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There is much agreement within counseling psychology on the importance of social justice, yet social justice education and training remain limited in counseling psychology programs (Beerman et al., 2012; Pieterse et al., 2009; Singh et al., 2010). Critical components to social justice education and training include an emphasis on systems theories that could inform interventions (i.e. advocacy and activism) at the exosystem and mesosystem levels as well as learning about the breadth of activism and advocacy skills. Assessment, diagnosis, and conceptualization are considered core functional competencies in professional psychology (Fouad, 2009), yet these processes are often only taught at the individual level. If the goal of advocacy and activism are to foster systems change, considered a functional competency in counseling psychology (CCPTP, 2012), then it is crucial to provide systems-level theories and skills in counseling psychology education and training. We describe how we have attended to the provision of systems-level education and training in our respective programs. We will provide recommendations about the inclusion of systems-level theories, classroom formats, assignments, and mentorship designed to foster trainees’ development of a systems-level theoretical orientation, as well as skills to engage in social justice research, leadership, and both micro- and macro-level advocacy interventions.

Using the lifespan biopsychosocial model of cumulative vulnerability and minority health as a theroretical lens, the present study proposed two models to test the relationships among racial discrimination, cognitive–emotional factors, and risky sexual behaviors in a sample of 302 Black college students in the United States. Our models provided support for some of the hypothesized direct and indirect pathways. As expected, overt racial discrimination and subtle racial discrimination (i.e., racial microaggression) were both positively related to cognitive–emotional factors (i.e., anxiety, depression, hopelessness, and hostility). Racial microaggressions were significantly positively related to risky sexual behaviors, but overt racial discrimination was not. Hostility was the only cognitive–emotional factor that facilitated an indirect, significant effect from racial microaggressions to risky sexual behaviors. Potential implications are discussed for practice, training programs, and future counseling psychology research with Black college students using the lifespan biopsychosocial model of cumulative vulnerability and minority health.

Background The safety and immunogenicity profile of COVID-19 vaccines when administered concomitantly with seasonal influenza vaccines have not yet been reported. We therefore aimed to report the results of a substudy within a phase 3 UK trial, by evaluating the safety, immunogenicity, and efficacy of NVX-CoV2373 when co-administered with licensed seasonal influenza vaccines. Methods We did a planned exploratory substudy as part of the randomised, observer-blinded, placebo-controlled, phase 3 trial of the safety and efficacy of the COVID-19 vaccine (NVX-CoV2373) by co-administrating the influenza vaccine at four study hospitals in the UK. Approximately, the first 400 participants meeting the main study entry criteria—with no contraindications to influenza vaccination—were invited to join the substudy. Participants of the main study were randomly assigned (1:1) to receive two intramuscular injections of either NVX-CoV2373 (5 μg) or placebo (normal saline) 21 days apart; participants enrolled into the substudy were co-vaccinated with a single (0·5 mL) intramuscular, age-appropriate (quadrivalent influenza cell-based vaccine [Flucelvax Quadrivalent; Seqirus UK, Maidenhead] for those aged 18–64 years and adjuvanted trivalent influenza vaccine [Fluad; Seqirus UK, Maidenhead] for those ≥65 years), licensed, influenza vaccine on the opposite deltoid to that of the first study vaccine dose or placebo. The influenza vaccine was administered in an open-label manner and at the same time as the first study injection. Reactogenicity was evaluated via an electronic diary for 7 days after vaccination in addition to monitoring for unsolicited adverse events, medically attended adverse events, and serious adverse events. Immunogenicity was assessed with influenza haemagglutination inhibition and SARS-CoV-2 anti-spike protein IgG assays. Vaccine efficacy against PCR-confirmed, symptomatic COVID-19 was assessed in participants who were seronegative at baseline, received both doses of study vaccine or placebo, had no major protocol deviations affecting the primary endpoint, and had no confirmed cases of symptomatic COVID-19 from the first dose until 6 days after the second dose (per-protocol efficacy population). Immunogenicity was assessed in participants who received scheduled two doses of study vaccine, had a baseline sample and at least one post-vaccination sample, and had no major protocol violations before unmasking (per-protocol immunogenicity population). Reactogenicity was analysed in all participants who received at least one dose of NVX-CoV2373 or placebo and had data collected for reactogenicity events. Safety was analysed in all participants who received at least one dose of NVX-CoV2373 or placebo. Comparisons were made between participants of the substudy and the main study (who were not co-vaccinated for influenza). This study is registered with ClinicalTrials.gov, number NCT04583995. Findings Between Sept 28, 2020, and Nov 28, 2020, a total of 15 187 participants were randomised into the main phase 3 trial, of whom 15 139 received treatment (7569 received dose one of NVX-CoV2373 and 7570 received dose one of placebo). 431 participants were co-vaccinated with a seasonal influenza vaccine in the substudy (217 received NVX-CoV2373 plus the influenza vaccine and 214 received placebo plus the influenza vaccine). In general, the substudy participants were younger, more racially diverse, and had fewer comorbid conditions than those in the main study. Reactogenicity events were more common in the co-administration group than in the NVX-CoV2373 alone group: tenderness (113 [64·9%] of 174 vs 592 [53·3%] of 1111) or pain (69 [39·7%] vs 325 [29·3%]) at injection site, fatigue (48 [27·7%] vs 215 [19·4%]), and muscle pain (49 [28·3%] vs 237 [21·4%]). Incidences of unsolicited adverse events, treatment-related medically attended adverse events, and serious adverse events were low and balanced between the co-administration group and the NVX-CoV2373 alone group. No episodes of anaphylaxis or deaths were reported within the substudy. Co-administration resulted in no change to influenza vaccine immune response although a reduction in antibody responses to the NVX-CoV2373 vaccine was noted. NVX-CoV2373 vaccine efficacy in the substudy (ie, participants aged 18 to

