Caring for Whole Families: Relationships Between Providers and Families During Infancy and Toddlerhood.

Caring relationships among families and providers are at the heart of high-quality early care and education (ECE). This study examines relationships between parents and providers in a nationally representative sample of infants and toddlers and their families (N = 527) enrolled in the two-generation Early Head Start (EHS) program in the U.S. EHS' primary services include home visiting and center-based early education, taking a whole family approach to provide comprehensive services within caring and trusting relationships. Using weighted lagged regression models, we found that parent and provider reports of their positive relationships with one another at age 2 years were related to some child and family outcomes at the end of their EHS experience at age 3 years. Providers who reported better relationships with parents rated children as having lower behavior problems and enhanced social competence, language comprehension, language production, and home environments. Parents who reported better relationships with providers also reported lower parenting stress and family conflict. Findings suggest that caring relationships between providers and parents are a key part of high-quality ECE within an environment dedicated to an ethic of care not just for children, but for the whole family.

"Constantly Working on My Attitude Towards Statistics!" Education Doctoral Students' Experiences with and Motivations for Learning Statistics.

Doctoral students in education-related fields are required to take graduate level statistics courses and often face anxiety and negative attitudes about taking these courses. Using a mixed methods survey research design (N = 95), this study explored students' experiences with statistics anxiety and how course instructors can support them to mitigate statistics anxiety and improve attitudes. Analyses of quantitative survey data found that students who had never taken a statistics course before beginning their doctoral program, and students that had completed less doctoral coursework had higher negative attitudes towards learning statistics; and older students had higher statistics anxiety. Plans to use research in the future predicted more positive attitudes and lower statistics anxiety. Analysis of qualitative survey data found that students: (1) expressed that their attitude towards learning statistics was very important and played a big role in how they approached their coursework; (2) considered their plans to use research skills in the future as motivation to learn statistics; and (3) believed that their instructors' attitudes and instructional practices supported learning and decreased statistics anxiety. This study has implications for how statistics and research methods courses are taught in higher education, and how the experiences of graduate students in education may have lasting implications for research use in Prek-12 education settings.

Managing Disruptions in Early Care & Education: Lessons from COVID-19.

Families face challenging decisions about early care and education (ECE) for their children. Decisions about what is best for each child and family are constrained by family and contextual factors and are prone to disruptions. This study provides a descriptive look at patterns of ECE settings children were in the year prior to kindergarten, beginning in Fall 2019 through Spring 2021, a period during which most ECE arrangements were disrupted by the COVID-19 pandemic, and into the 2020-2021 kindergarten year. Analyses of survey (N = 121) and interview (n = 25) data from families whose children entered kindergarten in Fall 2020 revealed multiple and cascading disruptions during this time. Disruptions were nearly universal, and families made continual accommodations as they juggled employment needs and children's ECE needs. Findings from this study have implications for how actual and anticipated disruptions may have a greater influence on families' child care decision-making into the future.

COVID-19 and mental health: A systematic review of international medical student surveys.

Background: The medical school curriculum has imposed psychological stressors on students worldwide, some of which may induce feelings of increased depression and anxiety. Meanwhile, the COVID-19 pandemic has exacerbated the feelings of stress, depression, and anxiety that a portion of medical students experience in their daily life. The aim of this systematic review is to gather concrete data from medical schools around the globe, and further evaluate how the COVID-19 pandemic has impacted medical students' mental health. Materials and methods: Systematic search of data from PubMed, EMBASE, psycINFO, MEDLINE Complete, and Global Health for studies conducted between December 2019 and July 2021 was conducted. Data from 47 different surveys of medical students from various medical institutions throughout the world were included in this review. These surveys, administered in the form of questionnaires that utilized rating scales, measured anxiety, depression, and stress levels in medical students amidst the COVID-19 outbreak. Results: The COVID-19 outbreak was found to have negative effects on medical students, most notably causing emotional and behavioral changes and detrimental mental health impacts. Higher levels of stress, depression, and anxiety have been found in medical students since the outbreak. Conclusion: This systematic review highlights the sustained high prevalence of moderate depression, anxiety and stress among medical students during the COVID-19 pandemic. Appropriate support and research on which interventions could mitigate these risks is essential in order to ensure that future physicians are properly cared for, and ultimately have the adequate tools needed to provide high quality and empathetic care to future patients.

