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Background: Mild Cognitive Impairment with Suspected non‐Alzheimer's Pathophysiology (SNAP‐MCI) represents a group of patients with Alzheimer's disease (AD) like neurodegeneration without beta‐amyloid pathology. While this group likely has a heterogeneous etiology, tau pathology, as in Primary Age‐Related Tauopathy (PART), has been hypothesized to play a major role. We investigate tau positron emission tomography (PET) uptake in the medial temporal lobe (MTL) in SNAP‐MCI and the association of MTL Tau‐PET uptake with structural measures and delayed recall in beta‐amyloid negative (A‐) MCI patients. Method: 237 MCI patients and 301 A‐ controls with available beta‐amyloid and tau PET and magnetic resonance images (within 200 days) were included. Baseline hippocampal volume and entorhinal cortex (ERC) and Brodmann areas (BA)35 thickness were obtained using an in‐house developed pipeline and annualized atrophy rates were estimated in an unbiased fashion using follow‐up MRIs within 4.5 years. Βeta‐amyloid status (A+/‐) was determined by a standard cut‐off (Florbetapir: 1.11; Florbetaben: 1.08) and neurodegeneration status (N+/‐) by hippocampal volumes, corrected for intracranial volume, using the 90th percentile of A+ AD patients as the cut‐off. Tau‐PET standardized uptake value ratio (SUVR) in the ERC/BA35 was calculated. A composite z‐score of delayed recall at baseline and change over 2 years was obtained. Result: SNAP‐MCI had significantly higher ERC/BA35 Tau‐PET SUVR than A‐ controls (Table 1, corrected for age) and qualitatively higher than A‐N‐ MCI (p=0.10). ERC/BA35 Tau‐PET SUVR in A‐N‐ MCI was not significantly different from A‐ controls. In A‐ MCI patients, ERC/BA35 Tau‐PET SUVR was significantly associated with BA35 thickness and hippocampal, ERC and BA35 atrophy rates, corrected for beta‐amyloid PET SUVR (Table 2; Figure 1). MTL structural measures, but not ERC/BA35 Tau‐PET SUVR, were associated with cross‐sectional and longitudinal delayed recall measures (Table 3; Figure 2). Conclusion: SNAP‐MCI had elevated ERC/BA35 Tau‐PET SUVR and ERC/BA35 Tau‐PET SUVR was associated with MTL structural measures in A‐ MCI patients. This indicates that tau pathology might be an important driver of neurodegeneration in the absence of beta‐amyloid pathology, supporting the notion that PART contributes to SNAP‐MCI. Additionally, MTL structure was associated with memory performance, consistent with SNAP not being a benign condition. [ABSTRACT FROM AUTHOR]

NURSING licensure, OCCUPATIONAL roles, PROFESSIONAL ethics, TEAMS in the workplace, STATISTICS, EVALUATION of human services programs, NURSING, PROFESSIONS, RESEARCH methodology, HUMAN services programs, PRE-tests & post-tests, LEARNING strategies, INTERPROFESSIONAL relations, COMMUNICATION, QUESTIONNAIRES, DESCRIPTIVE statistics, INTERDISCIPLINARY education, NURSING students, STUDENT attitudes, STATISTICAL sampling, DATA analysis software, THEMATIC analysis, and TRAINING of athletic trainers

Background: The purpose of this article is to describe the development, implementation, and evaluation of a Simulation Interprofessional Education (Sim‐IPE) activity for healthcare students from different disciplines (athletic training [AT] and nursing). The objective for the Sim‐IPE activity was to engage AT and prelicensure nursing students in a realistic healthcare scenario to enhance knowledge about one another's profession, develop interprofessional skills, collaborate with one another, and communicate effectively as a team as they performed care. Methods: This mixed methods study employed a one‐time posttest design for a convenience sample of AT and prelicensure nursing students following a simulation intervention. Students completed the Student Perceptions of Interprofessional Clinical Education‐Revised (SPICE‐R) survey and answered open‐ended response questions. Results: Thirteen students (N = 13) from Cohort 1 and 12 students (N = 12) from Cohort 2 completed the SPICE‐R survey. Most students strongly agreed/agreed for each of the SPICE‐R survey questions. Qualitative findings indicated the students positively perceived the Sim‐IPE activity as it helped them discover the value of interprofessional patient care. Discussion: The quantitative findings indicated that the students found the Sim‐IPE an effective learning methodology to achieve the objectives while the qualitative findings gave further insight into the students' perceptions of interprofessional teamwork and the value of the prebrief session conducted before the simulation. The findings will inform future Sim‐IPE activities involving additional groups of healthcare students. [ABSTRACT FROM AUTHOR]

The left atrium is an early sensor of left ventricular (LV) dysfunction. Still, the prognostic value of left atrial (LA) function (strain) on cardiac magnetic resonance (CMR) in dilated cardiomyopathy (DCM) remains unknown. The goal of this study was to evaluate the prognostic value of CMR-derived LA strain in DCM. Patients with DCM from the Maastricht Cardiomyopathy Registry with available CMR imaging were included. The primary endpoint was the combination of sudden or cardiac death, heart failure (HF) hospitalization, or life-threatening arrhythmias. Given the nonlinearity of continuous variables, cubic spline analysis was performed to dichotomize. A total of 488 patients with DCM were included (median age: 54 [IQR: 46-62] years; 61% male). Seventy patients (14%) reached the primary endpoint (median follow-up: 6 [IQR: 4-9] years). Age, New York Heart Association (NYHA) functional class >II, presence of late gadolinium enhancement (LGE), LV ejection fraction (LVEF), LA volume index (LAVI), LV global longitudinal strain (GLS), and LA reservoir and conduit strain were univariably associated with the outcome (all P < 0.02). LA conduit strain was a stronger predictor of outcome compared with reservoir strain. LA conduit strain, NYHA functional class >II, and LGE remained associated in the multivariable model (LA conduit strain HR: 3.65 [95% CI: 2.01-6.64; P < 0.001]; NYHA functional class >II HR: 1.81 [95% CI: 1.05-3.12; P = 0.033]; and LGE HR: 2.33 [95% CI: 1.42-3.85; P < 0.001]), whereas age, N-terminal pro–B-type natriuretic peptide, LVEF, left atrial ejection fraction, LAVI, and LV GLS were not. Adding LA conduit strain to other independent predictors (NYHA functional class and LGE) significantly improved the calibration, accuracy, and reclassification of the prediction model (P < 0.05). LA conduit strain on CMR is a strong independent prognostic predictor in DCM, superior to LV GLS, LVEF, and LAVI and incremental to LGE. Including LA conduit strain in DCM patient management should be considered to improve risk stratification. [Display omitted] [ABSTRACT FROM AUTHOR]

PROFESSIONAL education, IDENTITY (Psychology), PROFESSIONAL identity, INTERPERSONAL conflict, CONFLICT management, and CURRICULUM

This article describes the development and assessment of teaching strategies to enhance student professional identity development by shifting the pedagogical focus from content knowledge to the practice of interpersonal and conflict resolution skills, and reflection to create awareness, observe growth, and find meaning. [ABSTRACT FROM AUTHOR]

ALCOHOL drinking, ENERGY consumption, WARNING labels, INCOME, WEIGHT gain, and CONSUMPTION (Economics)

