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Creativity is highly valued in both education and the workforce, but assessing and developing creativity can be difficult without psychometrically robust and affordable tools. The open-ended nature of creativity assessments has made them difficult to score, expensive, often imprecise, and therefore impractical for school- or district-wide use. To address this challenge, we developed and validated the Measure of Original Thinking for Elementary School (MOTES) in five phases, including the development of the item pool and test instructions, expert validation, cognitive pilots, and validation of the automated scoring and latent test structure. MOTES consists of three game-like computerized activities (uses, examples, and sentences subscales), with eight items in each for a total of 24 items. Using large language modeling techniques, MOTES is scored for originality by our open-access artificial intelligence platform with a high level of agreement with independent subjective human ratings across all three subscales at the response level (rs = .79, .91, and .85 for uses, examples, and sentences, respectively). Confirmatory factor analyses showed a good fit with three factors corresponding to each game, subsumed under a higher-order originality factor. Internal consistency reliability was strong for both the subscales (H = 0.82, 0.85, and 0.88 for uses, examples, and sentences, respectively) and the higher-order originality factor (H = 0.89). MOTES scores showed moderate positive correlations with external creative performance indicators as well as academic achievement. The implications of these findings are discussed in relation to the challenges of assessing creativity in schools and research.

Access to dangerous goods training for firefighters in remote areas is limited for financial and logistical reasons. Virtual reality (VR) is a promising solution for this challenge as it is cost-effective, safe, and allows to simulate realistic scenarios that would be dangerous or difficult to implement in the real world. However, rigorous evaluations of VR training tools for first responders are still scarce. In this exploratory user study, a simple VR training tool involving two dangerous goods scenarios was developed. In each scenario, trainees learned how to safely approach a jackknifed truck with a trailer and how to collect and communicate information about the transported materials. The tool was tested with a group of 24 professional firefighter trainees (n = 22) and instructors (n = 2), who each completed the two training scenarios. The main goal of the study was to assess the usability of the VR tool in the given scenarios. Participants provided feedback on cybersickness, perceived workload, and usability. They also filled out a knowledge test before and after the VR training and gave feedback at the end of the study. The VR tool recorded task completion duration and participants' navigation and use of tools events. Overall, the tool provided good usability, acceptance, and satisfaction. However, a wide range in individuals' responses was observed. In addition, no post-training improvement in participants' knowledge was found, likely due to the already high level of knowledge pre-training. Future directions for improving the VR tool, general implications for other VR training tools, and suggestions for future research are discussed.

Open-ended verbal creativity assessments are commonly administered in psychological research and in educational practice to elementary-aged children. Children's responses are then typically rated by teams of judges who are trained to identify original ideas, hopefully with a degree of inter-rater agreement. Even in cases where the judges are reliable, some residual disagreement on the originality of the responses is inevitable. Here, we modeled the predictors of inter-rater disagreement in a large (i.e., 387 elementary school students and 10,449 individual item responses) dataset of children's creativity assessment responses. Our five trained judges rated the responses with a high degree of consistency reliability ([alpha] = 0.844), but we undertook this study to predict the residual disagreement. We used an adaptive LASSO model to predict 72% of the variance in our judges' residual disagreement and found that there were certain types of responses on which our judges tended to disagree more. The main effects in our model showed that responses that were less original, more elaborate, prompted by a Uses task, from younger children, or from male students, were all more difficult for the judges to rate reliably. Among the interaction effects, we found that our judges were also more likely to disagree on highly original responses from Gifted/Talented students, responses from Latinx students who were identified as English Language Learners, or responses from Asian students who took a lot of time on the task. Given that human judgments such as these are currently being used to train artificial intelligence systems to rate responses to creativity assessments, we believe understanding their nuances is important.

