Factors influencing terrestriality in primates of the Americas and Madagascar.

Among mammals, the order Primates is exceptional in having a high taxonomic richness in which the taxa are arboreal, semiterrestrial, or terrestrial. Although habitual terrestriality is pervasive among the apes and African and Asian monkeys (catarrhines), it is largely absent among monkeys of the Americas (platyrrhines), as well as galagos, lemurs, and lorises (strepsirrhines), which are mostly arboreal. Numerous ecological drivers and species-specific factors are suggested to set the conditions for an evolutionary shift from arboreality to terrestriality, and current environmental conditions may provide analogous scenarios to those transitional periods. Therefore, we investigated predominantly arboreal, diurnal primate genera from the Americas and Madagascar that lack fully terrestrial taxa, to determine whether ecological drivers (habitat canopy cover, predation risk, maximum temperature, precipitation, primate species richness, human population density, and distance to roads) or species-specific traits (body mass, group size, and degree of frugivory) associate with increased terrestriality. We collated 150,961 observation hours across 2,227 months from 47 species at 20 sites in Madagascar and 48 sites in the Americas. Multiple factors were associated with ground use in these otherwise arboreal species, including increased temperature, a decrease in canopy cover, a dietary shift away from frugivory, and larger group size. These factors mostly explain intraspecific differences in terrestriality. As humanity modifies habitats and causes climate change, our results suggest that species already inhabiting hot, sparsely canopied sites, and exhibiting more generalized diets, are more likely to shift toward greater ground use.

Lower Airway Dysbiosis Augments Lung Inflammatory Injury in Mild-to-Moderate Chronic Obstructive Pulmonary Disease.

Rationale: Chronic obstructive pulmonary disease (COPD) is associated with high morbidity, mortality, and healthcare costs. Cigarette smoke is a causative factor; however, not all heavy smokers develop COPD. Microbial colonization and infections are contributing factors to disease progression in advanced stages. Objectives: We investigated whether lower airway dysbiosis occurs in mild-to-moderate COPD and analyzed possible mechanistic contributions to COPD pathogenesis. Methods: We recruited 57 patients with a >10 pack-year smoking history: 26 had physiological evidence of COPD, and 31 had normal lung function (smoker control subjects). Bronchoscopy sampled the upper airways, lower airways, and environmental background. Samples were analyzed by 16S rRNA gene sequencing, whole genome, RNA metatranscriptome, and host RNA transcriptome. A preclinical mouse model was used to evaluate the contributions of cigarette smoke and dysbiosis on lower airway inflammatory injury. Measurements and Main Results: Compared with smoker control subjects, microbiome analyses showed that the lower airways of subjects with COPD were enriched with common oral commensals. The lower airway host transcriptomics demonstrated differences in markers of inflammation and tumorigenesis, such as upregulation of IL-17, IL-6, ERK/MAPK, PI3K, MUC1, and MUC4 in mild-to-moderate COPD. Finally, in a preclinical murine model exposed to cigarette smoke, lower airway dysbiosis with common oral commensals augments the inflammatory injury, revealing transcriptomic signatures similar to those observed in human subjects with COPD. Conclusions: Lower airway dysbiosis in the setting of smoke exposure contributes to inflammatory injury early in COPD. Targeting the lower airway microbiome in combination with smoking cessation may be of potential therapeutic relevance.

Repair of Acute Respiratory Distress Syndrome in COVID-19 by Stromal Cells (REALIST-COVID Trial): A Multicenter, Randomized, Controlled Clinical Trial.

