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There is a long history of interest in individual differences in learning styles. Beginning in the 1960s, academic research endeavors began examining the concept of personalizing teaching as the best scholarship of teaching and learning best practice (SoTL). This current series of interconnected empirical studies take a fresh look at SoTL by examining students' self-perception of their learning styles and whether their perceptions relate to how they learn. Today's college students are growing up in the information age of the 21st Century. Many educators believe that a best practice is to focus on delivering personalized instructional material through technology. Thus, the current mixed methods study adds value to SoTL research by examining these concepts through a representative sample of the subject university in the United States. To assure the reliability and validity of the complex series of three integrated studies, research assistants were trained by a researcher experienced in experimental and survey designs. Data were analyzed using SPSS27®. The study's findings indicated that focusing instructional materials on individual learning styles does not equate to learning success; in fact, the data showed no relationship. The data showed that a combined instructional delivery methodology (kinetic and audio) had a positive influence on learning success. The findings revealed that explicit instructions with or without audio were the most effective in leading to students' ability to follow instructions successfully. Managing students' self-perceptions of learning styles is important to assure successful learning experiences. Findings, conclusions, implications, recommendations, and limitations are presented herein.

Traumatic Brain injury-induced disturbances in mitochondrial fission-and-fusion dynamics have been linked to the onset and propagation of neuroinflammation and neurodegeneration. However, cell-type-specific contributions and crosstalk between neurons, microglia, and astrocytes in mitochondria-driven neurodegeneration after brain injury remain undefined. We developed a human three-dimensional in vitro triculture tissue model of a contusion injury composed of neurons, microglia, and astrocytes and examined the contributions of mitochondrial dysregulation to neuroinflammation and progression of injury-induced neurodegeneration. Pharmacological studies presented here suggest that fragmented mitochondria released by microglia are a key contributor to secondary neuronal damage progression after contusion injury, a pathway that requires astrocyte-microglia crosstalk. Controlling mitochondrial dysfunction thus offers an exciting option for developing therapies for TBI patients.

Abstract Interactions between genetic perturbations and segregating loci can cause perturbations to show different phenotypic effects across genetically distinct individuals. To study these interactions on a genome scale in many individuals, we used combinatorial DNA barcode sequencing to measure the fitness effects of 8046 CRISPRi perturbations targeting 1721 distinct genes in 169 yeast cross progeny (or segregants). We identified 460 genes whose perturbation has different effects across segregants. Several factors caused perturbations to show variable effects, including baseline segregant fitness, the mean effect of a perturbation across segregants, and interacting loci. We mapped 234 interacting loci and found four hub loci that interact with many different perturbations. Perturbations that interact with a given hub exhibit similar epistatic relationships with the hub and show enrichment for cellular processes that may mediate these interactions. These results suggest that an individual’s response to perturbations is shaped by a network of perturbation-locus interactions that cannot be measured by approaches that examine perturbations or natural variation alone.

PurposeDespite a growing number of women entering medical school, a small proportion of women pursue surgical specialties, including pediatric surgery. This multi-center study assesses gender-based differences in measures of scholarly productivity and distribution of faculty positions.MethodsThis is a retrospective web-based study of all pediatric surgeons at twelve large institutions across the United States. Data published by the American Association of Medical Colleges was compiled and analyzed to understand the gender distributions of medical students, general surgery residents, and pediatric surgery fellows. P-values were calculated using two-sided Student's independent t-tests and chi-squared tests.ResultsThere have been a growing number of women applying into pediatric surgery, but the proportion of women matriculating into these fellowships is not concordant. Women are still underrepresented (28%) amongst the pediatric surgeon workforce. A total of 111 pediatric surgeons were identified for this study, which included 31 women (28%) and 80 males (72%). There was a significant difference in the distribution across academic ranks between genders (p

Objective: Cancer treatment misinformation (CTM) is pervasive and impacts patient health outcomes. Cancer clinicians play an essential role in addressing CTM. We previously identified four self-reported responses that characterize the communication process clinicians engage in to address CTM. Clinicians 1) work to understand the misinformation; 2) correct the misinformation through education; 3) advise about future online searches; and 4) preserve the clinician-patient relationship. We sought to confirm and expand on the model we developed by observing cancer clinicians' communication while addressing CTM with a standardized patient (SP). Methods: 17 cancer clinicians were audio recorded in a SP encounter, in which a breast cancer SP asked three questions based on CTM. We thematically analyzed transcriptions of the recordings. Results: Clinicians used four responses with associated strategies and skills to address CTM in a standardized clinical encounter, confirming the previously developed model. The four responses were: (1) work to understand the misinformation; (2) correct the misinformation through education; (3) advise about future online searches; and (4) preserve the clinician-patient relationship. This observational approach allowed us to refine strategies within each response and identify communication skills clinicians enact to address CTM. Conclusion: These findings provide a strong foundation for the Misinformation Response Model for cancer clinicians. Future research should examine which components of the model are most effective in improving patient outcomes. Innovation: This is the first study observing clinicians' communication through simulated practice with SPs about CTM.

