JWST detection of a supernova associated with GRB 221009A without an r-process signature.

Identifying the sites of r-process nucleosynthesis, a primary mechanism of heavy element production, is a key goal of astrophysics. The discovery of the brightest gamma-ray burst (GRB) to date, GRB 221009A, presented an opportunity to spectroscopically test the idea that r-process elements are produced following the collapse of rapidly rotating massive stars. Here we present James Webb Space Telescope observations of GRB 221009A obtained +168 and +170 rest-frame days after the gamma-ray trigger, and demonstrate that they are well described by a SN 1998bw-like supernova (SN) and power-law afterglow, with no evidence for a component from r-process emission. The SN, with a nickel mass of approximately 0.09 M ⊙, is only slightly fainter than the brightness of SN 1998bw at this phase, which indicates that the SN is not an unusual GRB-SN. This demonstrates that the GRB and SN mechanisms are decoupled and that highly energetic GRBs are not likely to produce significant quantities of r-process material, which leaves open the question of whether explosions of massive stars are key sources of r-process elements. Moreover, the host galaxy of GRB 221009A has a very low metallicity of approximately 0.12 Z ⊙ and strong H2 emission at the explosion site, which is consistent with recent star formation, hinting that environmental factors are responsible for its extreme energetics.

Treadmill-based system for postural studies: Design and validation.

Computer-controlled treadmills are common in many gait labs and offer great potential for conducting perturbation-based postural studies. However, the time-course of these disturbances can be too brief to be controlled manually through product software. Here we present a system that combines a Bertec® split-belt treadmill with custom hardware and software to deliver postural disturbances during standing and record data from multiple sources simultaneously. We used this system to administer to 15 healthy participants an 8-session perturbation-based training protocol in which they learned to respond without stepping to progressively larger perturbations. Kinematic, electromyographic, and force data were collected throughout. Motion capture was used to characterize the accuracy and repeatability of the treadmill-delivered perturbations with respect to duration, displacement, and peak velocity. These (observed) data were compared to that expected based on software commands and the known constraints of the treadmill (i.e., 10 Hz operating speed). We found perturbation durations to be as expected. Peak velocities and displacements were slightly higher than expected (average increases were 0.59 cm/s and 1.76 cm, respectively). Because this increase in magnitude was consistent, it did not impede training or affect data analysis. Treadmill behavior was repeatable across 95 % of trials.

The measurement of college athletes' knowledge and behavior on pre- and post-workout nutrition utilizing a text message intervention.

Objective: The purpose of this study was to measure college student athletes' nutrition knowledge and behavior before and after a text message-based educational intervention. Participants: Athletes (n = 35) participated by completing a pre- and post-intervention survey. Methods: This survey gathered information on ability to identify carbohydrate and protein food sources, pre-and post-workout intake, and behavior. Text messages were sent during the 4-week intervention and included information regarding the importance of carbohydrate consumption before training, and a carbohydrate-protein mixture for recovery. Results: Dependent t-tests revealed a lack of statistically significant increases in total knowledge (p = 0.156) or behavior (p = 0.177), but an increase in the behavior questions regarding efficacy of carbohydrate before training (p = 0.026) and carbohydrate and protein after training (p = 0.016). Conclusion: This suggests the text message educational intervention did influence behavioral outcomes. Future research should focus on the effectiveness, length, and frequency of the text message intervention, and investigate the athletes' willingness to change dietary behaviors.

The five most significant barriers to healthy eating in collegiate student-athletes.

The objective of the present study was to elucidate what student-athletes believe are the most significant barriers to consuming a healthy diet. 418 student-athletes at an NCAA Division 1 university were invited to complete a survey on their nutritional habits and barriers to healthy eating. The survey was designed utilizing the current literature in student-athletes and young adults and underwent a professional review and pilot study before use in data collection. 169 student-athletes (40%) fully completed the survey. Responses indicate the five most significant barriers are lack of time, easy access to unhealthy foods, cost of healthy foods, lack of knowledge about what foods are healthy, and lack of knowledge and skills to cook healthy foods, respectively. Further, data show significant relationships between several variables and the rate of selection of various barriers. Overall, these findings lay the groundwork for future interventions while also presenting initial, usable information for professionals.

