Complete Assessment Research Articles

“Doing well”: Intraoperative entrustable professional activity assessments provided limited technical feedback

BackgroundEntrustable Professional Activities (EPAs) allow for the assessment of specific, observable, essential tasks in medical education. Since being developed in non-surgical fields, EPA assessments have been implemented in surgery to explore intraoperative entrustment. However, assessment burden is a significant problem for faculty, and it is unknown whether EPA assessments enable formative technical feedback. EPAs' formative utility could inform how surgical programs facilitate technical feedback for trainees. We aimed to assess the extent to which narrative comments provided through the Fellowship Council (FC) EPA assessments contained technical feedback. MethodsThe FC previously collected EPA assessments for subspecialty surgical fellows from September 2020 to October 2022. Two raters reviewed assessments' narrative comments for inclusion of each skill area that makes up part of the Objective Structured Assessment of Technical Skills (OSATS). A third rater reconciled discrepant ratings. ResultsDuring the study period, there were 3302 completed EPA assessments, including 1191 fellow self-assessments, 1124 faculty assessments, and 987 assessments without an identified assessor role. We found that assessments' narrative comments related to a median of two of the seven OSATS areas (IQR:1–2). There were no comments relevant to any of the seven OSATS areas in 16.0 % of all assessments. ConclusionsIn this review of narrative comments for EPA assessments from the FC, we found that limited technical feedback of the kind included in the OSATS was provided in many assessments. These results suggest benefit to adjusting the EPA form, enhancing faculty development, or continuing additional types of targeted technical assessment intraoperatively. Key messageThis analysis of narrative comments from fellowship EPA assessments showed that many assessments included limited technical feedback. To allow for continued technical feedback for fellows, these results highlight the need for further refinements of the EPA assessment form, additional faculty development, or ongoing use of other types of technical assessment.

NMR-Based Analysis of Plasma Lipoprotein Subclass and Lipid Composition Demonstrate the Different Dietary Effects in ApoE-Deficient Mice.

Plasma lipid levels are commonly measured using traditional methods such as triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and cholesterol (CH). However, the use of newer technologies, such as nuclear magnetic resonance (NMR) with post-analysis platforms, has made it easier to assess lipoprotein profiles in research. In this study involving ApoE-deficient mice that were fed high-fat diets, significant changes were observed in TG, CH, free cholesterol (FC), and phospholipid (PL) levels within the LDL fraction. The varied proportions of TG in wild-type mice and CH, FC, and PL in ApoE-/- mice were strikingly different in very low-density lipoproteins (VLDL), LDL, intermediate-density lipoprotein (IDL), and HDL. This comprehensive analysis expands our understanding of lipoprotein subfractions and the impacts of the APOE protein and high-fat diet in mouse models. The new testing method allows for a complete assessment of plasma lipids and their correlation with genetic background and diet in mice.

On the Evidence for Molecular Outflows in High-redshift Dusty Star-forming Galaxies

Galactic-scale outflows of molecular gas from star-forming galaxies constitute the most direct evidence for the regulation of star formation. In the early Universe (z > 4), such outflows have recently been inferred from gravitationally lensed dusty star-forming galaxies (DSFGs) based on ubiquitous detections of OH absorption extending to more blueshifted velocities than [C ii] or CO emission in spatially integrated spectra. Because these lines are redshifted to submillimeter wavelengths, such measurements require careful corrections for atmospheric absorption lines, and a proper accounting of sometimes large variations in measurement uncertainties over these lines. Taking these factors into consideration, we reanalyze OH and [C ii] data taken with the Atacama Large Millimeter/submillimeter Array for five sources where such data are available, of which four were categorised as exhibiting outflows. Based on their spatially integrated spectra alone, we find statistically significant (≥3σ) OH absorption more blueshifted than [C ii] emission in only one source. By contrast, searching channel maps for signals diluted below the detection threshold in spatially integrated spectra, we find evidence for a separate kinematic component in OH absorption in all five sources in the form of (i) more blueshifted OH absorption than [C ii] emission and/or (ii) a component in OH absorption exhibiting a different spatio-kinematic pattern than in [C ii] emission, the latter presumably tracing gas in a rotating disk. Providing a more complete and accurate assessment of molecular outflows in gravitationally lensed DSFGs, we suggest methods to assess the precision of corrections for atmospheric absorption better and to measure the source continuum in future observations more accurately.

