To examine the benefits of interventional therapy for cicatricial constriction using a high-frequency electric knife, saccular dilatation, and cryotherapy.This case series included patients with central tracheobronchial cicatricial constriction admitted to the Department of Tuberculosis of Henan Provincial Chest Hospital from July 2018 to March 2021 and treated with bronchoscopic interventional therapies based on systemic anti-tuberculosis treatment.96 patients were included, in whom 443 interventional therapies were performed. The total mid-(3 months) and long-term (12 months) effective rates were both 100%. The internal diameter of tracheobronchial stenosis increased after the operation, and the difference was statistically significant . After interventional treatment, patients’ symptoms of choking sensation in the chest and shortness of breath were relieved. Respiratory function was obviously improved. The ratios of hemorrhage, granulation hyperplasia, chest pain, and postoperative fever were 58.2%, 42.6%, 31.3%, and 26.7%, respectively. No focal transmission and progression of tuberculosis occurred, and no serious complications were observed.The use of a high-frequency electric knife, saccular dilatation, and/or cryotherapy according to the pathological stage of the tracheobronchial cicatricial constriction is feasible, with good mid- and long-term curative effects and few complications. Benign central tracheobronchial stenosis refers to tracheobronchial stenosis caused by various benign pathological changes in the trachea, left and right primary bronchi, and right middle part of the bronchus due to stenosis after endotracheal intubation, tracheostomy tube placement, surgery, infections, inflammatory disorders, extrinsic compression, benign endobronchial tumors, and tracheobronchomalacia –5. It isIn the past, tracheobronchial stenosis was mostly treated by surgical resection and end-to-end anastomosis or reconstruction of the trachea –8. In reMechanical dilatation is a means to open strictures, but it should not be used alone because of the risk of additional cicatricial tissue formation , 10. EleTherefore, this case series study aimed to examine the benefits of interventional therapy for cicatricial constriction using a high-frequency electric knife, saccular dilatation, and cryotherapy.This case series included patients with central tracheobronchial cicatricial constriction admitted to the Department of Tuberculosis of Henan Provincial Chest Hospital from July 2018 to March 2021 and treated with bronchoscopic interventional therapies based on systemic anti-tuberculosis treatment. All patients signed the informed consent form and underwent bronchoscopy.Mycobacterium tuberculosis, (5) underwent bronchoscopic interventional therapy, (6) follow-up of ≥ 12 months, and (7) all patients received medical anti-tuberculosis treatment.The inclusion criteria were (1) 18–60 years of age, (2) diagnosed with tuberculosis according to positive sputum or sputum culture , with reThe exclusion criteria were (1) intracavitary stenosis, dynamic stenosis, stenosis caused by external pressure, or stenosis caused by tracheobronchial softening, (2) irregular anti-tuberculosis treatment or stopped anti-tuberculosis medication for > 1 month, or (3) tuberculosis resistant to multiple drugs.Before and after bronchoscopic interventional treatment, all patients underwent routine lung high-resolution computed tomography (CT) (HRCT) : tube voltage of 120 kV, tube current of 600 mA, thickness of 1 mm, and scanning time 500 ms. The patients were lying flat on the table for HRCT, and a three-dimensional reconstruction of the trachea was made on the computer after HRCT examination of the lung. And all patients underwent routine Pulmonary function tests, Forced expiratory volume in 1 s (FEV1) and peak flow velocity (PEF) were measured with CUST0 vitm pulmonary function meter. Bronchoscopy  was performed to evaluate the length and degree of the central tracheobronchial stenosis. According to the different stages of pathological changes of the cicatricial constriction and the actual manifestations of patients through bronchoscopy, the patients were roughly grouped and managed as follows. In the stage of scars hyperplasia, when the mucous membranes of the tracheobronchial walls were congestive, dropsical, and asperous, with caseous necrosis almost disappearing, cryotherapy was mainly performed, with saccular dilatation if necessary. In the period of repair under scar formation, when the caseous necrosis on the mucous membranes of the tracheobronchial walls completely disappeared, the mucous membranes of the tube walls were not as dropsical as before, and the superficial scars were changed, with no more acute inflammations; saccular dilatation and sequential cryotherapy were performed. In the mature stage of the scars, when the tube wall was thickened, the scars on the mucous membrane were obvious, which were white and not congestive, with no caseous necrosis and hyperplasia of granulation; then, high-frequency electric knife, saccular dilatation, and sequential cryotherapy were used. The first 32 patients in each phase treated during the study period were included. All patients were treated with interventional therapies by the full-time medical team in the bronchoscopy room.2 as the freezing source. The multi-point freezing method was adopted, 30–120 s for each part. Saccular dilatation was performed using a three-level tracheobronchial Foley’s tube with outer diameters of 8, 9, and 10 mm . A pressure pump was used to press the saccule from low to high. The pressure was 4–10 atm for 60–180 s, and each part was dilated one or two times. A high-frequency electric knife  and supporting acusector were used to relieve the scars, from shallow to deep, about 5 mm deep every time, and saccular dilatation was performed afterward. The frequency of examination and treatment of all patients was gradually prolonged, from once a week to once every 2 weeks to once every 3 weeks. According to the changes in patients’ conditions and their pathological stage, the treatment time and plan were properly adjusted. After their conditions were stable, the patients were re-examined after 3 months and 1 year to judge the mid- and long-term curative effects.An ERBE cryotherapy equipment and soft flexible cryoprobe with a diameter of 1.9 mm and a probe measuring 10 mm were used , with liquid COThe inner diameter of tracheobronchial stenosis was measured by the scale plate of the bronchoscope with the chest CT image: the inner diameter of tracheobronchial stenosis was calculated as /2. When the bronchoscope (diameter of 4.9 mm) could not advance in the bronchial stenosis, the length of the bronchoscope entering the body was recorded from the nose or mouth, as appropriate. The tracheobronchial stenosis, distal lung conditions, the diseased bronchial wall with or without calcification, and the surrounding blood vessels were observed. The relevant data was measured, mainly the length of the tracheobronchial stenosis and the diameter of the narrowest part.The diameter of tracheobronchial stenosis of all patients before and after the first interventional therapy and at the mid- and long-term follow-ups was recorded. The numbers of interventional therapies, including cryotherapy, balloon dilatation, and high-frequency electric knife needed to achieve significant therapeutic effect were recorded, and the incidence of complications such as bleeding, mediastinal emphysema, and tracheobronchial perforation, thoracalgia, and granulation hyperplasia after interventional therapies. The recurrence of tracheobronchial stenosis at 3 and 12 months was recorded.Completely effective therapy was defined as a recovery of the internal diameter of the constrictive trachea to > 80%. Significantly effective was defined as the internal diameter of the constrictive trachea recovered to 50–79%. Slightly effective was defined as stenosis still of > 50%, but the bronchoscope (with a diameter of 4.9 mm) could pass smoothly. Ineffective was defined as no improvement, and the bronchoscope could not pass , 21. TotSPSS 19.0  was used for statistical analysis. Continuous data were expressed as means ± standard deviation. Repeated measurement analysis of variance was used to compare the tracheobronchial diameter before treatment and after the operation. Bonferroni’s method to correct the P-value for the post hoc analyses. The categorical data were presented as n (%) and analyzed using the Chi-square test. P-values < 0.05 were considered statistically significant.This study included 96 patients aged from 22 to 54 years old, with an average age of 28.3 ± 8.1 years, and including 42 males and 54 females. All patients had tracheobronchial tuberculosis. The stenosis sites were the left primary bronchus for 47, the right primary bronchus for 31, and the right middle bronchus for 18  was sufficient to control active bleeding. There were no cases of severe hemoptysis, pneumothorax, and mediastinal emphysema. Some patients had throat and nose discomfort after the operation, most of which was relieved by themselves or relieved by inhaling budesonide after the operation. Twelve patients had a slight fever after the operation, and all of them recovered to normal within 3 days.In the present study, all patients were followed for at least 12 months and achieved good clinical treatment results. The curative effect evaluation showed that after the tracheobronchial stenosis was relieved, the scar was formed and relatively stable, with a smooth surface. The mid- and long-term effects were both good. The results suggest that high-frequency electric knife, saccular dilatation, and/or cryotherapy according to the pathological stage of the tracheobronchial cicatricial constriction is feasible, with good mid- and long-term curative effects and few complications.All treatment techniques have their advantages and disadvantages. The proper selection of interventional treatment techniques such as saccular dilatation, high-frequency electric knife, argon plasma coagulation (APC), cryotherapy, and tracheobronchial stent implantation according to the condition of the patient is of great importance to the treatment of benign tracheobronchial stenosis and lowering the incidence and degree of tracheobronchial restenosis. Because damage to the mucous membranes of the tracheobronchial walls will lead to subsequent local tissue hyperplasia, recovery and scar formation during interventional therapy can lead to restenosis in the mid and long term, with the need for repeated interventional therapy to relieve tracheobronchial stenosis, but still with a risk of restenosis. The proper selection of the management strategy is necessary to break the vicious cycle of “injury–recovery–stenosis–reinjury”. Cryotherapy might be ideal for breaking this cycle since tissue destruction by cryotherapy preserves the extracellular matrix and the regenerative properties of the tissues, which might allow healing with minimal fibrosis , 23. In Previous studies reported severe complications in 6–19% of the cases , 24. In This study has limitations. The sample size was small, and all patients were from the same hospital, probably introducing bias. In addition, processes that could be involved in recurrence, such as systemic inflammation, were not examined. Clinical trials are necessary to determine the efficacy and safety of the methods proposed here.In conclusion, using a high-frequency electric knife balloon dilatation and/or cryotherapy to manage cicatricial tracheobronchial stenosis according to the different pathological stages of repair under scar formation might be beneficial by relieving tracheobronchial stenosis and reducing the additional damages and injuries brought by the interventional therapy.


