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The article highlights the disconnect between U.S. bioethicists' views and those of clinicians and the general public, noting that bioethicists are often less diverse and thus less representative of broader society. Topics discussed include the need for bioethicists to better align with public perspectives, the importance of increased diversity within the field, and the value of integrating real-world experiences into bioethical research.

Decentralized clinical trials have gained in popularity over the last years due to their advantages related to broadening recruitment strategies and resource saving possibilities. As more clinical trials adopt decentralized strategies, it is essential to share the knowledge about both successful and unsuccessful efforts in the research community. In the present commentary, we explore potential reasons that led to early termination of a decentralized clinical trial in Oncology. [ABSTRACT FROM AUTHOR]

Positive health (PH) has been described as a promising transformative innovation to address the challenges of promoting well-being and reducing the burden of disease. For this study, we conducted a scientific literature review of the current state of knowledge about PH as introduced by Huber and colleagues, following the Cochrane Rapid Review recommendations. Three databases were searched (PubMed, Google Scholar, and CINAHL). Data were extracted and synthesised using a narrative approach. A total of 55 articles were included. The initial evaluation revealed promising results at both the individual and collective levels. However, several articles gave reason for further refinement of the conceptualisation of PH and of ways to measure the effects of PH interventions in greater detail. Professionals also expressed a desire for a more informed application and elaboration of the PH method, in various settings and populations, to increase its effectiveness in practice. The results from the rapid review highlight the transformative potential of PH in shifting from a disease-oriented to a health-oriented paradigm of healthcare. This underlines the need for continued research regarding further development of the concept and its practical method, along with the necessity for methodological innovation. [ABSTRACT FROM AUTHOR]

Background: In its most recent publications, the World Health Organization called for profound change in how mental health care is conceptualized and delivered--for a new paradigm for mental health. The new model will be non-coercive, person-centered, human rights-based, recovery-oriented, readily implementable in the community, and evidence-based and optimizable via ongoing quality studies. Methods: The author identified eight alternative models for mental health care from one or more of three sources: scientific publications, scientific journals, and/or professional associations. A narrative review was conducted in which the eight different models were reviewed and analyzed qualitatively regarding their potential to meet WHO criteria. Results: After qualitative analysis of complementary and alternative psychiatry, complementary and integrative psychiatry, energy or mind-body psychiatry, functional psychiatry, holistic psychiatry, lifestyle psychiatry, nutritional psychiatry, and orthomolecular psychiatry, lifestyle psychiatry was found to be the only model for mental health that meets all criteria recently established by the WHO. Conclusions: Lifestyle Psychiatry meets WHO criteria, and additionally, it is affordable, easy to implement, and effective, either as a standalone treatment or in tandem with the existing model of psychiatry. Lifestyle psychiatry should be widely implemented in community settings and taught in psychiatric residency training programs. [ABSTRACT FROM AUTHOR]

Endothelium-dependent vasodilation can be tested using a variety of shear stress paradigms, some of which may involve the production of reactive oxygen species. The purpose of this study was to compare different methods for assessing endothelial function and their specific involvement of reactive oxygen species and influence of aerobic training status. Twenty-nine (10 F) young and healthy participants (VO2max: 34–74 mL·kg−1·min−1) consumed either an antioxidant cocktail (AOC; vitamin C, vitamin E, α-lipoic acid) or placebo (PLA) on each of two randomized visits. Endothelial function was measured via three different brachial artery flow-mediated dilation (FMD) tests: reactive hyperemia (RH-FMD: 5 min cuff occlusion and release), sustained shear (SS-FMD: 6 min rhythmic handgrip), and progressive sustained shear (P-SS-FMD: three intensities of 3 min of rhythmic handgrip). Baseline artery diameter decreased (all tests: 3.8 ± 0.5 to 3.7 ± 0.6 mm, p = 0.004), and shear rate stimulus increased (during RH-FMD test, p = 0.021; during SS-FMD test, p = 0.36; during P-SS-FMD test, p = 0.046) following antioxidant consumption. However, there was no difference in FMD following AOC consumption (RH-FMD, PLA: 8.1 ± 2.6%, AOC: 8.2 ± 3.5%, p = 0.92; SS-FMD, PLA: 6.9 ± 3.9%, AOC: 7.8 ± 5.2%, p = 0.15) or FMD per shear rate slope (P-SS-FMD: PLA: 0.0039 ± 0.0035 mm·s−1, AOC: 0.0032 ± 0.0017 mm·s−1, p = 0.28) and this was not influenced by training status/fitness (all p > 0.60). Allometric scaling did not alter these outcomes (all p > 0.40). Reactive oxygen species may not be integral to endothelium-dependent vasodilation tested using reactive, sustained, or progressive shear protocols in young males and females, regardless of fitness level. [ABSTRACT FROM AUTHOR]

Major paradigms in sociology and social sciences usually embrace either individualism or anti‐individualism as fundamental worldview. This paper explores a third way between individualism and anti‐individualism developed by German sociologist Niklas Luhmann in his systems theory. Luhmann treats actors or individuals as psychic systems and he distinguishes them from social systems. In a nutshell, social systems produce communication, whereas psychic systems produce consciousness. In line with anti‐individualism, Luhmann therefore argues that social systems are irreducible to psychic systems and their actions. On the other hand, Luhmann joins ranks with individualism to assert that psychic systems are not rigorously constrained by social systems. Ultimately, Luhmann explains that social systems and psychic systems are part of each other's environment and that each type of systems provides the ecological conditions that the other type depends on to emerge and grow. To discuss this third way between individualism and anti‐individualism, the paper examines more specifically two central points in Luhmann's theory: (1) how social systems and psychic systems are separated from each other, and (2) how social systems and psychic systems are coevolving. [ABSTRACT FROM AUTHOR]