Anxiety and depression have increased exponentially and can be exacerbated by the ongoing individual and combined effects of the pandemic, ongoing unemployment, and systemic racism. Across the globe, career counsellors see the impact of these mental health concerns on individuals as they engage in career-decision making and problem-solving. Cognitive Information Processing theory (CIP; Sampson et al., 2020) can provide a useful framework for supporting diverse individuals experiencing heightened mental health and career concerns. In this article, we review key components of CIP theory, provide specific case examples that highlight the integration of career and mental health, and offer CIP-based conceptualizations and interventions.

Local anaesthesia is considered essential knowledge within the dental profession as it helps to address pain management. Operator percutaneous needlestick injuries associated with the delivery of dental anaesthesia are common for dental healthcare providers. The study proposes a supplemental technique to reduce self-inducing novice operator needlestick injury to complement existing pedagogies for the preclinical local anaesthesia curriculum. The purpose of the study is to evaluate whether a local anaesthesia behavioural video can navigate students to safer clinical practice. Further, a supplemental technique is proposed in whether assessing instrument retraction technique in clinical patient care leads to decreased self-inducing intraoral needle stick injury for novice predoctoral dental operator.Beginning in 2011, predoctoral dental students were asked to view a "what not to do" video within a summative assessment and identify at least five behaviours that were unacceptable errors for delivering local anaesthesia. Operator intraoral needlestick injury was also tracked per the bloodborne exposure reports within predoctoral patient clinics.Data from the learners' responses identified progression in recognising unacceptable errors from behavioural video. Intraoral needlestick injury, 8 and 9 years prior and after the introduction of video showed significance with a low correlation coefficient.More data need to be gathered and evaluated in other dental school settings to determine whether this supplemental educational video decreases needlestick injury in novice operators. Results suggest this behavioural video may guide novice operators to overall safer clinical practice.

As counselling psychology trainees graduate and often serve in health psychology roles or use health psychology theory-guided interventions in their practice and research, training opportunities or...

