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Abstract Unaccustomed eccentric exercise (EE) is protective against muscle damage following a subsequent bout of similar exercise. One hypothesis suggests the existence of an alteration in motor unit (MU) behaviour during the second bout, which might contribute to the adaptive response. Accordingly, the present study investigated MU changes during repeated bouts of EE. During two bouts of exercise where maximal lengthening dorsiflexion (10 repetitions × 10 sets) was performed 3 weeks apart, maximal voluntary isometric torque (MVIC) and MU behaviour (quantified using high‐density electromyography; HDsEMG) were measured at baseline, during (after set 5), and post‐EE. The HDsEMG signals were decomposed into individual MU discharge timings, and a subset were tracked across each time point. MVIC was reduced similarly in both bouts post‐EE (Δ27 vs. 23%, P = 0.144), with a comparable amount of total work performed (∼1,300 J; P = 0.905). In total, 1,754 MUs were identified and the decline in MVIC was accompanied by a stepwise increase in discharge rate (∼13%; P

Previous research has revealed how mature students are more likely to drop out of university education, achieve poorer degree outcomes and have greater family, financial, caring and work commitments to contend with than their younger peers. In response to calls for further empirical work on mature students' university experiences and informed theoretically by Transition Theory, the primary study aim was to explore the day-to-day encounters of 12 newly enrolled undergraduate mature students as they completed their first year of study at an English university in a post pandemic era. Supportive with previous research, participants were found to be academically but not socially and emotionally engaged. Having placed significant time and effort into their studies and achieved relative academic success, their expectations of university life were only partly met with most encountering a socially, emotionally and financially challenging first year. Practical implications for developing increasingly flexible and relational rich modes of educational provision that best address and support the needs, abilities, motivations, and expectations of mature students as they complete their university studies in a digital world are provided, as are future research avenues and limitations.

Abstract Introduction Primary care provides an important opportunity to detect unhealthy alcohol use and offer assistance but many barriers to this exist. In an Australian context, Aboriginal Community Controlled Health Services (ACCHS) are community-led and run health services, which provide holistic primary care to Aboriginal and Torres Strait Islander peoples. A recent cluster randomised trial conducted with ACCHS provided a service support model which showed a small but significant difference in provision of ‘any treatment’ for unhealthy alcohol use. However, it was not clear which treatment modalities were increased. Aims To test the effect of an ACCHS support model for alcohol on: (i) delivery of verbal alcohol intervention (alcohol advice or counselling); (ii) prescription of relapse prevention pharmacotherapies. Methods Intervention: 24-month, multi-faceted service support model. Design: cluster randomised trial; equal allocation to early-support (‘treatment’) and waitlist control arms. Participants: 22 ACCHS. Analysis: Multilevel logistic regression to compare odds of a client receiving treatment in any two-month period as routinely recorded on practice software. Results Support was associated with a significant increase in the odds of verbal alcohol intervention being recorded (OR = 7.60, [95% CI = 5.54, 10.42], p

Cervical disc arthroplasty (CDA), also known as cervical artificial disc replacement, has become an alternative for the treatment of cervical spondylosis with radicular or myelopathic symptoms. However, there is limited literature regarding its complications and outcomes. We present two cases that developed C5 nerve palsy (C5P) following two-level CDA. Both patients presented with C5P in a delayed fashion with 2/5 and 1/5 deltoid weakness on MMT, respectively. Postoperative imaging did not demonstrate any spinal cord compression and symptoms resolved (5/5 on MMT) with conservative management in both cases. To our knowledge, these represent the first cases of delayed C5P after cervical arthroplasty reported in the literature. We performed a literature review to further enhance our knowledge regarding CDA. By understanding its pathophysiology and response to treatment, these cases can serve as a guide for spine surgeons and improve their future outcomes.