Rationale: Mesenchymal stromal cells (MSCs) may modulate inflammation, promoting repair in coronavirus disease (COVID-19)-related acute respiratory distress syndrome (ARDS). Objectives: We investigated the safety and efficacy of ORBCEL-C (CD362 [cluster of differentiation 362]-enriched, umbilical cord-derived MSCs) in COVID-19-related ARDS. Methods: In this multicenter, randomized, double-blind, allocation-concealed, placebo-controlled trial (NCT03042143), patients with moderate to severe COVID-19-related ARDS were randomized to receive ORBCEL-C (400 million cells) or placebo (Plasma-Lyte 148). The primary safety and efficacy outcomes were the incidence of serious adverse events and oxygenation index at Day 7, respectively. Secondary outcomes included respiratory compliance, driving pressure, PaO2:FiO2 ratio, and Sequential Organ Failure Assessment score. Clinical outcomes relating to duration of ventilation, lengths of ICU and hospital stays, and mortality were collected. Long-term follow-up included diagnosis of interstitial lung disease at 1 year and significant medical events and mortality at 2 years. Transcriptomic analysis was performed on whole blood at Days 0, 4, and 7. Measurements and Main Results: Sixty participants were recruited (final analysis: n = 30 received ORBCEL-C, n = 29 received placebo; 1 participant in the placebo group withdrew consent). Six serious adverse events occurred in the ORBCEL-C group and three in the placebo group (risk ratio, 2.9 [95% confidence interval, 0.6-13.2]; P = 0.25). Day 7 mean (SD) oxygenation index did not differ (ORBCEL-C, 98.3 [57.2] cm H2O/kPa; placebo, 96.6 [67.3] cm H2O/kPa). There were no differences in secondary surrogate outcomes or in mortality at Day 28, Day 90, 1 year, or 2 years. There was no difference in the prevalence of interstitial lung disease at 1 year or significant medical events up to 2 years. ORBCEL-C modulated the peripheral blood transcriptome. Conclusion: ORBCEL-C MSCs were safe in subjects with moderate to severe COVID-19-related ARDS but did not improve surrogates of pulmonary organ dysfunction.

Diabetic Macular Edema and Diode Subthreshold Micropulse Laser: A Randomized Double-Masked Noninferiority Clinical Trial.

PURPOSE: To determine clinical effectiveness, safety, and cost-effectiveness of subthreshold micropulse laser (SML), compared with standard laser (SL), for diabetic macular edema (DME) with central retinal thickness (CRT) < 400 µm. DESIGN: Pragmatic, multicenter, allocation-concealed, double-masked, randomized, noninferiority trial. PARTICIPANTS: Adults with center-involved DME < 400 µm and best-corrected visual acuity (BCVA) of > 24 Early Treatment Diabetic Retinopathy Study (ETDRS) letters in one/both eyes. METHODS: Randomization 1:1 to 577 nm SML or SL treatment. Retreatments were allowed. Rescue with intravitreal anti-vascular endothelial growth factor therapies or steroids was permitted if 10 or more ETDRS letter loss occurred, CRT increased > 400 µm, or both. MAIN OUTCOME MEASURES: Primary outcome was mean change in BCVA in the study eye at 24 months (noninferiority margin 5 ETDRS letters). Secondary outcomes were mean change from baseline to month 24 in binocular BCVA; CRT and mean deviation of Humphrey 10-2 visual field in the study eye; percentage meeting driving standards; EuroQoL EQ-5D-5L, 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25), and Vision and Quality of Life Index (VisQoL) scores; cost per quality-adjusted life-years (QALYs) gained; adverse effects; and number of laser and rescue treatments. RESULTS: The study recruited fully (n = 266); 87% of SML-treated and 86% of SL-treated patients had primary outcome data. Mean ± standard deviation BCVA change from baseline to month 24 was -2.43 ± 8.20 letters and -0.45 ± 6.72 letters in the SML and SL groups, respectively. Subthreshold micropulse laser therapy was deemed not only noninferior but also equivalent to SL therapy because the 95% confidence interval (CI; -3.9 to -0.04 letters) lay wholly within both upper and lower margins of the permitted maximum difference (5 ETDRS letters). No statistically significant difference was found in binocular BCVA (0.32 ETDRS letters; 95% CI, -0.99 to 1.64 ETDRS letters; P = 0.63); CRT (-0.64 µm; 95% CI, -14.25 to 12.98 µm; P = 0.93); mean deviation of the visual field (0.39 decibels (dB); 95% CI, -0.23 to 1.02 dB; P = 0.21); meeting driving standards (percentage point difference, 1.6%; 95% CI, -25.3% to 28.5%; P = 0.91); adverse effects (risk ratio, 0.28; 95% CI, 0.06-1.34; P = 0.11); rescue treatments (percentage point difference, -2.8%; 95% CI, -13.1% to 7.5%; P = 0.59); or EQ-5D, NEI-VFQ-25, or VisQoL scores. Number of laser treatments was higher in the SML group (0.48; 95% CI, 0.18-0.79; P = 0.002). Base-case analysis indicated no differences in costs or QALYs. CONCLUSIONS: Subthreshold micropulse laser therapy was equivalent to SL therapy, requiring slightly higher laser treatments.