Aims/hypothesis We aimed to compare diabetic retinopathy outcomes in people with type 1 diabetes following introduction of continuous subcutaneous insulin infusion (CSII) therapy with outcomes in people receiving continuing therapy with multiple daily insulin injections (MDI). Methods This is a retrospective cohort study using the Scottish Care Information – Diabetes database for retinal screening outcomes and HbA1c changes in 204 adults commenced on CSII therapy between 2013 and 2016, and 211 adults eligible for CSII during the same period but who continued on MDI therapy. Diabetic retinopathy progression (time to minimum one-grade worsening in diabetic retinopathy from baseline grading) was plotted for CSII and MDI cohorts using Kaplan–Meier curves, and outcomes were compared using multivariate Cox regression analysis adjusting for age, sex, baseline HbA1c, blood pressure, cholesterol, smoking status and socioeconomic quintile. Impact of baseline HbA1c and change in HbA1c on diabetic retinopathy progression was assessed within CSII and MDI cohorts. Results CSII participants were significantly younger, were from less socially deprived areas, and had lower HbA1c and higher diastolic BP at baseline. There was a larger reduction in HbA1c at 1 year in those on CSII vs MDI (−6 mmol/mol [−0.6%] vs −2 mmol/mol [−0.2%], p p = 0.0097). High baseline HbA1c (75 mmol/mol [9%]) was associated with diabetic retinopathy progression in the MDI group (p = 0.0049) but not the CSII group (p = 0.93). Change in HbA1c at follow-up, irrespective of baseline glycaemic status, did not significantly affect diabetic retinopathy progression in either group. Conclusions/interpretation CSII was associated with reduced diabetic retinopathy progression compared with continued MDI therapy, and may be protective against diabetic retinopathy progression for those with high baseline HbA1c. Progression of diabetic retinopathy over 3 years was not associated with a change in HbA1c. Graphical abstract

Objective Research indicates that emerging adults (EAs) are at an increased risk for heavy drinking and its associated alcohol problems, and that both proximal and distal stressors (e.g., adverse childhood experiences [ACEs], and subtle racial discrimination [racial microaggressions]) may contribute to these high-risk outcomes. We investigated the relationship of ACEs with alcohol consumption and alcohol problems in a sample of Black and White EAs, and racial microaggressions with alcohol consumption and alcohol problems in the Black EAs in our sample. Method Six hundred two EAs (41.5% Black, 47% White; 57.3% women) completed measures assessing ACEs, alcohol consumption, and alcohol problems. One hundred ninety-six Black EAs in the sample were also asked to complete a measure of racial microaggressions that assessed their level of distress related to these experiences. Results Regression analyses demonstrated a positive association of ACEs with alcohol consumption and alcohol problems. Sex moderated the relation of ACEs with alcohol consumption such that the positive relationship between ACEs and alcohol consumption was minimally stronger for females. College status moderated the relation of ACEs with alcohol consumption such that the relationship between ACEs and alcohol consumption was stronger for college students than non-college students. Racial microaggressions were positively associated with alcohol problems, but not alcohol consumption. Conclusion Findings underscore the importance of childhood stressors with alcohol consumption and problems for EAs, and the need for additional research on racial microaggressions and alcohol problems in Black EAs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The challenges of archiving audio material in various forms continue to be present for both professional archivists and musical communities whose histories are held in these materials. Although traditional approaches to archiving allow some benefits to housing and caring for this material, particularly considering the particular care required for fragile records potentially in obsolete forms, this paper posits a greater benefit in collections of experimental music audio material that are cared for from within their communities of creation. For experimental music communities, the improvisatory content of sound material and the importance of ad hoc community gatherings form ephemeral connections that members of these communities are best suited to providing accurate and meaningful context for these collections. The paper highlights four North American experimental music archives: Chicago’s Creative Audio Archive, Calgary’s Bug Incision, and Toronto’s Continuum and Music Gallery.