Discrimination, Smoking, and Cardiovascular Disease Risk: A Moderated Mediation Analysis With MESA.

Carotid intima-media thickness (cIMT) and carotid plaque are reliable indicators of cardiovascular disease risk, and research highlights that racial and ethnic minority individuals generally exhibit higher cIMT and carotid plaque than White individuals. At present, the mechanisms driving these disparities among different racial and ethnic and biological sex groups are poorly understood. Data came from the baseline examination of MESA (Multi-Ethnic Study of Atherosclerosis). A total of 6814 participants aged 45 to 84 years free of clinical cardiovascular disease completed assessments on health behavior and perceived discrimination. Four sex-stratified moderated mediation models examined associations between discrimination, cigarette smoking, and mean cIMT and plaque. We hypothesized that cigarette use would mediate the association between discrimination and carotid artery disease features, and that these would differ by race and ethnicity. Indirect effects of discrimination on plaque were observed among Hispanic women such that discrimination was associated with cigarette use and, in turn, higher plaque (β=0.04 [95% CI, 0.01-0.08]). Indirect effects of discrimination on mean cIMT were found among Hispanic (β=0.003 [95% CI, 0.0001-0.007]) and White men (β=0.04 [95% CI, 0.01-0.08]) such that discrimination was associated with cigarette use and, in turn, higher cIMT. Finally, a positive indirect effect of discrimination on plaque was observed among Hispanic men (β=0.03 [95% CI, 0.004-0.07]). No other racial and ethnic differences were observed. To understand and address social determinants of cardiovascular disease, researchers must incorporate an intersectional framework that will allow us to understand the complex nature of discrimination and cardiovascular disease risk for individuals of varying intersecting identities and social positions.

Research on Evaluation Method of Wind Farm Wake Energy Efficiency Loss Based on SCADA Data Analysis

The large size of wind turbines and wind farm clustering aggravate the effect of wake on output power, resulting in a reduction in the economic benefits of wind farms. This paper took the actual operating turbines of an onshore wind farm in China as the research object and analyzed the influence of wake on energy efficiency loss by combining SCADA data. The research established a complete loss assessment method and proposed the corresponding evaluation criteria. The results showed that typical wind turbines seriously affected by wake accounted for 32.8% of the wind farm. The actual output power was only 84.2% of the theoretical output power at the lowest month, and the wake loss of the wind farm is serious. The economic efficiency of the wind farm is lower in the summer months (June–August). The study can provide a theoretical basis for the arrangement of wind farms and the development of an operation control strategy.

A Complete Assessment of the Emission Performance of an SI Engine Fueled with Methanol, Methane and Hydrogen

This study explores the potentiality of low/zero carbon fuels such as methanol, methane and hydrogen for motor applications to pursue the goal of energy security and environmental sustainability. An experimental investigation was performed on a spark ignition engine equipped with both a port fuel and a direct injection system. Liquid fuels were injected into the intake manifold to benefit from a homogeneous charge formation. Gaseous fuels were injected in direct mode to enhance the efficiency and prevent abnormal combustion. Tests were realized at a fixed indicated mean effective pressure and at three different engine speeds. The experimental results highlighted the reduction of CO and CO2 emissions for the alternative fuels to an extent depending on their properties. Methanol exhibited high THC and low NOx emissions compared to gasoline. Methane and, even more so, hydrogen, allowed for a reduction in THC emissions. With regard to the impact of gaseous fuels on the NOx emissions, this was strongly related to the operating conditions. A surprising result concerns the particle emissions that were affected not only by the fuel characteristics and the engine test point but also by the lubricating oil. The oil contribution was particularly evident for hydrogen fuel, which showed high particle emissions, although they did not contain carbon atoms.

