Diagnosis of renal lymphoma by Wright-Giemsa-stained cytocentrifuged urine evaluation in a cat.

Lymphoma represents up to 30% of neoplasms diagnosed in cats. Diagnosis of lymphoma in the urinary system by examination of urine sediment has been described in a dog, but apparently not previously in cats. Concurrent samples of serum, EDTA whole blood, and urine were submitted from a 15-year-old spayed female domestic shorthair cat exhibiting weight loss, polyuria, and polydipsia. Hematology and biochemical abnormalities included a mild normocytic, normochromic, non-regenerative anemia; an inflammatory leukogram; and azotemia. Urinalysis evaluation revealed inadequate urine concentration and marked proteinuria. Wet-mount urine sediment examination revealed moderate numbers of leukocytes and erythrocytes. A uniform population of intermediate-to-large lymphocytes was observed on a fresh, Wright-Giemsa-stained preparation from cytocentrifuged urine. The cat was euthanized and necropsy was completed. Bilateral renomegaly was identified and characterized by multifocal, pale-yellow, coalescing, poorly defined, homogenous nodules. Microscopically, these nodules were composed of dense sheets of CD3-positive round cells, consistent with T-cell renal lymphoma. Key clinical message: Lymphoma is a common neoplasm in cats that can affect many organ systems, including the upper urinary tract. This case represents an uncommon method of identifying neoplastic lymphocytes via evaluation of cytocentrifuged urine, and emphasizes the benefits of examining Romanowsky-stained urine sediment in animals.

Diagnostic du lymphome rénal chez un chat par évaluation d'urine cytocentrifugée avec coloration Wright-Giemsa. Le lymphome représente jusqu'à 30 % des néoplasmes diagnostiqués chez le chat. Le diagnostic d'un lymphome du système urinaire par examen des sédiments urinaires a été décrit chez un chien, mais apparemment pas à ce jour chez le chat. Des échantillons simultanés de sérum, de sang total dans un tube avec EDTA et d'urine ont été soumis provenant d'une chatte domestique à poils courts stérilisée de 15 ans présentant une perte de poids, une polyurie et une polydipsie. Les anomalies hématologiques et biochimiques comprenaient une légère anémie normocytaire, normochrome et non régénérative; une formule leucocytaire inflammatoire; et une azotémie. L'analyse d'urine a révélé une concentration urinaire insuffisante et une protéinurie marquée. L'examen microscopique des sédiments urinaires a révélé un nombre modéré de leucocytes et d'érythrocytes. Une population uniforme de lymphocytes de taille intermédiaire à grande a été observée sur une préparation fraîche colorée au Wright-Giemsa à partir d'urine cytocentrifugée. Le chat a été euthanasié et une autopsie a été réalisée. Une rénomégalie bilatérale a été identifiée et caractérisée par des nodules multifocaux, jaune pâle, coalescents, mal définis et homogènes. Au microscope, ces nodules étaient composés de feuilles denses de cellules rondes CD3-positives, compatibles avec un lymphome rénal à cellules T.Message clinique clé :Le lymphome est une tumeur courante chez le chat qui peut affecter de nombreux systèmes organiques, y compris les voies urinaires supérieures. Ce cas représente une méthode rare d'identification des lymphocytes néoplasiques via l'évaluation de l'urine cytocentrifugée et met l'emphase sur les avantages de l'examen des sédiments urinaires avec coloration de Romanowsky chez les animaux.(Traduit par Dr Serge Messier).

Rehabilitative Health Care Professionals' Perceptions of Appearance-Based Professionalism.