Early-Onset Asymptomatic Polypoid Cystitis in Two Adolescent Male Beagle Dogs.

This brief communication describes a rare spontaneous background lesion in the lower urinary tract of two male laboratory beagles. Proliferative lesions comprising a constellation of histological features consistent with polypoid cystitis were observed in the bladder of two adolescent dogs from a routine preclinical toxicology study. Both animals were clinically asymptomatic and had only minor alterations in urinalysis parameters. While chronic polypoid cystitis is well-recognized in adult pet dogs, this is the first reported case in purpose-bred laboratory beagles. An awareness of this uncommon background finding is important for toxicological pathologists to distinguish it from potential test article-related findings.

Method To Visualize the Intratumor Distribution and Impact of Gemcitabine in Pancreatic Ductal Adenocarcinoma by Multimodal Imaging.

Gemcitabine (dFdC) is a common treatment for pancreatic cancer; however, it is thought that treatment may fail because tumor stroma prevents drug distribution to tumor cells. Gemcitabine is a pro-drug with active metabolites generated intracellularly; therefore, visualizing the distribution of parent drug as well as its metabolites is important. A multimodal imaging approach was developed using spatially coregistered mass spectrometry imaging (MSI), imaging mass cytometry (IMC), multiplex immunofluorescence microscopy (mIF), and hematoxylin and eosin (H&E) staining to assess the local distribution and metabolism of gemcitabine in tumors from a genetically engineered mouse model of pancreatic cancer (KPC) allowing for comparisons between effects in the tumor tissue and its microenvironment. Mass spectrometry imaging (MSI) enabled the visualization of the distribution of gemcitabine (100 mg/kg), its phosphorylated metabolites dFdCMP, dFdCDP and dFdCTP, and the inactive metabolite dFdU. Distribution was compared to small-molecule ATR inhibitor AZD6738 (25 mg/kg), which was codosed. Gemcitabine metabolites showed heterogeneous distribution within the tumor, which was different from the parent compound. The highest abundance of dFdCMP, dFdCDP, and dFdCTP correlated with distribution of endogenous AMP, ADP, and ATP in viable tumor cell regions, showing that gemcitabine active metabolites are reaching the tumor cell compartment, while AZD6738 was located to nonviable tumor regions. The method revealed that the generation of active, phosphorylated dFdC metabolites as well as treatment-induced DNA damage primarily correlated with sites of high proliferation in KPC PDAC tumor tissue, rather than sites of high parent drug abundance.

Ice-Cream Substitute for Patients With Kidney Failure.

OBJECTIVE: Quality of life for patients with kidney failure is less than similar-aged, general population counterparts. A large part of the decrease in quality of life is from the change of diet and nutritional restrictions. One way to combat this decrease in quality of life is through oral nutrition supplements. METHODS: An ice-cream substitute product was developed for patients with kidney failure on peritoneal dialysis. The product consisted of an ice-cream-like base of rice milk, egg whites, evaporated coconut milk, sugar, and vanilla bean paste. Two flavors were then created: cinnamon and lemon. Both flavors were tested subjectively and objectively. Sensory taste testing was with peritoneal dialysis patients using a Likert scale ballot with a comment section. Texture analysis was completed using a CT3 Brookfield texture analyzer. The results from the sensory testing (taste, texture, overall acceptability) and the texture analysis were analyzed using paired-samples t-tests. Nutritional analysis for the product was calculated. RESULTS: The sensory test of taste, texture, and overall acceptability between the two flavors was not found to be statistically different between the cinnamon and lemon. Similarly, the objective results were also not statistically significant between the two flavors. CONCLUSION: Based on the nutritional analysis, both the lemon and the cinnamon flavors were found to be "good" sources of protein when compared with the Food and Drug Administration's definition of a "good" source of protein. In addition, patients found the sensory aspects of both flavors to be slightly to moderately likable.

Increasing fire and the decline of fire adapted black spruce in the boreal forest.