The Development, Validity, and Reliability of a Brief Self-Report Measure of Family Resilience in Military Families

Objective This study aimed to develop a brief and valid measure of family resilience for use in research with military families. Method A population-based sample of military spouses (N = 16,379) completed assessments of family resilience and validation constructs. Participants were randomized into two subsamples. Subsample 1 was used in a factor analysis to reduce the number of items, whereas subsample 2 was used in a series of models to confirm the initial model and evaluate dimensionality, reliability, and validity. Results Nine items were retained and demonstrated strong factor loadings (> .80) in the initial and confirmatory models. A bifactor model provided some evidence of multidimensionality, but not enough to dismiss the unidimensional construct. Brief measures of family resilience and its subconstructs demonstrated strong reliability and construct validity. Conclusions The 9-item instrument is a reliable and valid tool that can be used to assess military family resilience in future research. Significance statement The brief 9-item measure reduces survey burden and facilitates further empirical research on family resilience in military populations. Such research could inform interventions and preventative care intended to improve the health and well-being of military families.

Present and Future of Blood-Based Biomarkers of Alzheimer’s Disease: Beyond the Classics

The field of blood-based biomarkers for Alzheimer’s disease (AD) has advanced at an incredible pace, especially after the development of sensitive analytic platforms that can facilitate large-scale screening. Such screening will be important when more sophisticated diagnostic methods are scarce and expensive. Thus, blood-based biomarkers can potentially reduce diagnosis inequities among populations from different socioeconomic contexts. This large-scale screening can be performed so that older adults at risk of cognitive decline assessed using these methods can then undergo more complete assessments with classic biomarkers, increasing diagnosis efficiency and reducing costs to the health systems. Blood-based biomarkers can also aid in assessing the effect of new disease-modifying treatments. This paper reviews recent advances in the area, focusing on the following leading candidates for blood-based biomarkers: amyloid-beta (Aβ), phosphorylated tau isoforms (p-tau), neurofilament light (NfL), and glial fibrillary acidic (GFAP) proteins, as well as on new candidates, Neuron-Derived Exosomes contents (NDEs) and Transactive response DNA-binding protein-43 (TDP-43), based on data from longitudinal observational cohort studies. The underlying challenges of validating and incorporating these biomarkers into routine clinical practice and primary care settings are also discussed. Importantly, challenges related to the underrepresentation of ethnic minorities and socioeconomically disadvantaged persons must be considered. If these challenges are overcome, a new time of cost-effective blood-based biomarkers for AD could represent the future of clinical procedures in the field and, together with continued prevention strategies, the beginning of an era with a lower incidence of dementia worldwide.

Purpose in Life and Cognitive Function: Evidence for Momentary Associations in Daily Life.

Purpose in life is associated with healthier cognitive outcomes in older adulthood. This research examines within-person dynamics between momentary purpose and cognitive function to provide proof of concept that increases in purpose are associated with better cognitive performance. Participants (N = 303; 54% female; Mage = 51.71, SD = 7.32) completed smartphone-based momentary assessments of purpose and short cognitive tasks 3 times a day for 8 days. In moments when participants felt more purpose driven than their average, they had faster processing speed (b = -1.240, SE = 0.194; p < .001), independent of person, temporal, and contextual factors and practice effects. Momentary purpose was unrelated to visual working memory performance (b = -0.001, SE = 0.001; p = .475). In contrast to purpose, momentary hedonic affect (e.g., happiness) was unrelated to momentary cognition. Feeling more momentary purpose may support faster processing speed in daily life. Such evidence provides stage 0 support for a purpose-based intervention for healthier cognition, which may be particularly useful in middle adulthood and the transition to older adulthood before the onset of cognitive impairment.

Metal pollution in the topsoil of lands adjacent to Sahiwal Coal Fired Power Plant (SCFPP) in Sahiwal, Pakistan.

