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Rural adolescents are at risk for firearm-related injury and death. In response, professional organizations have called for communication between adolescents, parents, and providers about firearms. A shared understanding of firearms between providers and families can facilitate effectiveness of health interventions. However, few studies engage adolescents in identifying their perception of common firearm terminology. The current study aimed to understand how adolescents in rural communities defined firearm-related terms including firearm, carrying, and handling, and differences in terms based on prior firearm training. Data were from a mixed methods community-based participatory study of 93 adolescents from rural Washington state. Thematic qualitative coding identified themes for firearm (gun, weapon, projectile, and tool), carrying (on you/your person, transportation, and holding), and handling (actively using, safe use, and holding) and differences between those with prior firearms training. Findings provide insight into perceptions of firearm-related terms for adolescents, an often-neglected voice, and inform rural policy and prevention efforts.

Qualitative research seeks to provide context, nuance, and depth of understanding in regard to systems, behaviors, and/or lived experiences. As such, it plays a key role in many areas of medical education. Composed of myriad methods and methodologies, each of which may be valuable for some areas of inquiry but less so for others, qualitative research can be challenging to design, conduct, and report. This challenge can be conceptualized as ensuring that the study design, conduct, and reporting are fit for purpose, following directly from a well-formulated research question. In this Perspective, we share seven important and practical recommendations to enhance the design and conduct of high-quality qualitative research in medical education: 1) craft a strong research question, 2) link the study design to this question, 3) assemble a team with diverse expertise, 4) prioritize information power when selecting recruitment and sampling strategies, 5) collect data carefully, 6) rigorously analyze data, and 7) disseminate results that tell a complete story.

IntroductionDepressive symptoms are associated with higher risk of dementia, but how they impact cognition in diverse populations is unclear.MethodsAsian, Black, Latino, or White participants (n = 2227) in the Kaiser Healthy Aging and Diverse Life Experiences (age 65+) and the Study of Healthy Aging in African Americans (age 50+) underwent up to three waves of cognitive assessments over 4 years. Multilevel models stratified by race/ethnicity were used to examine whether depressive symptoms were associated with cognition or cognitive decline and whether associations differed by race/ethnicity.ResultsHigher depressive symptoms were associated with lower baseline verbal episodic memory scores (-0.06, 95% CI: -0.12, -0.01; -0.15, 95% CI: -0.25, -0.04), and faster decline annually in semantic memory (-0.04, 95% CI: -0.07, -0.01; -0.10, 95% CI: -0.15, -0.05) for Black and Latino participants. Depressive symptoms were associated with lower baseline but not decline in executive function.DiscussionDepressive symptoms were associated with worse cognitive outcomes, with some evidence of heterogeneity across racial/ethnic groups.HighlightsWe examined whether baseline depressive symptoms were differentially associated with domain-specific cognition or cognitive decline by race/ethnicity. Depressive symptoms were associated with worse cognitive scores for all racial/ethnic groups across different domains examined. Higher depressive symptoms were associated with faster cognitive decline for semantic memory for Black and Latino participants. The results suggest a particularly harmful association between depressive symptoms and cognition in certain racial/ethnic groups.

Children's literature is an important pedagogical tool in early childhood classrooms as it provides opportunities for young readers to engage with texts and to see the world from multiple perspectives. Central to cultivating equitable early childhood learning experiences is utilizing children's literature with multiple representations of historically underrepresented individuals and communities. In this article, we report on our analysis of episodes of care (Noddings, "Journal of Educational Change" 2:35-43, 2001) across select Pura Belpré awarded texts for early childhood grades. Additionally, we share findings from across our critical multicultural analysis of these select texts to highlight depictions of age, sex, race, ethnicities, socio-economic status, and geographic regions. Discussion focuses on exploring an ethic of care across the voices and representations of Latinx youth and families in these awarded texts and how such conversations are vital with young children in today's early childhood classrooms.

BACKGROUND: Pembrolizumab has a manageable safety profile as described in its label, which was primarily based on 2799 patients who participated in clinical trials for melanoma or non-small cell lung cancer. Here, we evaluated the safety of pembrolizumab in a broader population of patients from 31 advanced cancer clinical trials across 19 cancer types. METHODS: Safety was analyzed in patients who received at least one dose of pembrolizumab (200 mg every 3 weeks [Q3W], 10 mg/kg Q2W or Q3W, or 2 mg/kg Q3W). Adverse events (AEs) and immune-mediated AEs and infusion reactions were evaluated. RESULTS: Safety data from 8937 patients in 31 trials of pembrolizumab monotherapy were pooled (median, seven administrations; range, 1-59). Median duration on treatment was 4.1 months (range, 0.03-40.1). AEs occurred in 96.6% of patients. Grade 3-5 AEs occurred in 50.6% of patients. AEs led to pembrolizumab discontinuation in 12.7% of patients and death in 5.9%. Immune-mediated AEs and infusion reactions occurred in 23.7% of patients (4.6% experienced multiple immune-mediated AEs/infusion reactions) and led to pembrolizumab discontinuation in 3.6% and death in 0.2%. Grade 3-5 immune-mediated AEs occurred in 6.3% of patients. Serious immune-mediated AEs and infusion reactions occurred in 6.0% of patients. Median time to immune-mediated AE onset was 85 days (range, 13-163). Of 2657 immune-mediated AEs, 22.3% were initially treated with prednisone ≥ 40 mg/day or equivalent, and 8.3% were initially treated with lower steroid doses. CONCLUSIONS: This pooled analysis of 31 clinical trials showed that pembrolizumab has a consistent safety profile across indications.

