Limited Role Research Articles

Impact of Anxiety, Depression, and Coping Strategies on Health-Related Quality of Life in Patients with Cystic Fibrosis.

With the significant increase in the life expectancy of cystic fibrosis (CF) patients, many individuals now reach adulthood and develop specific coping strategies to maintain their physical and mental well-being. This study aims to evaluate coping styles and their relationship with mental health and Health-Related Quality of Life (H-RQoL) in adult CF patients. Thirty adult CF patients completed the Hospital Anxiety and Depression Scale to assess anxiety and depression, the Cystic Fibrosis Questionnaire-Revised to evaluate quality of life, and the Brief Coping Orientation to Problems Experienced questionnaire to assess coping strategies. Twelve individuals (40%) met the diagnostic criteria for being at risk of experiencing anxiety and/or depression. Anxiety risk group exhibited lower life quality scores in the domains of vitality, emotional functioning, and role limitations (P = .027, P = .001, and P = .001, respectively). Patients reporting depressive symptoms had lower scores in emotional functioning and role limitations domains of quality of life (P = .005 and P = .018, respectively). Multivariate analysis indicated that depression and anxiety scores were significant predictors of emotional quality of life. In terms of coping strategies, "acceptance" was the most commonly preferred, while "substance use" was the least preferred strategy among all participants. Patients at risk of anxiety and/or depression often chose "avoidance" as their coping strategy. Anxiety and depressive symptoms are prevalent and associated with poorer H-RQoL in adult CF patients. These patients preferred to employ giving up strategy when dealing with the disease. Therefore, it is essential to screen adult CF patients for mental health risks and to work on improving their coping strategies.

Contracting in the Public Interest? Re-examining the Role of Planning Obligations in Contemporary Town Planning Processes

Abstract This article investigates how local authorities in England seek to compel property developers to mitigate the impact of property development on local communities and on local infrastructure needs through the use of planning obligations made by agreement with developers pursuant to section 106 of the Town and Country Planning Act 1990. I pose three important new questions about these ‘section 106 agreements’. How do these agreements contribute to a development culture in which private developers do not always perform their public policy obligations? How does the presence of ostensibly binding promises in these agreements facilitate the exercise of regulatory decision-making in planning and property development processes? How do local authorities manage the implementation of novel developer obligations designed to shape broader community relations? I answer these questions by examining two case study development projects. In doing so, I highlight the limited role that these agreements have as an instrument for ordering the ‘private’ relations between a local authority and a developer. I then look outside the private ordering function of these agreements to scrutinise the public-facing work they do. Here, I highlight how a section 106 agreement carries a powerful expressive force, despite its weakness as a private ordering device, that developers and local authorities can use to justify contentious development proposals involving coercive compulsory purchase powers and potentially adverse equalities implications. The article thus adds to what is already known about the use and implementation of planning obligations, and sketches a research agenda that would inform debate about the future of this area of planning practice.

Epidemiologic Survey of Crimean-Congo Hemorrhagic Fever Virus in Suids, Spain.

We conducted a cross-sectional study in wild boar and extensively managed Iberian pig populations in a hotspot area of Crimean-Congo hemorrhagic fever virus (CCHFV) in Spain. We tested for antibodies against CCHFV by using 2 ELISAs in parallel. We assessed the presence of CCHFV RNA by means of reverse transcription quantitative PCR protocol, which detects all genotypes. A total of 113 (21.8%) of 518 suids sampled showed antibodies against CCHFV by ELISA. By species, 106 (39.7%) of 267 wild boars and 7 (2.8%) of 251 Iberian pigs analyzed were seropositive. Of the 231 Iberian pigs and 231 wild boars analyzed, none tested positive for CCHFV RNA. These findings indicate high CCHFV exposure in wild boar populations in endemic areas and confirm the susceptibility of extensively reared pigs to CCHFV, even though they may only play a limited role in the enzootic cycle.

[New frontiers in pacing: from myocardial pacing to conduction system pacing].