Coal fly ash from a coal fired power plant is a significant anthropogenic source of various heavy metals in surrounding soils. In this study, heavy metal contamination in topsoil around Sahiwal coal fired power plant (SCFPP) was investigated. Within distance of 0-10, 11-20, 21-30 and 31-40 km of SCFPP, total 56 soil samples were taken, 14 replicate from each distance along with a background subsurface soil sample beyond 60 km. Soil samples were subjected to heavy metals analysis including Fe, Cu and Pb by Atomic Absorption Spectrophotometer (AAS). Composite samples for each distance were analyzed for Al, As, Ba, Cd, Co, Cr, Mn, Mo, Ni, Se, Sr, Zn by Inductively Coupled Plasma (ICP). Pollution indices of exposed soil including Enrichment Factor (EF), Contamination Factor (CF), Geoaccumulation Index (Igeo), and Pollution Load Index (PLI) were calculated. Ecological risk index ([Formula: see text]) of individual metals and the Potential Ecological Risk Index (PERI) for all metals were determined. Soil samples within 40 km of SCFPP were significantly polluted with Pb (mean 2.81 ppm), Cu (mean 0.93 ppm), and Fe (mean 7.93 ppm) compared to their background values (Pb 0.45, Cu 0.3, and Fe 4.9 ppm). Some individual replicates were highly contaminated where Pb, Fe, and Cu values were as high as 6.10, 35.4 and 2.51 ppm respectively. PLI, Igeo, CF, and EF for metals classified the soil around CFPP as "moderate to high degree of pollution", "uncontaminated to moderately contaminated", "moderate to very high contamination", and "moderate to significant enrichment" respectively with average values for Cu as 2.75, 0.82, 3.09, 4.01; Pb 4.79, 1.56, 6.16, 7.76, and for Fe as 1.20, 0.40, 1.62, 3.35 respectively. Average Ecological Risk Index ([Formula: see text]) of each metal and Potential Ecological Risk Index (PERI) for all metals classified the soils as "low risk soils" in all distances. However, ([Formula: see text]) of Pb at a number of sites in all distances have shown "moderate risk". The linear correlation of physico-chemical parameter (EC, pH, Saturation %) and metals have recorded several differential correlations, however, their collective impact on Pb in 0-10 km, has recorded statistically significant correlation (p-value 0.01). This mix of correlations indicates complex interplay of many factors influencing metal concentrations at different sampling sites. The concentration of As, Cr, Co, Cd, and Zn was found within satisfactory limits and lower than in many parts of the world. Although the topsoil around SCFPP is largely recorded at low risk, for complete assessment of its ecological health, further research considering comprehensive environmental parameters, all important trace metals and variety of input pathways is suggested.

“The INOCA-IT: Rationale and design of a multicenter registry investigating ischemia in patients with non-obstructive coronary artery (INOCA) disease in Italy”

BackgroundIschemia with non-obstructive coronary artery (INOCA) disease is being progressively acknowledged as one of the pathophysiological mechanisms of chronic coronary syndrome (CCS) in an increasingly wide range of clinical pictures. Although the research has already begun to move towards a defined diagnostic pathway and a specific medical therapy for this disease, at present it remains a clinical challenge, especially if not thoroughly investigated. Methods and resultsThe INOCA IT Multicenter Registry RF-2019-12369486 is a prospective, multicentric, non-randomized, single-arm, open label clinical study which aims to evaluate the efficacy of a stratified diagnostic and therapeutic approach on adverse events prevention and symptom relief in Italian patients with INOCA disease. The study population includes patients with a clinical presentation of CCS for angina and/or positive stress test for myocardial ischemia and evidence of non-obstructive coronary artery disease (CAD) at coronary angiography. In these patients a complete invasive coronary physiology assessment is performed with the guidewire-based measurement of coronary flow reserve (CFR) and index of microvascular resistance (IMR), followed by acetylcholine (ACh) spasm provocation test. On the basis of the results of coronary function testing, patients are stratified into different INOCA endotypes (coronary microvascular disease, vasospastic angina, microvascular spasm, non-cardiac chest pain) and given a tailored medical therapy in accordance with the latest scientific evidence. At one year follow-up the impact of such a target therapy on angina class and quality of life, as well as on cardiovascular adverse events (hospitalization and coronary revascularization) is evaluated. ConclusionsThe INOCA-IT Multicenter Registry will inform clinicians on sex-specific prevalence of INOCA in Italy and will show the impact of a stratified diagnostic and therapeutic approach on symptoms burden and prognosis of INOCA patients.