Background: Alcohol is a discretionary, energy dense, dietary component. Compared to non-drinkers, people who consume alcohol report higher total energy intake and may be at increased risk of weight gain, overweight, and obesity, which are key preventable risk factors for illness. However, accurate consumer knowledge of the energy content in alcohol is low. To inform future behaviour change interventions among drinkers, this study investigated individual characteristics associated with changing alcohol consumption due to energy-related concerns.Methods: An online survey was undertaken with 801 Australian adult drinkers (18-59 years, 50.2% female), i.e. who consumed alcohol at least monthly. In addition to demographic and health-related characteristics, participants reported past-year alcohol consumption, past-year reductions in alcohol consumption, frequency of harm minimisation strategy use (when consuming alcohol), and frequency of changing alcohol consumption behaviours because of energy-related concerns.Results: When prompted, 62.5% of participants reported changing alcohol consumption for energy-related reasons at least 'sometimes'. Women, those aged 30-44 years, metropolitan residents, those with household income $80,001-120,000, and risky/more frequent drinkers had increased odds of changing consumption because of energy-related concerns, and unemployed respondents had reduced odds.Conclusions: Results indicate that some sociodemographic groups are changing alcohol consumption for energy-related reasons, but others are not, representing an underutilised opportunity for health promotion communication. Further research should investigate whether messaging to increase awareness of alcohol energy content, including through systems-based policy actions such as nutritional/energy product labelling, would motivate reduced consumption across a broader range of drinkers. [ABSTRACT FROM AUTHOR]

Background: While previous studies have demonstrated the effect of Alzheimer's disease (AD) CSF testing in changing diagnosis, we lack an understanding of how this testing affects clinical management. Therefore, we assessed changes in clinical management associated with AD CSF biomarker testing when ordered as part of routine clinical management. Method: The 'Investigating the Impact of Alzheimer's Disease Diagnostics in British Columbia' (IMPACT‐AD BC) study (NCT05002699) is a longitudinal study examining the impact of AD CSF testing on clinical management, personal utility and health care economics in British Columbia, Canada. After AD CSF testing was ordered as part of routine care (where the clinical scenario met the appropriate use criteria), the patient and their physician were eligible to participate in the study. The primary outcome was the change in management (pre‐ v. post‐biomarker results) in a composite measure including 1) AD drug therapy, 2) other relevant drug therapy, 3) other diagnostic procedures, and 4) referral or counselling. Result: Participants (n = 129) had a median age of 63 (IQR:58‐68); 49% were female. Cognitive impairment at baseline consisted of 7% with subjective cognitive impairment, 53% with mild cognitive impairment, and 40% with dementia. CSF biomarker profiles were consistent with an amyloid‐beta pathology (i.e., A+) in 72% of cases. Changes in clinical management because of testing occurred in 83% of cases including: referrals and counseling (57%), imaging (47%) and other diagnostic procedures (e.g., neuropsychological testing) (42%), and use of AD drug therapies (40%). For those with a non‐AD pre‐biomarkers diagnosis, 42% were changed to AD post‐biomarkers; for those with an AD pre‐biomarkers diagnosis, 18% were changed to non‐AD post‐biomarkers. Conclusion: This study has revealed substantial changes in clinical management as a direct result of AD CSF biomarker testing in routine care. An understanding of the implications of biomarker testing will in turn help us: improve appropriate utilization, understand the broader impacts on persons living with dementia and on the health care system, and prepare for expanded use of this testing with the availability of disease‐modifying therapeutics. [ABSTRACT FROM AUTHOR]

COMMUNICABLE diseases, INFECTIOUS arthritis, HOSPITAL patients, CELLULITIS, DRUG abuse, DRUGS, and FISHER exact test

Injection drug use poses a public health challenge. Clinical experience indicates that people who inject drugs (PWID) are hospitalized frequently for infectious diseases, but little is known about outcomes when admitted. Charts were identified from local hospitals between 2013–2018 using consultation lists and hospital record searches. Included individuals injected drugs in the past six months and presented with infection. Charts were accessed using the hospital information system, undergoing primary and secondary reviews using Research Electronic Data Capture (REDCap). The Wilcoxon rank-sum test was used for comparisons between outcome categories. Categorical data were summarized as count and frequency, and compared using Fisher's exact test. Of 240 individuals, 33% were admitted to the intensive care unit, 36% underwent surgery, 12% left against medical advice (AMA), and 9% died. Infectious diagnoses included bacteremia (31%), abscess (29%), endocarditis (29%), cellulitis (20%), sepsis (10%), osteomyelitis (9%), septic arthritis (8%), pneumonia (7%), discitis (2%), meningitis/encephalitis (2%), or other (7%). Sixty-six percent had stable housing and 60% had a family physician. Fifty-four percent of patient-initiated discharges were seen in the emergency department within 30 days and 29% were readmitted. PWID are at risk for infections. Understanding their healthcare trajectory is essential to improve their care. [ABSTRACT FROM AUTHOR]

COVID-19, SOCIAL responsibility, LIBRARY school students, and STAY-at-home orders

Population of the study The online intervention classes focused mainly on Library and Information Science Students from across universities in Africa. Among the 100 level students, few of the excerpts of the responses are presented below: I did not have any experience in Library and Information Science as some of my classmates do. Among the 300 Level Students, participants discussed more about the insight they have on careers they could pursue in the field of Library and Information Science. All the students are studying Library and Information Science in their respective universities. [Extracted from the article]

HEART failure patients, PATIENT reported outcome measures, PATIENTS' attitudes, CLINICAL trials, HEART failure, and QUALITY of life

There are many consequences of heart failure (HF), including symptoms, impaired health‐related quality of life (HRQoL), and physical and social limitations (functional status). These have a substantial impact on patients' lives, yet are not routinely captured in clinical trials. Patient‐reported outcomes (PROs) can quantify patients' experiences of their disease and its treatment. Steps can be taken to improve the use of PROs in HF trials, in regulatory and payer decisions, and in patient care. Importantly, PRO measures (PROMs) must be developed with involvement of patients, family members, and caregivers from diverse demographic groups and communities. PRO data collection should become more routine not only in clinical trials but also in clinical practice. This may be facilitated by the use of digital tools and interdisciplinary patient advocacy efforts. There is a need for standardization, not only of the PROM instruments, but also in procedures for analysis, interpretation and reporting PRO data. More work needs to be done to determine the degree of change that is important to patients and that is associated with increased risks of clinical events. This 'minimal clinically important difference' requires further research to determine thresholds for different PROMs, to assess consistency across trial populations, and to define standards for improvement that warrant regulatory and reimbursement approvals. PROs are a vital part of patient care and drug development, and more work should be done to ensure that these measures are both reflective of the patient experience and that they are more widely employed. [ABSTRACT FROM AUTHOR]

TELECOMMUNICATION, DIGITAL technology, PRIMARY care, ONCOLOGISTS, and ELECTRONIC health records

Healthcare providers have reported challenges with coordinating care for patients with cancer. Digital technology tools have brought new possibilities for improving care coordination. A web- and text-based asynchronous system (eOncoNote) was implemented in Ottawa, Canada for cancer specialists and primary care providers (PCPs). This study aimed to examine PCPs' experiences of implementing eOncoNote and how access to the system influenced communication between PCPs and cancer specialists. As part of a larger study, we collected and analyzed system usage data and administered an end-of-discussion survey to understand the perceived value of using eOncoNote. eOncoNote data were analyzed for 76 shared patients (33 patients receiving treatment and 43 patients in the survivorship phase). Thirty-nine percent of the PCPs responded to the cancer specialist's initial eOncoNote message and nearly all of those sent only one message. Forty-five percent of the PCPs completed the survey. Most PCPs reported no additional benefits of using eOncoNote and emphasized the need for electronic medical record (EMR) integration. Over half of the PCPs indicated that eOncoNote could be a helpful service if they had questions about a patient. Future research should examine opportunities for EMR integration and whether additional interventions could support communication between PCPs and cancer specialists. [ABSTRACT FROM AUTHOR]

MOTHERS, PARENT attitudes, SOCIAL norms, AGE distribution, CROSS-sectional method, INTERNET, FATHERS, SEX distribution, PARENTING, ALCOHOL drinking, DESCRIPTIVE statistics, PARENT-child relationships, and PARENTS

