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Abstract Background Cancer-related financial hardship is an increasingly recognized concern for patients, families, and caregivers. Many Native American (NA) patients are at increased risk for cancer-related financial hardship due to high prevalence of low income, medical comorbidity, and lack of private health insurance. However, financial hardship screening (FHS) implementation for NA patients with cancer has not been reported. The objective of this study is to explore facilitators and barriers to FHS implementation for NA patients. Methods We conducted key informant interviews with NA patients with cancer and with clinical staff at an academic cancer center. Included patients had a confirmed diagnosis of cancer and were referred to the cancer center through the Indian Health Service, Tribal health program, or Urban Indian health program. Interviews included questions regarding current financial hardship, experiences in discussing financial hardship with the cancer care and primary care teams, and acceptability of completing a financial hardship screening tool at the cancer center. Clinical staff included physicians, advanced practice providers, and social workers. Interviews focused on confidence, comfort, and experience in discussing financial hardship with patients. Recorded interviews were transcribed and thematically analyzed using MAXQDA® software. Results We interviewed seven patients and four clinical staff. Themes from the interviews included: 1) existing resources and support services; 2) challenges, gaps in services, and barriers to care; 3) nuances of NA cancer care; and 4) opportunities for improved care and resources. Patients identified financial challenges to receiving cancer care including transportation, lodging, food insecurity, and utility expenses. Patients were willing to complete a FHS tool, but indicated this tool should be short and not intrusive of the patient’s financial information. Clinical staff described discomfort in discussing financial hardship with patients, primarily due to a lack of training and knowledge about resources to support patients. Having designated staff familiar with I/T/U systems was helpful, but perspectives differed regarding who should administer FHS. Conclusions We identified facilitators and barriers to implementing FHS for NA patients with cancer at both the patient and clinician levels. Findings suggest clear organizational structures and processes are needed for financial hardship to be addressed effectively.

BackgroundSurvivorship care plans (SCPs) are provided at the completion of cancer treatment to aid in the transition from active treatment to long-term survivorship. They describe the details of a patient’s diagnosis and treatment and offer recommendations for follow-up appointments, referrals, and healthy behaviors. The plans are currently paper-based and become outdated as soon as a patient’s health status changes. There is a need to digitize these plans to improve their accessibility, modifiability, and longevity. With current technology, SCPs can be linked to mobile devices and activity trackers so that patients can track health behaviors and compare them to their clinical goals, taking charge of their own health. ObjectiveA mobile app, POSTHOC (POST-Treatment Health Outcomes of Cancer Survivors), that digitizes the SCP was developed, with goals of integrating it with wearable technologies and electronic medical records. Herein, we are conducting a randomized controlled trial that evaluates the POSTHOC app versus the traditional SCP on total symptom burden in the early posttreatment period. MethodsWe will recruit 54 patients who have recently completed curative therapy for cancer (any type) in person and remotely. They will be randomized 2:1, POSTHOC:usual care (unblinded). Those randomized to the POSTHOC group will receive their SCP via the app and will choose to focus on nutrition or exercise for the duration of the study based on their individual plan and personal preferences. Those randomized to the control group will get a paper-based plan. At baseline, 6 weeks, and 12 weeks, we will evaluate patient-reported outcomes, including total symptom burden (web-based questionnaire), diet (24-hour Automated Self-Administered [ASA24]), and physical activity (Fitbit Charge 6 [Google LLC]). We will also collect quantitative and qualitative feedback on the usability of the app from those in the POSTHOC arm to improve the app for future implementation studies, with a specific focus on patient-provider communication. For feasibility, we will calculate the percentage of patients who used the POSTHOC app at least 3 times per week. We will use linear mixed models to evaluate the effects of the POSTHOC app versus those of usual care on other outcomes at weeks 6 and 12. ResultsThis trial is open to accrual in the University of Maryland Medical System as of March 2024, and as of July 3, 2024, a total of 20 participants have consented. ConclusionsThis study is among the first to digitize the SCP in a mobile app and test the effects of a mobile health–delivered behavioral health intervention on symptom burden in cancer survivors. Our results will provide evidence about the effects of health self-management on symptoms. This knowledge will be integral to larger randomized controlled studies, integration with the electronic medical record, and nationwide implementation. Trial RegistrationClinicalTrials.gov NCT05499663; https://clinicaltrials.gov/ct2/show/NCT05499663 International Registered Report Identifier (IRRID)DERR1-10.2196/59222