Polynomials of this type do not generally admit factorizations. We recall a necessary and sufficient condition for existence of a factorization with univariate linear factors that has originally been stated by Skopenkov and Krasauskas. Such a factorization is, in general, non-unique by known factorization results for univariate quaternionic polynomials. We unveil existence of bivariate polynomials with non-unique factorizations that cannot be explained in this way and characterize them geometrically and algebraically. Existence of factorizations is related to the existence of special rulings of two different types (left/right) on the ruled surface parameterized by the bivariate polynomial in the projective space over the quaternions. Special non-uniqueness in above sense can be explained algebraically by commutation properties of factors in suitable factorizations. A necessary geometric condition for this to happen is degeneration to a point of at least one of the left/right rulings.We consider polynomials of bi-degree ( Factorization theory for univariate quaternionic polynomials fundamental theorem of algebra also holds true in the quaternionic case. Consequently, each univariate quaternionic polynomial admits a factorization into linear factors . Denote by Q. A simple necessary condition for existence of a factorization of the shapea, h, Already the case of factorization of bivariate polynomials of degree one in one of the indeterminates into univariate linear factors is interesting and will be in the focus of this paper. Motivated by potential applications in kinematics  with non-equivalent factorizations. If Q is such a polynomial, we will show that one is always able to compute a factorization of shape  are too limiting to allow the direct transfer of kinematic constructions from Hegedüs et al. .real quaternions by conjugate of h is norm is given byinverse is given by We denote the algebra of complex quaternions. It is the (complex) conjugate of h by q] for a projective quaternion represented by p, p] and [q] if these points are different. If By entclass1pt{minimat and s commute with the coefficients and with each other. This convention is motivated by potential later applications in kinematics and mechanism science where bivariate polynomials parameterize two-parametric rational motions  The polynomial g and So ). This sT, n different right factors of Since f. Niven , Hegedüsf. Niven ). Using n! factorizations , which In contrast to the univariate case, a generic bivariate polynomial Q satisfies the necessary factorization condition if Let Q can be written asa, In order to see that this condition is really necessary for existence of a factorization with univariate linear factors, assume that univariate linear factors. An important result, which is more or less stated in Skopenkov and Krasauskas  or  equals ABCD,  A,  by A and B, we find a representation A and B so that Q is monic, we conclude A and C according to Theorem Since Q.In our short proof of Corollary univariate factors of Q  and and\docued as in . Let \doLet us first consider Part (a). There is nothing to show if Q admits a factorization of the form  are elements of A and the M (counted with multiplicities) are elements of B, which shows that the multiplicity cardinalities Under the assumptions of Theorem equation  it folloThe lower bounds  need notFor Q.It is natural to relate the algebraic multiplicities Plücker quadric in intersection multiplicity. One can show that Via the Klein mapping Q.With the help of the multiplicity cardinalities (Uniqueness Theorem) Let fined in . Then \dQ of shape  is an element of B  Let fined in . Then thQ of shape (The assumptions guarantee existence of one factorization of shape . By TheoB are precisely the complex zeros of z. This is due to the fact that Let us prove that (b) implies (a). From mentclasspt{minimaN is the norm polynomial of the leftmost right factors (the t-factors immediately following the s-factor). More precisely, there exists Q.The class E nor F have a real polynomial factor of positive degree. Indeed, existence of such a factor would imply EF. By \documentz is a zero of N (note that H is defined according to (right jump of the s-factor is possible. If z is a zero of M, one can perform a left jump of the s-factor. In both cases one obtains Let us first assume that rding to . The facs-factor.Suppose M and right jumps of the s-factor of factorization left jumps of the s-factor of factorization Given two different classes rding to . For eacQ of Examples s-factor, we should therefore consider the third quadratic polynomial.Let us illustrate Theorem t-factors of the first factorization admits a second factorization:The product of the two rightmost s-factor of a given factorization of Q can be counted with the help of the multiplicity cardinalities s-factor. More precisely, m denotes the number of right factors and n denotes the number of left factors of the given factorization of Q. This immediately follows from the proof of Theorem Suppose Q with monic univariate linear factors, can be found by performing the following three steps: Step 1:Q with monic univariate linear factors (Theorem Compute a factorization of  Theorem .Step 2:s-factor to obtain Perform all possible left/right jumps of the  Theorem .Step 3:A and B with univariate linear factors (Theorem Compute all possible factorizations of Suppose The statement is just a summary of the mentioned theorems and corollaries. As mentioned in Sect. vectorial quaternion q with a quaternionic polynomial. Univariate polynomials then give one-parametric rational spherical motions, bivariate polynomials give two-parametric motions etc. For the sake of simplicity, we henceforth do not distinguish between motions and polynomials.A vector Q. The mechanism’s movement when following the motion Q requires that the first n joints and the last m joints share the same motion parameter. In order to achieve this mechanically, that is, without individually controlling each joint parameter, it is necessary to further constrain the mechanism. In the univariate case this can be done by considering further factorizations, each yielding a new sub-mechanism or “leg” that can be added. In this way, we may think of the univariate t-factors s-factor as “higher-order” joints with a single degree of freedom. The “mechanism” In this sense, the linear polynomial Q may admit non-equivalent factorizations but they cannot be used as additional legs because they do not further constrain the mechanism: The left and right jumps of Theorem The polynomial This is illustrated at hand of a simple example in Fig. Failure of immediate kinematic applications should not prevent us from further investigation on factorizability of bi- and multivariate quaternionic polynomials. A natural question is factorizability of polynomials of arbitrary bi-degree which is addressed in Lercher and Schröcker . That ar


Therapeutic interventions for people with problematic use of psychoactive substances can help tackle specific needs related to substance addiction consequences. This modified e-Delphi study aimed to establish consensus on a training program for self-management of substance addiction consequences. The study was conducted between February and April 2022, with an experts’ sample of 28 participants in the first round and 24 in the second. A priori consensus criteria were defined for each round. The results revealed a very strong consensus was achieved on the structure of the program and on clinical areas, such as the problematic use of substances, general health knowledge, health-seeking behavior and adherence, self-knowledge and well-being, social role and personal dignity, and family process. Additionally, over 80% participant consensus was achieved on an extensive number of interventions categorized as psychoeducational, psychotherapeutic, socio therapeutic, brief interventions, social skills training, problem solving techniques, relaxation techniques, and counseling. These findings may be able to fulfill a gap concerning structured treatment approaches for people with problematic use of psychoactive substances. Supporting self-management of the consequences of substance addiction and its application can change nurses’ interventions. Problematic substance use (PSU) and addiction are pervasive global health issues. In 2021, the United Nations Office on Drugs and Crime (UNODC) reported that 275 million people used drugs, while 36 million people had an addiction to a psychoactive substance worldwide . This isIndividuals with PSU and addiction are entitled to the highest standard of health care. Treatment programs should include comprehensive assessment, psychosocial interventions, and pharmacological interventions to manage mental and physical health comorbidities within the context of social care and support. Furthermore, active patient participation is essential in all treatment decisions . Nurses,There is increasing evidence that structured therapeutic interventions for people with SAC can be of benefit and help tackle specific symptoms and problems ,8. DiffeUnderstanding the importance of self-management in addiction treatment and recovery supported by a robust theoretical basis, we created an evidence-based nurse-led training program. The program focused on the self-management of substance addiction consequences for people integrated on medication-based programs using the modified e-Delphi technique. This program was based on different theoretical foundations.From a theoretical point of view, we integrated the principles of the Tidal Model, which considers that human nature can be expressed through physical, emotional, intellectual, social, and spiritual planes. The Tidal Model is a patient-centered model that is centered on recovery focused care. A key assumption is “tailoring care to fit the specific needs of the person by understanding the person’s story and unique lived experience told through a holistic assessment”  [p.173].The severity of substance addiction consequences (SAC) is often the reason for seeking help and joining medication-based programs . It can be defined as the severity of change in health status and social functions due to substance dependence . SAC is Problematic substance use can lead to addiction, a chronic illness caused by changes in brain functioning that affect areas critical for judgment and self-regulation . ChronicTogether, the Tidal Model and Chronic Illness Self-Management can empower the individual to change and to improve the management of the chronic problematic relationship with substances. This can be utilized with the trans-theoretical model, which can help the nurse understand how the individual is progressing through the health behavior change process . The proThe aim of this study is to identify and establish consensus on a training program for self-management of substance addiction consequences (in terms of content and form).-How do participants rate the importance of each part of the program?-Which parts of the program are considered essential by participants?-What suggestions do participants add to the structure, areas of focus and interventions?The initial draft of the program was based on a scoping review that examined evidence of structured therapeutic interventions for people with substance addiction consequences  and a quThe main assumption of the Delphi technique is that expert group consensus is more valid than individual analysis. It is useful for achieving agreement among experts or professionals in something where no previously agreement existed . BecauseWe utilized intentional non-probabilistic sampling. The selection criteria included the following: (1) Nurses AND (2a) Professional experience of at least 2 years with patients with problematic use of psychoactive substances or addiction in outpatient care, in the last 10 years OR (2b) Professional experience of at least 5 years, in the last 10, in inpatient psychiatric wards, with patients with substance use comorbidity OR (2c) Relevant curricular experience in the area of mental health or community health and experience in the construction of intervention programs with people with health needs in these two areas . Expertise was defined by professional and clinical experience , the lenThere is no agreement in the literature about the ideal sample size for Delphi studies, although usually 20 participants are considered sufficient. It is dependent on the purpose of the project, the time frame for data collection, and the number of rounds. Twenty nurses was considered the minimum for each round to ensure diversity of opinions . InvitatData were collected between 14 February and 3 April 2022. The first round was necessary in order to complete consensus on the structure and content of the program and a second round was added to obtain consensus on the expert feedback that was given from the open-comment boxes in round 1.Data were extracted from the Google Docs platform to an Excel file protected with a password on the computers of two researchers. Individual data were collected . Each participant was invited to rate how much he/she agreed on the structure of the proposed program , and areas of intervention/nursing diagnoses/interventions. A five-point Likert scale  was used. Omitting a labeled neutral mid-point forces participants to deliberate and form an opinion . ThroughThere is no full agreement on the consensus rate, but 70% is considered adequate ,31. For Quantitative data were analyzed using the IBM Statistical Package for Social Sciences (SPSS) v27.0. Frequencies, mean (M), median (MD), standard deviation (S), and interquartile range (IQR) were calculated to assess consensus. Additional recommendations by experts were evaluated by the research team to confirm if they were not already covered by the survey, within the scope of the study, and articulated clearly. Where they were not, the research group reviewed and adjusted the content . These aThis study had the previous approval of the Health Ethics Committee of the Regional Health Administration of Lisboa and Vale do Tejo (7211/CES/2020). All participants were sent an initial invitation in which they could access the link to the