Aims This study aimed to examine perceived social norms, the effect of parental drinking on these norms, alcohol use in front of children, and how norms and consumption vary based on child age and gender of the parent. Methods A cross-sectional online panel survey was undertaken with n  = 1000 Australian adults (including 670 parents) aged 18–59 years. The survey assessed: alcohol consumption in front of children; normative attitudes towards drinking in the presence of children; and perceived social norms. Results Overall, 33.9% of parents reported drinking a glass of alcohol each day or a couple of times a week, 18.2% reported getting slightly drunk and 7.8% indicated getting visibly drunk each day or a couple of times a week with their children present. In total, 37.5% reported drinking in front of their children at least weekly. Fathers were more likely to drink in front of children than mothers. Most parents deemed drinking small amounts of alcohol in front of children as acceptable but did not accept drunkenness. Respondents were less concerned about a father drinking one or two drinks in front of their children than a mother. Social expectations were not related to child age, but norms related to others' perceived behaviour were. Conclusions Many parents, particularly fathers consume alcohol in front of their children. There is a need to target health promotion strategies to adults and parents consuming in excess of health guidelines, and to the many parents who are consuming alcohol at higher levels in front of their children. [ABSTRACT FROM AUTHOR]

TEACHERS, TEACHING of controversial topics, STUDENTS, DISCUSSION in education, and SOCIAL conditions of students

Controversial topics may be uncomfortable for teachers to include in their in-class discussions. However, there are considerable cognitive and social-emotional benefits to engagement in controversial conversations, or classroom discussion about controversial topics. It is critical that teachers support students in respectful discussion to help them develop skills such as problem solving, critical thinking, and the ability to consider issues from multiple perspectives. These skills can enable students to meet larger educational goals such as engaged citizenship. The goal of this article is to highlight the benefits of controversial conversations in the classroom and describe teaching approaches that facilitate effective controversial conversations. First, we identify important factors for teachers' consideration in supporting effective and beneficial controversial conversations. Second, we provide examples of topics of conversations that may be appropriate for students of varying ages. Third, we review how the structure of conversation, scaffolding, classroom context, relationships, and students' individual differences can shape controversial conversations. [ABSTRACT FROM AUTHOR]

LEFT heart ventricle, PATIENT aftercare, CAUSES of death, CONFIDENCE intervals, MAGNETIC resonance imaging, GLOBAL longitudinal strain, SYSTEMIC scleroderma, TERTIARY care, DESCRIPTIVE statistics, RESEARCH funding, LOGISTIC regression analysis, ODDS ratio, LEFT heart atrium, HEART failure, and PROPORTIONAL hazards models

Objective This study aimed to determine whether lower values of feature-tracking cardiovascular magnetic resonance (CMR)-derived left atrial reservoir strain (LARS) and impaired left ventricular (LV) global longitudinal strain (GLS) were associated with the presence of symptoms and long-term prognosis in patients with SSc. Methods A total of 100 patients {54 [interquartile range (IQR) 46–64] years, 42% male} with SSc who underwent CMR imaging at two tertiary referral centres were included. All patients underwent analysis of LARS and LV GLS using feature-tracking on CMR and were followed-up for the occurrence of all-cause mortality. Results The median LV GLS was –21.8% and the median LARS was 36%. On multivariable logistic regression, LARS [odds ratio (OR) 0.964 per %, 95% CI 0.929, 0.998, P  = 0.049] was independently associated with New York Heart Association (NYHA) class II–IV heart failure symptoms. Over a median follow-up of 37 (21–62) months, a total of 24 (24%) patients died. Univariable Cox regression analysis demonstrated that LARS [hazard ratio (HR) 0.94 per 1%, 95% CI 0.91, 0.97, P  < 0.0001) and LV GLS (HR 1.10 per %, 95% CI 1.03, 1.17, P  = 0.005) were associated with all-cause mortality, while LV ejection fraction was not. Likelihood ratio tests demonstrated that LARS provided incremental value over prognostically important clinical and imaging parameters, including late gadolinium enhancement. Conclusion In patients with SSc, LARS was independently associated with the presence of NYHA class II–IV heart failure symptoms. Although both LARS and LV GLS were associated with all-cause mortality, only LARS provided incremental value over all evaluated variables known to be prognostically important in patients with SSc. [ABSTRACT FROM AUTHOR]

CHILDREN and AGE

Introduction and Aims: Parental role modelling of alcohol use is known to influence alcohol consumption in adolescence and in later life. This study aimed to assess relationships between parental status, child age and alcohol consumption, which have not been well documented.Design and Methods: Data were sourced from the 2013 Australian National Drug Strategy Household Survey. Analyses were conducted for 25-55 year olds (n = 11 591) by parental status, gender and age of youngest child in the household, controlling for socio-demographic factors.Results: Parents were less likely than non-parents to exceed the alcohol guideline for increased lifetime risk (18.2% vs. 24.2%) and short-term risk: at least weekly (14.2% vs. 21.2%); and at least monthly (27.5% vs. 35.9%). Fathers were just as likely to exceed the guidelines for lifetime risk as other men, but those with children aged 0-2, were less likely to exceed the guideline for short-term risk. Women were least likely to exceed the guideline for lifetime risk if they had children aged 0-2, 6-11 or 15 years and over, or the guideline for short-term risk, if they had children aged 0-2, or 15 years and over in the household. Parents were more likely to report drinking in the home.Discussion and Conclusions: Parents were less likely to exceed alcohol guidelines than non-parents, especially mothers whose youngest child was an infant or in high school or older. Consistent with population rates in men, fathers were more likely to exceed alcohol guidelines than mothers, and this excess consumption warrants public health attention. [ABSTRACT FROM AUTHOR]

GENETIC variation, SLEEP, MISSENSE mutation, GENETIC testing, CLOCK genes, SLEEP disorders, and EXOMES

Rare variants in ten genes have been reported to cause Mendelian sleep conditions characterised by extreme sleep duration or timing. These include familial natural short sleep (ADRB1, DEC2/BHLHE41, GRM1 and NPSR1), advanced sleep phase (PER2, PER3, CRY2, CSNK1D and TIMELESS) and delayed sleep phase (CRY1). The association of variants in these genes with extreme sleep conditions were usually based on clinically ascertained families, and their effects when identified in the population are unknown. We aimed to determine the effects of these variants on sleep traits in large population-based cohorts. We performed genetic association analysis of variants previously reported to be causal for Mendelian sleep and circadian conditions. Analyses were performed using 191,929 individuals with data on sleep and whole-exome or genome-sequence data from 4 population-based studies: UK Biobank, FINRISK, Health-2000-2001, and the Multi-Ethnic Study of Atherosclerosis (MESA). We identified sleep disorders from self-report, hospital and primary care data. We estimated sleep duration and timing measures from self-report and accelerometery data. We identified carriers for 10 out of 12 previously reported pathogenic variants for 8 of the 10 genes. They ranged in frequency from 1 individual with the variant in CSNK1D to 1,574 individuals with a reported variant in the PER3 gene in the UK Biobank. No carriers for variants reported in NPSR1 or PER2 were identified. We found no association between variants analyzed and extreme sleep or circadian phenotypes. Using sleep timing as a proxy measure for sleep phase, only PER3 and CRY1 variants demonstrated association with earlier and later sleep timing, respectively; however, the magnitude of effect was smaller than previously reported (sleep midpoint ~7 mins earlier and ~5 mins later, respectively). We also performed burden tests of protein truncating (PTVs) or rare missense variants for the 10 genes. Only PTVs in PER2 and PER3 were associated with a relevant trait (for example, 64 individuals with a PTV in PER2 had an odds ratio of 4.4 for being "definitely a morning person", P = 4x10-8; and had a 57-minute earlier midpoint sleep, P = 5x10-7). Our results indicate that previously reported variants for Mendelian sleep and circadian conditions are often not highly penetrant when ascertained incidentally from the general population. Author summary: Clinically ascertained family-based studies have previously identified rare genetic variation associated with causing life-long sleep conditions, specifically shorter sleep, and earlier or later sleep timing. However, the effects of previously reported genetic variants on sleep duration and timing when identified incidentally through population-based studies are not known. Here, we take advantage of up to 191,929 individuals from four population-based studies, including the UK Biobank, to estimate the effects of these variants on sleep duration and timing using self-reported and accelerometer-based sleep estimates coupled with sequencing data. Our analysis revealed no association between variants previously reported and extreme sleep conditions. Two variants located in two genes (PER3 and CRY1) showed evidence of association with sleep timing, but their estimated effects (~5 to 7 minutes) on sleep timing are much smaller relative to those previously reported. Our results indicate that previously reported variants are not causal for extreme sleep conditions in the general population. Finally, although we were unable to analyse a previously reported variant in the PER2 gene associated with sleep timing, additional analysis in the UK Biobank revealed carries of protein-truncating variants in this gene have an approximately 1-hour earlier sleep midpoint compared to non-carriers. These population-based estimates are important because of the recent dramatic increase in direct-to-consumer and health service genome-wide genetic testing. [ABSTRACT FROM AUTHOR]

