Groups Of Participants Research Articles

METTL23 Variants and Patients With Normal-Tension Glaucoma

This research confirms and further establishes that pathogenic variants in a fourth gene, METTL23, are associated with autosomal dominant normal-tension glaucoma (NTG). To determine the frequency of glaucoma-causing pathogenic variants in the METTL23 gene in a cohort of patients with NTG from Iowa. This case-control study took place at a single tertiary care center in Iowa from January 1997 to January 2024, with analysis occurring between January 2023 and January 2024. Two groups of participants were enrolled from the University of Iowa clinics: 331 patients with NTG and 362 control individuals without glaucoma. Patients with a history of trauma; steroid use; stigmata of pigment dispersion syndrome; exfoliation syndrome; or pathogenic variants in MYOC, TBK1, or OPTN were also excluded. Detection of an enrichment of METTL23 pathogenic variants in individuals with NTG compared with control individuals without glaucoma. The study included 331 patients with NTG (mean [SD] age, 68.0 [11.7] years; 228 [68.9%] female and 103 [31.1%] male) and 362 control individuals without glaucoma (mean [SD] age, 64.5 [12.6] years; 207 [57.2%] female and 155 [42.8%] male). There were 5 detected instances of 4 unique METTL23 pathogenic variants in patients with NTG. Three METTL23 variants-p.Ala7Val, p.Pro22Arg, and p.Arg63Trp-were judged to be likely pathogenic and were detected in 3 patients (0.91%) with NTG. However, when all detected variants were evaluated with either mutation burden analysis or logistic regression, their frequency was not statistically higher in individuals with NTG than in control individuals without glaucoma (1.5% vs 2.5%; P = .27). This investigation provides evidence that pathogenic variants in METTL23 are associated with NTG. Within an NTG cohort at a tertiary care center, pathogenic variants were associated with approximately 1% of NTG cases, a frequency similar to that of other known normal-tension glaucoma genes, including optineurin (OPTN), TANK-binding kinase 1 (TBK1), and myocilin (MYOC). The findings suggest that METTL23 pathogenic variants are likely involved in a biologic pathway that is associated with glaucoma that occurs at lower intraocular pressures.

Measuring Theory of Mind: a preliminary analysis of a novel linguistically simple and tablet-based measure for children

This study introduces a novel linguistically simple, tablet-based, behavioral Theory of Mind (ToM) measure, designed for neurotypical (NT) and autistic children aged 4–10 years. A synthesis of five comprehensive reviews of existing ToM measures revealed significant gaps in their designs; the weaknesses include a mismatch between the operational and conceptual definition of ToM, high verbal demands in most measures, materials that are minimally interesting for children, and often a lack of psychometric evaluations. These findings call into question the suitability of most of the currently available ToM measures used in children, both with and without developmental disorders, such as children with autism spectrum disorder (ASD). For example, the assessment of ToM in children with ASD may require reduced reliance on complex language or social interaction that can be part of the diagnostic criteria of the condition. This newly designed ToM measure, developed in line with the “Standards for Educational and Psychological Testing” of the American Educational Research Association, is linguistically simple, tablet-based, suitable for children with ASD, and is available in English, German, French, Italian, and Spanish. With a sample of 234 participants, including 152 NT children and 82 children with ASD between 4 and 10 years of age, the new ToM measure's psychometric properties were preliminarily evaluated. Descriptive statistics, measures of internal consistency, inter-item correlation, and validity checks were conducted in both groups. Further inspections of the measure's scale- and item-level characteristics were conducted with the help of exploratory factor analyses (EFA), and item response theory (IRT) within the NT children's group. These preliminary evaluations suggest that the newly developed ToM measure possesses good psychometric properties and is both accessible and engaging for children. Further investigation with a larger group of participants is necessary to reinforce these initial results. This will allow item- and scale-level assessments within a wider range of autistic children. For this purpose, the task will be made freely available to the scientific community.