server, read the informed consent, and they had the possibility to refuse or accept their participation. Until the last question and before submitting, participants could just close the survey and not submit it. The platform and data files were protected with a password, known only by two researchers.Participants (n = 28) were mostly women 21 (75%), with a mean age of 42.1 years (SD = 7.84) (range 26–54), with a similar representative academic degree on master or doctoral studies  and bachThe consensus was achieved in all parts of the program content, previous procedures, therapeutic sessions, and final procedures. All median values ≥4, IQR ≤1 and 80% of agreement in 4 or 5 on rate scale  .Through open boxes for each content evaluation, participants could add comments or suggestions, identifying missing important clinical indicators or explaining the reasons for the chosen ratings. Most suggestions concerned the need to formalize (possible) nursing diagnostics, using the International Classification for Nursing Practice (ICNP) . In factThe second round happened between the end of March and April 2022. Based on the participants’ responses, small but important changes had to be made in almost all areas of the program. Therefore, we decided to resend the revised detailed description program, as well as its schematization, and ask for it to be reassessed entirely, aiming to also evaluate the answers’ stability between rounds—knowing that there should be a less than 15% change in the responses . Two morAgain, consensus was achieved in all parts of the program content , previous procedures, therapeutic sessions, and final procedures . All of them had a median ≥4 and IQR = 1 .Between rounds, the difference in the mean of all items was 0.08 (first round 4.28 and second round 4.36), and the difference of median values was 0.07 (first round 4.24 and second round 4.35). In agreement, the percentage the difference between the two rounds was 0.08 (first round 90.04 and second round 89.96). These three criteria had a strong and stable consensus, with the average change between two rounds being less than 15%.The consensus reached after the expert opinion poll led to the conclusion that a nurse-led program for self-management of substance addiction consequences is pertinent and necessary to support an individual’s needs. Our results show that a nurse-led model of addiction treatment must be flexible enough to incorporate local needs and be transferable enough to be applied in the face of various normative guidelines and practice settings. It must be capable of being implemented with fidelity and sustainably, and allow for an evaluation of the process and impact . In the Participants rated the importance of each part of the proposed program and identified parts that were considered essential: a structured but flexible program. For example, a structured approach should consider selection criteria, number, time of sessions, and established procedures for all sessions, whereas flexible attention is needed to support substance addiction consequences experienced by patients. These procedures and clinical orientation follow the recommendations for the development of a complex intervention . The sugThe theoretical framework guiding assessment and intervention were based on a holistic view of the person and on their ability to be helped to reach their full potential using their own personal resources ,13. It aIntervention models for addiction treatment must have an integrative approach; that is, allowing the use of psychotherapeutic techniques with different approaches and based on an effective relationship and interpersonal communication between the nurse and the person being cared for . InterveOur proposal is adapted, in structural terms, from the Psychotherapeutic Intervention Model in Nursing , but alsThe program focuses on the needs expressed by individuals with PSU, addiction, and nurses in outpatient medication-based programs. Operationalization appears in A possible limitation of this study was the need to clarify the concept of substance addiction consequences, which was new to almost all of the participants, and to develop structured interventions addressing this problem. Some of the suggestions were not integrated because they were beyond the concept that this program intended to address. Because this study was conducted in Portugal, it may not be generalizable to different backgrounds and cultures. Additionally, because we utilized an electronic survey, participants had to submit their full answers at the same time, without the possibility to respond in parts.This study aims to fill a gap in scientific knowledge concerning structured approaches for people with PSU and addiction. This nurse-led intervention program aims to contribute to the improvement of the quality of life of people who use substances and are integrated into medication programs. The study can be considered to be a contribution due to the number, heterogeneity, and plurality of participants in each round. Six clinical areas and eighteen nursing diagnoses were considered in the e-Delphi: (1) problematic use of substances , (2) general health knowledge , (3) health-seeking behavior and adherence (impaired disease self-management and compromised attitude towards the therapeutic regimen); (4) self-knowledge and well-being , (5) social role and personal dignity , and difficulty in having a functional home and (6) family process (compromised family process).This proposal, being flexible and anticipating different characteristics of contexts and patients with PSU and addiction, needs to be tested in a real environment, complying with all ethical procedures. It can also be of clinical utility, after outcome analyses, to explore the potential to be adopted in different treatment contexts, not only in an outpatient setting.


In recent years, significant progress has been made on ways to improve executive function (EF) skills for school readiness involving direct EF training and classroom educational programs. Due to the absence of a well-structured Arabic program for EF training in children, the rationale of this study is to implement a comprehensive, evidence-based intervention program to help Egyptian children with learning disorders to overcome their EF impairment. It uses the multimodality approach to help meet the needs of students with a variety of learning styles. The aim of this study is to adapt the combined form of the “Executive Functions Training-Elementary” and the “Promoting Executive Function In The Classroom” programs and its application to test its effectiveness in the rehabilitation of Egyptian learning-disordered children.p-value < 0.001), and it also showed significant improvement in the Arabic dyslexia assessment test (ADAT) scores  for dyslexia evaluation.The results showed significant improvement in the Arabic version of Barkley Deficits in Executive Functioning Scale, Children and Adolescents long-form (BDEFS-CA) scores for executive functions (EF) evaluation (executive function summery score from 228.63 to 213.77 with The study concluded that designing an Arabic rehabilitation program specific for executive function difficulties was effective for improving both EF deficits and dyslexia, but there is a need for further studies comparing this program to other methods of traditional interventions.www.clinicaltrials.gov NCT05476133, approved on 26 July 2022. Register name is the following: application of a rehabilitation program for executive functions in a sample of Egyptian children with learning disorder.The study was retrospectively registered at  Executive functions (EF) are considered a group of cognitive abilities that enable individuals to perform targeted, purposeful behaviors and to adapt to novel situations, with conscious control. They are used as an umbrella term that includes a diverse group of hypothesized cognitive processes that have interrelated functions .Various conceptual models have been proposed to explain EF processes, although none has been universally adopted , 3. It hStudents who suffer from specific learning disorder (SLD) can also have an elevated risk of executive function difficulties (EdF) , 6. DuriIndeed, in these cases, developing EF skills requires continued efforts in the home and school environment by parents and teachers . In receDue to the absence of a well-structured Arabic program for EF training in children, the rationale of this study is to incorporate ideas from the “Executive Functions Training-Elementary”  and the It is formulation of a rehabilitation program for adaptation of therapy activities for improving EF deficits and overall academic performance and application of this program in cases with EdF to test its efficiency in improving EF deficits and academic skills in Egyptian Arabic-speaking children.This study was carried out on 40 children with specific learning disorder (SLD) and executive function deficits of both sexes and aged from 6 to 11 years attending the Unit of Phoniatrics, in the outpatient clinic of Alexandria Main University Hospital. Children with brain damage, mentally retarded, a history of clinical and subclinical fits, hearing impairment or visual impairment, and psychiatric problems were excluded from the study.www.clinicaltrials.gov NCT05476133.The ethics committee of the Faculty of Medicine, Alexandria University , approved the study . The study was retrospectively registered at An informed consent was orally taken from parents and/or legally caring surrogates in addition to the child’s assent of all children participating in the study.Formulation of the remediation program by using a combined form of the “Executive Functions Training-Elementary”, whp-value of < 0.001) and a weak positive correlation between syntactic comprehension and inhibitory control .More specifically, the research done by Pereira et al. (2020)  demonstrAs regard the type of school, it was found that the majority of cases 71.43%) went to governmental schools as most of the children referred to our facility were enlisted in these types of schools, and this is consistent with the study by Barbosa et al. (2019) [.43% wentIt was also found that 82.86% of the study sample had normal mainstream education (as opposed to integrated education) as the diagnosis of SLD and EdF was not yet confirmed. The literature reviews did not present relevant information about the relation between the type of school or education and EdF.As regards the general intelligence quotient (GIQ), it was found that the majority of the study sample (57.14%) had an average GIQ as most dyslexic children often have an average IQ; furthermore, the Stanford-Binet psychometric test evaluates the more basic cognitive processes which seem to be intact in these children. This is consistent with the findings of Locascio et al. 2010), which presented a sample that have a full-scale IQ that falls mostly in the average area (a mean of 92.07 and a standard deviation of 10.74). Furthermore, no correlation was found between the degree of EdF and the GIQ [10, whichp-value of < 0.001) which may be attributed to the similarity in the neural pathways and neurotransmitter defects between ADHD and EdF, and these results are consistent with the research done by Bathelt et al. (2018) [p-value of < 0.001, and are also consistent with the results of the research done by Barkley et al. (2014) [As regards ADHD, it was noticed that 71.43% of the study sample was diagnosed with ADHD with a significant positive correlation between the severity of EdF and ADHD (. (2018) , which r. (2014) , which dp-value of 0.721) which may be due to the difference in structural connectivity between dyslexia and EdF; furthermore, a larger number of cases may be needed to study the correlation between these variables, and this coincides with the study done by Bathelt et al. (2018) [p-value of 0.144. On the contrary, Pascual et al. (2019) [p-value of < 0.05.Although all the study samples were diagnosed with both dyslexia and EdF, no correlation was found between the severity of dyslexia and EdF (. (2019)  reportedp-value of < 0.001 as some components of the rehabilitation program directly address certain deficits in dyslexia such as reading comprehension and written expression. This is consistent with the findings of McClelland et al. (2018) [There was a statistically significant improvement in ADAT scores after applying the rehabilitation program with a . (2018) , which dp-value of < 0.001, and this goes with the study by Entwistle et al. (2014) [p-value of < 0.05.There was a statistically significant improvement in BDEFS-CA scores across all the scale domains , as well as the summary score (EFSS) after applying the rehabilitation program with a . (2014) , which rp-value of 0.001, 0.002, 0.019, and 0.007, respectively) except for the SM domain; furthermore, the degree of improvement of the EF overall score was significantly correlated with the degree of improvement of dyslexia with a p-value of < 0.001 which goes with the study by Sung et al. (2018) [p-value of < 0.001.It was found that a strong positive correlation exists between the degree of improvement of dyslexia and all EF domains  , which rSo, the rehabilitation program was effective mainly in improving EF deficits, as well as helping in the improvement of dyslexia for better academic performance in Egyptian elementary students. Limitation to this study included dropping out of some cases before completing the therapy and also poor compliance. In addition, delayed rehabilitation during the COVID-19 pandemic caused some difficulties in the proper administration of the rehabilitation program. Finally, some parents were not cooperative in applying the carryover activities in the home setting.This study proved that designing an Arabic rehabilitation program specific for EdF was effective for improving both EF deficits and dyslexia, but there is a need for further studies comparing this program to other methods of traditional interventions.It is recommended in further work to measure the improvement of scholastic achievement and learning process in the classroom through involvement of class teachers in the evaluation pre and post rehabilitation.