ATMOSPHERIC sulfur compounds, SULFUR deposits, CLIMATE change, GRASSLANDS, and PLANT communities

The predicted long lag time between a decrease in atmospheric deposition and a measured response in vegetation has generally excluded the investigation of vegetation recovery from the impacts of atmospheric deposition. However, policy-makers require such evidence to assess whether policy decisions to reduce emissions will have a positive impact on habitats. Here we have shown that 40 years after the peak of SO x emissions, decreases in SO x are related to significant changes in species richness and cover in Scottish Calcareous, Mestrophic, Nardus and Wet grasslands. Using a survey of vegetation plots across Scotland, first carried out between 1958 and 1987 and resurveyed between 2012 and 2014, we test whether temporal changes in species richness and cover of bryophytes, Cyperaceae, forbs, Poaceae, and Juncaceae can be explained by changes in sulphur and nitrogen deposition, climate and/or grazing intensity, and whether these patterns differ between six grassland habitats: Acid, Calcareous, Lolium , Nardus , Mesotrophic and Wet grasslands. The results indicate that Calcareous, Mesotrophic, Nardus and Wet grasslands in Scotland are starting to recover from the UK peak of SO x deposition in the 1970's. A decline in the cover of grasses, an increase in cover of bryophytes and forbs and the development of a more diverse sward (a reversal of the impacts of increased SO x ) was related to decreased SO x deposition. However there was no evidence of a recovery from SO x deposition in the Acid or Lolium grasslands. Despite a decline in NO x deposition between the two surveys we found no evidence of a reversal of the impacts of increased N deposition. The climate also changed significantly between the two surveys, becoming warmer and wetter. This change in climate was related to significant changes in both the cover and species richness of bryophytes, Cyperaceae, forbs, Poaceae and Juncaceae but the changes differed between habitats. [ABSTRACT FROM AUTHOR]

SEPTEMBER 11 Terrorist Attacks, 2001, HAZARDOUS substance exposure, MEDICAL screening, HAZARDS, and HEALTH risk assessment

The attack on the World Trade Center (WTC) on September 11th, 2001 exposed thousands of individuals to an unprecedented mix of chemicals, combustion products and micronized building materials. Clinicians at the Mount Sinai Irving Selikoff Center for Occupational and Environmental Medicine, in partnership with affected stakeholder organizations, developed a medical screening program to evaluate the health status of workers and volunteers who spent time at the WTC site and thus sustained exposure in the aftermath of September 11th. Standardized questionnaires were adapted for use in this unique population and all clinicians underwent training to ensure comparability. The WTC Worker and Volunteer Medical Screening Program (MSP) received federal funding in April 2002 and examinations began in July 2002. The MSP and the follow up medical monitoring program has successfully recruited nearly 22,000 responders, and serves as a model for the rapid development of a medical screening program to assess the health of populations exposed to environmental hazards as a result of natural and man-made disasters. The MSP constitutes a successful screening program for WTC responders. We discuss the challenges that confronted the program; the absence of a prior model for the rapid development of a program to evaluate results from mixed chemical exposures; little documentation of the size of the exposed population or of who might have been exposed; and uncertainty about both the nature and potential severity of immediate and long-term health effects. [ABSTRACT FROM AUTHOR]

WORLD Trade Center Bombing, New York, N.Y., 1993, RESCUE work, EMERGENCY medical services, SEPTEMBER 11 Terrorist Attacks, 2001, TERRORISM, MEDICAL screening, HEALTH risk assessment, DIAGNOSTIC services, and MEDICAL care

BACKGROUND: Approximately 40,000 rescue and recovery workers were exposed to caustic dust and toxic pollutants following the 11 September 2001 attacks on the World Trade Center (WTC). These workers included traditional first responders, such as firefighters and police, and a diverse population of construction, utility, and public sector workers. METHODS: To characterize WTC-related health effects, the WTC Worker and Volunteer Medical Screening Program was established. This multicenter clinical program provides free standardized examinations to responders. Examinations include medical, mental health, and exposure assessment questionnaires; physical examinations; spirometry; and chest X rays. RESULTS: Of 9,442 responders examined between July 2002 and April 2004, 69% reported new or worsened respiratory symptoms while performing WTC work. Symptoms persisted to the time of examination in 59% of these workers. Among those who had been asymptomatic before September 11, 61% developed respiratory symptoms while performing WTC work. Twenty-eight percent had abnormal spirometry; forced vital capacity (FVC) was low in 21%; and obstruction was present in 5%. Among nonsmokers, 27% had abnormal spirometry compared with 13% in the general U.S. population. Prevalence of low FVC among nonsmokers was 5-fold greater than in the U.S. population (20% vs. 4%). Respiratory symptoms and spirometry abnormalities were significantly associated with early arrival at the site. CONCLUSION: WTC responders had exposure-related increases in respiratory symptoms and pulmonary function test abnormalities that persisted up to 2.5 years after the attacks. Long-term medical monitoring is required to track persistence of these abnormalities and identify late effects, including possible malignancies. Lessons learned should guide future responses to civil disasters. [ABSTRACT FROM AUTHOR]

SEPTEMBER 11 Terrorist Attacks, 2001, PARTICLES, TOXINS, GLASS fibers, POLYCYCLIC aromatic hydrocarbons, DIOXINS, and PUBLIC health

In the aftermath of the September 11 World Trade Center (WTC) attack, a large number of people sustained potential exposures to smoke, dust, particulate matter, and a variety of toxins, including asbestos, pulverized concrete, glass fibers, polycyclic aromatic hydrocarbons (PAHs), and polychlorinated furans and dioxins. Additionally, many had exposure to psychological traumatogens. The most common effects seen to date are respiratory and mental health consequences. The long-term consequences of exposures are not yet known, and there remains concern about the potential for late-emerging diseases such as cancers. This article reviews WTC-related health effects, the spectrum of exposures and how they were documented, and discusses future preventive efforts. [ABSTRACT FROM AUTHOR]

INFANT mortality, ANTHROPOMETRY, HUMAN body composition, PLETHYSMOGRAPHY, LOGISTIC regression analysis, and MALNUTRITION in infants

