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Objective: Use the Life Course Theory (LCT) to explore the effects of involvement with the justice system on the health of Latina women and their children. Design: A supplementary analysis was conducted using data collected from the original study to answer a new research question. Setting: South Central Texas. Participants: A primary qualitative data set from 12 Latina women involved with the justice system. Methods: We applied LCT principles and used thematic content analysis as such we employed categoric distinction: lifespan development, time and place in individuals' lives, the timing of lives, human agency, and linked lives to analyze participants' narratives. Results: Five themes emerged that aligned with LCT principles: (1) It feels like I'm living in my own prison; (2) What do I have to live for now; (3) It is like double punishment; (4) They made my choices; and (5) People didn't really understand. Participants felt helpless with few options to overcome their prior adversities, which affected their ability to make positive future choices. Conclusions: Findings highlight the potential, long‐term, negative health consequences that may result from incarceration. Considering that justice system involvement can lead to more profound maternal and child health disparities, our findings suggest that greater advocacy from the nursing profession would increase accessibility to equitable and respectful maternity and women's health care services. Key points: Involvement with the justice system can result in negative health consequences for women and their children.Maternal and child health disparities are often more profound after involvement with the justice system.Greater advocacy is needed from the nursing profession to ensure access to equitable and respectful maternity and women's health care services. [ABSTRACT FROM AUTHOR]

Objective: There are approximately 231,000 women detained daily within the nation's jail and prison systems with women of color making up nearly half of those experiencing incarceration. The purpose of this scoping review was to synthesize the literature on the reproductive autonomy of Black women influenced by incarceration, using the three tenets of reproductive justice. Methods: We searched PubMed, CINAHL, SocINDEX, and PsycINFO for research related to reproductive justice written in English and published in the United States from 1980 to 2022. A review of 440 article titles and abstracts yielded 32 articles for full-text review; nine articles met inclusion. Results: Eight addressed Tenet 1; five mentioned Tenet 2; none addressed Tenet 3. Recognition of the influence of incarceration on the reproductive autonomy of Black women is limited. Conclusion: The findings from this review suggest a need to address (a) reproductive choice, (b) support goals, and (c) support of justice-involved Black women. [ABSTRACT FROM AUTHOR]

Mobile health applications have gained popularity in assisting high-risk, hard-to-reach groups in self-management of health conditions. One such population with high rates of health disparities comprises women under community supervision. In this review, we examine the literature on mHealth applications to address health disparities among women under community supervision. We searched CINAHL, PubMed, and PsycInfo for peer-reviewed research articles conducted in the U.S. After removal of duplicates, review of 231 article titles and abstracts and 36 articles for full-text review yielded five articles for analysis. Extracted data include author, year, design, sample, objectives, conclusions, measures, interventions and analytic approach. Of the five studies that addressed health disparities of individuals under community supervision, one was done with participants on probation, four with participants on medication therapy for substance use disorder, and one with participants in a drug court program. Only one article was specific to women or controlled for ethnicity. No studies were done with those on parole. None done with populations outside the U.S. Few studies focused on health disparities of women under community supervision. mHealth applications that address substance use, reproductive and sexual health, and safety issues specific to women under community supervision are warranted. mhealth apps can assist with alleviating health disparities in hard-to reach populations. Women on community supervision have unique health care needs based on their intersectionality. Conditions such as substance use disorder and violence often go under reported or undertreated. [ABSTRACT FROM AUTHOR]

Women's incarceration has significantly increased in the United States over the past 40 years. Individuals experience numerous social, political, and economic barriers following incarceration; however, little is known about the incarceration experiences of Latina mothers in Texas, who are disproportionately affected. This study aims to examine the experiences of Latina mothers impacted by incarceration, using reproductive justice as a sensitizing lens. We used a qualitative description design and twelve Latina mothers were interviewed. We used semi-structured, individual, interviews to address the research question, "What are the experiences of Latina mothers impacted by incarceration?" We applied the reproductive justice framework to inductively sensitize the experiences with respect to the right to bodily autonomy, right to have or not have children, and right to parent in safe, sustainable environments following arrest. An overarching theme (We're still human) and four major themes (I did whatever they wanted me to do; It's me against the world; Even through the pain you push through; Our voices haven't been heard loud enough) emerged from our analysis of interview data. These themes describe experiences of discrimination, trauma, barriers, resiliency, and desires, following arrest. The findings indicate a need for more research that takes an intersectional approach; policy reform that humanizes those influenced by arrest; bridging initiatives on the individual, relational, community, and societal levels; and making probation and medication-assisted therapy services mother-centered. [ABSTRACT FROM AUTHOR]

Objective: Prescription opioid use during pregnancy poses risk to maternal and infant health. However, there is limited research on proximate risk factors for prescription opioid use during pregnancy. This study aimed to evaluate the relationship between stressful life events experienced in the 12 months prior to birth and prescription opioid use during pregnancy. Methods: Data from the 2019 Pregnancy Risk Assessment Monitoring System were analyzed (N = 17,812 women who delivered a live birth in 2019). Logistic regression and multinomial logistic regression analyses were used to assess the association between levels of stressful life events (0, 1–2, 3–5, or 6+) on (1) prescription opioid use, (2) combined opioid use (mono- or poly-opioid use), and (3) patterns of opioid use (pain management, opioid misuse) during pregnancy while controlling for socio-demographic characteristics, patterns of substance use prior to pregnancy, and pregnancy-related characteristics. Results: Women with a greater accumulation of stressful life events in the 12 months prior to birth—especially 6 or more—had increased likelihood of prescription opioid use. Accumulating stressful life events were also associated with a higher risk of poly-opioid use, as well as using prescription opioids for pain management and patterns of opioid misuse. Conclusion: Stressful life events are a risk factor for prescription opioid use during pregnancy. Considering the harms posed by both stressors and opioid use for maternal and infant wellbeing, future research should assess efforts to prevent and manage stressful life events to reduce opioid use during pregnancy. [ABSTRACT FROM AUTHOR]

Background: Hispanic mothers are one of the largest groups to give birth. They also experience high rates of morbidity and mortality; however, there is limited data related to their health inequities. Purpose: The purpose of this study was to evaluate systemic inequities associated with discrimination using the Reproductive Justice Framework to observe factors that influenced depressive symptomology in Hispanic women. Methods: A path analysis was conducted to evaluate systemic inequities that influenced postpartum depression using the public database, Listening to Mothers III (LMIII). The sub‐sample consisted of n = 406 Hispanic mothers. Data was initially collected between the years 2011 and 2013. Results: Hispanic mothers were more likely to experience occurrences of perceived discrimination while seeking perinatal healthcare. These occurrences of discrimination led to lower trust in their healthcare providers, lower satisfaction with care, more instances of unwanted medical procedures, the need to feel to hold back comments about their health which ultimately resulted in higher rates of self‐reported postpartum depression. The model fit indices supported the model's plausibility (χ2/df ratio = 3.16, Comparative Fit Index = 0.91, Root Mean Square Error of Approximation = 0.06). Conclusions: This data supported our hypothesis that the pathway of discriminatory barriers Hispanic mothers experience during pregnancy influence postpartum depression. [ABSTRACT FROM AUTHOR]