Simple Summary: Contrary to the conventional understanding of DNA hypermethylation suppressing gene expression, a new mechanism emerges, suggesting that high methylation can paradoxically activate genes. This challenges the traditional notion that promoter methylation solely silences genes. The study employs a CRISPR-SunTag All-in-one system to manipulate the DNA methylation of the EBF3 gene promoter segment in melanoma cells. Successful methylation and demethylation demonstrate the paradoxical role of DNA methylation, offering insights into the EBF3 gene's function, particularly in the IFN pathway signaling. This research challenges conventional views on methylation, providing potential insights into epigenetic drivers of malignancy and metastasis. Cutaneous melanoma is rapidly on the rise globally, surpassing the growth rate of other cancers, with metastasis being the primary cause of death in melanoma patients. Consequently, understanding the mechanisms behind this metastatic process and exploring innovative treatments is of paramount importance. Recent research has shown promise in unravelling the role of epigenetic factors in melanoma progression to metastasis. While DNA hypermethylation at gene promoters typically suppresses gene expression, we have contributed to establishing the newly understood mechanism of paradoxical activation of genes via DNA methylation, where high methylation coincides with increased gene activity. This mechanism challenges the conventional paradigm that promoter methylation solely silences genes, suggesting that, for specific genes, it might actually activate them. Traditionally, altering DNA methylation in vitro has involved using global demethylating agents, which is insufficient for studying the mechanism and testing the direct consequence of gene methylation changes. To investigate promoter hypermethylation and its association with gene activation, we employed a novel approach utilising a CRISPR-SunTag All-in-one system. Here, we focused on editing the DNA methylation of a specific gene promoter segment (EBF3) in melanoma cells using the All-in-one system. Using bisulfite sequencing and qPCR with RNA-Seq, we successfully demonstrated highly effective methylation and demethylation of the EBF3 promoter, with subsequent gene expression changes, to establish and validate the paradoxical role of DNA methylation. Further, our study provides novel insights into the function of the EBF3 gene, which remains largely unknown. Overall, this study challenges the conventional view of methylation as solely a gene-silencing mechanism and demonstrates a potential function of EBF3 in IFN pathway signalling, potentially uncovering new insights into epigenetic drivers of malignancy and metastasis. [ABSTRACT FROM AUTHOR]

This article considers the contributions from the field of Disability Studies to the conceptualization of Quality of Life (QOL) for people labelled with Intellectual Disability (ID). We suggest four elements from the field of Disability Studies that may be incorporated into an evolving QOL paradigm. The first element concerns the meaning of disability itself. Those working in contemporary Disability Studies identify societal obstacles and points of inaccessibility as sources of disablement while also recognizing the experience of difference. We suggest this understanding of disability as an interaction between a person and the social world/environment may be included more explicitly in QOL conceptualization. A responsive and adaptable definition of disability in the QOL paradigm is recommended. The second element is the recognition of relationality. The field of contemporary disability studies challenges the value of considering a person's disability as a solitary medical experience and questions the goals of independence, instead considering the value in interdependence and community. This could be included in the QOL paradigm by further emphasizing the importance of relationships and contributions of those labelled with ID. The third element is participatory design and epistemic justice, making space for people labelled with ID to contribute to research and direct the course of their own lives and supports. This element of self‐determination is important to QOL but an increase in participatory research, service, and support design in the field is recommended. The final element is intersectionality, the idea that the experience of disability must be understood in the context of other points of identity or marginalization such as race, gender, and sexuality. We recommend that the QOL paradigm should allow for these additional elements to be included in further design and research in the field. [ABSTRACT FROM AUTHOR]

In this paper, we discuss the applicability of the consensus document, prepared by the Special Interest Research Group on quality of life (QoL) of the International Association for the Scientific Study of Intellectual Disabilities in August 2000, for persons with Profound Intellectual and Multiple disabilities (PIMD). We compare our findings from previous empirical research with some elements of the themes and principles of the consensus document. We will reflect (1) on the domains of QoL mentioned in the consensus document, and (2) on the assessment by proxies. We recommend reflection on the following aspects when composing a new consensus document, which includes QoL of persons with PIMD: first, reconsider whether all eight domains are useful in care practice for—and research about—persons with PIMD. We assert that the domains of health, well‐being, capability to influence the environment, and also (family) relationships, are particularly relevant for the QoL of persons with PIMD and, second, accept interpretation of signals and signs by proxies in the assessment of QoL in persons with PIMD and do not value this as second best. [ABSTRACT FROM AUTHOR]

Social change is built on paradigms and models. A paradigm needs an operational action model to successfully implement the paradigm, and an operational model needs a paradigm to give it credibility and content. This article describes the Quality of Life Supports Model (QOLSM) as a major pathway for applying the quality of life (QOL) paradigm. The QOLSM integrates the concepts of QOL and individualized supports. The article describes and illustrates: (a) the four elements of the QOLSM (core values, individual and family QOL domains, systems of supports, and facilitating conditions); and (b) the use of the QOLSM in the field of intellectual and developmental disabilities (IDDs) as a framework for supports provision. The article also discusses how the QOLSM represents a value‐based and actionable model that should be effective for solving problems regarding services and supports to people with IDD, developing new knowledge, making meaningful change, being evaluated, and contributing both theoretically and operationally to the field. [ABSTRACT FROM AUTHOR]

Medicine faces challenges that indicate that it may not be sustainable. A descriptive disease concept is apt to what philosopher of science Ian Hacking called "looping effects", which can explain why health care is faced with insatiable demands. Diseases are not only indifferent objects with an objective existence in the biology of individuals. They are often interactive identities that have attractive properties. We suggest a shift in medical practice where descriptive perspectives are complemented with functional perspectives to enable clinicians better to help people from merging with dysfunctional disease identities. [ABSTRACT FROM AUTHOR]

The article focuses on redefining religious studies by emphasizing the concept of the sacred and transcending traditional religious paradigms. It introduces the notion of the sacred as a realm of possibilities and impossibilities within communities, advocating for a deeper understanding of lived experiences and narratives through ethnographic methods. It also challenges the dichotomy between the secular and the sacred.

The medical metaverse and digital twin are set to revolutionise healthcare. Like all emerging technologies their benefits must be weighed against their ethical and social, impacts. If we consider the advances of medical technology as an expression of our values, such as the pursuit of knowledge, cures and healing, an ethical study allows us to align our values and steer the technology towards an agreed goal. However, to appreciate the long-term consequents of a technology, those consequences must be considered in the context of a society already shaped by that technology. This paper identifies the technologies currently shaping society and considers the ethical, and social consequences of the medical metaverse and digital twin in that future society. [ABSTRACT FROM AUTHOR]

An editorial is presented on the limitations of current information for prescribing analgesic drugs and the need for a summary of relevant information for healthcare providers dealing with chronic pain patients. Topics discussed include measuring descending pain modulation in humans, paradigms like conditioned pain modulation and offset analgesia, and the overlap between commonly used analgesics and the descending pain modulatory system.

