Structure of native lens connexin 46/50 intercellular channels by cryo-EM.

Gap junctions establish direct pathways for cell-to-cell communication through the assembly of twelve connexin subunits that form intercellular channels connecting neighbouring cells. Co-assembly of different connexin isoforms produces channels with unique properties and enables communication across cell types. Here we used single-particle cryo-electron microscopy to investigate the structural basis of connexin co-assembly in native lens gap junction channels composed of connexin 46 and connexin 50 (Cx46/50). We provide the first comparative analysis to connexin 26 (Cx26), which-together with computational studies-elucidates key energetic features governing gap junction permselectivity. Cx46/50 adopts an open-state conformation that is distinct from the Cx26 crystal structure, yet it appears to be stabilized by a conserved set of hydrophobic anchoring residues. 'Hot spots' of genetic mutations linked to hereditary cataract formation map to the core structural-functional elements identified in Cx46/50, suggesting explanations for many of the disease-causing effects.

A five year descriptive analysis of potentially preventable hospitalisations for Ear, Nose, and Throat conditions in regional Victoria, Australia, from 2015 to 2020.

BACKGROUND: Potentially preventable hospitalisations of ear, nose, and throat conditions in the Murray Primary Health Network region have been found to be higher than the state average of Victoria, Australia. This study aimed to examine the association between selected patient-level characteristics and the likelihood of residing in a Murray PHN postcode with higher than expected numbers of potentially preventable ENT hospitalisations. METHODS: Unit record hospital separation data were obtained from the Victorian Admitted Episodes Dataset. Postcodes were classified as having higher than expected numbers of potentially preventable hospitalisations across three subgroups of ENT using indirect standardisation techniques. Differences between patients from 'higher than expected' postcodes and 'other' postcodes with respect to the distribution of demographic and other patient characteristics were determined using chi-squared tests for each ENT subgroup. The results were confirmed by logistic regression analyses using resident of a postcode with higher than expected hospitalisations as the outcome variable. RESULTS: Of the 169 postcodes located in the catchment area, 15 were identified as having higher than expected numbers of upper respiratory tract infection hospitalisations, 14 were identified for acute tonsillitis, and 12 were identified for otitis media. Patients from postcodes with 'higher than expected' hospitalisations for these conditions were more likely than others to be aged between 0 and 9 years, Indigenous, or from a culturally and linguistically diverse background. CONCLUSION: Further investigation of the identified postcodes is warranted to determine access to and utilisation of primary healthcare services in the management of PPH ENT conditions in the region.

Audiologists' perspective on the treatment of ear-related ear, nose, and throat conditions in rural Victoria.

OBJECTIVES: To understand the experience of audiologists in managing and treating ear-related ear, nose and throat conditions in rural areas, and to identify the compounding factors that influence patient outcomes and potential targets for intervention. DESIGN: A focus group was conducted using a qualitative descriptive approach. Responses were audio-recorded, transcribed and thematically analysed. SETTING: The focus group was conducted in the rural town of Mildura in the state of Victoria, Australia. PARTICIPANTS: A sample of 19 audiologists from Victoria participated, of which 14 were rurally based and 5 were metropolitan-based. The length of participants' professional experience ranged from 1 to 43 years. RESULTS: Long wait lists, and a lack of locally based ear, nose and throat surgeons were identified as barriers to the treatment of ear-related ear, nose and throat conditions. Open communication between health services and efficient care for time-sensitive conditions were seen as outcomes of good practice. Hand hygiene, nose-blowing, reducing tobacco smoke exposure and promoting the use of noise protective equipment were the 4 community health campaigns mentioned to support ear care for those residing in rural areas. Additional themes of ear conditions, treatment, management and primary health care were identified. CONCLUSION: Improving referral pathways for the treatment of ear-related ear, nose and throat conditions, and providing education about ear, nose and throat assessment and treatment in primary health care settings could increase appropriate referrals, improve patient outcomes and reduce wait periods for treatment.

Estimating Wildfire Smoke Concentrations during the October 2017 California Fires through BME Space/Time Data Fusion of Observed, Modeled, and Satellite-Derived PM2.5.