Intensifying wildfire activity and climate change can drive rapid forest compositional shifts. In boreal North America, black spruce shapes forest flammability and depends on fire for regeneration. This relationship has helped black spruce maintain its dominance through much of the Holocene. However, with climate change and more frequent and severe fires, shifts away from black spruce dominance to broadleaf or pine species are emerging, with implications for ecosystem functions including carbon sequestration, water and energy fluxes, and wildlife habitat. Here, we predict that such reductions in black spruce after fire may already be widespread given current trends in climate and fire. To test this, we synthesize data from 1,538 field sites across boreal North America to evaluate compositional changes in tree species following 58 recent fires (1989 to 2014). While black spruce was resilient following most fires (62%), loss of resilience was common, and spruce regeneration failed completely in 18% of 1,140 black spruce sites. In contrast, postfire regeneration never failed in forests dominated by jack pine, which also possesses an aerial seed bank, or broad-leaved trees. More complete combustion of the soil organic layer, which often occurs in better-drained landscape positions and in dryer duff, promoted compositional changes throughout boreal North America. Forests in western North America, however, were more vulnerable to change due to greater long-term climate moisture deficits. While we find considerable remaining resilience in black spruce forests, predicted increases in climate moisture deficits and fire activity will erode this resilience, pushing the system toward a tipping point that has not been crossed in several thousand years.

Sotatercept for the Treatment of Pulmonary Arterial Hypertension.

BACKGROUND: Pulmonary arterial hypertension is characterized by pulmonary vascular remodeling, cellular proliferation, and poor long-term outcomes. Dysfunctional bone morphogenetic protein pathway signaling is associated with both hereditary and idiopathic subtypes. Sotatercept, a novel fusion protein, binds activins and growth differentiation factors in the attempt to restore balance between growth-promoting and growth-inhibiting signaling pathways. METHODS: In this 24-week multicenter trial, we randomly assigned 106 adults who were receiving background therapy for pulmonary arterial hypertension to receive subcutaneous sotatercept at a dose of 0.3 mg per kilogram of body weight every 3 weeks or 0.7 mg per kilogram every 3 weeks or placebo. The primary end point was the change from baseline to week 24 in pulmonary vascular resistance. RESULTS: Baseline characteristics were similar among the three groups. The least-squares mean difference between the sotatercept 0.3-mg group and the placebo group in the change from baseline to week 24 in pulmonary vascular resistance was -145.8 dyn · sec · cm-5 (95% confidence interval [CI], -241.0 to -50.6; P = 0.003). The least-squares mean difference between the sotatercept 0.7-mg group and the placebo group was -239.5 dyn · sec · cm-5 (95% CI, -329.3 to -149.7; P<0.001). At 24 weeks, the least-squares mean difference between the sotatercept 0.3-mg group and the placebo group in the change from baseline in 6-minute walk distance was 29.4 m (95% CI, 3.8 to 55.0). The least-squares mean difference between the sotatercept 0.7-mg group and the placebo group was 21.4 m (95% CI, -2.8 to 45.7). Sotatercept was also associated with a decrease in N-terminal pro-B-type natriuretic peptide levels. Thrombocytopenia and an increased hemoglobin level were the most common hematologic adverse events. One patient in the sotatercept 0.7-mg group died from cardiac arrest. CONCLUSIONS: Treatment with sotatercept resulted in a reduction in pulmonary vascular resistance in patients receiving background therapy for pulmonary arterial hypertension. (Funded by Acceleron Pharma; PULSAR ClinicalTrials.gov number, NCT03496207.).

Pilot feasibility study examining the effects of a comprehensive volume reduction protocol on hydration status and blood pressure in hemodialysis patients.