“Everyone’s brains are different…you can’t just have one therapy plan to suit everyone” – A qualitative investigation of community-based rehabilitation services following traumatic brain injury

Purpose To examine the lived experiences of adults who have received community-based rehabilitation (CBR) services in Australia or New Zealand for cognitive-communication disorders (CCDs) following traumatic brain injury (TBI) and their support people. Participants’ recommendations for future models of care were also explored to enhance rehabilitation services for people with TBI. Method A qualitative descriptive approach grounded in phenomenology was used, whereby semi-structured interviews were conducted with each participant. A total of 28 interviews were completed, four in-person and 24 via video conferencing. Two participant groups were recruited: Adults with TBI; and their support people. Sixteen adults with a self-reported diagnosis of cognitive-communication disorder (CCD) following TBI who had received CBR and 12 support people were included. Interviews were analysed using reflexive thematic analysis. Result Four themes were identified by the participant groups indicating the core pillars of CBR models of care. They included the importance of: (a) accessible and inclusive CBR services; (b) specialised clinical skills and treatment approaches; the acknowledgment that (c) knowledge is power; and the significance of (d) peer networks and support. Conclusion This study further advances the evidence base of how services can be optimised to meet the complex needs of adults with CCDs following a TBI. Clinicians, researchers, and service providers should endeavour to incorporate the four core pillars outlined to enhance future CBR models of care for this clinical population.

A Systematic Review of the Use of E-mentoring to Address Youth Health

Electronic mentoring, also known as e-mentoring, is the practice of using digital technology to facilitate mentoring relationships. It has been increasingly popular in recent times. However, there has been no comprehensive analysis of the effectiveness of e-mentoring in addressing youth health issues. The present study conducts a systematic review and evidence quality assessment to analyse the impact of e-mentoring on the health and well-being of youth aged 10-24 years. Out of the 833 records that were found, only 14 matched the eligibility criteria. These criteria included being published in English since 1995, targeting adolescent health and/or youth with health difficulties, and having communication that was fully digital or integrated with in-person engagement. The findings indicated that most studies on health-focused e-mentoring mostly focused on young individuals with pre-existing health concerns, rather than exploring the application of e-mentoring to enhance general health and well-being. The programs provided mostly focused on implementing mentoring for specific groups of young people who may face difficulties with traditional face-to-face models. The quality assessments of the studies included in the analysis indicated that the strength of the evidence is of moderate quality. The results indicate that e-mentoring can reach young individuals with specific health issues and encourage them to independently manage their health conditions as they transition into adulthood. Nevertheless, it is necessary to conduct more thorough evaluations of e-mentoring programs with bigger groups of participants.

Relationships Between Hearing Status, Cognitive Abilities, and Reliance on Visual and Contextual Cues

Objectives: Visual and contextual cues facilitate speech recognition in suboptimal listening conditions (e.g., background noise, hearing loss, hearing aid signal processing). Moreover, successful speech recognition in challenging listening conditions is linked to cognitive abilities such as working memory and fluid intelligence. However, it is unclear which cognitive abilities facilitate the use of visual and contextual cues in individuals with normal hearing and hearing aid users. The first aim was to investigate whether individuals with hearing aid users rely on visual and contextual cues to a higher degree than individuals with normal hearing in a speech-in-noise recognition task. The second aim was to investigate whether working memory and fluid intelligence are associated with the use of visual and contextual cues in these groups. Design: Groups of participants with normal hearing and hearing aid users with bilateral, symmetrical mild to severe sensorineural hearing loss were included (n = 169 per group). The Samuelsson and Rönnberg task was administered to measure speech recognition in speech-shaped noise. The task consists of an equal number of sentences administered in the auditory and audiovisual modalities, as well as without and with contextual cues (visually presented word preceding the sentence, e.g.,: “Restaurant”). The signal to noise ratio was individually set to 1 dB below the level obtained for 50% correct speech recognition in the hearing-in-noise test administered in the auditory modality. The Reading Span test was used to measure working memory capacity and the Raven test was used to measure fluid intelligence. The data were analyzed using linear mixed-effects modeling. Results: Both groups exhibited significantly higher speech recognition performance when visual and contextual cues were available. Although the hearing aid users performed significantly worse compared to those with normal hearing in the auditory modality, both groups reached similar performance levels in the audiovisual modality. In addition, a significant positive relationship was found between the Raven test score and speech recognition performance only for the hearing aid users in the audiovisual modality. There was no significant relationship between Reading Span test score and performance. Conclusions: Both participants with normal hearing and hearing aid users benefitted from contextual cues, regardless of cognitive abilities. The hearing aid users relied on visual cues to compensate for the perceptual difficulties, reaching a similar performance level as the participants with normal hearing when visual cues were available, despite worse performance in the auditory modality. It is important to note that the hearing aid users who had higher fluid intelligence were able to capitalize on visual cues more successfully than those with poorer fluid intelligence, resulting in better speech-in-noise recognition performance.

