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Introduction: While many aspects of emergency medicine (EM) residency training are standardized among residents within a single residency program, there is no standard for the distribution of chief complaints (CC) that residents should see over the course of residency. This could result in substantial variability in each resident’s clinical exposure. Our objective in this study was to explore EM residents’ clinical exposure to CCs to determine whether substantial variation exists. If such variation exists, this could suggest the need for curricular reform to address gaps in resident clinical exposure during training.Methods: This was a retrospective observational study of EM residents who graduated in the years 2016–2021 at a single, university-affiliated emergency department (ED) in the midwestern United States. All patient encounters where a CC was logged were included and categorized into 1 of 20 clinical domains based on the 2016 American Board of Emergency Medicine Model of Clinical Practice. We calculated descriptive statistics for the top 10 most encountered domains for comparison among residents.Results: We included a total of 228,916 patient encounters from 69 residents in the analysis. Residents were involved in an average of 3,323 distinct patient encounters during the study period. The overall interquartile range for patient encounters was 523. The three CC domains with the broadest interquartile variation were abdominal and gastrointestinal disorders (116), musculoskeletal disorders (nontraumatic)(93), and traumatic disorders (86).Conclusion: Within a single, three-year academic EM program, substantial variation existed among residents with regard to the variety of patient CCs seen during their residency training.

Mindfulness witnessed a substantial popularity surge in the past decade, especially as digitally self-administered interventions became available at relatively low costs. Yet, it is uncertain whether they effectively help reduce stress. In a preregistered (OSF https://doi.org/10.17605/OSF.IO/UF4JZ ; retrospective registration at ClinicalTrials.gov NCT06308744 ) multi-site study (nsites = 37, nparticipants = 2,239, 70.4% women, Mage = 22.4, s.d.age = 10.1, all fluent English speakers), we experimentally tested whether four single, standalone mindfulness exercises effectively reduced stress, using Bayesian mixed-effects models. All exercises proved to be more efficacious than the active control. We observed a mean difference of 0.27 (d = -0.56; 95% confidence interval, -0.43 to -0.69) between the control condition (M = 1.95, s.d. = 0.50) and the condition with the largest stress reduction (body scan: M = 1.68, s.d. = 0.46). Our findings suggest that mindfulness may be beneficial for reducing self-reported short-term stress for English speakers from higher-income countries.

Multiple myeloma is a treatable, but currently incurable, hematological malignancy of plasma cells characterized by diverse and complex tumor genetics for which precision medicine approaches to treatment are lacking. The Multiple Myeloma Research Foundations Relating Clinical Outcomes in Multiple Myeloma to Personal Assessment of Genetic Profile study ( NCT01454297 ) is a longitudinal, observational clinical study of newly diagnosed patients with multiple myeloma (n = 1,143) where tumor samples are characterized using whole-genome sequencing, whole-exome sequencing and RNA sequencing at diagnosis and progression, and clinical data are collected every 3 months. Analyses of the baseline cohort identified genes that are the target of recurrent gain-of-function and loss-of-function events. Consensus clustering identified 8 and 12 unique copy number and expression subtypes of myeloma, respectively, identifying high-risk genetic subtypes and elucidating many of the molecular underpinnings of these unique biological groups. Analysis of serial samples showed that 25.5% of patients transition to a high-risk expression subtype at progression. We observed robust expression of immunotherapy targets in this subtype, suggesting a potential therapeutic option.

