Genetic subgroups inform on pathobiology in adult and pediatric Burkitt lymphoma.

Burkitt lymphoma (BL) accounts for most pediatric non-Hodgkin lymphomas, being less common but significantly more lethal when diagnosed in adults. Much of the knowledge of the genetics of BL thus far has originated from the study of pediatric BL (pBL), leaving its relationship to adult BL (aBL) and other adult lymphomas not fully explored. We sought to more thoroughly identify the somatic changes that underlie lymphomagenesis in aBL and any molecular features that associate with clinical disparities within and between pBL and aBL. Through comprehensive whole-genome sequencing of 230 BL and 295 diffuse large B-cell lymphoma (DLBCL) tumors, we identified additional significantly mutated genes, including more genetic features that associate with tumor Epstein-Barr virus status, and unraveled new distinct subgroupings within BL and DLBCL with 3 predominantly comprising BLs: DGG-BL (DDX3X, GNA13, and GNAI2), IC-BL (ID3 and CCND3), and Q53-BL (quiet TP53). Each BL subgroup is characterized by combinations of common driver and noncoding mutations caused by aberrant somatic hypermutation. The largest subgroups of BL cases, IC-BL and DGG-BL, are further characterized by distinct biological and gene expression differences. IC-BL and DGG-BL and their prototypical genetic features (ID3 and TP53) had significant associations with patient outcomes that were different among aBL and pBL cohorts. These findings highlight shared pathogenesis between aBL and pBL, and establish genetic subtypes within BL that serve to delineate tumors with distinct molecular features, providing a new framework for epidemiologic, diagnostic, and therapeutic strategies.

The Legal Landscape for Opioid Treatment Agreements.

Policy Points Opioid treatment agreements (OTAs) are controversial because of the lack of evidence that their use reduces opioid-related harms and the potential risks they pose of stigmatizing patients and undermining the clinician-patient relationship. Even so, their use is now required in most jurisdictions, and their use is influencing the outcomes of civil and criminal lawsuits. More research is needed to evaluate how OTAs are implemented given existing requirements. If additional research does not resolve the current level of uncertainty regarding OTA benefits, then policymakers in jurisdictions where they are required should consider eliminating OTA mandates or providing flexibility in the legal requirements to make room for clinicians and health care institutions to implement best practices. CONTEXT: Opioid treatment agreements (OTAs) are documents that clinicians present to patients when prescribing opioids that describe the risks of opioids and specify requirements that patients must meet to receive their medication. Notwithstanding a lack of evidence that OTAs effectively mitigate opioids' risks, professional organizations recommend that they be implemented, and jurisdictions increasingly require them. We sought to identify the jurisdictions that require OTAs, how OTAs might affect the outcomes of lawsuits that arise when things go wrong, and instances in which the law permits flexibility for clinicians and health care institutions to adopt best practices. METHODS: We surveyed the laws and regulations of all 50 states and the District of Columbia to identify which jurisdictions require the use of OTAs, the circumstances in which OTA use is mandatory, and the terms OTAs must include (if any). We also surveyed criminal and civil judicial decisions in which OTAs were discussed as evidence on which a court relied to make its decision to determine how OTA use influences litigation outcomes. FINDINGS: Results show that a slight majority (27) of jurisdictions now require OTAs. With one exception, the jurisdictions' requirements for OTA use are triggered at least in part by long-term prescribing. There is otherwise substantial variation and flexibility within OTA requirements. Results also show that even in jurisdictions where OTA use is not required by statute or regulation, OTA use can inform courts' reasoning in lawsuits involving patients or clinicians. Sometimes, but not always, OTA use legally protects clinicians from liability. CONCLUSIONS: Our results show that OTA use is entwined with legal obligations in various ways. Clinicians and health care institutions should identify ways for OTAs to enhance clinician-patient relationships and patient care within the bounds of relevant legal requirements and risks.

Training Community Leaders to Serve as Equal Partners in Research: Penn Community Scholars Program, 2015-2023.