Telepsychiatry has become more widely accepted and practiced due to the global response to the COVID-19 pandemic. A recent study by Dr. Taishiro Kishimoto and colleagues examined the effectiveness of using two-way video for treating depressive disorder, anxiety disorder, and obsessive-compulsive disorder. The study found that two-way video treatment was noninferior to traditional face-to-face interventions, as measured by the SF-36 Mental Component Summary score. The study also found no differences in working alliance or client satisfaction between the two groups. These findings support the integration of telepsychiatry as a feasible and effective form of healthcare, particularly for patients who face barriers to accessing in-person services. However, further research is needed to address economic considerations and digital health equity, as well as to adapt telepsychiatry to different healthcare systems and contexts. [Extracted from the article]

The Public Health Agency of Canada is funding a new Canada Suicide Prevention Service (CSPS), timely both in recognition of the need for a public health approach to suicide prevention, and also in the context of the COVID-19 pandemic, which is causing concern about the potential for increases in suicide. This editorial reviews priorities for suicide prevention in Canada, in relation to the evidence for crisis line services, and current international best practices in the implementation of crisis lines; in particular, the CSPS recognizes the importance of being guided by existing evidence as well as the opportunity to contribute to evidence, to lead innovation in suicide prevention, and to involve communities and people with lived experience in suicide prevention efforts. [ABSTRACT FROM AUTHOR]

BACKGROUND Recent studies demonstrate comparable outcomes of Mohs micrographic surgery (MMS) versus local excision (LE) for melanoma in situ. These studies are limited by their focus on the head and neck. OBJECTIVE The primary objective was to compare 5-year overall and melanoma-specific mortality among patients with melanoma in situ of the trunk or extremities who undergo MMS versus LE. The secondary objective was to compare 5-year local recurrence among the same cohort of patients who undergo MMS versus LE. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results (SEER) database (2000-2015) was queried to identify patients who underwent MMS versus LE for melanoma in situ of the trunk, upper extremities, or lower extremities. Outcomes were 5-year recurrence, melanoma-specific mortality, and overall mortality. Multivariable regression analyses were performed. RESULTS Thirty three thousand nine hundred eighty-three patients underwent surgical treatment (MMS 3%; LE 97%). In adjusted analyses, there was no difference in local recurrence (hazard ratio [HR] 1.00, 95% confidence interval [CI] 0.56-1.78), melanoma-specific mortality (HR 0.89, 95% CI 0.12-6.47), nor overall mortality (HR 1.10, 95% CI 0.82-1.48) between MMS versus LE. CONCLUSION There is no difference of 5-year local recurrence, melanoma-specific mortality, nor overall mortality associated with MMS versus LE for melanoma in situ of the trunk or extremities. [ABSTRACT FROM AUTHOR]

Objective: Rural areas in Ontario have fewer psychiatrists, making access to specialist mental health care challenging. Our objective was to characterise psychiatrists delivering and patients receiving telepsychiatry in Ontario and to determine the number of patients who accessed a psychiatrist via telepsychiatry following discharge from psychiatric hospitalisation.Method: We conducted a serial panel study to evaluate the characteristics of psychiatrists providing telepsychiatry from April 2007 to March 2013. In addition, we conducted a cross-sectional study for fiscal year 2012-2013 to examine telepsychiatry patient characteristics and create an in-need patient cohort of individuals with a recent psychiatric hospitalisation that assessed if they had follow-up with a psychiatrist in person or through telepsychiatry within 1 year of discharge.Results: In fiscal year 2012-2013, a total of 3801 people had 5635 telepsychiatry visits, and 7% ( n = 138) of Ontario psychiatrists provided telepsychiatry. Of the 48,381 people identified as in need of psychiatric care, 60% saw a local psychiatrist, 39% saw no psychiatrist, and less than 1% saw a psychiatrist through telepsychiatry only or telepsychiatry in addition to local psychiatry within a year. Three northern regions had more than 50% of in-need patients fail to access psychiatry within 1 year.Conclusions: Currently, relatively few patients and psychiatrists use telepsychiatry. In addition, patients scarcely access telepsychiatry for posthospitalisation follow-up. This study, which serves as a preliminary baseline for telepsychiatry in Ontario, demonstrates that telepsychiatry has not evolved systematically to address need and highlights the importance of system-level planning when implementing telepsychiatry to optimise access to care. [ABSTRACT FROM AUTHOR]

Telepsychiatry (TP; video; synchronous) is effective, well received and a standard way to practice. Best practices in TP education, but not its desired outcomes, have been published. This paper proposes competencies for trainees and clinicians, with TP situated within the broader landscape of e-mental health (e-MH) care. TP competencies are organized using the US Accreditation Council of Graduate Medical Education framework, with input from the CanMEDS framework. Teaching and assessment methods are aligned with target competencies, learning contexts, and evaluation options. Case examples help to apply concepts to clinical and institutional contexts. Competencies can be identified, measured and evaluated. Novice or advanced beginner, competent/proficient, and expert levels were outlined. Andragogical (i.e. pedagogical) methods are used in clinical care, seminar, and other educational contexts. Cross-sectional and longitudinal evaluation using quantitative and qualitative measures promotes skills development via iterative feedback from patients, trainees, and faculty staff. TP and e-MH care significantly overlap, such that institutional leaders may use a common approach for change management and an e-platform to prioritize resources. TP training and assessment methods need to be implemented and evaluated. Institutional approaches to patient care, education, faculty development, and funding also need to be studied. [ABSTRACT FROM PUBLISHER]

The author discusses the National Inuit Suicide Prevention Strategy (NISPS) launched by Inuit Tapiriit Kanatami (ITK), a political organisation which represents Inuit in Canada. Topics include suicide among indigenous youth, identification of risk factors for suicide, and priority arease of the multi-level strategic approach.