There is a need to develop interventions to slow or reverse the degeneration of dopamine neurons in Parkinson’s disease after diagnosis. Given that preclinical and clinical studies suggest benefits of dietary n-3 polyunsaturated fatty acids, such as docosahexaenoic acid, and exercise in Parkinson’s disease, we investigated whether both could synergistically interact to induce recovery of the dopaminergic pathway. First, mice received a unilateral stereotactic injection of 6-hydroxydopamine into the striatum to establish an animal model of nigrostriatal denervation. Four weeks after lesion, animals were fed a docosahexaenoic acid-enriched or a control diet for the next 8 weeks. During this period, the animals had access to a running wheel, which they could use or not. Docosahexaenoic acid treatment, voluntary exercise, or the combination of both had no effect on (i) distance traveled in the open field test, (ii) the percentage of contraversive rotations in the apomorphine-induction test or (iii) the number of tyrosine-hydroxylase-positive cells in the substantia nigra pars compacta. However, the docosahexaenoic acid diet increased the number of tyrosine-hydroxylase-positive terminals and induced a rise in dopamine concentrations in the lesioned striatum. Compared to docosahexaenoic acid treatment or exercise alone, the combination of docosahexaenoic acid and exercise (i) improved forelimb balance in the stepping test, (ii) decreased the striatal DOPAC/dopamine ratio and (iii) led to increased dopamine transporter levels in the lesioned striatum. The present results suggest that the combination of exercise and docosahexaenoic acid may act synergistically in the striatum of mice with a unilateral lesion of the dopaminergic system and provide support for clinical trials combining nutrition and physical exercise in the treatment of Parkinson’s disease.

Creativity can be assessed using various methods, including divergent thinking performance, self-ratings, and teacher ratings. However, these measures may not always align, as they may not consistently identify creative potential in the same manner. The present study aimed to identify latent subgroups of students based on their observed originality, creative self-efficacy, teacher-rated originality, academic achievement in reading and mathematics, and demographic background characteristics. Data were collected from 243 elementary school students. We applied the normal mixture technique to classify participants into latent sub- groups. Five latent subgroups of students were identified: Overconfident Low Performers, Creative High Achievers, Under-Confident Below-Average Achievers, Mathematically Oriented Students, and Calibrated Above-Average Achievers. Female students tended to fall disproportionately into the subgroup of Creative High Achievers. Students receiving free/reduced lunch had a lower probability of being Creative High Achievers. Special education students had a higher probability of falling into the subgroup Overconfident Low Performers. Teacher ratings of students' originality were more in line with student academic performance rather than with their performance-based originality scores. Students' self-ratings of creativity bifurcated across subgroups, with Creative High Achievers and Overconfident Low Performers reporting the highest self-ratings of originality, despite displaying very different levels of performance on the divergent thinking assessment.

The COVID-19 pandemic highlighted Vaccine Hesitancy (VH) as an accelerating global phenomenon that must be addressed. According to the WHO, thirty to fifty percent of the world’s population are VH. Motivational Interviewing (MI) is an evidence-based communication style demonstrated to significantly reduce VH. MI guides people toward change through the expression of empathy and by respecting an individual’s autonomy. Healthcare providers (HCPs) are the primary implementors of vaccine policies and the most trusted advisors and influencers of vaccination intention at the individual patient level. Training HCPs in MI is one of the most effective strategies to overcome VH. Many countries are currently implementing HCP training programs and population-based MI interventions to improve vaccine uptake. MI conversations are ‘the heart’ of vaccine decision-making processes. Understanding individual patient-level drivers of hesitancy allows clinicians to efficiently provide tailored, accurate information that reinforces a person’s own motivation and confidence in their own decision. This paper describes a 4-step practical framework designed to support HCPs in their dialogue with vaccine-hesitant patients. (1) Engaging to establish a trustful relationship and safety to freely express opinions, beliefs, and knowledge gaps; (2) Understanding what matters most to the individual; (3) Offering Information to co-build accurate knowledge in order to guide the individual toward vaccine intention (4) Clarifying and Accepting to validate an individual’s decision-making autonomy. We believe that our pragmatic approach can contribute to greater acceptability of COVID-19 and other vaccines, and enable rapid deployment of practical MI skills across care systems.

Canada's National Pollutant Release Inventory (NPRI) is part of a global network of over 50 national Pollutant Release and Transfer Registries. These registries track industrial pollutant releases into the air, water, and land, and transfer and disposal of pollutants to various waste management practices. Despite the NPRI being a long-standing public dataset that can speak directly to Canadian progress on various reductions in chemical releases and waste generation sought by the United Nations' Sustainable Development Goal (SDG) 12, its data on pollutant transfers and disposals is so far overlooked in tracking SDG progress. This study aims to uncover the potential of this waste-related data to provide meaningful measures of progress toward SDG 12 using two case studies (on the Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and their Disposal and the Minamata Convention on Mercury) and a framework by the Organization for Economic Cooperation and Development to do so. The findings challenge the premise that progress in the current SDG 12.4 indicator (number of parties to international chemical agreements that transmit required information) also leads to progress on overall SDG 12.4 waste-related aims. This analysis sets a precedent for using publicly available PRTR data from any country to monitor progress toward SDG 12 waste-related objectives, opening up new possibilities for more accurate global tracking of this SDG.