Invited review: The consumer and dairy food waste: An individual plus policy, systems, and environmental perspective.

An estimated 40% of food produced in the United States is wasted, which poses a significant barrier to achieving a sustainable future-so much so that the United Nations Sustainable Development Goal no. 12, to "ensure sustainable consumption and production patterns," includes a goal to "halve per capita global food waste at the retail and consumer level, and reduce food losses along the production and supply chains by 2030." Annually, consumers waste approximately 90 billion pounds of food, equating to roughly 1 pound per person per day. More specifically, consumer waste is the largest contributor to the food waste problem when compared with other steps along the supply chain, such as production, post-harvest handling and storage, processing, and distribution. Furthermore, American families discard approximately 25% of the food and beverages they buy. When considering the type of waste coming from households, fresh fruits and vegetables rank highest at 22%, with dairy products, at 19%, following in close second. A variety of factors contribute to why consumers waste so much food. For dairy, commonly referenced reasons are related to the misunderstanding of date labels, poor planning of purchases, spoilage before consuming products, and improper storage. This wasted food accumulates in landfills and produces methane when decomposing, resulting in environmental consequences related to ozone depletion and climate change. Milk can have negative environmental impacts when disposed of down the drain. This review will discuss the food waste problem, causes, and potential solutions at the consumer level, with particular focus on dairy waste. An individual plus policy, system, and environment approach will also be integrated to provide a well-rounded view of the issue.

Peer group clinical supervision for community health nurses: Perspectives from an interpretive hermeneutic study.

AIM: To explore the lived experience of utilizing peer group supervision in practice for community health nurses. BACKGROUND: Community health nursing is an autonomous and challenging role where quality clinical supervision has benefits for the registered nurse. The structured New Zealand Coaching and Mentoring model of peer group supervision provides the foundation for this research. METHOD: An interpretative hermeneutic study explored the experience of peer group supervision in a regional health service in Australia. Qualitative in-depth interviews were conducted with all levels of nursing staff to gain an understanding of their experience of peer group supervision. RESULTS: Data interpretation through hermeneutic analysis revealed the value and professional sustenance gained by participants. Identified game changers include adherence to rules and the influence of group dynamics. These areas were found to impact the quality of supervision. CONCLUSIONS: This research provides different perspectives of peer group supervision that shares the experience of staff immersed in the process. Peer group supervision yields benefits for community health nurses; however, the research has implications for practice. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers require information when making key decisions regarding workplace implementation. Effective supervision is only possible when balance between benefits and game changers are achieved.

Fermented food consumption in wild nonhuman primates and its ecological drivers.

OBJECTIVES: Although fermented food use is ubiquitous in humans, the ecological and evolutionary factors contributing to its emergence are unclear. Here we investigated the ecological contexts surrounding the consumption of fruits in the late stages of fermentation by wild primates to provide insight into its adaptive function. We hypothesized that climate, socioecological traits, and habitat patch size would influence the occurrence of this behavior due to effects on the environmental prevalence of late-stage fermented foods, the ability of primates to detect them, and potential nutritional benefits. MATERIALS AND METHODS: We compiled data from field studies lasting at least 9 months to describe the contexts in which primates were observed consuming fruits in the late stages of fermentation. Using generalized linear mixed-effects models, we assessed the effects of 18 predictor variables on the occurrence of fermented food use in primates. RESULTS: Late-stage fermented foods were consumed by a wide taxonomic breadth of primates. However, they generally made up 0.01%-3% of the annual diet and were limited to a subset of fruit species, many of which are reported to have mechanical and chemical defenses against herbivores when not fermented. Additionally, late-stage fermented food consumption was best predicted by climate and habitat patch size. It was more likely to occur in larger habitat patches with lower annual mean rainfall and higher annual mean maximum temperatures. DISCUSSION: We posit that primates capitalize on the natural fermentation of some fruits as part of a nutritional strategy to maximize periods of fruit exploitation and/or access a wider range of plant species. We speculate that these factors contributed to the evolutionary emergence of the human propensity for fermented foods.