CONTEXT: Professionalism has been discussed and defined in a variety of ways, including attire and other forms of self-expression. OBJECTIVES: To determine athletic trainer (AT), physical therapist (PT), and athletic training or PT students' perceptions of appearance-based professionalism in the workplace and, secondly, to ascertain how perceptions differed across professions. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: Athletic trainers, PTs, and athletic training and PT students who were predominantly White, non-Hispanic, female, aged 30 ± 9 years, and recruited via listservs and social media. DATA COLLECTION AND ANALYSIS: The independent variables were participant demographics. The dependent variables were self-reported perceptions of professionalism for each photo. The survey consisted of 3 sections: demographics, 8 photos of ATs or PTs with depictions of patient-provider interactions, and open-ended responses. For each photo, participants selected yes, no, or unsure regarding the photo. An open-ended response was prompted with a no or unsure selection. The participant further described the reason for that choice. RESULTS: Most participants determined the health care provider depicted in 7 photos appeared professional. Only 1 photo was deemed unprofessional by the professional majority. Significant differences existed between students and professionals for 5 photos. The proportion of participants who reported the photos were unprofessional differed among professions for 2 photos. From our qualitative analysis, we found 6 domains: (1) unprofessional attire and hair, (2) situation-dependent attire, (3) role confusion and health care employer or employee identification, (4) nonappearance related, (5) tattoo-related bias, and (6) rethinking after question is displayed. CONCLUSION: What is considered appropriate and professional is not concrete. Differing concepts of professionalism generated biased judgments and criticisms. CLINICAL RELEVANCE: Our findings should lead providers to reexamine the definition of professionalism. The past should not dictate the future, and today's social mores can help shape the definition as it should be considered in today's settings.

Exploring Secondary School Athletic Trainers' Perspectives in Managing Mental Health Situations.

BACKGROUND: Most people believe that student-athletes experience fewer difficulties related to mental health than non-sport participants. However, several studies have shown high depression levels or emotional difficulties in adolescent athletes. Most secondary school students have access to athletic trainers in their schools. Secondary school athletic trainers (SSATs) are medical professionals who can provide health care for student-athletes, and they could be appropriate supporters in providing mental health management in secondary schools. However, there are no studies that have addressed their preparedness and confidence level to manage potential risk factors and mental health disorders. This study aims to ascertain preparedness and confidence levels from SSATs' perspectives in handling mental health disorders using a survey based on the mental health management guidelines and consensus statement. METHODS: This is a cross-sectional study design. The research team created an online survey questionnaire based on the National Athletic Trainers' Association (NATA) Mental Health Guidelines for Secondary School and Interassociation Recommendation: A Consensus Statement. Utilizing the NATA Research Survey Service, the online survey was emailed to SSATs who self-categorized as secondary school athletic trainers in the NATA membership system. (n = 171, 65% completion rate). SPSS was used to analyze the survey data. RESULT: This study found that 29.2% of SSATs reported they have policies or guidelines regarding mental health disorders management for minors. The most frequent policy was mandatory reporting in cases in which an individual is being abused or neglected (80.5%). The highest confidence area was aligned with the most frequent policy. The least frequent policy was considering unique stressors and triggers with student-athletes to recognize the potential mechanisms that may cause a mental illness or exacerbate an existing mental illness (58.5%). Even though the least frequent policy was not aligned with the least confidence area, it was the second lowest confidence level. This study identified significant differences between two different employment structures: school-based employment and hospital-based employment structures. Policies were more common in school-based employment than in hospital-based employment structures. CONCLUSION: This study demonstrated the gap between organizational and individual preparation. The majority of SSATs respondents expressed moderate to high confidence in their ability to manage mental health disorders, despite the lack of mental health policies or procedures in their secondary schools. This study recommends that SSATs create guidelines or procedures in the areas where they are least confident and prepared to offer mental health management for minor student-athletes. They can use the interassociation recommendations and the NATA guidelines for mental health care to close the gap.

Athletic Trainers' Beliefs Regarding Professionalism.

CONTEXT: Limited research exists regarding athletic trainers' (ATs') perceptions of professionalism. OBJECTIVE: To explore the lived experiences of ATs and their perceptions of professionalism. DESIGN: Qualitative study. SETTING: Participants were ATs who completed a semistructured interview protocol via audio-only recording conferencing. PATIENTS OR OTHER PARTICIPANTS: Seventeen participants (age = 33 ± 8 years; range = 25-56 years) who were certified ATs with an average of 10 years of experience (SD = ±8; range = 1-33 years) were interviewed. DATA COLLECTION AND ANALYSIS: Individuals self-identified their interest in participating in a follow-up interview recruitment located within a survey. Interviews occurred until saturation was met and included a variety of participants. Demographic information was gathered from the survey for each person. All transcripts were audio recorded, transcribed verbatim, and coded using a 3-person coding team following the consensual qualitative research protocol. Member checking, auditing, and triangulation established trustworthiness and credibility in the data-analysis process. RESULTS: A total of 4 domains with supporting categories were identified. Athletic trainers spoke of the employee environment that affected perceptions of what was determined to be professional, specifically in various settings or situations. They shared their personal determination of outward appearance and expression when differentiating what was deemed professional, including references to cleanliness, judgment of self-expression, and implicit bias. Whether intentional or unintentional, participants made comments that demonstrated a bias toward sex or race and ethnicity when determining outward appearance appropriateness. They noted various cultural awareness situations, including progression of perceptions over time, external pressure, and internal dialog. Respondents shared discourse regarding an internal struggle of what was right and wrong in their responses. They discussed professionalism based on the provider's conduct, mainly in terms of communication and patient care. Participants shared that communication occurring through both verbal and nonverbal means is vital to the perceptions of professionalism for ATs. CONCLUSIONS: Current views of professionalism in athletic training were shaped by various lived experiences. With the movement toward athletic training becoming more diverse, equitable, and inclusive, antiquated professionalism ideals need to shift to provide a better work environment for all.

