The excess incidence and mortality due to prostate cancer that impacts African American men constitutes the largest of all cancer disparities. Patient navigation is a patient-centered healthcare system intervention to eliminate barriers to timely, high-quality care across the cancer continuum and improves health outcomes among vulnerable patients. However, little is known regarding the extent to which navigation programs include cultural humility to address prostate cancer disparities among African American men. We present a scoping review protocol of an in-depth examination of navigation programs in prostate cancer care—including navigation activities/procedures, training, and management—with a special focus on cultural context and humility for African American men to achieve health equity.We will conduct comprehensive searches of the literature in PubMed, Embase, Web of Science, and CINAHL Complete, using keywords and index terms (Mesh and Emtree) within the three main themes: prostate cancer, patient navigation, and African American men. We will also conduct a search of the gray literature, hand-searching, and reviewing references of included papers and conference abstracts. In a two-phase approach, two authors will independently screen titles and abstracts, and full-text based on inclusion/exclusion criteria. All study designs will be included that present detailed data about the elements of navigation programs, including intervention content, navigator training, and/or management. Data will be extracted from included studies, and review findings will be synthesized and summarized.A scoping review focused on cultural humility in patient navigation within the context of eliminating disparities in PCa care among African American men does not yet exist. This review will synthesize existing evidence of patient navigation programs for African American prostate cancer patients and the inclusion of cultural humility. Results will inform the development and implementation of future programs to meet the unique needs of vulnerable prostate cancer patients in safety net settings.CRD42021221412PROSPERO 2021  Prostate cancer (PCa) is the second most common cancer among men in the United States of America (USA) . The grePatient navigation is an evidence-based intervention that can help reduce racial/ethnic disparities in cancer care , 18. LauThe National Cancer Institute (NCI) implemented the Patient Navigation Research Program to address the need for standardization of navigation programs across health systems  and defiWe aim to conduct a scoping review that examines navigation programs among African American men facing PCa from screening through survivorship, to uncover specific components and processes of navigation, including cultural humility to meet the unique needs of this underserved population, and how navigation is used to address disparities in quality of care. We will explore the following programmatic characteristics: (a) types of navigators—nurse, lay, peer, etc.; (b) navigators’ background and training; (c) managing navigators—who and how; (d) navigation activities/protocol; and (e) impact and outcomes measured. Results from this review will inform the development and implementation of an intervention protocol and training curriculum for peer navigation in safety net settings for African American men newly diagnosed with PCa.Our team will conduct a scoping review to identify published articles regarding navigation for African American men with PCa to explore details of cultural tailoring in navigation protocols, training of navigators, and measured outcomes. We chose a scoping review over a systematic review given our objective to examine the scope of relevant literature and inform practice of future patient navigation programs for African American men facing PCa . This prAll types of study designs will be included in this review. We will include studies of adult (18 years and older) males facing PCa. While we are focused on African American men, studies with other racial/ethnic groups will be considered for inclusion if at least 30% of participants were African American/Black men. Studies that describe or investigate navigation programs or interventions for PCa from screening through survivorship will also be eligible. We define navigation programs and interventions as any formal or informal, structured process designed to help patients overcome barriers to timely and effective health care . For exaTo identify published literature, we will conduct a comprehensive search of the following electronic databases: PubMed, Embase, Web of Science, and CINAHL Complete. All publication dates will be included through June 2022 (our anticipated end search date). To identify gray literature , the authors will hand search reference lists of included articles, conference abstracts, and conduct specialized Google searches. We will attempt to contact the corresponding author for conference abstracts found to get access to detailed information and results presented when no corresponding peer-reviewed publication is found. Abstracts and other gray literature will be excluded if no results or detailed information is obtained. Our biomedical research librarian (PT) developed search hedges along these three themes: PCa, peer navigation, and African American men. The peer navigation theme was expanded with terms encompassing community outreach, health disparities, community-based research, communication, education, health knowledge, decision making, and more. We used both keywords and index terms (Mesh and Emtree) in the construction of our searches. Complete search strategies for all databases are listed in Table Citations from the aforementioned databases will be collated, organized, and exported to the online Zotero bibliography management tool that can be shared among team members. Duplicates will be identified and removed. Remaining citations will move forward to the study selection process.Three team members  will independently review and screen articles for the study selection process based on the inclusion and exclusion criteria in a two-step process. One reviewer (ANS) will screen all of the articles, and two additional reviewers (BAC and GA) will screen 50% of the articles each. First, two members will independently review article titles and abstracts, to assess eligibility of the articles against the inclusion criteria, and will note inclusion for further review or reason for exclusion. All marginally relevant articles and those that do not contain enough information to determine eligibility  will be retained. For phase II, two members  will independently review the full text of articles, noting inclusion or reason for exclusion based on our criteria. For both phases, the two reviewers will discuss decisions and any discrepancies to reach consensus. When consensus cannot be reached, outstanding conflicts will be resolved by a third reviewer (NRP or TMF) who has extensive experience in conducting reviews relevant to cancer care –50. ReasPrior to data extraction, three independent reviewers  will pilot test five included articles and refine our data extraction form based on their feedback. This will also enable us to develop clear instructions to ensure relevant results are extracted and all reviewers understand the data extraction process. We will build an electronic database for our data extraction form using REDCap (Research Electronic Data Capture)—a secure, web-based system supported by our institution for building and managing research projects, such as building databases, collecting data, and data validation . Each reperson, extended family, neighborhood], (2) relationships and expectations , and (3) cultural empowerment . Cultural identity highlights the target audience or intervention points of entry . Relationships and expectations highlight attitudes and beliefs of one’s social network that support or hinder health behaviors and health decisions. Cultural empowerment highlights cultural beliefs and practices that have positive, neutral/harmless, or negative health consequences. The PEN-3 model will guide the extraction of key words related to integrating culturally relevant factors to develop navigation programs—for example, how programs were shaped and messages clarified. Additionally, some concepts necessary for cultural humility include, but are not limited to, creating a safe environment that is respectful and nurturing; integrating humanities curricula ; collaborating with community-based/public health experts; and understanding the role of language in patient-provider relationships [We will extract data based on metrics set by the NCI Patient Navigation Research Program  and knowowerment  [positivionships . Data exTwo reviewers  will independently assess study quality and risk of bias using the Mixed Methods Appraisal Tool (MMAT) —a tool tWe will report this scoping review following the PRIMSA-ScR format, which includes a checklist of 27 essential items for transparent reporting , 59. In Culturally tailored patient navigation provides a viable solution to the unique systemic problems faced by African American/Black men with PCa within the healthcare system. Previous reviews have investigated patient navigation programs for underserved populations across the cancer care continuum, noting more research is needed beyond screening and diagnosis, and outside of breast and colorectal cancers . FurtherWe will disseminate findings from this scoping review via institutional and community partnerships, local and national presentations, and a peer-reviewed publication. We plan to utilize findings to inform expansion of our public hospital’s current cancer navigation program, led by a team member (BC). We will prepare presentations for (a) patients and community members within our networks , (b) health care providers engaged in PCa care , and (c) local and national scientific meetings . Similarly, we will share findings with cancer-relevant community-based initiatives, such as the San Francisco Cancer Initiative—a cross-sector coalition to reduce cancer disparities , 61. We


