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Unintentional injuries pose a significant risk to children in early years globally. In particular, toddlers and preschoolers are vulnerable to injuries that occur at home. Despite the availability of preventive measures that can greatly reduce the risks of domestic injuries, some caregivers (e.g., parents) of children in early childhood may not fully implement these safety measures due to poor behavioral adherence or low awareness of the risk of domestic injury. Therefore, it is crucial to understand how caregivers in different cultural contexts approach injury prevention in the home environment. In this multi-cultural study, we investigated the motivational and belief processes underlying childhood domestic injury prevention among a total of 2059 primary caregivers (parents/guardians) of infant and toddlers (aged 2 to 6 years) across four societies, Australia (AU; N = 500), the United States (US; N = 500), Singapore (SG; N = 507), and Hong Kong (HK; N = 552), by applying the integrated model of self-determination theory (SDT) and theory of planned behavior (TPB). Our results support the key tenets of the integrated model and demonstrated cultural invariance model pathways across the four societies studied. In particular, the positive relationships among psychological need support, autonomous motivation, socio-cognitive beliefs, intention, and behavior adherence remained constant across societies. With a multi-cultural sample, this study provides valuable insights into the similarities and differences in motivation and beliefs surrounding childhood domestic injury prevention across these four societies.

Background Transgender and gender diverse (TGD) individuals and long‐term survivors with adult congenital heart disease (ACHD) are both growing populations with specialized needs. No studies assess temporal trends or evaluate the care of TGD individuals with ACHD. Methods and Results Meetings between congenital cardiology and gender‐affirming care specialists identified unique considerations in TGD individuals with ACHD. A retrospective chart review was then performed to describe patient factors and outpatient trends in those with an ACHD diagnosis undergoing gender‐affirming hormonal or surgical care (GAHT/S) at 1 adult and 1 pediatric tertiary care center. Thirty‐three TGD individuals with ACHD were identified, 21 with a history of GAHT/S. Fourteen (66%) had moderate or complex ACHD, 8 (38%) identified as transgender male, 9 (43%) transgender female, and 4 (19%) other gender identities. Three had undergone gender‐affirming surgery. There were zero occurrences of the composite end point of unplanned hospitalization or thrombotic event over 71.1 person‐years of gender‐affirming care. Median age at first gender‐affirming appointment was 16.8 years [interquartile range 14.8–21.5]. The most common treatment modification was changing estradiol administration from oral to transdermal to reduce thrombotic risk (n=3). An increasing trend was observed from zero TGD patients with ACHD attending a gender diversity appointment in 2012 to 14 patients in 2022. Conclusions There is a growing population of TGD patients with ACHD and unique medical and psychosocial needs. Future studies must fully evaluate the reassuring safety profile observed in this small cohort. We share 10 actionable care considerations for providers with a goal of overseeing a safe and fulfilling gender transition across all TGD patients with ACHD.

Background: Many students use laptops in the classroom to take notes; however, even when laptops are used for the sole purpose of taking notes they can negatively impact academic performance. Objective: The current study examined state-dependent effects, and the potential for a match in note taking and quiz taking methods to improve quiz performance. Method: Participants were placed into a congruent (take notes by hand and complete the quiz by hand or take notes using a laptop and complete an online quiz) or an incongruent condition (take notes by hand and take an online quiz or take notes using a laptop and complete the quiz by hand). Results: The results revealed that participants who took notes by hand performed better on the quiz overall, and better on conceptual questions, then students who took notes using a laptop. We failed to find evidence for state-dependent effects. Conclusions: The current study suggests that taking notes by hand may improve how students encode material, and result in higher quality external storage used by students when studying for quizzes. Teaching Implications: Reinforcing the notion that taking notes by hand may benefit quiz performance for lecture-style information and could improve student performance in class.

