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Abstract Background Faecal immunochemical tests (FITs) are used to triage primary care patients with symptoms that could be caused by colorectal cancer for referral to colonoscopy. The aim of this study was to determine whether combining FIT with routine blood test results could improve the performance of FIT in the primary care setting. Methods Results of all consecutive FITs requested by primary care providers between March 2017 and December 2020 were retrieved from the Oxford University Hospitals NHS Foundation Trust. Demographic factors (age, sex), reason for referral, and results of blood tests within 90 days were also retrieved. Patients were followed up for incident colorectal cancer in linked hospital records. The sensitivity, specificity, positive and negative predictive values of FIT alone, FIT paired with blood test results, and several multivariable FIT models, were compared. Results One hundred thirty-nine colorectal cancers were diagnosed (0.8%). Sensitivity and specificity of FIT alone at a threshold of 10 μg Hb/g were 92.1 and 91.5% respectively. Compared to FIT alone, blood test results did not improve the performance of FIT. Pairing blood test results with FIT increased specificity but decreased sensitivity. Multivariable models including blood tests performed similarly to FIT alone. Conclusions FIT is a highly sensitive tool for identifying higher risk individuals presenting to primary care with lower risk symptoms. Combining blood test results with FIT does not appear to lead to better discrimination for colorectal cancer than using FIT alone.

Background: Plant-based formulas have become increasingly popular due to their health benefits, environmental concerns, cultural beliefs, improved palatability, and decreased cost. A retrospective chart review of medically stable children transitioning from a hypoallergenic formula to a yellow pea protein plant-based formula (PPPBF) was included. This study aimed to assess gastrointestinal tolerance, weight changes, and adherence to receiving a unique PPPBF. Methods: Healthcare providers (HCPs) from pediatric clinics across the United States who requested increased PPPBF samples between the dates of 1 November 2021and 31 January 2022 and again from 1 February 2022 to 15 April 2022 inputted survey data. The HCPs selected participants based on the inclusion criteria. Results: Seventy-three completed patient surveys were included of children (ages 1–18 years old, 41% females, 59% males). After the transition to PPPBF, 38.4% experienced improvement in GI tolerance, 56.2% experienced no change, and 5.5% reported worsening GI tolerance. There was a 95% adherence rate, and 98.9% reported no adverse reactions or allergic manifestations after formula transition. Conclusions: Transitioning from a hypoallergenic formula to a PPPBF showed a trend toward stable GI tolerance, weight gain or stability, and adherence. A PPPBF offers a first-choice option for children who are on hypoallergenic formulas due to intolerance. [ABSTRACT FROM AUTHOR]

Background: Cochlear implants and hearing aids may facilitate the development of listening and spoken language (LSL) in deaf/hard of hearing young children, but they require aural rehabilitation therapy—often unavailable outside urban areas—for optimal outcomes. This trial assessed the relative effectiveness of LSL therapy delivered either in person or by interactive video. The hypothesis was that telehealth service delivery would be noninferior to in-person therapy. Methods: Most parents refused randomization of their children to telehealth or in-person conditions; therefore, randomization was impossible. In consultation with the funder (NIDCD), the study design was modified. Parents were allowed to select their preferred study condition, and the study team was blinded to group membership. Forty-two families were in the in-person group and 35 in telehealth (40 and 30, respectively, after attrition). Primary endpoints were total score, auditory comprehension, and expressive communication on the Preschool Language Scale, 5th edition. There were several secondary speech, hearing, and language outcome measures. Assessments occurred at baseline and at follow-up after 6 months of LSL therapy. Results: Propensity scores were used to create two matched groups. At baseline, groups did not differ on PLS-5 scores. Change from baseline to F/U on age-equivalents for all three scores was nearly identical for both groups, although the telehealth group was younger, on average, than the in-person group. Discussion: Telehealth was noninferior to in-person services for all primary endpoints. For secondary outcomes, neither group demonstrated a significant advantage. Magnitudes of estimated group differences were small, suggesting nonsignificant differences not predominantly because of sample size. The telehealth group showed greater improvement on 15/24 of secondary language outcome measures. The findings provide evidence that telehealth is equivalent to in-person care for providing LSL therapy to young children with cochlear implants and hearing aids. [ABSTRACT FROM AUTHOR]

While some people feel that an infant who will never see or hear can bring only heartache, Orion's family knew differently. Deafblindness is not just about the absence of sight and sound. It is so much more than the sum of these two parts. What one learns from experiencing the collaboration between a teacher of the deaf and a teacher of the visually impaired is that deafblindness is a unique condition "out on its own," with separate challenges and intervention needs from either deafness or blindness alone. This article presents Orion's story, and the importance of early intervention and interveners.