Playful approaches are recommended to enhance wheelchair skills training with young people. Inclusive dance allows participants to discover motor skills and improve social participation. Integrating wheelchair skills training into dance has not been evaluated. This study aimed to explore participants’ experiences in dance while integrating wheelchair skills, and the influence of dance on wheelchair skills and wheelchair use confidence in young people. A convergent mixed-methods design was used during a one-week dance camp. Data collection combined observations, two focus groups (with young dancers who used manual wheelchairs and with professional dancers without disabilities), and evaluation of wheelchair skills and confidence. Data analyses included deductive thematic analysis guided by the Quality Parasport Participation Framework, merged with pre–post comparisons in wheelchair skills and confidence. Three young female dancers were 11, 12 and 15 years of age and three professional female dancers were 22, 27 and 27 years of age. Emergent themes included skill mastery, belongingness, and supportive environments. There were improvements in wheelchair skills and confidence (16.7%, 19.4%, 16.7%; 0.8%, 11.4%, 4.5%, respectively). Participants described overall positive experiences with the dance camp and perceived enhanced skills and confidence. This study advances knowledge about innovative approaches to integrate wheelchair skills training for young people. Future larger-scale controlled studies are needed to determine efficacy.

Recent investigations into mechanisms behind the development of osteoporosis suggest that suppressing PPARγ-mediated adipogenesis can improve bone formation and bone mineral density. In this study, we investigated a co-treatment strategy to enhance bone formation by combining NELL-1, an osteogenic molecule that has been extensively studied for its potential use as a therapeutic for osteoporosis, with two methods of PPARγ suppression. First, we suppressed PPARγ genetically using lentiviral PPARγ-shRNA in immunocompromised mice for a proof of concept. Second, we used a PPARγ antagonist to suppress PPARγ pharmacologically in immunocompetent senile osteopenic mice for clinical transability. We found that the co-treatment strategy significantly increased bone formation, increased the proliferation stage cell population, decreased late apoptosis of primary mouse BMSCs, and increased osteogenic marker mRNA levels in comparison to the single agent treatment groups. The addition of PPARγ suppression to NELL-1 therapy enhanced NELL-1s effects on bone formation by upregulating anabolic processes without altering NELL-1s inhibitory effects on osteoclastic and adipogenic activities. Our findings suggest that combining PPARγ suppression with therapeutic NELL-1 may be a viable method that can be further developed as a novel strategy to reverse bone loss and decrease marrow adiposity in age-related osteoporosis.

Positive modulation of hepatocyte growth factor (HGF) signaling may represent a promising therapeutic strategy for Alzheimer's disease (AD) based on its multimodal neurotrophic, neuroprotective, and anti-inflammatory effects addressing the complex pathophysiology of neurodegeneration. Fosgonimeton is a small-molecule positive modulator of the HGF system that has demonstrated neurotrophic and pro-cognitive effects in preclinical models of dementia. Herein, we evaluate the neuroprotective potential of fosgonimeton, or its active metabolite, fosgo-AM, in amyloid-beta (Aβ)-driven preclinical models of AD, providing mechanistic insight into its mode of action. In primary rat cortical neurons challenged with Aβ (Aβ1-42), fosgo-AM treatment significantly improved neuronal survival, protected neurite networks, and reduced tau hyperphosphorylation. Interrogation of intracellular events indicated that cortical neurons treated with fosgo-AM exhibited a significant decrease in mitochondrial oxidative stress and cytochrome c release. Following Aβ injury, fosgo-AM significantly enhanced activation of pro-survival effectors ERK and AKT, and reduced activity of GSK3β, one of the main kinases involved in tau hyperphosphorylation. Fosgo-AM also mitigated Aβ-induced deficits in Unc-like kinase 1 (ULK1) and Beclin-1, suggesting a potential effect on autophagy. Treatment with fosgo-AM protected cortical neurons from glutamate excitotoxicity, and such effects were abolished in the presence of an AKT or MEK/ERK inhibitor. In vivo, fosgonimeton administration led to functional improvement in an intracerebroventricular Aβ25-35 rat model of AD, as it significantly rescued cognitive function in the passive avoidance test. Together, our data demonstrate the ability of fosgonimeton to counteract mechanisms of Aβ-induced toxicity. Fosgonimeton is currently in clinical trials for mild-to-moderate AD (NCT04488419; NCT04886063).