Teachers’ Opinions on Teacher Resilience during the COVID-19 Pandemic

The purpose of the study is to examine the teachers’ opinions on teacher resilience during the COVID-19 pandemic. The study employed a phenomenological design, implementing maximum variation sampling to select a participant group of 20 teachers from private schools in Istanbul and public schools in Erzurum's rural district, Hınıs. Semi-structured interviews were conducted both in-person and virtually, after which descriptive and content analyses were undertaken utilizing the MAXQDA 2020 software, facilitating the identification of predominant themes and sub-themes. Eight themes are surfaced from the study, encapsulating teachers' opinions on resilience, professional challenges, complications tied to distance education, environmental problems, factors contributing to resilience, leaving the profession, the COVID-19 pandemic's impact, along with suggestions for enhancing resilience. The study's findings indicate that teacher resilience during the COVID-19 pandemic is significantly affected by factors such as the lack of internet infrastructure, the lack of hardware, learning loss in students, absenteeism problems of students, physical distance, increase in workload, the lack of parental interest, the lack of support from the administration, and economic conditions. Conversely, professional dedication, professional development, positive attitude, administrative and parental support, collaboration among colleagues, and engaging in hobbies were identified as factors contributing to teacher resilience.

Psychological Changes in Green Food Consumption in the Digital Context: Exploring the Role of Green Online Interactions from a Comprehensive Perspective.

The advent of the digital economy has brought new opportunities to food marketing. In China, many food businesses have begun to use interactions under specific social media topics to open up new sales channels. Green food, as a representative of environmentally related topics, is increasingly influencing consumer choices through online interactions. In light of this, this study collected data from a large group of participants engaged in online green interactions to explore the psychological mechanisms behind consumers' choices of green food in an online context. The findings indicate that online green interactions positively influence the willingness to purchase green food, with environmental self-efficacy and flow experience serving as mediators in this relationship. Information trust and consumer traits act as boundary conditions. This study not only deepens the understanding of food consumer behavior in the digital context, but also provides important references for food companies on how to more effectively utilize online interaction to promote the market expansion of green food.

Jaw relation recording and transferring: Using digital technology to augment its instruction in predoctoral prosthodontics

AbstractObjectivesThe study compared the learning effectiveness and teaching satisfaction of dental students from three teaching methods (traditional, digital, and combined pedagogy) for instructing jaw relation recording and transferring (JRRT).MethodsNote that, 276 fourth‐year undergraduate students from three classes were randomly divided into three groups to study JRRT in complete dentures using different teaching methods: traditional pedagogy group, digital pedagogy group, and combined digital and traditional pedagogy group. After the course, the learning effectiveness of basic knowledge and satisfaction questionnaire was administered to the three groups of participants using a quick response code for online answering. The questionnaire was customized by the teacher based on the content delivered to each group.ResultsThe data were analyzed using the Chi‐square test with Fisher's exact test. Both the digital and combined pedagogy groups showed a significant increase in basic knowledge test scores and higher satisfaction, compared to the traditional pedagogy group (p < 0.01). Particularly, the participants from combined pedagogy showed better teaching satisfaction than the digital pedagogy group (p < 0.001).ConclusionsThe use of digital technology in JRRT significantly enhanced students' learning effectiveness and teaching satisfaction.Clinical significanceThis educational innovation emphasizes digital technology to visualize vital concepts and operational intricacies related to JRRT. The findings have major implications for improving teaching methods in the field of prosthodontic dentistry.

A Retrospective Study Examining Self-Reported Physical Activity Levels Among Asthma Patients Using the Behavioural Risk Factor Surveillance System (BRFSS) Database.