Are pre-pregnancy weight fluctuations and adherence to prenatal nutrition and exercise recommendations related to excessive gestational weight gain?

Women who have an overweight or obese pre-pregnancy body mass index (BMI) may be recommended to lose weight before pregnancy, however the association of preconception weight fluctuations and prenatal adherence to nutrition and exercise recommendations with gestational weight gain (GWG) have not been assessed. One hundred women with a pre-pregnancy BMI ≥ 25.0 kg/m2 who participated in the Nutrition and Exercise Lifestyle Intervention Program (NELIP) were included and stratified as gained weight excessively (n = 47) or not (n = 53) using the 2009 Institute of Medicine GWG guidelines. Participants completed a Weight Health History Questionnaire providing information about weight loss prior to the index pregnancy. Adherence was scored based on meeting six nutrition and exercise goals for the NELIP (/6). More women who gained excessively reported that they had actively tried to lose weight a year before the current pregnancy (61%) than women who did not gain excessively (39%; p = 0.02). Of the women attempting preconception weight loss, those who gained excessively lost more weight (6.7 ± 10.2 kg) than women who did not (2.1 ± 3.8 kg; p = 0.003). Adherence to the NELIP was lower among women who gained excessively (3.3 ± 0.8; 55%) than those who did not (4.4 ± 0.9;73%; p < 0.001). Program adherence (p < 0.001) was related to excessive GWG.

Sequential Introduction of Exercise First Followed by Nutrition Improves Program Adherence During Pregnancy: a Randomized Controlled Trial.

BACKGROUND: Adhering to nutrition and exercise recommendations simultaneously during pregnancy may be challenging. The purpose was to examine adherence to the sequential introduction of nutrition and exercise behaviors during pregnancy in comparison with a simultaneous approach. METHOD: A randomized controlled trial including nutrition and exercise was executed. Using a stratified body mass index (BMI) randomization, participants (n = 88) were allocated to one of three groups at 12-18 weeks gestation. Group A received nutrition and exercise simultaneously. Group B received nutrition first and Group C received exercise first, and the second behavior was added at 25 weeks gestation for both groups. The program included weekly weighing, supervised walking sessions, and/or nutrition counseling. Adherence (primary outcome) was measured by scoring women on meeting the intervention goals (3 nutrition and 3 exercise goals) and converted to a percentage. Secondary health outcomes were gestational weight gain (GWG) and excessive GWG on the program, birthweight, macrosomia (birthweight > 4000 g), and low birthweight (birthweight < 2500 g). RESULTS: Group C (n = 23) had the highest adherence to the program (80.2 ± 14.7%) compared with Groups A (n = 17; 60.9 ± 17.9%) and B (n = 20; 66.8 ± 16.7%; p < 0.05, ηp2 = 0.26). There was a significant effect for gestational weight gain (p < 0.05; ηp2 = 0.10) as Group C gained less weight (7.7 ± 2.2 kg) over Group B (9.8 ± 2.8 kg; p = 0.04), however, not Group A (9.1 ± 3.5, p = 0.35). Non-significant small effects favored Group C for the prevention of EGWG (Cramer's V = 0.13). CONCLUSION: Introducing exercise first followed by nutrition at 25 weeks gestation can improve adherence to multiple behavior change programs and thus have a positive effect on health outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02804061.