The Army Combat Fitness Test (ACFT), consisting of deadlift, standing power throw, hand release push-up, sprint-drag-carry, leg tuck or plank, and 2-mile run, is the United States Army’s new fitness test. The ACFT is designed to measure multiple fitness components required to perform combat tasks. One critical task is the tactical foot march (TFM), where soldiers cover long distances while carrying loads comprised of mission-essential equipment. As the ACFT is meant to predict soldier task performance, determining the relationships between the ACFT and the TFM is important. Data from 29 cadets (♂ = 20, ♀ = 9) from one university Reserve Officers’ Training Corps program were analyzed. The ACFT was recorded in raw and scaled scores. The TFM was performed over 6.44 km, with time recorded. Cadets carried a 15.88-kg rucksack, fighting load carrier, 3-L hydration pack, and replica M4 carbine. Independent samples t-tests evaluated ACFT and TFM between-sex differences. Partial correlations, controlling for sex, determined ACFT event and TFM relationships. Male cadets outperformed females in all ACFT tasks (p ≤ 0.039), except the push-up. ACFT total score, leg tuck, 2-mile run, and sprint-drag-carry showed large correlations with the TFM (r = ±0.463–0.531, p ≤ 0.026). Aerobic and anaerobic capacity and upper body/trunk strength were important fitness components for cadet TFM performance.

Aim: Internationalization at Home (IaH) strategies play an important role in nursing curricula to enhance nursing students' cultural awareness in the globalized world. The Community of Inquiry (CoI) is a theoretical framework for the optimal design of online learning environments to support critical inquiry and discourse among students and teachers. To optimise nursing students' online cultural awareness learning experiences, it was timely to develop online IaH strategies based on a sound theoretical model. This study aimed to examine the effectiveness of CoI‐guided online IaH strategies on enhancing the cultural awareness of nursing undergraduates who enrolled in a community nursing course. Design: This was an interventional pre‐test post‐test study. Method: One hundred and six nursing undergraduates who enrolled in the course participated in the study. The online IaH strategies were developed focusing on the interactions of teaching presence, cognitive presence and social presence of CoI framework and they were integrated into the course. A previously validated Cultural Awareness Scale was adopted for pre‐post evaluation. Higher scores indicate greater cultural awareness. Results: The results showed that there was a significantly higher total score of cultural awareness of participating students at post‐online IaH strategies. To be effective, aligning CoI‐guided online IaH strategies with course content, pedagogy and assessment was shown to be significant. The inclusion of technological elements in related strategies was also critical to engage student learning. The positive change on the total score of cultural awareness suggested the effectiveness of the deployed strategies. In this ever‐changing educational landscape, it may provide insights to educators regarding considering online IaH strategies with theoretical underpinning for curriculum planning and design. [ABSTRACT FROM AUTHOR]

Restorative justice (RJ) has been applied to intimate partner violence (IPV) cases, but some question whether RJ is appropriate for IPV. This review is the first to focus on qualitative research on how RJ is interpreted and used in IPV cases in the United States. Six articles met the inclusion criteria. Findings indicated that RJ is used with the criminal legal system (CLS), initiated by the victim, and is not community-oriented. Concerns for victims being harmed or retraumatized were not supported in RJ processes happening in relation to the CLS, with some providers highlighting the importance of facilitation training and techniques. Additional research is needed to explore RJ processes and their relationship to the CLS for IPV. [ABSTRACT FROM AUTHOR]