For many years, cardiac pacing has been based on the stimulation of right ventricular common myocardium to correct diseases of the conduction system. The birth and the development of cardiac resynchronization have led to growing interest in the correction and prevention of pacing-induced dyssynchrony. Many observational studies and some randomized clinical trials have shown that conduction system pacing (CSP) can not only prevent pacing-induced dyssynchrony but can also correct proximal conduction system blocks, with reduction of QRS duration and with equal or greater effectiveness than biventricular pacing. Based on these results, many Italian electrophysiologists have changed the stimulation target from the right ventricular common myocardium to CSP. The two techniques with greater clinical impact are the His bundle stimulation and the left bundle branch pacing. The latter, in particular, because of its easier implantation technique and better electric parameters, is spreading like wildfire and is representing a real revolution in the cardiac pacing field. However, despite the growing amount of data, until now, the European Society of Cardiology guidelines give a very limited role to CSP.

Barriers to and facilitators of deprescribing for older people in secondary care in Saudi Arabia: a qualitative study using a theory-based approach

Abstract Introduction In Saudi Arabia, more than 55% of older patients are subjected to potentially inappropriate prescribing.[1] Despite this, deprescribing by healthcare professionals (HCPs; e.g. physicians and pharmacists) is limited. Therefore, identifying barriers to and facilitators of deprescribing from HCPs’ perspective is crucial to establish the evidence base to inform future development of a deprescribing intervention in the hospital setting in Saudi Arabia. Aim To explore HCPs’ experiences and perspectives of deprescribing in older patients in order to identify barriers to and facilitators of deprescribing, using a theory-based approach. Methods A qualitative study using semi-structured interviews conducted with physicians and pharmacists who worked in hospitals in a southern region of Saudi Arabia. A purposive sampling approach was employed to recruit participants from various hospitals with different levels of experience. Physicians who worked with older inpatients and pharmacists with a ward-based role who had input into prescribing decisions were eligible to be included. Theoretical Domains Framework (TDF2)-based interviews were conducted with participants until theoretical data saturation was achieved.[2] Interviews were audio recorded, transcribed verbatim and data analysed inductively using reflexive thematic analysis. Themes were mapped to the TDF2, enabling prioritisation of domains and identification of behaviour change techniques (BCTs) for inclusion in future intervention development. Results Forty HCPs were interviewed (20 physicians and 20 pharmacists). Four themes associated with facilitators and barriers to deprescribing were identified: (i) perceptions and consequences of deprescribing; (ii) roles of HCPs and communication; (iii) factors influencing deprescribing decisions and (iv) culture, environment, and resources. All determinants from these themes were mapped to TDF domains. Six TDF domains were prioritised to represent key barriers and facilitators. These were: the limited role of pharmacists in deprescribing (‘Social/professional role and identity’); lack of formal documentation of deprescribing outcomes (‘Behavioural regulation’); perceived risks versus benefits of deprescribing (‘Beliefs about consequences’); lack of tailored guidelines for deprescribing (‘Knowledge’); lack of a connected system between different hospital settings (‘Environmental context/resources’) and the importance of inter-professional social support and collaboration between HCPs (‘Social influences’). These domains were mapped to 40 BCTs for consideration for inclusion in a deprescribing intervention. Conclusion This study served as a starting point for the design of a theory-based intervention in Saudi Arabia to implement deprescribing in hospital settings. The findings have revealed influences on deprescribing that have not previously been described in this context. These encompassed the need to enhance the interface between primary and secondary care and the potential impact of improving health and social care systems in Saudi Arabia to enable deprescribing. Participants were sampled across a southern region of Saudi Arabia, which enhanced the transferability of the findings to other similar hospital settings. However, only physicians and pharmacists were recruited, which may limit the international transferability of the findings to countries where other professionals have a role in deprescribing. Future work will determine the prioritised BCTs to be operationalised in the intervention using the APEASE (Affordability, Practicability, Effectiveness/cost-effectiveness, Acceptability, Side-effects/safety, Equity) criteria.

Quality of Life in Females with PCOS

The study aimed to assess the quality of life in females with Polycystic Ovarian Syndrome(PCOS) and identify the domains or health factor which most significantly impacted by this condition. This study involved 40 unmarried females diagnosed with PCOS. After completing demographic formalities, participants filled out the self-administered Polycystic ovarian syndrome quality of life (PCOSQOL) questionnaire, followed by the SF36 generic health quality of life measuring scale. The findings from the PCOSQOL questionnaire revealed that menstrual problems had the lowest mean score, while infertility issues had the highest mean score. Additionally, the SF36 results showed that emotional well-being and energy fatigue had the lowest scores, whereas role limitations in social and physical functioning had the highest scores. In conclusion, this study found that PCOS significantly diminishes the quality of life in affected females, particularly due to menstrual problems and emotional well-being.