INTRODUCTION: Chronic volume overload is a persistent problem in hemodialysis (HD) patients. The purpose of this study was to investigate the impacts of comprehensive volume reduction protocol on HD patient's hydration status and blood pressure (BP). METHODS: Twenty-three HD patients (age = 55.7 ± 13.3 years) completed a 6-month comprehensive volume control protocol consisting of: reducing postdialysis weight; reducing BP medication prescriptions; and weekly intradialytic counseling to reduce dietary sodium intake and interdialytic weight gain (IDWG). The primary outcome was volume overload (VO) measured by bioelectrical impedance spectroscopy. Secondary outcomes included: IDWG, postdialysis weight, estimated dry weight (EDW), dietary sodium intake, BP and BP medication prescriptions. FINDINGS: From baseline (0M) to 6 months (6M), significant improvements were noted in: VO (0M 3.9 ± 3.9 L vs. 6M 2.6 ± 3.4 L, P = 0.003), postdialysis weight (0M 89.4 ± 23.1 kg vs. 6M 87.6 ± 22.2 kg; P = 0.012), and EDW (0M 89.0 ± 23.2 vs. 6M 86.7 ± 22.5 kg., P = 0.009). There was also a trend for a reduction in monthly averaged IDWG (P = 0.053), and sodium intake (0M 2.9 ± 1.6 vs. 6M 2.3 ± 1.1 g/d, P = 0.125). Neither systolic BP (0M 162 ± 27 vs. 6M 157 ± 23 mmHg, P = 0.405) nor diastolic BP (0M 82 ± 21 vs. 6M 82 ± 19 mmHg, P = 0.960) changed, though there was a significant reduction in the total number of BP medications prescribed (0M 3.0 ± 1.0 vs. 6M 1.5 ± 1.0 BP meds; P = 0.004). DISCUSSION: Our volume reduction protocol significantly improved HD patient's hydration status. While BP did not change, the reduction in prescribed BP medication number suggests improved BP control. Despite these overall positive findings, the magnitude of change in most variables was modest. Comprehensive changes in HD clinics may be necessary to realize more clinically significant results.

Vitamin D status is associated with muscular strength in a nationally representative sample of US youth.

AIM: To evaluate the association between serum 25-hydroxyvitamin D (25OHD) and muscular strength in a nationally representative sample of US youth. METHODS: Participants (n = 3350) were 6- to 18-y-olds from 2011 to 2014 National Health and Nutrition Examination Survey. Relative handgrip strength was quantified using age- and sex-specific z-scores. Poor strength was defined as those <25th percentile. Multivariate general linear and logistic models were used to compare strength and poor strength status by clinically relevant groupings of 25OHD. RESULTS: Approximately 20.2% of youth had 25OHD <50 nmol/L. Mean relative strength was highest for those at ≥75 nmol/L of 25OHD. The percentage of boys/girls with poor strength in the <50 nmol/L, 50-74.9 nmol/L and ≥75 nmol/L groups was 34.9%/32.3%, 25.8%/28.2% and 14.0%/15.8%, respectively. The odds of boys and girls with <50 nmol/L 25OHD having poor strength were 2.8 (95% CI: 1.4, 5.5) and 3.4 (1.7, 6.8) times higher compared to those with ≥75 nmol/L, respectively. CONCLUSION: Higher levels of circulating vitamin D were associated with higher relative strength, and poor strength was more prevalent when 25OHD was <75 nmol/L. These findings highlight the value of vitamin D for the muscle-bone unit and potential extraskeletal ramifications.

Registered dietitian nutritionists and perceptions of liberalizing the hemodialysis diet.

BACKGROUND/OBJECTIVES: The objective of this study was to assess the level of awareness, comfort, and likelihood of liberalizing the hemodialysis diet in practicing renal registered dietitian nutritionists (RDN). SUBJECTS/METHODS: An original, cross-sectional survey was sent to the Academy of Nutrition and Dietetics' Renal Practice Group in May 2017, consisting primarily of renal dietitians. RESULTS: A total of 187 renal dietitians responded to the survey designed to assess their current practices regarding the renal diet for hemodialysis patients and how comfortable they would be liberalizing the current restrictions. On average, 16.3% of dietitians are extremely likely to liberalize the restrictions on various food groups including fruits and vegetables, beans and legumes, and whole grains. CONCLUSIONS: RDN feel confident in their ability to interpret and apply evidence-based literature into practice, and they are moderately comfortable liberalizing the renal diet. The participants were generally more comfortable liberalizing the phosphorus restriction than the potassium restriction, and the sodium restriction remains important to control interdialytic weight gain and hypertension. Future research is needed to establish efficacy of a liberalized diet as well as interventions to help RDN feel more comfortable implementing a liberalization of the renal diet.