We present waveguide cavity measurements used to evaluate several thin materials for use in radomes. In addition to the data on the materials, we show how these measurements can be performed with common laboratory equipment and simple calculations. We sought an approach that allowed candidate materials to be readily evaluated to deal with formerly selected materials becoming unavailable or cost-prohibitive. We used lengths of standard waveguide (WR650 and WR137 here) with readily manufactured irises and a vector network analyzer (Keysight N5225B here). To select the iris size and determine the limits of the simplifications in the equations used, we employed a full-wave 3D electromagnetic simulator (CST Microwave Studio). The equations required to calculate the dielectric properties of samples and their contribution to the equivalent system noise temperature from unloaded and loaded resonant frequencies and Q factors are shown. While these formulations can be found elsewhere, we did not find these assembled as conveniently in other studies in the literature. We also show that orienting the sample down the length of the cavity allows for higher-order modes to be fully utilized. We did not find this straightforward adaptation of the common cross-guide orientation in other works. Overall, the results allowed us to recommend three fabrics for use at the frequencies tested (1.7 and 5.6 GHz). The complete process is outlined to assist others in performing these measurements themselves.

Abstract Background According to Norwegian registries, 91% of individuals ≥ 16 years had received ≥ 1 dose of COVID-19 vaccine by mid-July 2022, whereas less than 2% of children

Abstract Three classes of BCMA-directed therapy (BDT) exist: antibody drug-conjugates (ADCs), CAR-T, and T-cell engagers (TCEs), each with distinct strengths and weaknesses. To aid clinicians in selecting between BDTs, we reviewed myeloma patients treated at Mayo Clinic with commercial or investigational BDT between 2018-2023. We identified 339 individuals (1-exposure = 297, 2-exposures = 38, 3-exposures = 4) who received 385 BDTs (ADC = 59, TCE = 134, CAR-T = 192), with median follow-up of 21-months. ADC recipients were older, with more lines of therapy (LOT), and penta-refractory disease. Compared to ADCs, CAR-T (aHR = 0.29, 95%CI = 0.20–0.43) and TCEs (aHR = 0.62, 95%CI = 0.43–0.91) had better progression-free survival (PFS) on analysis adjusted for age, the presence of extramedullary (EMD), penta-refractory disease, multi-hit high-risk cytogenetics, prior BDT, and the number of LOT in the preceding 1-year. Likewise, compared to ADCs, CAR-T (aHR = 0.28, 95%CI = 0.18–0.44) and TCEs (aHR = 0.60, 95%CI = 0.39–0.93) had superior overall survival. Prior BDT exposure negatively impacted all classes but was most striking in CAR-T, ORR 86% vs. 50% and median PFS 13-months vs. 3-months. Of relapses, 54% were extramedullary in nature, and a quarter of these cases had no history of EMD. CAR-T demonstrates superior efficacy and where feasible, should be the initial BDT. However, for patients with prior BDT or rapidly progressive disease, an alternative approach may be preferable.

Abstract Background The ongoing global crisis of Higher Education (HE) institutions during the post-COVID-19 pandemic period has increased the likelihood of enduring psychological stressors for staff. This study aimed to identify factors associated with job insecurity, burnout, psychological distress and coping amongst staff working at HE institutions globally. Methods An anonymous cross-sectional study was conducted in 2023 with staff at HE institutions across 16 countries. Job insecurity was measured using the Job Insecurity Scale (JIS), burnout using the Perceived Burnout measure question, psychological distress using the Kessler Psychological Distress Scale (K10), and coping using the Brief Resilient Coping Scale. Multivariable logistic regression with a stepwise variable selection method was used to identify associations. Results A total of 2,353 staff participated; the mean age (± SD) was 43(± 10) years and 61% were females. Most staff (85%) did not feel job insecurity, one-third (29%) perceived burnout in their jobs, more than two-thirds (73%) experienced moderate to very high levels of psychological distress, and more than half (58%) exhibited medium to high resilient coping. Perceived job insecurity was associated with staff working part-time [Adjusted Odds Ratio 1.53 (95% Confidence Intervals 1.15–2.02)], having an academic appointment [2.45 (1.78–3.27)], having multiple co-morbidities [1.86 (1.41–2.48)], perceived burnout [1.99 (1.54–2.56)] and moderate to very high level of psychological distress [1.68 (1.18–2.39)]. Perceived burnout was associated with being female [1.35 (1.12–1.63)], having multiple co-morbidities [1.53 (1.20–1.97)], perceived job insecurity [1.99 (1.55–2.57)], and moderate to very high levels of psychological distress [3.23 (2.42–4.30)]. Staff with multiple co-morbidities [1.46 (1.11–1.92)], mental health issues [2.73 (1.79–4.15)], perceived job insecurity [1.61 (1.13–2.30)], and perceived burnout [3.22 (2.41–4.31)] were associated with moderate to very high levels of psychological distress. Staff who perceived their mental health as good to excellent [3.36 (2.69–4.19)] were more likely to have medium to high resilient coping. Conclusions Factors identified in this study should be considered in reviewing and updating current support strategies for staff at HE institutions across all countries to reduce stress and burnout and improve wellbeing.