Exposure to wildfire smoke causes adverse health outcomes, suggesting the importance of accurately estimating smoke concentrations. Geostatistical methods can combine observed, modeled, and satellite-derived concentrations to produce accurate estimates. Here, we estimate daily average ground-level PM2.5 concentrations at a 1 km resolution during the October 2017 California wildfires, using the Constant Air Quality Model Performance (CAMP) and Bayesian Maximum Entropy (BME) methods to bias-correct and fuse three concentration datasets: permanent and temporary monitoring stations, a chemical transport model (CTM), and satellite-derived estimates. Four BME space/time kriging and data fusion methods were evaluated. All BME methods produce more accurate estimates than the standalone CTM and satellite products. Adding temporary station data increases the R2 by 36%. The data fusion of observations with the CAMP-corrected CTM and satellite-derived concentrations provides the best estimate (R2 = 0.713) in fire-impacted regions, emphasizing the importance of combining multiple datasets. We estimate that approximately 65,000 people were exposed to very unhealthy air (daily average PM2.5 ≥ 150.5 µg/m3).

Introducing early-phase medical students to clinical paediatrics using simulation and a flipped-classroom.

AIM: Both simulation and the flipped-classroom improve learning outcomes in medical education, with evidence emerging that they are effective in combination ('flipped-simulation'). Previous studies evaluating simulation in paediatrics have assessed efficacy for senior students. This study aimed to assess whether using flipped-simulation in early-phase medical student education would show similar benefits. METHODS: A flipped-simulation session was introduced into the earliest phase of the University of New South Wales Sydney's undergraduate medical program. A pre-test-post-test study design was used to assess short-term knowledge gains with an eight-item quiz administered before and after students attended the session. A retrospective cohort design was used to assess long-term knowledge retention, with student scores from a 10-item quiz administered at the second-phase paediatric course orientation, compared between a group that completed the flipped-simulation course and a group that attended an alternative play-based session. Additional survey data regarding student satisfaction were gathered. RESULTS: Students demonstrated short-term knowledge gains: mean test scores improved from the pre-test to post-test (3.4 ± 1.5 vs. 6.0 ± 1.3, P < 0.001). Students attending the flipped-simulation course retained knowledge more effectively in the longer term: mean test scores of students who completed the flipped-simulation session were significantly higher than those who attended the alternative play-based session (4.4 ± 1.9 vs. 3.4 ± 1.8, P < 0.001). Survey data demonstrated high student confidence in practical skills. CONCLUSION: Combining simulation and the flipped-classroom is effective for early-phase medical students, with improved knowledge over the short and long term, and high student satisfaction.

The Alcohol Sensitivity Questionnaire: Evidence for Construct Validity.

BACKGROUND: Variability in sensitivity to the acute effects of alcohol is an important risk factor for the development of alcohol use disorder (AUD). The most commonly used retrospective self-report measure of sensitivity, the Self-Rating of the Effects of Alcohol (SRE) form, queries a limited number of alcohol effects and relies on respondents' ability to recall experiences that might have occurred in the distant past. Here, we investigated the construct validity of an alternative measure that queries a larger number of alcohol effects, the Alcohol Sensitivity Questionnaire (ASQ), and compared it to the SRE in predicting momentary subjective responses to an acute dose of alcohol. METHODS: Healthy young adults (N = 423) completed the SRE and the ASQ and then were randomly assigned to consume either alcohol or a placebo beverage (between-subjects manipulation). Stimulation and sedation (Biphasic Alcohol Effects Scale) and subjective intoxication were measured multiple times after drinking. RESULTS: Hierarchical linear models showed that the ASQ reliably predicted each of these outcomes following alcohol but not placebo consumption, provided unique prediction beyond that associated with differences in recent alcohol involvement, and was preferred over the SRE (in terms of model fit) in direct model comparisons of stimulation and sedation. CONCLUSIONS: The ASQ compared favorably with the better-known SRE in predicting increased stimulation and reduced sedation following an acute alcohol challenge. The ASQ appears to be a valid self-report measure of alcohol sensitivity and therefore holds promise for identifying individuals at-risk for AUD and related problems.

Air-Quality Impacts and Intake Fraction of PM2.5 during the 2013 Rim Megafire.