Maternal depression and infant attachment security: A meta-analysis.

The purpose of this study is to clarify the magnitude of the association between maternal depression and infant attachment nonsecurity, and to identify possible moderators of this relationship. An extensive literature search was conducted using multiple databases of both published and unpublished studies. A meta-analysis was conducted to determine the relationship between maternal depression and infant attachment security and to establish the effect size. The main findings from this meta-analysis, which included 42 studies, indicate that there is a small, yet significant, relationship between maternal depression and infant attachment nonsecurity. The rate of nonsecurity in infants of mothers with depression was approximately 20% higher than expected rates in a nonclinical population, and the association between depressive symptoms and nonsecurity was small, but significant. Infants of mothers with depression were nearly twice as likely to have a nonsecure attachment than were infants of healthy mothers. Depression measure and maternal sample source were identified as significant moderators of the odds ratio effect size. Results of this study demonstrate that there is a significant relationship between maternal depression and infant attachment nonsecurity, and suggest that interventions that focus on both maternal mental health and the attachment relationship are warranted.

Propósito: Clarificar la magnitud de las asociaciones entre la depresión materna y la falta de seguridad en la afectividad del infante, así como identificar posibles moderadores de esta relación. Métodos: Se llevó a cabo una extensa búsqueda de la literatura existente usando múltiples bancos de información tanto de estudios publicados como de los no publicados. Se realizó un meta-análisis para determinar la relación entre la depresión materna y la seguridad de la afectividad del infante y establecer la dimensión del efecto. Resultados: Los principales resultados de este meta-análisis, el cual incluyó 42 estudios, indicaron que existe una pequeña pero significativa relación entre la depresión materna y la falta de seguridad en la afectividad del infante. La tasa de falta de seguridad en infantes de madres con depresión fue aproximadamente 20% más alta que la tasa esperada en una población no clínica, y la asociación entre los síntomas depresivos y la falta de seguridad fue pequeña pero significativa. Los infantes de madres con depresión estuvieron casi dos veces más propensos a tener una afectividad no segura que los infantes de madres saludables. Se identificó la medida de depresión y la fuente del grupo muestra materno como moderadores significativos de la dimensión del efecto en las posibilidades promedio. Conclusiones: Los resultados de este estudio demuestran que existe una significativa relación entre la depresión materna y la falta de seguridad en la afectividad del infante, y sugieren que las intervenciones que se enfocan tanto en la salud mental materna como en la relación de afectividad están garantizadas.

But: Clarifier la magnitude du lien entre la dépression maternelle et l'insécurité de l'attachement du nourrisson, et identifier des facteurs de modération possibles de cette relation. Méthodes: Une importante recherche sur les recherches a été faite en utilisant plusieurs bases de données comprenant à la fois des études publiées et des études non publiées. Une méta-analyse a été faite afin de déterminer la relation entre la dépression maternelle et la sécurité de l'attachement du nourrisson et afin d'établir la taille de l'effet. Résultats: Les principaux résultats de cette méta-analyse, qui a porté sur 42 études, ont indiqué qu'il existe une relation petite et cependant importante entre la dépression maternelle et l'insécurité de l'attachement du nourrisson. Le taux d'insécurité chez les nourrissons de mère avec une dépression était lié à des taux environ 20% plus élevés que les taux attendus chez une population non-clinique, et le lien entre les symptômes dépressifs et la non-sécurité était limité mais important. Les nourrissons de mères avec une dépression étaient presque deux fois plus à même d'avoir un attachement insécure que les nourrissons de mères en bonne santé. La mesure de dépression et la source de l'échantillon maternel ont été identifiées comme étant des facteurs de modération importants de l'ampleur des effets des rapports de cote. Conclusions: Les résultats de cette étude démontrent qu'il existe une relation importante entre la dépression maternelle et l'insécurité de l'attachement du nourrisson, et suggèrent que les interventions qui mettent l'accent à la fois sur la santé mentale maternelle et la relation d'attachement sont justifiées.

Gastrointestinal Microbiota in Patients with Chronic Kidney Disease: A Systematic Review.