PurposeTo determine effects of continued or discontinued use of omega-3 (ω3) fatty acid supplements through a randomized withdrawal trial among patients assigned to ω3 supplements in the first year of the DREAM study.MethodsPatients who were initially assigned to ω3 (3000 mg) for 12 months in the primary trial were randomized 1:1 to ω3 active supplements or placebos (refined olive oil) for 12 more months. The primary outcome was change in the Ocular Surface Disease Index (OSDI) score. Secondary outcomes included change in conjunctival staining, corneal staining, tear break-up time, Schirmer test, and adverse events.ResultsAmong 22 patients assigned to ω3 and 21 to placebo supplements, the mean change in OSDI score between month 12 and 24 was similar between treatment groups (mean difference in change -0.6 points, 95% confidence interval [CI], (-10.7, 9.5), p = 0.91). There were no significant differences between groups in mean change in conjunctival staining (difference in mean change -0.5 points; 95% CI (-1.2, 0.3)), corneal staining (-0.3 points; 95% CI (-1.2, 0.3)), tear break-up time (-0.8 s; 95% CI (-2.6, 0.9)) and Schirmer test (0.6 mm, 95% CI (-2.0, 3.2)). Rates of adverse events were similar in both groups.ConclusionAmong patients who received ω3 supplements for 12 months in the primary trial, those discontinuing use of ω3 for an additional 12 months did not have significantly worse outcomes compared to those who continued use of ω3. ClinicalTrials.gov number NCT02128763.

BackgroundDry eye disease is a common chronic condition that is characterized by ocular discomfort and visual disturbances that decrease quality of life. Many clinicians recommend the use of supplements of n-3 fatty acids (often called omega-3 fatty acids) to relieve symptoms.MethodsIn a multicenter, double-blind clinical trial, we randomly assigned patients with moderate-to-severe dry eye disease to receive a daily oral dose of 3000 mg of fish-derived n-3 eicosapentaenoic and docosahexaenoic acids (active supplement group) or an olive oil placebo (placebo group). The primary outcome was the mean change from baseline in the score on the Ocular Surface Disease Index (OSDI; scores range from 0 to 100, with higher scores indicating greater symptom severity), which was based on the mean of scores obtained at 6 and 12 months. Secondary outcomes included mean changes per eye in the conjunctival staining score (ranging from 0 to 6) and the corneal staining score (ranging from 0 to 15), with higher scores indicating more severe damage to the ocular surface, as well as mean changes in the tear break-up time (seconds between a blink and gaps in the tear film) and the result on Schirmer's test (length of wetting of paper strips placed on the lower eyelid), with lower values indicating more severe signs.ResultsA total of 349 patients were assigned to the active supplement group and 186 to the placebo group; the primary analysis included 329 and 170 patients, respectively. The mean change in the OSDI score was not significantly different between the active supplement group and the placebo group (-13.9 points and -12.5 points, respectively; mean difference in change after imputation of missing data, -1.9 points; 95% confidence interval [CI], -5.0 to 1.1; P=0.21). This result was consistent across prespecified subgroups. There were no significant differences between the active supplement group and the placebo group in mean changes from baseline in the conjunctival staining score (mean difference in change, 0.0 points; 95% CI, -0.2 to 0.1), corneal staining score (0.1 point; 95% CI, -0.2 to 0.4), tear break-up time (0.2 seconds; 95% CI, -0.1 to 0.5), and result on Schirmer's test (0.0 mm; 95% CI, -0.8 to 0.9). At 12 months, the rate of adherence to treatment in the active supplement group was 85.2%, according to the level of n-3 fatty acids in red cells. Rates of adverse events were similar in the two trial groups.ConclusionsAmong patients with dry eye disease, those who were randomly assigned to receive supplements containing 3000 mg of n-3 fatty acids for 12 months did not have significantly better outcomes than those who were assigned to receive placebo. (Funded by the National Eye Institute, National Institutes of Health; DREAM ClinicalTrials.gov number, NCT02128763 .).