Background: The period following pregnancy is a critical time window when future habits with respect to physical activity (PA) and sedentary behavior (SB) are established; therefore, it warrants guidance. The purpose of this scoping review was to summarize public health-oriented country-specific postpartum PA and SB guidelines worldwide. Methods: To identify guidelines published since 2010, we performed a (a) systematic search of 4 databases (CINAHL, Global Health, PubMed, and SPORTDiscus), (b) structured repeatable web-based search separately for 194 countries, and (c) separate web-based search. Only the most recent guideline was included for each country. Results: We identified 22 countries with public health-oriented postpartum guidelines for PA and 11 countries with SB guidelines. The continents with guidelines included Europe (n = 12), Asia (n = 5), Oceania (n = 2), Africa (n = 1), North America (n = 1), and South America (n = 1). The most common benefits recorded for PA included weight control/management (n = 10), reducing the risk of postpartum depression or depressive symptoms (n = 9), and improving mood/well-being (n = 8). Postpartum guidelines specified exercises to engage in, including pelvic floor exercises (n = 17); muscle strengthening, weight training, or resistance exercises (n = 13); aerobics/general aerobic activity (n = 13); walking (n = 11); cycling (n = 9); and swimming (n = 9). Eleven guidelines remarked on the interaction between PA and breastfeeding; several guidelines stated that PA did not impact breast milk quantity (n = 7), breast milk quality (n = 6), or infant growth (n = 3). For SB, suggestions included limiting long-term sitting and interrupting sitting with PA. Conclusion: Country-specific postpartum guidelines for PA and SB can help promote healthy behaviors using a culturally appropriate context while providing specific guidance to public health practitioners.

Landform maps are important tools in assessment of soil- and eco-hydrogeomorphic processes and hazards, hydrological modeling, and natural resources and land management. Traditional techniques of mapping landforms based on field surveys or from aerial photographs can be time and labor intensive, highlighting the importance of remote sensing products based automatic or semi-automatic approaches. In addition, the time-intensive manual labeling can also be subjective rather than an objective identification of the landform. Here we implemented such an objective approach applying a random forest machine learning algorithm to a set of observed landform data and 1m horizontal resolution bare-earth digital elevation model (DEM) developed from airborne light detection and ranging (LiDAR) data to rapidly map various landforms of a hilly landscape. The landform classification includes upland plateaus, ridges, convex slopes, planar slopes, concave slopes, stream channels, and valley bottoms, across a 400 km2 hilly landscape of the Ozark Mountains in northeastern Oklahoma. We used 4200 landform observations (600 per landform) and eight topographic indices derived from 2 m, 5 m and 10 m resolution LiDAR DEM in random forest algorithm to develop 2 m, 5 m and 10 m resolution landform models. We test the effectiveness of DEM resolution in mapping landforms via comparison of observed landforms with modeled landforms. Results showed that the approach mapped ∼84% of observed landforms when covariates were at 2 m resolution to ∼89% when they were at 10 m resolution. However, predicted maps showed that the 2 m resolution covariates performed better at capturing accurate landform boundaries and details of small-sized landforms such as stream channels and ridges. The approach presented here significantly reduces the time required for mapping landforms compared to traditional techniques using aerial imagery and field observations and allows incorporation of a wide variety of covariates. The landform map developed using this approach has several potential applications. It could be utilized in hydrological modeling, natural resource management, and characterizing soil-geomorphic processes and hazards in a hilly landscape.