Three colleagues critically reflect on their experiences as educators, curriculum designers, leaders, and activists who set out to apply social justice education and transformative leadership scholarship to the creation of a Leaders of Social Justice in Education course. They begin with their background, the diverse change agents selected to build a movement of leaders, and the educational context. Second, a theoretical framework is presented to explain the overall goals of the project and the development of the course. Third, the course curriculum and website created during the COVID-19 pandemic is described, specifically the culminating Social Justice Action Project. Fourth, outcomes of the project are identified, including lessons learned about transformative leadership in the context of social justice education. At the paper's conclusion, the authors reflect on the course and explain why ongoing learning opportunities, structures, and collaboratives are needed for cultivating and nurturing the next generation of leaders in social justice education.

Slow looking is the art and practice of learning through observation. Using object-based learning strategies provides instructors with innovative opportunities to pique curiosity while providing scaffolding for creativity skills needed to generate new clothing and apparel designs. This paper aims to identify how an FCS educator can use a slow- looking activity as an approach that integrates curiosity, creativity, and critical thinking in the apparel design classroom.

Purpose In intensive care units (ICUs), decisions about the continuation or discontinuation of life-sustaining treatment (LST) are made on a daily basis. Professional guidelines recommend an open exchange of standpoints and underlying arguments between doctors and families to arrive at the most appropriate decision. Yet, it is still largely unknown how doctors and families argue in real-life conversations. This study aimed to (1) identify which arguments doctors and families use in support of standpoints to continue or discontinue LST, (2) investigate how doctors and families structure their arguments, and (3) explore how their argumentative practices unfold during conversations. Method A qualitative inductive thematic analysis of 101 audio-recorded conversations between doctors and families. Results Seventy-one doctors and the families of 36 patients from the neonatal, pediatric, and adult ICU (respectively, N-ICU, P-ICU, and A-ICU) of a large university-based hospital participated. In almost all conversations, doctors were the first to argue and families followed, thereby either countering the doctor's line of argumentation or substantiating it. Arguments put forward by doctors and families fell under one of ten main types. The types of arguments presented by families largely overlapped with those presented by doctors. A real exchange of arguments occurred in a minority of conversations and was generally quite brief in the sense that not all possible arguments were presented and then discussed together. Conclusion This study offers a detailed insight in the argumentation practices of doctors and families, which can help doctors to have a sharper eye for the arguments put forward by doctors and families and to offer room for true deliberation., Author(s): Aranka Akkermans [sup.1] [sup.2], Sanne Prins [sup.1] [sup.2], Amber S. Spijkers [sup.1] [sup.2], Jean Wagemans [sup.3], Nanon H. M. Labrie [sup.4], Dick L. Willems [sup.5], Marcus J. Schultz [sup.6] [...]

The use of artificial intelligence (AI) is rapidly growing across many domains, of which the medical field is no exception. AI is an umbrella term defining the practical application of algorithms to generate useful output, without the need of human cognition. Owing to the expanding volume of patient information collected, known as ‘big data’, AI is showing promise as a useful tool in healthcare research and across all aspects of patient care pathways. Practical applications in orthopaedic surgery include: diagnostics, such as fracture recognition and tumour detection; predictive models of clinical and patient-reported outcome measures, such as calculating mortality rates and length of hospital stay; and real-time rehabilitation monitoring and surgical training. However, clinicians should remain cognizant of AI’s limitations, as the development of robust reporting and validation frameworks is of paramount importance to prevent avoidable errors and biases. The aim of this review article is to provide a comprehensive understanding of AI and its subfields, as well as to delineate its existing clinical applications in trauma and orthopaedic surgery. Furthermore, this narrative review expands upon the limitations of AI and future direction. Cite this article: Bone Joint Res 2023;12(7):447–454.