BackgroundSmall incentives could improve engagement in HIV care. We evaluated the short-term and longer-term effects of financial incentives for visit attendance on viral suppression among adults initiating antiretroviral therapy (ART) in Tanzania.MethodsIn a type 1 hybrid effectiveness-implementation study, we randomised (1:1) 32 primary care HIV clinics in four Tanzanian regions to usual care (control group) or the intervention (usual care plus ≤6 monthly incentives [22 500 Tanzanian Shillings, about US$10, each], conditional on visit attendance). Adults (aged ≥18 years) initiating ART (

The intention-to-treat (ITT) analysis of the Applying Wolbachia to Eliminate Dengue (AWED) trial estimated a protective efficacy of 77.1% for participants resident in areas randomised to receive releases of wMel-infected Aedes aegypti mosquitoes, an emerging dengue preventive intervention. The limiting assumptions of ITT analyses in cluster randomised trials and the mobility of mosquitoes and humans across cluster boundaries indicate the primary analysis is likely to underestimate the full public health benefit. Using spatiotemporally-resolved data on the distribution of Wolbachia mosquitoes and on the mobility of AWED participants (n = 6306), we perform complier-restricted and per-protocol re-examinations of the efficacy of the Wolbachia intervention. Increased intervention efficacy was estimated in all analyses by the refined exposure measures. The complier-restricted analysis returned an estimated efficacy of 80.7% (95% CI 65.9, 89.0) and the per-protocol analysis estimated 82.7% (71.7, 88.4) efficacy when comparing participants with an estimated wMel exposure of ≥ 80% compared to those with

More than twenty-five years ago, a group of women in South Minneapolis conceived of “a place to learn words,” a place where our children could learn the Dakota and Ojibwe languages. Today that place is Wicoie Nandagikendan Dakota and Ojibwe Immersion Program. For our entire existence, we have partnered with other organizations and borrowed space in others’ buildings to teach our children. Our Community-Based Inquiry began as a process of finding and creating our own space. Our inquiry has evolved into a journey of understanding that space is much more than a physical “place to learn words”; our space will be a place of health, wellness, culture, and language for our children, our organization, and our community.

The capture-recapture method is a common tool used in epidemiology to estimate the size of hidden populations and correct the underascertainment of cases, based on incomplete and overlapping lists of the target population. Log-linear models are often used to estimate the population size yet may produce implausible and unreliable estimates due to model misspecification and small cell sizes. A novel targeted minimum loss-based estimation (TMLE) model developed for capture-recapture makes several notable improvements to conventional modeling: targeting the parameter of interest, flexibly fitting the data to alternative functional forms, and limiting bias from small cell sizes. Using simulations and empirical data from the San Francisco, California, Department of Public Healths human immunodeficiency virus (HIV) surveillance registry, we evaluated the performance of the TMLE model and compared results with those of other common models. Based on 2,584 people observed on 3 lists reportable to the surveillance registry, the TMLE model estimated the number of San Francisco residents living with HIV as of December 31, 2019, to be 13,523 (95% confidence interval: 12,222, 14,824). This estimate, compared with a ground truth of 12,507, was the most accurate and precise of all models examined. The TMLE model is a significant advancement in capture-recapture studies, leveraging modern statistical methods to improve estimation of the sizes of hidden populations.

Populations in the United States rise daily, as do the number of people who are considered multicultural. With this comes a greater need for speech-language pathologists (SLPs) who are able to assess and treat such individuals -- a training process that begins in graduate programs. The primary objective of this study was to determine the knowledge and perceptions of graduate students in speech-language pathology as it pertains to multiculturalism. A survey was conducted to explore graduate students' knowledge and perceptions of multicultural topics. Participants were recruited from programs in the southeastern United States via email. Just under 400 surveys were returned with 322 complete responses received. Most graduate programs are covering multicultural and multilingual topics across courses to prepare students to work with such populations in future careers. Students recognize the importance of these topics because the opportunities to work with multicultural and multilingual clients are becoming more frequent. A firm foundation can set the tone for an SLP's career; without adequate training in the area of multiculturalism, many individuals may receive inadequate services whether the speech-language pathologist recognizes the gaps in care or not.