Seasonal Association of Pediatric Functional Abdominal Pain Disorders and Anxiety.

OBJECTIVES: Abdominal pain-related pediatric functional gastrointestinal disorders (AP-FGIDs) are defined by abdominal discomfort or pain that may provide obstacles to everyday activities, such as school attendance. It has been reported that AP-FGID symptoms may be reduced in summer, but it is unclear what drives this seasonal variation. This pilot study aimed to explore whether the seasonal variation in AP-FGID symptoms could be explained by various psychological and behavioral factors. METHODS: Parents of children with AP-FGID symptoms completed online questionnaires on symptoms, anxiety, parental responses to pain, sleep, diet, and physical activity once during spring months and again in the summer months. RESULTS: In a sample of 34 participants who completed both questionnaires, 22 reported improvements during the summer months. These participants reported a significantly higher seasonal decrease in anxiety than participants whose children's symptoms did not improve from spring to summer (mean decrease 2.21 vs 0.08, P = 0.017). Both groups reported equal improvements in sleep and decreased stress from spring to summer. Neither group experienced statistically significant seasonal change in physical activity or fruit, vegetables, dairy, or caffeine consumption. CONCLUSIONS: This study suggests that amelioration of gastrointestinal symptoms in pediatric patients with AP-FGID during summer months is associated with amelioration of anxiety in the same time period. It is not yet clear whether decreased anxiety is the cause or effect of decreased AP-FGID symptoms.

5-Flurouracil disrupts nuclear export and nuclear pore permeability in a calcium dependent manner.

Regulation of nuclear transport is an essential component of apoptosis. As chemotherapy induced cell death progresses, nuclear transport and the nuclear pore complex (NPC) are slowly disrupted and dismantled. 5-Fluorouracil (5-FU) and the camptothecin derivatives irinotecan and topotecan, are linked to altered nuclear transport of specific proteins; however, their general effects on the NPC and transport during apoptosis have not been characterized. We demonstrate that 5-FU, but not topotecan, increases NPC permeability, and disrupts Ran-mediated nuclear transport before the disruption of the NPC. This increased permeability is dependent on increased cellular calcium, as the Ca2+ chelator BAPTA-AM, abolishes the effect. Furthermore, increased calcium alone was sufficient to disrupt the Ran gradient. Combination treatments of 5-FU with topotecan or irinotecan, similarly disrupted nuclear transport before disassembly of the NPC. In both single and combination treatments nuclear transport was disrupted before caspase 9 activation, indicating that 5-FU induces an early caspase-independent increase in NPC permeability and alteration of nuclear transport. Because Crm1-mediated nuclear export of tumor suppressors is linked to drug resistance we also examined the effect of 5-FU on the nuclear export of a specific target, topoisomerase. 5-FU treatment led to accumulation of topoisomerase in the nucleus and recovered the loss nuclear topoisomerase induced by irinotecan or topotecan, a known cause of drug resistance. Furthermore, 5-FU retains its ability to cause nuclear accumulation of p53 in the presence of irinotecan or topotecan. Our results reveal a new mechanism of action for these therapeutics during apoptosis, opening the door to other potential combination chemotherapies that employ 5-FU as a calcium mediated inhibitor of Crm1-induced nuclear export of tumor suppressors.

Adherence to Traditionally Masculine Norms and Condom-Related Beliefs: Emphasis on African American and Hispanic Men.

Although studies have shown that adherence to traditional masculine norms (i.e., Status, Toughness, Antifemininity) affect men's attitudes toward sexual health, there is little research on how men's adherence to these norms affect them in the context of heterosexual, dyadic relationships. Among 296 young pregnant couples, we investigated the extent to which adherence to traditional masculine norms affected male and female partners' own condom-related beliefs (i.e., condom self-efficacy, positive condom attitudes) and that of their partners. We tested an interdependence model using a dyadic-analytic approach to path analysis. We also tested for differences across gender and race-ethnicity (i.e., African American, Hispanic). Results showed that adherence to the Antifemininity and Toughness masculine norms predicted negative condom-related beliefs, whereas, overall, adherence to the Status norm predicted positive condom-related beliefs. Men's and women's adherence to traditional norms about masculinity were associated with their partner's condom self-efficacy, and moderated associations based on gender and race-ethnicity were detected. In contrast, each dyad member's traditional masculine norms were not associated with his or her partner's positive condom attitudes. Taken together, findings indicated that the roles of traditional masculinity and condom-related beliefs in sexual health should be addressed within the context of relationships and associations between masculine norms and condom-related beliefs are not uniformly negative.