IntroductionEntering higher education (HE) is one of the most significant transitions in a student’s life and is negatively impacted by any disparity between expectation and initial experience when joining their course.MethodThe current study explored how the students’ experiences of learning and teaching practices in their previous educational environment influenced their expectations and initial experiences of HE. The study adopted a mixed methods approach, initially surveying 69 students concerning their previous educational experiences, expectations and experiences of HE. Informed by the questions in the survey, two semi-structured focus groups comprising a total of 6 students were completed and analysed using inductive thematic analysis.Results and discussionThe current research identified specific challenges students face as they transition into HE, often resulting in an initial culture shock as that adapt to their new learning environment. These challenges are, to some extent, a consequence of their previous learning environment. Whilst expectations of HE were cultivated in their previous educational environment, they were not always accurate and resulted in a mismatch between expectation and reality of HE. This article identifies what may be missing for a student as they transition from further education into HE, and explores some of the opportunities HE faces in addressing these deficits.

Background: Health-related mobile applications (apps) have the potential to improve health knowledge and promote healthy behaviours during pregnancy. Pregnancy apps are popular and extensively used by consumers. Objective: This study investigates the usage patterns, decision-making criteria and concerns regarding the quality and credibility of health-related information within pregnancy mobile applications. The aim of this study is to understand consumer perspectives to potentially contribute to guidelines for apps containing health-related information. Design: A cross-sectional study, utilising an online questionnaire for data collection. Methods: The study surveyed pregnant women in Australia who were recruited via online platforms, including social media and paid Facebook ads. Participants completed a 29-item questionnaire assessing their use of pregnancy apps, sources of health information and perceptions of app quality and safety, with data collected and analysed using the Qualtrics platform and SPSS Statistics. Results: The survey was survey completed by 427 current-or-recently pregnant individuals, aged 18 or over and located in Australia. Overall, 62.3% were currently pregnant and 37.7% were recently pregnant, within 6 months. Medical practitioners were the primary source of pregnancy-related health information, and pregnancy apps were the third most common source. Pregnancy apps were considered to be a trustworthy source of information by 63.8% of respondents and the majority used apps during pregnancy (94.2%). Of those who used pregnancy apps ( n = 325), information being safe and trustworthy was their top priority when selecting an app. However, 35.5% ( n = 115) had encountered information in an app they felt was unsafe or conflicted with previous knowledge or advice. Only 4.6% ( n = 15) were aware that health-related apps are not screened for accurate information/undergo quality assurance checks before being made available to download. If provided with a guide to evaluate app quality, 74.6% ( n = 241) would utilise the tool. Conclusions: These findings highlight a need to promote the critical assessment of health information within pregnancy apps and to develop resources to support consumers in doing so.

Apart from antibiotic resistance, the increasing incidence of cancers is among the serious health challenges facing humans today around the world. These indeed need new and environmentally friendly solutions. In this respect, synthesis and application of nanoparticles simply AgNPs have become of compelling interest within the last few years, especially within the area of biomedicine. The green synthesis of AgNPs using plant extracts is one of the promising eco-friendly methods that has treated microbial infections and acted against cancerous activities. A literature search on databases Web of Science, PubMed, and Scopus was performed between January 2023 and October 2023 in light of PRISMA. Afterward, screening for articles by title and abstract was implemented. Then, retrieved eligible studies were assessed for full-text inclusion criteria analysis. The reviewed findings show that AgNPs have contributed to health-related applications in the development of consumer goods like UV-resistant ointments and cosmetics. Their biomedical application is huge, especially regarding developing diagnosis devices for viruses such as Ebola, yellow fever, and Dengue. AgNPs thereby exhibited formidable antimicrobial action against a wide array of pathogenic microorganisms, each representing Gram-positive and Gram-negative bacteria. It proved to be effective even against antibiotic-resistant strains and pathogenic fungi. Besides this, their anticancer potentialities are quite extraordinary. In short, all these studies have given evidence for outstanding antimicrobial and anticancer efficiencies of biologically synthesized AgNPs to combat some of the serious health issues of the modern era.