The 2013 Rim Fire was the third largest wildfire in California history and burned 257 314 acres in the Sierra Nevada Mountains. We evaluated air-quality impacts of PM2.5 from smoke from the Rim Fire on receptor areas in California and Nevada. We employed two approaches to examine the air-quality impacts: (1) an evaluation of PM2.5 concentration data collected by temporary and permanent air-monitoring sites and (2) an estimation of intake fraction (iF) of PM2.5 from smoke. The Rim Fire impacted locations in the central Sierra nearest to the fire and extended to the northern Sierra Nevada Mountains of California and Nevada monitoring sites. Daily 24-h average PM2.5 concentrations measured at 22 air monitors had an average concentration of 20 µg/m3 and ranged from 0 to 450 µg/m3. The iF for PM2.5 from smoke during the active fire period was 7.4 per million, which is slightly higher than representative iF values for PM2.5 in rural areas and much lower than for urban areas. This study is a unique application of intake fraction to examine emissions-to-exposure for wildfires and emphasizes that air-quality impacts are not only localized to communities near large fires but can extend long distances and affect larger urban areas.

Student QSEN Participation During an Adult Medical-Surgical Rotation.

With the six QSEN competencies woven throughout the baccalaureate nursing curriculum, which includes high-fidelity simulation, the aim of this research was to uncover deficits in QSEN-related clinical opportunities. Pre-licensure BSN nursing students enrolled in a sophomore-level medical-surgical rotation augmented with 25 percent simulation were observed directly, with time-on-task for each QSEN competency recorded and tabulated. The students were found to spend little time addressing several of the six competency areas in both clinical and simulation settings. Fully integrated classroom, simulation, and clinical experiences need to be considered in an effort to offer a full spectrum of QSEN-based knowledge and skill theory and practice for pre-licensure nursing students.

Primary Health Care Interventions for Potentially Preventable Ear, Nose, and Throat Conditions in Rural and Remote Areas: A Systematic Review.

Background:Primary and secondary level preventive primary health care programs providing early detection and timely management of ear, nose, and throat (ENT) conditions in rural and remote regions are fundamental to preventing downstream impacts on health, social, and educational outcomes. However, the range and quality of evidence is yet to be reviewed. Objectives: The study objectives were to identify and synthesize the evidence of primary health care interventions for detection and management of ENT conditions in rural and remote areas, and evaluate the quality of the research and effectiveness of interventions. Methods: A systematic literature search of 6 databases (February 2023). The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, and the quality appraisal of studies was evaluated using the Mixed Methods Appraisal Tool (initial screening questions: Are there clear research questions? Do the collected data allow to address the research questions?). Results: Ten studies met the inclusion criteria. The results describe interventions for detection and management of respiratory tract infections, otitis media, and ear disease in primary health care settings. No studies met the inclusion criteria for tonsillitis. The role of community-based programs and allied health workers in the detection and management of ENT conditions was found to be effective in rural and remote regions. Only 2 of the studies met the screening criteria for quality appraisal. Conclusions: The study findings may inform future programs and policy development to address detection and management of ENT conditions in rural and remote primary care settings, and supports the need for further research on innovative models of care targeting potentially preventable hospitalizations through primary and secondary level prevention.

'SurgTalk': The Educational Outcomes Associated With Development of a Surgical Podcast for Undergraduate Medical Students.

OBJECTIVE: Educational podcast series are becoming increasingly popular as free open access medical education (FOAMed) resources, however, the educational benefit associated with their use is unclear. The aim of this study was to assess the educational outcomes associated with the implementation of a surgical podcast series for undergraduate medical students. METHODS: Two conversational case-based podcast episodes were recorded covering 2 common surgical presentations. Final-year medical students were recruited prospectively in January 2023 and underwent a baseline multiple choice question (MCQ) test covering the material within the podcast episodes. Participants were then provided with the episode files through encrypted Google Drive links. Two weeks following baseline assessment, students repeated the initial MCQ test and completed a postpodcast reaction survey. Data were analyzed using a paired t-test, multivariable regression analyses, and simple descriptive statistics. RESULTS: Fifty students were enrolled in the study. All participants undertook the baseline assessment. About 98% completed the postpodcast MCQ, while 94% completed the postpodcast reaction survey. All participants who undertook the reaction survey (n = 47) found the podcast helpful in explaining surgical concepts, 92% of participants found the podcast enjoyable to listen to. The most commonly reported activity undertaken while listening was "commuting/driving" (n = 24, 48%). The mean baseline MCQ score was 44.6%. The mean postpodcast MCQ score was 65.51%. There was a mean absolute increase in test score of 20.2% from baseline which was statistically significant (95%CI 14.67-25.6, p < 0.001). CONCLUSION: Implementation of this podcast series was associated with a statistically significant improvement in mean test score from baseline, reflecting knowledge acquisition. There was a positive user reaction and students were able to listen while performing other activities. Further evaluation of the educational outcomes associated with podcast use, particularly the effects on knowledge retention and clinical competence, is required.