With the shifts in science education emphasizing the integration of science practices with science content, there is a need to know how teachers understand those science practices within their teaching practice. Our primary research question was, "What do novice elementary teachers know about the science practices, in terms of what the practices are and how to engage students in the science practices?" To answer that question, the current qualitative case study investigated how three novice elementary teachers' knowledge of the science practices is evident in their teaching practice across 4 years: 2 years in a practice-based teacher education program and 2 years teaching. Data sources included videorecords of the teachers' science instruction, lesson plans, reflections, and interviews. The findings indicate that the novice elementary teachers' knowledge of the science practices and how to teach them varied, with their understanding of how to teach some science practices more evident than their knowledge of the nuances of the practices themselves. Across all of the science practices, they demonstrated a strong understanding that students should be the ones engaging in the intellectual work of the science practices, and not the teacher. As novice elementary teachers learn how to teach science, they may develop their "science practice-readiness," which can serve as a building block for understanding the science practices in greater depth with more teaching experience. The current study has implications for teacher educators when developing opportunities to support novices' understanding of the science practices in ways that can expand with more teaching experience.

An important part of promoting scientific literacy is developing disciplinary literacy practices, such as obtaining information from text and sharing investigation results through talk and writing. To support students to develop disciplinary literacy practices in science, educators must provide opportunities for them to work with multiple modes--resources for meaning-making--such as informational texts, photographs, videos, and physical materials. In this article, the authors share how teachers can support students as they investigate questions about the natural world, such as, "How do animals change their environments?"

Eastern gamagrass (Tripsacum dactyloides) is a highly productive, highly palatable native grass tolerant to both drought and flooding. It has frequently shown great response to nitrogen (N) applications, but the responses of southern native ecotypes in upland and bottomland sites have yet to be reported. The objectives were to measure the responses of long-established eastern gamagrass with different N application rates in two bottomland hay pastures and two upland grazed sites, and to measure the N responses for six diverse ecotypes in a common garden. A randomized block design was used with ecotype as the main block and fertilizer rate as the subplot. In the long-established sites, 75 N peak yields were not statistically different to those of 0 N, while upland yields across the season were consistently higher for 150 N but varied for the bottomland. The common garden ecotypes had no significant difference in yield between treatments when averaged across years. Roaring Springs showed the most consistent and greatest benefit to additional N, more than doubling the dry weight of the control. All remaining ecotypes, however, had more modest responses. Eastern gamagrass responds inconsistently to applications of 75 N, whereas most applications of 150 N generally result in higher yield, though significant increases are not guaranteed.

Microtubule-targeted agents are commonly used for cancer treatment, though many patients do not benefit. Microtubule-targeted drugs were assumed to elicit anticancer activity via mitotic arrest because they cause cell death following mitotic arrest in cell culture. However, we recently demonstrated that intratumoral paclitaxel concentrations are insufficient to induce mitotic arrest and rather induce chromosomal instability (CIN) via multipolar mitotic spindles. Here, we show in metastatic breast cancer and relevant human cellular models that this mechanism is conserved among clinically useful microtubule poisons. While multipolar divisions typically produce inviable progeny, multipolar spindles can be focused into near-normal bipolar spindles at any stage of mitosis. Using a novel method to quantify the rate of CIN, we demonstrate that cell death positively correlates with net loss of DNA. Spindle focusing decreases CIN and causes resistance to diverse microtubule poisons, which can be counteracted by addition of a drug that increases CIN without affecting spindle polarity. These results demonstrate conserved mechanisms of action and resistance for diverse microtubule-targeted agents. Trial registration: clinicaltrials.gov, NCT03393741.

The failure of metabolic tissues to respond to insulin is an early marker of type 2 diabetes. Here, the authors show, using global phosphoproteomics, that insulin resistance is caused by a marked rewiring of both canonical and non-canonical insulin signalling, and includes dysregulated GSK3 activity.