For those that have experienced how much point of care ultrasound can positively impact patient care, the potential of an organized point of care ultrasound program is moderated by the reality of building such a program from scratch. We have watched novice and intermediate users ride the roller coaster of ambition and reality checks at each of the hands-on skills sessions across the nation. The first climb occurs on the morning of Day 1. Anticipation grows over how hard it might be to learn this skill, then peaks and dips into the exhilaration of seeing success with what feels like minimal guidance. A comprehension of attainability takes over, and after each hands-on session, confidence climbs fast. Day 2 begins with the courage of some experience, and the anticipation of more success. The questions start as the climb up the second hill begins: “This is practice changing! How do I start a program at my home institution?” The ride turns into a steady flow of dips, spins, and twists as facilitators use less guidance and allow for more struggle. The questions turn to statements as learners develop a metered sense of capability: “I NEED a program at my home institution. My colleagues are going to want to know how to do this too, and I want to develop my skills.” The momentum is strong for physicians to integrate Point of Care Ultrasonography (POCUS) across the spectrum of ambulatory and inpatient care. Nephrologists can interpret and evaluate patients using point of care ultrasound in nephrology (POCUN) and it is becoming a key part of training Making the biggest possible impact with POCUS requires an alignment of the POCUS user’s skillset with the patient’s needs. Patients with kidney disease use acute care services disproportionately and POCUS can decrease the burden of care experienced by a patient at a reduced cost to the system as a whole Visualization of common kidney and bladder pathologies such as hydronephrosis, cysts, stones, prostatomegaly, and masses are possible with a basic POCUN skill set. Basic echocardiography can evaluate for pericardial effusion, gross valvular abnormalities, and gross assessments of ejection fraction. Assessment for maturation of the arteriovenous fistula and guidance of vascular access cannulation are also potential adjuncts to key procedural ultrasound skills for central venous catheter placement and renal biopsy Knowing who to recruit will help expedite organization and communication at the early stages of program design and eliminate obstacles during implementation and execution phases. The cornerstone of a program, of course, is the faculty that can use POCUS clinically and become part of the fabric of the program. Beyond capable physician faculty within the nephrology division that will perform the scans, relationships with others outside nephrology are critical to program success. Non-physician sonographers are part of those teams for many institutions, for example, and can be an outstanding asset for one-on-one hands-on instruction of learners. Having an established relationship with radiologists can lead to a robust image review and quality assurance team. Cardiologists are an excellent addition for focused echocardiographic reviews. Emergency medicine physicians benefit from decades of experience with POCUS implementation and education. Departmental collaboration increases the educator pool for all departments. Collaboration can also streamline impact on patient care. For example, a multi-department collaborative can perform as a committee when implementing standardized documentation of POCUS findings which would allow tracking of findings over time for an individual patient. Information Technology (IT) is crucial in developing an efficient and seamless way to store images for both review and billing purposes, not to mention integration into security frameworks so that personal health information (PHI) remains protected. Many of the newer handheld devices utilize wireless information uploading and cloud-based image storage. Successful image storage integration into existing structures such as picture archive communication system (PACS) is crucial. The biomedical and engineering teams also have a stake in equipment to be purchased by a hospital and used by faculty in the care of patients, especially at the inevitable point of needing repair or replacement. The support of your executive leadership can make for more fluid program-building as the development of a program from scratch inevitably requires investment for equipment and IT workflow solutions, even if the plan is simply to integrate into an existing electronic medical record and Digital Imaging and Communications in Medicine (DICOM) PACS storage solution.Table 1 provides a quick rundown of pros and cons for each. One place where they differ greatly is in price comparisons. Handhelds are increasingly subscription and cloud based. This means a pay structure with either yearly or monthly fees in addition to hardware costs in order to maintain access to image storing clouds and/or device tools for interpretation and education. In contrast, cart or laptop-based systems are currently still offered as one-time hardware costs with a more traditional warranty structure. The outright cost for handhelds ranges from $2000 to $8000 with subscriptions costing an additional amount yearly depending on subscription type  If you are talking about clinical POCUS, then the choice is really between a handheld device and a small cart-based ultrasound. There are now multiple options in both categories making the devices competitive in class. Patients can have a more positive healthcare experience and a better understanding of their diagnoses and care when POCUS is utilized Quality assurance (QA) and image review are a fundamental part of any POCUS program fulfilling many key functions including creating a teaching file of pathologic images, providing feedback to learners, building a learner image portfolio for credentialing, and communicating missed or incidental findings to patients. Setting up your team to include POCUS clinicians from other divisions and departments can become valuable when organizing the approach to image review and QA. Image review requires a reliable, retrievable, and organized collection of images to be stored securely. How to accomplish this can be fairly individualized, but there is one aspect that is universal: person-power. No matter what, a person or a team will need to have the time allotted to perform basic image review for quality assurance. When thinking about the image storage location, some of the most common solutions are a HIPAA compliant cloud, DICOM PACS, or third-party HIPAA compliant server. Transferring the images from the device to the storage solution will involve the IT team. Once uploaded, the POCUS clinical team will need a method to determine how images are selected for review. For instance, should all trainee-generated images be pushed to the patient’s chart or should poor quality images remain sequestered in the image archiving solution? The method for organizing QA solutions is individualized to suit the needs of the participating reviewers and the institutional demands. Some percentage of total images should be reviewed to ensure image acquisition and interpretation meets departmental thresholds for accuracy. Who participates in image review, how often it occurs, and what percentage of images are reviewed are part of the program design. Some programs will choose to QA 100% of images, whereas more established programs may only review 5-10% Establishing criteria for what constitutes a clinically adequate image supports users in performing clinically adequate scans as well as a structure for critique and improvement. The minimum of “pass/fail” image review does little to support the user in neither improving nor troubleshooting. Providing written or verbal feedback better supports the user and ultimately the patient.A robust system for QA lays the groundwork for continuous quality improvement (QI). QI in POCUS is the process of evaluating the system as a whole and systematically investigating and implementing specific measures for the furtherance of patient care and trainee education using bedside ultrasound.Kim, Thiessen, and Strony break down the differences between these terms as specifically applied to POCUS Whether or not a system requests credentialing as a pathway to obtaining privileges, or permission to use POCUS is a reflection of the unique medical structure at each practice site. Certification programs can serve as surrogate practice-based pathways when residency pathways or hospital-based pathways are unavailable, or even in addition to those pathways. While not required to demonstrate competency, certification in aspects of clinical ultrasound—as can be obtained through the American Society of Diagnostic and Interventional Nephrology—serve as a bolster for nephrology faculty specializing in POCUS, signaling to peers and institutions that they are committed and capable in the field The aforementioned foundational structure is well-served by having a designated leader with clearly delineated responsibilities At every branchpoint of growth there is a corresponding number of responsibilities. Growth and maintenance will not likely occur without a designated POCUN Director. As each part of a program expands, the administrative burden grows. Growth in education such as the addition of a fellowship and education at the student or resident level requires recruitment, marketing, and curricular design. Growth in number of clinical users adds to the number of studies for QA as well as the responsibilities for oversight. Growth in the number of devices corresponds to the number of times something needs a fix, repair, or simply guidance for use. The role and responsibilities of POCUN Director deserves protected time to be most effective.How does a program become self-sustaining? Expanding the core nephrology faculty is an obvious first goal in order to allow for shared responsibilities across the spectrum of administrative and educational need. There is no one best way to expand the faculty leadership cohort. Integrating POCUS faculty development into existing responsibilities is possible with approaches curated to the specialty with respect to demands on the participants time and in tandem with learners at different career stages Integrating POCUS into the core fellowship curriculum is one way to grow a foundational program into a sustainable cohort of skilled bedside sonographers and expand a programs capacity for image review. Koratala, et al. describe one such method of building POCUS education and skill development into the first 18 months of nephrology fellowship training Documentation to support billing includes the indication for the study, the type of exam, findings, and the note-writer’s interpretation of these findings as well as at least a still image, saved and retrievable Excluded from this review thus far has been any mention of a specific educational pathway for those looking to start a POCUN program or expand their ultrasound using cohort. A one-day course is enough to light the fire, but how does one keep it stoked and challenged? Hands-on courses, online content and curricula, and even Twitter are the modern-day core content providers How to move POCUS users engaged in a program from curious to competent remains a black box even in 2021, as there is an ongoing lack of sufficient evidence on the best methods to assess competency Considering a physician needs time, creative head space, and motivation to pursue developing a new program in their department, there are more than a few ways the current pandemic might stunt this type of growth. What is lost in the limitations to networking at national conferences or in-person courses is potentially a gain for the increased physical presence of the local cohort at one’s home institution. And the pandemic has shifted many national organizations to virtual formats for education with additional opportunities for online learning growing steadily. Troubleshooting the challenges of COVID-19 imposed physical distancing restrictions with the need for personal protective equipment (PPE) preservation is already underway by POCUS educators These Nuts and Bolts can build a program in many different ways. There is no specific timeline to follow to engage potential teammates. A starting program in a site with three nephrologists well-trained in POCUN with strong administrative support and easy collaboration across departments would be expected to progress beyond the basics of program development rather quickly. On the other hand, a solo aficionado working to increase their skills through a national certificate program while simultaneously building the scaffolding for a well-designed program could be expected to need several years to accomplish the network described above. Invariably, there will be more that is unexpected than is planned, but that is the allure of building something from scratch. With a plan for each of the basic pieces described above, a new program will have solid footing on which to start.None.