Background Most adults with sickle cell disease will experience a silent cerebral infarction (SCI) or overt stroke. Identifying patient subgroups with increased stroke incidence is important for future clinical trials focused on stroke prevention. Our 3‐center prospective cohort study tested the primary hypothesis that adults with sickle cell disease and SCIs have a greater incidence of new stroke or SCI compared with those without SCI. A secondary aim focused on identifying additional risk factors for progressive infarcts, particularly traditional risk factors for stroke in adults. Methods and Results This observational study included adults with sickle cell disease and no history of stroke. Magnetic resonance imaging scans of the brain completed at baseline and >1 year later were reviewed by 3 radiologists for baseline SCIs and new or progressive infarcts on follow‐up magnetic resonance imaging. Stroke risk factors were abstracted from the medical chart. Time‐to‐event analysis was utilized for progressive infarcts. Median age was 24.1 years; 45.3% of 95 participants had SCIs on baseline magnetic resonance imaging. Progressive infarcts were present in 17 participants (17.9%), and the median follow‐up was 2.1 years. Incidence of new infarcts was 11.95 per 100 patient‐years (6.17–20.88) versus 3.74 per 100 patient‐years (1.21–8.73) in those with versus without prior SCI. Multivariable Cox regression showed that baseline SCI predicts progressive infarcts (hazard ratio, 3.46 [95% CI, 1.05–11.39]; P=0.041); baseline hypertension was also associated with progressive infarcts (hazard ratio, 3.23 [95% CI, 1.16–9.51]; P=0.025). Conclusions Selecting individuals with SCIs and hypertension for stroke prevention trials in sickle cell disease may enrich the study population with those at highest risk for infarct recurrence.

Background: Tobacco cannabis co-use is common and becoming more prevalent. Frequent and heavy users of cannabis may struggle to quit smoking. Quitlines offer free cessation treatment in the United States and 25% of quitline callers may also be cannabis users. The present paper describes a randomized pilot study of a tailored intervention for cannabis and cigarette co-users. The intervention combines the quitline smoking cessation treatment with a motivational enhancement therapy-based cannabis intervention. Methods: The randomized pilot study was conducted within four state-funded quitlines with quitline coaches as interventionists. 102 quitline callers who were cannabis and cigarette co-users were randomized to receive treatment as usual (TAU) or the new Quitline Check-Up (QLCU) intervention. Outcomes were collected 90 days post-randomization. Primary outcomes included feasibility and acceptability of delivering the QLCU in the quitline setting. Secondary outcomes included 7-day point prevalence tobacco abstinence, past 30-day cannabis use, and Cannabis Use Disorder Identification Test scores. Results: Study participants were heavy cannabis users, averaging 25 days of use in the past 30; nearly 70% used at a level considered hazardous. Fidelity ratings indicated coaches were successful at delivering the intervention. Treatment engagement was high for both groups (TAU m = 3.4 calls; QLCU m = 3.6 calls) as was treatment satisfaction. Intent-to-treat quit rates (with survey non-responders classified as smokers) were 28.6% for the TAU control group and 24.5% for the QLCU group ( P = .45). Discussion: Hazardous cannabis use rates were high in this sample of tobacco cannabis co-users calling quitlines to quit smoking. The intervention for co-users was acceptable and feasible to deliver. No improvements in tobacco cessation outcomes were observed. Pragmatic intervention development within a real-world clinical setting can streamline the intervention development process. More research is needed on tobacco cannabis co-users and who can benefit from a tailored intervention. Registered: ClinicalTrials.gov NCT04737772, February 4, 2021.