Summary: Despite extensive global research into genetic predisposition for severe COVID-19, knowledge on the role of rare host genetic variants and their relation to other risk factors remains limited. Here, 52 genes with prior etiological evidence were sequenced in 1,772 severe COVID-19 cases and 5,347 population-based controls from Spain/Italy. Rare deleterious TLR7 variants were present in 2.4% of young (

Few studies have examined the genetic population structure of vector-borne microparasites in wildlife, making it unclear how much these systems can reveal about the movement of their associated hosts. This study examined the complex host–vector–microbe interactions in a system of bats, wingless ectoparasitic bat flies (Nycteribiidae), vector-borne microparasitic bacteria (Bartonella) and bacterial endosymbionts of flies (Enterobacterales) across an island chain in the Gulf of Guinea, West Africa. Limited population structure was found in bat flies and Enterobacterales symbionts compared to that of their hosts. Significant isolation by distance was observed in the dissimilarity of Bartonella communities detected in flies from sampled populations of Eidolon helvum bats. These patterns indicate that, while genetic dispersal of bats between islands is limited, some non-reproductive movements may lead to the dispersal of ectoparasites and associated microbes. This study deepens our knowledge of the phylogeography of African fruit bats, their ectoparasites and associated bacteria. The results presented could inform models of pathogen transmission in these bat populations and increase our theoretical understanding of community ecology in host–microbe systems.

Abstract In this study, we explore the utilization of penalized likelihood estimation for the analysis of sparse photon counting data obtained from distributed target lidar systems. Specifically, we adapt the Poisson Total Variation processing technique to cater to this application. By assuming a Poisson noise model for the photon count observations, our approach yields denoised estimates of backscatter photon flux and related parameters. This facilitates the processing of raw photon counting signals with exceptionally high temporal and range resolutions (demonstrated here to 50 Hz and 75 cm resolutions), including data acquired through time-correlated single photon counting, without significant sacrifice of resolution. Through examination involving both simulated and real-world 2D atmospheric data, our method consistently demonstrates superior accuracy in signal recovery compared to the conventional histogram-based approach commonly employed in distributed target lidar applications.

Wild bovids provide important ecosystem functions as seed dispersers and vegetation modifiers. Five wild bovids remain in Thailand: gaur (Bos gaurus), banteng (Bos javanicus), wild water buffalo (Bubalus arnee), mainland serow (Capricornis sumatraensis) and Chinese goral (Naemorhedus griseus). Their populations and habitats have declined substantially and become fragmented by land-use change. We use ecological niche models to quantify how much potential suitable habitat for these species remains within protected areas in Asia and then specifically Thailand. We combined species occurrence data from several sources (e.g. mainly camera traps and direct observation) with environmental variables and species-specific and single, large accessible areas in ensemble models to generate suitability maps, using out-of-sample predictions to validate model performance against new independent data. Gaur, banteng and buffalo models showed reasonable model accuracy throughout the entire distribution (greater than or equal to 62%) and in Thailand (greater than or equal to 80%), whereas serow and goral models performed poorly for the entire distribution and in Thailand, though 5 km movement buffers markedly improved the performance for serow. Large suitable areas were identified in Thailand and India for gaur, Cambodia and Thailand for banteng and India for buffalo. Over 50% of suitable habitat is located outside protected areas, highlighting the need for habitat management and conflict mitigation outside protected areas.

BackgroundHigher rates of physical inactivity and comorbid conditions are reported in Hispanic/Latinx and Black cancer patients receiving chemotherapy compared to their White counterparts. Despite the beneficial effect of exercise training for cancer patients, rates of participation in exercise oncology clinical trials are low among disadvantaged and racial and ethnic minority groups. Here, we will examine the effect of an exercise intervention using a novel, accessible, and cost-effective home-based exercise approach among Hispanic/Latinx and Black cancer patients receiving chemotherapy on exercise participation and cardiovascular disease risk.MethodsThe THRIVE trial is an 8-month prospective, three-arm study of 45 patients who are randomized in a 1:1:1 fashion to a supervised exercise intervention (SUP), unsupervised exercise (UNSUP), or an attention control (AC) group. Eligible patients include those with breast, colorectal, or prostate cancer, who are sedentary, overweight or obese, self-identify as Hispanic/Latinx or Black, and plan to receive chemotherapy. Patients randomized to the SUP group participate in a home-based 16-week periodized aerobic and resistance exercise program performed three days per week, supervised through video conference technology. Patients randomized to the UNSUP group participate in an unsupervised 16-week, telehealth-based, periodized aerobic and resistance exercise program performed three days per week using the same exercise prescription parameters as the SUP group. Patients randomized to the AC group receive a 16-week home-based stretching program. The primary outcome is changes in minutes of physical activity assessed by 7-day accelerometry at post-intervention. Secondary outcomes include cardiovascular risk factors, patient-reported outcomes, and physical function. Outcome measures are tested at baseline, post-intervention at month 4, and after a non-intervention follow-up period at month 8.DiscussionThe THRIVE trial is the first study to employ a novel and potentially achievable exercise intervention for a minority population receiving chemotherapy. In addition, this study utilizes an intervention approach to investigate the biological and behavioral mechanisms underlying exercise participation in these cancer patients. Results will guide and inform large randomized controlled trials to test the effect of home-based exercise on treatment outcomes and comorbid disease risk in minority patients with cancer undergoing chemotherapy.Clinical trial registrationhttps://classic.clinicaltrials.gov/ct2/show/NCT05327452, identifier (NCT#05327452).

