and rewriting, review by target community members and a scientific advisory panel, and message revision, concluding with usability testing. ResultsAll message content was theory-grounded, derived by needs assessment analysis and evidence-based materials, reviewed and revised by the target population, health literacy experts, and scientific advisors. The final program, “Txt2Commit,” was developed as a fully automated system, designed to deliver 3 proactive messages per day for a 1-month postpartum smoking relapse intervention, with crave and lapse user-initiated message functions available when needed. ConclusionsThe developmental process suggests that the application of theory and best practices in the design of text messaging smoking cessation interventions is not only feasible but necessary for ensuring that the interventions are evidence based and user-centered.

The pressure to lead schools effectively while fulfilling instructional leadership and school management tasks could impact school administrators' perceptions of their leadership capabilities. The purpose of this quantitative, cross-sectional study was to identify the relationship between the varied tasks of school administrators as related to their leadership self-efficacy. Data were collected from 73 school administrators to ascertain leadership self-efficacy of principals and assistant principals based upon the completion of instructional leadership tasks and school management tasks. The major findings of the study indicated a positive, linear relationship between leadership self-efficacy and the instructional leadership tasks and school management tasks of school administrators. The practical application of this study provides insight into the types of tasks that impact the leadership self-efficacy of principals and assistant principals and could drive the professional learning of school administrators and the delegation of their tasks.

Background/Objective: Although low-methoxy (LM) pectin (polysaccharides extracted from citrus peels) can reduce inflammation by binding to and inhibiting the TLR-2 pathway in animal models and in vitro studies, the anti-inflammatory effects of LM pectin in humans and mood have not been explored to date. The purpose of this study is to assess the role of dietary supplementation with LM pectin in healthy volunteers on inflammatory markers and on mood, specifically anxiety and depression. Methods: We carried out a 4-week dietary intervention with LM citrus pectin on healthy volunteers (N = 14, age 40 ± 16 y, BMI 24.7 ± 3.0 kg/m2, sex F 57%) comparing the effects of daily supplementation with 20 g of LM citrus pectin versus 10 g of maltodextrin as the control (N = 15 age 43.2 ± 11 y, BMI 25.18 ± 2.0 kg/m2, sex F 66%). The effects on mood and inflammation were also tested with LM pectin at 5 g, 10 g and 15 g (2 weeks each) in an independent cohort of n = 15 healthy volunteers (age 36 ± 21 y, BMI 23.5 ± 2.4 kg/m2, sex F 80%). We assessed serum levels of TNF-alpha (downstream from TLR-2 activation), IL-1 beta, IL-6, IL-10, INF-gamma, CRP, zonulin and TLR-2 concentration which were measured using ELISA in blood samples collected at both the baseline and follow-up visits. Validated measures of anxiety and depression were collected at baseline and follow-up. Results: Supplementation with 20 g of LM pectin resulted in decreases in the pro-inflammatory markers TNF-alpha, IL-1 beta, IL-6 and INF-gamma (all p < 0.05) and an increase in anti-inflammatory marker IL-10 (p = 0.01) at the end of the 4 weeks. No such effects were observed in the control group. In addition, a significant drop in anxiety scores (from 8.38 to 4.46, p < 0.006) was found with the 20 g/day intervention but not in the control arm. In the dose–response study, anti-inflammatory effects were seen only at 15 g for TNFα (p < 0.003) and a suggestive increase in IL-10 (p = 0.08), alongside a drop in TLR-2 (p < 0.027). No significant anti-inflammatory effects were observed at 5 g and 10 g doses of LM pectin supplementation. Significant dose-dependent drops in both anxiety and depression scores were found with 10 g (p < 0.001) and 15 g per day (p < 0.0002). Conclusions: The current study identifies anxiety-reducing and anti-inflammatory effects of supplementation with 15 g/day LM pectin in healthy humans. Further research is needed to elucidate the precise mechanism and to validate the efficient dose and minimum duration of supplementation. [ABSTRACT FROM AUTHOR]

Plastic production on a commercial scale began in the 1950s, reaching an annual production of 460 million metric tons in 2019. The global release of 22% of produced plastics into the environment has raised concerns about their potential environmental impacts, particularly on aquatic ecosystems. Here, we quantify and categorize plastic debris found along Richland Creek, a small, heavily forested watershed in western North Carolina, USA. Plastics within the riparian zone of seven 50 m reaches of Richland Creek and its tributaries were sampled two or three times. The 1737 pieces of collected plastic debris were returned to the lab where they were measured and categorized. A small-scale laboratory study using seven of the items collected was performed to determine their ability to break down into microplastics (particles < 5 mm in size). The majority (76%) of collected items were made of either plastic film (particularly bags and food wrappers, 43%) or hard plastics (e.g., bottles, 2%). However, when viewed on a surface area basis, films and synthetic fabrics (e.g., clothing, sleeping bags) equally dominated. Roughly three-quarters of the items collected had a width less than 10 cm, due primarily to the fragmentation of the original items; over two-thirds of the collected items were fragmented. Items composed of foams and films exhibited the highest fragmentation rates, 93% and 86%, respectively. Most collected plastics were domestic in nature, and the number of items increased downstream through more developed areas. Laboratory studies showed that plastic debris has a propensity to break down into microplastics. We believe the data collected here should be replicated in other streams, as these freshwater environments are the source of plastics that eventually enter the oceans. [ABSTRACT FROM AUTHOR]