Background: With the greatest burden of infant undernutrition and morbidity in low and middle income countries (LMICs), there is a need for suitable approaches to monitor infants in a simple, low-cost and effective manner. Anthropometry continues to play a major role in characterising growth and nutritional status. Methods: We developed a range of models to aid in identifying neonates at risk of malnutrition. We first adopted a logistic regression approach to screen for a composite neonatal morbidity, low and high body fat (BF%) infants. We then developed linear regression models for the estimation of neonatal fat mass as an assessment of body composition and nutritional status. Results: We fitted logistic regression models combining up to four anthropometric variables to predict composite morbidity and low and high BF% neonates. The greatest area under receiver-operator characteristic curves (AUC with 95% confidence intervals (CI)) for identifying composite morbidity was 0.740 (0.63, 0.85), resulting from the combination of birthweight, length, chest and mid-thigh circumferences. The AUCs (95% CI) for identifying low and high BF% were 0.827 (0.78, 0.88) and 0.834 (0.79, 0.88), respectively. For identifying composite morbidity, BF% as measured via air displacement plethysmography showed strong predictive ability (AUC 0.786 (0.70, 0.88)), while birthweight percentiles had a lower AUC (0.695 (0.57, 0.82)). Birthweight percentiles could also identify low and high BF% neonates with AUCs of 0.792 (0.74, 0.85) and 0.834 (0.79, 0.88). We applied a sex-specific approach to anthropometric estimation of neonatal fat mass, demonstrating the influence of the testing sample size on the final model performance. Conclusions: These models display potential for further development and evaluation in LMICs to detect infants in need of further nutritional management, especially where traditional methods of risk management such as birthweight for gestational age percentiles may be variable or non-existent, or unable to detect appropriately grown, low fat newborns. [ABSTRACT FROM AUTHOR]

ALCOHOL drinking, SCHOOL children, CROSS-sectional method, STUDENT health, DRINKING behavior, FORECASTING, FRIENDSHIP, HEALTH education, SCHOOLS, STUDENTS, and DISEASE prevalence

Background: Alcohol consumption by young people (particularly early initiation) is a predictor for poorer health in later life. In addition, evidence now clearly shows a causal link between alcohol and cancer. This study investigated prevalence, predictors of alcohol consumption among adolescents including perceptions of the link between alcohol and cancer, and the role of parents and peers.Methods: A sample of Australian school students aged 12-17 years participated in a survey (n = 2885). Logistic regression analysis was undertaken to determine predictors.Results: Alcohol use increased with age and by 16, most had tried alcohol with 33.1% of students aged 12-17 reporting that they drank at least occasionally (95% CI = 31.0-35.2). Awareness of the link between alcohol and cancer was low (28.5%). Smoking status and friends' approval were predictive of drinking, whereas parental disapproval was protective. Those aged 14-17 who did not think the link between alcohol and cancer was important were more likely to drink, as were those living in areas of least disadvantage. The only factors that predicted recent drinking were smoking and the perception that alcohol was easy to purchase.Conclusions: An education campaign highlighting the link between alcohol and cancer may have positive flow-on effects for young people, and schools should incorporate this messaging into any alcohol education programs. Consideration should be given to factors that serve to regulate under-aged accessibility of alcohol. [ABSTRACT FROM AUTHOR]

OCCUPATIONAL therapy, PRIMARY care, MEDICAL rehabilitation, PHYSICAL therapy, and MEDICAL care

Background: Primary healthcare (PHC) is central to increased access and transformation in South African healthcare. There is limited literature about services required by occupational therapists in PHC. Despite policy being in place, the implementation of services at grassroots level does not always occur adequately. Objectives: This study aimed at gaining an understanding of the challenges of being disabled and the services required by occupational therapists (OTs) in rural communities in order to better inform the occupational therapy (OT) training curriculum. Method: An exploratory, descriptive qualitative design was implemented using purposive sampling to recruit 23 community healthcare workers from the uGu district. Snowball sampling was used to recruit 37 members of the uGu community, which included people with disability (PWD) and caregivers of PWDs. Audio-recorded focus groups and semi-structured interviews were used to collect data, which were thematically analysed. Ethical approval was obtained from the Biomedical and Research Ethics Committee of the University of KwaZulu-Natal (BE248/14). Results: Two main themes emerged namely: firstly, the challenges faced by the disabled community and secondly appropriate opportunities for intervention in PHC. A snapshot of the social and physical inaccessibility challenges experienced by the community was created. Challenges included physical and sexual abuse, discrimination and marginalisation. Community-based rehabilitation and ideas for health promotion and prevention were identified as possible strategies for OT intervention. Conclusion: The understanding of the intervention required by OT in PHC was enhanced through obtaining the views of various stakeholders' on the role. This study highlighted the gaps in community-based services that OTs should offer in this context. [ABSTRACT FROM AUTHOR]

BEER, INTERNATIONAL economic relations, and INTERNATIONAL trade

Demonstrates how United States and Canadian controls on the alcohol market affect public health. US-Canadian alcohol control; Public health implications; How the trade agreements (GATT, FTA, NAFTA) work; Trade disputes since 1985; The larger meaning of the disputes; Chronology of the US-Canada beer dispute; Glossary; Summary.

PREMATURE labor, BIRTH weight, LOW birth weight, BIRTH intervals, COHORT analysis, CHORIOAMNIONITIS, and CHILDBIRTH at home

Background: Approximately 20.5 million infants were born weighing <2500 g (defined as low birthweight or LBW) in 2015, primarily in low- and middle-income countries (LMICs). Infants born LBW, including those born preterm (<37 weeks gestation), are at increased risk for numerous consequences, including neonatal mortality and morbidity as well as suboptimal health and nutritional status later in life. The objective of this study was to identify predictors of LBW and preterm birth among infants in rural Uganda. Methods: Data were derived from a prospective birth cohort study conducted from 2014–2016 in 12 districts across northern and southwestern Uganda. Birth weights were measured in triplicate to the nearest 0.1 kg by trained enumerators within 72 hours of delivery. Gestational age was calculated from the first day of last menstrual period (LMP). Associations between household, maternal, and infant characteristics and birth outcomes (LBW and preterm birth) were assessed using bivariate and multivariable logistic regression with stepwise, backward selection analyses. Results: Among infants in the study, 4.3% were born LBW (143/3,337), and 19.4% were born preterm (744/3,841). In multivariable analysis, mothers who were taller (>150 cm) (adjusted Odds Ratio (aOR) = 0.42 (95% CI = 0.24, 0.72)), multigravida (aOR = 0.62 (95% CI = 0.39, 0.97)), or with adequate birth spacing (>24 months) (aOR = 0.60 (95% CI = 0.39, 0.92)) had lower odds of delivering a LBW infant Mothers with severe household food insecurity (aOR = 1.84 (95% CI = 1.22, 2.79)) or who tested positive for malaria during pregnancy (aOR = 2.06 (95% CI = 1.10, 3.85)) had higher odds of delivering a LBW infant. In addition, in multivariable analysis, mothers who resided in the Southwest (aOR = 0.64 (95% CI = 0.54, 0.76)), were ≥20 years old (aOR = 0.76 (95% CI = 0.61, 0.94)), with adequate birth spacing (aOR = 0.76 (95% CI = 0.63, 0.93)), or attended ≥4 antenatal care (ANC) visits (aOR = 0.56 (95% CI = 0.47, 0.67)) had lower odds of delivering a preterm infant; mothers who were neither married nor cohabitating (aOR = 1.42 (95% CI = 1.00, 2.00)) or delivered at home (aOR = 1.25 (95% CI = 1.04, 1.51)) had higher odds. Conclusions: In rural Uganda, severe household food insecurity, adolescent pregnancy, inadequate birth spacing, malaria infection, suboptimal ANC attendance, and home delivery represent modifiable risk factors associated with higher rates of LBW and/or preterm birth. Future studies on interventions to address these risk factors may be warranted. [ABSTRACT FROM AUTHOR]