The α-crystallin Chaperones Undergo a Quasi-ordered Co-aggregation Process in Response to Saturating Client Interaction.

Small heat shock proteins (sHSPs) are ATP-independent chaperones vital to cellular proteostasis, preventing protein aggregation events linked to various human diseases including cataract. The α-crystallins, αA-crystallin (αAc) and αB-crystallin (αBc), represent archetypal sHSPs that exhibit complex polydispersed oligomeric assemblies and rapid subunit exchange dynamics. Yet, our understanding of how this plasticity contributes to chaperone function remains poorly understood. Using biochemical and biophysical analyses combined with single-particle electron microscopy (EM), we examined structural changes in αAc, αBc and native heteromeric lens α-crystallins (αLc) in their apo-states and at varying degree of chaperone saturation leading to co-aggregation, using lysozyme and insulin as model clients. Quantitative single-particle analysis unveiled a continuous spectrum of oligomeric states formed during the co-aggregation process, marked by significant client-triggered expansion and quasi-ordered elongation of the sHSP oligomeric scaffold, whereby the native cage-like sHSP assembly displays a directional growth to accommodate saturating conditions of client sequestration. These structural modifications culminated in an apparent amorphous collapse of chaperone-client complexes, resulting in the creation of co-aggregates capable of scattering visible light. Intriguingly, these co-aggregates maintain internal morphological features of highly elongated sHSP oligomers with striking resemblance to polymeric α-crystallin species isolated from aged lens tissue. This mechanism appears consistent across αAc, αBc and αLc, albeit with varying degrees of susceptibility to client-induced co-aggregation. Importantly, our findings suggest that client-induced co-aggregation follows a distinctive mechanistic and quasi-ordered trajectory, distinct from a purely amorphous process. These insights reshape our understanding of the physiological and pathophysiological co-aggregation processes of α-crystallins, carrying potential implications for a pathway toward cataract formation.

Summary and analysis of approaches linking visual range, PM2.5 concentrations, and air quality health impact indices for wildfires.

Several U.S. state and tribal agencies and other countries have implemented a methodology developed in the arid intermountain western U.S. where short-term (1- to 3-hr) particulate matter (PM) with aerodynamic diameters less than 2.5 microm (PM2.5) concentrations are estimated from an observed visual range (VR) measurement. This PM2.5 concentration estimate is then linked to a public health warning scale to inform the public about potential health impacts from smoke from wildfire. This methodology is often used where monitoring data do not exist (such as many rural areas). This work summarizes the various approaches, highlights the potential for wildfire smoke impact messaging conflicts at state and international borders, and highlights the need to define consistent short-term health impact category breakpoint categories. Is air quality "unhealthy" when 1- to 3-hr PM2.5 is > or = 139 microg/m3 as specified in the Wildfire Smoke, A Guide for Public Health Officials? Or is air quality unhealthy when 1- to 3-hr PM2.5 is > or = 88.6 microg/m3 as specified in the Montana categorizations? This work then examines the relationship between visual range and PM2.5 concentrations using data from the Interagency Monitoring of PROtected Visual Environments (IMPROVE) program and the IMPROVE extinction coefficient (beta ext) equation to simulate an atmosphere dominated by smoke for sites in the arid intermountain western U.S. and great plains. This was accomplished by rearranging the beta ext equation to solve for organic mass as a function of VR. The results show that PM2.5 and VR are related by PM2.5 = 622 * VR(-0.98) with a correlation of 0.99 and that at low VR values (<10 km) a small change in VR results in a large change in PM2.5 concentrations. The results also show that relative humidity and the presence of hygroscopic pollutants from sources other than fire can change the VR/PM2.5 relationships, especially at PM2.5 concentrations less than approximately 90 microg/m3.

Using integrated simulation in a nursing program to improve medication administration skills in the pediatric population.

AIM: The purpose of this evaluative study was to determine the overall influence of a mixed educational approach on student knowledge and self-confidence with pediatric intravenous medication administration. BACKGROUND: There are diminishing opportunities for students to practice IV medication administration in pediatric patients. Nurse educators must find ways to effectively train students that ready them for the real world of patient care while reducing risk. METHOD: After lecture and pretesting, junior-level students spent approximately 50 hours in a pediatric unit and 40 hours in a high-fidelity pediatric simulation completing scenarios with medical prescribing and system-based pharmaceutical error, unpredictable medication administration dilemmas, and acute drug reactions.After the clinical rotation, students completed a posttest and self-confidence survey. RESULTS: . Results revealed a rise in knowledge and student self-reporting of confidence of essential medication administration skills for the pediatric population. CONCLUSIONS: A clinical rotation enhanced with simulation provides a rich learning environment without endangering patients. It allows students to experience risk-free problem-solving while giving faculty a more predictable process to assess acquisition of skills.