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Background: The Nursing Education Model (NEM) introduced a framework for education reform. This study examined the applications of NEM in education to determine whether modifications to NEM were warranted. Method: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews process for scoping reviews was used. Online databases and searches identified peer-reviewed articles published from 2010-to June 2023, and 71 articles were identified that met the inclusion and exclusion criteria. Results: Six themes were derived from the findings: (1) learner-centered curricula; (2) instructional methods; (3) inclusive classrooms; (4) pedagogical creativity; (5) bridge theory-clinical divide; and (6) multiple units of analysis. Conclusion: The findings support the application of the NEM to promote a paradigm shift in instructional content, methods, and evaluation of outcomes. Based on use of the model identified in the literature, future modifications to NEM may be indicated, based on continued evidence. [J Nurs Educ. 2024;63(3):141–147.] [ABSTRACT FROM AUTHOR]

Simple Summary: Lung cancer therapeutics have dramatically improved in recent years. Indeed, precision oncology could be exemplified by non-small cell lung cancer (NSCLC), with molecular profiling and programmed death ligand 1 (PD-L1) immunohistochemical expression representing an integral part of its tailored treatment. The present narrative review aims to highlight the promising role of artificial intelligence (AI) technologies in the optimal, patient-centered management of NSCLC, by distilling as well as interpreting big data. Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality among women and men, in developed countries, despite the public health interventions including tobacco-free campaigns, screening and early detection methods, recent therapeutic advances, and ongoing intense research on novel antineoplastic modalities. Targeting oncogenic driver mutations and immune checkpoint inhibition has indeed revolutionized NSCLC treatment, yet there still remains the unmet need for robust and standardized predictive biomarkers to accurately inform clinical decisions. Artificial intelligence (AI) represents the computer-based science concerned with large datasets for complex problem-solving. Its concept has brought a paradigm shift in oncology considering its immense potential for improved diagnosis, treatment guidance, and prognosis. In this review, we present the current state of AI-driven applications on NSCLC management, with a particular focus on radiomics and pathomics, and critically discuss both the existing limitations and future directions in this field. The thoracic oncology community should not be discouraged by the likely long road of AI implementation into daily clinical practice, as its transformative impact on personalized treatment approaches is undeniable. [ABSTRACT FROM AUTHOR]

Previous research has shown that acute psychosocial stress impairs cognitive abilities, but recent studies suggest that this may be due to a decrease in willingness to engage in cognitive effort rather than a direct effect on performance. The aim of the present study was to replicate this last research and verify the influence of acute stress on avoidance of cognitive effort and cognitive performance. Fifty young, healthy individuals (26 females, 24 males) aged between 18 and 40 years were randomly assigned to two groups: a stress condition and a control condition. We used a Demand Selection Task paradigm (DST), in which participants chose between performing tasks that required either high or low cognitive effort. Stress was induced through the Trier Social Stress Test (TSST) and measured with both subjective and psychophysiological measurements. The results indicated that acute stress significantly increased participants' preference for less demanding behaviors, while no significant alterations in cognitive performance in task change activities were found. This study offers new perspectives on how stress affects behavior and decision‐making in everyday life. [ABSTRACT FROM AUTHOR]

Through their selective rehearsal, Central Speakers can reshape collective memory in a group of listeners, both by increasing accessibility for mentioned items (shared practice effects) and by decreasing relative accessibility for related but unmentioned items (socially shared retrieval induced forgetting, i.e., SSRIF). Subsequent networked communication in the group can further modify these mnemonic influences. Extant empirical work has tended to examine such downstream influences on a Central Speaker's mnemonic influence following a relatively limited number of interactions – often only two or three conversations. We develop a set of Markov chain simulations to model the long-term dynamics of such conversational remembering across a variety of group types, based on reported empirical data. These models indicate that some previously reported effects will stabilize in the long-term collective memory following repeated rounds of conversation. Notably, both shared practice effects and SSRIF persist into future steady states. However, other projected future states differ from those described so far in the empirical literature, specifically: the amplification of shared practice effects in communicational versus solo remembering non-conversational groups, the relatively transient impact of social (dis)identification with a Central Speaker, and the sensitivity of communicating networks to much smaller mnemonic biases introduced by the Central Speaker than groups of individual rememberers. Together, these simulations contribute insights into the long-term temporal dynamics of collective memory by addressing questions difficult to tackle using extant laboratory methods, and provide concrete suggestions for future empirical work. [ABSTRACT FROM AUTHOR]

Background: The availability of appropriate alcohol-related stimuli is a crucial concern for the evaluation and treatment of patients with alcohol dependence syndrome. The study aimed to standardize alcohol-related images with cultural relevance to the Indian setting. Methods: We produced an extensive database of 203 pictures, the Indian Alcohol Photo Stimuli (IAPS), portraying different categories and types of alcoholic beverages, after removing the confounding effects of low-level stimulus parameters (e.g. brightness and blurriness). Thirty patients with alcohol dependence syndrome, currently abstinent, rated each image on visual analog scale (VAS) ranging from 0 (no craving) to 10 (extreme), to determine how typical the stimuli served as craving-relevant stimuli. Results: The mean VAS scores across beverages (ordered from highest to lowest) were whiskey >rum >beer >wine >vodka. Repeated-measures analysis of variance (ANOVA) showed a significant difference in mean VAS scores across beverages (F = 2.93, df = 2.9/86.3, P = 0.039, Greenhouse--Geisser corrected); the effect size for the difference was small (ηp² = 0.092). A post hoc Bonferroni shows significantly higher VAS scores with whiskey compared with vodka (P = 0.029), whereas the scores were similar across other beverages. A two-way repeated-measures ANOVA for interaction between type of alcoholic beverages and activity was not significant (F = 2.67, df = 2.6/76.6, P = 0.061, Greenhouse--Geisser corrected). Conclusions: We created a standardized alcohol-related image database for studying cue-reactivity paradigms in individuals with alcohol use disorder (AUD). Further research is needed to validate the impact of image features on cue reactivity. [ABSTRACT FROM AUTHOR]

A key challenge of implementing advance care planning lies in the fact that decisions made in advance require patients and their family members to imagine what their clinical picture will look like rather than knowing or experiencing the clinical circumstances as they unfold. Even more important is the acknowledgment of the unpredictability of a given clinical course. This type of situation requires adaptiveness and flexibility in decision‐making that frequently occurs in the moment(s) triggered by changes in health state(s). We describe an alternative frameshifting approach called "Adaptive Care Planning (AdaptCP)," which features an evolving communication between physicians and patients/families with ongoing incorporation of the patient's/family's perspective. This process continues iteratively until each decision can be reached in a way that is both harmonious with the patient's/family's perspective and is consistent with medical treatment options that are actionable for the healthcare team. We include a table of tools drawn from the literature that can help clinicians when implementing AdaptCP. [ABSTRACT FROM AUTHOR]