Background:. Fracture-related infection is one of the most challenging complications in orthopaedic trauma surgery. However, the effect of infection on functional and pain-related outcomes has not been well established. The aims of this study were to evaluate functional recovery for patients with fracture and a deep surgical site infection compared with patients with fracture without infection and to evaluate whether pain severity, social support, and preinjury mental health have a moderating effect on the magnitude and direction of the relationship between deep surgical site infection and functional recovery. Methods:. This is a secondary retrospective cohort study using prospectively collected data from the VANCO trial (Local Antibiotic Therapy to Reduce Infection After Operative Treatment of Fractures at High Risk of Infection) and the OXYGEN (Supplemental Perioperative Oxygen to Reduce Surgical Site Infection After High Energy Fracture Surgery) trial. In this study, 2,116 patients with tibial plateau, pilon, or calcaneal fractures at high risk for infection were included. Patients were divided into cohorts of patients who experienced a deep surgical site infection and those who did not. The primary outcome measure was the functional outcome using the Veterans RAND 12-Item Health Survey (VR-12). Results:. After controlling for covariates, deep surgical site infection was independently associated with functional outcome, with a 3.3-point reduction in the VR-12 Physical Component Score, and pain severity was independently associated with functional outcome, with a 2.5-point reduction in the VR-12 Physical Component Score. Furthermore, the Brief Pain Inventory pain severity demonstrated an important moderating effect on the relationship between infection and functional outcome. In patients with lower pain scores, infection had a large negative impact on functional outcome, whereas, in patients with higher pain scores, infection had no significant impact on functional outcome. Furthermore, the functional outcome in the entire cohort remains at only 61% of baseline. Conclusions:. This study documents the negative impact of postoperative infection on functional recovery after injury, as well as the novel finding of pain severity as an important moderating factor. This study emphasizes not only the importance of developing effective interventions designed to reduce postoperative infection, but also the role that factors that moderate pain severity plays in limiting recovery of physical function. Level of evidence:. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Abstract Over the past decades, there has been increasing evidence for the prehistoric use of rock crystal in mountainous environments, including craft specialisation and long-distance exchange. Yet there are only a few known sites where the mineral was quarried in sustainable quantities. One of them is situated near Fiescheralp in the Upper Valais (Switzerland) and dates to the Early Mesolithic and a final stage of the Neolithic. Here we present the first petrographic characterisation of a prehistoric rock crystal mine in the Swiss Alps, involving a combination of different methods. The article provides a detailed description of the fluid inclusions within the quartz crystals and an overview over the related mineral paragenesis. This gives interesting new insights into the formation of the analysed fissure and allows comparing rock crystal artefacts found in other archaeological sites to this particular source. The results form the basis for further investigations concerning the circulation and distribution of the raw material in the past.

The purpose of this qualitative study was to evaluate a summer music camp, designed using principles of Universal Design for Learning, for children with disabilities. Data included one parent-child group interview, a children's musical self-efficacy rating scale, children's drawings, and children's explanations of their drawings. Participants were elementary school children with disabilities (n = 4) and their mothers (n = 4). The children were all male, aged 5 to 8 years. Three children had Autism Spectrum Disorder; one had a diagnosis not specified by his mother. Three themes for children's perceptions of the camp (social interaction/play, enjoyment of making music, and positive representation) and three themes for parents' perceptions (camp structure, camp teachers, and benefits for the children) emerged. Musical self-efficacy ratings did not change, but the children's explanations of the sources of musical self-efficacy indicated that two children may have experienced positive changes in musical self-efficacy.

2019 Novel coronavirus (COVID-19) vaccination rates in the United States have plateaued in specific populations, including rural areas. To improve COVID-19 vaccination rates and to encourage early vaccine uptake in future pandemics, this study aimed to examine vaccine attributes associated with early adoption. Data are from an anonymous online survey of adults using targeted Facebook pages of rural southern Indiana towns in January and February 2021 (n = 286). The diffusion of innovation theory states that the rate of adoption of a product in a specific population is explained by five perceived attributes: relative advantage, compatibility, observability, complexity and trialability. Binary logistic regression analyses were used to examine the association of Diffusion of Innovation theory attributes of the COVID-19 vaccine on early adoption. Results indicated that trialability [odds ratio (OR) = 3.307; 95% confidence interval (CI) = 1.964-5.571; P < 0.001], relative advantage (OR = 2.890; 95% CI = 1.789-4.667; P < 0.001) and compatibility (OR = 2.606; 95% CI = 1.476-4.601; P < 0.001) showed significant independent associations with early adoption. Furthermore, age and political ideology were significant moderators of complexity and relative advantage, respectfully. Health education strategies for early vaccine uptake should focus on building trust in vaccine safety, increasing short-term benefits of vaccination and promoting relatability to personal values.