Organizational Expectations Regarding Documentation Practices in Athletic Training.

CONTEXT: Although guidance is available, no nationally recognized standard exists for medical documentation in athletic training, leaving individual organizations responsible for setting expectations and enforcing policies. Previous research has examined clinician documentation behaviors; however, the supervisor's role in creating policy and procedures, communicating expectations, and ensuring accountability has not been investigated. OBJECTIVE: To investigate supervisor practices regarding support, hindrance, and enforcement of medical documentation standards at an individual organization level. DESIGN: Mixed-methods study. SETTING: Online surveys and follow-up interviews. PATIENTS OR OTHER PARTICIPANTS: We criterion sampled supervising athletic trainers (n = 1107) in National Collegiate Athletic Association member schools. The survey collected responses from 64 participants (age = 43 ± 11 years; years of experience as a supervisor = 12 ± 10; access rate = 9.6%; completion rate = 66.7%), and 12 (age = 35 ± 6 years; years of experience as a supervisor = 8 ± 5) participated in a follow-up interview. DATA COLLECTION AND ANALYSIS: We used measures of central tendency to summarize survey data and the consensual qualitative research approach with a 3-person data analysis team and multiphase process to create a consensus codebook. We established trustworthiness using multiple-analyst triangulation, member checking, and internal and external auditing. RESULTS: Fewer than half of supervisors reported having formal written organization-level documentation policies (n = 45/93, 48%) and procedures (n = 32/93, 34%) and an expected timeline for completing documentation (n = 24/84, 29%). Participants described a framework relative to orienting new and existing employees, communicating policies and procedures, strategies for holding employees accountable, and identifying purpose. Limitations included lack of time, prioritization of other roles and responsibilities, and assumptions of prior training and record quality. CONCLUSION: Despite a lack of clear policies, procedures, expectations, prioritization, and accountability strategies, supervisors still felt confident in their employees' abilities to create complete and accurate records. This highlights a gap between supervisor and employee perceptions, as practicing athletic trainers have reported uncertainty regarding documentation practices in previous studies. Although supervisors perceive high confidence in their employees, clear organization standards, employer prioritization, and mechanisms for accountability surrounding documentation will result in improved patient care delivery, system outcomes, and legal compliance.

Comparison of peripheral leukocyte parameters in patients receiving conventionally and hypofractionated radiotherapy schemes for the treatment of newly diagnosed glioblastoma.

Introduction: Treatment for glioblastomas, aggressive and nearly uniformly fatal brain tumors, provide limited long-term success. Immunosuppression by myeloid cells in both the tumor microenvironment and systemic circulation are believed to contribute to this treatment resistance. Standard multi-modality therapy includes conventionally fractionated radiotherapy over 6 weeks; however, hypofractionated radiotherapy over 3 weeks or less may be appropriate for older patients or populations with poor performance status. Lymphocyte concentration changes have been reported in patients with glioblastoma; however, monocytes are likely a key cell type contributing to immunosuppression in glioblastoma. Peripheral monocyte concentration changes in patients receiving commonly employed radiation fractionation schemes are unknown. Methods: To determine the effect of conventionally fractionated and hypofractionated radiotherapy on complete blood cell leukocyte parameters, retrospective longitudinal concentrations were compared prior to, during, and following standard chemoradiation treatment. Results: This study is the first to report increased monocyte concentrations and decreased lymphocyte concentrations in patients treated with conventionally fractionated radiotherapy compared to hypofractionated radiotherapy. Discussion: Understanding the impact of fractionation on peripheral blood leukocytes is important to inform selection of dose fractionation schemes for patients receiving radiotherapy.

