Fruit and Vegetable Intake, Food Security, Barriers to Healthy Eating, and Empowerment Among Dietetic Interns and Physician Assistant Interns: A Cross-Sectional Pilot Study

Students are required to complete supervised practice hours prior to becoming Registered Dietitians and Physician Assistants. Research suggests that environmental and social factors affect dietetic interns’ diets during their internship, although these factors have not been studied among physician assistant interns. This cross-sectional study utilized an online survey to compare dietetic interns’ (n = 81) and physician assistant interns’ (n = 79) fruit and vegetable intake, food security, barriers to healthy eating, and empowerment for making healthy dietary choices during an internship. Differences were assessed via independent t-tests and chi-square distributions. The significance was set at p \u3c 0.05. Dietetic interns had a higher vegetable intake (p = 0.002) while physician assistant interns had higher rates of food insecurity (p = 0.040). Dietetic interns reported a greater impact on their dietary choices due to mental fatigue (p = 0.006), while physician assistant interns’ dietary choices were more heavily impacted by peer influence, interactions with patients, and interactions with preceptors (p \u3c 0.05). There was not a group difference in overall empowerment (p = 0.157), although both groups rated empowerment for asking for help with food and nutrition challenges the lowest of the empowerment sub-items. Addressing interns’ unique needs may support students’ educational success and wellbeing once they are professionals, promote a diverse workforce, and ensure optimal care for patients

The clinical and cost effectiveness of surgical repair of partial rotator cuff tears in patients with subacromial shoulder pain: a comparison of surgical repair versus surgery with no repair. Partial Rotator Cuff Repair Trial (PRoCuRe Trial)

Aims and objectives: To assess if surgical repair of partial rotator cuff tears is effective in patients with persistent shoulder pain despite physiotherapy and steroid injection. Background: Rotator cuff tears are shoulder tendon tears causing pain, weakness and loss of movement, leading to problems with daily activities, work, recreation and sleep. Tears can be full thickness (whole tendon) or partial. Patients who do not get better with non-operative treatments may choose surgery. Although rotator cuff tears cause pain and disability, it is not known which surgery is best or if repairing partial tears prevents full tears and worsening problems. Methods: We planned a randomised controlled trial across 20 UK NHS hospitals . Between July 2021 and August 2022 we aimed to recruit 376 patients over 18 years of age suffering persistent shoulder pain and partial rotator cuff tears . Eligible patients received arthroscopic (keyhole) surgery to either debride (shave away inflamed tissue, rough tear edges and bone spurs) and repair the tear, or debride only without repair. Patients were followed up using questionnaires. Key findings: This study of an elective surgical procedure was severely impacted by the COVID-19 pandemic, especially staff shortages, sickness and redeployment. Changes post pandemic to the patient pathway and national surgical prioritisation processes had a major impact on identifying eligible patients with partial tears. All these factors effected site set-up and patient recruitment. The study closed early due to slow recruitment. Only 10 patients from 9 NHS Trusts were randomised, precluding any meaningful analysis . Patient and public involvement: Patients were involved in the study design, set up and monitoring. Conclusions and future plans: The impact of the pandemic prevented trial progression and this research question is now likely to remain unanswered. Detailed post-pandemic feasibility work is needed before attempting a similar study

Nurse prescribing evaluation 1 The initial training programme and implementation : final report

Includes bibliographical references. Title from coverAvailable from British Library Document Supply Centre- DSC:m03/27622 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

A spatio-temporal assessment of simian/human immunodeficiency virus (SHIV) evolution reveals a highly dynamic process within the host