Comparison of Near Point of Accommodation and Near Point of Convergence with Positive Fusional Vergence among Young Adults, Bengaluru

Background: When encountered with mass screening and increased walk-in patients in outpatient departments (OPD), evaluating complete binocular vision assessment becomes time-consuming. Consequently, there is a need to streamline the testing process. This study also aims to explore if there are any correlations between Near Point of Accommodation (NPA) and Near Point of Convergence (NPC) with Positive Fusional Vergence (PFV). Methodology: A retrospective study was carried out at Sankara Eye Hospital in Bangalore. Data from patients aged 18 to 35, who underwent binocular vision assessment between 2016 and 2020, were included. Out of 101,896 patients who visited the hospital during this period, 3,449 attended the vision therapy clinic. Among them, 1708 patients met the criteria for inclusion, while 1,741 were excluded. Results: Out of 1708 subjects, 759 are females and 949 are males. The relationship between Near Point of Accommodation (NPA), Near Point of Convergence (NPC), and Positive Fusional Vergence (PFV) blur and break values were analysed. A positive correlation was observed between NPA and PFV blur (Spearman's rho = 0.069, p=0.004) and a negative correlation between NPC and PFV break (Spearman's rho = -0.370, p&lt;0.001). There was a significant difference between NPA and PFV blur, as well as NPC and PFV break (p=0.000), emphasizing the importance of incorporating all three tests in a binocular vision assessment. Conclusion: These results emphasize the necessity for complete binocular vision assessment to effectively diagnose and manage binocular vision anomalies. By accounting for the various parameters involved in this investigation, clinicians can enhance the precision and quality of their assessments and plan for appropriate treatment strategies for patients with binocular vision anomalies.

The Perceived Informal Support Questionnaire: Validation and Clinical Correlates in People with Post-Traumatic Stress Disorder Symptoms

Purpose: This study developed and validated a novel measure that captures the diverse positive experiences related to perceived informal support. We also examined its cross-sectional and longitudinal correlates in people with post-traumatic stress disorder (PTSD) symptoms. Method: We analyzed data from an international clinical trial. Participants with PTSD symptoms completed assessments at baseline (N = 230) and after 1 month (N = 80). Results: The 34-item Perceived Informal Support Questionnaire (PISQ) had a two-factor structure, was internally consistent, and showed convergent validity with a general measure of social support. Additionally, baseline emotional support predicted fewer depressive symptoms (β = -.356, p = .015) and lower levels of impairments (β = -.271, p = .018) at 1-month follow-up. Discussion: This study offers a novel measure that captures the diverse experiences related to perceived informal support. It also highlights the importance of involving and supporting caregivers of individuals with mental health struggles, specifically PTSD symptoms.

Effectiveness of structured psycho-oncological counseling for relatives of lung cancer patients based on the CALM approach—study protocol of a randomized controlled trial

