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Background Limited COVID‐19 vaccination acceptance among healthcare assistants (HCAs) may adversely impact older adults, who are at increased risk for severe COVID‐19 infections. Our study objective was to evaluate the perceptions of COVID‐19 vaccine safety and efficacy in a sample of frontline HCAs, overall and by race and ethnicity. Methods An online survey was conducted from December 2020 to January 2021 through national e‐mail listserv and private Facebook page for the National Association of Health Care Assistants. Responses from 155 HCAs, including certified nursing assistants, home health aides, certified medical assistants, and certified medication technicians, were included. A 27‐item survey asked questions about experiences and perceptions of COVID‐19 vaccines, including how confident they were that COVID‐19 vaccines are safe, effective, and adequately tested in people of color. Multivariable regression was used to identify associations with confidence in COVID‐19 vaccines. Results We analyzed data from 155 completed responses. Among respondents, 23.9% were black and 8.4% Latino/a. Most respondents worked in the nursing home setting (53.5%), followed by hospitals (12.9%), assisted living (11.6%), and home care (10.3%). Respondents expressed low levels of confidence in COVID‐19 vaccines, with fewer than 40% expressing at least moderate confidence in safety (38.1%), effectiveness (31.0%), or adequate testing in people of color (27.1%). Non‐white respondents reported lower levels of confidence in adequate testing of vaccines compared to white respondents. In bivariate and adjusted models, respondents who gave more favorable scores of organizational leadership at their workplace expressed greater confidence in COVID‐19 vaccines. Conclusion Frontline HCAs reported low confidence in COVID‐19 vaccines. Stronger organizational leadership in the workplace appears to be an important factor in influencing HCA's willingness to be vaccinated. Action is needed to enhance COVID‐19 vaccine uptake in this important population with employers playing an important role to build vaccine confidence and trust among employees.

Diverse branching forms have evolved multiple times across the tree of life to facilitate resource acquisition and exchange with the environment. In land plants, sporophyte branching enabled the diversification of the dominant vascular plant clade and arose in their last shared common ancestor; the bryophyte sisters to vascular plants are unbranched. Mechanisms for sporophyte branching are well known in Arabidopsis, where branch initiation and plastic branch outgrowth require directional auxin transport by PIN proteins. However, no broadly applicable genetic mechanisms for branching in vascular plants are known. We have used a combination of surgical and pharmacological treatments and PIN expression analyses in the lycophyte Selaginella kraussiana to identify PIN-mediated auxin transport as the ancestral mechanism for branching within vascular plants. We show that shortrange auxin transport out of the shoot tips promotes branching, and that branch dominance is coordinated by long-range auxin transport throughout the shoot system. Moreover, the plastic outgrowth of a branch from a unique organ system innovated in lycophytes (the rhizophore) is regulated by long-range auxin transport and associated with a transitory drop in PIN expression. We conclude that an ancestral mechanism for branching was independently recruited into plastic branch outgrowth in lycophytes and seed plants. Considered in conjunction with data from other species, our results highlight a pivotal role for the co-option of PINs into the evolution of branching in diverse plant forms.

The CLAVATA pathway is a key regulator of stem cell function in the multicellular shoot tips of Arabidopsis, where it acts via the WUSCHEL transcription factor to modulate hormone homeostasis. Broad scale evolutionary comparisons have shown that CLAVATA is a conserved regulator of land plant stem cell function, but CLAVATA acts independently of WUSCHEL-like (WOX) proteins in bryophytes. The relationship between CLAVATA, hormone homeostasis and the evolution of land plant stem cell functions is unknown.Here we show that in the moss, Physcomitrella (Physcomitrium patens), CLAVATA affects stem cell activity by modulating hormone homeostasis. CLAVATA pathway genes are expressed in the tip cells of filamentous tissues, regulating cell identity, filament branching, plant spread and auxin synthesis. The receptor-like kinase PpRPK2 plays the major role, and Pprpk2 mutants have abnormal responses to cytokinin, auxin, and auxin transport inhibition, and show reduced expression of PIN auxin transporters. We propose a model whereby PpRPK2 modulates auxin gradients in filaments to determine stem cell identity and overall plant form. Our data indicate that CLAVATA-mediated auxin homeostasis is a fundamental property of plant stem cell function, likely exhibited by the last shared common ancestor of land plants.