An implementation and effectiveness evaluation of the Community Scholars Program was conducted at the University of Pennsylvania to enhance community capacity to collaborate with academics in mutually beneficial, equitable, and transformative research. Mixed methods were employed using administrative data, surveys, and key informant interviews. Participants expressed high satisfaction, valued interactive learning, and identified areas for improvement. The program increased knowledge and self-confidence in research-related skills and trust in the research process. The program serves as an institutional model to create long-term, mutually beneficial community-academic partnerships. (Am J Public Health. 2024;114(3):284-288. https://doi.org/10.2105/AJPH.2023.307549).

Emotional stimuli similarly disrupt attention in both visual fields.

People often need to filter relevant from irrelevant information. Irrelevant emotional distractors interrupt this process. But does the degree to which emotional distractors disrupt attention depend on which visual field they appear in? We thought it might for two reasons: (1) people pay slightly more attention to the left than the right visual field, and (2) some research suggests the right-hemisphere (which, in early visual processing, receives left visual field input) has areas specialised for processing emotion. Participants viewed a rapid image-stream in each visual field and reported the rotation of an embedded neutral target preceded by a negative or neutral distractor. We predicted that the degree to which negative (vs. neutral) distractors impaired target detection would be larger when targets appeared in the left than the right stream. This hypothesis was supported, but only when the distractor and target could appear in the same or opposite stream as each other (Experiments 2a-b), not when they always appeared in the same stream as each other (Experiments 1a-1b). However, this effect was driven by superior left-stream accuracy following neutral distractors, and similar left- and right-stream accuracy following negative distractors. Emotional distractors therefore override visuospatial asymmetries and disrupt attention, regardless of visual field.

Pathways and processes to the embodiment of historical trauma secondary to settler colonialism.

AIM(S): This discursive article aims to examine how systemic factors of settler colonialism influence health outcomes among Indigenous peoples in the United States through pathways and processes that may lead to the embodiment of historical trauma. DESIGN: Discursive paper. METHODS: We completed a comprehensive search of empirical and grey literature between September 2022 and January 2023 in PubMed, CINAHL and Google Scholar. Using these articles as a foundation, we explored factors related to the pathways and processes leading to the embodiment of historical trauma rooted in settler colonialism. RESULTS: A conceptual framework of the pathways and processes of the embodiment of historical trauma secondary to settler colonialism was developed, and is presented. CONCLUSION: The societal and historical context for Indigenous peoples includes harmful settler colonial structures and ideologies, resulting in stressors and historical trauma that impact health outcomes and disparities through the phenomenon of the process of embodiment. IMPLICATIONS FOR NURSING: To provide holistic nursing care, nurses must be aware of settler colonialism as a determinant of health. They must be attuned to the pathways and processes through which settler colonial exposures may impact health among Indigenous peoples. Nurses must challenge existing structural inequities to advance health equity and social justice.

Effect of nusinersen on respiratory function in paediatric spinal muscular atrophy types 1-3.

INTRODUCTION: Nusinersen is used in spinal muscular atrophy (SMA) to improve peripheral muscle function; however, respiratory effects are largely unknown. AIM: To assess the effects of nusinersen on respiratory function in paediatric SMA during first year of treatment. METHODS: A prospective observational study in paediatric patients with SMA who began receiving nusinersen in Queensland, Australia, from June 2018 to December 2019. Outcomes assessed were the age-appropriate respiratory investigations: spirometry, oscillometry, sniff nasal inspiratory pressure, mean inspiratory pressure, mean expiratory pressure, lung clearance index, as well as polysomnography (PSG) and muscle function testing. Lung function was collected retrospectively for up to 2 years prior to nusinersen initiation. Change in lung function was assessed using mixed effects linear regression models, while PSG and muscle function were compared using the Wilcoxon signed-rank test. RESULTS: Twenty-eight patients (15 male, aged 0.08-18.58 years) were enrolled: type 1 (n=7); type 2 (n=12); type 3 (n=9). The annual rate of decline in FVC z-score prior to nusinersen initiation was -0.58 (95% CI -0.75 to -0.41), and post initiation was -0.25 (95% CI -0.46 to -0.03), with a significant difference in rate of decline (0.33 (95% CI 0.02 to 0.66) (p=0.04)). Most lung function measures were largely unchanged in the year post nusinersen initiation. The total Apnoea-Hypopnoea Index (AHI) was reduced from a median of 5.5 events/hour (IQR 2.1-10.1) at initiation to 2.7 events/hour (IQR 0.7-5.3) after 1 year (p=0.02). All SMA type 1% and 75% of SMA types 2 and 3 had pre-defined peripheral muscle response to nusinersen. CONCLUSION: The first year of nusinersen treatment saw reduced lung function decline (especially in type 2) and improvement in AHI.