Brand influencers and celebrities, politicians, and science communicators had above average post engagement while public health and government and news media had lower. Finally, most influencers saw the largest proportion of neutral sentiment comments. Crisis messages must be designed to include combinations of constructs that increase message acceptance and influence risk perception and efficacy to increase the adoption of recommended and mandated behaviours.Successful mitigation of emerging infectious disease requires that the public adopt recommended behaviours, which is directly influenced by effective crisis communication. Social media has become an important communication channel during COVID-19 where official actors, influencers, and the public are co-creating crisis messages. Our research examined COVID-19-related crisis messages across Canadian influencer accounts within news media, politicians, public health and government, science communicators, and brand influencer and celebrities, posted on Instagram between December 2019 and March 2021 for Health Belief Model and Extended Parallel Processing Model constructs and the corresponding public comment sentiment and engagement. Thirty-three influencer accounts resulted in a total of 2,642 Instagram posts collected, along with 461,436 comments, which showed overall low use of constructs in both captions and images. Further, most posts used no combinations ( Behaviour change is an important outcome of many public health initiatives, including those surrounding the COVID-19 pandemic. Successful mitigation of COVID-19 requires that the public follows public health recommendations, including mask wearing, physical distancing, and getting vaccinated. Effective crisis communication can increase adherence to public health measures, which is necessary to reduce the burden of COVID-19 and other public health emergencies. Effective crisis communication is an essential element of the strategic response to COVID-19 where people are empowered to follow recommendations. Not only is effective crisis communication essential for the shorter term uptake of public health recommendations, but it has important longer term impacts including preventing pandemic fatigue, encouraging vaccine uptake and engagement with the healthcare system, and importantly, maintaining trust [Practice and research have resulted in guiding principles for effective crisis communication that should be used to increase acceptance of and adherence to messages. Guiding principles for effective communication include communicating uncertainty and with transparency, being first and empathic, and ensuring information is clear and targeted to various subpopulations –5. HowevIn Canada, governments, public health and healthcare, and other actors at all levels have implemented measures to slow the spread of COVID-19. Issues with distrust among the public , criticiSocial media is an important communication channel for crisis communication, especially during COVID-19, and Canadians are spending more time on social media than ever before . A 2019 Social media provides an excellent channel through which to share information quickly to subpopulations by targeting and tailoring information and selecting appropriate platforms . PartnerSocial media monitoring provides important evidence about the impact of social media communication. Analyzing data gives insight into how content is preforming with audiences, identifying key influencers, analyzing trends, and identifying what strategies work best for different audiences . Many ofGiven the complexity of crisis communication and its ultimate goal of ensuring the adoption of public health measures, theory-driven public health messaging may be more effective to persuade individuals to follow recommended behaviours . One of Additionally, the Extended Parallel Processing Model (EPPM) conceptualizes aspects of the HBM to explain how message components including perceived severity and susceptibility, and efficacy can lead to either rejection or adoption of protective behaviours –37. Two The HBM and EPPM have been used to assess social media messages during emerging infectious diseases by examining the presence of the constructs of each model and the relationship with message transmission, effectiveness, and behaviour intentions. For example, a quantitative content analysis of vaccine-related influenza tweets was analyzed for HBM constructs and user engagement during the 2018 and 2019 flu seasons and found messages contained high fear content but low efficacy content and resulted in low engagement . A COVIDMuch of the research using the HBM and EPPM has been to evaluate whether the constructs are effective at influencing behaviour change, usually by involving participants in the research to assess how they perceive constructs in messages and their corresponding behavioural intentions . HoweverThe aim of this research is to describe and compare how different Canadian influencers on Instagram are incorporating HBM and EPPM constructs in their COVID-19-related crisis messages and how the messages are being received by publics.To describe the number of COVID-19 Instagram posts, average number of comments, average number of loves, average number of replies, and average post engagement rate across influencer categories .To describe the trinary sentiment  of comments related to included Instagram posts by influencer category.To describe the use of severity, susceptibility, benefits, barriers, and cues to action/efficacy in COVID-19 Instagram text captions across influencer categories.To describe the use of severity, susceptibility, benefits, barriers, and cues to action/efficacy in COVID-19 Instagram images across influencer categories.To describe the presence of the EPPM danger control and fear control processes in COVID-19 Instagram captions and images across influencer categories.The objectives of this research include:As per the University of Guelph’s Research Ethics Board, ethics approval for this study was not required as it used publicly available Instagram pages.Posts made between December 31, 2019  and March 3, 2021  were included when the post was in English, was an Instagram post , and related to COVID-19 . Additionally, influencers residing or operating in Canada that represented an actual person or organizational account were included when they were macro-level influencers with no less than 100,000 followers or were relevant to the federal level. Posts were excluded if the comments were turned off the post, posts that contained videos rather than a picture, or advertisement posts.Instagram posts related to COVID-19 from influencers across five categories  were manually collected by three researchers in March 2021. Influencers relevant to the federal level were chosen for news media, politicians, and public health and government. Science communicators and brand influencers and celebrities were chosen using HypeAuditor  and StarNGage, which is no longer available at the time of writing. Influencer ranking works but analyzing real followers and authentic engagement  daily for accounts with more than 10,000 followers to compare influencers with the highest following and engagement . The topEach included influencer’s Instagram page was accessed, and posts related to study inclusion criteria were manually collected including the account information , total number of posts during inclusion dates, post caption, post image captured by screenshot, number of comments, number of loves, and comments and replies on included posts. Comments and replies were automatically collected using the Phantombuster Instagram Post Commentors automation, which accesses the Instagram Application Programming Interface .An identification letter was created for each influencer and a combination of the identification letter and a unique number was used for each post. An Excel spreadsheet  was usedThe number of comments, loves, and replies were collected, as well as total number of followers for each influencer.A post engagement rate was calculated for each post by totalling engagements by post (number of loves + number of comments) dividing by total number of followers, multiplied by 100 . The posSentiStrength (Java version) was used to conduct a trinary sentiment analysis of follower comments . Each coTo improve the accuracy of the results, some of the word’s pre-assigned scores were modified as they were inaccurately driving negative results, which can occur during highly specific events such as the COVID-19 pandemic . For exaThe constructs of the HBM and EPPM were used to assess crisis communication messages for constructs of behaviour change and risk perception models that can predict message acceptance and adoption of behaviour change. The constructs and corresponding definitions can be found in Table n = 265) and captions (n = 256) separately for the HBM constructs using NVivo 12 Plus [A codebook describing each construct was created and a codebook training session with the involved researchers occurred before coding began. Two researchers independently coded a 10% random sample of the data , followed by politicians 2.94), science communicators (2.87), public health and government (0.78), and finally news media (0.64). See Table .94, scieThe pattern of sentiment differed across influencer types Table  and was p < 0.05). The trinary sentiment analysis of comments and replies made on included Instagram posts showed the largest percent of comments were neutral for news media (43%), politicians (51%), public health and government (43%), and brand influencers and celebrities (52%). Science communicators was the only influencer category that saw the largest percentage of comments classified as positive (49%). The percentage of negative comments compared to positive and neutral was lowest across all influencer sources. and thus no combinations of constructs, were the most common for all influencer categories except public health and government for which one was the most common number of HBM constructs in post captions. Influencer categories made relatively few posts with HBM construct combinations (n = 2 or more constructs). Post captions with 5 constructs were between 0 posts  to 1 post (news media and science communicators).When examining the number of HBM constructs used per post caption Table , posts wn = 2 or more constructs). With only one exception, no images contained 4 or 5 HBM constructs across influencer categories.Similarly, when examining the number of constructs used per post image Table , most frn = 38 or 3.6% of total constructs for news media), followed by science communicators for severity and cues to action/efficacy . The combined presence of severity and susceptibility and cues to action/efficacy was highest among news media (1.2%), followed by science communicators (0.8%), and public health and government (0.7%). A statistically significant (p < 0.05) relationship was found between the combinations of threat and efficacy messages and source.Threat (susceptibility and severity) and efficacy (efficacy and cues to action) were examined in combination Table  in captin = 14 or 2%). Only news media (n = 2 or 0.2%) and science communicators (n = 3 or 0.5%) shared images that combined both threat and cues to action/efficacy. The relationship between constructs and source was not found to be statistically significant.Threat and efficacy were examined in combination Table  to assesThis research analyzed COVID-19-related crisis communication on Instagram by Canadian influencers including news media, politicians, public health and government, science communicators, and brand influencers and celebrities. Our analysis examined whether influencer crisis communication employed HBM and EPPM constructs within Instagram captions and images, as well as the corresponding engagement rate and sentiment of public comments in response to the posts. Our research found that across influencers, the HBM constructs are not being widely incorporated into captions and images, especially in combination. Further, the combination of threat appeals and efficacy, which elicit the danger control process, are rarely incorporated in Instagram captions across influencer categories. Finally, in terms of public response to messaging, neutral sentiment of comments to COVID-19-related Instagram posts was the most common for all influencer types except for science communicators, for whom positive sentiment comments were the most common. Average post engagement rate was highest for brand influencers and celebrities and lowest for news media and public health and government.Much of the prior research examining the use of HBM constructs in crisis communication is experimental and focused on examining social media posts made by publics for the constructs. For example, Meadows et al. (2019) examined 3000 tweets posted by publics during the California measles outbreak for HBM constructs. They found individuals were more likely to discuss severity, while organizations were most likely to offer cues to action . Other sIn terms of post engagement rate, the average rate per post across all types of posts and accounts was 2.02% in 2020 . InteresAnother COVID-19-related study found that celebrities who shared their lived experience influenced risk perception and reinforced public health