BACKGROUND: Home-delivered meals promote food security, socialization, and independence among homebound older adults. However, it is unclear which of the two predominant modes of meal delivery, daily-delivered vs. drop-shipped, frozen meals, promotes community living for homebound older adults with dementia. Our objective is to present the protocol for a pilot multisite, two-arm, pragmatic feasibility trial comparing the effect of two modes of meal delivery on nursing home placement among people with dementia. We include justifications for individual randomization with different consent processes and waivers for specific elements of the trial. METHODS: 236 individuals with dementia on waiting lists at three Meals on Wheels programs’ in Florida and Texas will be randomized to receive either: 1) meals delivered multiple times per week by a Meals on Wheels volunteer or paid driver who may socialize with and provide an informal wellness check or 2) frozen meals that are mailed to participants’ homes every two weeks. We will evaluate and refine processes for recruitment and randomization; assess adherence to the intervention; identify common themes in participant experience; and test processes for linking participant data with Medicare records and nursing home assessment data. We will conduct exploratory analyses examining time to nursing home placement, the primary outcome for the larger trial. CONCLUSION: This pilot will inform the follow-on large-scale, definitive pragmatic trial. In addition, the justifications for individual randomization with differing consent procedures for elements of a pragmatic trial provide a model for future trialists looking to develop ethical and feasible pragmatic studies enrolling people with dementia.

COVID-19 vaccination rates have been suboptimal in frontline healthcare assistants (HCAs). We sought to characterize contributors to COVID-19 vaccine hesitancy among HCAs. We conducted an analysis of online survey responses from members of the National Association of Health Care Assistants from December 2020-January 2021. Respondents were asked what it would take for them to be vaccinated against COVID-19. Responses from 309 HCAs were coded to characterize respondents' willingness to be vaccinated and identify contributors to vaccine hesitancy. Approximately 60% (n = 185) of HCAs expressed hesitancy but would consider getting vaccinated under certain circumstances. We identified 8 overarching themes for contributors to COVID-19 vaccine hesitancy, the most common being safety concerns (70% of respondents). Others included efficacy (11.4%), workplace requirements (9.7%), societal influence (9.2%), and compensation (8.1%). Interventions to increase vaccine uptake among HCAs may be most effective by addressing concerns regarding the short-term and long-term safety implications of COVID-19 vaccines.

Summary There can be no doubt that early land plant evolution transformed the planet but, until recently, how and when this was achieved was unclear. Coincidence in the first appearance of land plant fossils and formative shifts in atmospheric oxygen and CO2 are an artefact of the paucity of earlier terrestrial rocks. Disentangling the timing of land plant bodyplan assembly and its impact on global biogeochemical cycles has been precluded by uncertainty concerning the relationships of bryophytes to one another and to the tracheophytes, as well as the timescale over which these events unfolded. New genome and transcriptome sequencing projects, combined with the application of sophisticated phylogenomic modelling methods, have yielded increasing support for the Setaphyta clade of liverworts and mosses, within monophyletic bryophytes. We consider the evolution of anatomy, genes, genomes and of development within this phylogenetic context, concluding that many vascular plant (tracheophytes) novelties were already present in a comparatively complex last common ancestor of living land plants (embryophytes). Molecular clock analyses indicate that embryophytes emerged in a mid-Cambrian to early Ordovician interval, compatible with hypotheses on their role as geoengineers, precipitating early Palaeozoic glaciations.