Background: Increased burden of white‐matter hyperintensities (WMHs) on MRI is common among different types of dementia. WMHs can be caused by various underlying etiologies and are non‐specific markers of tissue abnormality. Therefore, global measures such as WMH burdens may not distinguish between degrees of cognitive impairment. We explored the associations between lobar‐specific WMH volumes and cognitive dysfunction across different dementia subtypes. Method: N=57 participants (7 Alzheimer's disease [AD]/5 subcortical vascular dementia [SVaD]/7 mixed dementia [MixD]/38 vascular cognitive impairment [VCI]; Sex:34M/23F; Age:73±8yrs; pooled from three independent studies) were scanned on 3T MRI. WMHs were segmented on 3D‐FLAIR (MixD/AD/SVaD) or dual‐echo PD/T2‐weighted (VCI) images. T1‐weighted images were processed with Freesurfer 6.0. Left and right frontal, temporal, occipital and parietal lobes plus basal ganglia volumes were constructed using the Freesurfer segmentation outputs. We calculated the proportion of WMH burden within each lobe, i.e. the ratio of lobar WMH volume over the lobar volume. The Montreal Cognitive Assessment (MoCA) was used as a measure of cognitive function. We used a general linear model to determine the association between the WMH/lobar volume ratios and the MoCA scores. Covariates included age, sex, and presence of AD‐related (yes for MixD/AD, no for rest) and vascular‐related conditions (yes for SVaD/VCI/MixD, no for AD). Additionally, we assessed the relationship between the MoCA scores and the ratio of total WMH burden over the whole‐brain parenchymal volume. Result: The model yielded a significant association between the MoCA scores and WMH/lobar ratios within the left (p=0.031) and the right (p=0.035) frontal lobes, with higher ratios predicting lower MoCA scores. The effect was not significant within the temporal, occipital, parietal lobes and the basal ganglia. The effect was insignificant at the whole‐brain level (p=0.08). Conclusion: We found a significant association between the frontal lobe WMH burden and the MoCA scores, especially sensitive to frontal executive functions. This suggests that region‐specific assessments of WMHs may provide improved imaging‐cognitive correlations over the global WMH burden. Future studies with more consistent imaging protocols and broader cognitive/clinical assessments are warranted to further characterize the relationship between WMHs and cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) with cerebrovascular disease is known as 'mixed' dementia (MixD).[Wang_2012][Langa_2004] MixD can have heterogeneous clinical/imaging presentations. This makes it difficult to distinguish MixD from AD or vascular dementia (VaD) using structural markers such as atrophy or white matter hyperintensity (WMH) volumes. [Suri_2014] We explored whether WM tissue properties on MRI, represented by R2* and diffusion‐tensor (DTI) images, could distinguish MixD from AD or VaD. Method: N=17 participants (cross‐sectional; 7 MixD/5 Subcortical VaD/5 AD; Sex: 11M/6F; Age: 75±8yrs) were scanned on a 3T Philips Achieva. WMHs were segmented on 3D‐Fluid Attenuated Inversion Recovery images. T1‐weighted MP‐RAGE images were segmented into the grey/white‐matters using SPM12. These outputs were combined to construct WMH and normal‐appearing WM (NAWM) masks. DTI images were processed using FSL. R2* images were computed using in‐house software. For each participant, the average R2*, fractional anisotropy (FA) and mean diffusivity (MDf) values were calculated within the WMH and NAWM masks. Result: Average WMH volumes were (mean±SD) AD: 5191±4693mm3, MD: 34680±17059mm3 (p<.05 compared to AD), SVaD: 20896±14920mm3 (p>.05 compared to MixD or AD). A linear model was used to predict the measured R2*, FA or MDf values from the diagnosis subtypes, adjusting for age and sex. R2* results: Pairwise t‐tests revealed significantly lower R2* values within the WMHs compared to NAWM (all subtypes p<0.0005). MixD had significantly lower WMH R2* values compared to AD (p=0.01) or VaD (p=0.02) subgroups. DTI results: Pairwise t‐tests revealed significantly higher MDf values within the WMHs compared to NAWM (all subtypes p<0.009). FA values were significantly lower within the WMHs compared to NAWM for the MixD (p=0.0002) and VaD (p=0.03) but not the AD (p=0.09) subtype. Conclusion: Our MixD cohort was characterized by potentially disrupted fiber integrity (represented by decreased FA) and increased water content (represented by lower R2*) within the WMH areas. These abnormalities likely represent etiologies caused by both neurodegenerative and cerebrovascular factors. Future studies that incorporate measures of neurodegeneration or neuroinflammation, such as biofluid markers, may help to further characterize WM tissue abnormalities in MixD compared to those found in 'pure' AD or VaD. [ABSTRACT FROM AUTHOR]

Background: Vascular dementia (VaD) is often difficult to distinguish from Alzheimer's disease (AD).[O'Brien_2015] Areas of cognitive/clinical decline due to cerebrovascular diseases depend on the frequency and location of the lesions, and may overlap with those found in AD.[Suri_2014] Moreover, AD and cerebrovascular diseases frequently occur simultaneously, leading to heterogeneous 'mixed dementia (MixD)'.[Wang_2012][Langa_2004] It is unclear whether the presence of both neurodegenerative and cerebrovascular pathologies further aggravates dementia‐related imaging abnormalities. We investigated whether the lobar distribution of white matter hyperintensities (WMHs) on MRI differed among AD, VaD and MixD. Method: N=17 participants (cross‐sectional; subtypes:7 MixD/5 Subcortical VaD/5 AD; Sex: 11M/6F; Age: 75±8yrs) were scanned on a 3T Philips Achieva. T1‐weighted MP‐RAGE images were processed with Freesurfer 6.0. Areas of WMHs were segmented on Fluid Attenuated Inversion Recovery (3D‐FLAIR) images using a combination of intensity thresholding and manual correction. Left and right frontal, temporal, occipital and parietal lobes plus basal ganglia volumes were constructed using the Freesurfer segmentation outputs. Individual WMH masks were transformed to their respective T1‐weighted spaces, and the ratios of WMH volumes to different lobar volumes were calculated. Result: Average WMH volumes were (mean±SD) AD: 5191±4693mm3, MixD: 34680±17059mm3 (sig. greater than AD), SVaD: 20896±14920mm3 (n.s. from MixD or AD). We used a linear model to predict the ratios of WMH to lobar volumes from the diagnosis subtypes, adjusting for age and sex. A significant diagnosis‐subtype effect was found in both the left and right frontal lobes. (p=0.012 and 0.045, respectively). In the left frontal lobe, the proportion of WMHs was significantly greater in the MixD subgroup compared to the AD (p=0.0045) or the VaD (p=0.026) subtypes. In the right frontal lobe, the proportion was greater in the MixD subtype compared to the AD (p=0.018) but not compared to VaD (p=0.074) subtype. AD vs. VaD were not significantly different in either sides (p=0.5). Conclusion: The MixD subtype of our pilot study cohort was characterized by a significantly greater presence of WMHs in the frontal lobar areas. Future studies are warranted to investigate the characteristics of underlying tissue abnormalities that could be specific to the diagnosis subtypes. [ABSTRACT FROM AUTHOR]

PATIENT advocacy, EMPATHY, INTERVIEWING, INTERNSHIP programs, UNDERGRADUATES, UNIVERSITIES & colleges, NURSING students, STUDENT attitudes, THEMATIC analysis, and BULLYING