The present study investigated abbreviation methods for the Test of Memory Malingering (TOMM) in relation to traditional manual-based test cutoffs and independently derived more stringent cutoffs suggested by recent research (≤48 on Trial 2 or 3). Consecutively referred outpatient U.S. military veterans (n = 260) were seen for neuropsychological evaluation for mild traumatic brain injury or possible attention-deficit/hyperactivity disorder. Performance on TOMM Trial 1 was evaluated, including the total score and errors on the first 10 items (TOMMe10), to determine correspondence and redundancy with Trials 2 and 3. Using the traditional cutoff, valid performance on Trials 2 and 3 was predicted by zero errors on TOMMe10 and by Trial 1 scores greater than 41. Invalid performance was predicted by commission of more than three errors on TOMMe10 and by Trial 1 scores less than 34. For revised TOMM cutoffs, a Trial 1 score above 46 was predictive of a valid score, and a TOMMe10 score of three or more errors or a Trial 1 score below 36 was associated with invalid TOMM performance. Conditional abbreviation of the TOMM is feasible in a vast majority of cases without sacrificing information regarding performance validity. Decision trees are provided to facilitate administration of the three trials. [ABSTRACT FROM AUTHOR]

Objective: The goal was to explore low‐income, Black fathers' personal strengths and barriers to engaged fatherhood, healthy relationships, and economic stability. Background: Fatherhood programs often rely on case management and education to promote positive fathering, healthy relationships, and economic stability. However, methods should be tailored to fit the strengths and needs of participating fathers. Low‐income, Black fathers face additional challenges related to systemic discrimination and structural violence that can hinder their success. To effectively serve this group, research is required to understand their relevant strengths and barriers. Methods: Semistructured focus groups explored fathers' personal strengths and barriers specific to the three areas of interest with fatherhood program staff (n = 8) and enrolled fathers (n = 26). Thematic analysis was conducted then systematically vetted by community scholars (previously enrolled or graduated fathers). Results: Fathering strengths included empathy, listening skills, and active family participation. Barriers included limited custody or access, individual constraints, and unmet social needs. Participants contextualized these findings with structural issues related to coparenting and the legal system (e.g., biased court systems). Men's relationship strengths included mutual respect and teamwork. Barriers included past trauma, lack of healthy relationship models, and relationship strain. Economic stability strengths included financial literacy and motivation to provide, whereas barriers included legal history, financial obligations, and limited resources. Conclusion: These findings highlight key individual‐level strengths and barriers grounded in fathers' intersectional identities as predominantly low‐income, Black men. Implications: Programs serving low‐income, Black fathers should consider tailoring their programming to the lived experiences of participants to navigate these critical barriers and amplify assets for success. [ABSTRACT FROM AUTHOR]

Law enforcement officers are frequently subjected to highly stressful and traumatic situations with increased negative physical and mental health outcomes. Mindfulness is proposed as a means of improving self-reported physical or mental health outcomes, including depression, anxiety, burnout, and sleep disturbances. This meta-analysis aims to pool the results from studies evaluating mindfulness for police officers, providing an overall effect size for each outcome of interest. Through systematic review, four studies were identified for meta-analysis. Fixed and random inverse variance effects were used. Results indicate that mindfulness-based intervention programs likely decrease depression and may result in reductions of anxiety and burnout. [ABSTRACT FROM AUTHOR]

Abstract Background Estimates of contralateral breast cancer (CBC) risk in the modern treatment era by year of diagnosis and characteristics of the first breast cancer are needed to assess the impact of recent advances in breast cancer treatment and inform clinical decision making. Methods We examined CBC risk among 419,818 women (age 30–84 years) who were diagnosed with a first unilateral invasive breast cancer and survived ≥ 1 year in the US Surveillance, Epidemiology, and End Results program cancer registries from 1992 to 2015 (follow-up through 2016). CBC was defined as a second invasive breast cancer in the contralateral breast ≥ 12 months after the first breast cancer. We estimated standardized incidence ratios (SIRs) of CBC by year of diagnosis, age at diagnosis, and tumor characteristics for the first breast cancer. Cumulative incidence of CBC was calculated for women diagnosed with a first breast cancer in the recent treatment era (2004–2015, follow-up through 2016). Results Over a median follow-up of 8 years (range 1–25 years), 12,986 breast cancer patients developed CBC. Overall, breast cancer patients had approximately twice the risk of developing cancer in the contralateral breast when compared to that expected in the general population (SIR = 2.21, 95% CI = 2.17–2.25). SIRs for CBC declined by year of first diagnosis, irrespective of age at diagnosis and estrogen receptor (ER) status (p-trends