Adherence to physical activity guidelines in mid-pregnancy does not reduce sedentary time: an observational study.

BACKGROUND: Physical activity (PA) interventions designed to prevent prenatal complications have focused on increasing moderate PA yielding conflicting results. Minimal attention has focused on the evaluation of sleep, sedentary behavior (SB), light activity or total daily PA during pregnancy. The purpose of this prospective, longitudinal study was to 1) objectively quantify and compare habitual PA and SB during the 2nd and 3rd trimester; and 2) evaluate differences in activity patterns for women meeting prenatal PA guidelines versus those that did not. METHODS: Forty-six participants wore 2 PA monitors (SenseWear Mini and activPAL) during week 18 and week 35 of pregnancy. We compared differences in sleep duration, postural allocation, daily steps, and PA between the 2nd and 3rd trimester and for women who met and did not meet PA guidelines. RESULTS: During the 2(nd) trimester, 30% of the women's day (24-hours) was total sleep; 52% SB; 13% light; 3% moderate; and 0% vigorous PA. Light (P = 0.05), vigorous (P = 0.02), and moderate-vigorous PA (MET-minutes; P = 0.02), decreased with a trend in increased SB (P = 0.07). Activity of other intensities and sleep duration did not significantly change. Only 39% and 37% of participants slept between 7-9 hours/night at week 18 and 35, respectively. Forty-six percent (n = 21) and 28% (n = 13) of participants met prenatal PA guidelines during the 2(nd) and 3(rd) trimester, respectively. At week 18, no differences in total sleep, SB, or light PA existed for women who met PA guidelines versus those who did not; total PA was significantly greater for women who met guidelines. At week 35, women that met PA guidelines had significantly less SB (P < 0.005) than women who did not. CONCLUSIONS: This study demonstrates that pregnant women spend the majority of their day in SB. Significant reductions in total activity across pregnancy may be attributed, in part to shifts in light PA and increased SB. Based on the lifestyle of our sample, regardless of meeting PA guidelines in mid-pregnancy, no significant difference exists in time spent in SB, however meeting PA recommendations in late pregnancy may reduce SB. Future interventions should target reducing SB by increasing light and moderate PA beyond volitional exercise.

Screening Offenders: The Exploration of a Youth Level of Service/Case Management Inventory: (YLS/CMI) Brief Screener.

Although structured assessments have helped standardize juvenile court processes by systematically measuring risk for recidivism, it has been argued that some assessments lack the ability to perform as a brief screener. This study explored the potential for the original 42-item Youth Level of Service/Case Management Inventory (YLS/CMI) risk assessment to perform as a brief screener for a sample of first-time juvenile offenders in a mid-western, industrialized county. Results indicated that the original and shortened version of the YLS/CMI significantly predicted two-year recidivism for male and female offenders. Implications for situationally targeted forms of risk assessment are discussed.

Contribution of peer group supervision to nursing practice: An interpretive phenomenological study.