Emerging evidence suggests that gastrointestinal (GI) microbiota dysbiosis is associated with chronic kidney disease (CKD) and metabolite concentrations. The purpose of this systematic review was to evaluate and contextualize the research characterizing GI microbiota in patients with CKD. We searched for full-text, peer-reviewed, English studies in PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Google Scholar using a combination of MeSH terms and keywords. Eleven of the 20 studies examined GI microbiota in patients with CKD, and 9 studies focused on the effect of interventions on GI microbiota or metabolites. Available data characterizing GI microbiota in patients with CKD suggest a decline in saccharolytic bacteria and an increase in fermenters of nitrogen-containing compounds, serving as a source for circulating uremic toxins. However, studies examined limited sets of predetermined microbes, which do not reflect the entire GI microbial community and its influence on host physiology. We recommend further studies examining the entire microbial community and the potential role in regulating host physiology in CKD.

Collapsars as a major source of r-process elements.

The production of elements by rapid neutron capture (r-process) in neutron-star mergers is expected theoretically and is supported by multimessenger observations1-3 of gravitational-wave event GW170817: this production route is in principle sufficient to account for most of the r-process elements in the Universe4. Analysis of the kilonova that accompanied GW170817 identified5,6 delayed outflows from a remnant accretion disk formed around the newly born black hole7-10 as the dominant source of heavy r-process material from that event9,11. Similar accretion disks are expected to form in collapsars (the supernova-triggering collapse of rapidly rotating massive stars), which have previously been speculated to produce r-process elements12,13. Recent observations of stars rich in such elements in the dwarf galaxy Reticulum II14, as well as the Galactic chemical enrichment of europium relative to iron over longer timescales15,16, are more consistent with rare supernovae acting at low stellar metallicities than with neutron-star mergers. Here we report simulations that show that collapsar accretion disks yield sufficient r-process elements to explain observed abundances in the Universe. Although these supernovae are rarer than neutron-star mergers, the larger amount of material ejected per event compensates for the lower rate of occurrence. We calculate that collapsars may supply more than 80 per cent of the r-process content of the Universe.

Problem-solving therapy reduces subjective burden levels in caregivers of family members with mild cognitive impairment or early-stage dementia: Secondary analysis of a randomized clinical trial.

OBJECTIVES: Interventions addressing burden have limited impact among long-term family caregivers. We examined whether problem-solving therapy (PST) would reduce burden levels of caregivers of individuals diagnosed with mild cognitive impairment (MCI) or early-stage dementia (AD). METHODS: Caregivers (N = 73) randomly received PST or nutritional training (NT). Burden measures were assessed over 1-year post-intervention. RESULTS: Relative to NT, caregivers receiving PST endorsed improved perceived burden levels over time, regardless of the type of caregiver. Distress over the care recipient's dementia-related behaviors remained low over time among MCI caregivers receiving PST, while these burden levels among MCI caregivers receiving NT rose over time. AD caregivers receiving PST endorsed reductions in these burden levels over time, while AD caregivers in the NT group endorsed higher burden levels over time. CONCLUSION: PST, taught early in the caregiving trajectory, improves subjective burden levels among caregivers of family members with relatively mild cognitive deficits.

Brief Report: Does Watching The Good Doctor Affect Knowledge of and Attitudes Toward Autism?

Individuals' knowledge and attitudes about autism spectrum disorder (ASD) work together to shape the stigma held about ASD. One way that this information is communicated to the public is through popular media; however, little is known about the effectiveness of fictional depictions of ASD in educating and shaping attitudes about ASD. The purpose of this research was to investigate the impact media has on knowledge about and attitudes towards ASD, compared to that of a college lecture on the subject. Exposure to one episode of a fictional drama depicting ASD, compared to watching a lecture, resulted in more accurate knowledge, more positive characteristics associated with ASD, fewer negative characteristics associated with ASD, and a greater desire to learn more about ASD.

Characterization and Validation of a Human 3D Cardiac Microtissue for the Assessment of Changes in Cardiac Pathology.