Tobacco mosaic virus movement protein (TMV MP) is essential for virus spread between cells. To accomplish its task, TMV MP binds viral RNA, interacts with components of the cytoskeleton, and increases the size exclusion limit (SEL) of plasmodesmata. Plasmodesmata are gated intercellular channels that allow passage of small molecules and macromolecules, including RNA and protein, between plant cells. Moreover, plasmodesmata are diverse and those connecting different cell types appear to have unique mechanisms to regulate macromolecular trafficking, which likely contributes to the establishment of distinct cell boundaries. Consequently, TMV MP might be competent to mediate RNA transport through some but not all plasmodesmal gates. Due to a lack of viral mutants defective for movement between specific cell types, the ability of TMV MP in this regard is incompletely understood. In contrast, a number of trafficking impaired Potato spindle tuber viroid (PSTVd) mutants have been identified. PSTVd is a systemically infectious non-coding RNA that nevertheless can perform all functions required for replication as well as cell-to-cell and systemic spread. Previous studies have shown that PSTVd employs different structure and sequence elements to move between diverse cell types in host plants, and mutants defective for transport between specific cell types have been identified. Therefore, PSTVd may serve as a tool to analyze the functions of MPs of viral and cellular origin. To probe the RNA transport activity of TMV MP, transgenic plants expressing the protein were inoculated with PSTVd mutants. Remarkably, TMV MP complemented a PSTVd mutant defective for mesophyll entry but could not support two mutants impaired for phloem entry, suggesting it fails to productively interface with plasmodesmata at the phloem boundary and that additional viral and host factors may be required. Consistent with this idea, TMV co-infection, but not the combination of MP and coat protein (CP) expression, was able to complement one of the phloem entry mutants. These observations suggest that phloem loading is a critical impediment to establishing systemic infection that could involve the entire ensemble of TMV proteins. They also demonstrate a novel strategy for analysis of MPs. Nicotiana benthamiana plants expressing TMV MP. TMV MP complemented a PSTVd mutant defective for invasion of underlying mesophyll following inoculation to epidermal cells. However, it failed to complement two mutants that are unable to enter the phloem, although one could be complemented by co-infection with TMV. These observations suggest that TMV MP alone does not productively interact with plasmodesmata at the phloem boundary and that additional viral and host factors are required. They further confirm that phloem loading is more complex than other types of cell-to-cell movement, and demonstrate a novel approach for the analysis of MPs.TMV 30 kDa movement protein (TMV MP) mediates virus spread in part by increasing the size exclusion limit of plasmodesmata, intercellular channels that provide cytoplasmic continuity between plant cells and regulate trafficking of protein and RNA. However, plasmodesmata connecting different cell types have unique gating mechanisms that likely contribute to the establishment of distinct cell boundaries. Thus, TMV MP may enable viral RNA passage through some but perhaps not all plasmodesmal gates. In particular, its ability to support RNA trafficking between bundle sheath cells and phloem parenchyma, a key step in phloem loading, is unknown. To address this question, available PSTVd RNA mutants defective for trafficking between specific cell types were used to infect transgenic  Potato spindle tuber viroid (PSTVd) and Tobacco mosaic virus (TMV) continue to be important models for the analysis of RNA trafficking in plants. TMV has a plus-sense single-stranded RNA genome of ~6.5 kb that specifies four proteins. Conversely, PSTVd is a circular non-coding RNA of 359 nucleotides, thus all functions required for host plant infection are mediated by sequence and structure elements within the genomic RNA -UTP-labeled probe was used in the present study. To prepare (DIG)-labeled PSTVd riboprobes, pInter(-) plasmid was linearized with SpeI (New England Biolabs) [in vitro transcription using the MAXIscript T7 Transcription Kit (ThermoFisher Scientific). Signal was captured using myECL Imager (ThermoFisher Scientific).Plant RNA samples were prepared using Trizol reagent (Invitrogen) according to the manufacturer’s instructions. Prior to subsequent experiments, RNA samples were incubated with DNase I (Invitrogen) at 37°C for 2 h to remove genomic DNA. RNA blotting was performed essentially as described , except Biolabs) . This wapetD-d24 in sense and antisense orientation, reverse primers petD-d24-senseR (5’-GTATCTAGGGAATAGTCACT-3’) and petD-d24-antisenseR (5’-GTTAATAAATTCCAAAATCCAT-3’) were used. Reverse primer PSTVd-R (5’- GCTTCAGTTGTTTCCACCGG-3’) was used to clone PSTVd progeny. PCR reactions were performed with MPdetect-R and MPdetect-F (5’-AGCCGGTTTGGTCGTCACGG-3’), CPdetect-R and CPdetect-F (5’-CTCCATCTCAGTTCGTGTTCTTG-3’), actindetect-R and actindetect-F (5’-AACTGATGAAGATACTCACAG-3’), MPclone-R and MPclone-F (5’-ATGGCTCTAGTTGTTAAAGG-3’), CPclone-R and CPclone-F (5’-CGACGACAAGACCGTCACCATGTCTTACAGTATCACTACTC-3’), MBPclone-R and MBPclone-F (5’-CAGTGGTGGTGGTGGTGGTGCTCGAGTTAAGTCTGCGCGTCTTTCAGGGCT-3’), petD-d24-senseR and petD-d24-senseF (5’-TAATACGACTCACTATAGTTAATAAATTCCAAAATCC-3’), petD-d24-antisenseR and petD-d24-antisenseF (5’-TAATACGACTCACTATAGAGTGACTATTCCCTAGATACAC-3’), or PSTVd-R and PSTVd-F (5’-GCTGTCGCTTCGGCTACTAC-3’). To prepare TMV-GFP (TE1), site-directed mutagenesis was performed using TE1-F (5’AAAGGAAAAGTGATATCAATGAGTTT-3’) and TE1-R (5’-AAACTCATTGATATCACTTTTCCTTT-3’) primers. To prepare TMV-GFP (ΔCP) mutant, PCR products were prepared using ΔCP-F (5’-AAGTTCATTTCATTTGGAGAGGGTATTTTTACAACAATTACCAACAACAACAAAC-3’), ΔCP-R1 and (5’TGGGCCCCTACCGGGGGTAACGGGGGGATTCGAACCCCTCGCTTTATTACGTG -3’) PCR was carried out using Phusion High-Fidelity DNA Polymerase (New England Biolabs). PCR products were subjected to 1.5% agarose gel electrophoresis, and images were taken after ethidium bromide staining.Reverse transcription was performed with Superscript III Reverse Transcriptase (ThermoFisher Scientific) using RNA samples from indicated plants as template. Reverse primers MPdetect-R (5’-TGGGCCCTCCGTCTCTCACG-3’), CPdetect-R (5’-CAAACCAGAAGAGCTCTCGAAAG-3’) and actindetect-R (5’-CAGGATACGGGGAGCTAATGC-3’) were used to detect MP, CP and actin expression, respectively. To clone the MP, CP, and MBP open reading frames (ORFs), reverse primers MPclone-R (5’-TTAAAACGAATCCGATTCGG-3’), CPclone-R (5’-GAGGAGAAGAGCCGTCGTCAAGTTGCAGGACCAGAG-3’), and MBPclone-R (5’-CAGTGGTGGTGGTGGTGGTGCTCGAGTTAAGTCTGCGCGTCTTTCAGGGCT-3’) were employed, respectively. To prepare DNA fragments composed of T7 promoter region and 182 bp Full-length progeny sequences were amplified from greater than full-length reverse transcription products as described , using f6MBP-MP) [6MBP expression vector, the entire MBP cDNA was amplified from pDEST-HisMBP vector. After gel purification, MBP cDNA was cloned into pET-28a expression vector carrying N-terminal His tag through homologous recombination. Through the same method, pCB301 vector carrying full-length TMV, kindly provided by Dr. Jiejun Peng at Ningbo University, was used as a template to clone TMV CP full length cDNA. CP cDNA