AdventHealth University

Parkinson’s disease requires complex pharmacological choices, yet patients often feel insufficiently involved in decisions. Understanding how patients and healthcare providers perceive shared decision-making, and what predicts perceived shared decision-making, can guide improvement. To compare patient and provider perceptions of shared decision-making in pharmacological management of Parkinson’s disease, and to examine whether sociodemographic variables and patient health literacy predict perceived shared decision-making. A cross-sectional online survey included 210 patients with Parkinson’s disease and 80 prescribing healthcare providers in the USA. Shared decision-making was measured with the nine-item Shared Decision-Making Questionnaire for patients and the physician version for providers. Patient health literacy was measured with the Health Literacy Instrument for Adults (range 0–132). Analyses included descriptive statistics, independent group comparisons, analysis of variance, simple linear regression, and multiple linear regression. Patients reported a mean shared decision-making score of 29.56 (standard deviation 10.39), and providers reported 37.83 (standard deviation 6.47). Providers rated perceived shared decision-making significantly higher than patients at the group level. Among patients, analysis of variance showed no differences by age, education, ethnicity, employment, region type, or region of residence; marital status was associated with higher scores for married, divorced, and widowed individuals compared with single, never married individuals. Health literacy predicted patient-reported shared decision-making in simple models but was not significant when sociodemographic variables were included. In multiple regression, graduate education, being married, divorced, or widowed, and rural residence predicted perceived shared decision-making. Provider ethnicity and region of residence predicted provider-reported shared decision-making. Differences in general perceptions of shared decision-making exist between patients and providers. Enhancing communication, using decision aids, and intentionally engaging care partners may strengthen shared decision-making in the pharmacological management of Parkinson’s disease.

Despite being heavily infiltrated by immune cells, tuberculosis (TB) granulomas often subvert the host response to Mycobacterium tuberculosis (Mtb) infection and support bacterial persistence. Human TB granulomas are enriched for immunosuppressive factors typically associated with tumor-immune evasion, raising the possibility that they promote tolerance to infection. Here we identify candidate drivers for establishing this tolerogenic niche and show that the magnitude of this response correlates with bacterial persistence. We conducted a multimodal spatial analysis of 52 granulomas from 16 nonhuman primates infected with low-dose Mtb for 9-12 weeks. Each granuloma's bacterial burden was quantified individually, enabling us to assess how granuloma spatial structure and function relate to infection control. We found that a universal feature of TB granulomas is partitioning of the myeloid core into two distinct metabolic environments, one of which is hypoxic. This hypoxic environment is associated with pathological immune cell states, dysfunctional cellular organization of the granuloma, and a near-complete blockade of lymphocyte infiltration that would be required for a successful host response. The extent of these hypoxia-associated features correlates with higher bacterial burden. We conclude that hypoxia correlates with immune cell state and organization within granulomas and might subvert immunity to TB.

INTRODUCTION:Executive function is important ability for individuals to deal with daily living activities, and the Adult Executive Functioning Inventory (ADEXI) with promising psychometric properties was developed to assess executive function in nonclinical adult populations. However, psychometric properties evidence for ADEXI was primarily based on classical test theory; therefore, the current study used Rasch analysis to examine ADEXI to provide additional psychometric properties evidence. METHODS:Participants aged 18-25 years (n = 1764; 55.9% women) were recruited using a social media platform (Dcard). They completed self-report Mandarin version of the ADEXI (of which includes three subscales of working memory, inhibition, and flexibility) and demographic characteristics (age, gender, and educational level) via online survey. Rasch analyses with differential item functioning (DIF) were used as analytic methods. RESULTS:All ADEXI items aligned with their intended subscales, with fit statistics of mean square ranging between 0.5 and 1.5. Moreover, the 5-point Likert scale of the ADEXI followed its order to indicate the difficulty (i.e., a higher score in the Likert scale indicates a poorer level of executive function). Moreover, no DIF items were displayed for the ADEXI across gender subgroup (men vs. women) or educational subgroup (college or above vs. high school or below). CONCLUSION:The psychometric properties of ADEXI were satisfactory, as indicated by the Rasch analysis findings. Unidimensionality of each ADEXI subscale was supported, categorical function was in order for the response, and no items displayed DIF. Therefore, the ADEXI can be used to evaluate executive function for general population and to enhance health promotion.

IMPORTANCE:Intraprofessional collaboration between occupational therapists and occupational therapy assistants enhances treatment outcomes and ensures coordinated and client-centered care. Although the Intraprofessional Collaborative Practice Survey (ICPS) was developed to assess intraprofessional collaboration, psychometric validation has not been established. OBJECTIVE:To evaluate the psychometric properties of the ICPS among occupational therapy students in the United States. DESIGN:Cross-sectional study. SETTING:Accredited occupational therapy programs across the United States. PARTICIPANTS:A total of 389 occupational therapy students (236 in master of occupational therapy [MOT] programs and 153 in occupational therapy doctorate [OTD] programs) completed the ICPS. A subset of 289 students also completed an adapted version of the Interprofessional Collaborative Competency Attainment Survey (ICCAS). OUTCOMES AND MEASURES:The ICPS, occupational therapy version, and an adapted version of the ICCAS. RESULTS:Factor analyses supported the hypothesized four-domain structure for both perceived importance and perceived ability modules in the ICPS. Internal consistency was excellent. Evidence of convergent, discriminant, and concurrent validity was found, with moderate to strong correlations with the ICCAS. Measurement invariance was supported across MOT and OTD program students. CONCLUSIONS AND RELEVANCE:The ICPS is a valid and reliable instrument for assessing intraprofessional collaboration competencies. Its alignment with the Accreditation Council for Occupational Therapy Education's 2023 practice-based standards underscores its value for program evaluation and professional development. PLAIN-LANGUAGE SUMMARY:Collaboration between occupational therapists and occupational therapy assistants is essential for safe, effective client care. This study validated the use of the Intraprofessional Collaborative Practice Survey (ICPS) among occupational therapy students and found it to be reliable and consistent across master's and doctoral programs. The ICPS can help educators and researchers evaluate student learning, track collaboration competencies, and strengthen training programs.

Chaplains play a vital role within the Department of Veterans Affairs (VA) by providing spiritual care and supporting veterans' mental health needs. The present study explored 11 VA chaplains' lived experiences regarding their support of veterans' mental health. Using a phenomenological qualitative approach, it explored their motivations, perceptions of mental health patterns, collaborative practices, and assessments of training adequacy. Semi-structured interviews were conducted with a purposive sample of 11 VA chaplains. Interviews were transcribed and analyzed using thematic coding to identify themes reflecting chaplains' lived experiences. Five primary themes emerged: (1) values and purpose underpinning veteran care; (2) veteran mental health patterns; (3) chaplain interventions; (4) collaboration with mental health professionals; and (5) education and training. The study supports the chaplains' unique role at the intersection of spiritual and mental health care within the VA. While chaplains demonstrate increased awareness of veterans' psychological and spiritual needs, gaps persist in the application of interventions. Strengthening collaborative practices and integrating mental health education within formal chaplain curricula and clinical training may enhance chaplains' capacity to address mental health issues among veterans and foster supportive relationships with mental health professionals. Future research would benefit from mixed-methods approaches that could capture more comprehensive insights into the implementation of mental health initiatives.