Pharmaceutical agents despite their efficacy to treat disease can cause additional unwanted cardiovascular side effects. Cardiotoxicity is characterized by changes in either the function and/or structure of the myocardium. Over recent years, functional cardiotoxicity has received much attention, however morphological damage to the myocardium and/or loss of viability still requires improved detection and mechanistic insights. A human 3D cardiac microtissue containing human induced pluripotent stem cell-derived cardiomyocytes (hiPS-CMs), cardiac endothelial cells and cardiac fibroblasts was used to assess their suitability to detect drug induced changes in cardiac structure. Histology and clinical pathology confirmed these cardiac microtissues were morphologically intact, lacked a necrotic/apoptotic core and contained all relevant cell constituents. High-throughput methods to assess mitochondrial membrane potential, endoplasmic reticulum integrity and cellular viability were developed and 15 FDA approved structural cardiotoxins and 14 FDA approved non-structural cardiotoxins were evaluated. We report that cardiac microtissues provide a high-throughput experimental model that is both able to detect changes in cardiac structure at clinically relevant concentrations and provide insights into the phenotypic mechanisms of this liability.

A Qualitative Exploration of Weight Bias and Quality of Health Care Among Health Care Professionals Using Hypothetical Patient Scenarios.

The purpose of this study was to determine whether weight bias exhibited by health care professionals (HCPs) impacts quality of health care provided to individuals with obesity. HCPs (n = 220; 88% female, 87% nurses) in the Midwest region of the United States were recruited to complete an online survey. In this within-subjects study design, participants completed the Attitudes Towards Obese Persons (ATOP) scale to assess weight bias and responded to 2 (1 person with obesity and 1 person without obesity) hypothetical patient scenarios to evaluate quality of care. A median split was calculated for ATOP scores to divide participants into high or low weight bias groups. Within these groups, thematic analysis was used to uncover themes in quality of care based on participants' responses to each scenario. The analysis revealed that HCPs in the high weight bias group gave specific diet and exercise recommendations, offered health advice regarding weight loss, and used less teaching discourse when responding to the patient with obesity. In addition, in both weight bias groups, patients with obesity were started on pharmaceutical therapies sooner. The findings of this study suggest a need to educate HCPs on the importance of empathy and compassion when providing treatment to all patients, regardless of weight, to increase quality of care and ultimately improve patient outcomes.

5 Hz Repetitive transcranial magnetic stimulation for posttraumatic stress disorder comorbid with major depressive disorder.

BACKGROUND: Standard clinical protocols for repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD) apply 10 Hz pulses over left prefrontal cortex, yet little is known about the effects of rTMS in more diagnostically complex depressed patients. OBJECTIVE/HYPOTHESIS: Posttraumatic stress disorder (PTSD) is commonly comorbid with MDD, and while rTMS has been shown to alleviate PTSD symptoms in preliminary studies, ideal parameters remain unclear. We conducted a prospective, open-label study of 5 Hz rTMS for patients with comorbid PTSD + MDD and hypothesized stimulation would reduce symptoms of both disorders. METHODS: Outpatients (N = 40) with PTSD + MDD and at least moderate global severity were enrolled. 5 Hz rTMS included up to 40 daily sessions followed by a 5-session taper. Symptoms were measured using the PTSD Checklist (PCL-5) and Inventory of Depressive Symptomatology, Self-Report (IDS-SR). Baseline-to-endpoint changes were analyzed. RESULTS: The intent-to-treat population included 35 participants. Stimulation significantly reduced PTSD symptoms (PCL-5 baseline mean ±â€¯SD score 52.2 ±â€¯13.1 versus endpoint 34.0 ±â€¯21.6; p < .001); 23 patients (48.6%) met a pre-defined categorical PTSD response criteria. MDD symptoms also improved significantly (IDS-SR, baseline 47.8 ±â€¯11.9 to endpoint 30.9 ±â€¯18.9; p < .001); 15 patients (42.9%) demonstrated categorical response and 12 (34.3%) remitted. PTSD and MDD symptom change was highly correlated (r = 0.91, p < .001). LIMITATIONS: Unblinded single-arm study, with modest sample size. CONCLUSION: Significant and clinically meaningful reductions in both MDD and PTSD symptoms were observed following stimulation. The preliminary efficacy of 5 Hz rTMS for both symptom domains in patients with comorbid disorders supports future controlled studies.