Regular physical activity benefits respiratory health by reducing the risk of developing asthma. This is achieved by reducing bronchial hyperresponsiveness and preventing lung function decline. The objective of the study is to assess the prevalence of self-reported physical activity among asthma patients in the United States in 2021, based on demographic, socioeconomic, and healthcare access variables. The original research study was conducted using the Behavioural Risk Factor Surveillance System (BRFSS) database for the year 2021. Data regarding asthma status, physical activity, age, gender, race, education level, income level, employment status, and time since the last routine check-up were collected. In the BRFSS study conducted in the USA in 2021, there were 43,6121 participants in total. Of these, 61,362 (14.07%) had asthma and 374,759 (85.93%) did not; 43,678 (71.2%) participants with asthma were engaging in physical activity while 17,684 (28.8%) were not. In the group of participants who did not have the disease, 285,932 (76.3%) were engaging in physical activity and 88,827 (23.7%) were not. Demographically, the highest physical activity among those with asthma was observed in the age group of 18 to 24 years (4,079, 83%), male participants (17,725, 76.4%), and white non-Hispanics (31,964, 72.5%). Higher physical activity levels among asthma patients were associated with advanced education 31,947 (76.5%), employment 23,233 (79.8%), and annual incomes exceeding $150,000, 4,091 (89.9%). Participants who self-reported not having asthma have a higher prevalence of physical activity in all categories studied. There is a significant association between physical activity and self-reported asthma, shaped by demographic and socioeconomic factors, as well as the frequency of routine medical check-ups.

High prevalence of HPV-56 and HPV-39 in Sari, Iran: an analysis of genotype distribution

BackgroundHuman papillomavirus (HPV) is responsible for the most common sexually transmitted infection, particularly among sexually active individuals. Understanding the geographical distribution and epidemiology of the most prevalent HPV genotypes is essential for developing effective prevention strategies. Consequently, this study aimed to examine the distribution of HPV genotypes among HPV-positive women and men in Sari, the capital city of Mazandaran province in northern Iran.Materials and methodsHPV DNA was extracted (PZP Company, Molecular IVD, Iran) from genital and cervical samples of the study participants. Genotyping was conducted for 90 cases utilizing the High + Low Papilloma Strip test (Operon Company, Spain). Demographic data were statistically analyzed in correlation with the virological data (STATA version 17).ResultsOverall, 67.7% (61 out of 90) of the cases tested positive for HPV, with 75% of those being classified as high-risk. The participant group consisted of 92% females (83) and 8% males (7). The highest HPV prevalence, 75% (36), was observed in females and males aged under 31, with the majority of positive cases belonging to high-risk genotypes. The most frequently identified genotypes were HPV-11 (23%), HPV-6 (21%), HPV-56 (18%), HPV-39 (16%), HPV-16, HPV-91, and HPV-66 each comprising (14%). HPV-56 was the most common high-risk genotype, accounting for 11 cases (18%), followed by HPV-39, which was present in 10 cases (16%).ConclusionThe prevalence of HPV infection was particularly high among individuals under the age of 31 for both genders, with men exhibiting a 100% infection rate. These findings emphasize the urgent need for targeted education aimed at the younger population and the implementation of infection control measures. Specifically, widespread HPV vaccination targeting HPV-6, HPV-11, HPV-39, and HPV-56 should be prioritized for the general population.

Searching for Linearity: Reconstructive Processes Reverse Temporal Scrambling in Memory for Movie Scenes

Meaning-making and temporal memory are closely intertwined, yet we still do not know how the overall understanding of complex events affects retrospective temporal judgments. The present study investigated the effect of a manipulation of the temporal linearity of a narrative on the subsequent memory-for-time performance. Participants indicated the time of occurrence of short video clips extracted from a previously encoded movie on a horizontal timeline representing the movie duration. Importantly, a group of participants ( N = 20) watched the original movie, which depicts events occurring in chronological order, whereas another group ( N = 30) watched a scrambled version of the same movie in which the temporal linearity was lost. This procedure allowed us to measure the quantity and direction of the temporal memory bias. The scrambled presentation produced a mild and general impairment of recognition memory compared to the linear presentation. More importantly, it biased temporal judgments as a function of the direction and amount of discrepancy between the story and the viewing time, in accordance with an automatic reshaping of temporal memory caused by a chronological representation of the storyline. This effect could be distinguished from a tendency to move judgments toward the center of the timeline, independently from the specific scrambling arrangement, consistent with the idea that the non-linearity of the story also generally increased the degree of temporal uncertainty. Taken together, our results provide further evidence that temporal memories are automatically reconstructed according to the general meaning of the events.

