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Purpose: Classical and alternative macrophage activation could play important roles in atherosclerotic plaque progression and rupture, in part by increasing production of proteases, including matrix metalloproteinases (MMPs), which directly destabilize plaques. Lymphocyte-derived cytokines are believed essential for classical and alternative macrophage activation in plaques, although this hypothesis has not been rigorously tested.Methods and Results: We measured the expression of phenotypic markers and MMPs in classically and alternatively activated mouse macrophages in vitro. We then compared mRNA expression levels of these genes in foam cells derived from subcutaneous sponges of high fat fed ApoE knockout and ApoE/Rag-1 double knockout mice. Furthermore, we performed immunohistochemistry in aortic root and brachiocephalic arteries to detect marker and MMP protein expression in vivo. Classical activation of mouse macrophages in vitro (n=3-6) significantly increased NOS-2, COX-2 and MMPs-13 and -14, whereas alternative activation increased arginase-1, CD206, Ym-1 and MMP-19 expressions (p<0.05). Interestingly, LPS partially reversed the effect of IL-4 on Arg-1 and Ym-1 and completely reversed the overexpression of CD206, so that a combination of LPS and IL-4 generated a combined phenotype with markers of both classically and alternatively activated macrophages. Foam cells in subcutaneous sponges from ApoE mice also expressed phenotypic markers and MMPs, irrespective of Rag-1 genotype. The proportion of plaque staining for markers of classical or alternative activation were examined using immunohistochemistry in brachiocephalic arteries from mice that had been given a high-fat diet. Although the plaque size was smaller in male ApoE/Rag1 KO mice, little difference was found in the proportion of macrophages present (ApoE KO 29 ± 4.3% of plaque area (mean ± SEM); ApoE/Rag1 KO 33 ± 4.8%), or the levels of the markers of activation. For example, male mice had similar iNOS (ApoE KO 16 ± 4.3%; ApoE/Rag1 KO 19 ± 5.1%), arginase-1 (ApoE KO 13 ± 4.1%; ApoE/Rag1 KO 15 ± 4.0%) and Ym-1 content (ApoE KO 2.5 ± 0.80%; ApoE/Rag1 KO 8.7 ± 3.5%). These results suggest that half of the foamy macrophages in the plaques bore markers of classical or alternative activation, irrespective of genotype.Conclusions: Classical and alternative macrophage activation in sponge and plaque foam cell macrophages can occur independently of T- and B-lymphocytes. [ABSTRACT FROM AUTHOR]

Background: The incidence of chronic disease is increasing worldwide which, in turn, increases the demand for healthcare services. To meet these demands, healthcare systems are adapting their services in order to reduce treatment costs and ensure coherence for patients with multiple diseases. One form of adaptation is shared outpatient consultations between internal medical specialties. However, little is known about how patients interact with multiple clinicians in shared consultations., Aim: This project aimed to explore how patients with diabetes and chronic kidney disease interact with multiple clinicians in a shared outpatient setting., Research Methods: We performed a qualitative ethnographic study, combining focused participant observations with informal field interviews. We included 17 participants, nine males and eight females with a mean age of 67.3 in the project. The data analysis was guided by Braun and Clarke's reflexive thematic analysis and Arthur Kleinman's theory of illness and disease., Results: We found one over-arching theme: 'A consultation which encompassed both illness and disease' and four subthemes: (1) 'The medical focal point' pertained to the focus on physiological measurements in dialogue between patients and clinicians. (2) 'The possibility of negotiations' illustrated how decisions about dialysis and pharmacological treatment were based on negotiations. (3) 'Speaking different languages' displayed how patients used alternative illness-based explanations whereas clinicians tended to use biomedical language. (4) 'Perceptions of everyday life' concerned what patients considered was best for them when managing their illness and everyday lives., Conclusion: Patients present information on how they balance life with physiological and psychosocial challenges. When clinicians employ a biomedical perspective, opportunities to gain information on patients' illness behaviours or cues to negotiate are missed. Patients prioritise functioning on a daily level over following treatment regimes. These findings are tenuous and require verification in similar studies in similar settings., Short Phrases: Shared Outpatient Clinic, Patient-clinician interactions., (© 2024 The Author(s). Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