Background It is recognised that longer-term needs after stroke may not be well addressed by current services. The aim of this programme of research was to develop a novel primary care model to address these needs and to evaluate this new approach. Objectives The work was divided into three workstreams: development of a primary care model development of a ‘Managing Life After Stroke’ programme (including self-management) for people with stroke evaluation of the effectiveness and cost effectiveness of these interventions. Design The development of the primary care model involved information gathering in the form of literature reviews, patient and public involvement workshops, qualitative studies (interviews and focus groups), a consensus study and a pilot study, all feeding into a multidisciplinary intervention development group that approved the final primary care model. In parallel, a further literature review, consultation workshops with healthcare professionals and patients and public involvement fed into the iterative development of the ‘My Life After Stroke’ programme. In the final phase of the programme, the two interventions were evaluated in a cluster randomised controlled trial, which included a process evaluation and within-trial cost-effectiveness analysis. Setting General practices in the East of England and East Midlands. Participants People with a history of stroke identified from general practice stroke registers. Interventions The Improving Primary Care After Stroke model of primary care delivery. This comprised five components: a structured review; a direct point of contact; improving communication between primary and secondary care; local service mapping; and training of primary care professionals. The ‘My Life After Stroke’ self-management programme for people with stroke comprised an initial individual session, four weekly group-based sessions and a final individual session. Main outcome measures The coprimary end points for the trial were two subscales (emotion and participation) of the Stroke Impact Scale v3.0 at 12 months after randomisation. Secondary outcomes included the Stroke Impact Scale Short Form, the EuroQol-5 Dimension, five level questionnaire, the ICEpop CAPability measure for Adults, the Southampton Stroke Self-Management Questionnaire and the Health Literacy Questionnaire. Data sources General practice records for health economic costing data. Patient questionnaires for outcomes. Results Trial: 46 clusters (general practices) were randomised with 1040 participants. At 12 months, there was a 0.64 (97.5% confidence interval −1.7 to +2.8) improvement in the emotion outcome in the intervention arm compared to the control arm and a 1.3 (97.5% confidence interval −2.0 to +4.6) increase in the participation outcome in the intervention arm compared to control. There was also no evidence of effect of the intervention on short form Stroke Impact Scale, quality of life (EuroQol 5 Dimension 5 level questionnaire), well-being (ICEpop CAPability measure for Adults), Southampton Stroke Self-Management questionnaire or health literacy (Health Literacy Questionnaire). Process evaluation: over 80% of participants received a review. Only a third of patients attended the ‘My Life After Stroke’ course. The direct point of contact service was hardly used. The local directory of services had variable take-up by healthcare professionals. It did not prove possible to support improved communication between primary and secondary care as originally intended. Training fidelity was high. Cost-effectiveness analysis: the intervention increased primary care workload and was associated with a non-significant, higher quality-adjusted life-year at 12 months. The incremental cost per quality-adjusted life-year was £20,863. Limitations There were differences in age, sex and proportion of people from minority ethnic groups in the trial population as compared to a typical general practice stroke register. Uptake of the intervention was variable. Ceiling effects were observed in the primary outcome measure. Follow-up was limited to 12 months. Conclusions This programme of research has reaffirmed the importance of addressing longer-term needs of people after stroke in the community. The most commonly expressed need is fatigue. The primary care model that we developed was not effective at addressing these needs. Our qualitative findings suggest that an intervention focused on patients earlier after their stroke or one which is more intensive might be effective. There was a mismatch between the needs reported by stroke survivors and evidence available for how to address these needs. Future work Research to inform who should be offered poststroke assessment of needs in the community in the longer term (after 6 months). Development and evaluation of interventions to address fatigue, low mood and cognitive problems in people with stroke in the community. Study registration This study is registered as PROSPERO 2015 CRD42015026602. Trial registration This trial is registered as ISRCTNCT03353519. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: PTC-RP-PG-0213-20001) and is published in full in Programme Grants for Applied Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information. Plain language summary What was the question? People tell us that their longer-term problems after a stroke are not always well dealt with. We wanted to develop a new way for general practice to look after their patients who have had a stroke in such a way that these problems are better addressed. What did we do? We looked at the evidence that already exists in terms of what problems people face after their stroke. Then we spoke to people with stroke and their carers and to healthcare professionals to understand how general practice might be better able to support people. A multiprofessional group, including patients, met to discuss our findings and propose a new way of working. The approach included: review of patient needs by a practice nurse using a checklist adapted for use in general practice group-based self-management course directory of relevant local services direct point of contact for people with stroke to use ways to improve communication between primary care and specialist staff training for practice nurses. Over 1 year, we followed up patients with stroke in 23 practices who tried out this new model of care and compared what happened to them and how they felt with patients from 23 practices that had not introduced this new model. What did we find? We found that the commonest problems that people reported included fatigue, difficulties in thinking and mood. We found that the new model did not change the impact of stroke on patients who received it. Some participants indicated that the approach might have been more helpful earlier in their stroke journey. What does this mean? The services developed in this research are not relevant to all people after stroke in the longer term. Research is needed on how to address the specific poststroke problems that patients report. Scientific summary Background There is evidence that stroke survivors and their carers have longer-term needs that are not well addressed by current services. This shortfall might be met by extending access to specialist services or enhancing generalist primary care services. This programme of research focuses on the latter approach. Objectives Develop a primary care-based model to optimise postdischarge longer-term care: Understand perspectives of stroke survivors and carers on experiences of health and care services since discharge from specialist services. Explore roles of specialist and primary care services for stroke aftercare and avenues of communication between specialist and primary care. Consider poststroke checklists for primary care. Establish criteria for rereferral from primary care to specialist care. Agree the components of the primary care model. Pilot the primary care model. Develop a ‘Managing Life After Stroke’ (MLAS) programme (including self-management) for people with stroke. Evaluate the effectiveness and cost-effectiveness of these interventions. Methods The primary care model was informed by: A systematic review and meta-ethnography of the literature We recorded themes identified by authors of the included studies and grouped these into issues relating to continuity of care, access to services, information and quality of communication. We then developed our own overarching explanation of why stroke survivors and caregivers had the experiences that they did. Qualitative interviews with patients and carers Semistructured interviews were carried out with 22 stroke survivors and their caregivers (n = 14), recruited from general practice stroke registers. Interviews were audio-recorded, transcribed and analysed using a framework approach. Focus groups with healthcare professionals and patients Six focus groups were run involving healthcare professionals (HCPs) from primary care and from six NHS acute trusts in the East of England and East Midlands in order to better understand communication processes between generalists and specialists with regard to stroke care. Focus groups were carried out to explore the use of checklists to support management of healthcare needs of people with stroke in primary care. Focus groups with HCPs and with patients and their carers were held separately. Modified Research And Development Corporation Appropriateness Consensus Study The purpose of this study was to understand