Promoting Students’ Speaking Proficiency through Communicative Activities. Case Study of Department of English, Faculty of Education, Champasack University

The study was to examine the effectiveness of the communicative activities (CAs), and to explore the students’ attitudes and perceptions towards the application of communicative activities by two groups before treatment and after treatment. The Quasi-experimental design was used. There were 54 total English third-year students at the English Department, Faculty of Education, Champasack University. There were two groups of participants: the “Experimental group” (30 students) and the “Control group” (24 students). The experimental teaching was conducted for 36 hours within a 9-week period in 4 cycles with the uses of the three communicative activities; group discussion, role-play, and debate which including Pre-Posttest, rubric of speaking proficiency, attitude and perception questionnaire, observation checklist, ten sub-commutative activities within 4 debate periods were employed for this study. Pre-posttest and questionnaires were given to students in both experimental and control groups to check the reliability of the test, this research used three senior score raters to measure the students’ speaking proficiency by using the rubric of speaking proficiency. The observation checklist was noted by the researcher in every class within the communicative activities used. The data were statistically analyzed by t-test independent and paired-t test for the dependent sample by comparing the mean scores of the pretest and posttest to determine whether there was a significant difference between the experimental and control groups. Moreover, the students were required to respond the attitude and perception questionnaire to explore their attitudes and perceptions towards the communicative activities. Two groups compared the findings of the test; it was found that the CAs were effectiveness to improve students’ speaking proficiency as can be seen through the increasing of the test score of the experimental group, which started from 74.43 to 83.90 (9.47) with the significant level of p < .05. In addition, the majority of the students had positive attitude and perception towards the effectiveness of the communicative activities used.

Cognitive load in remote simultaneous interpreting: place name translation in two Mandarin variants

This study examined the accuracy of place name translation during remote simultaneous interpreting (RSI) when interpreters were required to use a different variant of their native language. Participants, professional English/ Mandarin from mainland China, were divided into two groups: the Taiwan group, using the Taiwanese Mandarin variant, and the control group, using the mainland variant. The source speech consisted of three lists of place names, some of which had the same Chinese translation in both the mainland China Mandarin variant and the Taiwanese Mandarin variant, while others did not. The two groups of participants performed RSI from English into Chinese. The analysis focused on the third item in each list, chosen due to the differences in Chinese translations between the two Mandarin variants. Results showed no significant difference in the number of incorrect translations for the first test item between the two groups. However, significant variations were observed for the second and third test items, potentially linked to progressive mental fatigue and increased cognitive demand faced by the Taiwan group participants. This suggests that using a non-habitual language variant can impact the accuracy of RSI.

Self‐regulation and self‐efficacy of EFL learners in hybrid educational settings in Türkiye

AbstractDistance learning, online learning and hybrid learning models have been a part of language education for a long time. The adoption of these models and research focusing on related phenomena have become even more frequent since the breakout of the COVID‐19 pandemic in 2019. This mixed‐method study examines the relationship between online learning self‐efficacy and online self‐regulation of preparatory class English as a Foreign Language (EFL) learners to provide a picture of the learners' perspective regarding the online segment of the hybrid education system that was in effect during the mentioned era, to provide deeper insights regarding learner perceptions during such times of emergency. Turkish adaptations of the Online‐Learning Self‐Efficacy Scale and Online Self‐regulated Learning Questionnaire were utilized as data collection instruments. To validate and expand the content of quantitative findings, semi‐structured interviews were conducted with a selected group of participants. The findings reveal that preparatory year Turkish EFL learners perceive themselves to be self‐efficacious and self‐regulated at a satisfactory level in online learning environments. The study provides insight into the learners' perceptions during this period and contributes to filling a significant gap within the field as well as offering new perspectives in case we face similar conditions in the future.

Framing openness: Exploring Similarities and Differences in Patients' and Their Social Networks' Experiences with Participating in Dialogical Network Meetings Through the Lens of Mattering.