Consumption of Common Bean Suppresses the Obesogenic Increase in Adipose Depot Mass: Impact of Dose and Biological Sex.

Obesity prevention is stated as a simple objective in the public health guidelines of most countries: avoid adult weight gain. However, the success of the global population in accomplishing this goal is limited as reflected in the persisting pandemic of overweight and obesity. While many intervention strategies have been proposed, most are directed at mitigating the consequences of obesity. Efforts intended to prevent unintentional weight gain and associated adiposity are termed anti-obesogenic. Herein, evidence is presented that a neglected category of foods, pulses, i.e., grain legumes, have anti-obesogenic activity. Using a preclinical mouse model of obesity, a dose-response study design in animals of both biological sexes, and cooked, freeze-dried, and milled common bean as a representative pulse, data are presented showing that the rate of body weight gain is slowed, and fat accumulation is suppressed when 70% of the dietary protein is provided from common bean. These anti-obesogenic effects are reduced at lower amounts of common bean (17.5% or 35%). The anti-obesogenic responsiveness is greater in female than in male mice. RNA sequence analysis indicates that the sex-related differences extend to gene expression patterns, particularly those related to immune regulation within adipose tissue. In addition, our findings indicate the potential value of a precision nutrition approach for human intervention studies that identify "pulse anti-obesogenic responders". A precision approach may reduce the concentration of pulses required in the diet for benefits, but candidate biomarkers of responsivity to pulse consumption remain to be determined.

Interprofessional Team Collaboration for Routine and Emergent Mental Health Concerns Among Collegiate Student-Athletes: A Case Series from the Association for Athletic Training Education Research Network.

Collegiate student-athletes experience an increasing number of mental health concerns. To help address these concerns and provide high-quality health care for student-athletes, institutions of higher education are being encouraged to create interprofessional health care teams that are specifically dedicated to managing mental health. We interviewed 3 interprofessional health care teams who collaborate to manage routine and emergency mental health conditions in collegiate student-athletes. Teams represented all 3 National Collegiate Athletics Association (NCAA) divisions and included athletic trainers, clinical psychologists, psychiatrists, dietitians and nutritionists, social workers, nurses, and physician assistants (associates). The interprofessional teams indicated that the existing NCAA recommendations helped to solidify members and roles of the mental health care team; however, they all believed their teams would benefit from more counselors and psychiatrists. Teams had different mechanisms for referral and accessing mental health resources on their campuses, which may make on-the-job training for new members of the team an organizational necessity.

Caregiver survey in glioblastoma focused on cognitive dysfunction: development and results from a multicenter study.

Aim: To develop a cognitive dysfunction (CD) focused questionnaire to evaluate caregiver burden in glioblastoma. Materials & methods: The survey was developed from stakeholder consultations and a pilot study, and disseminated at eight US academic cancer centers. Caregivers self-reported caring for an adult with glioblastoma and CD. Results: The 89-item survey covered demographics, CD symptoms and caregiver burden domains. Among 185 caregivers, most were white, educated females and reported memory problems as the most common CD symptom. An exposure-effect was observed, with increase in number of CD symptoms significantly associated with greater caregiver burden. Conclusion: This questionnaire could guide caregiver interventions and be adapted for use longitudinally, in community cancer settings, and in patients with brain metastases.

Glioblastoma (GBM) is a very aggressive brain cancer. People who have GBM have trouble remembering things and are unable to do things they used to do. These changes can be very hard. Researchers are trying to better understand what it is like for people who take care of people with GBM (or caregivers). In this study, researchers created a new survey for caregivers. The survey included questions about what caregivers see happening in their loved one with GBM. Caregivers said that memory problems were common. Also, when the patient had more problems the caregiver had a harder time, too. Researchers hope to improve the survey and use it in the future for more studies.

Thwarting Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) with Common Bean: Dose- and Sex-Dependent Protection against Hepatic Steatosis.