Problematic Online Behaviours among University Students and Associations with Psychological Distress Symptoms and Emotional Role Limitations: A Network Analysis Approach

AbstractVery little research has simultaneously explored the interactions between generalized problematic internet use (GPIU), problematic social media use (PSMU), problematic online gaming (POG), psychological distress, and emotional well-being among university students. Therefore, the present study aimed to determine (i) the associations between GPIU, PSMU, and POG symptoms, (ii) whether symptoms of these three problematic online behaviours form distinct entities, and (iii) whether there are associations between problematic online behaviours, psychological distress symptoms, and emotional role limitations using network analysis. A total of 807 Spanish university students participated (57.7% female; Mage = 21.22 years [SD = 3.68]). Two network models were computed. Network 1 showed a complex interaction of nodes, with particularly strong connections between analogous symptoms of GPIU and PSMU. Symptoms organised into distinct dimensions, featuring a unique dimension for POG symptoms, one that includes preoccupation and a conflict symptom of GPIU, and two other dimensions with symptoms of GPIU and PSMU. Network 2 showed significant connections between GPIU and depression, GPIU and emotional role limitations, PSMU and anxiety, PSMU and emotional role limitations, POG and depression, and POG and anxiety. The findings support the conceptualization of GPIU as a nonspecific disorder, the independence of PSMU and POG as distinct constructs, and aligning with perspectives that separate POG from the GPIU spectrum. The study reinforces the model of compensatory internet use and emphasizes the impact of problematic online behaviours on emotional well-being. The findings have practical implications for the assessment and intervention of problematic online behaviours.

Development and implementation of a treatment pathway to reduce coronary angiograms - lessons from a failure

BackgroundThe rates of coronary angiograms (CA) and related procedures (percutaneous intervention [PCI]) are significantly higher in Germany than in other Organisation for Economic Co-ordination and Development (OECD) countries. The current guidelines recommend non-invasive diagnosis of coronary heart disease (CHD); CA should only have a limited role in choosing the appropriate revascularisation procedure. The aim of the present study was to explore whether improvements in guideline adherence can be achieved through the implementation of regional treatment pathways. We chose four regions of Germany with high utilisation of CAs for the study. Here we report the results of the concomitant qualitative study.MethodsGeneral practitioners and specialist physicians (cardiologists, hospital-based cardiologists, emergency physicians, radiologists and nuclear medicine specialists) caring for patients with suspected CHD were invited to develop regional treatment pathways. Four academic departments provided support for moderation, provision of materials, etc. The study team observed session discussions and took notes. After the development of the treatment pathways, 45 semi-structured interviews were conducted with the participating physicians. Interviews and field notes were transcribed verbatim and underwent qualitative content analysis.ResultsPathway development received little support among the participants. Although consensus documents were produced, the results were unlikely to improve practice. The participants expressed very little commitment to change. Although this attempt clearly failed in all study regions, our experience provides relevant insights into the process of evidence appraisal and implementation. A lack of organisational skills, ignorance of current evidence and guidelines, and a lack of feedback regarding one’s own clinical behaviour proved to be insurmountable. CA was still seen as the diagnostic gold standard by most interviewees.ConclusionsOversupply and overutilisation can be assumed to be present in study regions but are not immediately perceived by clinicians. The problem is unlikely to be solved by regional collaborative initiatives; optimised resource planning within the health care system combined with appropriate economic incentives might best address these issues.

Frequency of Androgen Receptor Positivity in Tumors: A Study Evaluating More Than 18,000 Tumors

Androgen receptor (AR) is a transcription factor expressed in various normal tissues and is a therapeutic target for prostate and possibly other cancers. A TMA containing 18,234 samples from 141 different tumor types/subtypes and 608 samples of 76 different normal tissue types was analyzed by immunohistochemistry. AR positivity was found in 116 tumor types including 66 tumor types (46.8%) with ≥1 strongly positive tumor. Moderate/strong AR positivity was detected in testicular sex cord-stromal tumors (93.3–100%) and neoplasms of the prostate (79.3–98.7%), breast (25.0–75.5%), other gynecological tumors (0.9–100%), kidney (5.0–44.1%), and urinary bladder (5.4–24.2%). Low AR staining was associated with advanced tumor stage (pTa versus pT2-4; p < 0.0001) in urothelial carcinoma; advanced pT (p < 0.0001), high tumor grade (p < 0.0001), nodal metastasis (p < 0.0001), and reduced survival (p = 0.0024) in invasive breast carcinoma; high pT (p < 0.0001) and grade (p < 0.0001) in clear cell renal cell carcinoma (RCC); and high pT (p = 0.0055) as well as high grade (p < 0.05) in papillary RCC. AR staining was unrelated to histopathological/clinical features in 157 endometrial carcinomas and in 221 ovarian carcinomas. Our data suggest a limited role of AR immunohistochemistry for tumor distinction and a prognostic role in breast and clear cell RCC and highlight tumor entities that might benefit from AR-targeted therapy.