In this qualitative study conducted at a public mental health outpatient clinic in Norway, the integration of patients' social network in treatment was examined. The aim was to explore the experiences of patients and their network during dialogical network meetings and discuss any similarities and differences between the two participant groups. Reflexive thematic analysis was performed on data obtained from fifty-three meetings, resulting in the development of five themes. For patients, there were two themes: "Enhanced trust within our relationships" and "Providing us a safe space to talk openly," and for network members there were three: "Empowered through participation," Being welcomed and taken seriously," and "Provide more clarity to enhance our ability to contribute." Mattering was employed as a conceptual framework to discuss the similarities and differences between the themes of the two participant groups. Both patients and network members placed strong emphasis on the freedom of expression and acknowledged the crucial role of the meeting leaders in facilitating discussions on important and challenging topics. Differences included network members' emphasis on feeling welcome and their need to add value, while patients emphasized strengthened relationships and feeling valued and empowered by being trusted to control the discussion content. Overall, mattering appears to be a valuable tool for understanding the relational dynamics within network meetings.\.

High autistic traits linked with reduced performance on affective task switching: An ERP study

Few studies have investigated affective flexibility in individuals with high autistic traits. In the present study, we employed affective task-switching paradigm combined with event related potential (ERP) technology to explore affective flexibility in individuals with high autistic traits. Participants were instructed to switch between identifying the gender (gender task) and emotion (emotion task) of presented faces. Two groups of participants were recruited based on the Autism Spectrum Quotient (AQ) scores: a High Autistic Group (HAG) and a Low Autistic Group (LAG). The results confirmed that the HAG exhibited greater behavioral emotion switch costs and increased N2 and decreased P3 components when switching to the emotion task. Additionally, we identified an affective asymmetric switch cost in the HAG, where the switch cost for the emotion task was larger than for the gender task at both behavioral and electrophysiological levels. In contrast, a symmetrical switch cost was observed in the LAG. These findings indicate that the HAG experiences difficulties with affective flexibility, particularly in tasks involving emotional processing. The patterns of affective asymmetric switch costs observed in both groups differed from previous results in autistic children and the general population, suggesting that the relative dominance of gender and emotion tasks may vary between the two groups. We propose that the dominance of emotion tasks declines as autistic traits increase.

Cognitive processing speed improvement after cochlear implantation.

Untreated hearing loss has an effect on cognition. It is hypothesized that the additional processing required to compensate for the sensory loss affects the cognitive resources available for other tasks and that this could be mitigated by a hearing device. The impact on cognition of cochlear implants (CIs) was tested in 100 subjects, ≥60 years old, with bilateral moderately-severe to profound post linguistic deafness using hearing aids. Data was compared pre and 12 and 18 months after cochlear implantation for the speech spatial qualities questionnaire, Mini Mental State Examination (MMSE), Trail making test B (TMTB) and digit symbol coding (DSC) from the Wechsler Adult Intelligence Scale version IV and finally the timed up and go test (TUG). Subjects were divided into young old (60-64), middle old (65-75) and old old (75+) groups. Cognitive test scores and times were standardized according to available normative data. Hearing significantly improved pre- to post-operatively across all age groups. There was no change post-implant in outcomes for TMTB, TUG or MMSE tests. Age-corrected values were within normal expectations for all age groups for the TUG and MMSE. However, DSC scores and TMTB times were worse than normal. There was a significant increase in DSC scores between baseline and 12-months for 60- to 64-year-olds (t[153] = 2.608, p = 0.027), which remained at 18 months (t[153] = 2.663, p = 0.023). The improved attention and processing speed in the youngest age group may be a consequence of reallocation of cognitive resources away from auditory processing due to greatly improved hearing. The oldest age group of participants had cognition scores closest to normal values, suggesting that only the most able older seniors tend to come forward for a CI. Severe to profoundly deaf individuals with hearing aids or cochlear implants were still poorer than age-equivalent normally hearing individuals with respect to cognitive flexibility, attention, working memory, processing speed and visuoperceptual functions. Due to a lack of data for the TUG, TMTB and DSC in the literature for hearing impaired individuals, the results reported here provide an important set of reference data for use in future research.

The four Cs of physician leadership: A key to academic physician success.