Objective This study examines the psychometric properties of the Alliance Negotiation Scale-Supervision Version (ANS-S) for clinical trainees. Analyses were designed to evaluate the relationship between the ANS-S and other measures of supervision process and outcome. Method Online surveys included items from established measures in addition to questions about supervisor and supervisee training experiences. The survey was administered to a sample of mental health clinicians practicing under a licensed supervisor (N = 113). Results The ANS-S (a 12-item unidimensional scale) demonstrated sound psychometric properties, including evidence of reliability as well as content and construct validity. Conclusions The ANS-S was associated with several related supervision measures and outcome variables in the expected directions. These results extend previous findings on the ANS' psychometric integrity and offer a validated measure that can be used in further research on supervision.

We investigated the relationship between racial microaggressions and work volition in a sample of racially diverse adults ( N = 171) in the United States for this online cross-sectional study. Correlation analyses revealed that higher levels of racial microaggressions across five of the six racial microaggression dimensions (i.e., criminality, environmental invalidations, foreigner, invisibility, and low-achieving/undesirable culture) related to lowered work volition. We explored how the relationship between dimensions of racial microaggressions and work volition varied by level of bicultural self-efficacy. Regression analyses indicated that bicultural self-efficacy significantly moderated the relationship between four dimensions of racial microaggressions (i.e., criminality, invisibility, low- achieving/undesirable culture, and sexualization) and work volition. More specifically, high levels of bicultural self-efficacy buffered some of the effects of these racial microaggressions on work volition. Implications for practice, limitations, and future directions for career research are discussed.

We have performed a comprehensive analysis of the involvement of histone H3 and H4 residues in the regulation of chronological lifespan in yeast and identify four structural groups in the nucleosome that influence lifespan. We also identify residues where substitution with an epigenetic mimic extends lifespan, providing evidence that a simple epigenetic switch, without possible additional background modifications, causes longevity. Residues where substitution result in the most pronounced lifespan extension are all on the exposed face of the nucleosome, with the exception of H3E50, which is present on the lateral surface, between two DNA gyres. Other residues that have a more modest effect on lifespan extension are concentrated at the extremities of the H3-H4 dimer, suggesting a role in stabilizing the dimer in its nucleosome frame. Residues that reduce lifespan are buried in the histone handshake motif, suggesting that these mutations destabilize the octamer structure. All residues exposed on the nucleosome disk face and that cause lifespan extension are known to interact with Sir3. We find that substitution of H4K16 and H4H18 cause Sir3 to redistribute from telomeres and silent mating loci to secondary positions, often enriched for Rap1, Abf1 or Reb1 binding sites, whereas H3E50 does not. The redistribution of Sir3 in the genome can be reproduced by an equilibrium model based on primary and secondary binding sites with different affinities for Sir3. The redistributed Sir3 cause transcriptional repression at most of the new loci, including of genes where null mutants were previously shown to extend chronological lifespan. The transcriptomic profiles of H4K16 and H4H18 mutant strains are very similar, and compatible with a DNA replication stress response. This is distinct from the transcriptomic profile of H3E50, which matches strong induction of oxidative phosphorylation. We propose that the different groups of residues are involved in binding to heterochromatin proteins, in destabilizing the association of the nucleosome DNA, disrupting binding of the H3-H4 dimer in the nucleosome, or disrupting the structural stability of the octamer, each category impacting on chronological lifespan by a different mechanism.

Background Established in 2013 this network of volunteer family carers is a national advocacy group that presents a vital opportunity for carers to use their voice to raise awareness of issues affecting families living with dementia in Ireland. The network is facilitated by a dementia specific service provider. These carer advocates wish to present on a piece of qualitative research they have recently conducted on the topic of carer resilience at the advanced stages of caring for a loved one with dementia. Methods There are 43 family carer advocates on the network, all of whom were invited to participate in this research. The piece of qualitative research conducted by the network with its members took the form of a questionnaire. The research sought to ascertain how informed and supported carers felt as their loved ones transitioned to long term residential care and the stage thereafter. This research did not discuss the level of professional care given to their loved one but what supports and services were offered to the carer at that time and how this affected their resilience. The aspect of caring for a loved one availing of hospice care naturally emerged during the research process and this topic was also explored in relation to carer resilience. Completed questionnaires were analysed to show findings and draw conclusions. Results The research gives insight into the lived experience of carer resilience told by carer advocates. The results show that carer advocates feel ill-informed and badly supported as their loved one transitions to or resided in long term residential care. The research also showed that carers feel more informed and supported if their loved one availed of hospice care rather than long term residential care. Conclusion Carers are not properly informed or supported when their loved one transitions to or resides in long term residential care and this negatively affects their resilience.