Introduction.Aphanorrhegma (Physcomitrella) patens(Hedw.) Lindb. is an attractive model system for comparative analyses of leaf development because it evolved leaves (phyllids) independently toflowering plants, yet its genome contains homologues of many gene families that regulate angiosperm leaf development. In addition,A. patensphyllids are primarily a single cell layer thick, making it simple to identify the cellular basis of defects that perturb shape. Identification of gene functions in shape determination depends on like-for- like comparison of mutant versus wild-type plants.Key results.Here we show that, if heteroblasty is not perturbed, such comparisons should use phyllid L13 or above in the heteroblastic series, and fully expanded phyllids above P7 in the developmental series. Using a quantitative approach, we show that heteroblastic size variation reflects differences in cell proliferation rather than cell size and shape. A comparison of control topinA pinBmutant phyllid development verifies that PIN proteins promote cell proliferation and suppress expansion to determine phyllid shape.Conclusion.The results and approach that we have generated will be applicable to any study of A. patensphyllid development to reveal the cellular basis of phyllid size and shape variations.

PurposeConceptual ambiguity about the term “teacher leadership” has retarded development of useful research on this topic. The purpose of this paper is to propose a conceptual framework that researchers might utilize to clarify key assumptions embedded in their use of the term “teacher leadership,” enabling members of this research community to better understand and build upon each other’s work and to develop a knowledge base on teacher leadership.Design/methodology/approachIn 2016 a community of researchers convened in a conversation about their varied conceptions of teacher leadership. The authors analyzed documentation from this convening to identify key ways in which members’ conceptions of teacher leadership diverged. They then drew upon the teacher–leader research literature and their own experiences with teacher–leader initiatives to propose a conceptual framework that would support researchers to define teacher leadership in ways that meet established criteria for an empirically-useful concept.FindingsFour dimensions of teacher leadership that should be referenced in an empirically-useful definition of teacher leadership are: legitimacy, support, objective and method. It is hypothesized that clarifying one’s assumptions about each of these dimensions and providing descriptive evidence of how they are instantiated will address the conceptual ambiguity that currently stymies the accumulation of knowledge in this field.Originality/valueThis paper presents a framework that can provide a strong foundation for the development of a knowledge base on teacher leadership, which is needed to inform education leaders’ efforts to maximize teachers’ leadership influence as asset for improving teaching, learning and schools.

Jill Harrison, one of the authors of Leadership in Early Childhood: Challenges and Complexities, considers a problem-solving approach to conflict resolution.

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Objective The vaccination of skilled nursing facility (SNF) staff is a critical component in the battle against COVID-19. Together, residents and staff, constitute the single most vulnerable population in the pandemic. The health of these workers is completely entangled with the health of those they care for. Vaccination of SNF staff is key to increasing uptake of the vaccine, reducing health disparities, and reopening SNFs to visitors. Yet, as the vaccine rollout begins, some SNF staff are declining to be vaccinated. The purpose of this article is to describe reasons for COVID-19 vaccine hesitancy reported by staff of skilled nursing facilities and understand factors that could potentially reduce hesitancy. Design Five virtual focus groups were conducted with staff of skilled nursing facilities as part of a larger project to improve vaccine uptake. Setting and Participants Focus groups with fifty-eight staff members were conducted virtually using Zoom. Measures Focus groups sought to elicit concerns, perspectives, and experiences related to COVID-19 testing and vaccination. Results Our findings indicate that some SNF staff are hesitant to receive the COVID-19 vaccine. Reasons for this hesitancy include beliefs that the vaccine has been developed too fast and without sufficient testing; personal fears about pre-existing medical conditions, and more general distrust of the government. Conclusions and Implications SNF staff indicate that seeing people like themselves receive the vaccination is more important than seeing public figures. We discuss the vaccination effort as a social enterprise and the need to develop long-term care provider-academic-community partnerships in response to COVID-19 and in expectation of future pandemics., Vaccination of skilled nursing staff (SNF) for COVID-19 is critical, yet some staff are hesitant to receive the vaccine. We highlight how provider-academic-community partnerships can help.