The Evolution and Future of Targeted Cancer Therapy: From Nanoparticles, Oncolytic Viruses, and Oncolytic Bacteria to the Treatment of Solid Tumors.

While many classes of chemotherapeutic agents exist to treat solid tumors, few can generate a lasting response without substantial off-target toxicity despite significant scientific advancements and investments. In this review, the paths of development for nanoparticles, oncolytic viruses, and oncolytic bacteria over the last 20 years of research towards clinical translation and acceptance as novel cancer therapeutics are compared. Novel nanoparticle, oncolytic virus, and oncolytic bacteria therapies all start with a common goal of accomplishing therapeutic drug activity or delivery to a specific site while avoiding off-target effects, with overlapping methodology between all three modalities. Indeed, the degree of overlap is substantial enough that breakthroughs in one therapeutic could have considerable implications on the progression of the other two. Each oncotherapeutic modality has accomplished clinical translation, successfully overcoming the potential pitfalls promising therapeutics face. However, once studies enter clinical trials, the data all but disappears, leaving pre-clinical researchers largely in the dark. Overall, the creativity, flexibility, and innovation of these modalities for solid tumor treatments are greatly encouraging, and usher in a new age of pharmaceutical development.

Urological Emergencies and Diseases in Wilderness Expeditions.

When considering medical emergencies that might affect an expedition, urologic emergencies are typically not included. However, the reality is that manageable and prevalent urologic disease processes can pose significant challenges for the wilderness medicine physician and warrant consideration. The purpose of this review is to identify and discuss the most commonly encountered urologic emergencies and diseases in the wilderness setting and to prepare the expedition medicine physician for management of these urgent conditions. A PubMed and Internet search for urologic emergencies and diseases in wilderness conditions was conducted. We also searched bibliographies for useful supplemental literature and material from leading mountain medicine and wilderness medicine societies as well as population-based studies for common urologic diseases. Urologic emergencies and diseases on expeditions and in wilderness conditions have been reported primarily with retrospective case series and case reports. The most commonly reported urologic emergencies in this setting include urologic trauma, renal calculi, and urinary retention. Parasitic infections in the urinary tract also have been reported to cause urinary symptoms and urinary retention in wilderness conditions. Although urologic diseases in such conditions are uncommon, significant morbidity and even potentially life-threatening sequelae to urologic emergencies were found to occur. Major genitourinary emergencies in expedition medicine are uncommon but involve both potentially manageable urgent conditions and serious life-threatening conditions best treated with urgent stabilization and occasionally medical evacuation. The opportunity exists for increased awareness for management strategies for urologic conditions in the often remote or extreme environments of an expedition.

Seated row and biceps curl exercises present similar acute responses on muscle thickness, arm circumference, and peak force for elbow flexors after a resistance training session in recreationally-trained subjects.

BACKGROUND: The primary purpose of this study was to measure the acute effects on muscle thickness, arm circumference, and peak force between unilateral seated row and unilateral biceps curl exercises for elbow flexors after a RT session in recreationally-trained subjects. METHODS: Fourteen resistance-trained men (25.3±2.5years, 76.5±6.4kg, 174.6±7cm) performed 6 sets of 10RM and 2-min rest for one of two exercises (unilateral seated row exercise, USR or unilateral biceps curl, UBC). Muscle thickness (MT), arm circumference (AC), and peak force (PF) were measured before 10-min (control), pre-RT session and post-RT (immediately after, 15-min and 30-min). All acute RT variables were measured during both exercises: maximal number of repetitions (MNR), total number of repetitions (TNR), time under tension (TUT), rating of perceived exertion (RPE). Two-way ANOVAs were used to test differences between exercises and moments with an alpha of 5%. RESULTS: For PF, there was a significant difference between pre- and post-0 for UBC and USR (P<0.001). For AC, there were significant differences between pretest × post-0-min for both exercises (P<0.001). For MT, there were significant differences between pretest × post 0-min (P<0.001), pretest × post 15-min (P<0.001) for both exercises and pretest × post 30-min only for UBC (P=0.006). CONCLUSIONS: Both exercises induced similar increases in AC and MT for elbow flexors and reduction in peak force.