The two aims of this study were, first, to explore nursing students' experiences and perspectives of reporting poor care and second, examine the process by which they raised concerns. The nursing literature is replete with studies which explore nursing students' experiences of clinical placement. However only a small number explore students experiences of challenging poor care and how this is enacted in the practice setting. Fourteen nursing students from undergraduate pre-registration nursing programs across three universities, two in the United Kingdom (UK) and one in Australia. This paper reports findings from narrative interviews about students' clinical experiences of reporting poor care. Data were audio recorded, transcribed verbatim and analyzed using a constant comparison approach. Emerging themes were identified, discussed and verified by the researchers. Four montages from the narratives highlight the overarching themes: bullying, patient advocacy, lack of empathy and poor care. They demonstrate how, driven by an ethical imperative, students speak up when they witness poor care despite the difficulties of doing so: in some cases, the students in this study were prepared to continue speaking out even when initial concerns were dismissed. Both practice and university teams have a responsibility to support students' development as ethical and courageous practitioners, able to recognize when care falls below an acceptable standard. • This paper highlights the vital role that students play in highlighting poor nursing care practices. • Nursing students are capable of reporting poor nursing care even when it might come at a cost to themselves. • Clinicians and academics must support students to challenge poor nursing care practices. [ABSTRACT FROM AUTHOR]

ATHEROSCLEROSIS treatment, TYPE 2 diabetes treatment, GLUCOSE intolerance, THERAPEUTIC use of monoclonal antibodies, DISEASE progression, ATHEROSCLEROSIS complications, TYPE 2 diabetes complications, ARTERIES, ATHEROSCLEROSIS, CLINICAL trials, COMPARATIVE studies, INTERLEUKIN-1, RESEARCH methodology, MEDICAL cooperation, MONOCLONAL antibodies, RESEARCH, EVALUATION research, RANDOMIZED controlled trials, BLIND experiment, CHEMICAL inhibitors, and DISEASE complications

Background: Evidence suggests that interleukin (IL)-1β is important in the pathogenesis of atherosclerosis and its complications and that inhibiting IL-1β may favorably affect vascular disease progression.Objectives: The goal of this study was to evaluate the effects of IL-1β inhibition with canakinumab versus placebo on arterial structure and function, determined by magnetic resonance imaging.Methods: Patients (N = 189) with atherosclerotic disease and either type 2 diabetes mellitus or impaired glucose tolerance were randomized to receive placebo (n = 94) or canakinumab 150 mg monthly (n = 95) for 12 months. They underwent magnetic resonance imaging of the carotid arteries and aorta.Results: There were no statistically significant differences between canakinumab compared with placebo in the primary efficacy and safety endpoints. There was no statistically significant change in mean carotid wall area and no effect on aortic distensibility, measured at 3 separate anatomic sites. The change in mean carotid artery wall area was -3.37 mm2 after 12 months with canakinumab versus placebo. High-sensitivity C-reactive protein was significantly reduced by canakinumab compared with placebo at 3 months (geometric mean ratio [GMR]: 0.568; 95% confidence interval [CI]: 0.436 to 0.740; p < 0.0001) and 12 months (GMR: 0.56; 95% CI: 0.414 to 0.758; p = 0.0002). Lipoprotein(a) levels were reduced by canakinumab compared with placebo (-4.30 mg/dl [range: -8.5 to -0.55 mg/dl]; p = 0.025] at 12 months), but triglyceride levels increased (GMR: 1.20; 95% CI: 1.046 to 1.380; p = 0.01). In these patients with type 2 diabetes mellitus or impaired glucose tolerance, canakinumab had no effect compared with placebo on any of the measures assessed by using a standard oral glucose tolerance test.Conclusions: There were no statistically significant effects of canakinumab on measures of vascular structure or function. Canakinumab reduced markers of inflammation (high-sensitivity C-reactive protein and interleukin-6), and there were modest increases in levels of total cholesterol and triglycerides. (Safety & Effectiveness on Vascular Structure and Function of ACZ885 in Atherosclerosis and Either T2DM or IGT Patients; NCT00995930). [ABSTRACT FROM AUTHOR]

TOXOPLASMA, POLYMERS, TUBULINS, MICROTUBULES, and XENOPUS

Background: TgDCX is a doublecortin-domain protein associated with the conoid fibers, a set of strongly curved non-tubular tubulin-polymers in Toxoplasma. TgDCX deletion impairs conoid structure and parasite invasion. TgDCX contains two tubulin-binding domains: a partial P25α and the DCX/doublecortin domain. Orthologues are found in apicomplexans and their free-living relatives Chromera and Vitrella. Results: We report that isolated TgDCX-containing conoid fibers retain their pronounced curvature, but loss of TgDCX destabilizes the fibers. We crystallized and determined the 3D-structure of the DCX-domain, which is similar to those of human doublecortin and well-conserved among TgDCX orthologues. However, the orthologues vary widely in targeting to the conoid in Toxoplasma and in modulating microtubule organization in Xenopus cells. Several orthologues bind to microtubules in Xenopus cells, but only TgDCX generates short, strongly curved microtubule arcs. EM analysis shows microtubules decorated with TgDCX bundled into rafts, often bordered on one edge by a "C"-shaped incomplete tube. A Chromera orthologue closely mimics TgDCX targeting in Toxoplasma and binds to microtubules in Xenopus cells, but does not generate arcs or "C"-shaped tubes, and fails to rescue the defects of the TgDCX-knockout parasite. Conclusions: These observations suggest that species-specific features of TgDCX enable it to generate strongly curved tubulin-polymers to support efficient host-cell invasion. [ABSTRACT FROM AUTHOR]

This study explores the perceptions of final year occupational therapy students at the University of KwaZulu Natal and their supervisors, regarding their preparedness to practice as well as their views about the efficacy of the undergraduate curriculum in accomplishing adequate levels of preparedness. Method: A qualitative design using focus groups and semi-structured interviews with students and clinical supervisors to obtain their views and backed up by an analysis of relevant documents of the Health Professions Council of SA and the World Federation of Occupational Therapists, the outcome of which formed the conceptual framework guiding analysis of the data from the interviews and focus groups. Results/findings: Both students and their supervisors felt they possessed adequate graduate competencies to prepare them for practice. Some concerns related to curriculum content, teaching methods, and relationships with lecturers and clinical supervisors emerged. Students’ level of professional confidence was directly influenced by their degree of enjoyment of the fieldwork practical and positive experiences related to this. Supervisors also reported that students display high levels of ethical awareness. Conclusions: the findings provide insights into understanding the relevance of current occupational therapy training specifically at UKZN but also of relevance to the rest of South Africa. [ABSTRACT FROM AUTHOR]

Nearly 6.5 million Americans are living with heart failure (HF), the leading cause of hospitalization among adults aged 65 and older. Despite advancements in medical therapy, HF patient outcomes remain of concern. HF readmission rates remain high and only half of patients diagnosed with heart failure are expected to live beyond 5 years of diagnosis. Increasing prevalence and poor outcomes provide significant opportunities for improvement. Hospital participation in a quality initiative designed to improve care by promoting adherence to the scientific guidelines, such as Get With the Guidelines®-Heart Failure (GWTG-HF), assists hospitals in effectively delivering high quality care to improve patient outcomes. The objective of this project is to form multidisciplinary collaboratives that will rapidly implement evidence-based guidelines to develop best practices that can be shared to improve heart failure patient outcomes. The AHA will lead a quality improvement initiative for transforming heart failure care in three major cities including Chicago, Milwaukee and St. Louis. • A retrospective review was conducted using GWTG-HF on measures with low adherence from participating hospitals in the metro markets. • Baseline data of specific HF measures from Quarter 1, 2018 were analyzed and to determine areas of improvement needed. • Using regional and 1:1 hospital meetings, AHA will lead a quality improvement initiative to transform HF patient care. • The HF project will focus on professional education, enhancing systems of care and facilitating the sharing of best practices. • The patient population will include patients from GWTG-HF with a principal/primary diagnosis of heart failure. The project goal within the 2-year timeframe of this initiative is to achieve 20% improvement from baseline data OR achieve AHA's 85% adherence threshold in each measure. AHA Quality staff will observe and monitor market-level data within GWTG-HF to uncover and recommend improvements, provide consultation to clinicians, deliver targeted training and resources such as webinars, conferences, toolkits, care pathways, educational materials and to foster best-practice sharing to address common barriers. Participating hospitals vary in size, discharge volume, GWTG participation tenure, FTE support and resources • *There is incomplete baseline date for the three thirty day follow up measures • Initiative implementation may vary slightly in 3 metro markets The two-year multi-city quality initiative will bring together multiple hospitals to share best practices, develop resources and analyze Get With The Guidelines data for performance improvement to accelerate heart failure patient outcomes. Further investigation is merited evaluating the effectiveness of quality collaboratives to enhance care. [ABSTRACT FROM AUTHOR]