In this study, we applied different text-mining methods to the originality scoring of the Unusual Uses Test (UUT) and Just Suppose Test (JST) from the Torrance Tests of Creative Thinking (TTCT)--Verbal. Responses from 102 and 123 participants who completed Form A and Form B, respectively, were scored using three different text-mining methods. The validity of these scoring methods was tested against TTCT's manual-based scoring and a subjective snapshot scoring method. Results indicated that text-mining systems are applicable to both UUT and JST items across both forms and students' performance on those items can predict total originality and creativity scores across all six tasks in the TTCT-Verbal. Comparatively, the text-mining methods worked better for UUT than JST. Of the three text-mining models we tested, the Global Vectors for Word Representation (GLoVe) model produced the most reliable and valid scores. These findings indicate that creativity assessment can be done quickly and at a lower cost using text-mining approaches.

Asking questions is a key characteristic of creativity and an important component of the creative process. Although much evidence has supported the association between asking questions and creativity, less research has examined the "nature of questions" asked by creative persons. In this study, we investigated the relation between creativity indicators--fluency and originality--and three types of questions: Open- vs. Closed-Ended questions, Possibility thinking, and Temporal thinking. To examine these relationships, we conducted four sets of analyses using questions posed by a sample of undergraduate students (n = 165) in two divergent thinking tasks (i.e., Activity 1 -- Asking Questions and Activity 6 -- Unusual Questions) from two different forms (i.e., Form A and Form B) of an earlier version of the Torrance Tests of Creative Thinking--Verbal. Results indicated that participants with higher originality and fluency scores were more likely to ask Open-Ended Questions. Additionally, creativity indicators were significantly associated with Possibility Thinking Questions in Activity 6, and Temporal Thinking Questions in Form A -- Activity 1. We discussed the implications of the findings and potential reasons for varied results.

Just like the androgen receptor (AR), the estrogen receptor [alpha] (ER[alpha]) is expressed in the prostate and is thought to influence prostate cancer (PCa) biology. Yet the incomplete understanding of ER[alpha] functions in PCa hinders our ability to fully comprehend its clinical relevance and restricts the repurposing of estrogen- targeted therapies for the treatment of this disease. Using 2 human PCa tissue microarray cohorts, we first demonstrate that nuclear ER[alpha] expression was heterogeneous among patients, being detected in only half of the tumors. Positive nuclear ER[alpha] levels were correlated with disease recurrence, progression to metastatic PCa, and patient survival. Using in vitro and in vivo models of the normal prostate and PCa, bulk and single-cell RNA-Seq analyses revealed that estrogens partially mimicked the androgen transcriptional response and activated specific biological pathways linked to proliferation and metabolism. Bioenergetic flux assays and metabolomics confirmed the regulation of cancer metabolism by estrogens, supporting proliferation. Using cancer cell lines and patient- derived organoids, selective estrogen receptor modulators, a pure anti-estrogen, and genetic approaches impaired cancer cell proliferation and growth in an ER[alpha]-dependent manner. Overall, our study revealed that, when expressed, ER[alpha] functionally reprogrammed PCa metabolism, was associated with disease progression, and could be targeted for therapeutic purposes., Introduction Prostate cancer (PCa) is the most common cancer for men in 112 countries (1). This disease is highly dependent on the androgen receptor (AR), a transcription factor that modulates [...]