Successful collaborative research is dependent on excellent ideas and innovative experimental approaches, as well as the provision of appropriate support networks. Collaboration requires venues, infrastructures, training facilities, and, perhaps most importantly, a sustained commitment to work together as a community. These activities do not occur without significant effort, yet can be facilitated and overseen by the leadership of a research network that has a clearly defined role to help build resources for their community. Over the past 20 years, this is a role that the UKRI-BBSRC-funded GARNet network has played in the support of the UK curiosity-driven, discovery-led plant science research community. This article reviews the lessons learnt by GARNet in the hope that they can inform the practical implementation of current and future research networks., Lessons learnt from the activities of the GARNet research network in their support of the global plant science community are discussed.

All Evo-Devo studies rely on representative sampling across the tree of interest to elucidate evolutionary trajectories through time. In land plants, genetic resources are well established in model species representing lineages including bryophytes (mosses, liverworts, and hornworts), monilophytes (ferns and allies), and seed plants (gymnosperms and flowering plants), but few resources are available for lycophytes (club mosses, spike mosses, and quillworts). Living lycophytes are a sister group to the euphyllophytes (the fern and seed plant clade), and have retained several ancestral morphological traits despite divergence from a common ancestor of vascular plants around 420 million years ago. This sister relationship offers a unique opportunity to study the conservation of traits such as sporophyte branching, vasculature, and indeterminacy, as well as the convergent evolution of traits such as leaves and roots which have evolved independently in each vascular plant lineage. To elucidate the evolution of vascular development and leaf formation, molecular studies using RNA Seq, quantitative reverse transcription polymerase chain reaction, in situ hybridisation and phylogenetics have revealed the diversification and expression patterns of KNOX, ARP, HD-ZIP, KANADI, and WOX gene families in lycophytes. However, the molecular basis of further trait evolution is not known. Here we describe morphological traits of living lycophytes and their extinct relatives, consider the molecular underpinnings of trait evolution and discuss future research required in lycophytes to understand the key evolutionary innovations enabling the growth and development of all vascular plants.

The Alcohol Care Team launched on January 1st 2020 and was tasked with developing a service to reduce hospital length of stay and readmissions to hospital for primary alcohol patients. The team consists of 2 clinical nurse specialists and 6 in reach workers, covering 7 days a week 8am-8pm. Brief interventions are delivered by the in reach workers with the CNS providing specialist alcohol assessments and prescribing advice, all team members refer to the 2 community providers we work closest with. The CNS also took on the responsibility of screening those with alcohol related liver disease indicators via blood test and/or Fibroscan, as per CQUIN CCGX: Alcohol harm reduction: Early identification of liver disease. Between Jan 1st to the end of March 391 patient referrals where accepted to the ACT within Hull Royal Infirmary and Brief Intervention advice around alcohol consumption was given to patients scoring 7–19 on the Alcohol Use Disorder Identification Tool. 111 were fully assessed by the Alcohol CNS as requiring specialist interventions including substitute prescribing whilst inpatient, alcohol detoxification, nutritional support, relapse prevention prescribing and or on-going aftercare. 99 where referred into community alcohol care providers, 50 where followed up in telephone clinics by the CNS post discharge and thus far 12% patients treated in that time frame remain abstinent at 30 days following detoxification. 58% patients have been screened for liver damage, with another 21 awaiting clinics to be restarted following Covid 19 closures, 63% of those screened have so far been identified as having liver disease that requires further staging with the Hepatology services. Whilst the service hasn’t been running long enough at this point to be able to say readmissions have been positively impacted, the team have worked with a number of frequent attenders to help them secure accommodation, enter community treatment and access mental health support. A small but growing number of successful abstinent patients that prior to engagement with us had attended hospital 2 or more times in a 6 month period, since then they have not required to attend other than for routine outpatient appointments. The COVID-19 pandemic has dramatically reduced both hospital and community service availability but the ACT continue to see patients that need admission and support those outside the hospital as much as possible via telephone. But with 5 months left on the original contract the ACT team have much to still achieve.