Coding and noncoding drivers of mantle cell lymphoma identified through exome and genome sequencing.

Mantle cell lymphoma (MCL) is an uncommon B-cell non-Hodgkin lymphoma (NHL) that is incurable with standard therapies. The genetic drivers of this cancer have not been firmly established, and the features that contribute to differences in clinical course remain limited. To extend our understanding of the biological pathways involved in this malignancy, we performed a large-scale genomic analysis of MCL using data from 51 exomes and 34 genomes alongside previously published exome cohorts. To confirm our findings, we resequenced the genes identified in the exome cohort in 191 MCL tumors, each having clinical follow-up data. We confirmed the prognostic association of TP53 and NOTCH1 mutations. Our sequencing revealed novel recurrent noncoding mutations surrounding a single exon of the HNRNPH1gene. In RNA-seq data from 103 of these cases, MCL tumors with these mutations had a distinct imbalance of HNRNPH1 isoforms. This altered splicing of HNRNPH1 was associated with inferior outcomes in MCL and showed a significant increase in protein expression by immunohistochemistry. We describe a functional role for these recurrent noncoding mutations in disrupting an autoregulatory feedback mechanism, thereby deregulating HNRNPH1 protein expression. Taken together, these data strongly imply a role for aberrant regulation of messenger RNA processing in MCL pathobiology.

Type 1 diabetes knowledge assessment: The KAT-1 validation study.

OBJECTIVE: This study sought to examine the reliability and validity of a novel pediatric type 1 diabetes knowledge assessment (KAT-1) designed for children, adolescents, young adults and their parents/guardians. The instrument was designed to be integrated into the clinic workflow to obtain objective data electronically. RESEARCH DESIGN AND METHODS: KAT-1 was developed by a multidisciplinary team and includes 11 independent topical subscales. Forty children/caregivers participated in a pilot study; their feedback was used to improve item clarity and readability. Subsequently, a validation study was performed in 200 participants (100 children/adolescents/young adults with type 1 diabetes ages 11-21 years and 100 parents/guardians of children with type 1 diabetes ages 1-15 years) to examine correlations between the KAT-1 scores and Revised Diabetes Knowledge Test (DKT2) scores and HbA1c. An item analysis was conducted to determine internal consistency and reliability; topical subscales were evaluated using Cronbach's alpha. RESULTS: Total KAT-1 scores were positively correlated with DKT2 scores r = 0.674, p < 0.001, and negatively correlated with HbA1c, r = -0.3, p < 0.001. All KAT-1 subscales were positively and significantly correlated with one another and with total KAT-1 score. Internal consistency of total KAT-1 score was strong (Cronbach's α = 0.938, mean score 84.6, SD = 16.1) and 9 of 11 independent topical subscales demonstrated strong internal consistency. Completion time for subscales was <5 min. CONCLUSIONS: KAT-1 is a valid instrument to assess type 1 diabetes knowledge. The instrument's short topical subscales can be used to objectively assess specific knowledge and individualize diabetes education. KAT-1 has been integrated into our electronic health record (EPIC) and is available online at no cost.