Background: Hip fractures in frail patients result in excess mortality not accounted for by age or comorbidities. The mechanisms behind the high risk of mortality remain undetermined but are hypothesized to be related to the inflammatory status of frail patients. Methods: In a prospective observational exploratory cohort study of hospitalized frail hip fracture patients, 92 inflammatory markers were tested in pre-operative serum samples and markers were tested against 6-month survival post-hip fracture surgery and incidence of acute kidney injury (AKI). After correcting for multiple testing, adjustments for comorbidities and demographics were performed on the statistically significant markers. Results: Of the 92 markers tested, circulating levels of fibroblast growth factor 23 (FGF-23) and interleukin-15 receptor alpha (IL15RA), both involved in renal disease, were significantly correlated with 6-month mortality (27.5% overall) after correcting for multiple testing. The incidence of postoperative AKI (25.4%) was strongly associated with 6-month mortality, odds ratio = 10.57; 95% CI [2.76-40.51], and with both markers plus estimated glomerular filtration rate (eGFR)- cystatin C (CYSC) but not eGFR-CRE. The effect of these markers on mortality was significantly mediated by their effect on postoperative AKI. Conclusion: High postoperative mortality in frail hip fracture patients is highly correlated with preoperative biomarkers of renal function in this pilot study. The effect of preoperative circulating levels of FGF-23, IL15RA, and eGFR-CYSC on 6-month mortality is in part mediated by their effect on postoperative AKI. Creatinine-derived preoperative renal function measures were very poorly correlated with postoperative outcomes in this group. [ABSTRACT FROM AUTHOR]

Orally and later in written form, stories have been used to identify and reinforce the values of a culture. The parables of the Bible and the vocalization of articulate animals in Aesop fables continue to be used to teach morals to children. While the majority of existing research investigates the effective use of animals as a tool in character and values education, limited research has been done regarding the benefits of using articulate animals to teach leadership education and to promote the wise selection of leaders. The purpose of this pilot study will be to qualitatively test the theory that students who read and discuss selections from modern fantasy that identify specific articulate animals as role models or bullies will respond differently to questions posed in whole-group discussion. The random selection of middle-school students engaged in followership training will read and discuss the roles of specific animals in selected children's literature. During whole group discussion, responses will be observed and recorded, noting differences to the following two questions: "Are followers responsible for the actions of a leader?" and "Is a bully a leader?" (Contains 25 footnotes.)

Germ-line RB-1 mutations predispose to pineoblastoma (PinB), but other predisposing genetic factors are not well established. We recently identified a germ-line DICER1 mutation in a child with a PinB. This was accompanied by loss of heterozygosity (LOH) of the wild-type allele within the tumour. We set out to establish the prevalence of DICER1 mutations in an opportunistically ascertained series of PinBs. Twenty-one PinB cases were studied: Eighteen cases had not undergone previous testing for DICER1 mutations; three patients were known carriers of germ-line DICER1 mutations. The eighteen PinBs were sequenced by Sanger and/or Fluidigm-based next-generation sequencing to identify DICER1 mutations in blood gDNA and/or tumour gDNA. Testing for somatic DICER1 mutations was also conducted on one case with a known germ-line DICER1 mutation. From the eighteen PinBs, we identified four deleterious DICER1 mutations, three of which were germ line in origin, and one for which a germ line versus somatic origin could not be determined; in all four, the second allele was also inactivated leading to complete loss of DICER1 protein. No somatic DICER1 RNase IIIb mutations were identified. One PinB arising in a germ-line DICER1 mutation carrier was found to have LOH. This study suggests that germ-line DICER1 mutations make a clinically significant contribution to PinB, establishing DICER1 as an important susceptibility gene for PinB and demonstrates PinB to be a manifestation of a germ-line DICER1 mutation. The means by which the second allele is inactivated may differ from other DICER1-related tumours.

Early menarche is a risk factor for breast cancer. We investigated the variation in age at menarche by socioeconomic status (SES) and race.A cohort study was conducted on 1,091 black and 986 white girls from the three sites in the United States as part of the NHLBI Growth and Health Study (NGHS), who were aged 9–10 years at baseline and followed through adolescence over a 10-year period with annual exams. Using logistic regression models, we evaluated the nature and strength of associations between two socioeconomic indicators (household income and parental education) and early menarche (