was cloned into the pCAMBIA1301 vector to establish CP-expressing vector using T4 DNA Polymerase (ThermoFisher Scientific)-mediated ligation. MYC-expressing pCAMBIA1301 vector, TMV-GFP-expressing pCB301 vector and GUS-expressing pCB301 vector were kindly provided by Dr. Kelei Han at Ningbo University. The TMV-GFP(TE1) mutant was constructed by site-directed mutagenesis. The TMV-GFP(ΔCP) mutant was prepared by homologous recombination.The entire TMV MP ORF was amplified from NB+MP plants and purified following agarose gel electrophoresis using the Zymoclean Gel DNA Recovery Kit. The ORF was then cloned into the pCR8 TOPO gateway vector using the pCR8/GW/TOPO TA Cloning Kit (ThermoFisher Scientific). Through an LR reaction using Gateway LR Clonase Enzyme mix (ThermoFisher Scientific), the MP ORF was cloned into the pDEST-HisMBP vector for expression as a His6 maltose binding protein fusion (His6MBP-MP) . ConstruAgrobacterium tumefaciens. Transfected agrobacteria were cultivated in LB medium containing 25 μg/ml kanamycin and 100 μg/ml rifampicin at 28°C overnight. The next day, agrobacteria were collected and resuspended in MMA solution . To perform TMV infection at 3 days post PSTVd inoculation (dpi), OD values were adjusted to 0.1. To express TMV CP at 5 and 10 dpi, OD values were adjusted to 0.5.TMV CP-, and MYC-expressing pCAMBIA1301 vectors, as well as TMV-GFP(TE1), TMV-GFP(ΔCP), TMV- and GUS-expressing pCB301 vectors, were transfected into E. coli strain BL21 (EMD Millipore). Bacteria were cultivated at 37°C until a A600 value close to 0.6 was reached. IPTG was added to 0.1 mM and, following incubation for a further 4 h, cultures were centrifuged at 5000 g for 15 min at 4°C. To extract protein, cell pellets were resuspended in native binding buffer  Triton X-100). Lysozyme (1 mg/ml) was then added to the cell suspension. Cell lysis was performed on ice for 30 min. After sonication, cell lysates were centrifuged at 5000 g for 15 min at 4°C to collect supernatant, which was incubated with Ni-NTA agarose (Qiagen) to adsorb His tagged fusion protein. Ni-NTA agarose and bound protein were collected by centrifugation. After washing the pellet with native washing buffer , fusion protein was eluted using native elution buffer . Gel filtration was performed with Sephadex G-25 beads (Sigma-Aldrich) prior to subsequent assays. Proteins were visualized by Coomassie blue staining of a 10% SDS-polyacrylamide (37.5:1) gel.The pDEST-HisMBP vector carrying TMV MP and pET-28a vector carrying MBP were transfected into In vitro transcripts of WT PSTVd and the GG, 76AU and 156AU mutants, as well as spinach chloroplast petD-d24, were prepared and folded as previously described [6MBP-MP fusion protein  in 10 μl binding buffer  (ThermoFischer Scientific) for 30 min at 4°C. Binding products were subjected to 6% native polyacrylamide gel (29:1) electrophoresis at 4°C for 3h at 120V. RNA blots were performed to analyze binding.escribed . RNA folpetD-d24 transcripts (1 ng) were incubated with 40 ng His6MBP-MP fusion protein or 40 ng His6MBP protein alone, or in the presence of 100 ng ssDNA, or dsDNA. To prepare dsDNA samples, a mixture of pCR8 TOPO TA vector, pGEM-T easy vector, and pDEST-HisMBP vector  was first digested with RNase A overnight to remove all potential RNA contamination, followed by three rounds of phenol-chloroform extraction to remove RNase A. To prepare ssDNA samples, the three plasmids were linearized using EcoRI, SpeI, and EcoRI, respectively. Plasmid mixtures were incubated at 98°C for 10 min, followed by freezing in liquid nitrogen prior to use. To prepare dspetD-d24 RNA, sense and antisense petD-d24 RNAs were mixed . The mixture was denatured at 98°C for 10 min, followed by slow cooling to room temperature. The resulting dspetD-d24 RNA was purified twice through 5% native PAGE gel electrophoresis to completely remove ssRNA.In competition assays, PSTVd or in situ hybridization was performed as described [Preparation of inoculated leaf transverse paraffin sections and escribed . Two inoS1 FigThe presence of TMV MP transcripts in extracts obtained from nine randomly selected Nb+MP plants was confirmed by RT-PCR using MP-specific primers. Actin mRNA served as an internal control. M, non-transgenic Nb plant.(TIF)Click here for additional data file.S2 FigSix Nb and Nb+MP plants were co-inoculated on two lower leaves by agroinfiltration with pCB301 vectors to express the trafficking-defective TMV-GFP(TE1) mutant and GUS. As a positive control, another six Nb plants were co-inoculated with pCB301 expressing TMV-GFP(TE1) and a second pCB301 vector expressing TMV. (A) GFP fluorescence was monitored under UV light nine days post-inoculation. Uniform dark red color in the absence of GFP is due to chlorophyll autofluorescence. As indicated by GFP signal in upper leaves, systemic spread of TMV-GFP(TE1) was observed in Nb+MP plants, and in Nb plants when co-inoculated with TMV. In Nb plants co-inoculated with TMV-GFP(TE1) and GUS, GFP fluorescence was confined to agroinfiltration sites on lower leaves. (B) MP expression was monitored by RT-PCR, with actin as an endogenous control. P, positive control. M, mock. Extracts were obtained from upper, systemic leaves at 9 days post-inoculation. In Nb+MP plants, expression can be attributed to the 35S-MP transgene and the TMV-GFP(TE1) mutant, whereas MP is expressed from virus in Nb plants co-inoculated with TMV and TMV-GFP(TE1). However, presence of the TE1 mutant sequence was confirmed by progeny sequencing (six plants in each group).(TIF)Click here for additional data file.S3 Figt test. (C) Systemic infection assay at 10 dpi. Upper leaves from the same plants noted in (A) Rub-inoculated leaves of the same Nb and Nb+MP plants noted in (TIF)Click here for additional data file.S4 FigSix Nb plants were co-agroinfiltrated with a pCB301 vector expressing trafficking-defective TMV-GFP(ΔCP) mutant and a pCAMBIA1301 vector expressing MYC. Another six Nb plants were co-agroinfiltrated with a pCAMBIA1301 vector expressing TMV CP and a pCB301 vector expressing trafficking-defective TMV-GFP(ΔCP) mutant. (A) GFP signal indicating systemic trafficking of TMV-GFP(ΔCP) was detected at nine days post agroinfiltration. (B) Systemic trafficking of TMV-GFP(ΔCP) was also confirmed by RT-PCR amplification of TMV MP with actin as an endogenous control. P, positive control. M, mock.(TIF)Click here for additional data file.S5 FigNb+MP plants were first inoculated with WT PSTVd or the 76AU and 156AU mutants, followed by agroinoculation of the same leaves with pCAMBIA vectors expressing TMV CP (Nb+MP+CP) or MYC  at 5 and 10 dpi. TMV CP expression was confirmed at 15 dpi by RT-PCR with actin as an endogenous control. P, positive control. M, mock.(TIF)Click here for additional data file.S6 Fig(A) Local infection assay at 10 dpi. Rub-inoculated leaves of Nb+MP plants also expressing TMV CP (Nb+MP+C) or MYC  noted in (TIF)Click here for additional data file.S7 FigNb plants rub-inoculated with WT PSTVd, 76AU, or 156AU were agroinfiltrated at 3 dpi with a pCB301 vector expressing TMV or GUS (negative control) at 3 dpi. (A) Nb+TMV and Nb+GUS (negative control) plants Click here for additional data file.S8 Fig(A) Local infection assay at 10 dpi. Rub-inoculated leaves of the same Nb+TMV and Nb+GUS plants noted in (TIF)Click here for additional data file.S9 FigRNA samples isolated from rub-inoculated leaves of the same Nb+TMV and Nb+GUS plants noted in (TIF)Click here for additional data file.