Design and evaluation of achiral, non-atropisomeric 4-(aminomethyl)phthalazin-1(2H)-one derivatives as novel PRMT5/MTA inhibitors.

MRTX1719 is an inhibitor of the PRMT5/MTA complex and recently entered clinical trials for the treatment of MTAP-deleted cancers. MRTX1719 is a class 3 atropisomeric compound that requires a chiral synthesis or a chiral separation step in its preparation. Here, we report the SAR and medicinal chemistry design strategy, supported by structural insights from X-ray crystallography, to discover a class 1 atropisomeric compound from the same series that does not require a chiral synthesis or a chiral separation step in its preparation.

Effects of an intergenerational program on adolescent self-concept clarity: A pilot study.

OBJECTIVE: This pilot study examined the effects of a newly developed intergenerational program on self-concept clarity (SCC) of adolescent participants. METHOD: In 12 encounter groups, 58 secondary school students and 50 nursing home residents shared their life stories and discussed existential questions about life (e.g., important values in life, how to deal with failure and regret). The life story encounter program (LSEP) is based on the dyadic Life Story Interview and was expanded into a group format consisting of ten 90-min sessions. SCC was measured with the SCC Scale before, shortly after, and three months after the end of the LSEP. RESULTS: Analyses suggest that adolescent LSEP participants' SCC improved compared to a control group (no LSEP participation). Findings also indicate that increases in SCC were associated with LSEP participants' extraversion and agreeableness. CONCLUSIONS: The LSEP is a promising program for fostering SCC in adolescence. Implications for the application of the LSEP are discussed.

[Using the Treatment Passport to stimulate Advance Care Planning]. / Het gebruik van het Behandelpaspoort voor het stimuleren van Proactieve Zorgplanning.

Care recipients are becoming increasingly involved in the decision-making process for suitable treatments. Advance Care Planning (ACP) enables care recipients and healthcare professionals to timely think and discuss wishes and preferences for treatments, before a care recipient becomes limited by disease, cognitive problems or age. The Treatment Passport is developed by geriatric specialist Esther Bertholet and contains supportive questions to think about treatment wishes. This study aimed to evaluate the experiences of civilians and healthcare professionals with the usage of the Treatment Passport during ACP. Involved care organisations distributed the Treatment Passports to healthcare professionals, for example dementia casemanagers. Healthcare professionals then handed the Treatment passports to civilians, for example older persons. Thereafter, healthcare professionals (N=30) and civilians (N=80) filled out a questionnaire about the experiences with usage of the Treatment Passport. 65% of the civilians had a disease and a mean age 75.3 years. The Treatment Passport was considered a helpful tool to think and talk about treatment wishes. 57% of the healthcare professionals wants to keep using the Treatment Passport and 78% of the civilians would recommend it to others. Participants who found the passport of limited added value mostly had their own methods of discussing their treatment wishes.

Characteristics and clinical implications of the relationship between veganism and pathological eating behaviours.

OBJECTIVE: Veganism may serve as a socially acceptable means to restrict food intake and disguise pathological eating behaviours. Studies that include vegan participants typically group them with other meat avoiders (e.g., vegetarians), potentially masking risk factors unique to veganism. METHOD: We addressed this issue by recruiting two Amazon Mechanical Turk samples of 110 vegan and 118 omnivore participants, with comparable gender composition. We aimed to examine whether vegans showed higher disordered eating than omnivores, and if motives for pursuing a vegan diet impacted disordered eating. We assessed disordered eating using the Eating Attitudes Test, the Eating Disorder Examination-Questionnaire, and the Eating Pathology Symptom Inventory. RESULTS: Vegans displayed more pathological eating behaviours than omnivores, which was significantly predicted by cognitive restraint. However, body dissatisfaction levels were higher in omnivores than vegans. Diet motives did not influence vegans' disordered eating. CONCLUSION: We propose vegans have high levels of cognitive restraint, possibly due to their intention to avoid animal products. In turn, cognitive restraint subscales in eating disorder measures might be over-pathologising rates of eating disorders in vegans. Future research should monitor the progression of people's eating-related attitudes and behaviours before and after they transition to veganism to establish whether veganism increases the risk of disordered eating, or vice versa. LEVEL OF EVIDENCE: IV, cross-sectional study.