when referrals to specialist services are appropriate from the perspective of HCPs. Fictional scenarios were devised covering all the areas of need that had been identified in our work on checklists. In the first round, panellists representing both secondary and primary care were asked to rate online the appropriateness of referral decisions in these scenarios. In the second round, the panellists met face to face to discuss each referral decision. Scoping review The aim was to give an overview of interventions delivered in the community that were effective at addressing long-term outcomes after stroke. We conducted a systematic search to identify reviews of randomised controlled trials (RCTs), reviews of observational studies, and single trials published in the last 5 years. Pilot study A 6-month single arm (i.e. no control group) feasibility study was carried out in a single practice in Cambridgeshire. The Managing Life After Stroke programme The MLAS programme was informed by a literature review; a consultation phase with a multidisciplinary healthcare professional group and stroke survivors; an iterative phase in two cycles and a feasibility study. The evaluation phase involved three components: Cluster randomised controlled trial Forty-six general practices were randomised to usual care or the new model of care. Participants were people with stroke on the practice stroke registers. The coprimary outcomes were two subscales (emotion and participation) of the stroke impact scale. Follow-up was by postal questionnaire at 6 and 12 months. Process evaluation A mixed-methods design was used to assess fidelity of design, training, delivery and engagement. Methods included questionnaires sent to practices (to ascertain ‘usual care’); video-recording and audio-recording of training sessions of staff; direct observations; and interviews with staff and participants. Cost-effectiveness analysis The evaluation takes a ‘within-trial’ approach and assesses only those costs and benefits that fall within the first 12 months following the evaluation. Costs were measured from the perspective of the UK NHS. Resources to implement the intervention were costed using a micro-costing approach that took into account the time spent by healthcare staff on training and intervention delivery. Health service use was assessed through patient questionnaires and primary care electronic health records. Quality-adjusted life-years (QALYs) were estimated from the EuroQol-5 Dimension, five level questionnaire (EQ-5D-5L) questionnaire. We calculated incremental cost-effectiveness ratios to represent the incremental cost required to obtain one additional QALY when moving from usual care to the new intervention. Results A systematic review and meta-ethnography of the literature Key themes were lack of proactive follow-up; premature withdrawal of services; lack of support in specific areas; lack of information about local services and realistic timescales for recovery; and poor communication both between patients and HCPs and between different HCPs. Our overarching narrative was of marginalisation of stroke survivors and caregivers by the healthcare system, characterised by passivity of both patients and health services and fluidity of needs. Qualitative interviews with patients and carers Patients talked about many different needs, including physical (e.g. fatigue), psychological (e.g. fear of another stroke; loss of confidence) and informational (e.g. feeling unprepared; lack of prognosis). They noted a lack of continuity and advance planning from health services. Caregivers added the impact on themselves, such as the loss of the physical/emotional side of a relationship. General practice was the first point of contact with health services to raise any of these needs. Focus groups with healthcare professionals and patients Roles of generalist and specialist overlapped, but they tended to work in silos. Referral decision-making was associated with quality of communication, which was variable. Barriers to communication included different information technology systems, different technical languages and lack of knowledge of roles. Both HCPs and patients were supportive of the idea of using a checklist, though healthcare professionals emphasised the importance of having a pathway to address identified needs. Some needs were added to the 11 in the published checklist that was used as a starting point. Modified Research And Development Corporation Appropriateness Consensus Study For most referral decisions (59 out of 69, 86%), there was agreement as to whether or not referral was indicated. Lack of consensus tended to be where it was questioned if specialist input would lead to patient benefit. This lack of consensus was not related to professional background. Scoping review Rehabilitation and physiotherapy interventions to address activities of daily living were most common. Cognitive problems, fatigue and specific mental health outcomes were not addressed. Pilot study Out of 48 stroke survivors invited, 13 (27%) took part. All attended a stroke review with a practice nurse. Action plans were generated for 10 (77%) patients. The Improving Primary Care After Stroke (IPCAS) model The final model included five elements: a structured review; a direct point of contact (DPoC); improving communication between primary and secondary care; local service mapping; and training of primary care professionals. Managing Life After Stroke development work The feasibility study involved 17 stroke survivors and 7 carers in three courses. Fifteen (88%) patients completed the course and 5 (71%) carers. Fourteen of 15 (93%) participants who completed a follow-up questionnaire said they would recommend the course to someone else. The final MLAS self-management programme for people with stroke comprised an initial individual session, four weekly group-based sessions and a final individual session. Cluster randomised controlled trial One thousand and forty patients with a mean age of 70.6, 63% male, were recruited from 46 general practices (range per practice: 8–36). Median time since last stroke was 5 years. Primary outcome data were available for 76% of those still alive at 12 months. There was a 0.64 [97.5% confidence interval (CI) −1.7 to +2.8] improvement in the emotion outcome in the intervention arm compared to the control arm and a 1.3 (97.5% CI −2.0 to +4.6) increase in the participation outcome in the intervention arm compared to control. There was no evidence of effect of the intervention on short form Stroke Impact Scale, quality of life (QoL) (EQ-5D-5L), well-being ICEpop CAPability measure for Adults, Southampton Stroke Self-Management questionnaire or Health Literacy Questionnaire (HLQ). One hundred and seventy (43%) patients in the intervention arm identified fatigue as a need. Mobility (153, 39%), mood (130, 33%) and cognition (128, 33%) were the next most commonly identified needs. Process evaluation With regard to the different components of IPCAS, delivery of the structured review had the most uptake, with 421 (81%) of 522 participants receiving a review and action plans being generated. These included follow-up appointments (29%), referrals (25%) and provision of advice (45%). Only 139 patients attended an MLAS course, but those who did appeared to value it. Practice staff perceived that a lot of effort was put into setting up the DPoC service, but this was hardly used. The local directory of services had variable take-ups by HCPs. It did not prove possible to support improved communication between primary and secondary care as originally intended. Instead, we needed to rely on videos of specialist staff explaining what they did and how to access their service. Training fidelity was high. Cost-effectiveness analysis There was a non-significant mean QALY difference of 0.013 (95% CI −0.024 to 0.048) in favour of the intervention. The intervention was associated with an incremental cost to the NHS of £267.07 per person. This equated to an incremental cost per QALY of £20,863. Conclusions Implications for health care We found no evidence that structured stroke reviews offered in primary care to all stroke survivors in the community are effective at addressing stroke-related needs. Such reviews should perhaps therefore be time-limited after stroke and only continued in selected patients. The 15-item checklist that we developed is perceived to be useful and practicable in primary care. Greater attention needs to be paid to services that can address the prevalent long-term needs of stroke survivors, namely fatigue, low mood and cognitive issues. From the evidence in the wider literature, self-management programmes have a role in improving QoL of stroke survivors in the community. Our findings suggest that such programmes are likely to be of greatest value if offered early after discharge from hospital. Research recommendations Research to inform who should be offered poststroke assessment of needs in the community in the longer term (after 6 months). Development and evaluation of interventions to address fatigue, low mood and cognitive problems in people with stroke in the community. Study registrations This study is registered as PROSPERO 2015 CRD42015026602. Trial registration This trial is registered as ISRCTNCT03353519. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: PTC-RP-PG-0213-20001) and is published in full in Programme Grants for Applied Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information.