Hepatic steatosis signifies onset of metabolic dysfunction-associated fatty liver disease (MAFLD) caused by disrupted metabolic homeostasis compromising liver function. Regular consumption of common beans reduces the risk of metabolic impairment, but its effective dose, the impact of biological sex, and underlying mechanisms of action are unknown. We fed female and male C57BL6/J mice with obesogenic yet isocaloric diets containing 0%, 17.5%, 35%, and 70% of total dietary protein derived from cooked whole common beans. Liver tissue was collected for histopathology, lipid quantification, and RNA-seq analyses. Beans qualitatively and quantitatively diminished hepatic fat deposition at the 35% dose in female and 70% dose in male mice. Bean-induced differentially expressed genes (DEGs) most significantly mapped to hepatic steatosis and revealed dose-responsive inhibition of de novo lipogenesis markers (Acly, Acaca, Fasn, Elovl6, Scd1, etc.) and triacylglycerol biosynthesis, activation of triacylglycerol degradation, and downregulation of sterol regulatory element-binding transcription factor 1 (SREBF1) signaling. Upregulated fatty acid ß-oxidation was more prominent in females, while suppression of Cd36-mediated fatty acid uptake-in males. Sex-dependent bean effects also involved DEGs patterns downstream of peroxisome proliferator-activated receptor α (PPARα) and MLX-interacting protein-like (MLXIPL). Therefore, biological sex determines amount of common bean in the diet required to prevent hepatic lipid accumulation.

Experiences of Current National Collegiate Athletic Association Division I Collegiate Student-Athletes With Mental Health Resources.

CONTEXT: Collegiate student-athletes (SAs) experience psychological stressors due to rigid schedules, team conflict, and injury. These factors can result in symptoms of mental health conditions, decreased daily functioning, and suicidality. OBJECTIVE: To explore National Collegiate Athletic Association Division I SAs' experiences with mental health and access to and experiences with mental health resources at their university. DESIGN: Consensual qualitative research study. SETTING: One-on-one interviews. PATIENTS OR OTHER PARTICIPANTS: Twenty-three Division I SAs (18 women, 5 men; mean age = 20 ± 2 years). MAIN OUTCOME MEASURE(S): Participants completed a semistructured interview that focused on their experiences with mental health. The interviews were audio recorded and transcribed verbatim via Zoom. Credibility and trustworthiness were established via member checking, triangulation, and peer discussion among a 3-person coding team. RESULTS: Two domains, increased expectations and resources and management, were identified. The participants shared how they balanced life as a college student, academic stressors, performance expectations, and a sport-first mindset they perceived from coaches and support staff. They discussed their experience with the internal support network of coaches, the athletic department, and sport psychology. Participants remarked on their external support network, which included their family, friends, and psychological services. The resources available at their institutions and their accessibility were perceived both positively and negatively. Some collegiate SAs described resources as helpful, whereas others portrayed a lack of timeliness for appointments, lack of advertisement, incomprehension by counselors of athlete demands, and no sport-specific counseling as barriers. CONCLUSIONS: Collegiate SAs expressed mental health concerns due to stress and the demands of sport participation. Self-regulated coping strategies and support networks continue to be powerful and helpful resources for mental health, with or without a diagnosed condition. Barriers to mental health service use were a lack of sport specificity and lack of access. Institutions need to focus on creating athlete-centered mental health resources with annual advertisements to increase use.

Athletic trainers' viewpoints of patient-centered care: Preliminary findings.

The core competency of patient-centered care (PCC) states that for positive patient outcomes, the provider must respect the patient's views and recognize their experiences. The Athletic Training Strategic Alliance Research Agenda Task Force identified a profession-wide belief that examining the extent to which athletic trainers (ATs) provide PCC in their clinical practice would benefit the profession. To first address this line of inquiry, we must study the subjectivity of how ATs view PCC. This study used Q methodology which is a research design that collects data from participants from a quantitative and qualitative perspective. A total of 115 (males = 62, females = 53, age = 37±10 y, experience = 13±10 y) ATs dispersed between 11 job settings volunteered for this study. Participants were asked to pre-sort (agree, disagree, neutral) 36 validated statements representing the 8 dimensions of PCC, then completed a Q-sort where they dragged-and-dropped the pre-sorted statements based on perceived importance in providing PCC. The Q-sorts were analyzed using QMethod software. A principal component analysis was used to identify statement rankings and factors. Factors were determined by an Eigenvalue > 1 and analyzed using a scree plot. The 6 highest selected statements per factor were assessed to create the distinguishing viewpoints. Two distinguishing viewpoints emerged from the factor analysis of the Q-sorts: 1) the interpersonal connection that valued teamwork, open communication, and respectful care with varied populations; 2) the holistic gatekeeper that valued personal promotion for activities of daily living, self-care, and quality of life. Overall, ATs value patient's preferences and respect. However, a lack of importance was identified for incorporating the disablement model which is a core competency and adopted framework by the athletic training profession.