"Sivulirijat aksururnaqtukkuurnikugijangat aktuiniqaqsimaninga kinguvaanginnut" translates as "the trauma experienced by generations past having an effect in their descendants." The legacy of the history of colonialism is starting to take narrative shape as Inuit give voice to the past and its manifestations in the present through public commissions such as the federal Truth and Reconciliation Commission and the Inuit-led Qikiqtani Truth Commission. However, an examination of other discursive contexts reveals a collective narrative of the colonial past that is at times silent, incomplete or seemingly inconsistent. Reading the political narrative through the Nunavut Land Claims Agreement, and the proceedings of the Legislative Assembly of Nunavut since its formation on April I, 1999, exposes an almost complete silence about this history. Oral histories, an important form for the preservation and transmission of traditional cultural knowledge, do narrate aspects of this experience of contact, but in accounts that can appear highly individual, fragmented, even contradictory. In contrast, one domain that does seem to register and engage with the impacts of this history of colonialism is Inuit art, specifically visual art and film. In some cases these artistic narratives pre-date the historical trauma narratives of the commissions, which began with the Royal Commission on Aboriginal Peoples (RCAP) in the mid-1990s. This paper examines these narrative alternatives for recounting historic trauma in Nunavut, while also considering the implications of understanding historical trauma as narrative. [ABSTRACT FROM AUTHOR]

Knowledge of molecular and genetic mechanisms controlling wheat grain quality characteristics is significant for improving flour for end-product functionality. Flour b* colour is an important quality trait for breeding wheat varieties to produce grain for specific market requirements. The degree of flour yellowness is due to the accumulation of carotenoids in grain, particularly lutein. Flour b* is under polygenic control and quantitative trait loci (QTL) have frequently been reported on chromosome 7AL. Analysis of carotenoid genes showed that phytoene synthase (PSY) co-located to the QTL on 7AL but other genes at this locus are also thought to contribute flour b* colour variation. This study used the wheat genome survey sequence and identified the chromosomal location of all wheat carotenoid genes, but none other than PSY were located on 7AL and, therefore, other genes may control flour b* colour variation including oxidative genes that degrade carotenoids. An investigation of EST bin mapped to 7AL identified a gene encoding a catalase enzyme ( Cat3- A1) that was phylogenetically related to other plant class III enzymes, co-located to the QTL for flour b* colour variation on 7AL in three mapping populations and expressed during seed development. Therefore, Cat3- A1 was functionally associated with flour b* colour variation. Catalase acts upon hydrogen peroxide as a substrate and it was postulated that Cat3- A1 alleles control varying degrees of bleaching action on lutein in developing wheat grain. Markers for Cat3- A1 developed in this study can be used in conjunction with other candidate gene markers including phytoene synthase and lycopene-ε-cylase to develop a molecular signature for selecting lines with specific flour b* colour values in wheat breeding. [ABSTRACT FROM AUTHOR]

Flour b* colour is an important grain quality parameter for specific wheat end-products. The genetic control of b* colour in Australian wheat accessions is controlled by quantitative trait loci (QTL) on chromosomes 3A, 3B, 7A and 7B accumulating lutein, a compound of the carotenoid biosynthetic pathway. The relationship between lutein accumulation and flour b* colour provides an opportunity to identify sequence variants of genes encoding enzymes from the biosynthetic pathway that may control trait variation. This study identified a single nucleotide polymorphism (SNP) in the gene encoding lycopene-ε-cylcase on chromosome 3A ( e- LYC3A) between two wheat accessions Ajana and WAWHT2074, identifying two alleles, e- LYC3Aa and e- LYC3Ab, respectively. e- LCY3Ab was present in 62.5 % of the wheat accessions analysed. A highly significant ( P < 0.01) association with QTL on chromosome 3A in two mapping populations indicated that e- LYC3A is functionally associated with b* colour variation in some Australian wheat accessions. The SNP induced a serine/glycine substitution at amino acid residue 123 and a subtle change in protein folding at amino acid residue 119. The e- LYC3A SNP may be considered along with other alleles and genes on homoeologous group 3 and 7 chromosomes for selecting desirable flour b* colour variation in marker-assisted breeding. [ABSTRACT FROM AUTHOR]

Introduction: Despite a good evidence base for telepsychiatry (TP), economic cost analyses are infrequent and vary in quality. Methods: A scoping review was conducted based on the research question, "From the perspective of an economic cost analysis for telehealth and telepsychiatry, what are the most meaningful ways to ensure a study/intervention improved clinical care, provided value to participants, had population level impact, and is sustainable?" The search in seven databases focused on keywords in four concept areas: (1) economic cost analysis, (2) evaluation, (3) telehealth and telepsychiatry, and (4) quantifiable health status outcomes. The authors reviewed the full-text articles based on the inclusion (Medical Subject Headings [MeSH] of the keywords) and exclusion criteria. Results: Of a total of 2,585 potential references, a total of 99 articles met the inclusion criteria. The evaluation of telehealth and TP has focused on access, quality, patient outcomes, feasibility, effectiveness, outcomes, and cost. Cost-effectiveness, cost–benefit, and other analytic models are more common with telehealth than TP studies, and these studies show favorable clinical, quality of life, and economic impact. A standard framework for economic cost analysis should include: an economist for planning, implementation, and evaluation; a tool kit or guideline; comprehensive analysis (e.g., cost-effectiveness or cost–benefit) with an incremental cost-effectiveness ratio; measures for health, quality of life, and utility outcomes for populations; methods to convert outcomes into economic benefits (e.g., monetary, quality of adjusted life year); broad perspective (e.g., societal perspective); sensitivity analysis for uncertainty in modeling; and adjustments for differential timing (e.g., discounting and future costs). Conclusions: Technology assessment and economic cost analysis—such as effectiveness and implementation science approaches—contribute to clinical, training, research, and other organizational missions. More research is needed with a framework that enables comparisons across studies and meta-analyses. [ABSTRACT FROM AUTHOR]

Psychotherapy, a central social space for remembering, has from its inception centred upon the healing and integrative power of putting experience into words and narrative forms of expression. However, those who have experienced traumatic events often lack a coherent memory for or understanding about the trauma they have undergone; they may be haunted by inchoate bodily sensations and "memories" that have not been fully integrated and cannot be put into language. Such splits in experience—between body and mind—can provide a means to understand the way we conceptualize memory, consciousness, and body-mind. This paper describes an intervention that seeks to help people to make the experiences of the body more intelligible. [ABSTRACT FROM AUTHOR]

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of preventable death in the U.S., and its public health and economic burdens are rising. There is substantial evidence that dietary factors significantly reduce ASCVD-related morbidity and mortality, and that Americans, including those with established ASCVD, adhere poorly to cardio-protective diet patterns. Despite this, there continues to be a large gap in nutrition education during medical school and post-graduate training, leaving physicians poorly prepared to counsel patients on diet, nutrition, and related behavior change. The result is a massive missed opportunity to improve cardiovascular disease prevention at the health system level. However, recent calls for change by stakeholder groups, and a surprising new experiential learning model, suggest this may be changing. [ABSTRACT FROM AUTHOR]

Infant disorganized attachment is a significant predictor for later psychopathology. The Working Model of the Child Interview (WMCI; C.H. Zeanah, D. Benoit, & M.L. Barton, 1986) elicits and classifies caregivers' perceptions and subjective experience of their child and relationship with the child, which are related to concurrent and future attachment to the caregiver. However, when the WMCI was first developed, the disorganized attachment classification had not been fully developed, so the original WMCI did not include a classification that is linked to disorganized attachment. We adapted the WMCI coding scheme to include items similar to those identified by K. Lyons-Ruth, E. Bronfman, and E. Parsons (using the Atypical Maternal Behavior Instrument for Assessment and Classification, or AMBIANCE, 1999), which reflect disrupted caregiver behaviors associated with disorganized attachment. This resulted in a new WMCI-Disrupted (WMCI-D) scale and classification, disrupted. WMCI-D was used to code 35 WMCIs administered prenatally. A prenatal disrupted classification was significantly associated with caregiver unresolved classification on the Adult Attachment Interview (M. Main, N. Kaplan, & J. Cassidy, 1985), infant disorganized Strange Situation classification (M.D.S. Ainsworth, M.C. Blehar, E. Waters, & S. Wall, 1978), and disrupted caregiver behaviors toward the infant (using AMBIANCE; K. Lyons-Ruth et al., 1999), at infant age 12 months. These data suggest WMCI-D can capture disrupted caregiver internal representations, and identify dyads at risk for disorganized attachment and caregivers with unresolved mourning/trauma. These data also provide evidence for the convergent and predictive validity of the WMCI-D Scale. [ABSTRACT FROM AUTHOR]