There is a lack of knowledge about factors that play a role in ethical decision-making of physiotherapists internationally. The purpose of this study was to explore, describe and map factors in ethical decision-making of physiotherapists from around the globe. A descriptive research design and constructivist research paradigm was applied. Elements of both a coding reliability thematic analysis and a reflexive thematic analysis method were used deductively and inductively to analyse the content of responses to an optional open question in an internationally distributed online survey with 559 participants from 72 countries through several steps and cycles. A spectrum of 43 factors was identified within 200 individual responses, allocated to five themes: individual factors (19 factors); relational factors (6 factors); organisational factors (6 factors); situational factors (6 factors); and societal factors (6 factors). The importance of context on organisational, situational and societal levels, interrelatedness of physiotherapists, individual characteristics and situatedness of patients/clients and physiotherapists, as well as aspects and features of the patient/client-physiotherapist relationship became apparent throughout analysis. To meet the emerging requirements for ethical physiotherapy practice, we advocate that both physiotherapy students and practicing physiotherapists internationally need to be trained as moral agents in integrated manners. Based on the results of this study we conclude that such training should embrace professionalism, professional values, ethical codes, ethical theories and ethical decision-making frameworks that acknowledge interrelatedness, epistemology and situatedness, self-reflective and communicative techniques, critical thinking, social/societal determinants of health, social responsibility, cultural competence and self-care techniques. [ABSTRACT FROM AUTHOR]

Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disease characterized by recurrent attacks of fever and polyserositis. Its first description as a new entity was published by Siegal in 1945. Colchicine has been the treatment of choice for this disease since 1972. Significant progress has been made over the years in understanding FMF's clinical features, diagnosis, mode of inheritance, pathogenesis and therapeutic approach. However, many old paradigms related to FMF have proven inaccurate, leading to the emergence of new concepts that provide more precise insights. The term 'FMF' is no longer appropriate as the disease is found beyond the Mediterranean basin. The concept of diagnosis based only upon clinical ground proved to be wrong. The paradigm that MEFV mutations in FMF lead to loss of function of the encoded peptide pyrin turned out to be a gain of function mutation. Finally, the concept that as a genetic disease FMF should be treated for life was found to be inaccurate for the subpopulation of the heterozygote patients. Thus, the breakthroughs of identifying the gene associated with the disease (MEFV) and the deciphering of its pathogenesis revolutionized our old paradigms and replaced them with new and more precise insights. [ABSTRACT FROM AUTHOR]

Simple Summary: Hepatocellular carcinoma (HCC) is a highly aggressive malignancy with global impact, especially in the context of the rising epidemic of metabolic-dysfunction-associated steatotic liver disease and alcohol-related liver disease. The treatment landscape for HCC is evolving and has changed significantly in the last few years with new treatment options for patients, while the multidisciplinary team model of care remains critical. This review aims to summarize the various treatment options for patients at all stages of HCC, highlighting the growing array of systemic therapies with multi-modal options, including the potential of combining locoregional therapies with immunotherapy across different stages of the disease. With the increasing recognition of the importance of patient-centered care, the future paradigm of HCC care includes the incorporation of non-hospice palliative care in the multidisciplinary team care model to improve patient quality of care, quality of life, and overall outcomes. Liver cancer is the third most common cause of cancer-related deaths worldwide, and hepatocellular carcinoma (HCC) makes up the majority of liver cancer cases. Despite the stabilization of incidence rates in recent years due to effective viral hepatitis treatments, as well as improved outcomes from early detection and treatment advances, the burden of HCC is anticipated to rise again due to increasing rates of metabolic dysfunction-associated steatotic liver disease and alcohol-related liver disease. The treatment landscape is evolving and requires a multidisciplinary approach, often involving multi-modal treatments that include surgical resection, transplantation, local regional therapies, and systemic treatments. The optimal approach to the care of the HCC patient requires a multidisciplinary team involving hepatology, medical oncology, diagnostic and interventional radiology, radiation oncology, and surgery. In order to determine which approach is best, an individualized treatment plan should consider the patient's liver function, functional status, comorbidities, cancer stage, and preferences. In this review, we provide an overview of the current treatment options and key trials that have revolutionized the management of HCC. We also discuss evolving treatment paradigms for the future. [ABSTRACT FROM AUTHOR]

Automated Machine Learning (AutoML) utilizing meta-learning (M-L) has gained prominence in the scientific community. Current M-L methods necessitate substantial data and computational resources for extracting meta-features encoding data properties. However, the time needed for meta-feature extraction exceeds that for predictions in M-L systems. This article proposes a domain-specific M-L paradigm tailored to social science, aiming to identify universally applicable meta-features in social science data. Investigating domain-specific properties, the study discerned common meta-features across social science domains, facilitating an efficient AutoML strategy with reduced data requirements. Ninety meta-features, clustered into eight groups characterizing social science data, were employed, focusing on education and business domains. An analysis of 46 datasets revealed domain-specific variations in meta-feature values, confirmed by Wilcoxon tests. Notably, certain meta-features exhibited consistency across social science domains, demonstrating potential for crossdomain AutoML adoption. This research introduces a targeted M-L approach, optimizing AutoML efficiency for social science applications by identifying common meta-features across diverse domains. [ABSTRACT FROM AUTHOR]

In a society where people often communicate through digital technology, it is crucial to investigate whether the transmission mode influences destination memory performance (our capacity to remember to whom we transmitted certain information). In Experiment 1, we asked young adults (N = 31) to share of a set of familiar proverbs only by typing and the rest by both typing and saying them aloud. Better destination memory was observed when the information was transmitted by the two means (aloud and typing). Did this better performance occur because participants shared the information aloud or because the information was transmitted by two means? In Experiment 2, young adults (N = 34) shared familiar proverbs aloud, by typing, or simultaneously aloud and by typing. Results showed that transmission aloud led to a better destination memory than typing, and no further improvement occurred when the transmission was both aloud and by typing. Additionally, no differences were observed regarding item memory, supporting the idea that item and destination memories are two different types of memory. [ABSTRACT FROM AUTHOR]