recommendations . A studyMonitoring social media for sentiments and emotions is another important way for actors to assess the effectiveness of their crisis communication . Our resOverall, the most frequent use of a construct was severity-related information on Instagram captions made by politicians (60%) and public health and government (60%). Susceptibility information was not widely included with 17% or less of captions and 16% or less of images across influencer categories. Benefits, barriers, and cues to action/efficacy were incorporated inconsistently between influencer categories and captions and images. Past research examining influenza vaccine behaviour found that severity, susceptibility, barriers, and cues to action/efficacy together were significantly related to intention to get vaccinated . Another study that examined COVID-19 vaccine behaviour found that self-efficacy was an important predictor of vaccine behaviours and play a mediating role with other constructs including barriers, benefits, and cues to action . Cues ton = 0 -1 or an average of 60% for captions and 94% for images) of constructs. Posts with 5 constructs in captions (average of 0.2% of posts) and images (average of 0% of posts) were extremely uncommon across influencer categories. The combination of 4 constructs in captions (average of 1% of posts) was slightly higher for captions but quite low in comparison to other combinations. While there are various theories regarding variable ordering in the HBM, a recent study regarding an influenza vaccination campaign found that variable ordering is complex but there is significant interaction between each variable [Influencer categories saw most posts with no combination  in captions with declining numbers across the other combinations and categories. The combination of threat (severity and susceptibility) and cues to action/efficacy in captions was highest for news media (1.2%) and between 0- 0.7% across the other influencer categories. Lower combinations were found within post images, with science communicators sharing images with higher combinations of threat and cues to action/efficacy (2%) with most combinations across influencers being 0 or under 1%. The EPPM theorizes the combination of threat and efficacy can elicit the danger control process, which impacts beliefs, attitudes, intentions, and behaviours in accordance with the message recommendations . When thThe findings of our research provide public health and other actors important information about providing crisis messages that reflect theory. Importantly, combining the constructs of the HBM and the EPPM to be able to adequately influence behaviour in crisis messages must be improved. Captions tended to include more constructs than images, representing an important area for improvement. Images are the most viewed aspect compared to captions and should convey the constructs to influence behaviour. Additionally, a focus specifically on combining threat and cues to action/efficacy to influence the danger control process where individuals understand the threat of the disease is high and understands how to protect themselves and feels able to do so. Finally, the response to messaging can be improved, especially with official actor messages. Public health had a lower than average engagement rate with their posts and overall the great proportion of comments were neutral, which was also seen for news media. Public health should consider monitoring social media to assess the effectiveness of messaging and incorporate aspects of messages shown to increase engagement and positive sentiment. Finally, partnering with brand influencers and local celebrities can help amplify public health messages within a captive and responsive audience.Using Instagram as the social media platform of choice was a source of limitations for this study. Namely, the manual data collection necessary when using Instagram limits the amount of data that can be collected when compared to automatically collecting data using a platform’s API. Additionally, young adults represent the largest group present on Instagram with older adults using the platform much less compared to Facebook. In addition, different audience segments may follow the various influencers included in this research, which may impact sentiment and engagement. As such, it is important to also evaluate crisis communication on other social media platforms for quality and public response, including engagement and sentiment. Additionally, the vast number of variables that can be collected related to Instagram posts, such as engagement metrics, comments and replies, and caption and image information provide a rich dataset that can be analyzed many ways. As such, our research presents descriptive statistics that describe the various variables included in this research. Future research should focus on further analyzing the relationships between variables to better understand if and how HBM constructs are related to engagement and sentiment. Finally, the HBM and EPPM include constructs that are centered on individual perception. To evaluate whether actors are using HBM and EPPM constructs in crisis communication, constructs were operationalized to reflect key features that can be identified in messages. Further research can involve participants to understand their perception related to various constructs and how they impact behavioural intentions related to COVID-19 and other public health emergencies.Theory-driven crisis communication plays an important role in mitigating the burden of disease during emerging infectious disease through impacting risk perception, efficacy, and ultimately the adoption of behaviours that reduce disease spread. Health Belief Model and Extended Parallel Processing mode constructs theorize that individuals will adopt behaviours to prevent disease when constructs are included in messaging. Our research found low use of constructs across crisis Instagram messages by a variety of influencer accounts during COVID-19. Moreover, extremely low combinations of constructs, including those that include threat and efficacy, were found. Neutral sentiment was highest for most accounts in response to crisis messages. Public health and government and news media were found to have lower than average engagement rates on their posts, while celebrities, brand influencers, and science communicators had higher engagement. These influencers represent important spokespersons with large followings and strong connections with their followers. Public health and government should partner with influencers who can amplify accurate public health information, influence risk perception, reach subpopulations, and increase trust. Overall, constructs should be combined in crisis messages to improve crisis communication, increase message acceptance, and influence risk perception and empower individuals to adopt risk protective measures.


This study aimed to identify methodological aspects involved in determining anthropometric measurements among studies assessing the nutritional status of individuals with cystic fibrosis (CF).A search of the literature was performed on MEDLINE via Pubmed, Embase, and Web of Science databases. The population comprised children and adolescents with CF. Observational studies and clinical trials using anthropometric and body composition measures and indices determined by dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance assessment (BIA) were included. Use of a standardized procedure for data collection was defined when details on the instruments and their calibration were given, the measuring procedures were described, and when it was clear measures had been determined by a trained team, or the use of an anthropometric reference manual was cited. Data extracted were expressed as absolute and relative frequencies.2; 35%), weight , and height . Among the 28 studies that used anthropometric measures, 21 (75%) provided a complete or partial description of the measurement instruments used, 3 (11%) reported information on equipment calibration, 10 (36%) indicated the measurement procedures employed by assessors, and 2 (7%) stated a trained team had carried out the measurements.A total of 32 articles were included, and a total of 233 measures or indices were observed. The most frequently used measures were body mass index (kg/mThe poor description of measuring procedures precluded a meaningful evaluation of data quality. Scientific debate on this theme can help raise awareness of the need to ensure quality in collecting and fully presenting data. In spite of therapeutic improvements in recent years, according to the Brazilian Cystic Fibrosis Registry (Registro Brasileiro de Fibrose Cística), the median age at death is 19.4 years. Malnutrition and recurrent pulmonary exacerbations are recognized strong predictors of CF mortality.Cystic fibrosis (CF) is a hereditary recessive genetic disease that affects several organs and systems because of dysfunction of the CFTR  above the 50th percentile because this is associated with better pulmonary function. Weight gain should thus take place through an increase in lean mass as opposed to body fat only. Besides BMI monitoring, body composition evaluation methods such as skinfolds measurement, dual-energy X-ray absorptiometry (DXA), and bioelectrical impedance assessment (BIA) are recommended.Close monitoring of nutritional status is recommended for CF individuals, through periodical follow-up of anthropometry and body composition parameters. Since the validity of results of any survey depends on the absence of systematic methodological errors, measurements such as weight and height must be obtained through accurate procedures to be suitably interpreted.The most used method for nutritional assessment, anthropometry, is frequently associated with measurement errors in patients, introduced by instruments, operators, or changes in the subjects’ body composition.The objective of this study was to identify methodological aspects involved in determining anthropometric measurements among studies assessing the nutritional status of children and adolescents with CF. Preliminary searches of the International Prospective Register of Systematic Reviews (PROSPERO) and JBI Evidence Synthesis revealed no previous reviews on the topic, justifying the conducting of the present scoping review.https://jbi.global), and the study protocol was registered with the Open Science Framework (https://osf.io/q2acf/). A systematic search of the literature was performed on MEDLINE via PubMed, Embase, and Web of Science databases. The following research questions were addressed: Which anthropometric and body composition measures are used for evaluating the nutritional status of children and adolescents with CF in clinical practice and in research?Are standardized procedures employed to obtain these anthropometric measurements? and Which reference populations are used to classify the nutritional status of people with CF?The study was carried out based on the recommendations of the Joanna Briggs for scoping reviews . The population comprised children and adolescents with CF of both genders. Concept was defined as anthropometric data, including the use of simple anthropometric measurements:Eligibility criteria were as follows: articles that included children and adolescents with CF, age 6–18 years, even if individuals of other ages were also assessed; involved evaluation of nutritional status or evolution of childhood growth, or the statistical relationship of anthropometric and body composition measurements with clinical outcomes, such as pulmonary function; and used at least one of the anthropo-metric measurements or indices cited