Abstract Here we use phase field to model and simulate “hopper” crystals, so named because of their underlying cubic structure but with a hopper-like depression on each of the six faces. Over the past three decades simulations of single phase solidification have successfully explored dendritic structures, in two and three dimensions, formed under high undercooling from a slight perturbation in anisotropy. More recently we see the modelling of faceted structures at near equilibrium, and also, under high undercooling, the formation of dendritic-like structures in two dimensions which retain some faceting in the dendrite arms. A cubic hopper crystal appears to be a hybrid structure, somewhere between a perfect cube and a dendrite, and, to date, has not appeared in the modelling literature. In this paper we describe a model for faceted cubic growth and explore results, necessarily in three dimensions, that include perfect cube, hopper and dendritic. We also touch briefly on one other morphology—octahedral.

Abstract Traumatic Brain injury-induced disturbances in mitochondrial fission-and-fusion dynamics have been linked to the onset and propagation of neuroinflammation and neurodegeneration. However, cell-type-specific contributions and crosstalk between neurons, microglia, and astrocytes in mitochondria-driven neurodegeneration after brain injury remain undefined. We developed a human three-dimensional in vitro triculture tissue model of a contusion injury composed of neurons, microglia, and astrocytes and examined the contributions of mitochondrial dysregulation to neuroinflammation and progression of injury-induced neurodegeneration. Pharmacological studies presented here suggest that fragmented mitochondria released by microglia are a key contributor to secondary neuronal damage progression after contusion injury, a pathway that requires astrocyte-microglia crosstalk. Controlling mitochondrial dysfunction thus offers an exciting option for developing therapies for TBI patients.

Interventions are needed to increase low HPV vaccination rates within rural areas in the United States, particularly in the state of Florida, which has the seventh highest number of HPV-related cancers. Florida also ranks low compared to other states in terms of HPV vaccination. Rural-residing parents may benefit from two evidence-based strategies to increase vaccination rates: reminder messages informing and prompting vaccination appointments and mobile clinics to reduce transportation barriers. We sought to identify parental attitudes towards (1) message features that promote rural-residing parents’ receptivity to HPV vaccination; (2) parents’ acceptability of three reminder message modalities (text, postcard, phone); and (3) implementation factors that promote parents’ acceptability of using a mobile clinic for vaccination. We recruited 28 rural-residing parents of 9- to 12-year-old children (unvaccinated for HPV) for focus group and individual interviews and thematically analyzed transcripts. Three features promoted parents’ receptivity to HPV vaccination messages: source credibility, specific information coverage, and personalization (name and birthday wishes). Parents most preferred text messages and identified three factors promoting parents’ mobile clinic use: convenience and feasibility, trustworthiness, and detailed information. The findings indicate rural-residing parents’ acceptability of reminder messages and mobile clinics as well as the importance of trust and feasibility when implementing these evidence-based strategies for rural-residing parents.