GammaTile® brachytherapy in the treatment of recurrent glioblastomas.

BACKGROUND: GammaTile® (GT) is a recent U.S. Food and Drug Administration (FDA) cleared brachytherapy platform. Here, we report clinical outcomes for recurrent glioblastoma patients after GT treatment following maximal safe resection. METHODS: We prospectively followed twenty-two consecutive Isocitrate Dehydrogenase (IDH) wild-type glioblastoma patients (6 O6-Methylguanine-DNA methyltransferase methylated (MGMTm); sixteen MGMT unmethylated (MGMTu)) who underwent maximal safe resection of recurrent tumor followed by GT placement. RESULTS: The cohort consisted of 14 second and eight third recurrences. In terms of procedural safety, there was one 30-day re-admission (4.5%) for an incisional cerebrospinal fluid leak, which resolved with lumbar drainage. No other wound complications were observed. Six patients (27.2%) declined in Karnofsky Performance Score (KPS) after surgery due to worsening existing deficits. One patient suffered a new-onset seizure postsurgery (4.5%). There was one (4.5%) 30-day mortality from intracranial hemorrhage secondary to heparinization for an ischemic limb. The mean follow-up was 733 days (range 279-1775) from the time of initial diagnosis. Six-month local control (LC6) and twelve-month local control (LC12) were 86 and 81%, respectively. Median progression-free survival (PFS) was comparable for MGMTu and MGMTm patients (~8.0 months). Median overall survival (OS) was 20.0 months for the MGMTu patients and 37.4 months for MGMTm patients. These outcomes compared favorably to data in the published literature and an independent glioblastoma cohort of comparable patients without GT treatment. CONCLUSIONS: This clinical experience supports GT brachytherapy as a treatment option in a multi-modality treatment strategy for recurrent glioblastomas.

Rapid Interval Recurrence of Glioblastoma Following Gross Total Resection: A Possible Indication for GammaTileⓇ Brachytherapy.

Glioblastoma recurrence between initial resection and standard-of-care adjuvant chemoradiotherapy (CRT) is a negative prognostic factor in an already highly aggressive disease. Re-resection with GammaTileⓇ(GT Medical Technologies Inc., Tempe, AZ) placement affords expedited adjuvant radiation to mitigate the likelihood of such growth. Here, we report a glioblastoma patient who underwent re-resection and GammaTileⓇ (GT) placement within two months of the initial gross total resection due to regrowth that reached the size of the original presenting tumor. The patient subsequently received concurrent temozolomide and 60 Gy external beam to regions outside of the brachytherapy range, fulfilling the generally accepted Stupp regimen. The patient tolerated the treatment without complication. The dosimetrics and implications of the case presentation are reviewed.

Pre-Clinical Insights into the Iron and Breast Cancer Hypothesis.

Population studies, systematic reviews, and meta-analyses have revealed no relationship between iron status and breast cancer, a weak positive association, or a small protective effect of low iron status. However, in those studies, the authors concluded that further investigation was merited. The set of experiments reported here used preclinical models to assess the likely value of further investigation. The effects of iron status on the initiation and promotion stage of mammary carcinogenesis are reported. Using the classical model of cancer initiation in the mammary gland, 7,12 dimethyl-benz[α]anthracene-induced carcinogenesis was unaffected by iron status. Similarly, excess iron intake showed no effect on the promotion stage of 1-methyl-1-nitrosurea-induced mammary carcinogenesis, though iron deficiency exerted a specific inhibitory effect on the carcinogenic process. Though iron-mediated cellular oxidation is frequently cited as a potential mechanism for effects on breast cancer, no evidence of increased oxidative damage to DNA attributable to excess iron intake was found. The reported preclinical data fail to provide convincing evidence that the further evaluation of the iron-breast cancer risk hypotheses is warranted and underscore the value of redefining the referent group in population-based studies of iron-cancer hypotheses in other tissues.