Background/objectives: Overall priorities of the international pediatric-onset spinal cord injury (SCI) population are unknown. The purpose was to describe and compare Life and Health (L&H) domain overall priorities of European youth with SCI and their parents and caregivers (P&C)., Methods: A survey with a cross-sectional design, prepared by the PEPSCI Collaboration, was conducted in six European countries. In total, 202 participants, including youth with SCI (n = 101) and their P&C (n = 101), were included. Overall priorities were calculated based on unhappiness, importance, and research., Results: The sample included youth aged 8-12 years (30.7%) and 13-25 years (69.3%; 38.6% 13-17-year-olds and 30.7% youth aged 18-25 years), in addition to their P&C. The top three L&H priorities highlighted by P&C of the youth aged 8-12 years were "bladder" function (78%), "leg/foot movement" (77%), or "bowel" function (74%), compared with "leg/foot movement" (79%), "sit-to-stand" (76%), or "walking/ability to move" (75%) reported by P&C of the youth aged 13-25 years. The youth aged 13-25 years considered "leg/foot movement" (68%), "bowel" (66%), or "bladder" function (65%) as priorities. The top 10 priorities highlighted by the youth aged 13-25 years compared to the top 10 priorities rated by P&C were issues related to "personal needs". Nevertheless, "pressure injuries", "pain", "bowel function", or "mobility in the community" were highlighted as top preferences of priorities for the youth aged 13-25 years compared to their P&C., Conclusions: Adolescents/young adults highlighted health domain priorities compared with their P&C, who equally considered L&H domains. Life domains, which were previously unaddressed, were highlighted by P&C, including "adulthood expectations" and "parenthood expectations". This survey will promote the involvement of stakeholders for comprehensive rehabilitation management for this population.