The effect of the COVID-19 pandemic on the caregiving burden of individuals caring for patients with chronic neurological diseases.

Caring for neurological patients poses a serious burden on caregivers, even in normal times. It is likely that this burden has become even more painful post-COVID-19 pandemic. This study evaluates the effect of the COVID-19 pandemic on the care burden of those who care for patients with chronic neurological diseases. The study included 50 patients and 50 caregivers. All the tests were conducted twice, it was answered firstly, according to the pre-COVID-19 pandemic, and secondly, during the COVID-19 pandemic period. The depression levels of the patients and caregivers were assessed with the Beck Depression Scale, their sleep quality with the Pittsburgh Sleep Quality Index, their quality of life was assessed with the RAND 36-Item Health Survey, and caregivers' burden of care was evaluated with the Zarit Caregiver Burden Scale. It was observed at the end of the study that the depression levels of patients (p = 0.00), and caregivers (p = 0.00) increased post-COVID-19 pandemic, the sleep quality of caregivers (p = 0.00), and patients (p = 0.02) decreased post-COVID-19 pandemic. On the other hand, it was determined that caregivers' burden of care increased (p = 0.00). Sub-parameters of the RAND 36-Item Health Survey, physical functioning (p = 0.02), role limitations due to physical health (p = 0.00), and role limitations due to emotional problems (p = 0.03) decreased for caregivers. In summary, we concluded that the well-being and psychological status of both patients and their caregivers were adversely affected by the COVID-19 pandemic.

Contextual Action Theory in Nursing Home Settings: A Conceptual Framework for Considering the Active Role of Residents

AbstractNursing home (NH) residents are often considered passive recipients of care with a limited role in shaping their experience. This perspective is often reproduced in NH research, which restricts resident participation, thereby upholding ageist views that cause discrimination of older adults living in NH settings. In this article, we propose using Contextual Action Theory (CAT) as a conceptual framework for exploring NH experiences in a way that incorporates the active role of residents. CAT supports the active role of NH residents by emphasizing the capabilities of human beings to form preferences and act on those preferences, without assumptions of rationality. The emphasis on human action allows researchers to consider NH experiences as co-constructed between residents, care providers, and family members, which means placing an emphasis on the actions and goals of NH residents, no matter their cognitive or physical impairments. CAT also supports personhood and social citizenship concerns in NH research, by acknowledging the differing preferences and thereby differing experiences of NH care by individual residents. We argue that CAT should be considered a useful framework for putting residents in the center of NH research.

Low Detection of High-risk Human Papilloma Virus in Individuals with Ameloblastoma in a Tertiary Hospital in Lagos, Nigeria

Abstract Background: Ameloblastoma is a benign but aggressive epithelial odontogenic neoplasm of unknown etiology. The role of human papilloma virus (HPV) in the etiology of oral squamous cell carcinoma has prompted the investigation of HPV as an etiologic factor in ameloblastoma. This study aimed to determine the frequency of high-risk (HR) HPV in conventional ameloblastoma and the clinical parameters associated with infection. Materials and Methods: The study was approved by the ethical review boards of the institution. DNA was extracted from fresh tissue collected 750 μL of DNA/RNA Shield (Zymo Research, United States) using Invitrogen PureLink Viral RNA/DNA Mini Kit (Invitrogen, USA). The extracted DNA was assayed for the detection of 14 HR HPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) using Anyplex™ II HPV HR Detection kit (Cat. No. HP7E00X) (Seegene Inc., Republic of Korea) on CFX-96TM Real-Time Polymerase Chain Reaction (PCR) System (Bio-Rad). Data on gender, age of patient, site of lesion, clinicohistological types of ameloblastoma and history of smoking, alcohol consumption, and practice of oral sex were collected. Data analysis was performed using analysis program SPSS version 25 and statistical significance was set at P < 0.05. Results: Two cases of conventional ameloblastoma were positive with HPV and none of the ameloblastic carcinoma cases were positive. The HPV 16 serotype was observed in both cases. While 5 of the cases had a history of alcohol consumption, none of these cases were positive for HPV serotype. Conclusions: HPV 16 positivity was detected in two cases of conventional ameloblastomas and none in ameloblastic carcinoma using real-time PCR. There was no effect of exposure to smoking, alcohol consumption, and practice of oral sex and HPV in the etiology of ameloblastoma. Data available are suggestive of a limited role of HPV in the etiology of ameloblastoma.