Close to 6 million Americans have Alzheimer's disease (AD) or Alzheimer's disease and related dementia (AD/ADRD). These high-need, high-cost patients are vulnerable to receiving poor quality uncoordinated care, ultimately leading to adverse health outcomes, poor quality of life, and misuse of resources. Improving the care of persons living with dementia (PLWD) and their caregivers is an urgent public health challenge that must be informed by high-quality evidence. Although prior research has elucidated opportunities to improve AD/ADRD care, the adoption of promising interventions has been stymied by the lack of research evaluating their effectiveness when implemented under real-world conditions. Embedded pragmatic clinical trials (ePCTs) in healthcare systems have the potential to accelerate the translation of evidence-based interventions into clinical practice. Building from the foundation of the National Institutes of Healthcare Systems Collaboratory, in September 2019 the National Institute on Aging Imbedded Pragmatic AD/ADRD Clinical Trials (IMPACT) Collaboratory was launched. Its mission is to build the nation's capacity to conduct ePCTs within healthcare systems for PLWD and their caregivers by (1) developing and disseminating best practice research methods, (2) supporting the design and conduct of ePCTs including pilot studies, (3) building investigator capacity through training and knowledge generation, (4) catalyzing collaboration among stakeholders, and (5) ensuring the research includes culturally tailored interventions for people from diverse backgrounds. This report presents the rationale, structure, key activities, and markers of success for the overall NIA IMPACT Collaboratory. The articles that follow in this special Issue describe the specific work of its 10 core working groups and teams. J Am Geriatr Soc 68:S1-S7, 2020.

Embedded pragmatic clinical trials (ePCTs) of nondrug interventions for Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) are conducted in real-world clinical settings and designed to generate an evidence base to inform clinical and policy decisions about care for this vulnerable population. The ePCTs exist within a complex ecosystem of relationships between researchers, payors, policymakers, healthcare systems, direct care staff, advocacy groups, families, caregivers, and people living with dementia (PLWD). Because the rapid increase of the number of Americans with AD/ADRD outpaces curative treatments, there is an urgent need to mobilize the power of these relationships to improve dementia care and address a mounting public health crisis. Stakeholder engagement in ePCTs is essential to generate research questions, establish the relevancy of trials to the intended end users, and understand the factors that influence dissemination and implementation in real-world clinical settings. The process of including stakeholders in ePCTs for dementia is similar to stakeholder engagement in ePCTs for other diseases and conditions; however, the unique nature of embedded research, prevalence of caregiver and provider burden, and the progressive worsening of cognitive impairment in PLWD must be approached with additional strategies. This article presents key considerations of stakeholder engagement for ePCTs in AD/ADRD and main activities of the stakeholder engagement team in the National Institute on Aging IMPACT Collaboratory to move the field forward. J Am Geriatr Soc 68:S62-S67, 2020.

Bryophytes and vascular plants represent the broadest evolutionary divergence in the land plant lineage, and comparative analyses of development spanning this divergence therefore offer opportunities to identify truisms of plant development in general. In vascular plants, organs are formed repetitively around meristems at the growing tips in response to positional cues. In contrast, leaf formation in mosses and leafy liverworts occurs from clonal groups of cells derived from a daughter cell of the apical stem cell known as merophytes, and cell lineage is a crucial factor in repetitive organ formation. However, it remains unclear whether merophyte lineages are a general feature of repetitive organ formation in bryophytes as patterns of organogenesis in thalloid liverworts are unclear. To address this question, we developed a clonal analysis method for use in the thalloid liverwort Marchantia polymorpha, involving random low-frequency induction of a constitutively expressed nuclear-targeted fluorescent protein by dual heat-shock and dexamethasone treatment. M. polymorpha thalli ultimately derive from stem cells in the apical notch, and the lobes predominantly develop from merophytes cleft to the left and right of the apical cell(s). Sector induction in gemmae and subsequent culture occasionally generated fluorescent sectors that bisected thalli along the midrib and were maintained through several bifurcation events, likely reflecting the border between lateral merophytes. Such thallus-bisecting sectors traversed dorsal air chambers and gemma cups, suggesting that these organs arise independently of merophyte cell lineages in response to local positional cues.