Objectives: To explore patients' preferences regarding virtual consultations (via telephone or video) and to explore healthcare professionals' assessment of whether virtual consultations can maintain the same clinical quality as in-person consultations for outpatient care., Methods: A cross-sectional survey was conducted among patients with an in-person consultation at the outpatient clinic for internal medicine and among healthcare professionals who treated the patients. The prevalence of preference was determined using descriptive statistics based on cross-tabulated frequencies. Percentages are presented with 95% confidence intervals (95%CI)., Results: In total, 218 patients (response rate 67%) completed the questionnaire; 79 patients (36%) preferred a virtual consultation (95%CI: 30%-43%); telephones were the most popular and preferred by 72 patients (33%; 95%CI: 27%-39%) followed by video preferred by 54 patients (25%; 95%CI: 19%-31%). Regarding contextual factors, male gender and previous experiences with telephone or video consultations were statistically significant predictors in favour of virtual consultations. Healthcare professionals estimated that 58 consultations (21%; 95%CI: 17%-26%) could have been conducted virtually with the same professional and clinical quality as the current in-person consultations., Conclusions: Current practice does not fully align with patient preferences for virtual visits in internal medicine outpatient clinics. Patients should be given the choice of virtual consultations whenever they are deemed professionally and clinically possible to enhance patient autonomy and satisfaction, while being mindful of speciality-specific considerations., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Background: Almost half of all women in the US experience intimate partner violence (IPV) in their lifetime. The US Preventive Services Task Force recommends IPV screening paired with intervention for women of reproductive age. We aim to understand clinical practices and policies that are beneficial, detrimental, or insufficient to support survivors of IPV in a safety-net healthcare system., Methods: We sampled 45 women who were 18-64 years old, had experienced IPV within the prior year and were patients in the San Francisco Health Network. We conducted in-depth, semi-structured interviews to elicit their perspectives on disclosing IPV and obtaining support within the healthcare system. We analyzed our data using thematic analysis and grounded theory practices informed by ecological systems theory., Findings: We identified four themes regarding factors that impeded or facilitated discussing and addressing IPV across interpersonal and systemic levels relating to relationship-building, respect, autonomy and resources. (1) Interpersonal barriers included insufficient attention to relationship-building, lack of respect or concern for survivor circumstances, and feeling pressured to disclose IPV or to comply with clinicians' recommended interventions. (2) Interpersonal facilitators consisted of patient-centered IPV inquiry, attentive listening, strength-based counseling and transparency regarding confidentiality. (3) Systemic barriers such as visit time limitations, clinician turn-over and feared loss of autonomy from involvement of governmental systems leading to separation from children or harm to partners, negatively affected interpersonal dynamics. (4) Systemic facilitators involved provision of resources through IPV universal education, on-site access to IPV services, and community partnerships., Conclusions: Women experiencing IPV in our study reported that relationship-building, respect, autonomy, and IPV-related resources were essential components to providing support, promoting safety, and enabling healing in the healthcare setting. Successful trauma-informed transformation of healthcare systems must optimize interpersonal and systemic factors that improve survivor wellbeing while eliminating barriers., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Background: Although feedback from people with adult-onset spinal cord injury (SCI) has been considered for new rehabilitation programs, little is known about the priorities of the pediatric-onset SCI population. This study describes and compares health and life (H&L) domain research priorities of youth with pediatric-onset SCI and their parents/caregivers., Methods: A cross-sectional survey, designed by the Pan-European Paediatric Spinal Cord Injury (PEPSCI) Collaboration, was performed at six European countries. Dyad data from 202 participants, youth with pediatric-onset SCI (n = 101) and their parents/caregivers (n = 101), were analyzed with the PEPSCI H&L domain surveys., Results: The cohort was composed of 8 to 12-year-olds (30.7%), 13 to 17-year-olds (38.6%), and 18 to 25-year-olds (30.7%). The top three H&L domain research priorities reported by parents/caregivers of 8 to 12-year-olds were "walking/ability to move" (91%), "bladder" function (90%), and "general health/feel" (89%), compared with "physical function" (93%), "general health/feel" (90%), and "walking/ability to move" (89%) rated by parents/caregivers of 13 to 25-year-olds. "Bowel" function (85%), "leg/foot movement" (84%), and "bladder" function (84%) were reported as priorities by 13 to 25-year-olds, whereas "physical function" (84%), "experience at school" (83%), and "general mood" were highlighted by 8 to 12-year-olds. The top 10 priorities preferred by 13 to 25-year-olds when compared with the top 10 priorities reported by their parents/caregivers, included problems related to "bowel" and "pain.", Conclusions: Health domain research priorities were highlighted by 13 to 25-year-olds, compared with their parents/caregivers who equally identified H&L domains. This survey will aid health care and clinical research organizations to engage stakeholders to implement a comprehensive research strategy for the pediatric SCI population., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: Rises in average life expectancy, increased comorbidities and frailty among older patients lead to higher admission rates to intensive care units (ICU). During an ICU stay, loss of physical and cognitive functions may occur, causing prolonged rehabilitation. Some functions may be lost permanently, affecting quality of life (QoL). There is a lack of understanding regarding how many variables are relevant to health-related outcomes and which outcomes are significant for the QoL of frail, elderly patients following discharge from the ICU. Therefore, this scoping review aims to identify reported variables for health-related outcomes and explore perspectives regarding QoL for this patient group., Methods and Analysis: The Joanna Briggs Institute guidelines for scoping reviews will be employed and original, peer-reviewed studies in English and Scandinavian languages published from 2013 to 2023 will be included. The search will be conducted from July 2023 to December 2023, according to the inclusion criteria in Embase, MEDLINE, PsycINFO and CINAHL. References to identified studies will be hand-searched, along with backward and forward citation searching for systematic reviews. A librarian will support and qualify the search strategy. Two reviewers will independently screen eligible studies and perform data extraction according to predefined headings. In the event of disagreements, a third reviewer will adjudicate until consensus is achieved. Results will be presented narratively and in table form and discussed in relation to relevant literature., Ethics and Dissemination: Ethical approval is unnecessary, as the review synthesises existing research. The results will be disseminated through a peer-reviewed publication in a scientific journal., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Context/objective: No information is available regarding priorities for pediatric-onset spinal cord injury (SCI). This study described the Health and Life (H&L) domain priorities of youth with pediatric-onset SCI and their parents/caregivers living in Spain., Design: A cross-sectional survey., Setting: Two SCI rehabilitation centers., Participants: Sixty participants, youth with pediatric-onset SCI (n = 26) and parents/caregivers (n = 34)., Interventions: Not applicable., Outcome Measures: Median overall priorities calculated on the basis of importance, unhappiness, and research measured with a new survey of pediatric H&L domains and rated using a 5-point Likert Scale., Results: A total of 60 surveys were received providing information on 35 individuals with SCI: 2-7-year-olds (25.7%), 8-12-year-olds (22.9%), 13-17-year-olds (31.4%), and 18-25-year-olds (20.0%). The top three overall H&L priorities reported by parents/caregivers of 2-12-year-olds were "parenthood expectations" (84%), "leg/foot movement" (83%), and "bladder" function (83%), compared to "dressing/undressing" (78%), "walking/ability to move" (77%) and "bladder" function (77%) rated for 13-25-year-olds. "Sit-to-stand" (79%), "leg/foot movement" (78%) and "arm/hand movement" (77%) were reported as priorities by 13-25-year-olds. The 13-25-year-olds highlighted "sit-to-stand" (100%), "eating/drinking" (54%), and "physical function" (94%) as their top unhappiness, importance, and research priorities, respectively. Significant differences between tetraplegia and paraplegia were found in "mobility in the community" (unhappiness item) for 13-25-years-old., Conclusion: Health domains were considered the top overall H&L priorities by parents/caregivers of 13-25-year-olds, compared to life domains reported for their 2-12-year-olds. This survey will aid rehabilitation professionals to engage stakeholders to implement a comprehensive SCI management program for the pediatric population.