<div><p>The process by which drug-resistant HIV-1 arises and spreads spatially within an infected individual is poorly understood. Studies have found variable results relating how HIV-1 in the blood differs from virus sampled in tissues, offering conflicting findings about whether HIV-1 throughout the body is homogeneously distributed. However, most of these studies sample only two compartments and few have data from multiple time points. To directly measure how drug resistance spreads within a host and to assess how spatial structure impacts its emergence, we examined serial sequences from four macaques infected with RT-SHIV_mne027, a simian immunodeficiency virus encoding HIV-1 reverse transcriptase (RT), and treated with RT inhibitors. Both viral DNA and RNA (vDNA and vRNA) were isolated from the blood (including plasma and peripheral blood mononuclear cells), lymph nodes, gut, and vagina at a median of four time points and RT was characterized via single-genome sequencing. The resulting sequences reveal a dynamic system in which vRNA rapidly acquires drug resistance concomitantly across compartments through multiple independent mutations. Fast migration results in the same viral genotypes present across compartments, but not so fast as to equilibrate their frequencies immediately. The blood and lymph nodes were found to be compartmentalized rarely, while both the blood and lymph node were more frequently different from mucosal tissues. This study suggests that even oft-sampled blood does not fully capture the viral dynamics in other parts of the body, especially the gut where vRNA turnover was faster than the plasma and vDNA retained fewer wild-type viruses than other sampled compartments. Our findings of transient compartmentalization across multiple tissues may help explain the varied results of previous compartmentalization studies in HIV-1.</p></div

Compartmentalization relationships between different samples reveal transient and stable patterns.

<p>Probability of a significant pairwise compartmentalization test between vRNA subsampled from each compartment for the four macaques (columns) over time (x-axis). Each row represents comparisons between the vRNA in each compartment marked at the right (from top to bottom: plasma, PBMC, LN, gut and vagina vRNA) to all other compartments. Because all pairwise relationships are shown for each compartment, lines are repeated (i.e., the lymph node versus plasma line is present in both the lymph node and plasma rows). The y-axis indicates the proportion of K_ST tests significant at the 5% significance level when subsampled to 10 sequences per compartment 1000 times. Coloration indicates that the comparison was done between the focal compartment for the row and plasma (green), PBMC (pink), LN (purple), gut (dark blue) or vagina (light blue). Rx1 is treatment FTC+TFV+EFV and Rx2 is the treatment TFV+L870812+DRV/r.</p

Compartmentalization test results reveal pairwise RT-SHIV RNA compartmentalization relationships between blood, lymph node, gut, and vagina.

<p>Each circle summarizes the results of three compartmentalization tests performed pairwise between the vRNA from compartments within a macaque at a given time, and the position of the segment represents the test performed (left: KST, top-right: Slatkin-Maddison (SM), bottom-right: AMOVA). The coloration indicates the probability of a significant test result at the 5% significance level when subsampling 10 sequences from each compartment averaged across each macaque and all time points with red indicating a high probability and white indicating a low probability of a significant test. The area of the segment indicates the number of comparisons contributing to that average (i.e., the number of time points with a sufficient number of sequences in each compartment within a macaque). Because we used 10 unique subsampled sequences to perform the SM test, the SM test could not be performed on some macaque time points, resulting in smaller sample sizes (see <a href="http://www.plospathogens.org/article/info:doi/10.1371/journal.ppat.1006358#sec011" target="_blank">Materials and Methods</a> for details).</p

Summary of results from a subset of HIV-1 compartmentalization studies.

<p>Summary of results from a subset of HIV-1 compartmentalization studies.</p

Drug resistance increase over time across all compartments.

<p>Drug resistance was defined as the proportion of vRNA (dashed lines) or vDNA (solid lines) sequences having K103N and/or M184V/I within each compartment for animals T98133, A99039, and A99165. Gray shading indicates the FTC or EFV treatment periods for the macaques.</p

Change in compartmental viral composition over time varies by compartment and drug pressure.

<p>For each macaque, K_ST tests are plotted between all time points with adjacent samples (i.e., week 12 or 13 compared to week 15 or 16) for each compartment (vRNA top, vDNA bottom). Black dots indicate time points with samples of at least 3 sequences. Red lines indicate that a K_ST test comparing those two samples is significantly different (with a 5% FDR). Grey lines indicate a failure to reject the null hypothesis of being well-mixed at the 5% FDR level. Grey shading indicates monotherapy or combination therapy, as indicated below the x-axis. Rx1 is treatment FTC+TFV+EFV and Rx2 is the treatment TFV+L870812+DRV/r.</p