Purpose Intensive care is a stressful environment in which team-family conflicts commonly occur. If managed poorly, conflicts can have negative effects on all parties involved. Previous studies mainly investigated these conflicts and their management in a retrospective way. This study aimed to prospectively explore team-family conflicts, including its main topics, complicating factors, doctors' conflict management strategies and the effect of these strategies. Methods Conversations between doctors in the neonatal, pediatric, and adult intensive care unit of a large university-based hospital and families of critically ill patients were audio-recorded from the moment doubts arose whether treatment was still in patients' best interest. Transcripts were coded and analyzed using a qualitative deductive approach. Results Team-family conflicts occurred in 29 out of 101 conversations (29%) concerning 20 out of 36 patients (56%). Conflicts mostly concerned more than one topic. We identified four complicating context- and/or family-related factors: diagnostic and prognostic uncertainty, families' strong negative emotions, limited health literacy, and burden of responsibility. Doctors used four overarching strategies to manage conflicts, namely content-oriented, process-oriented, moral and empathic strategies. Doctors mostly used content-oriented strategies, independent of the intensive care setting. They were able to effectively address conflicts in most conversations. Yet, if they did not acknowledge families' cues indicating the existence of one or more complicating factors, conflicts were likely to linger on during the conversation. Conclusion This study underlines the importance of doctors tailoring their communication strategies to the concrete conflict topic(s) and to the context- and family-related factors which complicate a specific conflict., Author(s): Amber S. Spijkers [sup.1] [sup.2], Aranka Akkermans [sup.1] [sup.2], Ellen M. A. Smets [sup.1] [sup.2], Marcus J. Schultz [sup.3] [sup.4] [sup.5], Thomas G. V. Cherpanath [sup.3], Job B. M. [...]

Eastern gamagrass (Tripsacum dactyloides) is highly palatable, ideal for grazing and hay production in the United States. It is deep rooted and resilient, tolerant of flooding and drought. Objectives of this study were to develop plant parameters for different ecotypes of this grass. Data collected in field plots of diverse ecotypes included biomass, leaf area index (LAI), light extinction coefficient (k), and radiation use efficiency (RUE). Average LAI was 1.06 and average k was −1.05. The power response of k to LAI offers a new approach to simulating light interception at very low LAI values and throughout the range of LAI values of these ecotypes and similar grass species. The RUE values, which ranged from 1.16 to 4.31 g/MJ, highlight the immense diversity of eastern gamagrass. The high RUE values for the most productive ecotypes emphasizes the importance of this grass species for hay and grazing. While not as large as switchgrass (Panicum virgatum) values, it is still a prominent forage species that even is comparable to maize (Zea mays L.) in productivity when expressed as radiation use efficiency. These results are an important step in developing relationships and parameters to simulate the different ecotypes of this grass with process-based models.

Climate-sensitive hazards, including extreme heat, wildfire smoke, flooding, and rising sea levels, can jeopardize the health of all populations. However, certain population groups are more vulnerable to harm from these hazards. While youth–particularly those from historically marginalized groups and communities–are among those at the highest risk, their abilities may be underutilized in local climate adaptation efforts. This exploratory research aimed to identify opportunities for youth involvement in climate and environmental solutions in their historically marginalized communities. Specifically, this study (1) investigated youth risk perceptions and impacts of various climate-sensitive hazards (e.g. extreme heat, wildfire smoke, flooding, and sea level rise); (2) examined current barriers, resource needs, and opportunities for youth to engage in climate and environmental solution work; and (3) explored current methods and spaces where youth and community leaders can support youth-led climate-related initiatives. Through focus group discussions with youth and in-depth interviews with community leaders who are directly with youth, this study identified opportunities to leverage youth experiences, perceptions, and assets to promote a healthy and resilient community in the face of various compounding climate-related threats. Results showed that while youth recognize the changing climate and associated health impacts, they require more financial resources and support from local decision-makers to maintain their engagement and promote community resilience. Engaging youth in climate action and community resilience involves more than just centering youth voices and perspectives–it requires intentional collaboration, capacity-building, organizing, granting decision-making power, and other strategies to produce inclusive, intersectional, and sustainable solutions.