The Deese-Roediger and McDermott (DRM) paradigm and visually guided saccade tasks are both prominent research tools in their own right. This study introduces a novel DRM-Saccade paradigm, merging both methodologies. We used rule-based saccadic eye movements whereby participants were presented with items at test and were asked to make a saccade to the left or right of the item to denote a recognition or non-recognition decision. We measured old/new recognition decisions and saccadic latencies. Experiment 1 used a pro/anti saccade task to a single target. We found slower saccadic latencies for correct rejection of critical lures, but no latency difference between correct recognition of studied items and false recognition of critical lures. Experiment 2 used a two-target saccade task and also measured corrective saccades. Findings corroborated those from Experiment 1. Participants adjusted their initial decisions to increase accurate recognition of studied items and rejection of unrelated lures but there were no such corrections for critical lures. We argue that rapid saccades indicate cognitive processing driven by familiarity thresholds. These occur before slower source-monitoring is able to process any conflict. The DRM-Saccade task could effectively track real-time cognitive resource use during recognition decisions. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is Known on the Subject?: Artificial intelligence (AI) is freely available, responds to very basic text input (such as a question) and can now create a wide range of outputs, communicating in many languages or art forms. AI platforms like OpenAI's ChatGPT can now create passages of text that could be used to create plans of care for people with mental health needs. As such, AI output can be difficult to distinguish from human‐output, and there is a risk that its use could go unnoticed. What this Paper Adds to Existing Knowledge?: Whilst it is known that AI can produce text or pass pre‐registration health‐profession exams, it is not known if AI can produce meaningful results for care delivery.We asked ChatGPT basic questions about a fictitious person who presents with self‐harm and then evaluated the quality of the output. We found that the output could look reasonable to laypersons but there were significant errors and ethical issues. There are potential harms to people in care if AI is used without an expert correcting or removing these errors. What are the Implications for Practice?: We suggest that there is a risk that AI use could cause harm if it was used in direct care delivery. There is a lack of policy and research to safeguard people receiving care ‐ and this needs to be in place before AI should be used in this way. Key aspects of the role of a mental health nurse are relational and AI use may diminish mental health nurses' ability to provide safe care in its current form.Many aspects of mental health recovery are linked to relationships and social engagement, however AI is not able to provide this and may push the people who are in most need of help further away from services that assist recovery. Background: Artificial intelligence (AI) is being increasingly used and discussed in care contexts. ChatGPT has gained significant attention in popular and scientific literature although how ChatGPT can be used in care‐delivery is not yet known. Aims: To use artificial intelligence (ChatGPT) to create a mental health nursing care plan and evaluate the quality of the output against the authors' clinical experience and existing guidance. Materials & Methods: Basic text commands were input into ChatGPT about a fictitious person called 'Emily' who presents with self‐injurious behaviour. The output from ChatGPT was then evaluated against the authors' clinical experience and current (national) care guidance. Results: ChatGPT was able to provide a care plan that incorporated some principles of dialectical behaviour therapy, but the output had significant errors and limitations and thus there is a reasonable likelihood of harm if used in this way. Discussion: AI use is increasing in direct‐care contexts through the use of chatbots or other means. However, AI can inhibit clinician to care‐recipient engagement, 'recycle' existing stigma, and introduce error, which may thus diminish the ability for care to uphold personhood and therefore lead to significant avoidable harms. Conclusion: Use of AI in this context should be avoided until a point where policy and guidance can safeguard the wellbeing of care recipients and the sophistication of AI output has increased. Given ChatGPT's ability to provide superficially reasonable outputs there is a risk that errors may go unnoticed and thus increase the likelihood of patient harms. Further research evaluating AI output is needed to consider how AI may be used safely in care delivery. [ABSTRACT FROM AUTHOR]

Background: Sexual minority women (SMW) use alcohol at higher rates and experience greater alcohol‐related harms than their heterosexual counterparts. Evidence from observational studies suggests that minority stress (i.e., stress experienced due to marginalization in society) is an important risk factor among SMW, yet there is a lack of experimental evidence to establish a direct causal role of minority stress on alcohol use in this population. We adapted the preexisting personalized guided stress induction paradigm to conduct a pilot study of how minority stress is related to stress response (assessed via subjective measures and salivary cortisol) and mechanisms of alcohol use (craving, demand, and risky decision making) in SMW. Methods: Using a within‐subjects design (N = 8) cisgender SMW who endorsed high‐risk drinking (≥1 heavy drinking episode in the past 30 days) completed three study visits: a script development session and two in‐person imagery induction appointments (minority stress and neutral). Analyses examined feasibility and acceptability, stress response, and mechanisms of alcohol use. Results: The paradigm significantly increased subjective stress response (g = 1.32). Data supported the feasibility, acceptability, and appropriateness of the paradigm for use with SMW. While the paradigm did not significantly change scores on minority stress and alcohol outcomes measures, effect sizes for craving and minority stress outcomes were in the small‐to‐medium range (gs = 0.24–0.54). Conclusions: The adapted minority stress paradigm appears to be feasible and appropriate for use with SMW to induce stress in laboratory settings. Future research can use this paradigm to understand the causal effects of minority stress on alcohol use and related outcomes. [ABSTRACT FROM AUTHOR]

Changes in quantitative sensory testing (QST) after manual therapy can provide insight into pain relief mechanisms. Prior systematic reviews have evaluated manual-therapy-induced QST change. This overview of systematic reviews aims to consolidate this body of literature and critically review evidence on the hypoalgesic effects of manual therapy in clinical populations. A comprehensive search was conducted on PubMed, CINAHL, PsycInfo, and Embase. Peer-reviewed systematic reviews with or without meta-analysis were eligible if the reviews examined the effect of manual therapy compared to non-manual therapy interventions on QST outcomes in clinical populations. Methodological quality was assessed with the AMSTAR 2 tool. Meta-analysis results and qualitative (non-meta-analysis) interpretations were summarized by type of manual therapy. Overlap of studies was examined with the corrected covered area (CCA) index. Thirty systematic reviews, including 11 meta-analyses, met inclusion. There was a slight overlap in studies (CCA of 1.72% for all reviews and 1.69% for meta-analyses). Methodological quality was predominantly low to critically low. Eight (27%) reviews examined studies with a range of manual therapy types, 13 (43%) reviews focused on joint-biased manual therapy, 7 (23%) reviews focused on muscle-biased manual therapy, and 2 (7%) reviews focused on nerve-biased manual therapy. Twenty-nine (97%) reviews reported on pressure pain threshold (PPT). Meta-analytic results demonstrated conflicting evidence that manual therapy results in greater hypoalgesic effects compared to other interventions or controls. Our overview of QST effects, which has relevance to mechanisms underlying hypoalgesia, shows conflicting evidence from mostly low to critically low systematic reviews. [ABSTRACT FROM AUTHOR]