in the main concept of the present study.Exclusion criteria were as follows: studies that included hospitalized subjects, individuals on a lung, pancreas, or liver transplantation waiting list, those who had undergone any type of transplant surgery, pregnant women, and individuals with associated conditions such as celiac disease, Crohn’s disease, or cancer. Experimental studies assessing the pharmacodynamics and pharmacokinetics of drugs or studies with self-referenced body composition or anthropometric measurements were also excluded.The search strategy was defined by two reviewers (FMDE and DPB) who conducted independent searches. The search included observational studies or clinical trials pursuant to the study objective. To make the scoping review possible, the studies included were restricted to those published between January 2014 and December 2021 and to those articles in English and Portuguese.Specific descriptors for each database were used: MeSH terms  in Pubmed and thesaurus Emtre® in Embase®. Initially, keywords associated with the PCC acronym were searched in Pubmed and then in the other databases; adaptations were made when no corresponding matches were found in the MeSH terms. The terms were linked by Boolean operators AND (restriction) and OR (addition) and constituted search phrases  used on An initial selection of the studies was made based on titles and abstracts, independently by two authors (FMDE and DPB). When abstracts did not include age group or a description of anthropometric or body composition measurements, the methods section of the article was consulted. Differences were resolved by consensus. The original checklist contains 27 questions and was devised and validated to assess the methodological quality of observational studies and clinical trials on the domains of reporting, external validity, internal validity (bias), confounding/selection bias, and power. Because the present study included articles with different designs, only questions 1, 2, 3, 5, 6, 7, 10, 11, 12, 16, and 20 were applied. Differences were resolved by consensus. The maximum possible score for each article was 12 points. Articles scoring 9 or more points were considered eligible. For question 20 [“Were the main outcome measures used accurate ?”], only the methodological aspects pertaining to the use of anthropometric and body composition data to focus on the abovementioned concept were evaluated.As part of the selection process, two independent reviewers (FMDE and DPB) applied the Downs and Black checklist. namely, Anthropometric and body composition measures and indices used;Source of each measurement – either by direct measurement or extracted from medical record;Details on instruments, such as manufacturer, type, and scale;Calibration of instruments;Details on measuring procedures, such as descriptions of measuring techniques, clothing worn, and presence of accessories;Training given;Use of anthropometric reference manual;Reference curves; andCriteria for grading nutritional status.Data were extracted to characterize the studies and methodological aspects that allowed the use of standardized anthropometric data collection procedures,The data extracted were recorded by the two independent evaluators (FMDE and DPB) using a chart. Differences were resolved by consensus.The data obtained were analyzed using the statistical software package Stata version 13  and expressed qualitatively (descriptive text) or quantitatively (in tables) in the form of absolute and relative frequencies.The initial search resulted in the retrieval of 667 articles, excluding duplicates; 249 (37%) of these were subsequently selected. Of this initial total, 32 (13%) articles were considered eligible and included in this scoping review  and 2.1Regarding study type, 22 (69%) were cross-sectional, 8 (25%) were longitudinal, and 2 (6%) were clinical trials. Studies were mostly carried out in Europe (34%), South America (25%), and North America (22%). Sample size ranged from 15 to 42,921: 24 (75%) studies involved fewer than 100 subjects with CF, 5 (16%) had 101–500 subjects, and 3 (9%) included more than 500 subjects  and 2.1 For anthropometric data, a similar proportion of measures (52%) and indices (48%) were employed. The most frequently used anthropometric measures were body weight , height , and BMI . For body composition, DXA was the most frequently used measuring technique ; lean mass was determined by DXA in 25% (n=14) of measurements.The articles employed, on average, seven measures or indices . Overall, a total of 233 measures or indices were used, predominantly derived from anthropometry  .11-42 Of the total anthropometric measurements reported (n=85), 60 (71%) comprised primary data collected during study execution, 17 (20%) were secondary data obtained from medical records, and 6 (7%) involved data extracted from patient Registries, while for 2 (2%) studies, the first measurement was performed directly and the remainder was obtained from medical records.Of the total studies (n=28) which used anthropometric measures, 21 (75%) reported full or partial details on the measuring instruments applied, 3 (11%) provided information on instrument calibration, 10 (36%) detailed the measuring procedures applied by evaluators, and 2 (7%) reported giving training to the team that took the measurements. The anthropometric measures employed by the studies, together with methods applied, are listed in  to define the measuring procedures.Three (4%) articles cited the use of reference manuals and of the World Health Organization (WHO); however, references were also made to specific populations such as Italian, Greek, Egyptian, Dutch, and British. The cutoff points adopted by the authors were mainly derived from consensuses or specific recommendations for CF subjects.The most commonly cited reference populations were those of the Centers for Disease Control and Prevention (CDC)This review identified anthropometry as the most widely used tool for nutritional assessment of individuals with CF, where BMI (35%), body weight (33%), and height (33%) were the most commonly reported measures. Few articles described the methods used to obtain measurements, hampering the assessment of these aspects. Ascertaining the quality of the technical procedures adopted in the studies and in clinical practice is the key to minimize misclassifications of nutritional status, which may impact clinical and nutritional approaches in treatment planning. This critical review of the leading articles concerning nutritional assessment of CF individuals revealed that, although the instruments used for most of the anthropometric measurements were reported, very few studies described calibration procedures. This finding implies a significant risk of systematic errors. In addition, few studies described measuring procedures in detail, compromising reliability and affecting the potential for comparisons between reference values and other values of interest. In addition, few measurements were taken by trained investigators, and the use of standardized procedures by others studies remained merely implicit.Methodological studies with a focus on assessing the quality of anthropometric measures in CF are scarce. states that each specialized center should maintain calibrated anthropometric instruments and measurement protocols and also perform team training, in order to ensure reliable measurements. Since many studies included in this review used data taken from medical records, these recommendations seem to be critical to avoid inaccurate conclusions. Studies carried out using medical record-based data may not be reliable due to failures in recording of the data, different approaches used to obtain measurements, or missing data from the medical records. The same criticism may be applied to studies based on patient registries, since these may include the additional bias of methodological heterogeneity in measurements collected by different institutions. This possible source of error can be reduced by adopting standard criteria for datum measurement and quality control during the collection of data. Professional capacity building and the standardization of techniques may also improve the precision and accuracy of measurements.The “Consensus Report on Nutrition for Pediatric Patients” with CF the importance of error-free measurements lies in the fact that statistics are incapable of correcting an unreliable datum. Unreliable data may lessen the strength of correlation between variables, result in incorrect decisions for tests of hypotheses, and reduce the power of statistical tests, leading to the need to increase the sample size.According to Fleiss, and 17 subjects with CF. As the power of the statistical test is intrinsically related to sample size, a difference between groups may not be detected when the sample size is too small. The decision to include all patients may mitigate precision issues, but if the measurements are not standardized, other methodological errors may remain and jeopardize the internal validity of the results. Measurement errors in the nutritional evaluation of individuals with CF may have significant implications for the patient’s overall status and impact treatment decisions.Since CF is a fairly rare disease, studies involving patients with CF include relatively small samples, generally fewer than 100 patients. The current review identified studies that included only 15 and DXA has emerged as the preferred approach to investigate body composition in the case of individuals with CF. However, its high cost has been a constraint to broader application of the technique.The finding that anthropometry was the most frequent measure adopted in the nutritional studies was expected, given that they have validated psychometric properties, are readily collected, and are of low cost. The ability of BMI to evaluate body composition is still a matter of debate,Since people with CF have the potential to grow normally, there is no specific growth curve for this group. The usual reference values for the general population, such as the CDC and WHO curves, were the most frequently adopted in the studies.The studies describing body fat and lean mass used equations derived from anthropometric measurements, resistance and reactance measurements of BIA, or measurements provided by DXA. These data may have intrinsic limitations, since the equations may have been constructed for other populations or be specific for the manufacturers of the DXA apparatus.Limitations of the present study included constraints on the search period and language of publication. The defining of the score for considering a study eligible was arbitrary and may have led to the exclusion of some important articles. However, all restrictions served to reduce the number of articles and make the review possible. No complementary searches of other sources, such as gray literature, were carried out, given the articles obtained included different anthropometric and body composition methods generally recommended.The findings of this review highlight the key role played by hospitals and health services as a source of data in CF. Nutritional assessment is important to guide decisions on patient treatment. Scientific debate on this theme can help raise awareness of the need to ensure quality in collecting and presenting complete data, allowing readers to analyze the internal validity of the studies.In studies evaluating nutritional status of children and adolescents with CF, few details were given on the measurement procedures used to obtain the commonly used anthropometric measures, hindering a more far-reaching analysis of the nutritional picture in CF and aggregation of data.