Infection-associated Immune Perturbations Resolve 1 Year Following Treatment for Loa loa.

BACKGROUND: We have previously demonstrated that eosinophil-associated processes underlie some of the differences in clinical presentation among patients with Loa loa infection prior to therapy and that some posttreatment adverse events appear to be dependent on eosinophil activation. METHODS: We first conducted a retrospective review of 204 patients (70 microfilaria [MF] positive/134 negative) with Loa loa both before and following definitive therapy. We then measured filarial-specific antibodies, eosinophil- and Th2-associated cytokines, and eosinophil granule proteins in their banked serum prior to and at 1 year following definitive treatment. We also evaluated the influence of pretreatment corticosteroids and/or apheresis in altering the efficacy of treatment. RESULTS: Patients without circulating microfilariae (MF negative) not only had a higher likelihood of peripheral eosinophilia and increased antifilarial antibody levels but also had significantly increased concentrations of granulocyte-macrophage colony-stimulating factor, interleukin (IL) 5, and IL-4 compared with MF-positive patients. However, these differences had all resolved by 1 year after treatment, when all parameters approached the levels seen in uninfected individuals. Neither pretreatment with corticosteroids nor apheresis reduced the efficacy of the diethylcarbamazine used to treat these subjects. CONCLUSIONS: Our results highlight that, by 1 year following treatment, infection-associated immunologic abnormalities had resolved in nearly all patients treated for loiasis, and pretreatment corticosteroids had no influence on the resolution of the immunologic perturbations nor on the efficacy of diethylcarbamazine as a curative agent in loiasis. CLINICAL TRIALS REGISTRATION: NCT00001230.

A Randomized, Placebo-controlled, Double-blind Pilot Study of Single-dose Humanized Anti-IL5 Antibody (Reslizumab) for the Reduction of Eosinophilia Following Diethylcarbamazine Treatment of Loa loa Infection.

BACKGROUND: Diethylcarbamazine citrate (DEC) treatment of loiasis is complicated by adverse reactions that are correlated with the number of circulating microfilariae (mf). The cause of these reactions is unknown, but they are accompanied by a dramatic interleukin-5 (IL-5)-dependent increase in eosinophilia and evidence of eosinophil activation. METHODS: To explore the role of IL-5 driven eosinophilia in post-DEC reactions, 8 adults with confirmed loiasis and <5000 mf/mL blood were enrolled in a randomized, double-blind, placebo-controlled trial of the humanized anti-IL-5 antibody, reslizumab, (1.0 mg/kg IV) administered 3 to 7 days prior to initiation of DEC treatment (9 mg/kg/day for 21 days). The primary endpoint was the reduction in absolute eosinophil count (AEC) during the first week of DEC treatment. RESULTS: Baseline characteristics were comparable between the two groups. Single dose reslizumab lowered the AEC by 77% prior to initiation of DEC therapy (vs. 12% in the placebo group, P < .05). More importantly, AEC remained below baseline in the first week of DEC treatment in all subjects who received reslizumab and in none of the placebo subjects. Mf clearance occurred within 2 days of initiation of DEC in all 7 mf-positive subjects. Mild to moderate adverse events were seen in all 8 subjects and were not significantly different between the groups. CONCLUSIONS: In summary, although reslizumab was able to blunt peripheral eosinophilia post-DEC treatment in subjects with loiasis and had no effect on microfilarial clearance, the reduction in AEC appeared to have been insufficient to prevent post-treatment AEs.

Patient perceptions, opinions and satisfaction of telehealth with remote blood pressure monitoring postpartum.