Preserving cognitive vitality: Value of cognitive rehabilitation in addressing cognitive deficits in the elderly

The recent advancements in medical sciences has resultedin not only increasing life expectancy of the elderly but hasalso improved survival rate in elderly with neurologicaldisorders including those with head trauma . This hasresulted in an increasing number of persons with cognitivedeficits. Cognitive functions such as executive functioningand memory play an important role in success of arehabilitation programme and therefore can positivelycontribute to public health goals. Considering cognitivedecline at present has no cure and pharmacologicaltherapies have a limited role, efforts are usually made todelay the onset and progression of cognitive decline andimprove quality of life. Literature suggests that active lifestyle, regular exercise, actively performing activities of dailyliving can have a significant impact on cognitive skills. Inaddition different models of cognitive rehabilitation andapproaches can be integrated into practice to improvecognitive reserve and cause neuroplastic changes tofacilitate cognitive function by providing cognitive stimulusand training. Moreover with technological advancements,the computerized cognitive intervention field is growing.This usually integrates conventional cognitive interventionwith digital smart devices to provide an engaging and costeffective alternate approach. This review aims to highlightthe importance of cognitive rehabilitation and suggest afew evidence based approaches that may be consideredby rehabilitation professionals to promote and improvecognitive rehabilitation in Pakistan.Keywords: Cognition, Cognitive Decline, CognitiveRehabilitation, Elderly, Executive functions, Memory.

Cancer population norms using a new value set for the SF-6Dv2 based on the preferences of patients with breast or colorectal cancer in Quebec.

Because health resources are limited, health programs should be compared to allow the most efficient ones to emerge. To that aim, health utility instruments have been developed to allow the calculation of quality-adjusted life-year (QALY). However, generic instruments, which can be used by any individual regardless of their health profile, typically consider the preferences of the general population when developing their value set. Consequently, they are often criticized for lacking sensitivity in certain domains, such as cancer. In response, the latest version of the Short Form 6-Dimension (SF-6Dv2) has been adapted to suit the preferences of patients with breast or colorectal cancer in the Canadian province of Quebec. By extension, our study's aim was to determine cancer population norms of utility among patients with breast or colorectal cancer in Quebec using the SF-6Dv2. To determine the cancer population norms, we exploited the data that were used in the development of a new value set for the SF-6Dv2. This value set was developed considering the preferences of patients with breast or colorectal cancer. Stratification by time of data collection (i.e., T1 and T2), sociodemographic variables (i.e., age, sex, body mass index, and self-reported health problems affecting quality of life), and clinical aspects (i.e., cancer site, histopathological classification, cancer stage at diagnosis, modality, and treatment characteristics) was performed. In 353 observations, patients were more likely to have negative utility scores at T1 than at T2. Males had higher mean utility scores than females considering type of cancer and comorbidities. Considering the SF-6Dv2's dimensions, more females than males reported having health issues, most which concerned physical functioning. Significant differences by sex surfaced for all dimensions except "Role Limitation" and "Mental health." Patients with multifocal cancer had the highest mean and median utility values in all cancer sites considered. Cancer population norms can serve as a baseline for interpreting the scores obtained by a given population in comparison to the situation of another group. In this way, our results can assist in comparing utility scores among cancer patients with different sociodemographic groups to other patients/populations groups. To our knowledge, our identified utility norms are the first for patients with breast or colorectal cancer from Quebec.