Implementing Point-of-care ultrasound (POCUS) in community practice could help to decide upon and prioritise initial treatment, procedures and appropriate specialist referral or conveyance to hospital. A recent literature review suggests that image quality, portability and cost of ultrasound devices are all improving with widening indications for community POCUS, but evidence about community POCUS use is needed in the UK. We aimed to explore views of clinical practitioners, actively using ultrasound, on their experiences of using POCUS and potential facilitators and barriers to its wider implementation in community settings in the UK.We conducted a qualitative interview study with practitioners from community and secondary care settings actively using POCUS in practice. A convenience sample of eligible participants from different clinical specialties and settings was recruited using social media adverts, through websites of relevant research groups and snowball sampling. Individual semi-structured interviews were conducted online using Microsoft Teams. These were recorded, transcribed verbatim, and analysed using a Framework approach supported by NVivo 12.We interviewed 16 practitioners aged between 40 and 62 years from different professional backgrounds, including paramedics, emergency physicians, general practitioners, and allied health professionals.Participants identified key considerations and facilitators for wider implementation of POCUS in community settings in the UK: resource requirements for deployment and support of working devices; sufficient time and a skilled workforce; attention to training, education and support needs; ensuring proper governance, guidelines and quality assurance; workforce considerations; enabling ease of use in assisting decision making with consideration of unintended consequences; and more robust evidence to support perceptions of improved patient outcomes and experience.POCUS could be useful for improving patient journey and health outcomes in community care, but this requires further research to evaluate outcomes. The facilitators identified could help make community POCUS a reality.The online version contains supplementary material available at 10.1186/s12913-023-09069-4. In the wake of the current pandemic, the Beneficial Changes Network (BCN) was established in England to explore how health care provider systems and the public used innovations to respond to COVID-19 and to continue to provide quality healthcare for individual patients and populations. In line with this, point-of-care ultrasound (POCUS) has been identified as technology that could support clinical practice in community settings, particularly in prehospital and primary care.POCUS involves the use of a highly portable ultrasound system at the side of the patient wherever they might be. While this might be by trained clinicians at the patient’s bedside in hospital settings , the incPOCUS could play an important role in patient care, as evidence suggests POCUS could help to prioritise initial treatment and transportation of a patient to the most appropriate hospital , 5. ThisA further systematic review found that image quality and portability of ultrasound devices were improving while equipment costs were decreasing, and indications for prehospital POCUS were widening . AnotherDespite these positive developments, most of the evidence comes from outside the UK, and there is therefore a need for further research about the use or role of POCUS in the UK to support its future implementation in UK community settings , 10. ThiWe conducted a qualitative interview study with practitioners who used POCUS in their routine practice. Participants were from community and secondary care settings, and interviews were conducted online via Microsoft Teams.We used non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) technology implementation framework  and DiffA convenience sampling approach through social media and a snowballing technique were used to recruit eligible participants. The inclusion criteria were practitioners (irrespective of gender) using ultrasound in practice, willing to participate in individual interviews using telephone or video, and willing to give informed consent. The research team had expertise in qualitative research. It was estimated that 15 to 20 participants would generate sufficient data to address the objectives of the study, but we planned to continue interviewing until data saturation in code and meaning  was achiFollowing ethics approval, participants were identified by using a flyer advertising the study on social media (Twitter) and websites of relevant research and professional groups. This was supplemented using a snowballing approach with those interviewed identifying further participants. Interested participants contacted the researcher (JA) who sent further details of the study, including a Participant Information Sheet and a Consent Form, by email.Interviews were conducted via Microsoft Teams (video conferencing software), each lasting around an hour, following a topic guide that had been collectively developed by the research team (see below).The interviews were audio recorded, transcribed verbatim and analysed using a Framework  approachWith the initial codes in mind, the various stages of Framework analysis were followed: familiarisation; identifying a thematic framework; indexing; charting; mapping and interpretation . SubsequThis systematic approach provided a clear audit trail from raw data to final themes, thus ensuring trustworthiness of the results , 17. In A total of 16 practitioners, aged between 40 and 62 years, with a range of professional backgrounds including paramedics, prehospital emergency physicians, general practitioners (GPs) and allied health professionals, participated in the interviews : 32-item checklist.


Mental health concerns have become a common problem among college students. Studies have shown that college students have a higher depression rate than the general population. The effect of campus green spaces on college students’ mental health has been widely studied. However, the internal mechanism of campus green spaces affecting college students’ mental health is not fully discussed. The data came from a cross-sectional survey of 45 Chinese universities. This paper discussed the relationship between campus green spaces, academic achievement, and college students’ mental health. Depending on gender, college students displayed different levels of mental health. The prevalence of depression among female students was higher than among male students. The effect of campus green spaces on mental health was higher in males than females, while the effect of campus green spaces on academic achievement had little gender difference. We call for the construction, improvement, and renewal of campus green spaces in the future not only to meet the needs of different gender groups, but also to pay more attention to the needs of female college students and improve the differences in mental health, so as to improve the mental health of the whole college student population. The World Health Organization lists depression and mental health problems as the leading causes of disability globally . CollegeScholars of many disciplines have studied the relationship between mental health and nature, such as environmental psychology, geography, urban planning, medicine, and landscape architecture . There iStudies have shown that outdoor campus green spaces are considered a potential recovery environment, which helps students’ psychological recovery ,19 and aStudents’ success depends mainly on their academic achievement, so they have high expectations for their studies . More acPrevious studies have focused on the relationship between campus green spaces and college students’ mental health ,32,33,34Are there gender differences between Chinese college students’ mental health, campus green spaces, and academic achievement?Do campus green spaces significantly affect college students’ mental health levels and academic achievement? Does academic achievement, the intermediary variable of campus green spaces, affect the mental health of college students?Are there gender differences in the effects of campus green spaces and academic achievement on college students’ mental health status?At the same time, some scholars have paid attention to the gender differences in college students’ mental health. However, few studies have considered the reasons for gender differences in college students’ mental health. Our study focused on campus green spaces and the mental health of Chinese college students, explored whether there was a correlation between campus green spaces, academic achievement, and mental health of college students, and analyzed the differences between genders. Our research mainly addressed the following research questions:https://www.wjx.cn/app/survey.aspx, accessed on 9 November 2021) was our electronic questionnaire release. The survey was conducted under the supervision of the Academic Council of Shanghai University of Technology from 1 October 2021 to 30 January 2022. Furthermore, each college student participant completed the questionnaire voluntarily. Since the questionnaire star was an open questionnaire platform, to ensure the reliability of the data, the survey of this questionnaire was assisted by the deans, teachers, and other leaders of each university and college. In order to ensure the validity of the data, we set a password for the survey site and the login certificate and students cannot enter the certificate without the password. Students who participated in the survey were asked to answer specific related questions about the evaluation of campus green spaces, their mental health, and academic achievement. Eventually, 1261 students participated in the survey. With the effective organization of university leaders, the validity of the recovered questionnaire was as high as 98%, and 1236 valid samples were finally obtained.  evaluated depression in China. It included five positive emotional items: (1) feeling happy and comfortable; (2) feeling calm and relaxed; (3) feeling energized; (4) waking up feeling awake and well-rested, and; (5) everyday life is full of exciting things. College students’ mental health was assessed by asking the frequency of these five positive emotions in the recent two weeks. A score ranged from 6 to 0. Less than 13 points indicated depression. College students’ mental health was measured on a scale of 1 to 6. The higher score indicated better mental health.Campus green spaces were part of students’ overall life experience, and the effect of campus green spaces on college students has been confirmed ,30. The Most researchers measured students’ academic achievement around GPA . The acaIn the conceptual model of this paper, education, parental education level, and monthly expenditure were included as control variables. Education levels were assigned as follows: 1 = freshman; 2 = sophomore; 3 = junior; 4 = senior; 5 = Master1; 6 = Master2; 7 = Master3; 8 = 1st Year PhD student; 9 = 2nd Year PhD student; 10 = 3rd Year PhD student and above. The item of parental education level was scored on a scale 1 to 7  To improve female college students’ recognition of campus green spaces and relieve pressure, and; ii) To improve the effect of campus green spaces on female college students’ mental health, improve their academic achievement, and effectively improve the mental health of female college students from various aspects.More specifically, the mental health of male college students is more affected by campus green spaces. Therefore, in the future improvement and renewal of campus green spaces, the mental health level of male college students can be improved by expanding the coverage area of the campus’s natural environment. However, the mental health of female college students is affected by both environment and performance. Consequently, in the future construction of the university landscape environment, we should pay more attention to campus green spaces that affect the performance of female college students and relieve their academic pressure. According to the ART theory, we can help female college students improve their academic achievement by creating more green spaces for rest and full contact with nature in the future campus green spaces improvement and renewal so as to improve the mental health of female college students. We call for the future improvement and renewal of campus green spaces, not only to meet the needs of different gender groups, but also to pay more attention to the needs of female college students, thereby reducing the differences in mental health and improving the mental health of the overall college student population.Nevertheless, there are some limitations to the study. Firstly, the survey scope and the number of the sample are limited. This research could not represent all campus green spaces in China because only a few colleges are selected for an in-depth survey. In the future, more empirical studies need to be conducted. Furthermore, the representativeness of samples of college students must be improved. Finally, the assessment of campus green spaces is subjective. Our following research on the association between campus green spaces and the mental health of college students should combine subjective and objective assessments of campus green spaces assessments through more objective data, to better explore the relationship between campus green spaces and college students’ mental health.Our findings found differences in mental health among Chinese college students. Female college students had slightly lower mental health status than male college students. The prevalence of depression was minimally higher than that of male college students. So, we need to pay special attention to the mental health of female college students.Our study found that campus green spaces had an essential effect on college students’ mental health, and academic achievement was the mediating variable of campus green spaces affecting college students’ mental health. More importantly, we found the differences in the effects of campus green spaces on the mental health of college students of different genders. Campus green spaces had a more significant effect on the mental health of male college students, and there were minor gender differences in the influence of campus green spaces on academic achievement. There was no gender difference in the impact of performance on college students’ mental health.The conclusions of this paper provide new ideas for the construction, improvement, and renewal of the current campus green spaces. For college students, campus green spaces, academic achievement, and mental health are social ecosystems that affect each other. In order to improve the overall mental health status of college students and reduce gender differences, it is necessary to put forward targeted strategies according to the characteristics of different genders of college students.