AIM: To provide insight into peer group supervision practices through understanding the lived experience of community health nurses. BACKGROUND: The recent Covid-19 health crisis highlights the importance of supportive mechanisms to sustain and retain nurses in the workforce. While the support of quality clinical supervision for registered nurses is recognised, the benefits and challenges of peer group supervision are less clearly articulated. DESIGN: Nurses' experiences of peer group supervision in an Australian tertiary health service were explored using a Gadamerian philosophical hermeneutic approach. METHOD: Semi-structured in-depth interviews were conducted in 2021 and provided nurses with the opportunity to share their experiences of using the New Zealand Coaching and Mentoring Model of peer group supervision. The study included a total of 31 nurse participants across multiple community health contexts. Interview data were analysed using a hermeneutic approach from which themes arose. FINDINGS: The findings demonstrated that strong peer group supervision foundations that include personal and professional preparation and active participation are essential. Dual pillars of "the unique individual" and "the unique group" with responsibilities identified in each pillar that enable interactions and worthiness in peer group supervision practice. The foundations and pillars support peer group supervision in nursing practice to provide a mechanism for reflection, support and professional guidance. CONCLUSIONS: Peer group supervision is a worthy, contributory process in community health nursing when implementation processes are supported and teams are educated and prepared. Perceptions of peer group supervision are unique and varied across individuals. The individual experience has an impact on the group experience and vice versa. Knowledge of the process and group by participants is required to enable professional reflection through nursing peer group supervision.

Ultrasound guided platelet rich plasma injections for post-traumatic greater occipital neuralgia following concussion: a pilot randomized controlled trial.

Background: Treatment for post-traumatic greater occipital neuralgia (GON) includes serial injections of steroid/anesthetic. While these injections can alleviate pain, effects can be transient, frequently lasting only 1 month. As a potential alternative, platelet-rich plasma (PRP) injections are an emerging biological treatment with beneficial effects in peripheral nerve disorders. We investigated the feasibility, safety, and effectiveness of a single PRP injection for post-traumatic GON in comparison to saline or steroid/anesthetic injection. Methods: In this pilot randomized, double-blinded, placebo-controlled trial, 32 adults with post-traumatic GON were allocated 1:1:1 to receive a single ultrasound-guided injection of (1) autologous PRP (2) steroid/anesthetic or (3) normal saline. Our primary outcome was feasibility (recruitment, attendance, retention) and safety (adverse events). Exploratory measures included headache intensity and frequency (daily headache diaries) and additional questionnaires (headache impact, and quality of life) assessed at pre-injection, 1 week, 1 month, and 3 months post-injection. Results: We screened 67 individuals, 55% were eligible and 95% of those participated. Over 80% of daily headache diaries were completed with 91% of participants completing the 3-month outcome questionnaires. No serious adverse events were reported. There were no significant differences between groups for headache intensity or frequency. Headache impact on function test-6 scores improved at 3 month in the PRP (ß = -9.7, 95% CI [-15.6, -3.74], p = 0.002) and saline (ß = -6.7 [-12.7, -0.57], p = 0.033) groups but not steroid/anesthetic group (p = 0.135). Conclusion: PRP is a feasible and safe method for treating post-traumatic GON with comparable results to saline and steroid/anaesthetic. Further trials with larger sample sizes are required.Clinical trial registration:https://clinicaltrials.gov/, identifier NCT04051203.

Systems Thinking and Sustainable Food Systems in Dietetics Education: A Survey of Directors.

BACKGROUND: Systems thinking is recommended, but not required, for teaching food and water system sustainability in nutrition and dietetics education. OBJECTIVE: This study investigated systems thinking and sustainable, resilient, and healthy food and water systems (SRHFWS) in nutrition and dietetics programs. It examined program directors' practices, values, attitudes, confidence levels, and the relationships between systems thinking, teaching SRHFWS topics, confidence levels, and years of experience as a dietitian and program director. DESIGN: Conducted in September 2022, the study used a descriptive design with a validated 20-item Systems Thinking Scale (STS) and a researcher-designed survey with 1-5 Likert-type scales. PARTICIPANTS/SETTING: The online survey was distributed to 611 Accreditation Council for Education in Nutrition and Dietetics (ACEND) program directors, with a 27% (n=163) response. STATISTICAL ANALYSIS: Descriptive statistics (frequency, mean, standard deviation) were calculated using Excel. Inferential statistics were examined using R. ANOVA was used to compare experience as RDN and experience as a program director to confidence levels in teaching each SRHFWS topic. Linear regression was used determine the relationship between total STS score and demographic and programmatic variables. RESULTS: Seventy-seven percent of program directors scored high on the STS (mean score 65.2, on a 0-80 scale, SD 8.4), and more than 85% of directors agreed including systems thinking in dietetics was important. However, only 32.1% reported teaching systems thinking. Less than half of program directors agreed systems thinking was adequately addressed in ACEND standards, and nearly 80% of program directors agreed there was room to strengthen systems thinking content. Directors neither agreed nor disagreed there are adequate ACEND standards addressing SRHFWS and reported SRHFWS topics were inconsistently taught. Confidence levels were lowest for teaching economic and environmental topics. Awareness and use of resources developed by the Academy of Nutrition and Dietetics Foundation was low. CONCLUSIONS: Integration of systems thinking in nutrition and dietetics education presents promising opportunities to address complexity in the field. Applying systems thinking to teach SRHFWS may narrow the disparity between educators' perceived importance and program coverage. Enhancing program directors' awareness and utilization of Foundation resources and improved alignment between practice standards and accreditation standards may empower program directors to use systems thinking to teach sustainability-related challenges in nutrition and dietetics.

