The Experiences and Needs of Families of Comatose Patients After Cardiac Arrest and Severe Neurotrauma: The Perspectives of National Key Stakeholders During a National Institutes of Health-Funded Workshop.

OBJECTIVES: Severe acute brain injury (SABI) from cardiac arrest and traumatic brain injury happens suddenly and unexpectedly, carrying high potential for lifelong disability with substantial prognostic uncertainty. Comprehensive assessments of family experiences and support needs after SABI are lacking. Our objective is to elicit "on-the-ground" perspectives about the experiences and needs of families of patients with SABI. DESIGN: Two-phase qualitative study of families and multidisciplinary U.S. healthcare professionals (mHCPs) with expertise in SABI: Phase 1 included semistructured interviews to generate formative findings; phase 2 entailed facilitated discussions to confirm and expand initial findings. SETTING: Phase 1: academic medical center; phase 2: virtual workshop. SUBJECTS: Phase 1 included seven family members and 12 mHCPs. Phase 2 included nationally recruited stakeholders (17 family members and 12 mHCPs). INTERVENTION: None. MEASUREMENTS AND RESULTS: We explored: 1) what are families' needs in the first 48 hours? 2) How are these needs addressed? and 3) How can hospitals better meet these needs? Qualitative analysis included inductive and deductive approaches guided by a conceptual ecological model. Four major needs were identified: 1) challenges in coping with uncertainty in early prognostication, 2) inattention to physical needs of family, 3) deficits in compassionate and consistent communication, and 4) need for engagement with families as stakeholders in improving future practices. Participants' recommendations included: 1) ways to communicate more clearly and consistently, 2) better assistance with navigating resources and access to places for families to care for themselves, and 3) opportunities for families to remain connected with their loved ones, social support networks, and the clinical team. CONCLUSIONS: Stakeholders identified novel insights regarding families' experiences during the hospitalization of comatose SABI patients and factors that can contribute to improved decision-making and physical/emotional outcomes. Interventions to address these unmet needs are promising targets to improve outcomes.

Evaluation of an Alternative Small Stem Assay for Blight Resistance in American, Chinese, and Hybrid Chestnuts (Castanea spp.).

We tested an alternative small stem assay (SSA) for blight resistance in chestnuts (Castanea spp.). Whereas standard SSAs are done by inoculating small incisions in stems, we cut off stems (4 to 5 mm diameter), inoculated the cut ends with discs of Cryphonectria parasitica inoculum, and covered them with plastic sleeves. This method was designed to be simple to implement, to consistently induce cankering, and to better enable seedlings to recover by developing shoots from the lower stem (standard SSAs delay removal of blighted stems until late in the growing season, if at all). We conducted six experiments with seedlings and orchard trees of Castanea dentata (susceptible), Castanea mollissima (resistant), and hybrids expected to vary in resistance. Experiments with seedlings and two of the three orchard experiments showed clear differentiation between susceptible and resistant types, especially >90 days postinoculation and when the orange-colored zone of the canker was measured. One orchard experiment failed to give clear results but was ended earlier (60 days) than the other experiments. We observed only two failed inoculations out of >200 performed. Comparisons with other studies suggest that this SSA method performs at least as well as the standard SSA method in distinguishing resistant and susceptible types, at least in seedlings. Survivorship after 1 year for seedlings inoculated in 2018 ranged from 70% for C. dentata to 100% for C. mollissima, and in 2019 they ranged from 40% in hybrids to 100% for C. mollissima. Deaths of seedlings after SSAs were mostly unrelated to the inoculations (e.g., root rot).

A qualitative study to explore the help-seeking views relating to depression among older Black Caribbean adults living in the UK.

Numbers of older adults are rising globally. In the UK, rates of mental ill-health are thought to be higher in Black Asian and Minority Ethnic communities than in the white population. Older adults from BAME groups are an under researched group. It is important to understand the experiences and beliefs that underlie help-seeking behaviour among BAME older adults to deliver effective, culturally appropriate, and accessible services. This study aims to explore help-seeking views and strategies utilized in relation to depression among older Black Caribbean people in the UK. Semi-structured interviews were conducted with eight UK Black Caribbean participants, aged between 65 and 79 years. Transcripts were analysed using Interpretative Phenomenological Analysis. Three master themes emerged from the analysis: (1) 'If you don't know, you don't seek help', (2) 'I was depressed…I knew I was depressed', 3) 'You have to decide': Attitudes to help-seeking and mental health service use. Participants' past personal experiences of coping with depression, including migratory histories, cultural and religious views, and personal relationships influenced their help-seeking views and preferred coping methods for depression.

Body checking in non-clinical women: Experimental evidence of a specific impact on fear of uncontrollable weight gain.

Body checking is used widely among clinical and non-clinical individuals. It is suggested to be a safety behavior, reducing anxiety initially but potentially enhancing eating and shape concerns in the longer term. However, there is little causal evidence of those negative effects. This experimental study tests the potential negative impact of body checking. Fifty non-clinical women took part in a study of the effects of body checking in naturalistic settings. Each checked their wrist size every 15 minutes for eight hours on one day, then did not check the next day (order randomized). The impact on eating cognitions and body dissatisfaction was measured at the end of each day, and levels of change in those characteristics were also associated with eating pathology levels. Body checking did not result in more negative general eating attitudes or body dissatisfaction, but did result in a significant increase in a specific cognition that is hypothesised to be relevant to eating pathology - the fear of uncontrollable weight gain following eating. This impact was greater among those women with more negative existing eating attitudes. These findings add to the small experimental evidence base, demonstrating negative causal links between body checking and eating pathology. The findings need to be extended to clinical groups, but support the use of existing cognitive-behavioral methods to reduce body checking behavior.