Abstract Cancer cells produce heterogeneous extracellular vesicles (EVs) as mediators of intercellular communication. This study focuses on a novel method to image EV subtypes and their biodistribution in vivo. A red‐shifted bioluminescence resonance energy transfer (BRET) EV reporter is developed, called PalmReNL, which allows for highly sensitive EV tracking in vitro and in vivo. PalmReNL enables the authors to study the common surface molecules across EV subtypes that determine EV organotropism and their functional differences in cancer progression. Regardless of injection routes, whether retro‐orbital or intraperitoneal, PalmReNL positive EVs, isolated from murine mammary carcinoma cells, localized to the lungs. The early appearance of metastatic foci in the lungs of mammary tumor‐bearing mice following multiple intraperitoneal injections of the medium and large EV (m/lEV)‐enriched fraction derived from mammary carcinoma cells is demonstrated. In addition, the results presented here show that tumor cell‐derived m/lEVs act on distant tissues through upregulating LC3 expression within the lung.

Access to experimental X-ray diffraction image data is fundamental for validation and reproduction of macromolecular models and indispensable for development of structural biology processing methods. Here, we established a diffraction data publication and dissemination system, Structural Biology Data Grid (SBDG; data.sbgrid.org), to preserve primary experimental data sets that support scientific publications. Data sets are accessible to researchers through a community driven data grid, which facilitates global data access. Our analysis of a pilot collection of crystallographic data sets demonstrates that the information archived by SBDG is sufficient to reprocess data to statistics that meet or exceed the quality of the original published structures. SBDG has extended its services to the entire community and is used to develop support for other types of biomedical data sets. It is anticipated that access to the experimental data sets will enhance the paradigm shift in the community towards a much more dynamic body of continuously improving data analysis.

In algae, it is well established that the pyrenoid, a component of the carbon-concentrating mechanism (CCM), is essential for efficient photosynthesis at low CO2. However, the signal that triggers the formation of the pyrenoid has remained elusive. Here, we show that, in Chlamydomonas reinhardtii, the pyrenoid is strongly induced by hyperoxia, even at high CO2 or bicarbonate levels. These results suggest that the pyrenoid can be induced by a common product of photosynthesis specific to low CO2 or hyperoxia. Consistent with this view, the photorespiratory by-product, H2O2, induced the pyrenoid, suggesting that it acts as a signal. Finally, we show evidence for linkages between genetic variations in hyperoxia tolerance, H2O2 signaling, and pyrenoid morphologies.

We describe the first documented case of sinking skin flap syndrome (SSFS) following head and neck cancer resection with free flap reconstruction. This rare syndrome, also known as “syndrome of the trephined,” is an uncommon complication typically seen after decompressive craniectomy prior to cranioplasty. Thought to be related to atmospheric pressure and gravity overwhelming intracranial pressure, the scalp is displaced inward, and cortical compression can occur over the surgical site, leading to neurologic changes (e.g. headache, mental status changes, seizures, focal deficits) as well as dysautonomia. A 58-year-old male underwent wide local excision of a large, advanced squamous cell carcinoma of the scalp that required craniectomy and dural resection, followed by reconstruction with a latissimus dorsi myofascial free flap and overlying meshed skin graft. On post-operative day 11, he developed acute right hemiparesis with right facial droop, altered mental status, hypotension and bradycardia, with subsequent CT of the head supporting a diagnosis of sinking skin flap syndrome. He improved within 48 hours with conservative treatment, without long term sequelae. While this is a rare phenomenon, it is important to keep sinking skin flap syndrome in the differential diagnosis for patients who develop neurologic changes or autonomic dysfunction following calvarial resection with soft tissue free flap reconstruction.