PURPOSE: Alcohol use and handgun carrying are more prevalent among youth in rural than urban areas and their association may be stronger among rural adolescents. Alcohol use may be modifiable with implications for reducing handgun carrying and firearm-related harm. We examined the association between lagged alcohol use and subsequent handgun carrying in rural areas and examined variation in the association by developmental stages, hypothesizing that it would be stronger among adolescents than youth adults. METHODS: We used a longitudinal sample of 2,002 adolescents from ages 12 to 26 growing up in 12 rural communities in 7 states with surveys collected from 2004 to 2019. We estimated the association of lagged past-month alcohol use on handgun carrying in the subsequent 12 months using population-average generalized estimating equations with logistic regression on multiply imputed data. FINDINGS: During adolescence (ages 12-18), those who drank heavily had 1.43 times the odds (95% CI = [1.01, 2.03]) of subsequent handgun carrying compared to those who did not drink alcohol, and those who consumed alcohol but did not drink heavily had 1.30 times the odds of subsequent handgun carrying compared to those who did not drink (95% CI = [0.98, 1.71]). During young adulthood (ages 19-26), associations of alcohol use (OR = 1.28; 95% CI = [0.94, 1.63]) and heavy drinking (OR = 1.38; 95% CI = [1.08, 1.68]) were similar to adolescence. CONCLUSIONS: Alcohol use and subsequent handgun carrying were positively associated during adolescence and young adulthood among individuals who grew up in rural areas, similar to findings in urban areas. Reducing alcohol use may be an important strategy to prevent handgun carrying and firearm-related harm among young people in rural areas.

The purpose of this study was to examine international students' racial sensemaking and perceptions of race, racism, and racial conflict in the United States in the years 2020/2021. The past year was one filled with contention, including the politicizing of a global virus and racial conflict from anti-Blackness and anti-Asian violence. Although racism felt far removed from many participants' personal sphere until the arrival of the pandemic and racial conflicts in the year 2020, George Floyd's murder served a critical incident that elicited reactions to U.S. racial dynamics, the Black Lives Matter movement, and racial protests. The participants' experiences challenged what they thought they knew about race and shaped how they moved forward while living and learning in the United States.

Abstract Many actors have recently launched significant new initiatives in the domain of climate change and health. Given this important nexus, we undertook a review of funding patterns from 1985 – 2022, using the NIH RePORTER database for the United States and the Dimensions database globally. This includes an assessment of more than 9 million publicly funded projects across both databases with a collective budget of more than $3 trillion. We estimate that between 1985 and 2022 only 0.26% of research funding awarded by the NIH related to climate change, and only 0.70% of funded projects in the Dimensions database related to climate change and human health. Moreover, we thematically map funding patterns according to four thematic areas: changes in climate, the effects of climate change, health impacts, and interventions and strategies. More funding is needed to better anticipate and prepare for the projected health impacts of climate change.

During their transition from basic to higher education, first-year undergraduate nursing students need to balance theoretical and clinical requirements, as well as their social life. A significant number of them struggle with this, due to a lack of coping mechanisms due to poor resilience. This study aimed to determine factors that influence resilience among first-year undergraduate nursing students at a South African university. A cross-sectional descriptive research design was followed, with stratified convenient sampling. Data were collected during August 2023 using an adapted self-administered online questionnaire. The reliability and validity of the adapted version was ensured in the context of this study. Principal component analysis and varimax rotation were used to analyse data. A total of 123 participants (47.2% from campus A and 52.8% from campus B) completed the questionnaire. The majority (88%) were females. This study showed that resilience can be dependent on various factors, such as lecturer support, parental support, academic achievement, peer and mentor support, optimism about the future, and self-determination. It is recommended that higher education institutions should consider incorporating the factors presented in this study as part of the broader orientation of first-year undergraduate nursing students when they first arrive at university.