The genetics of intelligence and social outcomes in a Hungarian twin sample

Most previous research found that within-family resemblance on social outcomes and intelligence is mostly due to genetic factors with a limited role of the shared environment, with the exception of educational attainment. Hypotheses about a gene-environment interaction with SES, with a presumably smaller role of genetic factors in families with low social status, have been only partially confirmed. However, these results do not necessarily generalize to all societies, and data from Central or Eastern European countries is currently deficient. In the current work we replicate using data from the Hungarian Twin Registry that intelligence, income, and educational attainment are substantially heritable, with limited role of the shared environment. In contrast to studies in Anglo-Saxon or Western European countries, we found an influence of the shared environment on standardized high school test scores, especially history. Both genetic and shared environmental (but not nonshared environmental) correlations were substantial, in line with generalist genes and shared environments but specific nonshared environmental effects. The results show that the heritability of social traits is observable in Central/Eastern Europe, but they highlight a potentially problematic aspect of Hungarian high school final tests, as students' family of origin appears to be a potent determinant of grades.

The effect of osteopathic manipulative treatment on quality of life in patients with cardiac implantable electronic devices.

Osteopathic manipulative treatment (OMT) has been demonstrated to have an effect on the autonomic nervous system, which may have antiarrhythmic effects. The effects of OMT in patients with cardiac implantable electronic devices (CIEDs) have not previously been reported. This study investigated the impact of OMT on quality of life (QOL) in this patient population. The purpose of this study is to investigate the effects of OMT on QOL in CIED patients. Subjects with CIEDs were recruited into a double-blind randomized controlled institutional review board (IRB)-approved clinical trial (ClinicalTrials.gov ID: NCT04004741) and randomized to OMT or light touch (control) groups. Subjects received a one-time intervention, performed by board-certified neuromusculoskeletal medicine (NMM) and osteopathic manipulative medicine (OMM) physicians. The OMT protocol utilized techniques including myofascial release, rib raising, facilitated positional release (FPR), and osteopathic cranial manipulative medicine. Subjects' QOL was assessed immediately preceding intervention and one-month postintervention utilizing the Research ANd Development (RAND) 36-Item Short Form Health Survey (SF-36, eight parameters). Groups were compared utilizing unpaired t tests; α=0.05. Forty-two subjects were enrolled, with four lost to follow-up, which resulted in 19 OMT and 19 control subjects for analysis. Of the eight QOL parameters, two showed significant improvement with OMT: role limitations due to physical health (p=0.001) and pain (p=0.003). This study demonstrates the potential for QOL improvement in CIED patients. Specifically, subjects in the OMT group reported an improvement in activities of daily living as well as a decrease in overall pain, including pain interfering with work. Additional research is necessary to further understand the physiologic effects of OMT, including its effects on arrhythmias, in CIED patients.

Surveillance of Sarcoptic Mange in Iberian Ibexes (Capra pyrenaica) and Domestic Goats (Capra hircus) in Southern Spain.

Sarcoptic mange is a highly contagious skin disease caused by Sarcoptes scabiei. Sera were collected from 411 Iberian ibexes, comprising 157 individuals with sarcoptic mange skin lesions and 254 clinically healthy animals, in 13 population nuclei across Andalusia (southern Spain) between 2015 and 2021. Skin samples from 88 of the 157 animals with mange-compatible lesions were also obtained. Moreover, 392 serum samples from domestic goats (Capra hircus) were collected in the same region and study period. Antibodies against S. scabiei were tested using an in-house indirect ELISA, while the presence of mites of S. scabiei was evaluated in the skin samples by potassium hydroxide digestion. Seropositivity was found in eight (3.1%) of the clinically healthy ibexes and in 104 (66.2%) of the animals with mange-compatible lesions. The presence of S. scabiei was confirmed in 57 (64.8%) out of the 88 skin samples analysed and anti-S. scabiei antibodies were found in 49 (86.0%) of these 57 mite-positive individuals. Seropositive animals were detected in population nuclei with previous records of sarcoptic mange, where S. scabiei mites were detected by potassium hydroxide digestion in individuals with sarcoptic mange-compatible external lesions. However, seropositivity was not observed in population nuclei that were historically free of this disease. None of the 392 domestic goats had antibodies against S. scabiei, suggesting an independent epidemiological cycle of sarcoptic mange in Iberian ibex populations in the study area, and a limited or null role of domestic goats in the transmission of the parasite to this wild species. Overall, our findings underscore the importance of maintaining and/or implementing integrated surveillance programs and control strategies in wildlife and livestock, to limit the risk of S. scabiei circulation in Iberian ibex populations.

Difference in the Effect of Applying Bacillus to Control Tomato Verticillium Wilt in Black and Red Soil.