Sensory Integration Dysfunction (SID), a sensory processing problem that afflicts about 15% of children, sets many children on a developmental trajectory of emotional and social problems. Children with SID often unintentionally alienate parents, peers, and teachers in their efforts to modify the amounts of sensory stimulation they receive. They then miss out on the social and cognitive interactions needed for healthy development, and develop secondary mental health problems such as fear, loneliness, and low self-esteem. Counselors who understand SID can intervene to help these children get "back on track" with normative social and cognitive development.

ObjectiveTo evaluate clinical characteristics, outcome, and prognostic variables in a cohort of dogs surviving > 1 year after an initial diagnosis of osteosarcoma.DesignRetrospective case series.Animals90 client-owned dogs.ProceduresMedical records for an 11-year period from 1997 through 2008 were reviewed, and patients with appendicular osteosarcoma that lived > 1 year after initial histopathologic diagnosis were studied. Variables including signalment, weight, serum alkaline phosphatase activity, tumor location, surgery, and adjuvant therapies were recorded. Median survival times were calculated by means of a Kaplan-Meier survival function. Univariate analysis was conducted to compare the survival function for categorical variables, and the Cox proportional hazard model was used to evaluate the likelihood of death > 1 year after diagnosis on the basis of the selected risk factors.Results90 dogs met the inclusion criteria; clinical laboratory information was not available in all cases. Median age was 8.2 years (range, 2.7 to 13.3 years), and median weight was 38 kg (83.6 lb; range, 21 to 80 kg [46.2 to 176 lb]). Serum alkaline phosphatase activity was high in 29 of 60 (48%) dogs. The most common tumor location was the distal portion of the radius (54/90 [60%]). Eighty-nine of 90 (99%) dogs underwent surgery, and 78 (87%) received chemotherapy. Overall, 49 of 90 (54%) dogs developed metastatic disease. The median survival time beyond 1 year was 243 days (range, 1 to 1,899 days). Dogs that developed a surgical-site infection after limb-sparing surgery had a significantly improved prognosis > 1 year after osteosarcoma diagnosis, compared with dogs that did not develop infections.Conclusions and clinical relevanceResults of the present study indicated that dogs with an initial diagnosis of osteosarcoma that lived > 1 year had a median survival time beyond the initial year of approximately 8 months. As reported previously, the development of a surgical-site infection in dogs undergoing a limb-sparing surgery significantly affected prognosis and warrants further study.

Despite successful primary tumor treatment, the development of pulmonary metastasis continues to be the most common cause of mortality in patients with osteosarcoma. A conventional drug development path requiring drugs to induce regression of established lesions has not led to improvements for patients with osteosarcoma in more than 30 years. On the basis of our growing understanding of metastasis biology, it is now reasonable and essential that we focus on developing therapeutics that target metastatic progression. To advance this agenda, a meeting of key opinion leaders and experts in the metastasis and osteosarcoma communities was convened in Bethesda, Maryland. The goal of this meeting was to provide a "Perspective" that would establish a preclinical translational path that could support the early evaluation of potential therapeutic agents that uniquely target the metastatic phenotype. Although focused on osteosarcoma, the need for this perspective is shared among many cancer types. The consensus achieved from the meeting included the following: the biology of metastatic progression is associated with metastasis-specific targets/processes that may not influence grossly detectable lesions; targeting of metastasis-specific processes is feasible; rigorous preclinical data are needed to support translation of metastasis-specific agents into human trials where regression of measurable disease is not an expected outcome; preclinical data should include an understanding of mechanism of action, validation of pharmacodynamic markers of effective exposure and response, the use of several murine models of effectiveness, and where feasible the inclusion of the dog with naturally occurring osteosarcoma to define the activity of new drugs in the micrometastatic disease setting.