Monkeypox virus (MPXV), an Orthopoxvirus; the wild mammalian reservoir species is not known. There are two genetic clades of MPXV: clade I and clade II , with only Cameroon reporting both clades  is a zoonotic disease caused by Annual mpox case and death counts during 2018–2021 were compiled from national surveillance data, WHO bulletins, and published case reports or outbreak investigations, and were verified with country surveillance teams; these data are presented with human mpox case report data since 1970. Since 2018, cases occurred in six African countries: Cameroon, Central African Republic (CAR), DRC, Nigeria, Republic of the Congo (ROC), and Sierra Leone  Figure)Figure). After 39 years without reports, Nigeria experienced a reemergence of cases caused by Clade II beginning in August 2017; this outbreak culminated in May 2018 with 122 confirmed or probable cases among 17 states and included seven deaths  reported working with orthopoxviruses for diagnostic (50), research (52), vaccine development (15), or manufacturing (four) purposes; and 38 (30%) worked with MPXV. Laboratories working with orthopoxviruses were present in the European (30 laboratories), Americas (21), African (11), Eastern Mediterranean (two), Southeast Asian (three), and Western Pacific (11) regions.Orthopoxvirus (Variola virus). It was during the period of intensified surveillance for smallpox-like disease in the early 1980s that the clinical presentation, epidemiology, and transmission of mpox were largely defined. It was also during this time that investigations to identify mammalian reservoir species in the regions of Africa with endemic disease (largely in DRC with clade I) occurred. Additional assessments of human disease, including refinements of the different clinical spectrum of illness and epidemiology associated with clade II, occurred during a multistate U.S. outbreak in 2003 associated with the exotic pet trade  of lesion specimens has been a standard and effective method of diagnosis of cases in persons with active rash illness. The lack of MPXV-specific serology and existence of cross-reactivity with other orthopoxviruses, including vaccinia virus, hampers the use of serology as a confirmatory test for diagnosis of an infection. This poses challenges for ecologic investigations, where wild mammals must be sampled during an active infection or soon thereafter, as detectable virus and viral DNA appear to be quickly cleared from mucosal surfaces and major organ systems in putative reservoir species (Continued advancements in laboratory diagnostic assays and validation of additional specimen types during the course of infection will aid the ability to detect MPXV, and use of these assays in areas with endemic disease will be necessary to improve surveillance capacity. Laboratory capacity for Treatment of MPXV infection in patients with immunosuppression due to health conditions is challenging (Countries with enzootic mpox face an increasingly complex epidemiologic situation, which might include extensive human-to-human transmission, in addition to zoonotic transmission. The use of nonstigmatizing methods for community engagement in populations at risk will be critical to detection and containment. Advances in diagnostics, treatments, and safer vaccines identified through basic and clinical research including during the current outbreak response might be used to improve surveillance, treatment, and prevention of disease in areas where mpox is endemic.The number of mpox cases reported from rural areas in West and Central Africa had been increasing before 2018.During 2018–2021, mpox cases were confirmed in six African countries. Eight primary and three secondary cases associated with travel to Nigeria were identified in four non-African countries. Online training courses on mpox prevention and control have been available since 2018.Mpox continues to present challenges to public health and health care personnel in endemic areas. Improvements in surveillance and community engagement will be critical to detection and containment of the virus. Vaccines and treatments might reduce morbidity and mortality in areas with endemic disease.


The National Center for Advancing Translational Science (NCATS) seeks to improve upon the translational process to advance research and treatment across all diseases and conditions and bring these interventions to all who need them. Addressing the racial/ethnic health disparities and health inequities that persist in screening, diagnosis, treatment, and health outcomes  is central to NCATS’ mission to deliver more interventions to all people more quickly. Working toward this goal will require enhancing diversity, equity, inclusion, and accessibility (DEIA) in the translational workforce and in research conducted across the translational continuum, to support health equity. This paper discusses how aspects of DEIA are integral to the mission of translational science (TS). It describes recent NIH and NCATS efforts to advance DEIA in the TS workforce and in the research we support. Additionally, NCATS is developing approaches to apply a lens of DEIA in its activities and research – with relevance to the activities of the TS community – and will elucidate these approaches through related examples of NCATS-led, partnered, and supported activities, working toward the Center’s goal of bringing more treatments to all people more quickly. At this event, NCATS Director, Dr. Joni Rutter, introduced aspirational goals over the next decade for NCATS to change from bringing “more treatments to more people more quickly” to bringing “more treatments to all people more quickly.” In her first NCATS Director’s message of 2022, Dr. Rutter affirmed the Center’s commitment to “tackle health disparities in all areas we support, while also building an organizational culture that supports diversity, equity, inclusion, and accessibility” [In December 2021, the National Center for Advancing Translational Sciences (NCATS) celebrated its 10ibility” , 4.To ensure equitable access for all communities and the advances translational science has to offer, maximum incorporation of diversity, equity, inclusion, and accessibility (DEIA) must be a central concern for translational science  includes diverse perspectives?How do we ensure research outcomes have relevance to the full diversity of the US population?How do we engage diverse populations and communities to increase involvement in research, both as collaborators and participants?How do we ensure equitable access to translational solutions ?Viewing translational science through a DEIA lens can illuminate translational roadblocks across all stages of research, among all diseases and conditions, and ensure relevance of solutions to the community. It is imperative that workforce diversity is prioritized along with the research process. Past research shows that aspects of DEIA, particularly diverse research teams, can positively impact creativity and innovation in science , and ultall people more quickly.In this paper, we describe ongoing efforts toward applying a DEIA lens across NCATS workforce and research activities. We also highlight core issues for consideration and share examples of how these considerations are being assessed in NCATS programs, operations, and practices. This paper outlines ongoing and planned efforts that illustrate NCATS’ interest and commitment to efforts that support DEIA with an understanding that these efforts will also support the Center’s mission to bring more treatments to In Summer 2020, aligned with global protests against anti-Black racism, self-assembled employee groups of Black NIH staff, who were motivated to ensure the NIH workplace culture is one free of racism, discrimination, and harassment, penned an anonymous open letter to NIH Director Francis Collins, called the Eight Changes for Racial Equity (8CRE), to address racial inequities within the NIH workforce . The letIn alignment with NIH, NCATS is examining its internal and external activities to identify and address practices that can perpetuate systemic bias and structural racism in the biomedical research workforce. This examination includes analyzing workforce diversity in both internal and external areas and identifying approaches to create inclusive environments for all members of the workforce. NCATS is working toward advancing DEIA in the translational science workforce through three activities: (1) forming the internal NCATS Inclusion, Diversity, and Equity in Action (IDEA) Council to examine NCATS’ internal workforce diversity and culture; (2) creating education and training initiatives; and (3) disseminating extramural research grants.Formed in July 2020, the NCATS IDEA Council focuses on the internal workforce and culture at NCATS. Members represent all NCATS Offices and Divisions, include both scientific and administrative positions, and are diverse by race/ethnicity and gender identity. The vision of this Council is to create a culture of belonging for people at NCATS and of inclusive excellence through holistic and innovative approaches to incorporating DEIA into NCATS activities.The IDEA Council has quickly turned its efforts toward assessing the results of NCATS employee responses to the Federal Employee Viewpoint Survey (FEVS), an annual climate survey of the Federal workforce. The FEVS shares high-level results, including employee gender and racial demographic categories. NCATS reviewed the 2020 FEVS data, identifying baseline findings by demographic group, and the Council reported these findings to NCATS leadership and to staff through all-hands town hall meetings and reports accessible to all staff. Results have been used by NCATS administration to identify specific areas for intervention  and areas for continued improvement . Due to the COVID-19 pandemic, the FEVS was conducted with different questions in 2021 and NCATS-level data were not available. NCATS is awaiting the 2022 data and plans to review that data by gender and racial demographic categories. NCATS will be able to compare the 2022 data to the 2020 baseline to examine any change in results.Additionally, the NIH is aligning its efforts with President Biden’s Executive Order 13,985 to enhance racial equity through Federal Government policies . Thus, NSubsequently, the IDEA Council organized a two-day, NCATS Supervisory staff training focused on historical and institutional racism in the United States. The goal was to establish a shared understanding of the foundations of structural racism in the United States to support discussions regarding approaches to advance DEIA across NCATS activities. Results from a post-evaluation survey of 43 out of 69 attendees revealed that, although the training was perceived as being dense with information by 35% of respondents, 67% enjoyed learning about the historical context of systemic racism and 85% were eager to learn more and address systemic racism in the workplace. Additionally, the training was successful in increasing the number of attendees from 33% pre-training to 62% post-training who indicated they had knowledge of systemic racism and how it relates to NCATS. Lastly, 74% of attendees were eager to attend more DEIA trainings. The overall positive response to this training with supervisors led to further targeted anti-racism training for supervisors and plans to offer similar trainings to all NCATS staff. NCATS staff has also participated in an NIH-wide training focused on addressing microaggressions in the workplace which was received positively by attendees, and this training was held again in Fall 2022 specifically for NCATS staff.Currently, the Council is building on these efforts through establishing workgroups to continue analyzing workforce data, plan staff educational activities, create and implement plans to diversify the translational science workforce, and develop goals for future activities. Additionally, the Council is working with