Introduction: Universal screening for suicide risk in primary care settings is a promising avenue for preventing self-harm and improving health outcomes. Triaging youth to an appropriate level of care, including diverting lower-risk patients from the emergency department (ED) is a meaningful goal. Previous research indicates integrated behavioral health (IBH) may prevent unnecessary admission to the ED on the day of suicide risk screening. We hypothesized that youth who received an IBH consultation the same day as suicide risk screening would be less likely to be admitted to the ED, but more likely to contact IBH services and utilize primary care in the following month., Methods: We conducted a retrospective chart review of 3,649 youth aged 10-18 years who were screened with the Ask Suicide-Screening Questions (ASQ) in two pediatric primary care practices. We collected demographic data, ASQ and Patient Health Questionnaire-9 (PHQ-9) scores, as well as patient contacts with IBH, the ED, and medical primary care the day of screening and the following 31 days. We conducted a series of logistic regressions and chi-square analyses to determine whether contact with IBH on the same day as positive suicide risk screenings predicted same-day admission to the ED, IBH contact, and medical primary care utilization., Results: Among the 7,982 ASQ scores, 1,380 (18%) were non-acute and 87 ASQs (1%) screened acutely positive. Over 90% of positive screens were diverted from the ED regardless of IBH contact. None of the patients died from suicide. Same-day IBH was associated with higher likelihood of general ED visits for all positive screens (acute and non-acute together). None of the positive screens that received an IBH consultation on the same day as screening were admitted to the ED in the subsequent month. Contact with IBH the same day as screening positively predicted utilization of IBH and medical primary care services in the subsequent month, especially for youth with minority race and ethnicity identities., Discussion: In the context of clinics with IBH and systematic risk assessment processes, most youth who screen positive for suicide risk are diverted from the ED. However, contrary to our hypothesis, our study showed that youth who received same-day IBH consultations were more likely to be admitted to the ED compared to peers who did not receive IBH consultations. These findings suggest that systematic suicide screening combined with IBH consultations in pediatric primary care can effectively identify risk levels and triage patients to appropriate care., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Wellen, Wright, Bickford, Bakken and Riley.)

Objective: To determine the relationship between constructive adolescent problem solving (positive problem-solving orientation and rational problem-solving style) and caregiver problem solving and collaborative involvement with primary caregiver among adolescents with spinal cord injuries (SCIs). Positive constructive adolescent problem solving was hypothesized to be predicted by more effective caregiver problem solving and higher collaborative involvement., Methods: Participants in this cross-sectional study were 79 adolescent and primary caregiver dyads recruited from a pediatric rehabilitation care system in North America. All participants completed a standardized problem-solving instrument and adolescent participants completed an adapted measure of collaborative parent involvement., Results: More effective caregiver problem solving and adolescent perceptions of more collaboration with caregivers around SCI care were significantly associated with higher positive problem-solving orientation and higher rational problem-solving style among adolescents., Conclusions: Results underscore the importance of caregiver problem-solving skills and their collaboration with adolescents with SCI when addressing care needs. Clinically, findings highlight opportunities for parent involvement and skill-building as an important factor of rehabilitation for adolescents with SCI., Competing Interests: The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer CS declared a past co-authorship with the authors KZ and LV to the handling Editor., (© 2023 Clark, Rivelli, Mroczkowski, Espino, Kelly, Vogel and Zebracki.)