Patient-Directed Valgus Stress Radiograph of the Knee: A New and Novel Technique.

The radiographic investigation of patients with medial-compartment osteoarthritis of the knee is a critical element in the decision-making process of determining whether the patient is a candidate for unicompartmental or total knee arthroplasty. A valgus stress radiograph of the affected knee is an essential part of this radiographic investigation. Historically, this has been performed with manual stress applied by the surgeon or the radiologic technologist; thus, this examination requires 2 individuals to complete. In addition to being inefficient, 1 individual is exposed to radiation, which can be undesirable over many exposures and in a long career. For these reasons, we instituted a quality improvement project to develop a method of obtaining the valgus stress view with 1 technologist that would obviate these concerns. Of 78 examinations performed, 5 studies did not show complete correction of the varus deformity. Of these, 3 showed complete correction on a manual valgus stress radiograph, and 2 did not. Three patients displayed collapse of the lateral compartment, indicating a nonfunctional lateral compartment. The remaining 70 patients had identical radiographic results with both the manual and patient-directed valgus stress.

Neonatal abstinence syndrome: evaluating the effectiveness of an evidence-based multidisciplinary care approach.

An evidence-based, multidisciplinary neonatal abstinence syndrome protocol was developed using a stepwise continuous quality improvement (CQI) approach with the goal of standardizing care procedures for these infants. A retrospective secondary data analysis was performed to evaluate the differential effects of each step of the CQI project on 4 key clinical outcome measures: length of stay (total and post-opioid wean), weaning time from opioids, and use of adjunct medications. Data were analyzed from 386 newborn infants with a diagnosis of neonatal abstinence syndrome undergoing treatment in a level III neonatal intensive care unit. After implementation of a pharmacologic weaning protocol as a foundational first step of the CQI project, the weaning time from opioids remained stable throughout each of the subsequent CQI steps (P = .905). The overall total neonatal intensive care unit length of stay was reduced by 10.35 days (P = .002), and the length of neonatal intensive care unit stay after completing wean from opioids was reduced by 2.79 days (P < .001). Use of adjunct medications also decreased from 30.1% of infants at the initiation of the CQI project to 24.5% at the completion of the project (P = .020). These findings indicate that this multidisciplinary treatment approach led to an overall improved efficiency of both opioid weaning and symptom management for these infants.

Conservative management of a young adult with hip arthrosis.

STUDY DESIGN: Case report. BACKGROUND: Clinical practice guidelines regarding the conservative management of degenerative hip conditions in older adults routinely incorporate therapeutic exercise and manual therapy. However, the application of these recommendations to young, active adults is less clear. The purpose of this case report is to describe the management of a young adult with advanced hip arthrosis using a multifaceted rehabilitation program. CASE DESCRIPTION: A 28-year-old female with severe left hip degeneration, as identified with diagnostic imaging, was referred to physical therapy. Reduced hip range of motion and strength, sacroiliac joint asymmetries, and a modified Harris Hip Score of 76 were observed. She was seen for 12 visits over a 3-month period and treated with an individualized program including manual therapy, therapeutic exercise, and neuromuscular re-education. OUTCOME: Substantial improvements were noted in pain, hip range of motion, and strength and function (modified Harris Hip Score of 97). In addition, she discontinued the use of anti-inflammatory medications and returned to her prior level of activity. Improvements were maintained at a 3-month follow-up, with symptom recurrence managed using a self-mobilization technique to the left hip and massage to the left iliopsoas. DISCUSSION: Degenerative hip conditions are common among older adults but are relatively rare in the younger population. Although it is likely that this patient will experience a return of her symptoms and functional limitations as her hip disease progresses, the immediate improvements may delay the need for eventual surgical management. These outcomes suggest that physical therapy management should be considered in those with an early onset of degenerative hip disease and are consistent with results previously reported in the older population. LEVEL OF EVIDENCE: Therapy, level 4.