Ozanimod is the first sphingosine 1-phosphate (S1P) receptor modulator approved for the treatment of moderately to severely active ulcerative colitis (UC). In clinical trials, participants with moderately to severely active UC who received once-daily oral ozanimod demonstrated significantly improved rates of clinical, endoscopic, and histologic outcomes than participants receiving placebo. Ozanimod is also approved for the treatment of relapsing forms of multiple sclerosis (MS). This review summarizes safety data from UC and MS clinical trials and discusses treatment considerations when using ozanimod in clinical practice. Ozanimod is an oral, small molecule agent with a novel mechaism of action that differentiates it from other UC therapies. Ozanimod was generally well tolerated in clinical trials, and the incidence of adverse events of special interest based on prior associations with S1P receptor modulation was low overall. Of note, the risk for clinically significant bradycardia upon treatment initiation was mitigated by gradual dose titration, few patients experienced lymphopenia or serious infections, macular edema and malignancy occurred infrequently, and most hepatic events were transient and did not require treatment discontinuation. Given the safety and efficacy profile of ozanimod, it may be an early treatment option in patients with moderate disease or in those hesitant to use biologics, and it could also be beneficial after other treatments have failed. Further investigation is needed to determine the positioning of ozanimod within the UC treatment armamentarium. Plain Language Summary: This article provides information about the use of ozanimod in treating patients with moderately to severely active ulcerative colitis (UC) and offers practical guidance for nurses, nurse practitioners, and other healthcare providers to help address questions that may come up in clinical practice. Ozanimod is an oral medication that improves UC symptoms as well as current biologics, while also reducing the need for corticosteroids, a key aspect in treating UC. Ozanimod may be used either after a patient has failed a biologic or as an early treatment option before starting a biologic in patients with moderate UC who may be hesitant to start biologics. This article includes tools to help guide clinical practice decision-making, educate on possible adverse events, and provide the monitoring necessary to ensure patient safety and best practices in the use of ozanimod. [ABSTRACT FROM AUTHOR]

With the aim of providing evidence about doctor-managers' resilience during the Covid-19 pandemic, this study analyzes the characteristics of 114 doctor-managers operating within the Italian National Health Service (NHS). During the emergency, doctor-managers had to show adaptive capacities to deal with unexpected situations and develop new paradigms, procedures, and quick responses to patients' needs. This is in line with resilience, and in this perspective, it is crucial to investigate resilience determinants. The paper, therefore, provides an identikit of the resilient doctor-manager. The research was conducted between November and December 2020. Primary data were collected through an online questionnaire consisting of six sections. Participation was voluntary and anonymous. Data were analyzed using quantitative techniques and employing Stata 16. Confirmatory Factor Analysis was employed to test construct validity and scale reliability. Results show that increasing levels of individual resilience are related to increasing levels of managerial identity. Moreover, physicians' individual resilience has a positive association with commitment, knowledge diffusion, and Evidence-Based Medicine adoption. Finally, physicians' individual resilience has a negative association with their role in the university, their specialty, and their gender. The study suggests some practical implications for healtcare organizations. In general, career paths are decided primarily on competency assessment, while an important role should be devoted to behavioral characteristics. Furthermore, organizations should take care of the levels of individual commitment and encourage professional networking because both help doctor-managers cope with uncertainty. The originality of the study relies on a fresh look at all previous work. There are currently few contributions in the literature to explore and investigate resilience elements in doctor-managers during the pandemic era. [ABSTRACT FROM AUTHOR]

Background: Social touch is an integral part of social relationships and has been associated with reward. Major depressive disorder (MDD) is characterized by severe impairments in reward processing, but the neural effects of social touch in MDD are still elusive. In this study, we aimed to determine whether the neural processing of social touch is altered in MDD and to assess the impact of antidepressant therapy. Methods: Before and after antidepressant treatment, 53 MDD patients and 41 healthy controls underwent functional magnetic resonance imaging (fMRI) while receiving social touch. We compared neural responses to social touch in the reward network, behavioral ratings of touch comfort and general aversion to interpersonal touch in patients to controls. Additionally, we examined the effect of treatment response on those measures. Results: Clinical symptoms decreased after treatment and 43.4% of patients were classified as responders. Patients reported higher aversion to interpersonal touch and lower comfort ratings during the fMRI paradigm than controls. Patients showed reduced responses to social touch in the nucleus accumbens, caudate nucleus and putamen than controls, both before and after treatment. Contrary to our hypotheses, these effects were independent of touch velocity. Non-responders exhibited blunted response in the caudate nucleus and the insula compared to responders, again irrespective of time. Conclusions: These findings suggest altered striatal processing of social touch in MDD. Persistent dysfunctional processing of social touch despite clinical improvements may constitute a latent risk factor for social withdrawal and isolation. [ABSTRACT FROM AUTHOR]

Introduction: The main objective of this study is to evaluate working memory and determine EEG biomarkers that can assist in the field of health neuroscience. Our ultimate goal is to utilize this approach to predict the early signs of mild cognitive impairment (MCI) in healthy elderly individuals, which could potentially lead to dementia. The advancements in health neuroscience research have revealed that aective reminiscence stimulation is an eective method for developing EEG-based neuro-biomarkers that can detect the signs of MCI. Methods: We use topological data analysis (TDA) on multivariate EEG data to extract features that can be used for unsupervised clustering, subsequent machine learning-based classification, and cognitive score regression. We perform EEG experiments to evaluate conscious awareness in aective reminiscent photography settings. Results: We use EEG and interior photography to distinguish between healthy cognitive aging and MCI. Our clustering UMAP and random forest application accurately predict MCI stage and MoCA scores. Discussion: Our team has successfully implemented TDA feature extraction, MCI classification, and an initial regression of MoCA scores. However, our study has certain limitations due to a small sample size of only 23 participants and an unbalanced class distribution. To enhance the accuracy and validity of our results, future research should focus on expanding the sample size, ensuring gender balance, and extending the study to a cross-cultural context. [ABSTRACT FROM AUTHOR]

Proper names are especially prone to retrieval failures and tip-of-the-tongue states (TOTs)—a phenomenon wherein a person has a strong feeling of knowing a word but cannot retrieve it. Current research provides mixed evidence regarding whether related names facilitate or compete with target-name retrieval. We examined this question in two experiments using a novel paradigm where participants either read a prime name aloud (Experiment 1) or classified a written prime name as famous or non-famous (Experiment 2) prior to naming a celebrity picture. Successful retrievals decreased with increasing trial number (and was dependent on the number of previously presented similar famous people) in both experiments, revealing a form of accumulating interference between multiple famous names. However, trial number had no effect on TOTs, and within each trial famous prime names increased TOTs only in Experiment 2. These results can be explained within a framework that assumes competition for selection at the point of lexical retrieval, such that successful retrievals decrease after successive retrievals of proper names of depicted faces of semantically similar people. By contrast, the effects of written prime words only occur when prime names are sufficiently processed, and do not provide evidence for competition but may reflect improved retrieval relative to a "don't know" response. [ABSTRACT FROM AUTHOR]