Serial analysis of gene expression (SAGE) and related techniques are gaining popularity as tools for exploring expression of plant genes but remain suboptimal because of smaller-than-expected average concatemer sizes. The presence of low-molecular-weight contaminants in high-molecular-weight concatemer fractions reduces the average size of cloned fragments, thereby limiting the viability of high-throughout sequencing methods. Implementation of an additional digestion step to promote formation of linear concatemer fragments appears to reduce the proportion of contaminants indirectly, but with variable results. We explored the effect of initial dicta polymerase chain reaction (PCR) quantity on the average size of cloned concatemers from the greater than 1000-bp Traction. The quantity of PCR material used was found to have a strong influence on the frequency of low molecular-weight contaminants within this fraction, which has important implications for reducing costs associated with high-throughput sequencing of concatemer clones. [ABSTRACT FROM AUTHOR]

Electrophilic trisubstituted ethylene monomers, ring-substituted methyl 2-cyano-3-phenyl2-propenoates, RC6H4CH=C(CN)CO2 CH3 (where R = H, 2-CH3, 3-CH3, 4-CH3, 2-C2H5, 4-C2H5, 4-iC3H7, 4-C4H9 and 2,4,6-(CH3)3), were synthesized by the piperidine-catalyzed Knoevenagel condensation of ring-substituted benzaldehydes and methyl cyanoacetate, and characterized by CHN elemental analysis, IR, 1H- and 13C-NMR. Co-polymerization of the propenoates and vinyl acetate in solution with radical initiation (AIBN) at 70°C yielded equimolar alternating co-polymers. The composition of the co-polymers was calculated from nitrogen analysis and the structures were analyzed by IR, 1H- and 13C-NMR, GPC, DSC and TGA. The high Tg of the co-polymers in comparison with that of polyvinyl acetate indicates a substantial decrease in chain mobility of the co-polymer due to the high dipolar character of the trisubstituted ethylene monomer unit. The gravimetric analysis indicated that the co-polymers decompose in the 214–400°C range. [ABSTRACT FROM AUTHOR]

Cellulase and xylanase digestive enzyme activities were compared in four freshwater crayfish (Genus Cherax) and three marine prawn (Genus Penaeus) species. Temperature and pH profiles for cellulase (endoglucanase) were found to be very similar in all species, with maximum activity occurring at 60°C and pH 5.0. Temperature and pH profiles for xylanase (endoxylanase) were also very similar in all crayfish species, with maximum activity occurring at 50°C and pH 5.0. Xylanase activity was not detected in the three prawn species examined. In addition, in vitro studies showed that most species were able to liberate glucose from carboxymethyl cellulose, indicating that cellulose substrates can be a source of energy for both crayfish and prawn species. [ABSTRACT FROM AUTHOR]

The most abundant organic compound produced by plants is cellulose; however, it has long been accepted that most animals do not produce endogenous enzymes required for its degradation, but rely instead on symbiotic relationships with microbes that produce the necessary enzymes. Here, we present the genomic organisation of an endogenous glycosyl hydrolase family (GHF) 9 gene in redclaw crayfish (Cherax quadricarinatus), consolidated from a cDNA sequence determined by Byrne et al. [Gene 239 (1999) 317–324.]. Comparison with several other invertebrate GHF9 genes reveals the conservation of both intron position/phase and splice sequence, which adds support to an argument for an ancestral animal cellulase gene. Furthermore, two introns in plant GHF9 genes are also identical in position, implying a more ancient origin for this class of animal cellulase.Protein purification from redclaw gastric fluid via fast performance liquid chromatography (FPLC) indicated the presence of two endoglucanase enzymes. The molecular weights of these components were determined by matrix-assisted laser desorption/ionisation—time-of-flight (MALDI-TOF) to be 47,887 Da (Cel1) and 50,295 Da (Cel2). Cel1 is possibly the functional product of the described cellulase gene, with N-terminal amino acid residues identical to the translated amino acid sequence from the corresponding gene region. Cel2 was identical to Cel1 for 7 of 11 N-terminal residues and likely to be the product of a paralogous endoglucanase gene. These results suggest that redclaw crayfish possess at least one and possibly two functional, endoglucanase enzymes, although further work is required to confirm their origin and attributes. [Copyright &y& Elsevier]

Background: During the COVID-19 pandemic, the use of telemedicine as a way to reduce COVID-19 infections was noted and consequently deregulated. However, the degree of telemedicine regulation varies from country to country, which may alter the widespread use of telemedicine. This study aimed to clarify the telepsychiatry regulations for each collaborating country/region before and during the COVID-19 pandemic. Methods: We used snowball sampling within a global network of international telepsychiatry experts. Thirty collaborators from 17 different countries/regions responded to a questionnaire on barriers to the use and implementation of telepsychiatric care, including policy factors such as regulations and reimbursement at the end of 2019 and as of May 2020. Results: Thirteen of 17 regions reported a relaxation of regulations due to the pandemic; consequently, all regions surveyed stated that telepsychiatry was now possible within their public healthcare systems. In some regions, restrictions on prescription medications allowed via telepsychiatry were eased, but in 11 of the 17 regions, there were still restrictions on prescribing medications via telepsychiatry. Lower insurance reimbursement amounts for telepsychiatry consultations v. in-person consultations were reevaluated in four regions, and consequently, in 15 regions telepsychiatry services were reimbursed at the same rate (or higher) than in-person consultations during the COVID-19 pandemic. Conclusions: Our results confirm that, due to COVID-19, the majority of countries surveyed are altering telemedicine regulations that had previously restricted the spread of telemedicine. These findings provide information that could guide future policy and regulatory decisions, which facilitate greater scale and spread of telepsychiatry globally. [ABSTRACT FROM AUTHOR]

An editorial introduction to the issue is presented, highlighting featured articles on suicide prevention policies in Canada by Kathryn Bennett, Donald B. Langille and Eduardo Chachamovich.

The article explores the case of a 28-year-old military veteran, a married father of two who presented with insomnia and nightmares at the emergency department. Topics discussed include the history of the patient that could possibly land on a diagnosis of posttraumatic stress disorder (PTSD), the criterias for diagnosis of PTSD according to Diagnostic and Statistical Manual of Mental Disorders and the best initial intervention for this case.