Abstract Porcine reproductive and respiratory syndrome virus (PRRSV) in late gestation causes a profound suppression of circulating maternal and fetal thyroid hormone during a critical window of development. To understand this relationship, we evaluated thyroid hormone metabolism at the maternal–fetal interface and within fetal tissues, along with hormone metabolite levels in serum. Fetuses were classified using an established model based on viral load in serum and thymus, and preservation status, including uninfected (UNIF), high-viral load viable (HV-VIA), and high-viral load meconium-stained (HV-MEC), with additional controls from sham-inoculated gilts (CON). Expression of three iodothyronine deiodinases, five sulfotransferases, sulfatase, and two solute carriers known to transport thyroid hormone were evaluated in maternal endometrium and fetal placenta, liver, and kidney. Serum thyroxin (T4), reverse triiodothyronine (rT3), and diiodothyronine (T2) were evaluated via liquid chromatography tandem mass spectrometry. Significant changes in gene expression were observed in all four tissues, with the liver being the most severely impacted. We observed local and fetal specific regulation of maternal tissues through significant upregulation of DIO2 and DIO3 expression in the endometrium corresponding to infected but viable fetuses relative to uninfected and control fetuses. Expression levels of DIO2 and DIO3 were significantly higher in the resilient (HV-VIA) fetuses relative to the susceptible (HV-MEC) fetuses. A substantial decrease in serum T4 was confirmed, with no corresponding increase in rT3 or T2. Collectively, these results show that thyroid hormone metabolism is altered at the maternal–fetal interface and within the PRRSV infected fetus and is associated with fetal viability.

Diploptera punctata, also known as the Pacific beetle cockroach, is a viviparous cockroach that gives birth to live offspring and secretes a highly concentrated mixture of glycosylated proteins as a source of nourishment for developing embryos. These proteins are lipocalins that bind to lipids and crystallize in the gut of the embryo. A structure of milk crystals harvested from the embryos showed that the milk-derived crystals were heterogeneous and made of three proteins (called Lili-Mips). We hypothesized that the isoforms of Lili-Mip would display different affinities for fatty acids due to the ability of the pocket to bind multiple acyl chain lengths. We previously reported the structures of Lili-Mip from crystals grown in vivo and recombinantly expressed Lili-Mip2. These structures are similar, and both bind to several fatty acids. This study explores the specificity and affinity of fatty acid binding to recombinantly expressed Lili-Mip 1, 2 & 3. We show that all isoforms can bind to different fatty acids with similar affinities. We also report the thermostability of Lili-Mip is pH dependent, where stability is highest at acidic pH and declines as the pH increases to physiological levels near 7.0. We show that thermostability is an inherent property of the protein, and glycosylation and ligand binding do not change it significantly. Measuring the pH in the embryo's gut lumen and gut cells suggests that the pH in the gut is acidic and the pH inside the gut cells is closer to neutral pH. In various crystal structures (reported here and previously by us), Phe-98 and Phe-100 occupy multiple conformations in the binding pocket. In our earlier work, we had shown that the loops at the entrance could adapt various conformations to change the size of the binding pocket. Here we show Phe-98 and Phe-100 can reorient to stabilize interactions at the bottom of the cavity-and change the volume of the cavity from 510 Å3 to 337 Å3. Together they facilitate the binding of fatty acids of different acyl chain lengths.