an outside contractor to identify areas of strength and improvement within NCATS in building the Center’s plans to incorporate DEIA in its practices. Altogether, these efforts aim to integrate DEIA into the Center culture and empower staff to proactively incorporate DEIA into their roles. All initiatives are rigorously evaluated by Center staff to ensure DEIA initiatives are successful and continuously improved.Activities to diversify the translational science workforce will also benefit from expanded education and training opportunities that offer a broader range of entry points. This will build upon existing NCATS education and training resources that have been focused on individuals at the doctoral, postdoctoral, and early-career faculty levels , 13. ExpAdditionally, in Spring 2022, NCATS joined the NIH Science Education Partnership Awards (SEPA) Funding Opportunity Announcement supporting science education activities for students ranging from pre-kindergarten to grade 12. The overall goals of this program are to encourage individuals from diverse backgrounds, including those from underrepresented groups, to pursue further studies or careers in biomedical, behavioral, and clinical research, and help these individuals build their understanding of research and its implications. In its over 30-year history, SEPA has successfully enhanced interest in future science education and careers among diverse students . NCATS’ In addition, NCATS offers undergraduate, postbaccalaureate, graduate, and postdoctoral research training opportunities on the NIH campus at the NCATS intramural research laboratories . An eighNCATS provides funding to support extramural clinical and translational research in the Clinical and Translational Science Awards (CTSA) Program, which provided over $586 million in support to 61 research institutions in fiscal year 2021 . The CTSIn February 2022, NCATS’ CTSA Program joined an effort coordinated by the NIH Office of The Director to support retention of diverse researchers through Administrative Supplements to Recognize Excellence in Diversity, Equity, Inclusion, and Accessibility Mentorship [Prioritization of DEIA in translational science focuses on identifying challenges and opportunities to integrate DEIA into research across the translational spectrum. These challenges might be specific to a particular phase of the translational spectrum – such as basic research, clinical research, or population health research – or a more systemic issue that cuts across all research activities. Here, we share information about an internal NCATS working group that has developed an action plan for integrating DEIA across NCATS and its research activities. Then, we highlight four key considerations NCATS has explored for advancing DEIA in translational science, along with examples of NCATS-affiliated activities that reflect these considerations.In Summer 2020, the NCATS Director created the Health Disparities Working Group (HDWG) and charged the group with developing an action plan for how NCATS could leverage its activities and national leadership position in translational science toward eliminating racial/ethnic health disparities and advancing DEIA. The HDWG is a coalition of willing and committed staff from all NCATS offices and divisions, crossing all scientific and administrative roles, ranks, races/ethnicities, and genders.n = 149, 25% of the NCATS workforce) and confidential follow-up interviews (n = 27). These methodologies provided staff with an opportunity to share information about NCATS activities that could be leveraged toward a strengthened commitment to investing in DEIA and to identify opportunities for NCATS to break cycles of institutional practices that contribute to the pervasiveness of racism and health inequity. Completed in Spring 2022, the summary findings provided the foundation for developing the HDWG’s action plan. The action plan provides considerations for NCATS leadership and employees to incorporate DEIA into NCATS’ practices to address health inequities and health disparities. These considerations are categorized into three focus areas: (1) fostering an organizational culture that increases awareness and continued learning of DEIA; (2) expanding the NCATS scientific portfolio to prioritize research activities that advance the science on minority health, health disparities, and health equity; and (3) addressing practices to support a diverse workforce at NCATS and the broader translational science community. Implementation of these practices is currently in discussion by IDEA Council and NCATS leadership and will be continuously evaluated by Center staff to assess short-term outcomes and long-term impact. In terms of prioritizing research activities, next we share key strategies identified in NCATS-affiliated initiatives.To inform development of the action plan, the HDWG gathered information through an all-staff survey  create innovative approaches to provide equitable access; (2) develop intentional engagement strategies for communities who lack resources to access gene-targeted therapies; (3) democratize access to high-quality education materials; and (4) build a trustworthy field of science . DiscussAnother collaborative initiative within NCATS’ Clinical and Translational Science Awards (CTSA) Program is the Trial Innovation Network (TIN) . The TINIn this era of big data, there are many opportunities to identify, address, implement, and evaluate the effectiveness of solutions that integrate DEIA into research efforts across the translational spectrum. Inconsistencies and limitations in race/ethnicity data reporting and collection are translational science challenges hindering research on minority health and health disparities and therefore negatively impacting the entire translational spectrum. For example, imprecise and broad categorizations of race lead to information loss, preventing population-level discoveries and clinical decision-making and treatment efforts . FurtherLimitations also occur earlier in the translation process where preclinical models do not span the broad racial/ethnic groups that are observed in human populations. For example, cancer cell lines used for functional variant modeling knowledge are mostly derived from non-Latino white individuals, and to address cancer health disparities, different modeling techniques may need to be developed . Thus, tOne example of NCATS investment in informatics and big data is the National COVID Cohort Collaborative (N3C). The N3C is a partnership of NCATS with the CTSA-funded institutions, NCATS-supported National Center for Data to Health, and the National Institute for General Medical Sciences-supported Institutional Development Award Networks for Clinical and Translational Research, (IDeA-CTR). These partners worked together to obtain existing clinical data from COVID-tested patients from over 70 clinical sites across the United States, including research institutions, federally qualified health centers, and community health centers.As of May 2022, the N3C provides a national research resource for COVID-19 clinical data derived from over 5 million COVID patients, and over 70 data-contributing organizations on symptoms, medical conditions, medical care received, and more . The N3CThe N3C’s broad outreach allows for data collection representing diverse demographic and geographic groups. NCATS sought a Consultation with Tribal Nation leaders in early 2022 to solicit input on whether and how to appropriately make American Indian/Alaska Native data available to Tribal researchers and to the broader scientific research community . As of SA critical translational science challenge is addressing the health needs of underserved populations in the United States, which has been historically in need of support as reflected in funding and research . A centrNCATS is leading or collaborating on efforts to advance research with a focus on health challenges disproportionately impacting underserved populations. For example, NCATS plays a role in the NIH Helping to End Addiction Long-term (HEAL) Initiative, which aims to improve prevention and treatment strategies for opioid misuse, pain, addiction, and problems that have disproportionately burdened underserved populations . NCATS iAnother NCATS partnership is with NIH RADx-UP (Rapid Acceleration of Diagnostics-Underserved Populations) . RADx-UPLast-mile translation involves ensuring that research findings and the translational applications they produce  reach the public. A DEIA lens recognizes differential barriers to accessing understandable, accurate, and relevant information on translational findings and applications, and responds with tailored solutions. These barriers for last-mile translation can occur at any point of the translational spectrum to impact how research outcomes reach the public. For example, a DEIA lens would consider only including participants who are not underserved in clinical trials to be a barrier to applicability of approved medications to underserved populations who the disease may disproportionately impact. Another barrier to last-mile translation is access to resources in multiple languages.NCATS is investing in eliminating disparities related to last-mile translation through increasing equitable access to the Genetic and Rare Diseases (GARD) Information Center, funded by NCATS and the National Human Genome Research Institute. Viewed by a global audience of over 16 million individuals, of whom nearly 12% are Spanish-language speakers, the GARD website aims to provide users  with access to current, reliable, and accessible health information about rare and/or genetic diseases in both English and Spanish. GARD also offers multilingual support to users that request information about rare diseases to translate resources into plain language and/or Spanish.Systematic reviews for Spanish-language consumer health information technology interventions point to additional strategies for effectively disseminating research findings to diverse audiences . Beyond all people more quickly and to bringing a lens of DEIA into our activities. Along with the NIH, NCATS is examining its current activities, and considering additional efforts and processes to address long-recognized challenges caused by structural racism and advance DEIA across NCATS activities. The examples offered here demonstrate how translational science can be leveraged to advance DEIA in research and ultimately contribute to addressing health disparities and inequities. Internal NCATS considerations will include long-term sustainability and accountability through rigorous evaluation of goals and benchmarks to advance DEIA and ensure that scientific and operational aspects of translational science benefit all people equitably.NCATS is committed to applying the power of translational science to bring more treatments to