BackgroundDry eye disease is a common chronic condition that is characterized by ocular discomfort and visual disturbances that decrease quality of life. Many clinicians recommend the use of supplements of n-3 fatty acids (often called omega-3 fatty acids) to relieve symptoms.MethodsIn a multicenter, double-blind clinical trial, we randomly assigned patients with moderate-to-severe dry eye disease to receive a daily oral dose of 3000 mg of fish-derived n-3 eicosapentaenoic and docosahexaenoic acids (active supplement group) or an olive oil placebo (placebo group). The primary outcome was the mean change from baseline in the score on the Ocular Surface Disease Index (OSDI; scores range from 0 to 100, with higher scores indicating greater symptom severity), which was based on the mean of scores obtained at 6 and 12 months. Secondary outcomes included mean changes per eye in the conjunctival staining score (ranging from 0 to 6) and the corneal staining score (ranging from 0 to 15), with higher scores indicating more severe damage to the ocular surface, as well as mean changes in the tear break-up time (seconds between a blink and gaps in the tear film) and the result on Schirmer's test (length of wetting of paper strips placed on the lower eyelid), with lower values indicating more severe signs.ResultsA total of 349 patients were assigned to the active supplement group and 186 to the placebo group; the primary analysis included 329 and 170 patients, respectively. The mean change in the OSDI score was not significantly different between the active supplement group and the placebo group (-13.9 points and -12.5 points, respectively; mean difference in change after imputation of missing data, -1.9 points; 95% confidence interval [CI], -5.0 to 1.1; P=0.21). This result was consistent across prespecified subgroups. There were no significant differences between the active supplement group and the placebo group in mean changes from baseline in the conjunctival staining score (mean difference in change, 0.0 points; 95% CI, -0.2 to 0.1), corneal staining score (0.1 point; 95% CI, -0.2 to 0.4), tear break-up time (0.2 seconds; 95% CI, -0.1 to 0.5), and result on Schirmer's test (0.0 mm; 95% CI, -0.8 to 0.9). At 12 months, the rate of adherence to treatment in the active supplement group was 85.2%, according to the level of n-3 fatty acids in red cells. Rates of adverse events were similar in the two trial groups.ConclusionsAmong patients with dry eye disease, those who were randomly assigned to receive supplements containing 3000 mg of n-3 fatty acids for 12 months did not have significantly better outcomes than those who were assigned to receive placebo. (Funded by the National Eye Institute, National Institutes of Health; DREAM ClinicalTrials.gov number, NCT02128763 .).

Background: Metformin has been linked to improved survival among diabetic prostate cancer (PCa) patients, while hyperinsulinemia and insulin usage has been related to worse prognosis. Objective: To evaluate the association of metformin and other antidiabetic drugs with PCa death and androgen deprivation therapy (ADT). Design, setting, and participants: The study cohort included 14 424 men who underwent radical prostatectomy in Finland during 1995–2013. Cases were identified, and clinical data were collected from patient files and national registries using personal identification numbers. Intervention: Information on the use of each antidiabetic drug during 1995–2014 was collected from prescription registry of the Social Insurance Institution of Finland. Outcome measurements and statistical analysis: The risks of PCa death and initiation of ADT were analyzed by antidiabetic drug use with the Cox regression method. Each antidiabetic drug group was analyzed separately to model simultaneous usage. Pre- and postdiagnostic uses were analyzed separately. Results and limitations: Prediagnostic use of antidiabetic drugs in general had no association with the risk of PCa death. Prediagnostic use of metformin was related to a reduced risk of ADT initiation (hazard ratio [HR] 0.75, 95% confidence interval [CI] 0.59–0.96), while high-dose insulin users had an increased risk. Overall, antidiabetic drug use after PCa diagnosis was associated with an elevated risk of PCa death. Only postdiagnostic metformin use was associated with reduced risks of PCa death (HR 0.47, 95% CI 0.30–0.76) and ADT initiation compared with nonusers. Study limitations are missing information on glycemic control, smoking, living or exercise habits, prostate-specific antigen, and Gleason score. Conclusions: Among surgically treated PCa patients, use of metformin was associated with improved disease-specific survival, while insulin and insulin secretagogues were associated with poor survival. Metformin might be a favorable diabetes treatment among men with PCa. Patient summary: In this Finnish nationwide study, we found that the risks of prostate cancer death and cancer progression are lowered among metformin users, but not among other antidiabetic drug users. Metformin might be a favorable treatment choice for diabetes in men with prostate cancer.