Compositional Changes of the High-Fat Diet-Induced Gut Microbiota upon Consumption of Common Pulses.

The gut microbiome is involved in the host's metabolism, development, and immunity, which translates to measurable impacts on disease risk and overall health. Emerging evidence supports pulses, i.e., grain legumes, as underutilized nutrient-dense, culinarily versatile, and sustainable staple foods that promote health benefits through modulating the gut microbiota. Herein, the effects of pulse consumption on microbial composition in the cecal content of mice were assessed. Male mice were fed an obesogenic diet formulation with or without 35% of the protein component comprised by each of four commonly consumed pulses-lentil (Lens culinaris L.), chickpea (Cicer arietinum L.), common bean (Phaseolus vulgaris L.), or dry pea (Pisum sativum L.). Mice consuming pulses had distinct microbial communities from animals on the pulse-free diet, as evidenced by ß-diversity ordinations. At the phylum level, animals consuming pulses showed an increase in Bacteroidetes and decreases in Proteobacteria and Firmicutes. Furthermore, α-diversity was significantly higher in pulse-fed animals. An ecosystem of the common bacteria that were enhanced, suppressed, or unaffected by most of the pulses was identified. These compositional changes are accompanied by shifts in predicted metagenome functions and are concurrent with previously reported anti-obesogenic physiologic outcomes, suggestive of microbiota-associated benefits of pulse consumption.

Ethics consultations in neuro-oncology.

BACKGROUND: Management of patients with brain tumors can lead to ethical and decisional dilemmas. The aim of this study was to characterize ethical conflicts encountered in neuro-oncologic patients. METHODS: Retrospective review of ethics consultations performed upon patients with primary and metastatic brain tumors at a tertiary cancer center. An ethics consultation database was examined to characterize ethical conflicts, contextual factors, and interventions by the consultation team. RESULTS: Fifty consultations were reviewed; 28 (56%) patients were women, median age 54 (range 4-86); 27 (54%) patients had a primary central nervous system malignancy; 20 (40%) had brain metastasis. At the time of consultations, 41 (82%) patients lacked decisional capacity; 48 (96%) had a designated surrogate decision maker; 3 (6%) had an advance directive outlining wishes regarding medical treatment; 12 (24%) had a Do Not Attempt Resuscitation (DNAR) order. Ethical conflicts centered upon management of end-of-life (EOL) circumstances in 37 (72%) of cases; of these, 30 did not have decisional capacity. The most common ethical issues were DNAR status, surrogate decision making, and request for nonbeneficial treatment. Consultants resolved conflicts by facilitating decision making for incapacitated patients in 30 (60%) cases, communication between conflicting parties in 10 (20%), and re-articulation of patients' previously stated wishes in 6 (12%). CONCLUSIONS: Decisional capacity at EOL represents the primary ethical challenge in care of neuro-oncologic patients. Incomplete awareness among surrogate decision makers of patients' prognosis and preferences contributes to communication gaps and dilemmas. Early facilitation of communication between patients, caregivers, and medical providers may prevent or mitigate conflicts and allow the enactment of patients' goals and values.

Building a Foundation for Precision Onco-Nutrition: Docosahexaenoic Acid and Breast Cancer.

In vivo evidence of heterogeneous effects of n-3 fatty acids (N3FA) on cell signaling pathways associated with the reduced growth of breast cancer has been reported and is consistent with the expectation that N3FA will not exert uniform effects on all molecular subtypes of the disease. Similarly, available evidence indicates that many metabolites of N3FA are synthesized by mammalian cells and that they exert metabolite-specific biological activities. To begin to unravel the complex relationships among molecular subtypes and effects exerted by specific N3FA metabolites on those pathways, proof-of-concept experiments were conducted using cell lines representative of common molecular subtypes of human breast cancer. N3FA differed in anticancer activity with docosahexaenoic acid (DHA) having greater anticancer activity than eicosapentaenoic acid. 4-oxo-docosahexaenoic (4-oxo-DHA), a penultimate metabolite of 5-lipoxygenase mediated DHA metabolism, induced dose-dependent inhibition of cell number accumulation with apoptosis as a primary effector mechanism. Interrogation of protein expression data using the Ingenuity Pathway Analysis (IPA) bioinformatics platform indicated that 4-oxo-DHA differentially impacted six canonical pathways and the cellular functions they regulate across common molecular subtypes of breast cancer. This included the endocannabinoid pathway for cancer inhibition that has not been previously reported. These findings provide a rationale for juxtaposing molecular subtype targeted treatment strategies with the adjuvant use of specific N3FA metabolites as an example of precision onco-nutrition (PON) for the management and control of breast cancer.