BackgroundThe high incidence combined with the high lethality and bad prognosis of lung cancer highlight the need for psycho-oncological care for both patients and their relatives. While psychological interventions for relatives might be helpful, further research on the impact of specific interventions is necessary. Therefore, this trial aims to evaluate structured psycho-oncological counseling for relatives of lung cancer patients based on the Managing Cancer And Living Meaningfully (CALM) approach compared to usual care. In addition, we explore the impact of psycho-oncological support of relatives on the patients’ mental health outcomes.MethodsThe study is a single-center, prospective, randomized controlled trial with two measurement time points. Relatives of lung cancer patients and, thus, the patients themselves (i.e., dyads) are randomly allocated to the intervention group (IG) or the control group (CG) regardless of their disease or treatment stage. Relatives in the IG receive structured counseling based on the CALM approach (three to six sessions with psycho-oncologists). The CG receives usual psycho-oncological care. In addition, cancer patients in both study arms can request psycho-oncological support (usual care) as needed, but they will not get a specific intervention. Relatives and patients complete assessments at baseline (T0) and after the intervention/6 weeks (T1). The primary outcome for relatives is anxiety. Relatives’ secondary outcomes include depressive symptoms, distress, supportive care needs, and quality of life. Patients’ outcomes include anxiety, depression, and distress. All outcomes are assessed using self-report validated questionnaires. Intervention effects will be evaluated using analysis of covariance (ANCOVA) adjusting for baseline values. Power calculations reveal the need to enroll 200 subjects to detect an effect of d = 0.4.DiscussionThe study will provide evidence for the effectiveness of the CALM intervention in relatives of lung cancer patients. Furthermore, study results will contribute to a better understanding of the effectiveness of a psycho-oncological intervention for highly impaired cancer patients and their relatives. If the CALM intervention positively affects the relatives’ psychosocial outcome, it may be implemented in routine care.Trial registrationGerman Clinical Trials Register DRKS00030077. Retrospectively registered on 26 October 2022.

Caring for caregivers and persons living with dementia under home-based primary care: protocol for an interventional clinical trial

BackgroundApproximately 7.5 million older adults are homebound, who have difficulty and/or need assistance to leave their homes. In this growing population, the prevalence of people living with dementia (PLWD) is approximately 50%. Current dementia care models in the USA were developed for traditional office-based primary care and have not been tailored to home-based primary care (HBPC) delivery models. Literature has shown that office-based collaborative interventions can improve caregiver outcomes including caregiver stress, well-being, and morbidity and patient outcomes including improved quality of life and reduced emergency department visits (Possin KL, Merrilees JJ, Dulaney S, Bonasera SJ, Chiong W, Lee K, JAMA Int Med 179:1658, 2019). To date, the evidence for HBPC dementia interventions is lacking. Though HBPC has demonstrated benefit in homebound older adults, there is limited literature on the effects of HBPC on persons living with dementia (Nguyen HQ, Vallejo JD, Macias M, Shiffman MG, Rosen R, Mowry V, J Am Geriatr Soc 70:1136–46, 2021). Our goal is to develop a HBPC-focused dementia care intervention that integrates the components of two previously developed dementia care models and test the feasibility of implementing it in HBPC practices to improve the quality of life and wellbeing of homebound PLWD and their caregivers.MethodsWe will first conduct qualitative focus groups at two HBPC practice sites, one in the Southeast and one in Hawaii in order to obtain preliminary feedback on the proposed intervention. At each site, there will be one focus group with caregivers of PLWD and another with HBPC clinicians and staff to help develop and refine our intervention. We will then conduct an open-pilot trial of the refined intervention at the two HBPC practices. A total of up to 25 patient/caregiver dyads will be recruited at each site (N = 50 total). Outcomes measured through pre-and-post assessments and exit interviews will include (a) feasibility for the caregiver to engage with and complete baseline assessments and access educational materials and community resources and (b) feasibility for the practice to identify potential caregivers/patients, assess eligible patient/caregiver dyads, use patient and caregiver assessments, recruit patient/caregiver dyads, recruit racial and ethnic minorities, use care modules, and engage with the tele-video case conference, (c) net promoter score, (d) acceptability of the intervention to caregivers and patients to participate in the intervention, (e) caregivers feeling heard and understood, and (f) caregiver well-being.DiscussionTesting the feasibility and acceptability of the adapted intervention in these two HBPC practices will provide the basis for future testing and evaluation of a fully powered intervention for PLWD and their caregivers cared for in HBPC with the goal of disseminating high-quality and comprehensive dementia-care focused interventions into HBPC practices.Trial registrationThis trial was registered with ClinicalTrials.gov NCT05849259 in May 2023.