Introduction: Esophageal injury is one of the most serious complications of pulmonary vein isolation (PVI) with thermic energy sources. Better tissue selectivity of primarily non‐thermic pulsed field ablation (PFA) may eliminate collateral injury, particularly the risk of atrio‐esophageal fistula (AEF). Objective: To compare the incidence of any (peri)‐esophageal injury following PVI using PFA to thermic energy sources. Methods: Using endoscopy, endoscopic ultrasound, and electrogastrography before and after PVI, esophageal and periesophageal injury (mucosal lesions, food retention, periesophageal edema, or vagal nerve injury) were assessed following PFA and radiofrequency (RF)‐ or cryoballoon (CB)‐PVI. Results: Between December 2022 and February 2023, 20 patients (67 ± 10 years, 53% male) undergoing PFA (Farapulse, Boston Scientific) for atrial fibrillation (AF) were studied and compared with a previous cohort of 57 patients who underwent thermic PVI (CB: n = 33; RF: n = 24). Following PFA‐PVI, none of the patients had mucosal lesions, food retention, or ablation‐induced vagal nerve injury; four patients showed periesophageal edema. Following thermic ablation, 33/57 patients (58%) showed esophageal and/or periesophageal injury (CB: 21/33 [64%], RF: 12/24 [50%]), in detail 4/57 mucosal lesions, 18/57 food retention, 17/57 vagal nerve injury, and 20/52 edema. Midterm success rates were similar for all energy sources. Conclusion: In contrast to thermic ablation tools, PFA is not associated with relevant esophageal and periesophageal injury, and might, therefore, reduce or eliminate the risk of potentially lethal AEF in interventional treatment of AF. The etiology of ablation‐induced periesophageal edema is unknown but has not been shown to be related to lesion progression. [ABSTRACT FROM AUTHOR]

Undoubtedly, the discipline of nursing has been influenced extensively by both Western and Eastern/Asian philosophies. What remains unknown or, perhaps, poorly articulated is the potential influence of African philosophy on the onto‐epistemology of nursing. As a starting point, this article sought to examine the core claims of African philosophy and how they may offer new meanings to the metaparadigm domains of interest in the discipline of nursing. At the core of African philosophy is the notion of personhood (which is distinguished from what it means to be a human being), community, solidarity, and relationality. A major claim of African philosophy is the notion that 'a person is a person through persons' which may mean that nursing will be relevant from the African philosophical perspective if it is able to attain this. Health and illness from the African philosophical perspective are defined relationally which shifts attention from the biomedical framework to holism and relational care. The sick 'person' is also distinguished from the sick 'human being' which has the potential of leading to exclusion from the African philosophical viewpoint. Put together, the African philosophical stance potentially extends the meaning of the metaparadigm domains of interest to the discipline of nursing which warrants further exploration. [ABSTRACT FROM AUTHOR]

The article titled "The Mind Beyond Representation: The Multiple Faces of Embodied Cognition and 4E Theories" proposes a plural and diverse approach to the study of human cognition, questioning the idea that mental representations are necessary to explain mental phenomena. The importance of the body and artifacts as constitutive elements of the mind is emphasized, and theories of embodied, situated, extended, and enactive cognition are presented as alternatives to the computational perspective. The article also addresses the importance of integrating cultural and social context in understanding human cognition, and highlights the growing community of researchers in Latin America studying 4E theories. Additionally, the therapeutic use of psychotropic substances is discussed, arguing that it is necessary to consider symbolic aspects and cultural contexts in studying their therapeutic effects. [Extracted from the article]

Background: Eculizumab for the treatment of atypical hemolytic uremic syndrome (HUS) is a standard of care. Central nervous system (CNS) involvement in Shiga toxin–producing Escherichia coli (STEC)-HUS is associated with increased morbidity and mortality. There is no consensus on the use of plasma exchange and/or eculizumab. We report a series (n = 4) of children with CNS involvement in STEC-HUS with excellent outcomes after treatment with eculizumab only and supportive therapies. Methods: A retrospective chart review of patients with CNS involvement in STEC-HUS is managed with supportive therapies and eculizumab only. Results: Four patients (75% female) with a median age of 5 years and 11 months (IQR: 23.5–105.5 months) were admitted to a tertiary pediatric nephrology center with CNS involvement in STEC-HUS. Neurological symptoms presented between days 2 and 7 of illness and included ataxia, altered mental status, visual symptoms, and seizures. All had an abnormal MRI brain. All received two doses of eculizumab, 1 week apart (dosing according to weight). Resolution of neurological symptoms was evident at a mean of 60 h post-administration (range: 24–72 h). All patients have complete kidney and neurological recovery at 12-month follow-up. Conclusion: We present a case series of four children with STEC-HUS and CNS involvement, managed with eculizumab only, in lieu of plasma exchange (as per our previous policy). The marked improvement in symptoms in our cohort supports the use of eculizumab, rather than plasma exchange in the CNS involvement of STEC-HUS. [ABSTRACT FROM AUTHOR]

Background: Parental participation in their young children's rehabilitation has been promoted to increase intervention intensity, but parents' perspectives on increased involvement remain unclear. The objective of this study was to explore parents' experiences partnering with physical therapists (PTs) to administer early, intensive rehabilitation to their young children with cerebral palsy (CP). Methods: Twelve mothers and one father of children between 8 months and 3 years old with CP were interviewed. Semistructured interviews were conducted before and after parents partnered with a PT to deliver a 12 week activity‐based intervention targeting their child's lower extremities. The intervention occurred in the child's home and in PT clinical sites. Interviews were audio recorded and transcribed verbatim. Interpretive description was used as the methodological framework. Results: The three themes were (1) focus on maximizing the child's potential, (2) participation in intensive rehabilitation is challenging, and (3) the importance of a positive experience with therapy. Families discussed a number of barriers and facilitators to participating in intensive rehabilitation. Conclusions: These results provide considerations for clinicians and researchers to facilitate meaningful engagement of parents in their young children's rehabilitation. This is especially important with increasing evidence for early, activity‐based interventions for young children with CP. [ABSTRACT FROM AUTHOR]

The article focuses on the critique of neoliberalism's influence on social policy and services, particularly in the context of homelessness, care, and social work's role in promoting a more compassionate society. Topics include the impact of neoliberal ideas on housing policies, the humanitarian concern of homelessness despite human rights declarations, and the importance of social work advocacy and intervention models in addressing homelessness.