Comparison of Quality and Safety Education for Nurses (QSEN)-related student experiences during pediatric clinical and simulation rotations.

Nurse educators are challenged with providing meaningful clinical experiences for students. However, patient safety regulations constrain what nursing students are able to accomplish in the pediatric setting. So, what are students actually doing in their clinical rotation? This pilot observational study was undertaken to provide a snapshot of the experiences available to nursing students that develop the six Quality and Safety Education for Nurses (QSEN) competencies. Students were directly observed during pediatric clinical and pediatric simulation rotations, and their time-on-task was calculated and categorized. Three of the six QSEN competencies were observed more often than the others during both the simulation and clinical experiences. Much work needs to be done to include all QSEN-related knowledge and skills into prelicensure clinical rotations.

The α-crystallin chaperones undergo a quasi-ordered co-aggregation process in response to saturating client interaction.

Small heat shock proteins (sHSPs) are ATP-independent chaperones vital to cellular proteostasis, preventing protein aggregation events linked to various human diseases including cataract. The α-crystallins, αA-crystallin (αAc) and αB-crystallin (αBc), represent archetypal sHSPs that exhibit complex polydispersed oligomeric assemblies and rapid subunit exchange dynamics. Yet, our understanding of how this plasticity contributes to chaperone function remains poorly understood. This study investigates structural changes in αAc and αBc during client sequestration under varying degree of chaperone saturation. Using biochemical and biophysical analyses combined with single-particle electron microscopy (EM), we examined αAc and αBc in their apo-states and at various stages of client-induced co-aggregation, using lysozyme as a model client. Quantitative single-particle analysis unveiled a continuous spectrum of oligomeric states formed during the co-aggregation process, marked by significant client-triggered expansion and quasi-ordered elongation of the sHSP scaffold. These structural modifications culminated in an apparent amorphous collapse of chaperone-client complexes, resulting in the creation of co-aggregates capable of scattering visible light. Intriguingly, these co-aggregates maintain internal morphological features of highly elongated sHSP scaffolding with striking resemblance to polymeric α-crystallin species isolated from aged lens tissue. This mechanism appears consistent across both αAc and αBc, albeit with varying degrees of susceptibility to client-induced co-aggregation. Importantly, our findings suggest that client-induced co-aggregation follows a distinctive mechanistic and quasi-ordered trajectory, distinct from a purely amorphous process. These insights reshape our understanding of the physiological and pathophysiological co-aggregation processes of sHSPs, carrying potential implications for a pathway toward cataract formation.

Treatment of Alcohol Use Problems Among Rural Populations: a Review of Barriers and Considerations for Increasing Access to Quality Care.

Purpose of Review: Individuals living in rural areas face unique challenges when accessing services for alcohol-related problems and are at increased risk of experiencing alcohol-related harms. We outline research on rural-urban treatment gaps in alcohol use treatment, identify common barriers to treatment, and provide recommendations for how to address the difficulties faced by this population. Recent Findings: Globally, individuals living in rural and remote areas are less likely to receive care for alcohol-related concerns compared to those residing in urban areas. Rural areas suffer from insufficient access to specialty providers, and rural residents are likely to experience greater stigma regarding seeking treatment for alcohol-related concerns. Summary: Given rural-urban disparities in access to treatment for alcohol use concerns, treatment efforts should incorporate stakeholders across the medical system. Telehealth options are particularly promising for increasing access to care. Adaptations should emphasize existing strengths among rural populations, such as strong religious beliefs and close community ties.

Effects of Fluids on the Sublingual Microcirculation in Sepsis.

