The prioritization of English language in clinical research is a barrier to translational science. We explored promising practices to advance the inclusion of people who speak languages other than English in research conducted within and supported by NIH Clinical Translational Science Award (CTSA) hubs. Key informant interviews were conducted with representatives (n = 24) from CTSA hubs (n = 17). Purposive sampling was used to identify CTSA hubs focused on language inclusion. Hubs electing to participate were interviewed via Zoom. Thematic analysis was performed to analyze interview transcripts. We report on strategies employed by hubs to advance linguistic inclusion and influence institutional change that were identified. Strategies ranged from translations, development of culturally relevant materials and consultations to policies and procedural changes and workforce initiatives. An existing framework was adapted to conceptualize hub strategies. Language justice is paramount to bringing more effective treatments to all people more quickly. Inclusion will require institutional transformation and CTSA hubs are well positioned to catalyze change.

Background: To enrich our understanding of the impact of Alzheimer’s disease (AD) CSF biomarker testing on patients and caregivers, we examined these perspectives within the IMPACT-AD BC study. Methods: IMPACT-AD BC (NCT05002699, impactAD.org) is an observational, longitudinal study examining the impact of AD CSF biomarker testing (i.e., amyloid-beta and tau proteoforms) on personal and medical utility, and health economics. Patients underwent AD biomarker testing as part of medical care (n=142), and for the personal utility arm, a subset of patients (n=34), and their ‘care partner’ (n=31), were interviewed post-biomarker disclosure to understand their decision-making to undergo testing and the impact of learning the test results. Results: The primary consideration in patients’ decision to undergo testing was the desire for diagnostic clarity (63%). After biomarker result disclosure, patients’ positive feelings stemmed largely from having greater diagnostic certainty (55%) and the ability to plan for the future (23%), including making financial changes (58%) and care plans (21%). Care partners conveyed that biomarker testing provided needed information to help plan for the future and spurred them to connect with community resources. Conclusions: Patients and care partners value the diagnostic clarity from AD biomarker testing and use the information to make informed future plans.

Background: Within the IMPACT-AD BC study, we sought to address the gap in knowledge around how the use of Alzheimer’s disease (AD) CSF biomarker testing impacts clinical management. Methods: IMPACT-AD BC (NCT05002699, impactAD.org) is an observational, longitudinal study examining the role of AD CSF biomarker testing (i.e., amyloid-beta and tau proteoforms) in medical and personal decision-making, and health economics. For medical decision-making, physicians completed surveys on patient management plans before and after receiving the biomarker findings. Overall change in management was assessed as a composite measure of changes in the use of: (i) AD symptomatic medications, (ii) other dementia-relevant medications, (iii) diagnostic procedures, and (iv) referrals or counselling. Results: Of the 142 participants, 66% were determined to have CSF biomarker profiles on the AD continuum. Overall change in management was observed in 89% of patients, with the greatest changes by category being: diagnostic procedures > referrals and counselling > AD symptomatic medications > other dementia-relevant medications. Conclusions: The use of AD CSF biomarker testing increases diagnostic confidence and aids in medical decision-making. Notably, the addition of biomarker testing leads to a reduction in the use of other diagnostic procedures, helps optimize pharmacotherapy and results in increased physician-patient/family member counselling.

Infants and children born with CHD are at significant risk for neurodevelopmental delays and abnormalities. Individualised developmental care is widely recognised as best practice to support early neurodevelopment for medically fragile infants born premature or requiring surgical intervention after birth. However, wide variability in clinical practice is consistently demonstrated in units caring for infants with CHD. The Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative, formed a working group of experts to create an evidence-based developmental care pathway to guide clinical practice in hospital settings caring for infants with CHD. The clinical pathway, “Developmental Care Pathway for Hospitalized Infants with Congenital Heart Disease,” includes recommendations for standardised developmental assessment, parent mental health screening, and the implementation of a daily developmental care bundle, which incorporates individualised assessments and interventions tailored to meet the needs of this unique infant population and their families. Hospitals caring for infants with CHD are encouraged to adopt this developmental care pathway and track metrics and outcomes using a quality improvement framework.