While positive parenting programs are an initiative aligned with the Family-Centered Care model and the Council of Europe’s Recommendation on Positive Parenting, implementation in healthcare centers remains a challenge. The aims of this study were to (1) investigate how the hybrid version (online course plus face-to-face activities) of the program “Gain Health & Wellbeing From 0 to 3” was implemented in Spain from professionals’ perspective, and (2) explore the perceived impact of this hybrid version of the program on the implementers’ professional development. We used a qualitative mixed-methods design that included focus groups and surveys. Fifty professionals from 17 centers completed the survey on professional development. Thirty-one of these also participated in the focus groups to address the first aim. The key themes identified from the focus group were professional training, parent recruitment, program features, organizational issues, parental responses, and program sustainability. Survey results related to positive professional impact fit nicely with subthemes concerning collaboration with parents, parental needs, center coordination, and future expectations. The perceived relevance of the parenting program and its positive impact on the implementers’ professional development were potential predictors for the adoption and sustainability of the program in the public health system. Most Primary Healthcare centers have begun to pay attention to the Family-Centered Care (FCC) model Shields, . FCC is However, the introduction of the FCC model into primary healthcare centers remains a challenge. First, pediatrician training programs, as compared to nursing and social work programs, have paid little attention to psychosocial aspects of child health, such as care and education in the family context Briggs, . Second,http://aulaparentalidad-msssi.com/.The Spanish Ministry of Health sponsored the positive parenting program “Ganar Salud y Bienestar de 0 a 3 Años” , as well as systemic-organizational variables that constitute the context of the program  agreed to promote only the use of the online version of the GH&W program through dissemination of leaflets at regular check-ups to parents who had children between 0 and 3 years of age. Participants in Level 2 centers (L2), in addition to dissemination, were asked to conduct four face-to-face group workshops following the online version content developed through experiential methodology with those parents interested in the online course. Workshops were conducted in primary healthcare centers. Participants in Level 3 centers (L3), in addition to performing the L1 and L2 activities, provided individual support at regular pediatric check-ups (one session at the beginning of the program) involving the Teachable Moment Technique, which consists of creating an event to prompt behavior change , and the moderator skills necessary to manage the group workshop effectively. Participants in L3 received an additional 2-hr session  on the content of the individual support. All participants received technical assistance and supervision throughout the process. After the initial training, participants recruited parents at regular check-ups and implemented the program twice.n = 12) and L3 (n = 19) participated, since they were the ones who had implemented the program, whereas the survey involved the full sample of participants in L1 (n = 12), L2 (n = 16), and L3 (n = 22).For the focus group, only participants in L2 (n = 26) and pediatricians (n = 20) than social workers (n = 4). Participants’ demographics did not differ significantly across the three levels of intervention described in the procedure.We initially contacted a total of 67 healthcare professionals from 20 centers. The final sample consisted of 50 participants from 17 centers who completed the survey, and of those, 31 also participated in a focus group. The participants were very similar professionally across the qualitative and quantitative phases. The ages of the participants ranged from 26 to 61 years (average of 45), of whom 45 identified as female, 25 reported having conducted parenting activities, 23 had a bachelor’s degree, 26 a master’s degree, and one a doctorate. The participants reported an average of 20 years of professional experience. There were more nurses , position, years of experience as a practitioner, and whether or not they had experience running parenting interventions.I have more skills to help me understand what happens to families”); (b) Impact on teamwork ; and, (c) Impact on center organization . The score of the subscales corresponded to the mean score of their items . Higher scores indicated a more positive impact on individual, teamwork, and healthcare office professional development, respectively.We adapted this survey from the one used for face-to-face parenting programs  and then the focus groups were held. The survey was completed online. Each generally took around 10 min to complete. We conducted six separate focus groups, and participants selected the one that suited them best. The focus groups had a mean size of 6 people and lasted a mean of 48 min. At the end of each focus group, the coordinator summarized the main ideas and asked participants whether this summary reflected what they had intended to express. We tape-recorded and transcribed all the focus groups.To explore participants’ opinions on the impact that the experience had for their professional development, we analyzed their responses to the survey. For these analyses, we calculated the mean scores by accumulating the items of each aspect, since the reliabilities were adequate. Using the IBM SPSS v25, we performed ANOVAs on the mean scores corresponding to each of the three aspects surveyed . We used the assignation of the participants to L1, L2, and L3 conditions as the independent variable to examine under which level of intervention participants were more likely to see a positive impact of the program on each aspect surveyed.We used a joint display  and 902 coded comments related to the implementation process and its impact on professional development .Participants shared their opinions about the content, duration, and delivery format of the training received from the research team. Participants were generally satisfied with the face-to-face format and content. Others asked for longer and more in-depth training on group dynamics.Some participants’ comments revealed that parent recruitment and adherence were seen as the main challenges, since the enrolment rates were lower than expected, there was low commitment to regularly attend the sessions and at-risk parents were very difficult to reach. The main recruitment context was the medical check-ups, although some professionals mentioned the use of mailing lists or phone calls. Participants linked the recruitment and adherence challenges with possible solutions such as coordination with other services  or using mass media to disseminate the information.Most participants showed an overall satisfaction with the GH&W program design and content as well as with the workshop design. They also praised the experiential methodology based on the interactive approach. They mentioned some points for improvement, such as clarifying the interpretation of some videoclips in the GH&W program or proposing the incorporation of new activities at workshops. With regard to the program evaluation, they were not comfortable with the number of evaluation instruments given to parents.This was the theme most mentioned. They focused on professional, parent, and organizational barriers and possible solutions as well as facilitating factors for future implementation. Participants suggested the need for longer preparation periods, since time restrictions were generally seen as an organizational barrier.Participants also identified some facilitating factors, such as the head of the center’s positive attitude towards the innovation. Participants also talked about what would be required to continue implementing the sessions. One of the most frequently mentioned points was the importance of considering the program implementation as part of their regular practice. Furthermore, they made suggestions about the convenience of holding two program editions per year involving four workshop sessions each instead of only one edition. In sum, participants pointed out lack of time, but they also made specific proposals to overcome these issues in further program implementations.This theme covered mainly the participants’ reflections on the positive parent engagement in the activities, such as satisfaction with the program and high levels of engagement at the workshop sessions, their changing views about how to manage the group discussions in the workshops, and some improvements in the parents’ autonomy, who became less dependent on professionals to cope with day-to-day parenting challenges. Participants also mentioned one attendance issue related to the need to bring together a minimum number of participants to run a group following the experiential methodology, since it is based on parent participation. They stated that parents were pleasantly surprised to receive this kind of parenting support in primary care settings. Participants highlighted this aspect as one of the reasons behind the low attendance rate in certain areas.Most participants commented on their concerns for the sustainability of the experience. The majority mentioned the importance of integrating parenting support into the healthcare office using programs such as GH&W. Moreover, they considered this innovation feasible if some basic requirements were to be assured, such as including parenting support activities in their work schedule. Regarding satisfaction with the experience, participants especially valued having time to devote to health prevention and not only to the treatment of problems. They were also satisfied with having participated in an innovative project, which allowed them to develop new practices, such as facilitating group workshop dynamics.Like program sustainability, participants reported that GH&W program implementation positively influenced their professional development. They pointed out improvements in their collaborative relationships with parents and in the learning of new issues regarding the positive parenting approach and psychological developmental landmarks. They also perceived themselves as more aware of parents’ needs as promoters of their children’s health.In this study, we provided a comprehensive picture from the professional’s perspective of the implementation process in primary care settings of the supportive activities that corresponded to the hybrid version of the GH&W program. As for the first aim, the categories widely covered those dimensions mentioned in the Berkel and colleagues  implemenProfessionals praised the quality of the online version of the GH&W program, which is a factor that may also facilitate its adoption  at the individual level regardless of the level of intervention to which professionals were assigned, since all had been exposed to the introduction of the online version of the GH&W program. Moreover, in the focus groups, professionals pointed out changes in their beliefs and practices related to the key factors of parenting support in FCC: the collaborative approach, knowledge of child development and positive parenting, and the ability to identify parental needs. These findings can be explained by the experiential methodology of the program which facilitates learning about handling group dynamics to understand parental needs in addition to the children’s health issues  on the implementation process.We identified three predictors of success for the adoption of the hybrid version of the GH&W program: (a) professionals perceived the program as a key tool to promote child health and development, (b) they found it feasible and complementary with the topics they already cover at medical check-ups and they perceived that families were also satisfied with the program, and (c) the implementation of the program had a positive impact on their professional development. In sum, this experience can be considered a best practice to place universal parenting support at the forefront of European family policy to be applied across healthcare, educational, and social services.