Objectives: To examine patients' and relatives' experiences with participation in an online kidney school (OKS) and its influence on their choice of treatment modality; furthermore, to report on healthcare professionals' (HCPs) first experiences with OKS. Methods : A mixed-methods design with parallel data collection involving two questionnaires for participants, including patients and relatives and a focus group discussion (FGD) with HCPs. Results : The OKS was feasible, and overall, patients and relatives were satisfied. Participation in the OKS increased the percentage of those who felt ready to make a decision regarding treatment. One over-arching theme ( evolvement of the online kidney school over time ) and three sub-themes ( concerns and perceived barriers, facilitators, and benefits and future possibilities ) emerged from the FGD. Conclusions: The OKS proved feasible, was well-accepted, and increased participants' abilities to choose a preferred treatment modality. HCPs displayed initial concerns regarding the quality of the OKS and worried about the practicality of conducting the OKS. They experienced a feeling of something being lost. However, over time, HCPs developed strategies to tackle initial concerns and discovered that patients were more capable of participating than they had anticipated.

Introduction: Christmas, which is just around the corner, is associated with stress in Danish homes. Therefore, it is important to find interventions that reduce stress levels. Classical music is known to have a soothing effect as it reduces systolic blood pressure and increases quality of life. However, whether or not Christmas music can bring about the same effect is unknown. Therefore, the purpose of this study was to examine whether or not Christmas music has a calming effect., Methods: The design was a classical intervention study, in which participants were subjected to Christmas music. Blood pressure was measured prior to, and after, the intervention, and a questionnaire was completed regarding demographical questions and questions about one's attitude to Christmas and Christmas spirit. We used a paired t-test to test the primary outcome and a p-value ≤ 0.05 was considered statistically significant., Results: Ten participants took part in the study, of whom 8 were female (and 1 unknown). The systolic blood pressure fell by 3.5 mmHg (p = 0.12) and the Christmas mood which was on an average of 5 at the beginning of the study rose by 0.8 point following the intervention., Conclusion: In this study, we displayed that Christmas music has the potential to reduce blood pressure and increase the Christmas spirit. Therefore, we recommend that one plays Christmas music throughout the month of December to reduce stress levels and bring us whole skinned and in high spirits through the Christmas season., Funding: none., Trial Registration: none.

Increasing numbers of patients are being referred to specialised palliative care (SPC) which, in order to be beneficial, is recommended to last more than three months. This cohort study aimed to describe time to end-of-life after initiating SPC treatment and to explore potential regional variations. We used national register data from all Danish hospital SPC teams. We included patients who started SPC treatment from 2015-2018 to explore if time to end-of-life was longer than three months. Descriptive statistics were used to summarise the data and a generalised linear model was used to assess variations among the five Danish regions. A total of 27,724 patients were included, of whom 36.7% (95% CI 36.2-37.1%) had over three months to end-of-life. In the Capital Region of Denmark, 40.1% (95% CI 39.0-41.3%) had over three months to end-of-life versus 32.5% (95% CI 30.9-34.0%) in North Denmark Region. We conclude that most patients live for a shorter period of time than the recommended three months after initiating SPC treatment. This is neither optimal for patient care, nor the healthcare system. A geographical variation between regions was shown indicating different practices, patient groups or resources. These results warrant further investigation to promote optimal SPC treatment.