The article discusses the narrative medicine which incorporate into a story-based approach towards medical practice. Topics mention including the introduction of indigenous methods which can provide alternative ways of knowing medicines, factors which affects the health and well-being of the indigenous communities and sharing of bioethics.

Previous studies have documented natural infections of SARS-CoV-2 in various domestic and wild animals. More recently, studies have been published noting the susceptibility of members of the Cervidae family, and infections in both wild and captive cervid populations. In this study, we investigated the presence of SARS-CoV-2 in mammalian wildlife within the state of Vermont. 739 nasal or throat samples were collected from wildlife throughout the state during the 2021 and 2022 harvest season. Data was collected from red and gray foxes (Vulpes vulples and Urocyon cineroargentus, respectively), fishers (Martes pennati), river otters (Lutra canadensis), coyotes (Canis lantrans), bobcats (Lynx rufus rufus), black bears (Ursus americanus), and white-tailed deer (Odocoileus virginianus). Samples were tested for the presence of SARS-CoV-2 via quantitative RT-qPCR using the CDC N1/N2 primer set and/or the WHO-E gene primer set. Surprisingly, we initially detected a number of N1 and/or N2 positive samples with high cycle threshold values, though after conducting environmental swabbing of the laboratory and verifying with a second independent primer set (WHO-E) and PCR without reverse transcriptase, we showed that these were false positives due to plasmid contamination from a construct expressing the N gene in the general laboratory environment. Our final results indicate that no sampled wildlife were positive for SARS-CoV-2 RNA, and highlight the importance of physically separate locations for the processing of samples for surveillance and experiments that require the use of plasmid DNA containing the target RNA sequence. These negative findings are surprising, given that most published North America studies have found SARS-CoV-2 within their deer populations. The absence of SARS-CoV-2 RNA in populations sampled here may provide insights in to the various environmental and anthropogenic factors that reduce spillover and spread in North American's wildlife populations. [ABSTRACT FROM AUTHOR]

Background: Collaborative care (CC) could improve outcomes in primary care patients with common mental conditions. We assessed the effectiveness of a transdiagnostic model of telephone-based CC (tCC) delivered by lay providers to primary care patients with depression, anxiety, or at-risk drinking. Methods: PARTNERS was a pragmatic trial in 502 primary care adults presenting with depressive symptoms, anxiety symptoms, or at-risk drinking randomized to (1) usual care by primary care providers (PCPs) enhanced with the results of computer-assisted telephone-based assessments (at baseline and 4, 8, and 12 months later) (enhanced usual care [eUC]) or (2) tCC consisting of eUC plus frequent telephone coaching and psychoeducation provided by mental health technicians who also communicated to the PCP recommendations from a psychiatrist for evidence-based pharmacotherapy, psychotherapy, or, when indicated, referrals to mental health services. The primary analysis compared the change on the 9-item Patient Health Questionnaire (PHQ-9) in participants presenting with depression (n = 366) randomized to tCC versus eUC. Secondary analyses compared changes on the Generalized Anxiety Disorder-7 scale (GAD-7) in those presenting with anxiety (n = 298); or change in the number of weekly drinks in those presenting with at-risk drinking (n = 176). Results: There were no treatment or time×treatment effects between tCC and eUC on PHQ-9 scores for patients with depression during the 12-month follow-up. However, there was a treatment effect (tCC > eUC) on GAD-7 scores in those with anxiety and a time×treatment interaction effect on the number of weekly drinks (tCC > eUC) in those with at-risk drinking. Conclusion: Implementing transdiagnostic tCC for common mental disorders using lay providers appears feasible in Canadian primary care. While tCC was not better than eUC for depression, there were some benefits for those with anxiety or at-risk drinking. Future studies will need to confirm whether tCC differentially benefits patients with depression, anxiety, or at-risk drinking. [ABSTRACT FROM AUTHOR]

Engaging people with lived experience of mental health system encounters in the design and actualization of continuing professional development initiatives for mental health professionals can have transformative systemic impacts. Yet, despite evidence that involving people with lived experience benefits mental health professional education, far less focus has been placed on how to engage people with lived experience in continuing professional development initiatives. Tensions persist regarding the role of lived experience perspectives in continuing professional development, as well as how to establish people with lived experience as partners, educators and leaders in a thoughtful way. We propose that meaningful and equitable partnerships with people with lived experience can be realized by engaging in critical reflexivity and by systematically challenging assumptions. This paper explores three topics: (1) the current state of engagement with people with lived experience in continuing professional development initiatives; (2) barriers to meaningful engagement and (3) recommendations for using critical reflexivity to support the involvement and leadership of people with lived experience in continuing professional development for mental health professionals. Patient or Public Involvement: This viewpoint manuscript was co‐designed and co‐written by people with diverse lived and learned experiences. Each author's professional roles involve meaningfully and equitably partnering with and centring the perspectives of those with lived experience of mental health system encounters. In addition, approximately half of the authorship team identifies as having lived experience of accessing the psychiatric system and/or supporting family members who are navigating challenges related to mental health. These lived and learned experiences informed the conception and writing of this article. [ABSTRACT FROM AUTHOR]

Previous studies have documented natural infections of SARS-CoV-2 in various domestic and wild animals. More recently, studies have been published noting the susceptibility of members of the Cervidae family, and infections in both wild and captive cervid populations. In this study, we investigated the presence of SARS-CoV-2 in mammalian wildlife within the state of Vermont. 739 nasal or throat samples were collected from wildlife throughout the state during the 2021 and 2022 harvest season. Data was collected from red and gray foxes (Vulpes vulples and Urocyon cineroargentus, respectively), fishers (Martes pennati), river otters (Lutra canadensis), coyotes (Canis lantrans), bobcats (Lynx rufus rufus), black bears (Ursus americanus), and white-tailed deer (Odocoileus virginianus). Samples were tested for the presence of SARS-CoV-2 via quantitative RT-qPCR using the CDC N1/N2 primer set and/or the WHO-E gene primer set. Surprisingly, we initially detected a number of N1 and/or N2 positive samples with high cycle threshold values, though after conducting environmental swabbing of the laboratory and verifying with a second independent primer set (WHO-E) and PCR without reverse transcriptase, we showed that these were false positives due to plasmid contamination from a construct expressing the N gene in the general laboratory environment. Our final results indicate that no sampled wildlife were positive for SARS-CoV-2 RNA, and highlight the importance of physically separate locations for the processing of samples for surveillance and experiments that require the use of plasmid DNA containing the target RNA sequence. These negative findings are surprising, given that most published North America studies have found SARS-CoV-2 within their deer populations. The absence of SARS-CoV-2 RNA in populations sampled here may provide insights in to the various environmental and anthropogenic factors that reduce spillover and spread in North American's wildlife populations. [ABSTRACT FROM AUTHOR]