While there was some concern about the value of participating in a remote format, overall students in both formats viewed the program favorably, with students in the remote cohorts rating some aspects of the program significantly more favorably. In addition, more students who identified as Black or African American participated in the remote format than in the in-person format. We describe lessons learned from this unprecedented challenge and future program directions.Well-designed, accessible short-term research training programs are needed to recruit and retain underrepresented persons into clinical and translational research training programs and diversify the workforce. The Michigan Institute for Clinical and Health Research developed a summer research program, training over 270 students in 15 years. In response to the 2020 COVID-19 pandemic, we pivoted swiftly from an in-person format to a fully remote format. We describe this process, focusing on factors of diversity, equity, and inclusion including enabling student participation in remote research activities. We collected data about students’ learning experiences since the program’s inception; therefore, we could evaluate the impact of remote vs. in-person formats. We examined data from five cohorts: three in-person (2017–2019;  In recent years, there has been an increasing need to diversify the clinical and translational science workforce. In 2019, the National Institutes of Health released updated guidelines encouraging institutions to enhance the diversity of their workforce, stating that “scientists and trainees from diverse backgrounds and life experiences bring different perspectives, creativity, and individual enterprise to address complex scientific problems” . HoweverIn 2007, the Michigan Institute for Clinical and Health Research (MICHR) at the University of Michigan developed a CTSA-sponsored immersive, 3-month summer research program to provide graduate students from lower-resourced institutions with a structured CTR experience. In 2012, the program began intentionally recruiting from groups traditionally underrepresented in translational research. Studies related to other summer research programs have demonstrated that this type of short, immersive experience has many benefits, including an increase in students’ self-reported interest in research and research skills –12, haviFrom 2007 to 2019, MICHR’s summer research program was implemented as an in-person, mentored research experience. However, like many other CTSA hubs, in 2020 the COVID-19 pandemic necessitated an unanticipated and swift change in program format. Although previous work has described the impact the COVID-19 pandemic has had on CTR trainees and scholars ,16, few The MICHR summer research program was developed in 2007 to provide students in master’s and health professions degree programs with a participatory experience in translational research. In 2012, the program was restructured to concentrate on health disparities research. The program attracts students from across the US and Puerto Rico who have diverse research interests and backgrounds. Students accepted into the program participate in activities focused on interdisciplinary and collaborative work in translational and health disparities research.This short-term program is offered from June through August each year. As part of their application, students provide a brief description of their research interests, which assists the program manager in matching them with a faculty member at the University of Michigan who shares their research interests. Faculty mentors in all years of the program were given the opportunity to interview prospective students before agreeing to work with them.Students work approximately 35 hours a week with their assigned faculty mentor on an ongoing research project and participate for approximately five hours a week in a structured curriculum that explores substantive methodological and career topics related to health disparities and translational research. The curriculum is aligned with seven of the CTSA core thematic areas  includinPrior to 2020, students participated in all research and curriculum activities in-person at the University of Michigan Ann Arbor campus. However, due to restrictions related to the COVID-19 pandemic, the program was reformatted in 2020 to be fully remote, including participation in remote research activities. Students in the 2021 cohort also participated remotely.Since the inception of the MICHR summer research program, learning activities have been mapped to CTSA-defined competencies. To adapt this program to a remote format, all curriculum activities were reviewed by program managers and the faculty director to determine if 1) program competencies continued to align with the new remote program structure, 2) programmatic activities could be structured in a manner that fit a synchronous, remote learning format to accommodate multiple time zones, and 3) adequate resources were available to provide equitable access for all participants and to maintain the experiential and group learning structure that was deemed critical to the success of the summer program, including participation in remote research activities. Activities that met these criteria were retained and, if needed, redesigned for remote learning. Items that did not contribute to mastery of defined translational or health disparities research skills or those that were not able to be presented in a synchronous, virtual format were replaced with learning activities that better met the program goals.In all, 12 of the 15 activities (80%) from the in-person curriculum were retained in the remote format. Three activities were not included because the sponsoring departments ceased offering them in 2020. During program planning, we recognized that students’ access to online research tools and learning platforms would vary. To ensure that all students had fair and equitable access to the program, we contacted them before the program started and asked about their level of internet access, their access to a computer with a camera and microphone, what time zone they were in, and their familiarity with learning management systems. Adjustments were made to the curriculum activities to promote access for all students. For example, when we discovered connectivity issues, such as temporary loss of internet access for some students during Hurricane Isaias in 2020, we modified assignments to accommodate students’ needs.Synchronous, online learning in diversity, equity, and inclusion from across the University of Michigan was made available to students as optional activities in the curriculum. In addition, regular remote office hours with the program managers, unstructured chat sessions with a peer mentor, and a variety of virtual social activities  were added to foster connections and strengthen peer relationships. To reduce potential online participation fatigue and enhance contact with students, activities that were previously presented in 2–3 hour in-person seminars were adjusted to be presented in multiple 1-hour segments.Principles of instructional design were used to ensure that core learning objectives and the program’s critical hands-on learning structure were maintained . Pre-recAt the beginning of this transition, few faculty members at our institution had experience with remote learning. To familiarize our faculty presenters and research mentors with the virtual platform, we held multiple, brief training sessions that provided tips on best practices for remote teaching and learning. We also provided personal technical assistance during the synchronous remote seminars.Since the program’s inception, we have developed and implemented a robust evaluation plan. Because of this, we could evaluate the impact of the remote format in comparison with the in-person format. We chose to include data from three in-person cohorts (2017–2019) and two remote cohorts (2020 and 2021). To assess the success of the new remote program structure, students were asked to complete surveys once a month during the 3-month program  to ensure their needs were identified and responded to in an appropriate and timely manner. This was a necessary departure from the single end-program survey structure that past in-person cohorts of students completed. Students were asked to answer eight questions about their experiences in the program. Six questions matched those from past programmatic surveys, including questions related to the relevance of the didactic sessions to students’ research activities, whether and how the didactic sessions improved understanding of the topic presented, how often students met with their summer research teams, and students’ experiences working with their faculty mentors. Two new questions were included to assess the frequency and mode of communication between the students and their mentors as well as their experience with the technology used for the remote program sessions. We also administered a survey to faculty mentors at the end of the program in the 2020 and 2021 cohorts.We recognize that student evaluation surveys do not always provide a full picture to inform program improvement; therefore, we held focus group sessions with students in the 2020 and 2021 cohorts to supplement the survey data [To assess changes in student experience between the in-person and remote formats, scores from feedback surveys of three prior cohort years were compared to survey scores from the remote program cohorts. This analysis was conducted with a series of 5 × 1 one-way ANOVAs, with simple planned contrasts using SPSS 26 software . This prn = 102) participated in translational and health disparities research projects during their time in the program. Seven students in the 2020 cohort and four in the 2021 cohort participated in research projects directly related to COVID-19. As seen in Table Students from all five cohort years n = 10 participMean scores for each item and cohort year for the feedback survey are shown in Table n = 18) and the 2021 cohorts (n = 19). Five overarching themes emerged: 1) interest in the program, 2) impact of the program on students’ plans to continue with a career in research, 3) the effects of mentorship on students’ research experiences, 4) attitudes toward the program, and 5) the remote aspects of the program.Focus group sessions were held at the end of the program with students in the 2020 . When asked how participating in the program affected their plans for continuing in research, students said it had a positive impact on their long- and short-term career goals as well as their view of research as a career path . For some students, experience in the summer research program confirmed their choice of career, while others said the program exposed them to new career possibilities and was a catalyst to changing their career paths . When discussing their mentor/mentee relationships, students said their mentors exposed them to new career possibilities, helped them establish professional social networks and career goals, and provided support and guidance . In fact, several students said they planned to continue working with their mentor after the program ended, which was not their original intent. Lastly, students described the opportunity to develop research communication skills, the variety of learning experiences, and developing relationships with mentors as positive aspects of the program. Students also suggested potential program improvements and made recommendations for students considering applying to the program in the future.We asked students to share what they liked and did not like about the remote format. Several said they missed having social interactions with their peers and expressed a desire to be more connected . Students also expressed a need for more bonding time . This feedback suggests that while students liked the program, the online format constrained their ability to form a sense of community with students in their cohort and with their research mentors.Like other education programs in the era of COVID, moving our summer program online came with challenges. However, it also brought us the opportunity to recruit and train a more diverse group of students. The remote format allowed students greater access to training and resources they might not otherwise have had by eliminating barriers to participation, such as the cost of relocating to our university for the duration of the program, and providing increased access to a rich network of faculty mentors . In addisignificantly more than those in the in-person cohorts. We also saw a significant increase in the diversity of the students in our program, both in terms of race and disadvantaged status. The ability for students to participate remotely helped them see our program as a viable and attainable training opportunity, and we anticipate that the positive impact of the program will feed into the diversity of the CTR workforce.Because the program already included a robust evaluation plan, the evaluations we have conducted since 2017 enabled us to directly compare student perceptions of the remote format to the in-person format. Overall, students in both the in-person and remote cohorts viewed the program favorably, with students in the remote cohorts indicating their program experience increased their interest in pursuing a career in health disparities research, helped them learn new information that would be useful in their future career, and that they would recommend the program to others and could be measured through a structured program evaluation plan.Mapping curriculum learning activities to established competencies was an important tool in the design of our program, whether the learning was being conducted in-person or remotely. This strategy allowed us to design activities that met defined learning objectives and program goals ,26. Not In our program, web access, time zone changes, and other technical issues posed barriers to participation for some students. Research has shown that these types of issues may pose disproportionate barriers for underrepresented students ,27. WhenIn reviewing our curriculum, we realized that learning activities that worked well in two- or three-hour classroom seminars were too long to be presented in a remote format. To promote inclusion and engagement for all program participants, we divided curriculum activities into smaller segments. Taking frequent breaks to answer questions or provide clarity for activities also encouraged inclusion and engagement .When creating our curriculum, whether in-person or remote, we incorporated varied teaching strategies and learning technologies to encourage an inclusive learning environment and meet students’ needs ,28. We iSeveral important lessons were learned from the process of moving a highly successful in-person program to an equally successful remote program.The process of redesigning the MICHR summer research program was unanticipated, but it allowed us to meet students where they are and examine how equity and inclusion factor into and impact our program. In future years, we are thinking more critically about what would be most equitable for all students who may be interested in participating in our program, but who may have experiences or circumstances that may deter or prevent them from participating in an in-person or residential program at the University of Michigan. Students’ comments about longing to form community among their cohort or meet with their research mentor and team in-person echoed our own impressions that a remote connection cannot replace an in-person experience in all cases. In the summer of 2022 and beyond, we will explore potential hybrid approaches, with some students participating in in-person research and others participating in remote research, and all students participating in remote learning sessions and activities together. In the future, we will examine the long-term impact that the virtual program had on students’ publications and career trajectory.