Introduction Medical mis- and disinformation are on the rise and impact patient health outcomes. The complexity of modern medicine and health care delivery necessitates that care be delivered by an interprofessional team of providers well versed in addressing this increased prevalence of medical misinformation. Health professions educational curricula often lack opportunities for students to learn how to address medical misinformation, employ advanced communication techniques, and work collaboratively. Methods Based on literature and our previous qualitative research, we created a module offering prework learning on COVID-19 and addressing misinformation through advanced communication techniques and interprofessional collaboration. After completing prework, students participated in a standardized patient encounter addressing COVID misinformation. Health professions student dyads completed a preencounter planning huddle and together interviewed a standardized patient. Students received global and checklist-based feedback from standardized patients and completed pre- and postsession self-assessments. Results Twenty students participated (10 third-year medical, nine third-year pharmacy, one fourth-year pharmacy). Key findings included the following: Nine of 15 survey questions demonstrated statistically significant improvement, including all three questions assessing readiness to have difficult conversations and six of 10 questions assessing interprofessional collaboration and team function. Discussion Students participating in this novel curriculum advanced their readiness to address medical misinformation, including COVID-19 vaccine disinformation, with patients and coworkers to improve health decision-making and patient care. These curricular methods can be customized for use with a range of health professions learners.

Abstract Mechanical load is one of the main determinants of cardiac structure and function. Mechanical load is studied in vitro using cardiac preparations together with loading protocols (e.g., auxotonic, isometric). However, such studies are often limited by reductionist models and poorly simulated mechanical load profiles. This hinders the physiological relevance of findings. Living myocardial slices have been used to study load in vitro. Living myocardial slices (LMS) are 300‐μm‐thick intact organotypic preparations obtained from explanted animal or human hearts. They have preserved cellular populations and the functional, structural, metabolic and molecular profile of the tissue from which they are prepared. Using a three‐element Windkessel (3EWK) model we previously showed that LMSs can be cultured while performing cardiac work loops with different preload and afterload. Under such conditions, LMSs remodel as a function of the mechanical load applied to them (physiological load, pressure or volume overload). These studies were conducted in commercially available length actuators that had to be extensively modified for culture experiments. In this paper, we demonstrate the design, development and validation of a novel device, MyoLoop. MyoLoop is a bioreactor that can pace, thermoregulate, acquire and process data, and chronically load LMSs and other cardiac tissues in vitro. In MyoLoop, load is parametrised using a 3EWK model, which can be used to recreate physiological and pathological work loops and the remodelling response to these. We believe MyoLoop is the next frontier in basic cardiovascular research enabling reductionist but physiologically relevant in vitro mechanical studies.