Introduction: Increases in the use of telehealth in palliative care (telepalliative care) prior to, and during, the COVID-19 pandemic have resulted in a proliferation of studies on the topic. While knowledge is building on how providers and recipients adapt to telepalliative care, no reviews have, as of yet, examined telepalliative care from a patient and family perspective. Therefore, the aim of this integrative review is to explore patients and families' perspectives on telepalliative., Methods and Analysis: An integrative review will be performed inspired by the methodology of Remmington and Toronto from March 2022 to December 2022. Medline, Embase, PsycINFO and CINAHL will be searched for primary peer-reviewed studies that describe telepalliative care from patient and families' perspectives. Limiters will be used for age; 18 years+, time; 10 years, and language; English and Danish. Hand searches of authors of included articles and reference lists of included articles will be performed. Two reviewers will independently screen and appraise selected articles using the Mixed Method Appraisal Tool. Conflicts will be resolved through discussions with a third reviewer. Data will be extracted independently by two reviewers into a data matrix with predefined headings and analysed using thematic analysis. Findings will be reported thematically, summarised into a thematic synthesis and discussed in relation to relevant literature., Ethics and Dissemination: Ethical approval is not required for this review. Results will be published in an international peer-reviewed journal and presented at a relevant international conference. Reporting of this protocol was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocol checklist and prospectively reported to PROSPERO (CRD42022301206)., Competing Interests: Competing interests: ANOS reports personal fees from Leo Innovation Lab (an independently established unit of LEO PharmaA/S), OpenTeleHealth aps and a grant from Knud and Edith Eriksens Mindefond, outside the submitted work., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: More than 10% of the population worldwide is affected by chronic kidney disease (CKD). Despite many promising indications regarding the use of mHealth education for patients with CKD, there is still little evidence regarding the feasibility, effectiveness outcomes and outcome measures. Therefore, we will conduct a scoping review to examine the currently available evidence on mHealth education for patients with CKD and, thus, explore the existing evidence regarding feasibility, effectiveness outcomes and outcome measures, patient and/or provider perception and implementation challenges., Methods and Analysis: A scoping review will be conducted in accordance with Joanna Briggs Institute Manual for Evidence Synthesis chapter on scoping reviews.MEDLINE, Embase, CINAHL and PsycINFO will be searched. The search strategy will consist of blocks, which have been adopted and modified from former Cochrane reviews. Two independent reviewers will screen studies. Characteristics of the included studies, both quantitative and qualitative, will be reported using quantitative descriptive statistics. Quantitative results will be grouped by objectives (feasibility, effectiveness outcomes and outcome measures, patient perception and implementation challenges), types of intervention and characteristics of participants. Qualitative results will be organised into categories using an iterative process, as suggested by Pollock et al. ETHICS AND DISSEMINATION: As this scoping review does not involve primary data collection, ethical permission is unnecessary. Results of the scoping review will be published in an international peer-reviewed scientific journal., Trial Registration Number: Open Science Framework (https://osf.io/gxkeh/)., Competing Interests: Competing interests: ANØS reports personal fees from OpenTeleHealth, outside the submitted work., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Grinding stones and ground stone implements are important technological innovations in later human evolution, allowing the exploitation and use of new plant foods, novel tools (e.g., bone points and edge ground axes) and ground pigments. Excavations at the site of Madjedbebe recovered Australia's (if not one of the world's) largest and longest records of Pleistocene grinding stones, which span the past 65 thousand years (ka). Microscopic and chemical analyses show that the Madjedbebe grinding stone assemblage displays the earliest known evidence for seed grinding and intensive plant use, the earliest known production and use of edge-ground stone hatchets (aka axes), and the earliest intensive use of ground ochre pigments in Sahul (the Pleistocene landmass of Australia and New Guinea). The Madjedbebe grinding stone assemblage reveals economic, technological and symbolic innovations exemplary of the phenotypic plasticity of Homo sapiens dispersing out of Africa and into Sahul., (© 2022. Crown.)

The aim of this study was to describe the needs and research priorities of Swiss children/adolescents and young adults (from here, "young people") with spinal cord injury/disorder (SCI/D) or spina bifida (SB) and their parents in the health and life domains as part of the international Pan-European Pediatric Spinal Cord Injury (PEPSCI) collaboration. Surveys included queries about the satisfaction, importance, research priorities, quality of life (QoL), and characteristics of the young people. Fifty-three surveys with corresponding parent-proxy reports were collected between April and November 2019. The self-report QoL sum scores from young people with SCI/D and SB were 77% and 73%, respectively. Parent-proxy report QoL sum scores were lower, with 70% scores for parents of young people with SCI/D and 64% scores for parents of young people with SB. "Having fun", "relation to family members", and "physical functioning" were found to be highly important for all young people. "Physical functioning", "prevention of pressure injuries", "general health", and "bowel management" received the highest scores for research priority in at least one of the subgroups. As parents tend to underestimate the QoL of their children and young people prioritized research topics differently, both young peoples' and caregivers' perspectives should be included in the selection of research topics.

Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no conflicts of interest to disclose.