Introduction: Despite recent advances in resuscitation, some patients remain in ventricular fibrillation (VF) after multiple defibrillation attempts during out-of-hospital cardiac arrest (OHCA). Vector change defibrillation (VC) and double sequential external defibrillation (DSED) have been proposed as alternate therapeutic strategies for OHCA patients with refractory VF. The primary objective was to determine the feasibility, safety and sample size required for a future cluster randomized controlled trial (RCT) with crossover comparing VC or DSED to standard defibrillation for patients experiencing refractory VF. Secondary objectives were to evaluate the intervention effect on VF termination and return of spontaneous circulation (ROSC). Methods: We conducted a pilot cluster RCT with crossover in four Canadian paramedic services and included all treated adult OHCA patients who presented in VF and received a minimum of three defibrillation attempts. In addition to standard cardiac arrest care, each EMS service was randomly assigned to provide continued standard defibrillation (control), VC or DSED. Services crossed over to an alternate defibrillation strategy after six months. Prior to the launch of the trial, 2,500 paramedics received in-person training for VC and DSED defibrillation using a combination of didactic, video and simulated scenarios. Results: Between March 2018 and September 2019, 152 patients were enrolled. Monthly enrollment varied from 1.4 to 6.1 cases per service. With respect to feasibility, 89.5% of cases received the defibrillation strategy they were randomly allocated to, and 93.1% of cases received a VC or DSED shock prior to the sixth defibrillation attempt. There were no reported cases of defibrillator malfunction, skin burns, difficulty with pad placement or concerns expressed by paramedics, patients, families, or ED staff about the trial. In the standard defibrillation group, 66.6% of cases resulted in VF termination, compared to 82.0% in VC and 76.3% of cases in the DSED group. ROSC was achieved in 25.0%, 39.3% and 40.0% of standard, VC and DSED groups, respectively. Conclusion: Findings from our pilot RCT suggest the DOSE VF protocol is feasible and safe. VF termination and ROSC were higher with VC and DSED compared to standard defibrillation. The results of this pilot trial will allow us to inform a multicenter cluster RCT with crossover to determine if alternate defibrillation strategies for refractory VF may impact patient-centered, clinical outcomes

Studies of suicidal behaviour have provided valuable information about the risk factors associated with these behaviors, yet there is not much information about predictors of transitions from suicidal thoughts to actual suicide behavior.The current study aims to elucidate the mechanisms in which suicidal ideation emerges over time and how suicidal ideation can lead to suicidal actions.We attempt to determine the effects of psychopathology, non-suicidal self-injury (NSSI) and risk behaviors on suicidal behavior. This is examined through our model of youth suicidal behavior based on the theoretical framework of Joiner's Interpersonal Theory of Suicide.

Lieder and Griffiths rightly urge that computational cognitive models be constrained by resource usage, but they should go further. The brain's primary function is to regulate resource usage. As a consequence, resource usage should not simply select among algorithmic models of “aspects of cognition.” Rather, “aspects of cognition” should be understood as existing in the service of resource management.

Our recent discovery of hazardous concentrations of arsenic in shallow sedimentary aquifers in Cambodia raises the spectre of future deleterious health impacts on a population that, particularly in non-urban areas, extensively use untreated groundwater as a source of drinking water and, in some instances, as irrigation water. We present here small-scale hazard maps for arsenic in shallow Cambodian groundwaters based on >1000 groundwater samples analysed in the Manchester Analytical Geochemistry Unit and elsewhere. Key indicators for hazardous concentrations of arsenic in Cambodian groundwaters include: (1) well depths greater than 16 m; (2) Holocene host sediments; and (3) proximity to major modern channels of the Mekong (and its distributary the Bassac). However, high-arsenic well waters are also commonly found in wells not exhibiting these key characteristics, notably in some shallower Holocene wells, and in wells drilled into older Quaternary and Neogene sediments.

It is emphasized that the maps and tables presented are most useful for identifying current regional trends in groundwater arsenic hazard and that their use for predicting arsenic concentrations in individual wells, for example for the purposes of well switching, is not recommended, particularly because of the lack of sufficient data (especially at depths >80 m) and because, as in Bangladesh and West Bengal, there is considerable heterogeneity of groundwater arsenic concentrations on a scale of metres to hundreds of metres. We have insufficient data at this time to determine unequivocally whether or not arsenic concentrations are increasing in shallow Cambodian groundwaters as a result of groundwater-abstraction activities.

Excavations at the 109 hectare site of Kurd Qaburstan on the Erbil plain in the Kurdistan Region of Iraq were conducted by the Johns Hopkins University in 2013 and 2014. The Middle Bronze Age (Old Babylonian period) is the main period of occupation evident on the site, and the project therefore aims to study the character of a north Mesopotamian urban centre of the early second millennium b.c. On the high mound, excavations revealed three phases of Mittani (Late Bronze) period occupation, including evidence of elite residential architecture. On the low mound and the south slope of the high mound, Middle Bronze evidence included domestic remains with numerous ceramic vessels left in situ. Also dating to the Middle Bronze period is evidence of a city wall on the site edges. Later occupations include a cemetery, perhaps of Achaemenid date, on the south slope of the high mound and a Middle Islamic settlement on the southern lower town. Faunal and archaeobotanical analysis provide information on the plant and animal economy of the second millennium b.c. occupations, and geophysical results have documented a thirty-one hectare expanse of dense Middle Bronze Age architecture in the northern lower town.

Firestone & Scholl (F&S) rely on three problematic assumptions about the mind (modularity, reflexiveness, and context-insensitivity) to argue cognition does not fundamentally influence perception. We highlight evidence indicating that perception, cognition, and emotion are constructed through overlapping, distributed brain networks characterized by top-down activity and context-sensitivity. This evidence undermines F&S's ability to generalize from case studies to the nature of perception.