Abstract Refractoriness to lenalidomide is an important factor determining the choice of therapy at first relapse in multiple myeloma (MM). It remains debatable if resistance to lenalidomide varies among MM refractory to standard doses vs low dose maintenance doses. In this study, we assessed the outcomes with subsequent therapies in patients with MM refractory to standard dose vs low dose lenalidomide. We retrospectively reviewed all patients with MM at our institution who received first line therapy with lenalidomide containing regimens, and assessed progression free survival (PFS) and overall survival for these patients for second line therapy, and with lenalidomide retreatment. For second line therapy, we found no difference in the PFS between standard dose refractory and low dose refractory groups (median PFS 14 months vs 14 months, p = 0.95), while the PFS for both these groups was inferior to the not refractory group (median PFS 30 months, p

Abstract Background People who are unhoused, use substances (drugs and/or alcohol), and who have mental health conditions experience barriers to care access and are frequently confronted with discrimination and stigma in health care settings. The role of Peer Workers in addressing these gaps in a hospital-based context is not well characterized. The aim of this evaluation was to 1) outline the role of Peer Workers in the care of a marginalized populations in the emergency department; 2) characterize the impact of Peer Workers on patient care, and 3) to describe how being employed as a Peer Worker impacts the Peer. Methods Through a concurrent mixed methods evaluation, we explore the role of Peer Workers in the care of marginalized populations in the emergency department at two urban hospitals in Toronto, Ontario Canada. We describe the demographic characteristics of patients (n = 555) and the type of supports provided to patients collected through a survey between February and June 2022. Semi-structured, in-depth interviews were completed with Peer Workers (n = 7). Interviews were thematically analyzed using a deductive approach, complemented by an inductive approach to allow new themes to emerge from the data. Results Support provided to patients primarily consisted of friendly conversations (91.4%), discharge planning (59.6%), tactics to help the patient navigate their emotions/mental wellbeing (57.8%) and sharing their lived experience (50.1%). In over one third (38.9%) of all patient interactions, Peer Workers shared new information about the patient with the health care team (e.g., obtaining patient identification). Five major themes emerged from our interviews with Peer Workers which include: (1) Establishing empathy and building trust between the patient and their care team through self-disclosure; (2) Facilitating a person-centered approach to patient care through trauma-informed listening and accessible language; (3) Support for patient preferences on harm reduction; (4) Peer worker role facilitating self-acceptance and self-defined recovery; and (5) Importance of supports and resources to help Peer Workers navigate the emotional intensity of the emergency department. Conclusions The findings add to the literature on Peer Worker programs and how such interventions are designed to best meet the needs of marginalized populations.

Abstract The approach to patients with high-risk smoldering multiple myeloma (SMM) varies among clinicians; while some advocate early intervention, others reserve treatment at progression to multiple myeloma (MM). We aimed to describe the myeloma-defining events (MDEs) and clinical presentations leading to MM diagnosis among SMM patients seen at our institution. We included 406 patients diagnosed with SMM between 2013–2022, seen at Mayo Clinic, Rochester, MN. The 2018 Mayo 20/2/20 criteria were used for risk stratification. Median follow-up was 3.9 years. Among high-risk patients who did not receive treatment in the SMM phase (n = 71), 51 progressed by last follow-up; the MDEs included: bone lesions (37%), anemia (35%), hypercalcemia (8%), and renal failure (6%); 24% met MM criteria based on marrow plasmacytosis (≥60%) and/or free light chain ratio (>100); 45% had clinically significant MDEs (hypercalcemia, renal insufficiency, and/or bone lesions). MM diagnosis was made based on surveillance labs/imaging(45%), testing obtained due to provider suspicion for progression (14%), bone pain (20%), and hospitalization/ED presentations due to MM complications/symptoms (4%). The presentation was undocumented in 14%. A high proportion (45%) of patients with high-risk SMM on active surveillance develop end-organ damage at progression. About a quarter of patients who progress to MM are not diagnosed based on routine interval surveillance testing.