Background and Objectives: The Women's Wellness through Equity and Leadership (WEL) program was developed as a collaboration between 6 major medical associations in the United States. The goal was to contribute to the creation of equitable work environments for women physicians. The purpose of the current study was to evaluate the pilot implementation of WEL., Methods: Participants included a diverse group of 18 early career to midcareer women physicians from across medical specialties, 3 from each partner organization. WEL was developed as an 18-month program with 3 series focused on wellness, equity, and leadership and included monthly virtual and in-person meetings. After institutional board review approval, a mixed-methods evaluation design was incorporated, which included postseries and postprogram surveys and in-depth telephone interviews., Results: Participants delineated several drivers of program success, including peer support and/or networks; interconnectedness between the topics of wellness, equity, and leadership; and diversity of participants and faculty. Areas for improvement included more opportunities to connect with peers and share progress and more structured mentorship. Regarding program impact, participants reported increased knowledge and behavior change because of their participation., Conclusions: This longitudinal, cohort initiative resulted from a successful collaboration between 6 medical associations. Evaluation findings suggest that providing opportunities for women physicians to connect with and support each other while building knowledge and skills can be an effective way to advance wellness, equity, and leadership for women in medicine., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)

Objective: To provide a narrative overview of the current knowledge on Last Aid Courses (LAC) and experiences from the implementation process in different countries., Background: Major challenges for public health palliative care include supporting all people who wish to die at home and educating the public about death, dying and palliative care. LAC commenced in 2015 in order to educate and empower citizens to participate in end-of-life care and to improve the public debate about death and dying. The International Last Aid project and the International Last Aid working group were established to provide and evaluate public palliative care education (PPCE) using LAC., Methods: A literature search in PubMed/Medline was performed and a narrative overview of the existing literature on LAC and PPCE is provided. In addition, experiences from the implementation process are presented., Conclusions: An International Last Aid working group was established with representatives from different countries and national organisations. This group revises the curriculum and contents of LAC in regular intervals with the latest revision in October 2020. Scientific evaluation of LAC is coordinated by the international Last Aid Research Group Europe (LARGE). Work on LAC has commenced in 18 countries. The overall results show that LAC are feasible and very well accepted in many different countries and cultures. Adults, children, and other groups, such as hospital employees and police officers, have participated in LAC. LAC for citizens is also possible in an online course format that was established and tested during the COVID-19 pandemic. Scientific work on the effects of LAC and cultural issues connected to LAC are ongoing in a number of countries. LAC are feasible and well accepted by citizens in different countries. The courses can contribute to a public debate on death, dying and palliative care and may contribute to empowering citizens in providing end-of-life care.

Background: Medical advancements, limited resources and shifting demographics have increased the number of patients with palliative care needs in primary care. To address educational needs, the specialised palliative care team of South Jutland, Denmark, created a telemedicine educational programme in palliative care to empower district nurses., Aim: The study aimed to explore district nurses' views on and experiences with a telemedicine educational programme in palliative care., Research Methods: A qualitative explorative study based on interpretive description was conducted. Data collection consisted of four focus group interviews with district nurses from three municipalities, supplemented by participant observations and a focus group interview with teachers from the specialised palliative care team. Data were analysed using predominately inductive thematic analysis., Results: District nurses (n = 15) who participated in the programme and members of the specialised palliative care team (n = 6) who taught the programme were included. Analysis revealed the following advantages: reaffirming and updating existing knowledge, reduced professional isolation and creation of a forum to promote knowledge dissemination. A disadvantage was limited interaction between teachers and district nurses, questioning suitability for teaching complex palliative care. Initial technical problems affected motivation to participate. Organisational support differed between participating municipalities resulting in varying degrees of programme integration. Despite advantages of IT-expert-led sessions, key-nurse-led sessions in smaller groups proved more beneficial, suggesting a combination of IT support and key-nurse management to maximise benefits., Conclusion: The use of an inter-professional telemedicine educational programme to teach palliative care to district nurses is beneficial. However, programmes should be designed for interactivity and address varying educational needs. Key-nurse roles require managerial and IT support to optimise knowledge dissemination. Further research on implementation of telemedicine education in palliative care is needed., (© 2020 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

Background: Chlamydia trachomatis (CT) is a highly prevalent sexually transmitted infection in adolescents that can lead to serious complications. San Francisco has one of the highest rates of CT infections in the United States. At baseline, screening rates at the Children's Health Center were significantly below national and network levels. This project aimed to increase screening rates for female patients age 16-24 from 29.2% to 44% in an 18-month period., Methods: The organization engaged providers, residents, and nursing staff to understand the root causes and choose the screening approach. The following strategies were used to implement this approach in primary and urgent care: (1) universal urine collection, (2) provider and staff education, and (3) adoption of faculty Maintenance of Certification (MOC) credit and resident physician financial incentives., Results: The annual screening rate for CT in primary care female patients 16-24 years old increased from 29.2% to 61.5% in 18 months, and improved to 71.2% one year after the project. Screening rates for female patients over age 15 seen in the colocated urgent care also increased significantly. The research team found no instances of false positive results and had 4 positive results in high-risk patients who initially reported abstinence., Conclusions: The intervention design and engagement of stakeholders with incentives was associated with significant and sustainable improvements in the CT screening rate for female adolescent primary care patients. This work shows how universal opt-out screening can be a sustainable and effective method to address common barriers to increasing screening for CT in adolescents., (Published by Elsevier Inc.)