The androgen receptor (AR) is an established orchestrator of cell metabolism in prostate cancer (PCa), notably by inducing an oxidative mitochondrial program. Intriguingly, AR regulates cytoplasmic isocitrate dehydrogenase 1 (IDH1), but not its mitochondrial counterparts IDH2 and IDH3. Here, we aimed to understand the functional role of IDH1 in PCa. Mouse models, in vitro human PCa cell lines, and human patient‐derived organoids (PDOs) were used to study the expression and activity of IDH enzymes in the normal prostate and PCa. Genetic and pharmacological inhibition of IDH1 was then combined with extracellular flux analyses and gas chromatography–mass spectrometry for metabolomic analyses and cancer cell proliferation in vitro and in vivo. In PCa cells, more than 90% of the total IDH activity is mediated through IDH1 rather than its mitochondrial counterparts. This profile seems to originate from the specialized prostate metabolic program, as observed using mouse prostate and PDOs. Pharmacological and genetic inhibition of IDH1 impaired mitochondrial respiration, suggesting that this cytoplasmic enzyme contributes to the mitochondrial tricarboxylic acid cycle (TCA) in PCa. Mass spectrometry‐based metabolomics confirmed this hypothesis, showing that inhibition of IDH1 impairs carbon flux into the TCA cycle. Consequently, inhibition of IDH1 decreased PCa cell proliferation in vitro and in vivo. These results demonstrate that PCa cells have a hybrid cytoplasmic–mitochondrial TCA cycle that depends on IDH1. This metabolic enzyme represents a metabolic vulnerability of PCa cells and a potential new therapeutic target.

Study Design Retrospective cohort study. Purpose Our goal was to determine which radiographic images are most essential for degenerative spondylolisthesis (DS) classification and instability detection. Overview of Literature The heterogeneity in DS requires multiple imaging views to evaluate vertebral translation, disc space, slip angle, and instability. However, there are several restrictions on frequently used imaging perspectives such as flexion-extension and upright radiography. Methods We assessed baseline neutral upright, standing flexion, seated lateral radiographs, and magnetic resonance imaging (MRI) for patients identified with spondylolisthesis from January 2021 to May 2022 by a single spine surgeon. DS was classified by Meyerding and Clinical and Radiographic Degenerative Spondylolisthesis classifications. A difference of >10° or >8% between views, respectively, was used to characterize angular and translational instability. Analysis of variance and paired chi-square tests were utilized to compare modalities. Results A total of 136 patients were included. Seated lateral and standing flexion radiographs showed the greatest slip percentage (16.0% and 16.7%), while MRI revealed the lowest (12.2%, p0.05). Translational instability was shown to be more prevalent when associated with seated lateral or standing flexion than when combined with neutral upright (31.5% vs. 20.2%, p=0.041; and 28.1% vs. 14.6%, p=0.014, respectively). There were no differences between seated lateral or standing flexion in the detection of instability (all p>0.20). Conclusions Seated lateral radiographs are appropriate alternatives for standing flexion radiographs. Films taken when standing up straight do not offer any more information for DS detection. Rather than standing flexion-extension radiographs, instability can be detected using an MRI, which is often performed preoperatively, paired with a single seated lateral radiograph.

IntroductionAmyotrophic lateral sclerosis (ALS), a progressive and fatal neurodegenerative disorder, primarily affects the motor neurons of the brain and spinal cord. Like other neurodegenerative conditions, ongoing pathological processes such as increased inflammation, excitotoxicity, and protein accumulation contribute to neuronal death. Hepatocyte growth factor (HGF) signaling through the MET receptor promotes pro-survival, anti-apoptotic, and anti-inflammatory effects in multiple cell types, including the neurons and support cells of the nervous system. This pleiotropic system is therefore a potential therapeutic target for treatment of neurodegenerative disorders such as ALS. Here, we test the effects of ATH-1105, a small-molecule positive modulator of the HGF signaling system, in preclinical models of ALS.MethodsIn vitro, the impact of ATH-1105 on HGF-mediated signaling was assessed via phosphorylation assays for MET, extracellular signal–regulated kinase (ERK), and protein kinase B (AKT). Neuroprotective effects of ATH-1105 were evaluated in rat primary neuron models including spinal motor neurons, motor neuron-astrocyte cocultures, and motor neuron-human muscle cocultures. The anti-inflammatory effects of ATH-1105 were evaluated in microglia- and macrophage-like cell systems exposed to lipopolysaccharide (LPS). In vivo, the impact of daily oral treatment with ATH-1105 was evaluated in Prp-TDP43A315T hemizygous transgenic ALS mice.ResultsIn vitro, ATH-1105 augmented phosphorylation of MET, ERK, and AKT. ATH-1105 attenuated glutamate-mediated excitotoxicity in primary motor neurons and motor neuron- astrocyte cocultures, and had protective effects on motor neurons and neuromuscular junctions in motor neuron-muscle cocultures. ATH-1105 mitigated LPS-induced inflammation in microglia- and macrophage-like cell systems. In vivo, ATH-1105 treatment resulted in improved motor and nerve function, sciatic nerve axon and myelin integrity, and survival in ALS mice. Treatment with ATH-1105 also led to reductions in levels of plasma biomarkers of inflammation and neurodegeneration, along with decreased pathological protein accumulation (phospho-TDP-43) in the sciatic nerve. Additionally, both early intervention (treatment initiation at 1 month of age) and delayed intervention (treatment initiation at 2 months of age) with ATH-1105 produced benefits in this preclinical model of ALS.DiscussionThe consistent neuroprotective and anti-inflammatory effects demonstrated by ATH-1105 preclinically provide a compelling rationale for therapeutic interventions that leverage the positive modulation of the HGF pathway as a treatment for ALS.