Mild traumatic brain injury (mTBI) is a widespread and serious public health problem which also causes physical and psychological suffering to patients and their families and imposes a significant economic burden on society. But it is usually very difficult to detect and provide warning of mTBI in early stage. Therefore, a novel method is urgent for the increasing demands on the accurate and rapid prediction and feature selection of mTBI.  To establish a better idea of the performance of neuroimage biomarker in the acute phase of mTBI, our study adopts diffusion tensor imaging (DTI) which could present the pathophysiological changes of white matter through several parameters noninvasively and combined with behavioral experiments such as intelligence quotient test, memory, executive function, and motion function to find the relationship between DTI abnormal brain regions and behavioral abnormalities. Then, provide new method for rapid prediction and feature selection of mTBI.  77 mTBI patients were admitted to the Emergency and Neurosurgery Departments of the Third Xiangya Hospital of Central South University from August 2019 to July 2021; the patients  suffered mTBI because of car accident (36), assault (11), and fall (30). All the mTBI patients were examined through MRI scan and behavioral psychology test within 3 days after injury. MRI images and behavioral psychology tests were also collected; the correlation between the DTI biomarker and the cognitive psychological outcome was analyzed. A series of integration and computational methods were also used for fusion arithmetic and result analysis.  Compared with the healthy control group, the patients in the acute stage of mTBI presented lower scores in the digit symbol substitution test (DSST), suggesting that mTBI patients in the acute stage had decline in information processing speed and associative learning. The difference of DTI parameters in acute stage mTBI patients was mainly manifested as increased AD and MD values in multiple brain regions, while RD and FA values have no significant difference. The most significant brain regions were bilateral corticospinal tracts (CST), bilateral posterior internal capsule lentiform nucleus, bilateral superior longitudinal fasciculus, left terminal striae, and left sagittal plane with right posterior thalamic radiation. The Pearson correlation coefficient was significantly positive correlation between AD and MD elevation in the left sagittal layer and the results of DSST and digit span in acute stage mTBI patients.  The acute phase mTBI patients performed lower score on the DSST than those in the normal control group. This neuropsychological change was associated with increased AD value and MD value in the left sagittal layer, which indicated reduction of information processing speed in mTBI patients in the acute phase. It might be related to abnormal AD value and MD value in the upper longitudinal tract, lower longitudinal tract, lower frontal occipital tract, and sagittal layer. In this study, combined with neuropsychological test and increase of the AD value and MD value in certain brain region, neurosurgeon should pay more attention to the abnormal of the upper longitudinal tract and the patients' information processing speed in the diagnosis and treatment of the acute phase mTBI patients. The study offers a much more secure and integrated method for rapid prediction and feature selection of mTBI, which could have broader clinical approaches and application prospects. Most mTBI patients present normally in CT and MRI scans; hence, both doctors and patients do not pay enough attention to this n period . mTBI pan period . Among mn period .bubble effect of mTBI swelling in the acute stage [Pathological examinations in TBI animals and humans often report axon te stage , subacutte stage : the strte stage . HoweverDiffusion tensor imaging (DTI) can noninvasively present the pathophysiological changes of white matter through the mean diffusivity (MD), fractional anisotropy (FA), and axial diffusivity (AD) . At presTo better understand the performance of neuroimage biomarkers of DTI in the acute phase of mTBI, our study adopts both DTI and behavioral experiments including intelligence quotient (IQ), memory, executive function, and motion function: FA, AD, and MD values of the mTBI group and healthy control group were, respectively, calculated; then, the correlation analysis was implemented between behavioral abnormalities and DTI parameters which were found significantly higher in the brain regions; finally, the relationship between DTI abnormal brain regions and behavioral abnormalities was obtained.A total of 77 mTBI patients were admitted to the Emergency and Neurosurgery Departments of the Third Xiangya Hospital of Central South University from August 2019 to July 2021. The patients  suffered mTBI because of car accidents (36), assaults (11), and falls (30). The main design of the experiment is shown in To measure the cognitive level of the mTBI patients in the acute stage, the patient and control groups were examined with 14 cognitive behavioral tests, including IQ, general knowledge, digit span, mapping, digit symbols, and stroop test. These behavioral tests can reflect the patients' memory, attention, executive functions, learning association ability, visual memory, and logical association ability.Both the patient and control groups underwent the same MRI protocol using the 8-channel head orthogonal coil of Philips INGENIA 3.0T MRI  in Third Xiangya Hospital, Central South University. The patient group was examined within 3 days after mTBI injuries . All subjects were placed on the scanning bed with their heads fixed while keeping their heads as still as possible, staying awake, and not thinking anything or processing any tasks during the examination. The specific scanning parameters were the same as those in our previous mTBI studies, as shown in the supplementary materials .D is used in the DTI to describe the movements of molecules in all directions, including the combined movements in different directions. The matrix D is a symmetric 2nd order tensor, as shown inA diffusion tensor λ1, λ2, and λ3) are equal, it means isotropic, as shown in When the 3 eigenvalues :Fractional anisotropy (FA):Axial diffusivity (AD):Radial diffusivity (RD):b = 0) images as reference (including eddy current artifacts and motion artifacts). Then, the diffusion tensor eigenvalues , mean diffusion coefficient (MD), and anisotropy fraction (FA) of each voxel were calculated based on all DTI images, and the corresponding images were generated through the FSL toolbox.In preprocessing and calculation of DTI parameters: FSL  toolbox in MATLAB 2018b was adopted to preprocess the original data and perform the tensor calculation. Firstly, all DTI images were adjusted by using nondiffusion weighted  standard space template with affine registration and nonlinear registration. This standardized space is automatically segmented white matter and named by the white matter segmentation map (WMPM). With the standard space template, the regions of interest (ROI) can be chosen conveniently while the DTI parameters of each ROI are also ready for statistically analyzed.T-test was adopted in our study; otherwise, the Mann–Whitney U test was used in the statistical analysis. When P is less than 0.05, the difference was considered to be statistically significant.The SPSS statistical software was used to compare the four DTI parameters of each ROI between the mTBI group and the healthy control group. When the quantitative data met the normal distribution and homogeneous equation, two-sample independentP and R) with the algorithm shown in equations ; variable B represents behavioral parameters ; μA (or μB) and σA (σB) were the mean value and standard deviation of variable A (or B). The correlation analysis between neuroimage and neuropsychological assessment was conducted including the Wechsler intelligence scale for verbal intelligence  and operating intelligence  and the stroop color word test measuring cognitive-perform functions. The Pearson correlation coefficient analysis was measured through the correlation coefficient (quations  and 7)  P and R)quations  and (7),R and P. When the R value is close to 1, the two groups of variables have perfect positive correlation. The R value is close to -1; the two groups of variables have perfect negative correlation. The confidence space is reached when P is less than 0.05 [After calculation, the correlation coefficients of the two variables were presented as the han 0.05 .P < 0.05). There was no significant statistical difference between the mTBI group and the control group in other neuropsychological tests, such as digit span (forward and reverse) and stroop color-word interference test (color-word interference time), as shown in Compared to the control group, the digit symbol substitution test (DSST) performed significantly worse in the mTBI patients' group (P < 0.05) in the following brain regions: bilateral corticospinal tracts (CST), bilateral posterior internal capsule lenticula, bilateral superior longitudinal fasciculus, left terminal striae and left sagittal plane , and right posterior thalamic radiation , as shown in After calculation and statistical analysis, we found that DTI parameters in the acute stage of mTBI patients have varying degrees compared to the healthy control group. No significant statistical difference was found in FA and RD values. The axial diffusion coefficient AD increased significantly , as shown in R = 0.331; P = 0.0255), as shown in R = 0.506; P = 0.017), as shown in The Pearson correlation coefficients were calculated using DSTT and digit span  as well as MD and AD. We found that DSTT performance was associated with the increased AD value in the left sagittal plane , and right posterior thalamic radiation. The significantly positive Pearson correlation was found between AD and MD elevation in the left sagittal layer and between the results of DSST and digit span in acute stage mTBI patients.Narayana et al.  and HenrAs reported in pathological studies of acute phase mTBI, the axial membrane calcium channel permeability increased and Ca2+ influx was induced when the axon was stretched but not completely broken under mechanical force or acceleration . AnatomiOur study found no significant difference in RD value between acute stage mTBI patients and the control group. According to previous studies, RD value is mainly related to demyelination while the acute phase mTBI is more likely to suffer axon swelling. The demyelinating lesions are more possible to happen in the chronic phase of mTBI. Another factor might be due to that the traumatic brain injuries are mild and the cytotoxic edema is not often serious in mTBIs. Therefore, there was no significant change in RD values. In this study, the MD value was treated as the average diffusion rate of the three directions. When the AD value of axial diffusion increases and the RD value remains unchanged, the MD value will increase with the AD value.There are some limitations in this study. Firstly, most of the subjects were middle-aged and young with the age of 18-40 years; children and elderly are not leave out of consideration. Although this criterion can eliminate the interference factors caused by age and brain development, the data from the subjects of more varying ages might bring additional knowledge on the performance of neuroimage biomarkers in mTBI patients. Secondly, the mTBI patients were not divided into groups according to the mechanical loading features leading to mTBIs. From the perspective of mechanical mechanisms, the mechanical loading location and directions to the head may be highly associated to the location of the injured brain regions. If there were more than 200 samples for instance, collision location on the head  could be considered as a grouping criterion.. Thirdly, multiple follow-ups could be implemented within 2 weeks. For example, DTI scan and cognitive assessments can be performed on the first day, the third day, the seventh day, and the second week after injury, which will be helpful to observe the dynamic change in DTI parameters and neurophysiological changes.The acute phase mTBI patients showed lower scores on DSST than those in the healthy control group. This neuropsychological change was associated with the increased AD value and MD value in the left sagittal layer, which indicated a reduction of information processing speed in mTBI patients in the acute phase. It might be related to abnormal AD value and MD value in the upper longitudinal tract, lower longitudinal tract, lower frontal occipital tract, and sagittal layer. In this study, combined with neuropsychological test and an increase of the AD value and MD value in certain brain regions, surgeons should pay more attention to the abnormal structures of the upper longitudinal tract and the patients' information processing speed in the diagnosis and treatment of the acute phase mTBI patients.