BackgroundMany chemotherapy protocols have been reported for treatment of canine appendicular osteosarcoma (OSA), but outcome comparisons in a single population are lacking.ObjectiveTo evaluate the effects of protocol and dose intensity (DI) on treatment outcomes for carboplatin and doxorubicin-based chemotherapy protocols.AnimalsFour hundred and seventy dogs with appendicular OSA.MethodsA retrospective cohort study was performed comprising consecutive dogs treated (1997-2012) with amputation followed by 1 of 5 chemotherapy protocols: carboplatin 300 mg/m(2) IV q21d for 4 or 6 cycles (CARBO6), doxorubicin 30 mg/m(2) IV q14d or q21d for 5 cycles, and alternating carboplatin 300 mg/m(2) IV and doxorubicin 30 mg/m(2) IV q21d for 3 cycles. Adverse events (AE) and DI were evaluated. Kaplan-Meier survival curves and Cox proportional hazards regression were used to compare disease-free interval (DFI) and survival time (ST) among protocols.ResultsThe overall median DFI and ST were 291 days and 284 days, respectively. A lower proportion of dogs prescribed CARBO6 experienced AEs compared to other protocols (48.4% versus 60.8-75.8%; P = .001). DI was not associated with development of metastases or death. After adjustment for baseline characteristics and prognostic factors, none of the protocols provided a significant reduction in risk of development of metastases or death.Conclusions and clinical importanceAlthough choice of protocol did not result in significant differences in DFI or ST, the CARBO6 protocol resulted in a lower proportion of dogs experiencing AEs, which could be advantageous in maintaining high quality of life during treatment. DI was not a prognostic indicator in this study.

E-ticketing was an intriguing technology to many state transportation agencies (STAs) pre-COVID-19 pandemic but gained significant attention upon arrival of the pandemic due to the contactless nature of the technology. Research completed prior to the pandemic into E-ticketing for asphalt paving primarily identified qualitative benefits and concerns. However, minimal academic literature exists in the postpandemic era discussing the additional E-ticketing benefits not previously captured which resulted in increased implementation by STAs. This research seeks to address this gap by gathering information from state members of the American Association of State Highway and Transportation Officials Committee on Construction (AASHTO COC), employees of the Kentucky Transportation Cabinet (KYTC), and members of the Kentucky Association of Highway Contractors (KAHC) and the Plantmix Asphalt Industry of Kentucky (PAIKY) regarding E-ticketing practices for asphalt paving in the postpandemic era. The first portion of the study combines national and state-level survey responses to create a qualitative benefit-cost analysis for E-ticketing for asphalt paving operations based upon experience gained through emergency implementation during the pandemic. To reinforce the results of the qualitative analysis and increase the power of the study, the second portion of the research creates a quantitative benefit-cost analysis (BCA) from data collected from KYTC construction projects to compare the traditional weigh ticket collection process with E-ticketing processes for both project engineers and inspectors. The analysis shows a statistically significant time savings for field employees but not project management personnel. The monetary analysis for Kentucky indicates that whereas E-ticketing does not result in significant time savings for all employees, there is substantial monetary benefit worthy of STAs adopting E-ticketing as policy. The primary contributions to the body of knowledge include an improved BCA methodology applied to a new domain of electronic bulk material tickets and an informed quantitative BCA framework useful for STAs as a proof-of-concept to champion E-ticketing implementation and by transportation-focused researchers for evaluating emerging technological applications. Previous research has focused on improving safety and task efficiency for field employees associated with asphalt paving operations. E-ticketing (electronic ticketing) has been proposed as an innovative technology to help augment typical tasks associated with asphalt paving. Before the COVID-19 pandemic, several state transportation agencies (STAs) had introduced pilot projects to study E-ticketing, but these yielded minimal policy adoption results. During the COVID-19 pandemic, many STAs pivoted to emergency usage of E-ticketing as the primary means of collecting information about asphalt material used on construction projects. This research compares previous qualitative analyses regarding the benefits and concerns associated with E-ticketing prior to the COVID-19 pandemic with lessons learned by STAs across the country after utilizing E-ticketing during the pandemic. Additionally, a case study focused on the Kentucky Transportation Cabinet (KYTC) is used to create a quantitative benefit-cost analysis from project-level data collected from various asphalt paving projects during the 2022 construction season. The findings indicate a statistically significant time savings for field employees utilizing E-ticketing and a benefit-cost ratio that promotes STAs adopting E-ticketing as a permanent policy. [ABSTRACT FROM AUTHOR]