Abstract Regulatory T cells (Tregs) with multifaceted functions suppress anti-tumor immunity by signaling surrounding cells. Here we report Tregs use the surface lymphotoxin (LT)α1β2 to preferentially stimulate LT beta receptor (LTβR) nonclassical NFκB signaling on both tumor cells and lymphatic endothelial cells (LECs) to accelerate tumor growth and metastasis. Selectively targeting LTβR nonclassical NFκB pathway inhibits tumor growth and migration in vitro. Leveraging in vivo Treg LTα1β2 interactions with LTβR on tumor cells and LECs, transfer of wild type but not LTα-/- Tregs promotes B16F10 melanoma growth and tumor cell-derived chemokines in LTβR-/- mice; and increases SOX18 and FLRT2 in lymphatic vessels of LTβR-/- melanoma. Blocking the nonclassical pathway suppresses tumor growth and lymphatic metastasis by reducing chemokine production, restricting Treg recruitment to tumors, and retaining intratumoral IFNγ+ CD8 T cells. Our data reveals that Treg LTα1β2 promotes LTβR nonclassical NFκB signaling in tumor cells and LECs providing a rational strategy to prevent Treg promoted tumor growth and metastasis.

Nucleotide-binding oligomerization domain, leucine rich repeat containing X1 (NLRX1) is a negative regulator of the nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB) pathway, with a significant role in the context of inflammation. Altered expression of NLRX1 is prevalent in inflammatory diseases leading to interest in NLRX1 as a drug target. There is a lack of structural information available for NLRX1 as only the leucine-rich repeat domain of NLRX1 has been crystallised. This lack of structural data limits progress in understanding function and potential druggability of NLRX1. We have modelled full-length NLRX1 by combining experimental, homology modelled and AlphaFold2 structures. The full-length model of NLRX1 was used to explore protein dynamics, mutational tolerance and potential functions. We identified a new RNA binding site in the previously uncharacterized N-terminus, which served as a basis to model protein-RNA complexes. The structure of the adenosine triphosphate (ATP) binding domain revealed a potential catalytic functionality for the protein as a member of the ATPase Associated with Diverse Cellular Activity family of proteins. Finally, we investigated the interactions of NLRX1 with small molecule activators in development, revealing a binding site that has not previously been discussed in literature. The model generated here will help to catalyse efforts towards creating new drug molecules to target NLRX1 and may be used to inform further studies on functionality of NLRX1.

Abstract A lean muscular body of low weight is often associated with performance for cyclists and can be difficult to achieve. Disordered eating for some cyclists may develop in the pursuit of lean muscularity which is perceived to be beneficial to performance. Further, emotion dysregulation may exacerbate negative feelings about body image, increasing the risk of developing disordered eating as a means of controlling weight and shape. While research in athlete populations has been substantial, disordered eating in cyclists is relatively under-explored. The current study examined whether shape and weight concern and drive for leanness were associated with muscularity-oriented disordered eating and whether these relationships were moderated by emotion dysregulation. Interactions between these factors were also investigated. Participants were 139 Australian competitive cyclists (112 males, 27 females, aged 18–68 years) who completed a self-report questionnaire comprised of measures of shape and weight concern, drive for leanness, muscularity-oriented eating and emotion dysregulation variables. Both shape and weight concern and drive for leanness had a unique association with muscularity-oriented disordered eating. Emotion dysregulation was found to have a unique association with muscularity-oriented disordered eating when controlling for drive for leanness, but not when shape and weight concern was controlled. Additionally, emotion dysregulation moderated the association between shape and weight concern and muscularity-oriented disordered eating, whereby the relationship was intensified at higher levels of emotion dysregulation. Our study has extended the literature by indicating that cyclists’ desire to attain a lean body is associated with muscularity-oriented disordered eating. Further, emotion dysregulation moderated this link, suggesting it could be a maintaining factor worth addressing.