Purpose: Vertical sleeve gastrectomy (VSG) evolved in the early 2000s into the standalone weight loss procedure we see today. While numerous studies highlight VSG's durability for weight loss, and improvements co-morbidities such as type 2 diabetes mellitus and cardiovascular disease, patients with gastroesophageal reflux disease (GERD) have been counseled against VSG due to the concern for worsening reflux symptoms. When considering anti-reflux procedures, VSG patients are unable to undergo traditional fundoplication due to lack of gastric cardia redundancy. Magnetic sphincter augmentation lacks long-term safety data and endoscopic approaches have undetermined longitudinal benefits. Until recently, the only option for patients with a history of VSG with medically refractory GERD has been conversion to roux en Y gastric bypass (RNYGB), however, this poses other risks including marginal ulcers, internal hernias, hypoglycemia, dumping syndrome, and nutritional deficiencies. Given the risks associated with conversion to RNYGB, we have adopted the ligamentum teres cardiopexy as an option for patients with intractable GERD following VSG. Methods: A retrospective chart review was conducted of patients who had prior laparoscopic or robotic VSG and subsequently GERD symptoms refectory to pharmacological management who underwent ligamentum teres cardiopexy between 2017 and 2022. Pre-operative GERD disease burden, intraoperative cardiopexy characteristics, post-operative GERD symptomatology and changes in H2 blocker or PPI requirements were reviewed. Results: Of the study's 60 patients the median age was 50 years old, and 86% were female. All patients had a diagnosis of GERD through pre-operative assessments and were taking antisecretory medication. Of the 36 patients who have completed their one year follow up, 81% of patients had either a decrease in dosage or cessation of the antisecretory medication at one year following ligamentum teres cardiopexy. Conclusion: Ligamentum teres cardiopexy is a viable alternative to RNYGB in patients with a prior vertical sleeve gastrectomy with medical refractory GERD. [ABSTRACT FROM AUTHOR]

The shift to communication technologies during the pandemic has had positive and negative effects on clinical social worker practice. Best practices are identified for clinical social workers to maintain emotional well-being, prevent fatigue, and avoid burnout when using technology. A scoping review from 2000 to 21 of 15 databases focused on communication technologies for mental health care within four areas: (1) behavioral, cognitive, emotional, and physical impact; (2) individual, clinic, hospital, and system/organizational levels; (3) well-being, burnout, and stress; and (4) clinician technology perceptions. Out of 4795 potential literature references, full text review of 201 papers revealed 37 were related to technology impact on engagement, therapeutic alliance, fatigue and well-being. Studies assessed behavioral (67.5%), emotional (43.2%), cognitive (57.8%), and physical (10.8%) impact at the individual (78.4%), clinic (54.1%), hospital (37.8%) and system/organizational (45.9%) levels. Participants were clinicians, social workers, psychologists, and other providers. Clinicians can build a therapeutic alliance via video, but this requires additional skill, effort, and monitoring. Use of video and electronic health records were associated with clinician physical and emotional problems due to barriers, effort, cognitive demands, and additional workflow steps. Studies also found high user ratings on data quality, accuracy, and processing, but low satisfaction with clerical tasks, effort required and interruptions. Studies have overlooked the impact of justice, equity, diversity and inclusion related to technology, fatigue and well-being, for the populations served and the clinicians providing care. Clinical social workers and health care systems must evaluate the impact of technology in order to support well-being and prevent workload burden, fatigue, and burnout. Multi-level evaluation and clinical, human factor, training/professional development and administrative best practices are suggested. [ABSTRACT FROM AUTHOR]

Background: Distribution of naloxone and training on its proper use are evidence-based strategies for preventing opioid overdose deaths. In-person naloxone training was conducted in major metropolitan areas and urban centers across Texas as part of a state-wide targeted opioid response program. The training program transitioned to a live, virtual format during the COVID-19 public health emergency declaration. This manuscript describes the impact of this transition through analyses of the characteristics of communities reached using the new virtual training format. Case presentation: Training participant addresses were compared to county rates of opioid overdose deaths and broadband internet access, and census block comparison to health services shortages, rural designation, and race/ethnicity community characteristics. Conclusions: The virtual training format reached more learners than the in-person events. Training reached nearly half of the counties in Texas, including all with recent opioid overdose deaths. Most participants lived in communities with a shortage of health service providers, and training reached rural areas, those with limited broadband internet availability, and majority Hispanic communities. In the context of restrictions on in-person gathering, the training program successfully shifted to a live, online format. This transition increased participation above rates observed pre-pandemic and reached communities with the need for equipping those most likely to witness an opioid overdose with the proper use of naloxone. [ABSTRACT FROM AUTHOR]

Background: Between 1980 and 2018 Greenland has had one of the highest suicide rates in the world with an average rate of 96 suicides per 100,000 people annually. The aim of this study is to investigate suicide rates in Greenland according to age, birth cohort, period, sex, place of residence and suicide method from 1970 until 2018. Methods: Suicide rates were examined using register and census data from 1970–2018 among Greenland Inuit. Rates were calculated by Poisson regression in Stata and by use of Excel. In analyses of the period trends, rates were standardized according to the World Standard Population 2000–2025. Results: The suicide rate has been declining since a peak at 120 suicides per 100,000 people annually in the 1980s but remained high at a rate of 81.3 suicides per 100,000 people annually from 2015–2018. Descriptive analyses point to the decrease in male suicides as the primary factor for the overall decreasing rates while the rate among women has been increasing. Simultaneously, the proportion of women who used a violent suicide method increased from 60% in 1970–1979 to 90% in 2010–2018. The highest rates are seen among young people, especially young men aged 20–24 years and youth suicide rates increased with later birth cohorts. When the rates started to increase in the 1980s both the capital Nuuk and East Greenland had the highest rates. Since then, the rate in Nuuk has declined while the rate in East Greenland was three times the national rate from 2015–2018. Conclusions: From 1970 to 1989 the suicide rate increased from 28.7 to 120.5 per 100,000 people mirroring a rapid societal transition in the post-colonial period. The rate has slowly declined from the peak in the 1980s but remains at a very high level. Young people in general are at risk, but the steady increase in the rate among women is worrying and there is a need to investigate underlying causes for this development. [ABSTRACT FROM AUTHOR]