Sepsis is one of the most common and deadly syndromes faced in Intensive Care settings globally. Recent advances in bedside imaging have defined the changes in the microcirculation in sepsis. One of the most advocated interventions for sepsis is fluid therapy. Whether or not fluid bolus affects the microcirculation in sepsis has not been fully addressed in the literature. This systematic review of the evidence aims to collate studies examining the microcirculatory outcomes after a fluid bolus in patients with sepsis. We will assimilate the evidence for using handheld intra vital microscopes to guide fluid resuscitation and the effect of fluid bolus on the sublingual microcirculation in patients with sepsis and septic shock. We conducted a systematic search of Embase, CENTRAL and Medline (PubMed) using combinations of the terms "microcirculation" AND "fluid" OR "fluid resuscitation" OR "fluid bolus" AND "sepsis" OR "septic shock". We found 3376 potentially relevant studies. Fifteen studies published between 2007 and 2021 fulfilled eligibility criteria to be included in analysis. The total number of participants was 813; we included six randomized controlled trials and nine non-randomized, prospective observational studies. Ninety percent used Sidestream Dark Field microscopy to examine the microcirculation and 50% used Hydroxyethyl Starch as their resuscitation fluid. There were no clear effects of fluid on the microcirculation parameters. There was too much heterogeneity between studies and methodology to perform meta-analysis. Studies identified heterogeneity of affect in the sepsis population, which could mean that current clinical classifications were not able to identify different microcirculation characteristics. Use of microcirculation as a clinical endpoint in sepsis could help to define sepsis phenotypes. More research into the effects of different resuscitation fluids on the microcirculation is needed.

Zoster meningitis in an immunocompetent young patient post first dose of BNT162b2 mRNA COVID-19 vaccine, a case report.

Recently published observational data suggests an increased risk of herpes zoster infection post-vaccination with the BNT162b2 mRNA vaccine. We describe the case of VZV meningitis post BNT162b2 mRNA vaccination in a young immunocompetent patient. A 39-year-old patient with no medical history presented with a vesicular rash, headache, nausea and fever, days after receiving BNT162b2 mRNA vaccination. CSF analysis revealed a pleocytosis, and VZV DNA was confirmed by PCR testing. The patient received intravenous aciclovir with resolution of symptoms within 48 h. He was discharged after 14 days of treatment. Case reports of herpes zoster reactivation post vaccination and details of subsequent successful vaccination course completion have allowed us to recommend the patient receive his second dose of the BNT162b2 mRNA vaccine. At the time of writing, however, the patient has declined to receive further vaccination due to fears of an adverse event. To the best of our knowledge, this is the first reported case in a young patient of herpes zoster meningitis following COVID-19 mRNA vaccination. The sharing of clinical experiences and reporting of suspected side effects, particularly for vaccines that employ novel technology, increases knowledge of the safety profile of these vaccines and allows clinicians to better aid patients make informed decisions with regard to commencing and completing vaccination.

Beyond BASICS: A scoping review of novel intervention content to enhance the efficacy of brief alcohol interventions for emerging adults.

OBJECTIVE: Brief motivational interventions (BMIs) that include personalized drinking feedback delivered in a motivational interviewing (MI) style have demonstrated reductions in drinking across numerous clinical trials with emerging adults (EAs) ages 18-25. However, effect sizes for these BMIs are generally small to moderate and drinking reductions are often not maintained beyond short-term follow-ups. Additionally, EAs may be more interested in approaches that highlight wellness, mood enhancement, or goal pursuit rather than programs focused exclusively on reducing alcohol-related risk. Thus, there is a need to evaluate novel intervention content as an alternative or supplement to BMIs in this high-risk population. METHOD: This scoping review examined studies of novel intervention elements to reduce alcohol consumption among EAs. Eligible studies were published in peer-reviewed journals in English from January 2015 to September 2021 and evaluated novel brief interventions, operationalized as one to five sessions focused on alcohol-related outcomes with key content beyond what has typically been included in alcohol BMIs. Results were categorized as additions to BMIs or stand-alone interventions and were synthesized within these categories by theoretical approach. RESULTS: Although standard in-person BMIs have the greatest empirical support, there are a variety of alternative intervention approaches that might enhance health and wellness and that can be feasibly integrated with BMIs or offered as an appealing "gateway" to increase help-seeking among EAs who drink alcohol. CONCLUSIONS: More research is needed to empirically evaluate both the relative efficacy of supplements and stand-alone alternatives to BMI among higher risk EAs and their potential for widespread dissemination. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Nursing works: the application of lean thinking to nursing processes.

This article describes the Nursing Works program at Flinders Medical Centre, South Australia. Program goals were to use lean principles to increase the time direct care nurses spent at the bedside, improve patient outcomes, and make nursing work more efficient and satisfying for staff. Steps incorporating lean methodology are described. Outcomes indicate that lean thinking is an effective improvement methodology and a framework for change management of nursing work.