Athletic Trainers' Perceptions of Accessibility to Necessary Resources for Those Working Per Diem Services.

CONTEXT: As the demand for athletic training services has grown, the per diem athletic training setting has expanded to fulfill this need. Per diem services are provided by athletic trainers (ATs) who are hired as independent contractors for short time periods. These service opportunities help to increase access to care for medically underserved populations; however, due to the transient nature of the work, the quality of care may be compromised. OBJECTIVE: To examine current practices in per diem services and evaluate ATs' accessibility to resources. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: A total of 448 participants responded (access rate = 9.57%), of whom 210 were ineligible (46.9%). Of those who were eligible, 192 participants completed the entire tool (completion rate = 80.7%, age = 38 ± 12 years, years certified = 14 ± 11, years providing per diem services = 8 ± 8). MAIN OUTCOME MEASURE(S): The survey comprised 3 sections: (1) demographics, (2) accessibility to resources and influence on patient care, and (3) domains of athletic training while providing per diem services. Resources assessed included those that are relevant to ATs practicing in accordance with the Board of Certification "Standards of Professional Practice." The final instrument included approximately 30 questions (depending on display logic) and took an average of 12 minutes to complete. RESULTS: Of the 11 primary resources assessed, participants had limited accessibility to 6. Critical resources related to informatics, legalities, and health care delivery were often not available, were seen as unimportant to providing medical services, or both. CONCLUSIONS: Participants indicated varied perceptions about the need for and access to these resources. Yet such resources contribute to the creation of a safe infrastructure for providing medical services and should be part of the routine dialogue regarding independent contracting.

Preparedness, Confidence, and Best Practices in Preventing, Recognizing, Managing Mental Health Cases in NCAA Institutions.

CONTEXT: Currently, the National Collegiate Athletic Association (NCAA) recommends written policies and procedures that outline steps to support student athletes facing a mental health challenge and the referral processes for emergency and non-emergency mental health situations. OBJECTIVE: To assess the mental health policies and procedures implemented and athletic trainers' perceived confidence in preventing, recognizing and managing routine and crisis mental health cases across all three divisions of NCAA athletics. DESIGN: Cross-sectional survey design and chart review. SETTING: Online survey Participants: Athletic trainers with clinical responsibility at NCAA member institutions (n=1091, 21.5% response rate). MAIN OUTCOME MEASURE(S): Confidence in screening, preventative patient education, recognizing and referring routine and emergency mental health conditions (5-point Likert scale: 1= not at all confident, 2= hardly confident, 3= somewhat confident, 4= fairly confident, 5=very confident) using a content-validated survey (Cronbach's α=0.904) and mental health policy and procedure chart review. RESULTS: Respondents indicated they felt "fairly confident" with screening (40.21%, n=76/189) for risk of any mental health condition and "fairly confident" in implementing preventative patient education (42.11%, n=80/190). Respondents were "fairly confident" they could recognize (48.95%, n=93/190) and refer (45.79%, n=87/190) routine mental health conditions. Respondents were "fairly confident" they could recognize (46.84%, n=89/190), but "very confident" (46.32%, n=88/190) they could refer mental health emergencies. Policies lacked separate procedures for specific emergency mental health situations such as suicidal/homicidal ideation (36.1%), sexual assault (33.3%), substance abuse (19.4%), and confusional state (13.9%). Policies lacked prevention measures such as student athlete involvement (16.7%) in annual mental health education (16.7%). CONCLUSIONS: While athletic trainers were generally confident in their ability to address emergency and routine mental health conditions, opportunities exist to improve policies for prevention, screening, and referral. Best practice guidelines should be used as a guide to develop policies that foster an environment of mental health wellness.