Abstract Background Early in the COVID-19 pandemic, there was an urgent need to establish isolation spaces for people experiencing homelessness who were exposed to or had COVID-19. In response, community agencies and the City of Toronto opened COVID-19 isolation and recovery sites (CIRS) in March 2020. We sought to examine the provision of comprehensive substance use services offered to clients on-site to facilitate isolation, particularly the uptake of safer supply prescribing (prescription of pharmaceutical opioids and/or stimulants) as part of a spectrum of comprehensive harm reduction and addiction treatment interventions. Methods We conducted in-depth, semi-structured interviews with 25 clients and 25 staff (including peer, harm reduction, nursing and medical team members) from the CIRS in April–July 2021. Iterative and thematic analytic methods were used to identify key themes that emerged in the interview discussions. Results At the time of implementation of the CIRS, the provision of a safer supply of opioids and stimulants was a novel and somewhat controversial practice. Prescribed safer supply was integrated to address the high risk of overdose among clients needing to isolate due to COVID-19. The impact of responding to on-site overdoses and presence of harm reduction and peer teams helped clinical staff overcome hesitation to prescribing safer supply. Site-specific clinical guidance and substance use specialist consults were crucial tools in building capacity to provide safer supply. Staff members had varied perspectives on what constitutes ‘evidence-based’ practice in a rapidly changing, crisis situation. Conclusion The urgency involved in intervening during a crisis enabled the adoption of prescribed safer supply, meeting the needs of people who use substances and assisting them to complete isolation periods, while also expanding what constitutes acceptable goals in the care of people who use drugs to include harm reduction approaches.

Personal tutoring is renowned for the positive role it can play in supporting student satisfaction, engagement and attainment outcomes in higher education. Surprisingly though, few studies have specifically investigated the demands of this role from the perspective of the personal tutor. Through the theoretical lens of Role Theory, this study explored university tutors' experiences of their personal tutoring role within a sport educational setting at a United Kingdom university. All data was collected through face-to-face semi structured qualitative interviews and analysed using thematic analysis. Key findings were the negative impact of personal tutoring on participants role multiplicity, intra-role accumulation and role identity. Most participants viewed the role as being time consuming, emotionally challenging and one they would prefer not to undertake (role multiplicity), feeling under qualified and ill-equipped in assisting their tutees because of the increasingly serious and complex nature of non-academic related issues presented (intra-role accumulation). Several lacked confidence and interest in the role, finding it to be stressful and instead favouring greater research responsibilities within their workloads (role identity). The collective findings provide academic colleagues and senior university management teams with evidence to inform future institutional policies and practices. This will help ensure personal tutors working across multiple disciplines and academic levels fully understand what the role is, the demands they are likely to encounter, the continued professional development required to facilitate and support the role and how the role should be better recognised in academic promotion criteria. Study limitations and future research avenues are discussed.

تم في هذا البحث تقديم خصائص جديدة لتوسيع لتوزيع معكوس ويبل وهو من التوزيعات المستمرة وذلك عن طريق تركيب توزيع معكوس ويبل Inverse Weibull Distribution مع عائلة مارشال اولكين ويبل The Marshal Olkin Weibull H- Family للحصول على التوزيع الجديد ويطلق عليه توزيع مارشال اولكين ويبل معكوس ويبل Marshal Olkin Weibull Inverse Weibull Distribution ونرمز له بالرمز (MOWIW). وكذلك نقوم بدراسة بعض الخصائص الإحصائية والدوال مثل، دالة (البقاء)، ودالة (الخطر)، الإحصاءات المرتبة، ريني انتروبي، ثم بعد ذلك يتم عرض بعض الرسوم البيانية لبعض للدوال مثال ذلك (التوزيع التراكمي والكثافة الاحتمالية والبقاء والخطر) وكذلك باستخدام طريقة الأماكن الأعظم MLE يتمَّ تقدير المعالم المجهولة للتوزيع الجديد. وقد تم استخدام المحاكاة والتي هي من التقنيات الرقمية التي يمكن اجراء التجارب من خلال الكومبيوتر بحيث تتضمن هذه التقنية عدد من النماذج الرياضية وإن هذه النماذج الرياضية تصف سلوك أو نظام عمل معقد بفترة زمنية محددة أو معينة، لغرض الحصول على توزيعات تتميز بمرونة عالية. ويمكن وصفها بشكل آخر بأن عملية المحاكاة هي تقليد للواقع الحقيقي من خلال وصف الواقع بنماذج معينة بحيث إن هذه النماذج تكون مشابهة للواقع لتحقيق فهم أكبر قدر ممكن لهذا الواقع الحقيقي. وإن من أهم ما تتميز بها المحاكاة وهي تكرار التجربة لعدة مرات وبحجوم عينات مختلفة عن طريق تغيير المدخلات وإن هذه العينات التي يتمَّ توليدها تكون مستقلة.