Abstract Although wetlands are an important component of many landscapes, emergent plants have had variable impacts on wetland hydrology. In the present study, similar to what others have done with emergent plants, we investigated the impacts of black willow (Salix nigra Marshall) and Pennsylvania smartweed (Persicaria pensylvanica L.) on water loss from standing water relative to water loss with no emergent plants from 2018 to 2020. Pans were established with soil and standing water for three replications of five treatments: open water control, low population density black willow, high density black willow, low density smartweed, and high density smartweed. Each week during the growing season water levels, water temperature, leaf area index, and height were recorded. Pans were then refilled to the standard level. The assumption was that open water was just evaporation and the increase in water loss in the presence of plants was due to transpiration. Thus, we could partition water loss between evaporation and transpiration by calculating the difference between pans without plants and pans with plants. This difference is the transpiration by the plants. Water temperature was measured to check on any possible shading effect. Open water evaporation was lower than black willow and smartweed evapotranspiration. Mean increases in water use relative to the control were 37% for smartweed and 66% for black willow. These differences were even more dramatic when calculated for only the last 2 years. Smartweed increased water use by 40% and black willow by 92%. Because pans with plants had lower maximum daily water temperatures than those of the control in the summer, the increased water loss with plants was largely due to transpiration. Smartweed transpired more than willows. The willow root system and leaf area greatly increased after the first year, resulting in more water loss and lower summer water temperature. Low and high density treatments did not differ significantly for any metrics gathered, with few exceptions. This evapotranspiration information addresses wetland water balance questions and is useful for process‐based models.

This report describes a single center experience with laser fenestration of the inferior vena cava for the treatment of type 2 endoleak after endovascular abdominal aortic aneurysm repair. Our technique is reviewed, and clinical data after treatment are reported. Twelve patients underwent transcaval embolization via laser fenestration. Technical success was achieved in all cases (100%) with no postoperative complications. At a median follow-up of 12.9 months, no patient demonstrated a persistent endoleak and there were no cases of aortocaval fistula. Transcaval embolization, via laser fenestration, provides an additional strategy for the management of type 2 endoleak after endovascular abdominal aortic aneurysm repair.

IMPORTANCE AND OBJECTIVES:. To assess the knowledge, attitude, and practice of the patients who underwent prone positioning during their COVID-19 illness in the hospital. DESIGN:. Cross-sectional study. SETTING:. Aga Khan University Hospital, Karachi, Pakistan. PARTICIPANTS:. COVID-19–recovered patients. INTERVENTIONS:. None. MAIN OUTCOMES AND MEASURES:. Knowledge was assessed by five questions with a dichotomous response (yes/no). An yes response was awarded 1 score. Since there were five questions, five would be the highest score. Patients’ perceptions of the therapy were assessed by four questions, each scored on a Likert scale of 5 (5 = strongly agree, 4 = agree, 3 = neither agree nor disagree, 2 = disagree, and 1 = strongly disagree). As it had four questions, the maximum score achieved could therefore be 20. Proning practices were assessed using seven questions: four were used to calculate practice scores, whereas three were open-ended regarding the patient’s experience. Each question carries a different score, and the maximum score was 8. RESULTS:. The study included 98 patients. The mean age of the patients was 57 years (sd, 12.2 yr). Majority of the patients were males (70.4%). 69.1% of males and 76.6% of females fell in the poor knowledge group. The poor knowledge cohort had an educational level of 48% in high school, 45.5% in graduates, and 6% in postgraduates. Compared with 56.5% of males, 73% of females preferred prone positioning. Sixty percent of those with a high school education viewed prone positioning favorably, whereas 46% of those with graduate and postgraduate did. Seventy-nine percent of males and 63% of females scored positively on the practice questionnaire. Eighty percent of graduates and postgraduates preferred proning practices to 67% of participants with high school education levels. CONCLUSIONS AND RELEVANCE:. Our study population had a little understanding of awake proning, found it unpleasant, and practiced for a shorter period than advised. Despite the overall negative attitude toward the position, our patients highly recommend this position to future patients.

We used principal component analysis (PCA) to examine the component structure of a neuropsychological test battery administered to 943 cognitively-normal adults enrolled in the Southern Illinois University (SIU) Longitudinal Cognitive Aging Study (LCAS). Four components explaining the most variance (63.9%) in the dataset were identified: speed/cognitive flexibility, visuospatial skills, word-list learning/memory, and story memory. Regression analyses confirmed that increased age was associated with decreased component scores after controlling for gender and education. Our identified components differ slightly from previous studies using PCA on similar test batteries. Factors such as the demographic characteristics of the study sample, the inclusion of mixed patient and control samples, the inclusion of different test measures in previous studies, and the fact that many neuropsychological test measures assess multiple cognitive processes simultaneously, may help to explain these inconsistencies.