BackgroundTwo phase 3 clinical trials showed that use of a monthly vaginal ring containing 25 mg dapivirine was well tolerated and reduced HIV-1 incidence in women by approximately 30% compared with placebo. We aimed to evaluate use and safety of the dapivirine vaginal ring (DVR) in open-label settings with high background rates of HIV-1 infection, an important step for future implementation.MethodsWe did a phase 3B open-label extension trial of the DVR (MTN-025/HIV Open-label Prevention Extension [HOPE]). Women who were HIV-1-negative and had participated in the MTN-020/ASPIRE phase 3 trial were offered 12 months of access to the DVR at 14 clinical research centres in Malawi, South Africa, Uganda, and Zimbabwe. At each visit (monthly for 3 months, then once every 3 months), women chose whether or not to accept the offer of the ring. Used, returned rings were tested for residual amounts of dapivirine as a surrogate marker for adherence. HIV-1 serological testing was done at each visit. Dapivirine amounts in returned rings and HIV-1 incidence were compared with data from the ASPIRE trial, and safety was assessed. This study is registered with ClinicalTrials.gov, NCT02858037.FindingsBetween July 16, 2016, and Oct 10, 2018, of 1756 women assessed for eligibility, 1456 were enrolled and participated in the study. Median age was 31 years (IQR 27-37). At baseline, 1342 (92·2%) women chose to take the DVR; ring acceptance was more than 79% at each visit up until 12 months and 936 (73·2%) of 1279 chose to take the ring at all visits. 12 530 (89·3%) of 14 034 returned rings had residual dapivirine amounts consistent with some use during the previous month (>0·9 mg released) and the mean dapivirine amount released was greater than in the ASPIRE trial (by 0·21 mg; p

Glutathione transferase P1 (GSTP1) is a multi-functional protein that protects cells from electrophiles by catalyzing their conjugation with glutathione, and contributes to the regulation of cell proliferation, apoptosis, and signalling. GSTP1, usually described as a cytosolic enzyme, can localize to other cell compartments and we have reported its strong association with the plasma membrane. In the current study, the hypothesis that GSTP1 is palmitoylated and this modification facilitates its dynamic localization and function was investigated. Palmitoylation is the reversible post-translational addition of a 16-C saturated fatty acid to proteins, most commonly on Cys residues through a thioester bond. GSTP1 in MCF7 cells was modified by palmitate, however, GSTP1 Cys to Ser mutants (individual and Cys-less) retained palmitoylation. Treatment of palmitoylated GSTP1 with 0.1 N NaOH, which cleaves ester bonds, did not remove palmitate. Purified GSTP1 was spontaneously palmitoylated in vitro and peptide sequencing revealed that Cys48 and Cys102 undergo S-palmitoylation, while Lys103 undergoes the rare N-palmitoylation. N-palmitoylation occurs via a stable NaOH-resistant amide bond. Analysis of subcellular fractions of MCF7-GSTP1 cells and a modified proximity ligation assay revealed that palmitoylated GSTP1 was present not only in the membrane fraction but also in the cytosol. GSTP1 isolated from E. coli, and MCF7 cells (grown under fatty acid free or regular conditions), associated with plasma membrane-enriched fractions and this association was not altered by palmitoyl CoA. Overall, GSTP1 is modified by palmitate, at multiple sites, including at least one non-Cys residue. These modifications could contribute to regulating the diverse functions of GSTP1.