The role of parenting stress in young children's mental health functioning after exposure to family violence.

This study evaluates the associations of young children's exposure to family violence events, parenting stress, and children's mental health functioning. Caregivers provided data for 188 children ages 3 to 5 years attending Head Start programming. Caregivers reported 75% of children had experienced at least 1 type of trauma event, and 27% of children had experienced a family violence event. Child mental health functioning was significantly associated with family violence exposure after controlling for children's age, gender, household income, and other trauma exposure (ß = .14, p = .033). Stress in the parenting role partially mediated the relationship between family violence exposure and young children's mental health functioning (ß = .12, p = .015, 95% confidence interval [0.02, 0.21]). Interventions for young children exposed to family violence should address the needs of the child, as well as the caregiver while also building healthy parent-child relationships to facilitate positive outcomes in children faced with trauma.

The experience of nurses participating in peer group supervision: A qualitative systematic review.

AIM: This systematic review will identify, appraise, and synthesise the best available qualitative studies exploring nurses' experiences of peer group supervision. The review purpose draws from the synthesised evidence recommendations to enhance policy and implementation of peer group supervision in practice. BACKGROUND: Clinical Supervision is increasing in acceptance as a means of professional and best practice support in nursing. Peer group supervision is a non-hierarchical, leaderless model of clinical supervision delivery and is an option for implementation by nursing management when prioritising staff support with limited resources. This systematic review will provide a synthesis of the qualitative literature regarding the nursing peer group supervision experience. Understanding the experience of peer group supervision from those participating may provide constructive insights regarding implementation of this practice to benefit both nurse and patient driven outcomes. DESIGN: Included are peer reviewed journals focused on nurses' experiences of participating in peer group supervision. Participants are registered nurses of any designation. Qualitative articles, written in English and relating to any area of nursing practice and/or speciality are included. The standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement were used to guide the review. Two investigators independently screened titles, abstracts and selected full text studies describing the experience of peer group supervision. Pre-designed data extraction tools were utilised, and the review followed the Joanna Briggs Institute qualitative meta-aggregation approach with a hermeneutic interpretive analysis. RESULTS: Results identified seven studies that met the inclusion criteria. A total of 52 findings that described the experiences of nursing peer group supervision are synthesised into eight categories. Four overarching synthesised findings resulted: 1. facilitating professional growth 2. trusting the group 3. professional learning experience and 4. shared experiences. Benefits such as sharing of experiences whilst receiving feedback and support were identified. Challenges identified related to group processes. CONCLUSIONS: The paucity of international research into nursing peer group supervision poses challenges for nurse decision makers. Significantly, this review provides insight into the value of peer group supervision for nurses regardless of clinical context and setting. The ability to share and reflect with nursing peers enhances both personal and professional aspects of practice. The worth of the peer group supervision model varied across studies however the outcomes provided important insights into facilitating professional growth, enabling a space to share experiences and reflect, and to build teams where trust and respect develops in groups.