Abstract Background Between 2006 and 2016 the prevalence of overweight and obesity among children and adolescents aged 5–19 years in Peru increased from 22.7 to 27.0%. This investment case quantifies the economic impacts of childhood and adolescent overweight and obesity in Peru. It identifies and quantifies the potential impact of a set of new or expanded interventions that can strengthen current national efforts to prevent and reduce child and adolescent overweight and obesity. Methods A deterministic Markov cohort model with a societal cost perspective estimated reductions in mortality and morbidity from implementing interventions to prevent and reduce child and adolescent overweight and obesity and the impact in savings in healthcare costs and gains in wages and productivity. Interventions identified through a review of published literature includes a school-based social marketing campaign, exclusive breastfeeding promotion and support, a healthy food and drink policy for school premises, and a 20% subsidy on fruits and vegetables for people living below the national poverty line. The return on investment (ROI) was calculated along with the estimated cost savings associated with the interventions. Analysis was conducted to test ROI sensitivity to changes in the key parameters and assumptions. Results Between 2025 and 2092, the expected combined direct and indirect healthcare costs attributable to child and adolescent overweight and obesity in Peru are 210.6 billion USD. The direct healthcare costs are 1.8 billion USD, and the indirect costs are 208.8 billion USD. Expected savings for all interventions combined is 13.9 billion USD with a per-person savings of 12,089.8 USD. The expected ROI of the four interventions combined is 39.3 USD (30-years), 64.6 USD (50-years), and 164.1 USD (66-years) per one USD invested. Conclusions The overweight and obesity epidemic among children and adolescents in Peru requires wide-ranging and expanded implementation of policies to achieve long-term reductions in prevalence. This study’s findings show that the four priority interventions have high ROIs and can be used to guide policy to address the complex interplay of factors that contribute to the obesogenic environment.

The graduate school experience is a relevant part of professional development and can be instrumental in framing future careers. There is, however, a lack of resources and understanding concerning how institutions can best develop a positive culture during graduate school. In this paper, six professionals outline their graduate program experiences and how the faculty members and peers within their program worked to create a culture of shared responsibility that established meaningful relationships and set them up for success in the multiple career paths they chose to pursue. Specifically, the authors address: 1) creating a foundation of shared values, 2) navigating challenges and celebrating success, and 3) team learning and growth. These elements allowed them to establish meaningful and long-lasting connections that have been personally and professionally beneficial. The authors discuss perspectives on how other graduate students can cultivate professional development within their graduate program that will stem beyond their time in the classroom. These relationships formed within graduate programs continue to provide opportunities for professional collaboration, resource sharing, and an unwavering network of social support. It is vital that other graduate programs work toward creating positive experiences within their programs that will allow for future success in the professional field.

Social work education programs in the U.S. are accredited by the Council on Social Work Education. Amendments made to the 2022 competencies reflect antiracism language, which requires assessment opportunities in the classroom moving forward. An assessment tool that assesses efficacy across the four domains, specifically related to antiracism, is essential for practice readiness, assessment, and accountability for future professional social workers. This article presents the Social Work Education Anti-Racism Scale to help programs assess their progress toward preparing social work students to become practitioners who embrace antiracism. The final scale included 30 items on five subscales related to antiracism: knowledge, values, skills, cognitive and affective processes, and professional responsibility. Applications for accredited social work programs are discussed.

This paper reflects on the systematic interconnections between creative workers and higher education institutions (HEIs). Despite the latter representing key intermediaries in creative industries' development and creative workers' career trajectories, the relationship between the two has rarely been framed in a relational and systemic framework. To do so, we chose the UK theatre sector as the case study and adopted a mixed methodology: UK Higher Education Statistical Agency quantitative data, which informed us on the employment state of workers 6 months after graduation, were combined with 21 semi-structured interviews with actors and actresses to understand the complexity of their relationship with HEIs. HEIs emerge as the initial door to paid jobs and professional networks for graduates and as employers for those in the later stages of their careers: the lack of formal ways to access jobs and the precarious working conditions for performers make hence HEIs a crucial force in shaping workers' careers. Furthermore, HE remains throughout the career of theatre workers an important part of their portfolio, providing reliable income and more stable working patterns when needed. The paper concludes with the findings' policy implications and the future role of HEIs in creative and cultural ecosystems.