Objective: The American Academy of Pediatrics recommends screening parents for postpartum depression during pediatric primary care visits. Unfortunately, many women who screen positive do not obtain treatment. Providing mental health services for women in the same location as their children's primary care may facilitate treatment, but few such clinics exist. We designed a qualitative study to evaluate women's perceptions and experiences with receiving mental health services from psychiatrists embedded in a safety-net pediatric primary care clinic., Methods: Semistructured interviews were conducted with women receiving mental health care from embedded psychiatrists in a safety-net pediatric clinic. Data were analyzed using an inductive approach., Results: Twenty women participated. Five major themes emerged: 1) barriers to maternal mental health care, including psychiatric symptoms impairing access, stigma, and fear of Child Protective Services; 2) benefits of embedded care, including convenience, low barrier to entry and trust; 3) motherhood as facilitator to care, with early motherhood described as a time of vulnerability to relapse; 4) focus on parenting, including appreciation for parenting skills and normalization of the mothering experience; 5) treatment modality preferences, including concerns about medications and a preference for psychotherapy., Conclusions: Postpartum women face many barriers to psychiatric care. Mental health care embedded within the pediatric setting lowers barriers to care during this critical period. These insights should inform further collaboration between adult psychiatrists and pediatric care providers., (Copyright © 2019 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate treatment responses in benign familial neonatal epilepsy (BFNE)., Methods: We recruited patients with BFNE through a multicenter international collaboration and reviewed electroclinical and genetic details, and treatment response. All patients were tested at minimum for mutations/deletions in the KCNQ2, KCNQ3, and SCN2A genes., Results: Nineteen patients were included in this study. A family history of neonatal seizures was positive in 16 patients, and one additional patient had a family history of infantile seizures. Mutations or deletions of KCNQ2 were found in 14, and of KCNQ3 in 2, of the 19 patients. In all patients, seizures began at 2-5 days of life and occurred multiple times per day. Four patients developed status epilepticus. Seizures were focal, alternating between hemispheres, and characterized by asymmetric tonic posturing associated with apnea and desaturation, followed by unilateral or bilateral asynchronous clonic jerking. Twelve of 19 patients were treated with multiple medications prior to seizure cessation. Seventeen of (88%) 19 patients were seizure-free within hours of receiving oral carbamazepine (CBZ) or oxcarbazepine (OXC). Earlier initiation of CBZ was associated with shorter hospitalization (p < 0.01). No side effects of CBZ were reported. All patients had normal development and remain seizure-free at a mean follow-up period of 7.8 years (6 months-16 years)., Significance: This study provides evidence that CBZ is safe and rapidly effective in neonates with BFNE, even in status epilepticus. We propose that CBZ should be the drug of choice in benign familial neonatal seizures., (Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.)

Postpartum women are consuming their placentas to achieve claimed health benefits, including improved mood, energy, and lactation. Strong scientific evidence to substantiate these claims is lacking. Self-reported benefits from some women include improved mood and lactation; animal models suggest there may be an analgesic effect. Possible risks include infection, thromboembolism from estrogens in placental tissue, and accumulation of environmental toxins. Women's health care providers should be aware of this practice to help women make informed decisions., (Copyright © 2016 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

This article examines why organizations struggle with learning how to prevent discrimination against their employees with disabilities. To explore this issue, qualitative archival data were collected and analyzed from 53 Americans with Disabilities Act (ADA) lawsuits filed against 44 organizations. Theoretical analysis of the qualitative data suggests that several organizationally based learning theories explain the difficulty organizations have with creating a disability-friendly work environment. These barriers to learning are embedded in complex defense mechanisms and discriminatory organizational routines. Furthermore, organizations have difficulties engaging in higher-order and vicarious learning. We conclude the article with examples of successful learning practices as they relate to barriers identified in the qualitative analysis., (2005 John Wiley & Sons, Ltd.)