Background: Historically, childbearing women from diverse and systematically hard-to-reach populations have been excluded from nursing research. This practice limits the generalizability of findings. Maximizing research strategies to meet the unique needs of these populations must be a priority. Objectives: The aim of this study was to provide methodological context for the comprehensive application of reproductive justice strategies to guide research methods and promote engagement of underrepresented childbearing women while decreasing systemic bias. Methods: In this article, we use a reproductive justice lens to characterize and define strategies for enhancing ethical and equitable engagement in research involving childbearing women who are often systematically underrepresented using a case study approach. Using a specific case study exemplar, the core tenets of reproductive justice are outlined and affirm the need to advance research strategies that create ethical engagement of diverse populations, transform oppressive social structures, and shift research paradigms so research objectives intentionally highlight the strengths and resiliency inherent to the targeted communities. Results: We begin by describing parallels between the tenets of reproductive justice and the ethical principles of research (i.e., respect for persons, beneficence, and justice). We then apply these tenets to conceptualization, implementation (recruitment, data management, and retention), and dissemination of research conducted with childbearing women from diverse backgrounds who are systemically underrepresented. We highlight our successful research strategies from our case study example of women with histories of incarceration. Discussion: To date, outcomes from our research indicate the need for multilevel strategies with a focus on respectful, inclusive participant and key community partner engagement; the time investment in local communities to promote equitable collaboration; encouragement of the patient's autonomous right to self-determination; and mitigation of power imbalances. Nurse researchers are well positioned to advance research justice at the intersection of reproductive justice and ethics to fully engage diverse populations in advancing health equity to support the best health outcomes. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic disrupted the healthcare sector and forced hospitals to limit the number of elective procedures with the goal of reducing overcrowding of wards and thus viral transmission. Recent trends for ventral hernia repair have shifted towards retromuscular techniques, which normally require a longer length of stay. Therefore, the aim of this study is to investigate the impact of the COVID-19 pandemic on clinical outcomes of robotic retromuscular ventral hernia repair (rRVHR). Methods: Patients who underwent rRVHR up to 600 days before and after March 10, 2020, were included in this retrospective study and assigned to the pre- or post-COVID group depending on the date of their procedure. Pre-, intra-, and postoperative variables including patients' demographics, hernia characteristics, complications, and hernia recurrence were compared between both groups. Results: 153 (46% female) and 141 (51% female) patients were assigned to the pre- and post-COVID groups respectively. Median age was statistically different between both groups [pre-COVID: 57 (48–68) vs. post-COVID 55 (42–64) years, p = 0.045]. Median hospital length of stay (LOS) was 0 day (0–1) in both groups, and same day discharge were 61% pre-pandemic and 70% post-pandemic (p = 0.09). Mean postoperative follow-up was 39.2 (4.1–93.6) months. In total, 26 pre-COVID patients had postoperative complications, out of which 7 were pulmonary complications, whereas 23 complications were recorded in the post-COVID group, with only 3 pulmonary complications (p = 0.88). Rate of surgical-site events was comparable between both groups, and no recurrences were recorded. Conclusion: This is the first study to describe the impact of the COVID-19 on rRVHR. Hospital LOS was comparable between both groups. Rates of medical and hernia specific complications were not altered by the pandemic. [ABSTRACT FROM AUTHOR]

Introduction: Malnutrition and deconditioning impact postoperative morbidity and mortality. Computed tomography (CT) body composition variables are used as markers of nutritional status and sarcopenia. The objective of this study is to evaluate the impact of sarcopenia, using CT variables, on postoperative outcomes following transanal total mesorectal excision (TaTME) for rectal cancer. Methods: This was an institutional retrospective cohort analysis of consecutive rectal cancer patients who underwent TaTME between April 2014 and May 2020. Psoas muscle index (PMI) was calculated from diagnostic CT scans. Based on previous studies, patients in the lowest PMI tertile by gender were considered sarcopenic. Fisher's exact and Mann–Whitney U test were used to compare categorical and continuous variables, respectively. Readmission rates and postoperative complications were compared between groups. Backward stepwise logistic regression was used to determine the association between sarcopenia and 30-day postoperative complications. Results: 85 patients were analyzed, of which 63% were male, with a median age of 59 (IQR: 51–65), and median BMI of 28 (IQR: 24–32). Of the entire cohort, 34% (n = 29) were sarcopenic (median PMI 5.39 IQR: 4.49–6.71). No significant difference in baseline characteristics between sarcopenic and nonsarcopenic patients were observed. 55% of sarcopenic patients experienced a complication within 30 days compared to 24% of nonsarcopenic patients (p = 0.01). 41% of sarcopenic patients required hospital readmission within 30 days compared to 17% of their nonsarcopenic counterparts (p = 0.014). Sarcopenic patients also experienced significantly higher rates of post-operative small bowel obstruction (10% vs. 0%, p = 0.04). Multivariable analyses identified that sarcopenic patients have a fourfold increase in odds of experiencing a 30-day postoperative complication (OR: 4.44, 95%CI: 1.6–12.4, p < 0.05) after adjusting for gender. Conclusion: Preoperative sarcopenia is associated with increased 30-day postoperative complications following TaTME for rectal cancer. Postoperative complications can have serious oncologic implications by delaying adjuvant chemotherapy. Therefore, preoperative recognition of sarcopenia prior to undergoing TaTME for rectal cancer may provide an opportunity for early intervention with prehabilitation programs. [ABSTRACT FROM AUTHOR]

Background: Despite heightened interest in robotic transversus abdominis release (rTAR), concerns over its steep learning curve (LC) and associated challenges may limit its adoption. This study defines the operative time and morbidity-based LC of a single surgeon's experience with rTAR. Methods: A retrospective analysis of patients undergoing rTAR over an 8-year period was conducted. Consecutive ventral and incisional hernia repairs were stratified into four sub-categories based on bilaterality and complexity, with complex hernias being defined as those > 10 cm. Cumulative sum analyses (CUSUM) were used to evaluate skin-to-skin time and morbidity LCs. Results: This study included a total of 156 rTARs with a mean skin-to-skin time of 222.8 min. Mean skin-to-skin times (min) for sub-categories were as follows: unilateral non-complex (137.6), bilateral non-complex (206.8), unilateral complex (241.9), and bilateral complex (298.6). The CUSUM-LC was obtained by summing the differences between each procedure's operative time and its sub-category mean, revealing a quadratic best-fit line maximum at case 49 and a transition point between early and late phases at case 75. Although skin-to-skin times between early and late phases did not differ significantly (235.3 vs 211.2, respectively; p = 0.12), a significant difference was found in console times. Overall postoperative complications also decreased significantly from early to late phases (41.3% vs 25.9%; p = 0.041). Postoperative complications were predicted by a history of wound infection (c = 0.61). Conclusions: This study reveals that the rTAR LC was overcome between 49 and 75 cases, after which, console time and postoperative complications decreased significantly. [ABSTRACT FROM AUTHOR]

Background: Robot-assisted transabdominal preperitoneal inguinal hernia repair (rTAPP-IHR) is a safe and feasible approach for hernias of varying etiology. We aim to present a single surgeon's learning curve (LC) of this technique based on operative times, while accounting for bilaterality and complexity. Methods: This is a retrospective cohort analysis of patients who underwent rTAPP-IHR over a period of 5 years. Patients who underwent primary, recurrent, and complex (previous posterior repair, previous prostatectomy, scrotal, incarcerated) repairs were included. Cumulative and risk-adjusted cumulative sum analyses (CUSUM and RA-CUSUM) were used to depict the evolution of skin-to-skin times and complications/surgical site events (SSEs) with time, respectively. Results: A total of 371 patients were included in the study. Mean skin-to-skin times were stratified according to four subgroups: unilateral non-complex (46.8 min), unilateral complex (63.2 min), bilateral non-complex (70.9 min), and bilateral complex (102 min). A CUSUM-LC was then plotted using each procedures difference in operative time from its subgroup mean. The peak of the plot occurred at case number 138, which was used as a transition between 'early' and 'late' phases. The average operative time for the late phase was 15.9 min shorter than the early phase (p < 0.001). The RA-CUSUM, plotted using the weight of case complexity and unilateral/bilateral status, also showed decreasing SSE rates after the completion of 138 cases (early phase: 8.8% vs. late phase: 2.2%, p = 0.008). Overall complication rates did not differ significantly between the two phases. Conclusions: Our study shows that regardless of bilateral or complex status, rTAPP operative times and SSE rates gradually decreased after completing 138 procedures. Previous laparoscopic experience, robotic team efficiency, and surgical knowledge are important considerations for a surgeon's LC. [ABSTRACT FROM AUTHOR]