Advancing Mistuning Identification and Dynamic Modeling of Blisks Through Blade Detuning Tests

Blisks extensively used in advanced aeroengines are vulnerable to vibration problems due to the high sensitivity of the blisk’s forced response to blade mistuning. This paper proposes an emerging mistuning identification technique based on blade detuning tests (BDTID) for predictive dynamic modeling of blisks. The conventional frequency-mistuning modeling approaches relying on blade mistuning identification by reduced-order model techniques and modal test data of the full blisk are also adopted to construct different mistuned models of a blisk test piece for comparison purposes. A complete assessment of these blisk models is achieved through the forced response tests in a stationary traveling wave excitation test rig. The BDTID consists of blade-detuning tests followed by a correction procedure. The detuning tests enable us to approximately evaluate the “blade-alone” frequencies through blade-by-blade impact testing in combination with a mass detuning mechanism. The correction procedure is able to evaluate the detuning test quality by the quantification of the residual interblade coupling due to mass detuning. More importantly, a robustness investigation demonstrates that this procedure is able to capture the “true” blade mistuning even in cases of poor blade detuning test quality. The resultant mistuned blisk model exhibits high accuracy in the modal correlation and forced response validation results. Compared with conventional methods, BDTID takes advantage of easy implementation with less experimental effort and has proven robust performance. It is therefore recommended for blade mistuning identification and predictive blisk dynamic modeling in a wide variety of scenarios.

Concurrent and lagged associations among pain medication use, pain, and negative affect: a daily diary study of people with chronic low back pain.

People with chronic pain often attempt to manage pain and concurrent emotional distress with analgesic substances. Habitual use of such substances-even when not opioid-based-can pose side effect risks. A negative reinforcement model has been proposed whereby relief of pain and emotional distress following medication consumption increases the likelihood that the experience of elevated pain and distress will spur further medication use. People with chronic low back pain (N = 105) completed electronic diary assessments 5 times/day for 14 consecutive days. Lagged and cross-lagged analyses focused on links between time 1 pain and negative affect (NA) and time 2 analgesic medication use and vice versa. Sex differences were also explored. Primary results were as follows: (1) participants on average reported taking analgesic medication during 41.3% of the 3-hour reporting epochs (29 times over 14 days); (2) time 1 within-person increases in pain and NA predicted time 2 increases in the likelihood of ingesting analgesic medications; (3) time 1 within-person increases in medication use predicted time 2 decreases in pain and NA; and (4) lagged associations between time 1 pain/NA and time 2 medication use were strongest among women. Findings suggest that the use of analgesic medications for many people with chronic pain occurs frequently throughout the day. Results support the validity of a negative reinforcement model where pain and distress lead to pain medication use, which in turn leads to relief from pain and distress.

An 8-week injury prevention exercise program combined with change-of-direction technique training limits movement patterns associated with anterior cruciate ligament injury risk

Knee ligament sprains are common during change-of-direction (COD) maneuvers in multidirectional team sports. This study aimed to compare the effects of an 8-week injury prevention exercise program containing COD-specific exercises and a similar program containing linear sprint exercises on injury- and performance-related variables during a 135° COD task. We hypothesized that the COD-specific training would lead to (H1) stronger reductions in biomechanical variables associated with anterior cruciate ligament (ACL) injury risk during COD, i.e. knee abduction moment and angle, hip internal rotation angle and lateral trunk lean, and (H2) more effective improvements in COD performance according to the COD completion time, executed angle, ground contact time, and approach speed. Twenty-two sports science students (40% female) completed biomechanical assessments of COD movement strategies before and after participating in two supervised 25-min training sessions per week over 8 weeks. We observed significant ‘training x group’ interaction effects in support of H1: the COD-specific training but not the linear sprint training led to reduced peak knee abduction moments (interaction, p = 0.027), initial knee abduction (interaction, p < 0.001), and initial lateral trunk lean angles (interaction, p < 0.001) compared to baseline. Although the COD-specific training resulted in sharper executed angles (interaction, p < 0.001), the sprint-specific training group showed reduced COD completion (interaction, p = 0.037) and ground contact times (interaction, p < 0.001). In conclusion, a combination of generic and COD-specific injury prevention training resulted in COD technique adaptations that can help to avoid ACL injury-prone COD movements but may negatively affect COD speed.