Abstract Background The undergraduate first year of a nursing program is regarded as a difficult and challenging part of the nursing course, due to the variation experienced in the transition from basic to higher education compared to other first-year courses. This causes stress, which could contribute to students’ lack of coping with the transition to the university. These challenges call for coping strategies to ensure resilience among this cohort of undergraduate nursing students. Methods An exploratory descriptive qualitative research design was adopted to assess the coping mechanisms used by first-year nursing students during transition from basic to higher education. Data was gathered through four online focus group discussions which were conducted using the Microsoft Teams app, with participants purposefully selected from the two campuses where the study was conducted. The focus group discussions were recorded and transcribed verbatim for analysis. Data was analysed by the researcher and the co-coder using qualitative content data analysis. Findings Three categories emerged from the data: experiences of transition from basic to higher education, coping with transition from basic to higher education, and recommendations for coping with transition from basic to higher education. Participants expressed that they use the following six coping strategies during the transition from basic to higher education: adaptive coping, appraisal-focused coping, emotion-focused coping, problem-focused coping, social coping, and seeking help from mentors. Conclusions Transition from basic to higher education is challenging for undergraduate first-year nursing students. The study suggests that there is a need to standardize and contextualize the support measures for undergraduate first-year nursing students during their transition from basic to higher education in order to enhance their ability to cope.

Background: Theatre involves expressing meaning in a collaborative art using words, movements, and visual elements. However, theatre remains poorly used as a viable teaching strategy or a method for communicating health messages. Instead, it is relegated to solemnly transmitting indigenous knowledge. Aim: To explore and describe communication of educational health messages through theatre using an appreciative inquiry approach. Setting: The study was conducted among the Ubuntu theatre group from a rural province in South Africa. The group is famous for using theatre to communicate educational health messages through the lens of Ubuntu philosophy. Methods: A qualitative exploratory descriptive design was followed. A non-probability purposive sampling was used to select thirteen members of the Ubuntu theatre group. Data were collected by two moderators from the two focus group discussions through conference calls. Deductive thematic content data analysis was used to describe the 4-Ds of appreciative inquiry. Results: Theatre is a playful pedagogy that can cut through language and cultural barriers when used to communicate educational health messages. There is a need to formalise it as an alternative pedagogy within the health care sciences curriculum. Furthermore, the sustainability of theatre as an educational tool is dependent on expanding educational practices, documenting its success stories and periodical in-service training. Conclusion: Using Ubuntu innovation to communicate complex educational health messages through theatre can maximise learning. This study recommends that Ubuntu-infused health messages be conveyed using theatre. Contribution: The study adds to the body of knowledge by presenting Ubuntu innovation in communicating health messages through theatre.

Rurality is perceived by many to be a deficit or challenge when it comes to teacher recruitment and retention. However, recently, some have argued that moving away from a deficit model and treating rurality as an asset may hold promise for teacher staffing. Drawing on Person-Organization (P-O) fit theory, we extend this argument in our study by investigating the perceptions of teachers from the rural Lowcountry of South Carolina, a region with documented severe teacher shortages, concerning rural teaching advantages and challenges. These reflections provide the data necessary to develop realistic job previews (RJP) that can be highlighted in the teacher staffing process at their schools. To obtain the data, we conducted in-depth semi-structured interviews with 11 rural teachers and one principal (n=12). Several common themes emerged, which we used to develop a sample web-based RJP content for demonstration purposes.

The background of this study is situated within the COVID-19 pandemic as an acute challenge with chronic issues that international graduate students have faced continuously. With the pandemic serving as a critical incident, we highlight the political, systemic, and personal fragilities of international graduate students studying in the southern United States. The methods for our study were informed by a narrative inquiry approach combined with a systematic literature review to connect with the conceptual framework of Avison and Turner’s chronic strains and Robertson’s conception of timescales. The findings highlight three broad themes: shifting immigration policies and travel uncertainty, institutional responses, and mental health stressors and personal concerns. The study conclusions illuminate suggestions for institutions and policymakers, including clarifying policies, communicating better with international graduate students, and providing tailored counseling support. These suggestions are significant for improving international graduate students’ well-being in the face of any acute issues that may arise in the future.

Black women leaders in higher education face a double bind of gender and racial disparity and biases within the education workforce and their institutions. The literature does not fully articulate Black women's considerations when pursuing community college presidencies and the strategies they use to overcome the hurdles and discrimination they encounter. This research expands the literature by using critical race and Black feminist thought as theoretical frameworks to examine the ascension and succession of eight Black women leading community colleges and how they circumvented barriers associated with the male-dominated position. Findings reveal how three elements of resiliency--emotional intelligence, authenticity, and agility--contest and challenge the oppressive nature of White male privilege in gendered organizations. This newfound perspective has implications for the recruitment, retention, and persistence of faculty and administrators, leadership development programs, and succession planning at community colleges across the United States.