DISABILITY awareness, PEOPLE with disabilities, CRITICAL thinking, RESEARCH personnel, and STRATEGIC planning

Objective: The main objectives were to 1) search and map current disability awareness and training activities in Quebec, Canada, 2) collectively reflect on these practices, and 3) develop a five-year strategic plan.Methods: We used an integrated knowledge translation approach whereby researchers and community partners were involved in all stages. This project consisted of two sequential phases: 1) an environmental scan (web review and interview) of current practices, and 2) a reflection process with an external expert-facilitator in social transformation. Outcome results and process data are reported.Results: We identified 129 activities (71 training, 58 awareness) from 39 organizations (from 123 organizations initially invited). A wide range of characteristics were collected for each activity which allowed for the identification of gaps. The working group met seven times in one year to discuss results from phase 1 and co-create a five-year strategic plan. Main priorities are 1) the development of a methodology for measuring collective impact and 2) content synchronization of activities.Conclusion: Involvement of partners and researchers enabled a concerted and efficient approach to the development of a five-year strategic plan.Practice Implications: A transition committee led by partners will ensure implementation and sustainability of the plan across the province. [ABSTRACT FROM AUTHOR]

Marketers, filmmakers, and cinema-goers assume that genre has a large effect on how the audience responds to and engages with a film. However, trait measures such as transportability suggest that, in some cases, individual differences may shape audience engagement more than genre does. To investigate this disparity, we compared viewers' enjoyment, identification with characters, and story world absorption (including three subscales: Transportation, Attention, and Emotional Engagement) for film clips from two very different genres (an emotional family film vs. an action chase scene) in a within-subjects design. Across two studies--an exploratory study and a preregistered replication--we found that participants' feelings of being transported into the narrative (a dimension of story world absorption) were more highly correlated across films than other measures were and tended to be less related to genre preference than the other audience response measures were. This pattern of results suggests that feelings of transportation may be more dependent on individual differences, and less sensitive to genre, than other forms of audience response. An exploratory analysis of a short scale measuring trait transportability suggested this measure was not the basis of the individual differences theorized to underlie transportation. Our results further highlight the importance of examining viewer engagement with narrative as a multidimensional, rather than unitary, concept. [ABSTRACT FROM AUTHOR]

EDUCATIONAL leadership, EDUCATIONAL planning, HIGHER education, EDUCATIONAL programs, and POSTSECONDARY education

Promoting the development of educational leadership in higher education is essential for strengthening the quality of teaching and learning. Additional research is needed to conceptualize educational leadership, especially within informal roles. We analysed how faculty members in an academic development program conceptualized educational leadership. Five key characteristics emerged that inform the development of educational leadership capacity in postsecondary contexts: affective qualities, mentoring and empowering, action-orientation, teaching excellence, and research and scholarship. Three characteristics of academic programs aimed at developing educational leadership were also identified: funding and resources to implement a change initiative, building interdisciplinary communities, and embracing identity. [ABSTRACT FROM AUTHOR]

The article discusses a research study on system strategies for supporting cancer screening in primary care practice in the U.S. Researchers assessed the systems strategies used for screening of 2,475 primary care physicians for colorectal cancer (CRC), cervical and breast cancer in 2007. Results showed that a comprehensive set of strategies were being used by only 10% of physicians and reports of cancer screening rates were mainly for Papanicolaou (Pap) smear testing and mammography.

While much is known about nursing students' clinical placement experiences in general, less has been reported about their specific encounters with poor care delivery. A few small-scale qualitative studies have been undertaken, which suggest that nursing students do witness poor care but often decide not to act on what they see. This study sought to explore a wider international perspective on this issue. To explore nursing students' experiences of the care delivery practices witnessed during clinical placements and to provide descriptions of poor care. Nursing students from undergraduate pre-registration nursing programmes across three universities, two in the United Kingdom (UK) and one in Australia. A qualitative/quantitative survey design was utilised, and data were descriptively analysed. Two hundred and sixty-five students participated in the study. Overall the results were positive. Nevertheless, the participants did provide multiple and recurring examples of poor nursing care which related to a lack of compassion, poor communication, unkind and indifferent provision of personal care, and patient safety. Reporting of poor care was viewed as difficult and many participants highlighted potential repercussions should they take this course of action. This research provides contemporary international insights into care delivery practices from the perspective of a large number of nursing students. The results, although mainly positive, outline multiple examples of poor and ineffective practice. While the precise prevalence of these remains unknown, educators, practitioners and students should consider how best to address them when they occur. [ABSTRACT FROM AUTHOR]

HIV infection epidemiology, RESEARCH, RESEARCH evaluation, SOCIAL media, RESEARCH methodology, DISEASE incidence, EVALUATION research, MEDICAL cooperation, COMPARATIVE studies, and RESEARCH funding

Background: Adolescents and young adults in the age range of 13-24 years are at the highest risk of developing HIV infections. As social media platforms are extremely popular among youths, researchers can utilize these platforms to curb the HIV epidemic by investigating the associations between the discourses on HIV infections and the epidemiological data of HIV infections.Objective: The goal of this study was to examine how Twitter activity among young men is related to the incidence of HIV infection in the population.Methods: We used integrated human-computer techniques to characterize the HIV-related tweets by male adolescents and young male adults (age range: 13-24 years). We identified tweets related to HIV risk and prevention by using natural language processing (NLP). Our NLP algorithm identified 89.1% (2243/2517) relevant tweets, which were manually coded by expert coders. We coded 1577 HIV-prevention tweets and 17.5% (940/5372) of general sex-related tweets (including emojis, gifs, and images), and we achieved reliability with intraclass correlation at 0.80 or higher on key constructs. Bivariate and multivariate analyses were performed to identify the spatial patterns in posting HIV-related tweets as well as the relationships between the tweets and local HIV infection rates.Results: We analyzed 2517 tweets that were identified as relevant to HIV risk and prevention tags; these tweets were geolocated in 109 counties throughout the United States. After adjusting for region, HIV prevalence, and social disadvantage index, our findings indicated that every 100-tweet increase in HIV-specific tweets per capita from noninstitutional accounts was associated with a multiplicative effect of 0.97 (95% CI [0.94-1.00]; P=.04) on the incidence of HIV infections in the following year in a given county.Conclusions: Twitter may serve as a proxy of public behavior related to HIV infections, and the association between the number of HIV-related tweets and HIV infection rates further supports the use of social media for HIV disease prevention. [ABSTRACT FROM AUTHOR]

PREMATURE infants -- Hospital care, NURSING practice, HEALTH care teams, NEWBORN infant care, HEALTH outcome assessment, and BODY temperature regulation

Abstract: Late-preterm infants have unique nursing care needs that require attention for the infant to transition easily to the newborn phase of life. With limited physiological reserves to respond to stress, the focus of nursing care is early recognition of stress and conservation of reserves. Evaluating current nursing practices compared with evidence-based practices can reveal what may seem to be minor practices that can have significant negative effects on care of the late-preterm infant. Involving all members of the health care team to increase awareness of the issues surrounding this unique population can lead to staff development and united efforts that improve outcomes for the late-preterm infant. [Copyright &y& Elsevier]