Addressing the gap of early intervention for eating disorders in primary health care.

Only one in four individuals with eating disorders (EDs) seek help, with many barriers to treatment-seeking present. Placing an early intervention model in primary mental health care settings is one approach to reducing these barriers. To date, only one model (emerge-ED) has been evaluated in the literature. We aimed to replicate findings from the initial emerge-ED evaluation. We report on treatment outcomes in a new cohort and their views on barriers to treatment-seeking. We then examine how this early intervention model in primary health care has evolved to overcome the barriers to treatment delivery cited by health professionals in the initial evaluation. Eighty participants commenced treatment between July 2020 and March 2022 and completed a mean of 8.98 sessions, 70 (87.5%) completed >1 sessional measure on ED cognitions and behaviours, but only 31% (n = 24) completed lengthier assessments. Findings replicated initial emerge-ED outcomes, with small to moderate effect size decreases in the ED sessional measure at 70 days since treatment commencement for cognitions (d = .63) and ED behaviours (d = .09., .69). The most cited barrier by participants was "belief that my problem is not bad enough", reflective of denial of illness. Lastly, to overcome barriers to treatment delivery clinicians had to deviate from treatment protocols and work collaboratively with other healthcare providers. Our findings replicated the initial emerge-ED evaluation and highlight the importance of considering primary health care settings as an essential site in delivering early intervention services for EDs.

Type I interferons, inflammation, and fatigue in a longitudinal RNA study of women with breast cancer

BackgroundFatigue is a common side effect of cancer and its treatment and is thought to be driven in part by activation of the proinflammatory cytokine network. However, the cellular and molecular underpinnings of cancer-related fatigue (CRF) have not been determined, nor have immune pathways beyond inflammation been carefully investigated. The goal of this study was to examine the association between CRF and activation of canonical proinflammatory gene regulation pathways and Type I interferon (IFN) signaling pathways in breast cancer patients during and after treatment. MethodsWomen diagnosed with early-stage breast cancer (n = 181) completed assessments before and after treatment with radiation and/or chemotherapy and at 6, 12, and 18-month post-treatment follow-ups. Assessments included self-reported fatigue (Multidimensional Fatigue Symptom Inventory – Short Form) and expression of pre-specified sets of Type I IFN and pro-inflammatory immune response genes determined from mRNA sequencing of PBMCs. Mixed effect linear models examined changes in fatigue and immune gene expression over time and tested the hypothesis that fatigue would be associated with increased expression of Type I IFN and inflammatory response genes. ResultsThere were significant changes in fatigue and immune gene expression across the assessment period; all measures increased from pre- to post-treatment but showed diverging patterns over the follow-up, with declines in fatigue and persistent elevations in Type I IFN and proinflammatory gene expression. In mixed effect linear models, expression of Type I IFN response genes was elevated in association with fatigue across the assessment period, from pre-treatment to 18-month follow-up. In contrast, pro-inflammatory gene expression was associated with fatigue only at 6, 12, and 18-month follow-ups. Analyses controlling for changes in leukocyte subsets continued to show a significant association between fatigue and Type I IFN gene expression but reduced the time-dependent association with pro-inflammatory gene expression to non-significant. ConclusionsResults revealed unexpected complexity in the immune underpinnings of CRF and identify a novel role for IFN signaling as a robust contributor to this symptom before, during, and after treatment. Pro-inflammatory gene expression emerged as a predictor of fatigue later in the cancer trajectory, and that effect was primarily accounted for by a concurrent increase in monocyte prevalence.