BACKGROUND: Our aim was to conduct a post participation survey of respondent experiences with in-home remote patient monitoring via telehealth for blood pressure monitoring of women with postpartum hypertension. We hypothesized that the in-home remote patient monitoring application will be implemented with strong fidelity and have positive patient acceptability. METHODS: This analysis was a planned secondary analysis of a non-randomized controlled trial of telehealth with remote blood pressure patient monitoring for postpartum hypertension compared to standard outpatient monitoring in women with a hypertension-related diagnosis during pregnancy. In collaboration with survey experts, we developed a 41-item web-based survey to assess 1) perception of quality of care received, 2) ease of use/ease to learn the telehealth program, 3) effective orientation of equipment, 4) level of perceived security/privacy utilizing telehealth and 5) problems encountered. The survey included multiple question formats including Likert scale responses, dichotomous Yes/No responses, and free text. We performed a descriptive analysis on all responses and then performed regression analysis on a subset of questions most relevant to the domains of interest. The qualitative data collected through open ended responses was analyzed to determine relevant categories. Intervention participants who completed the study received the survey at the 6-week study endpoint. RESULTS: Sixty six percent of respondents completed the survey. The majority of women found the technology fit easily into their lifestyle. Privacy concerns were minimal and factors that influenced this included age, BMI, marital status, and readmissions. 95% of women preferred remote care for postpartum follow-up, in which hypertensive type, medication use and ethnicity were found to be significant factors in influencing location of follow-up. Most women were satisfied with the devices, but rates varied by hypertensive type, infant discharge rates and BMI. CONCLUSIONS: Postpartum women perceived the telehealth remote intervention was a safe, easy to use method that represented an acceptable burden of care and an overall satisfying method for postpartum blood pressure monitoring. TRIAL REGISTRATION: ClinicalTrials.gov identification number: NCT03111095 Date of registration: April 12, 2017.

Right Hemisphere Memory Bias Does Not Extend to Involuntary Memories for Negative Scenes.

Attention is unequally distributed across the visual field. Due to greater right than left hemisphere activation for visuospatial attention, people attend slightly more to the left than the right side. As a result, people voluntarily remember visual stimuli better when it first appears in the left than the right visual field. But does this effect-termed a right hemisphere memory bias-also enhance involuntary memory? We manipulated the presentation location of 100 highly negative images (chosen to increase the likelihood that participants would experience any involuntary memories) in three conditions: predominantly leftward (right hemisphere bias), predominantly rightward (left hemisphere bias), or equally in both visual fields (bilateral). We measured subsequent involuntary memories immediately and for 3 days after encoding. Contrary to predictions, biased hemispheric processing did not affect short- or long-term involuntary memory frequency or duration. Future research should measure hemispheric differences at retrieval, rather than just encoding.

A cohort study of initial self-harm events: method-specific case fatality of index events, predictors of fatal and nonfatal repetition, and frequency of method-switching.

Most studies evaluating self-harm repetition risk factors are from Asia and Europe, use cohorts of people who self-injure without differentiating incident and prevalent self-harm episodes, and do not stratify by suicide method. The current study uses an incident user design to (a) examine case fatality at index self-harm events and at each repeat event, by method, (b) describe method-switching, and (c) identify factors associated with repetition of self-harm among those who survive their index hospitalization. Specifically, this study reports psychiatric history and method-specific case fatality for the initial self-harm event among Utah residents with an index event in 2014 or 2015 and who have no history of prior self-harm in hospital records. For survivors of the index self-harm episode, we use Accelerated Failure Time models to identify risk factors for nonfatal repetition and separately for suicide. Key findings: 10,521 Utah residents with no 3-year self-harm hospital history experienced a 2014 or 2015 index event. Of the 9.5% with index deaths, 53.6% used firearms. Of the 90.5% who survived, 63.1% used drugs. Among the index nonfatal cases, over an average 1-year follow-up, 11.7% experienced a nonfatal repetition and 0.8% died by suicide. Most subsequent nonfatal repetitions (59.7%) and suicides (56.8%) had presented with an index drug poisoning; over half (56.8%) of those who died switched methods. For those who subsequently fatally self-harmed, most used poisoning by drugs (33.8%), hanging/strangulation (28.4%), or firearms (24.3%) in the terminal episode. Nonfatal repetition was associated with younger age, index cutting/piercing instruments, and past-year psychiatric and drug abuse diagnoses. Subsequent suicide was associated with male gender, older age, and index gas poisoning and hanging/suffocation. Of the 56 people who survived an index firearm event, none subsequently died by suicide during the study period.