In practical applications, the effectiveness of biological control agents such as Bacillus is often unstable due to different soil environments. Herein, we aimed to explore the control effect and intrinsic mechanism of Bacillus in black soil and red soil in combination with tomato Verticillium wilt. Bacillus application effectively controlled the occurrence of Verticillium wilt in red soil, reducing the incidence by 19.83%, but played a limited role in black soil. Bacillus colonized red soil more efficiently. The Verticillium pathogen decreased by 71.13% and 76.09% after the application of Bacillus combinations in the rhizosphere and bulk of the red soil, respectively, while there was no significant difference in the black soil. Additionally, Bacillus application to red soil significantly promoted phosphorus absorption. Furthermore, it significantly altered the bacterial community in red soil and enriched genes related to pathogen antagonism and phosphorus activation, which jointly participated in soil nutrient activation and disease prevention, promoting tomato plant growth in red soil. This study revealed that the shaping of the bacterial community by native soil may be the key factor affecting the colonization and function of exogenous Bacillus.

Psychologists and Integrated Behavioral Health Simulation Training: A Survey of Medical Educators and Perspectives of Directors of Clinical Training.

It is well established that the integration of behavioral healthcare into the medical home model improves patient outcomes, reduces costs, and increases resident learning. As academic health centers increasingly integrate behavioral healthcare, targeted training for interprofessional collaboration around behavioral healthcare is needed. Simulation educational approaches potentially can provide this training. Health service psychologists are well-poised to support this because of their specialized training in integrated healthcare. The present exploratory study aimed to evaluate existing simulation programs and develop recommendations for integrated behavioral health training and evaluation. Directors of ACGME accredited residency programs that are high utilizers of the medical home model (Pediatrics, Internal Medicine, Medicine/Pediatrics, Family Medicine) as well as Psychiatry residencies and medical schools with membership in the Society for Simulation in Healthcare were recruited to complete a 26-item survey to assess program usage of psychologists as part of simulation training for integrated behavioral healthcare services. Of 79 participants who completed initial items describing their training program, only 32 programs completed the entire survey. While many academic health centers offered integrated team and behavioral health simulations, few utilized psychology faculty in design, implementation, and evaluation. Other behavioral health providers (psychiatrists, social workers) were often involved in medical school and pediatric residency simulations. Few institutions use standardized evaluation. Qualitative feedback and faculty-written questionnaires were often used to evaluate efficacy. Survey responses suggest that psychologists play limited roles in integrated behavioral healthcare simulation despite their expertise in interdisciplinary training, integrated behavioral healthcare, and program evaluation.

Effect of Depression Interventions in Patients Undergoing Total Joint Arthroplasty Without a Formal Diagnosis of Depression: A Systematic Review

Purpose: Depression is a notable contributor to suboptimal outcomes after total joint arthroplasty (TJA). We conducted a systematic review of comparative studies to review the available evidence of interventions that affected depression scores and/or outcomes for patients undergoing TJA. Methods: EMBASE, Ovid MEDLINE, PubMed, and Scopus were reviewed systematically from inception until November 15, 2022. Studies that were relevant for this review included comparative studies between patients who received an intervention within 3 months before or after their primary total hip or knee arthroplasty procedure. The interventions included a wide range of modalities, which were grouped into psychotherapy, enhanced perioperative support, and pharmacotherapy. Other interventions included physiotherapy techniques with a psychological focus, art/music-based therapy, occupational therapy support, and educational interventions. Meta-analysis was conducted for psychotherapy and enhanced support. Results: The final systematic review consisted of 28 relevant studies, most of which were randomized controlled trials. A total of 3,702 patients, with a mean age of 66 years, were considered, of whom 59% were female. Most of the studies reported a notable reduction in depressive symptoms and/or scores based on the interventions being analyzed. At 3 months postoperatively, psychotherapy and enhanced support both resulted in markedly better depression and function scores compared with control subjects, with psychotherapy additionally improving pain scores. Conclusions: Overall, a wide range of interventions aimed at psychological optimization of patients undergoing TJA can improve depressive symptoms, pain, and function, even in the absence of a formal diagnosis of depression. Specifically, cognitive-based psychotherapy and enhanced perioperative support had the best evidence. Routine pharmacotherapy plays a limited role, if any, in the care of TJA. Additional efforts to develop pragmatic, evidence-based, and reproducible interventions are warranted to continue to optimize outcomes in TJA patients.