Background: Project ECHO is a virtual education model aimed at building capacity among healthcare providers to support optimal management for a range of health conditions. The expansion of the ECHO model, further amplified by the pandemic, has demonstrated an increased need to evaluate implementation success to ensure that interventions are implemented as planned. This study describes how Proctor et al.'s implementation outcomes (acceptability, adoption, appropriateness, costs, feasibility, fidelity, penetration, and sustainability) were adapted and used to assess the implementation of ECHO Ontario Mental Health (ECHO-ONMH), a mental health-focused capacity-building programme.Methods: Using Proctor et al.'s implementation outcomes, the authors developed an implementation outcomes framework for ECHO-ONMH more generally. Using this, outcome measures and success thresholds were identified for each outcome for the ECHO-ONMH context, and then applied to evaluate the implementation of ECHO-ONMH using data from the first 4 years of the programme.Results: An ECHO-ONMH implementation outcomes framework was developed using Proctor's implementation outcomes. ECHO-ONMH adapted implementation outcomes suggest that ECHO-ONMH was implemented successfully in all domains except for penetration, which only had participation from 13/14 regions. Acceptability, appropriateness and adoption success thresholds were surpassed for all 4 years, showing strong signs of sustainability. The programme was deemed feasible all 4 years and was found to be more cost-effective. ECHO-ONMH also showed high rates of fidelity to the ECHO model, and high rates of penetration.Conclusions: This is the first study to use Proctor et al.'s implementation outcomes to describe implementation success for a virtual capacity-building model. The proposed ECHO implementation outcomes framework provides a base for similar interventions to evaluate implementation success, which is an important precursor to understanding learning, service or health outcomes related to the model. Additionally, these findings can act as a benchmark for other international ECHOs and educational programmes. [ABSTRACT FROM AUTHOR]

Background: Neonatal abstinence syndrome (NAS) rates have dramatically increased. Breastfeeding is a nonpharmacological intervention that may be beneficial, reducing NAS symptom severity and thus the need for and duration of pharmacological treatment and length of hospital stay. Objectives: Conduct meta-analysis to determine whether breastfeeding results in better outcomes for NAS infants. Variables included symptom severity, need for and duration of pharmacological treatment, and length of hospital stay. Methods : PubMed, Scopus, Embase, and Cochrane Library were searched from 2000 to 2020, and comparative studies examining breastfeeding for NAS infants were extracted. Randomized trials and cohort studies were included. Data were extracted and evaluated with Review Manager Version 5.3. A random-effects model was used to pool discontinuous outcomes using risk ratio and 95% confidence intervals. Continuous outcomes were evaluated by mean differences and 95% confidence intervals. Results : Across 11 studies, 6,375 neonates were included in the meta-analysis. Using a random-effects analysis, breastfeeding reduced initiation of pharmacological treatment, reduced duration of pharmacological treatment, and reduced length of stay. No differences were detected for severity of NAS symptoms. Most studies only reported one to two variables of interest. For most studies, these variables were not the primary study outcomes. All studies were found to be of low risk and good quality based on the Cochrane Risk Assessment Tools. Varying breastfeeding definitions limit generalizability. Discussion : Breastfeeding is associated with decreased initiation and duration of pharmacological treatment and length of stay. [ABSTRACT FROM AUTHOR]

Paraconduit hiatal hernia (PCHH) is a known complication of esophagectomy with significant morbidity. PCHH may be more common with the transition to a minimally invasive approach and improved survival. We studied the PCHH occurrence following minimally invasive esophagectomy to determine the incidence, treatment, and associated risk factors. We retrospectively reviewed records of patients who underwent esophagectomy at an academic tertiary care center between 2013-2020. We divided the cohort into those who did and did not develop PCHH, identifying differences in demographics, perioperative characteristics and outcomes. We present video of our laparoscopic repair with mesh. Of 49 patients who underwent esophagectomy, seven (14%) developed PCHH at a median of 186 d (60-350 d) postoperatively. They were younger (57 versus 64 y, P < 0.01), and in cases of resection for cancer, more likely to develop tumor recurrence (71% versus 23%, P = 0.02). There was a significant difference in 2-y cancer free survival of patients with a PCHH (PCHH 19% versus no hernia 73%, P < 0.01), but no significant difference in 5-y overall survival (PCHH 36% versus no hernia 68%, P = 0.18). Five of seven PCHH were symptomatic and addressed surgically. Four PCHH repairs recurred at a median of 409 d. PCHH is associated with younger age and tumor recurrence, but not mortality. Safe repair of PCHH can be performed laparoscopically with or without mesh. Further studies, including systematic video review, are needed to address modifiable risk factors and identify optimal techniques for durable repair of post-esophagectomy PCHH. [ABSTRACT FROM AUTHOR]

A number of technologies are available to increase the abundance of DNA markers and contribute to developing high resolution genetic maps suitable for genetic analysis. The aim of this study was to expand the number of Diversity Array Technology (DArT) markers on the wheat array that can be mapped in the wheat genome, and to determine their chromosomal location with respect to simple sequence repeat (SSR) markers and their position on the cytogenetic map. A total of 749 and 512 individual DArT and SSR markers, respectively, were identified on at least one of four genetic maps derived from recombinant inbred line (RIL) or doubled haploid (DH) populations. A number of clustered DArT markers were observed in each genetic map, in which 20–34% of markers were redundant. Segregation distortion of DArT and SSR markers was also observed in each mapping population. Only 14% of markers on the Version 2.0 wheat array were assigned to chromosomal bins by deletion mapping using aneuploid lines. In this regard, methylation effects need to be considered when applying DArT marker in genetic mapping. However, deletion mapping of DArT markers provides a reference to align genetic and cytogenetic maps and estimate the coverage of DNA markers across the wheat genome. [ABSTRACT FROM AUTHOR]

The article discusses the importance of teacher knowledge and methods in reading instruction. The authors note the success of reading intervention and tutoring programs such as Reading Recovery at assisting students with literacy difficulties. Sound literacy techniques and cueing systems have been implemented in many classrooms. The authors note that teacher knowledge should be evaluated to measure its effect on student ability. A study utilizing miscue analysis in reading instruction revealed the state of a teacher's development in regards to literacy instruction.