Leadership is increasingly recognized as important in medicine. Physician leadership impacts healthcare delivery and quality. Little work has been done to determine how physician leadership in practice aligns with established models in leadership theory. We conducted 40 semi-structured, 50-minute interviews of physicians who had achieved the rank of professor in our school of medicine and were serving, or had served, in leadership positions. We used an inductive content analysis approach to identify content categories, with leadership emerging as one such category. Subsequently, for the present study, we performed a secondary analysis of the data. To do this, we reviewed all transcripts, seeking to identify if and how participants discussed leadership in relation to success in academic medicine. Following identification of sub-categories related to leadership, we performed qualitative content analysis. We then used a deductive content analysis approach to determine how participants' discussions of leadership aligned with major leadership theories. Then, the principal investigator conducted a secondary inductive content analysis revealing leadership themes that were synthesized into a new model of physician leadership. Twenty-nine participants spontaneously discussed leadership and leadership-related topics as important to their own academic success and comprised the present study cohort. Participants identified contributors to leadership success that aligned with multiple major leadership theories, including leadership traits, skills, behaviors styles, and situational leadership. None of the leadership theories aligned completely with our physician leaders' discussions, suggesting an alternate leadership framework was operating. Further analysis revealed a new model of leadership comprised of the "Four Cs of Physician Leadership": character, competence, caring, and communication. Our participant group of academic physicians identified leadership capabilities as being important in their academic success. While they discussed leadership in ways that fit to varying degrees with the major leadership theories, their discussions revealed a novel, more holistic leadership framework. Further work will be beneficial to determine if this model of leadership is specific to physicians or is more generalizable.

Associations between Adverse Childhood Experiences (ACEs) and Complex-PTSD, moral injury and perceived social support: A latent class analysis

BackgroundAdverse Childhood Experiences (ACEs), including childhood abuse and neglect, are consistently linked to poorer mental health and psychosocial outcomes in adulthood. Complex-posttraumatic stress disorder (C-PTSD) and moral injury are two conditions which can cause significant distress and functional impairment in individuals affected by trauma. However, not much is known about the complex relationships between ACEs, C-PTSD and moral injury. Furthermore, while perceived social support is a commonly cited protective factor for C-PTSD, there is little understanding about how it relates to ACEs in traumatised populations. The aim of this study was to investigate ACEs in a trauma-affected sample of UK military veterans using latent class analysis. Secondly, the study tested for associations between latent classes of ACEs, severity of C-PTSD and moral injury, and levels of perceived social support. MethodData was collected from a UK military veterans mental health charity, from a clinical sample (N = 336) who were receiving treatment for mental health difficulties. Participants completed standardised measures of ACEs, C-PTSD, moral injury, and perceived social support. Data was analysed using a bias-adjusted 3-step approach latent class analysis. Wald statistics were used to test for associations between classes of ACEs and C-PTSD, moral injury and perceived social support. FindingsA two-class model was found to be the best fit for the data, which depicted two classes of ACEs within the sample. The classes showed a distinction between a group of participants who were more likely to endorse experiencing high levels of ACEs, and a separate group who endorsed relatively lower levels of ACEs. As such, the model was interpreted as depicting a low-ACEs (class 1) vs. high-ACEs (class 2) distinction. 56 % of participants fell into class 1 (low ACEs) with 44 % in class 2 (high ACEs). Participants in class 2 (high ACEs) were significantly more likely to score highly for symptoms of C-PTSD and moral injury, and to report lower levels of perceived social support. ConclusionThe present study is the first to report a two-class model of low vs high-ACEs in a clinical sample of UK military veterans. It also describes how membership of the high-ACEs class was significantly associated with higher scores for key mental health and psychosocial variables in C-PTSD, moral injury and perceived social support. The findings have important clinical implications in highlighting the possible role of ACEs in understanding the aetiology of psychopathology in military populations affected by trauma. It also adds to the growing literature which demonstrates how many military personnel experience significant levels of pre-existing trauma and adversity before entering service, and how this can contribute to the development of complex mental health outcomes in adulthood.

Tirzepatide and blood pressure reduction: stratified analyses of the SURMOUNT-1 randomised controlled trial

BackgroundTreating obesity may be a pathway to prevent and control hypertension. In the SURMOUNT-1 trial in people with obesity or overweight with weight-related complications, 72-week tirzepatide treatment led to clinically...