BackgroundCandida parapsilosis is a common cause of invasive candidiasis, especially in newborn infants, and infections have been increasing over the past two decades. C. parapsilosis has been primarily studied in pure culture, leaving gaps in understanding of its function in a microbiome context.ResultsHere, we compare five unique C. parapsilosis genomes assembled from premature infant fecal samples, three of which are newly reconstructed, and analyze their genome structure, population diversity, and in situ activity relative to reference strains in pure culture. All five genomes contain hotspots of single nucleotide variants, some of which are shared by strains from multiple hospitals. A subset of environmental and hospital-derived genomes share variants within these hotspots suggesting derivation of that region from a common ancestor. Four of the newly reconstructed C. parapsilosis genomes have 4 to 16 copies of the gene RTA3, which encodes a lipid translocase and is implicated in antifungal resistance, potentially indicating adaptation to hospital antifungal use. Time course metatranscriptomics and metaproteomics on fecal samples from a premature infant with a C. parapsilosis blood infection revealed highly variable in situ expression patterns that are distinct from those of similar strains in pure cultures. For example, biofilm formation genes were relatively less expressed in situ, whereas genes linked to oxygen utilization were more highly expressed, indicative of growth in a relatively aerobic environment. In gut microbiome samples, C. parapsilosis co-existed with Enterococcus faecalis that shifted in relative abundance over time, accompanied by changes in bacterial and fungal gene expression and proteome composition.ConclusionsThe results reveal potentially medically relevant differences in Candida function in gut vs. laboratory environments, and constrain evolutionary processes that could contribute to hospital strain persistence and transfer into premature infant microbiomes. Video abstract.

Abstract Background Effective interprofessional team collaboration is one of the necessary domains for successful interprofessional collaborative practices in healthcare (IPCP), which is crucial for the delivery of safe and quality healthcare services. Therefore, understanding the contribution of interprofessional education in nursing students is vital to improving collaboration practices in nursing students, in preparation for the dynamics that await after registration in practice amongst the interprofessional team. Thus, the aim of the study was to summarise the contribution of interprofessional education in nursing education in developing competent undergraduate nursing students. Design The integrative literature review design as described by Whittemore and Knafl was adopted for the review. The review consists of five steps, namely, problem identification, literature search, data analysis, data interpretation, and the last step was data presentation. Three databases were searched for the articles, namely CINHAL, Scopus, and Science Direct. Articles were retrieved using Search terms such as “Competence,” “Contribution,”, “Development,” “Interprofessional education” and “Undergraduate nursing students” retrieved Articles published between 2018 and 2022 were selected. Results Three themes emerged from the review, namely the promotion of patient safety in nursing practice, the socialisation of nursing students in interprofessional collaboration, and the promotion of the development of professional identity. Conclusion This study is the first step in determining the contributions of early interprofessional education to nursing education. It could set the stage for further studies that examine strategies the undergraduate nursing curriculum can adopt and develop sound interprofessional competencies that promote patient safety and quality healthcare by nursing students. Impact The developers of the nursing curriculum and nursing educators can use the results in developing a curriculum that includes interprofessional education with the aim of improving the quality of teaching and learning that advances competent and safe nursing students.

BackgroundHoarding disorder (HD) is a highly debilitating psychiatric disorder that affects 2-6% of adults. Neuropsychological deficits in visual memory, detection, and categorization have been reported in HD. To date, no study has examined the relationship between neurocognitive functioning and treatment for HD. We aim to determine the association between neurocognitive functioning and treatment outcomes, as well as the impact of HD-specific treatment on cognitive functioning.Methods323 individuals with HD were randomized to 20 weeks of peer- or clinician-led group behavioral treatment. 242 participants completed pre- and post-treatment neuropsychological testing covering eight neurocognitive domains. Rates of cognitive impairment (CI) were assessed for each neurocognitive domain. The association of baseline neurocognitive function on treatment response was examined using multiple regression. MANOVA and post-hoc tests were used to determine neurocognitive performance change pre- to post treatment.ResultsSixty-seven percent of participants had CI on ≥1 cognitive domain. There was no significant effect of pre-treatment neurocognitive functioning on treatment outcome. Post-treatment improvements were observed in visual memory, visual detection, decision making, information processing speed, visuospatial processing, attention/working memory (p≤.001). Declines in performance were found in visual reaction time and categorization.LimitationsThis was a non-inferiority trial to examine two treatment types with no normative comparison group. Treatment seeking individuals are more likely to be insightful, motivated, and have other features which limit generalizability.ConclusionsPatterns of cognitive impairment in HD are similar to previous reports. Pre-treatment neurocognitive functioning did not impact treatment response. Neuropsychological functioning improved across multiple domains following targeted treatment.