Type 1 diabetes is associated with high morbidity and mortality from microvascular and macrovascular disease with considerable economic cost to society. Islet cell transplantation (ICT) is a treatment option recommended by National Institute for Health and Care Excellence (NICE) for people with debilitating hypoglycaemia due to type 1 diabetes, including those with renal failure where kidney transplantation may also be indicated. The primary aim of ICT is to improve glycaemic control, reduce severe hypoglycaemia, stabilise glycaemic variability and restore awareness of hypoglycaemia where this is compromised. Insulin independence, although not a primary aim, should also be considered a therapeutic goal. The impact ICT has on the progression of microvascular and macrovascular diabetes complications is derived from small studies and has not been examined in large clinical trials. Lifelong immunosuppression, which is necessary to avoid transplant rejection, has adverse effects on lipid metabolism, hypertension and renal function, which must also be considered. In this review, we discuss the role of ICT in type 1 diabetes management and the available evidence with respect to microvascular and macrovascular disease progression post-transplantation. We conclude that, following ICT, microvascular complications including retinopathy and neuropathy are stabilised or improved. Effects on nephropathy can be complicated by coexisting kidney transplantation and the impact of immunosuppression, the latter leading to an early decline in renal function; however, there is evidence to suggest stable renal outcomes in the long term. Short-term studies have demonstrated a positive impact of ICT on surrogate markers of macrovascular disease; however, long-term studies and trials in this area are lacking.

The COVID-19 pandemic has altered our approach to inpatient echocardiography delivery. There is now a greater focus to address key clinical questions likely to make an immediate impact in management, particularly during the period of widespread infection. Handheld echocardiography (HHE) can be used as a first-line assessment tool, limiting scanning time and exposure to high viral load. This article describes a potential role for HHE during a pandemic. We propose a protocol with a reporting template for a focused core dataset necessary in delivering an acute echocardiography service in the setting of a highly contagious disease, minimising risk to the operator. We cover the scenarios typically encountered in the acute cardiology setting and how an expert trained echocardiography team can identify such pathologies using a limited imaging format and include cardiac presentations encountered in those patients acutely unwell with COVID-19.

BACKGROUND The Benefits and Barriers Model proposes both benefits and barriers associated with nonsuicidal self-injury (NSSI) and that a negative association with the self plays a key role in the initial selection of and acute motivation for NSSI. The current investigation builds upon previous findings by assessing the added benefit of targeting self-criticism in the treatment of NSSI. METHODS Sample included 40 participants (30 females; Mage = 14.92) enrolled in dialectical behavior therapy for adolescents within a partial hospitalization program. All study participants received dialectical behavior therapy for adolescents, and those randomized to the experimental condition received an additional brief cognitive intervention developed to decrease self-criticism. RESULTS There was no evidence of an indirect effect of targeting self-criticism upon NSSI at post-treatment via post-treatment self-criticism (b = -0.98, p = .543); however, there was evidence of a significant interaction between treatment condition and self-criticism at pretreatment in the prediction of NSSI at post-treatment (b = 0.33, p = .030). Analyses of simple slopes indicated the conditional direct effect of targeting self-criticism varied as a function of patient's level of self-criticism at the onset of treatment, such that individuals -1 SD below the mean (b = -5.76, p = .037) and at average pretreatment levels of self-criticism (b = -4.09, p = .042), but not + 1 SD above the mean (b = -2.42, p = .056), experienced fewer incidents of NSSI at post-treatment. CONCLUSIONS The results of this investigation support the added benefit of targeting self-criticism in the treatment of NSSI for adolescents.