Abstract Introduction: Self-efficacy (or the belief in one’s ability to effect change) often moderates the relationship between education, interest, and actions in evaluations of training programs that prepare community-based investigators in the clinical and translational sciences workforce. Such evaluations, however, tend to emphasize individual-level attitudes when there are also community- or organizational-level outcomes impacted. Methods: This study uses a novel sequential, explanatory mixed-methods design to explore multiple levels of self-efficacy (or self-awareness of personal growth in leadership) in the Clinical Scholars program, an equity-centered leadership development program for mid- to later-career healthcare professionals. Our design involves: (1) bivariate correlations and confirmatory factor analysis of self-assessed competencies across all program participants to identify emergent combinations of competencies, which informed (2) more nuanced thematic coding of participants’ stories of most significant change in their personal and professional lives, as a result of the program. Results: In unpacking their accounts of personal leadership styles (that aligned with our quantitative analyses of competencies), we found that participants demonstrated multiple competencies simultaneously. Specifically, they employed emotionally intelligent learning and consensus-building dialogue to manage conflict for interpersonal impact. Additionally, they used this combination of skills to unite diverse stakeholders under a shared vision in order to lead and manage organizational change where all colleagues’ contributions were valued. Conclusion: Together, these methods extend our understanding of personal growth in leadership as an outcome of the program in terms of individual- and organizational-level impacts, using representative quantitative self-assessments to categorize rich qualitative descriptions.

BackgroundOwing to their low prevalence, rare diseases are poorly addressed in the scientific literature and clinical practice guidelines. Thus, health care workers are inadequately equipped to provide timely diagnoses, appropriate treatment, and support for these poorly understood conditions. These clinical tribulations are experienced as moral challenges by patients, jeopardizing their life trajectories, dreams, and aspirations. ObjectiveThis paper presents an ethical action plan for rare disease care and the process underlying its development. MethodsThis action plan was designed through an ethical inquiry conducted by the Ethics and Rare Diseases Working Group, which included 3 patient partners, 2 clinician researchers, and 1 representative from Québec’s rare disease association. ResultsThe plan is structured into 4 components. Component A presents the key moral challenges encountered by patients, which are the lack of knowledge on rare diseases among health care workers, the problematic attitudes that it sometimes elicits, and the distress and powerlessness experienced by patients. Component B emphasizes a vision for patient partnership in rare disease care characterized by open-mindedness, empathy, respect, and support of patient autonomy from health care workers. Component C outlines 2 courses of action prompted by this vision: raising awareness among health care workers and empowering patients to better navigate their care. Component D compares several interventions that could help integrate these 2 courses of action in rare disease care. ConclusionsOverall, this action plan represents a toolbox that provides a review of multiple possible interventions for policy makers, hospital managers, practitioners, researchers, and patient associations to critically reflect on key moral challenges experienced by patients with rare diseases and ways to mitigate them. This paper also prompts reflection on the values underlying rare disease care, patient experiences, and health care workers’ beliefs and behaviors. Health care workers and patients were the primary beneficiaries of this action plan.

Objectives: The objectives of our study were to compare the fusion rates and surgical outcomes of lumbar fusion surgery based on the (1) type of demineralized bone matrix (DBM) carrier allograft, (2) the presence/absence of a carrier, and (3) the presence of bone fibers in DBM. Methods: Patients >18 years of age who underwent single-level posterolateral decompression and fusion (PLDF) between L3 and L5 between 2014 and 2021 were retrospectively identified. We assessed bone grafts based on carrier type (no carrier, sodium hyaluronate carrier, and glycerol carrier) and the presence of bone fibers. Fusion status was determined based on a radiographic assessment of bony bridging, screw loosening, or change in segmental lordosis >5°. Analyses were performed to assess fusion rates and surgical outcomes. Results: Fifty-four patients were given DBM with a hyaluronate carrier, 75 had a glycerol carrier, and 94 patients were given DBM without a carrier. DBM carrier type, bone fibers, and carrier presence had no impact on 90-day readmission rates (P = 0.195, P = 0.099, and P = 1.000, respectively) or surgical readmissions (P = 0.562, P = 0.248, and P = 0.640, respectively). Multivariable logistic regression analysis found that type of carrier, presence of fibers (odds ratio [OR] = 1.106 [0.524–2.456], P = 0.797), and presence of a carrier (OR = 0.701 [0.370–1.327], P = 0.274) were also not significantly associated with successful fusion likelihood. Conclusion: Our study found no significant differences between DBM containing glycerol, sodium hyaluronate, or no carrier regarding fusion rates or surgical outcomes after single-level PLDF. Bone particulates versus bone fibers also had no significant differences regarding the likelihood of bony fusion.