Unintentional injuries pose a significant risk to children in early years globally. In particular, toddlers and preschoolers are vulnerable to injuries that occur at home. Despite the availability of preventive measures that can greatly reduce the risks of domestic injuries, some caregivers (e.g., parents) of children in early childhood may not fully implement these safety measures due to poor behavioral adherence or low awareness of the risk of domestic injury. Therefore, it is crucial to understand how caregivers in different cultural contexts approach injury prevention in the home environment. In this multi-cultural study, we investigated the motivational and belief processes underlying childhood domestic injury prevention among a total of 2059 primary caregivers (parents/guardians) of infant and toddlers (aged 2 to 6 years) across four societies, Australia (AU; N = 500), the United States (US; N = 500), Singapore (SG; N = 507), and Hong Kong (HK; N = 552), by applying the integrated model of self-determination theory (SDT) and theory of planned behavior (TPB). Our results support the key tenets of the integrated model and demonstrated cultural invariance model pathways across the four societies studied. In particular, the positive relationships among psychological need support, autonomous motivation, socio-cognitive beliefs, intention, and behavior adherence remained constant across societies. With a multi-cultural sample, this study provides valuable insights into the similarities and differences in motivation and beliefs surrounding childhood domestic injury prevention across these four societies. [ABSTRACT FROM AUTHOR]

Background: Adolescents and adults with CHD have increased risk for IE because of anatomic anomalies and burden of intracardiac prosthetic material. There are significant challenges in determining primary surgical or medical management along with limited guidelines to determine management. Methods: A retrospective review was performed at both the University of Colorado Hospital and Children's Hospital Colorado of patients 12 years of age and older with CHD who were treated for IE between 2009 and 2019. Results: Of 138 cases, the most common CHD lesions were bicuspid aortic valve (30%) and tetralogy of Fallot (14%). Seventy percent of patients had intracardiac prosthetic material. Of the cases where valvular IE was verified, 51% involved prosthetic valves. Surgical management was pursued in 53% of patients with 7% mortality; 11% of patients did not have surgical management due to elevated perioperative risk with 53% mortality; the remaining patients had non-surgical management due to lack of severe features with 0% mortality. Overall mortality during the initial IE treatment course was 9%, with all-cause mortality of 15%. Recurrence occurred in 12% of patients with median follow-up time of 1.68 years. Conclusions: We report a large single-center study of IE in the adolescent and adult CHD population. Mortality and recurrence rates remain high in this population. We propose a preliminary algorithm for determining surgical management for IE, as well as potentials for future innovations.

PurposeTo explore why glaucoma patients believe that glaucoma continues to cause vision loss despite the availability of effective treatment.MethodsNine focus groups were conducted in 3 geographically and ethnically diverse areas of the United States (Los Angeles, CA; Rochester, MN; Durham, NC) that included 56 participants, 31 with poor vision and 25 with good vision. Content analysis was used to identify important themes. Semiquantitative analysis was used to measure the frequency of each theme.ResultsA total of 474 relevant comments were made in the 9 focus groups. Focus groups elicited 305 comments about barriers to glaucoma management including issues with adherence (30%), the doctor-patient relationship (21%), knowledge about glaucoma (19%), personal support systems (19%), and barriers to health care delivery such as cost and insurance (11%). A total of 101 comments were made regarding feelings about glaucoma and 58 comments were made regarding beliefs about disease and treatment.ConclusionsThese focus groups brought up many issues surrounding barriers to glaucoma treatment, perceived susceptibility to glaucoma, perceived benefits to treatment, and the emotional response to living with glaucoma. There is a need to create a more comprehensive chronic disease management approach for patients with glaucoma to address both the concrete and emotional issues identified in these focus group discussions.

Abstract The rapid shift to online teaching in spring 2020 meant most of us were teaching in panic mode. As we move forward with course planning for fall and beyond, we can invest more time and energy into improving the online experience for our students. We advocate that instructors use inclusive teaching practices, specifically through active learning, in their online classes. Incorporating pedagogical practices that work to maximize active and inclusive teaching concepts will be beneficial for all students, and especially those from minoritized or underserved groups. Like many STEM fields, Ecology and Evolution shows achievement gaps and faces a leaky pipeline issue for students from groups traditionally underserved in science. Making online classes both active and inclusive will aid student learning and will also help students feel more connected to their learning, their peers, and their campus. This approach will likely help with performance, retention, and persistence of students. In this paper, we offer broadly applicable strategies and techniques that weave together active and inclusive teaching practices. We challenge instructors to commit to making small changes as a first step to more inclusive teaching in ecology and evolutionary biology courses.