Fracture healing is a complex cascade of cellular and molecular processes. These processes require the appropriate cellular and molecular environment to ensure the restoration of skeletal stability and resolution of inflammation. In order for fracture healing to occur, the necessary building blocks for bone metabolism and synthesis must be supplied through proper nutrition. Pharmacologic therapies aimed at modulating the inflammatory response to fractures have the potential to interfere with the synthesis of molecules needed for the production of bone. Infection can interfere with, and even prevent normal fracture healing from occurring. Cellular and genetic treatment strategies are actively being developed to target deficiencies, and bridge gaps that can influence how fractures heal. Evolving technologies, including nutritional supplementation, pharmacotherapies, antibiotics, surgical techniques, as well as genetic and cellular therapies, have the potential to enhance, optimize, and even revolutionize the process of fracture healing.

Objectives To increase diversity and inclusion in graduate medical education (GME), the Accreditation Council for Graduate Medical Education (ACGME) issued new diversity standards requiring programs to engage in practices that focus on systematic recruitment and retention of a diverse workforce of trainees and faculty. The literature on how program directors (PDs) can incorporate and prepare for this standard is limited. Methods We developed a diversity, equity, and inclusion (DEI) toolkit for PDs as an example of an institutional GME-led effort to promote inclusive recruitment and DEI awareness among residency and fellowship programs at a large academic center. Results A survey was sent to 80 PDs before the launch of the toolkit and 6 months afterwards with response rates of 27% (22/80) and 97% (78/80), respectively. At baseline, 45% (10/22) anticipated that the DEI toolkit might provide better resources than those currently available to them and 41% (9/22) perceived that the toolkit might improve recruitment outcomes. At 6 months, 63% (49/78) found the toolkit helpful in the 2021-2022 recruitment season. By contrast, 2% (2/78) of PDs did not find the toolkit helpful, and 33% (26/78) said they did not access the toolkit. When asked if a PD changed their program's recruitment practices because of the toolkit, 31% (24/78) responded yes. Programs that changed recruitment practices started to require unconscious bias training for all faculty and residents involved in the residency interviews and ranking. Others worked on creating a standardized scoring rubric for interviews focused on four main domains: Experiences, Attributes, Competencies, and Academic Metrics. Conclusion There is a need to support PDs in their DEI journey and their work to recruit a diverse workforce in medicine. Utilizing a DEI toolkit is one option to increase DEI knowledge, skills, awareness, and self-efficacy among PDs and can be adopted by other institutions and leaders in academic medicine.

There is a long history of interest in individual differences in learning styles. Beginning in the 1960s, academic research endeavors began examining the concept of personalizing teaching as the best scholarship of teaching and learning best practice (SoTL). This current series of interconnected empirical studies take a fresh look at SoTL by examining students’ self-perception of their learning styles and whether their perceptions relate to how they learn. Today’s college students are growing up in the information age of the 21st Century. Many educators believe that a best practice is to focus on delivering personalized instructional material through technology. Thus, the current mixed methods study adds value to SoTL research by examining these concepts through a representative sample of the subject university in the United States. To assure the reliability and validity of the complex series of three integrated studies, research assistants were trained by a researcher experienced in experimental and survey designs. Data were analyzed using SPSS27®. The study's findings indicated that focusing instructional materials on individual learning styles does not equate to learning success; in fact, the data showed no relationship. The data showed that a combined instructional delivery methodology (kinetic and audio) had a positive influence on learning success. The findings revealed that explicit instructions with or without audio were the most effective in leading to students’ ability to follow instructions successfully. Managing students’ self-perceptions of learning styles is important to assure successful learning experiences. Findings, conclusions, implications, recommendations, and limitations are presented herein.

Abstract Background In the United States, human papillomavirus (HPV) vaccination rates remain low. The President’s Cancer Panel suggests that effective messaging about the HPV vaccination focus on the vaccine’s safety, efficacy, ability to prevent cancer, and recommendation at ages 11- to 12-years. We aimed to develop messages about HPV vaccine that include the President Cancer Panel’s suggestions and were acceptable to caregivers of adolescents. Methods From August to October 2020, we conducted one-hour, Zoom videoconference focus groups with caregivers who lived in Florida, had an 11- to 12-year-old child, and had not had any of their children receive the HPV vaccine. Focus group moderators asked caregivers to react to three videos of clinician (i.e., MD, DO, APRN, PA) recommendations and three text message reminders. Thematic analysis was conducted using the constant comparative method and led by one author with qualitative analysis expertise. Two additional authors validated findings. Results Caregivers (n = 25 in six groups) were primarily non-Hispanic white (84%) and educated (64% had at least an Associate’s degree). Approximately a third of caregivers had delayed (44%) or decided against a vaccine for their child (36%). Caregivers described six preferred message approaches: recognize caregivers’ autonomy, balanced benefits and risks, trustworthy sources, increased feasibility of appointment scheduling, information prior to decision point, and preferred personalized information. Caregivers expressed a desire to have the follow-up doses mentioned in the introduction. Conclusions HPV vaccine messages, whether delivered by a clinician or via text message, will be more acceptable to caregivers if they approach HPV vaccination as the caregivers’ decision, and include information from trusted sources to help caregivers make an informed choice.