Should photographic triage become common practice?

Design Cross-sectional, exploratory study collecting photographic referral data over three months.Sample selection Paediatric referrals to the orthodontic and maxillofacial department at Alder Hey Hospital during the COVID-19 pandemic.Data analysis Photographic referrals were analysed using Microsoft Excel to determine treatment outcomes, including 'not to see', 'plan to see' and 'need to see'. Demographic information collected and analysed were patient age, gender, referral source and presenting complaint.Results In total, 220 photographic referrals were received, with swelling (30%) and dental trauma (27%) being the most common presenting complaints. Fifty-seven percent of the referrals were not seen, 23% were seen semi-urgently and 20% booked for outpatient review. Of those seen, seven children were examined elsewhere, with 44 receiving face-to-face consultations at Alder Hey Children's Hospital, with eight being admitted.Conclusions Photographic triage has potential to be a useful adjunctive assessment tool for new patient referrals, with secondary benefits for training junior staff and for populations who already find access to dental services challenging. Feasibility studies on the application should be seriously considered. However, the unique circumstances which resulted in the development of a photographic triage method need to be considered when generalising its use to normal working conditions.

Developing Prepare2Thrive, a community-based intervention targeting treatment engagement among African American individuals living with HIV and serious mental illness.

African American individuals living with HIV and serious mental illness (SMI) may report relatively low treatment engagement, despite treatment engagement being critical to managing both health conditions. Here, we have two aims: to describe the methodology we used to collect focus group data on treatment engagement with a sample of African American individuals living with HIV and SMI, and to describe the results of those focus groups in the context of intervention development. We conducted two focus groups (N = 15), integrating a social-ecological model for our theoretical framework, Community-Based Participatory Research for study design and execution, and group concept mapping for data analysis. Three thematic clusters relating to treatment engagement emerged from each group, with overlap across groups: Medication knowledge, Patient-provider relationships, and Barriers to treatment engagement. Items related to the Patient-provider relationship loaded onto all emergent clusters, demonstrating the pervasive impact of this variable. Findings informed the design of Prepare2Thrive, a community-based, culture-specific intervention aiming to increase treatment engagement among African American individuals living with HIV and SMI. Both our design and findings can be used in future collaborations aiming to maximize treatment engagement, and more broadly health, among individuals in this community.

Cognitive load exacerbates rightward biases during computer maze navigation.

Neurologically healthy individuals exhibit subtle attentional asymmetries, such that attention is preferentially directed leftwards for objects in near space and rightwards for objects in far space. These attentional biases also affect navigation and cause people to deviate to the right when passing through an aperture. The current study examined whether the rightward deviations observed in real-world environments translate to simulated environments. As proof of concept and to determine whether rightward biases could be further exacerbated, the degree of cognitive load imposed on participants was manipulated. Experiment 1 asked participants to navigate through the centre of a computer-based doorway. In one block of trials, participants completed the task by itself (baseline condition), while in another block of trials they also completed a simple auditory discrimination task (load condition). While analyses revealed rightward biases for both conditions, the difference between conditions was not significant. Experiment 2 therefore increased the difficulty of the auditory task. Analyses revealed a significant difference between conditions, suggesting that the degree of cognitive load further exacerbates rightward biases, demonstrating that the rightward asymmetries in navigation observed in the real world generalises to a simulated environment and that this phenomenon behaves in a way that is consistent with pseudoneglect.