Simple Summary: Despite the impressive efficacy of chimeric antigen receptor-T (CAR-T) cell therapy in the treatment of some subtypes of lymphomas, many patients are either not eligible or relapse after treatment. Thus, great efforts are being made to further improve the depth and durability of clinical responses, as well as to expand the settings in which CAR-T cells can be employed. The present review aims to summarize those efforts, offering an overview of recent advances and future perspectives in the field. In the last decade, anti-CD19 CAR-T cell therapy has led to a treatment paradigm shift for B-cell non-Hodgkin lymphomas, first with the approval for relapsed/refractory (R/R) large B-cell lymphomas and subsequently for R/R mantle cell and follicular lymphoma. Many efforts are continuously being made to extend the therapeutic setting in the lymphoma field. Several reports are supporting the safety and efficacy of CAR-T cells in patients with central nervous system disease involvement. Anti-CD30 CAR-T cells for the treatment of Hodgkin lymphoma are in development and early studies looking for the optimal target for T-cell malignancies are ongoing. Anti-CD19/CD20 and CD19/CD22 dual targeting CAR-T cells are under investigation in order to increase anti-lymphoma activity and overcome tumor immune escape. Allogeneic CAR product engineering is on the way, representing a rapidly accessible 'off-the-shelf' and potentially more fit product. In the present manuscript, we will focus on recent advances in CAR-T cell therapy for lymphomas, including new settings and future perspectives in the field, reviewing data reported in literature in the last decade up to October 2023. [ABSTRACT FROM AUTHOR]

Traditional health sciences (including nursing) paradigms, conceptual models, and theories have relied heavily upon notions of the 'person' or 'patient' that are deeply rooted in humanistic principles. Our intention here, as a collective academic assemblage, is to question taken‐for‐granted definitions and assumptions of the 'person' from a critical posthumanist perspective. To do so, the cinematic works of filmmaker David Cronenberg offer a radical perspective to revisit our understanding of the 'person' in nursing and beyond. Cronenberg's work explores bodily transformation and mutation, with the body as a fragile and malleable vessel. Cronenberg's work allows us to interrogate the body in all its complexity, contingency, and hybridity and provides avenues of rupture within current understandings of 'the person'. Reinventing the definition of what it means to be human, critical posthumanism offers opportunities to both critique humanist theories and build affirmative futurities. Also drawing on the work of Deleuze and Guattari, specifically, their concept of becoming, we propose a critical posthumanist alternative to the conceptualization of the person in the health sciences, that of the becoming‐mutant, so frequently explored in Cronenberg's films. Such a conceptualization permits the inclusion of various technological interventions of the contemporary subject: The postperson. This position offers the health science disciplines a radical reconceptualization of the conceptual and theoretical approaches, extending beyond those trapped within the quagmire of humanistic principles. [ABSTRACT FROM AUTHOR]

Living through the COVID-19 pandemic has been proven to have psychological impacts among individuals in both sport and non-sport populations. However, there is little available research comparing athlete and non-athlete populations in this context, especially among a non-western sample. This study employs a novel, longitudinal mixed method sequential explanatory research design to compare the impact of the COVID-19 pandemic between athlete and non-athlete populations and the role of physical activity. Phase A was a quantitative study measuring the psychological impact using the Impact of Event Scale-Revised among both groups (n = 32). Phase B was a qualitative study, with a sample (n = 7) participating in experiential interviews, exploring the lived experiences of participants over a 7-month period since Phase A was completed. Results indicated that athletes had lower psychological impact of the pandemic compared to non-athletes. Reflexive thematic analysis indicated that over the 7-month longitudinal period, athletes and non-athletes had different experiences across the themes of 'Appraisal and Coping', 'Cognitions', and 'Impact of the Pandemic'. Findings show A) a clear longitudinal impact of COVID-19 over a 7-month period; B) there is a clear contrast between sport and non-sport populations, with participants indicating sport and physical activity to be a protective factor limiting negative psychological impact. Findings are discussed with recommendations for physical activity and sport for reducing psychological impact among both athletes and non-athletes. [ABSTRACT FROM AUTHOR]

This small-scale qualitative study, involving commissioners of carers' services, contextualized in academic and other literature, adds to an understanding of groupwork for carers within the context of an English legal framework. Five commissioners, from different parts of England, participated in an online focus group. The dataset was analyzed thematically using a reflexive Thematic Analysis approach. Three themes were developed from the data. One theme indicated that differing understandings of the purpose of group activities for carers co-existed in each area and another that system-wide blocks meant that the choice of provider depends on factors like ability to risk-manage the contract value rather than skills needed to serve whole populations. This led to a third theme of commissioners attempting to "engineer" the development of successful groupwork. The findings suggest that Community Social Work is likely to be successful in working with carers but may face challenges within a quasi-market approach. [ABSTRACT FROM AUTHOR]

In this case study we used the holistic ecological approach (HEA) to examine an underserved athletic talent development environment (UATDE) in the United States to: (1) holistically describe a successful UATDE—in this case a community college basketball program known as Best Community College, and (2) explore factors contributing to the success of developing athletes that repeatedly earn athletic scholarships. Data were collected via in-situ observations, document analysis, and interviews (both formal and informal) with coaches, players, and other key stakeholders. The findings were summarized in two empirical models: (1) the UATDE empirical model of Best Community College, and (2) the underserved environment success factors (UESF) empirical model of Best Community College. The operation of the UATDE was significantly influenced by the underserved community in which it was embedded, translating to a lack of financial and human resources, while the team's roster was occupied by athletically talented, but psychosocially vulnerable players. These challenges were overcome, in part, by a dedicated support team as well as the cultural paradigm established by the head coach as a cultural leader. Conclusively, this case study constitutes an important supplementation to the evolving body of literature utilizing the HEA, highlighting how an environmental context can shift the focus of athletic talent development when we consider the concept of a UATDE. Lay summary: This case study explored a successful community college basketball program located within an underserved American community. While the investigation concludes that socioeconomic challenges in the surrounding community created significant barriers to success, the head coach and support team were able to help players succeed in sport and life. Those working in community colleges must be made aware of issues stemming from where the environment is located and also related to the backgrounds of the prospective athletes. Community college sports programs are an important steppingstone to life and sport success for the athletes they serve but a lack of human and financial resources are a large barrier to success that can be counteracted by strong cultural leaders within the sport program. UATDEs must be considered a unique context and practitioners should let this context inform their practice, for example, by supporting the staff as much as the athletes, supporting the head coach in developing a functional cultural paradigm, and supporting the athletes' broader psychosocial development and not only their performance. [ABSTRACT FROM AUTHOR]