Mycobacterium marinum is a waterborne pathogen responsible for tuberculosis-like infections in cold-blooded animals and is an opportunistic pathogen in humans. M. marinum is the closest genetic relative of the Mycobacterium tuberculosis complex and is a reliable surrogate for drug susceptibility testing. We synthesized and evaluated two nanoparticle (NP) formulations for compatibility with rifampicin, isoniazid, pyrazinamide, and ethambutol (PIRE), the front-line antimycobacterial drugs used in combination against active tuberculosis infections. Improved in vitro antimicrobial activity was observed with encapsulated rifampicin alone or in a cocktail of drugs formulated through co-encapsulation in amphiphilic polyanhydride NPs. Broth antimicrobial testing revealed that the encapsulation of PIRE in NP resulted in a significant increase in antimicrobial activity, with the benefit over soluble formulations at biologically relevant concentrations ranging from >10 to >3,000 fold. M. marinum-infected human macrophages treated with NP-PIRE were cleared of viable bacteria in 48 h following a single treatment, representing a >4 log reduction in colony-forming units and a >2,000-fold increase in antimicrobial activity. The amphiphilic polyanhydride nanoparticles demonstrated the ability to co-encapsulate PIRE antibiotics and enhance their antimicrobial activity against M. marinum in infected macrophages in culture and in vitro. These data suggest that polyanhydride nanoparticles are a promising nanotherapeutic for combatting Mycobacterium infections through improved intracellular targeting of encapsulated antibiotics.

Abstract Peripheral artery disease and the associated ischemic wounds are substantial causes of global morbidity and mortality, affecting over 200 million people worldwide. Although advancements have been made in preventive, pharmacologic, and surgical strategies to treat this disease, ischemic wounds, a consequence of end-stage peripheral artery disease, remain a significant clinical and economic challenge. Synechococcus elongatus is a cyanobacterium that grows photoautotrophically and converts carbon dioxide and water into oxygen. We present a novel topical biologic gel containing S. elongatus that provides oxygen via photosynthesis to augment wound healing by rescuing ischemic tissues caused by peripheral artery disease. By using light rather than blood as a source of energy, our novel topical therapy significantly accelerated wound healing in two rodent ischemic wound models. This novel topical gel can be directly translated to clinical practice by using a localized, portable light source without interfering with patients’ daily activities, demonstrating potential to generate a paradigm shift in treating ischemic wounds from peripheral artery disease. Its novelty, low production cost, and ease of clinical translatability can potentially impact the clinical care for millions of patients suffering from peripheral arterial disease.

Introduction People with disabilities have a higher prevalence of cigarette smoking than people without disabilities. However, little information exists on smoking cessation interventions tailored to address the unique needs of people with disabilities. This paper describes a systematic review protocol to identify and evaluate tobacco smoking cessation interventions designed to improve outcomes for people with disabilities.Methods and analysis We will conduct a systematic review of the literature using the procedures outlined by Cochrane. We will search four electronic databases (CINAHL Plus (EBSCO), Embase (Ovid), Medline (Ovid) and PsycINFO (Ovid)) with no date restriction to identify tobacco cessation interventions tailored to meet the needs of people with disabilities. We will extract data and assess risk of bias using the RoB2 and ROBINS-I for included studies using Covidence systematic review software. Quantitative and qualitative syntheses will summarise key study characteristics and outcomes with text, tables and forest plots; a meta-analysis will be conducted, if appropriate.Ethics and dissemination Ethical approval is not required as there are no primary data associated with the study. Data will be disseminated through a peer-reviewed articles and conference presentations.PROSPERO registration number CRD42022337434.

Research indicates that parent-child communication about sexual and reproductive health can improve safe sex practices among adolescents, but barriers to such communication exist. In this systematic review, we thematically synthesised qualitative data in 37 articles on parent-child sexual and reproductive health communication barriers conducted on five continents and in 19 different countries. We identified both barriers to communication and barriers to effective communication reported by parents and/or children. Internationally, both parents and children experienced personal barriers, such as embarrassment, discomfort and fear; communal barriers, such as outside sources and responsibility shift; and cultural barriers, such as sex as taboo, focus on abstinence and age/generational differences. Implications for future family communication interventions and measurement that could help parents navigate this form of sexual education are discussed.