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To increase density of superconductor digital and neuromorphic circuits by 10x and reach integration scale of $10^8$ Josephson junctions (JJs) per chip, we developed a new fabrication process on 200-mm wafers, using self-shunted Nb/Al-AlOx/Nb JJs and kinetic inductors. The process has a layer of JJs, a layer of resistors, and 10 fully planarized superconducting layers: 8 Nb layers and 2 layers of high kinetic inductance materials, Mo$_2$N and NbN, with sheet inductance of 8 pH/sq and 3 pH/sq, respectively. NbN films were deposited by two methods: with $T_c$=15.5 K by reactive sputtering of a Nb target in Ar+N$_2$ mixture; with $T_c$ in the range from 9 K to 13 K by plasma-enhanced chemical vapor deposition (PECVD) using Tris(diethylamido)(tert-butylimido)niobium(V) metalorganic precursor. PECVD of NbN was investigated to obtain conformal deposition and filling narrow trenches and vias with high depth-to-width ratios, which was not possible to achieve using sputtering and other physical vapor deposition (PVD) methods at temperatures below $200 ^oC$ required to prevent degradation of Nb/Al-AlOx/Nb junctions. Nb layers with 200 nm thickness are used in the process layer stack as ground planes to maintain a high level of interlayer shielding and low intralayer mutual coupling, for passive transmission lines with wave impedances matching impedances of JJs, typically, Comment: 12 pages, 16 figures, 4 tables, 49 references. Submitted to IEEE TAS on Nov. 10, 2022

We present measurements of the self- and mutual inductance of NbN and bilayer NbN/Nb inductors with Nb ground plane(s) fabricated in an advanced process for superconductor electronics developed at MIT Lincoln Laboratory. In this process, the signal traces of logic cell inductors are made either of a 200-nm NbN layer with $T_c$=15 K or of an in-situ deposited NbN/Nb bilayer, replacing a 200-nm Nb layer M6 in the standard SFQ5ee process with nine superconducting layers. Nb ground planes were preserved to maintain a high level of interlayer shielding and low intralayer mutual coupling. A two-step patterning of the top Nb and the bottom NbN layers of the NbN/Nb bilayer allows to create inductors in a very wide range of linear inductance values, from low values ~ 0.4 pH/$\mu$m typical for Nb geometrical inductors to ~ 35 pH/$\mu$m typical to thin-film kinetic inductors. Mutual inductance of NbN and Nb inductors, of NbN inductors, and of bilayer inductors is the same as between two Nb inductors with the same geometry and placement between the ground planes, i.e., mutual inductance does not depend on superconducting properties of the signal traces in the studied range of linewidths. We measured magnetic field penetration depth and kinetic inductance of NbN films with thickness t=200 nm to be $\lambda$ = 491+/-5 nm and 1.51 pH/sq, and 2.06 pH/sq at t=150 nm. The kinetic inductance was found to be larger than that expected for superconductors with short mean free path, indicating a reduction in the superfluid density, likely due to carrier localization effects. Kinetic inductance associated with right-angled bends of the NbN inductors is negligible at linewidths $w, Comment: 11 pages, 9 figures, 4 tables, 60 references

Objectives To assess the antimicrobial susceptibility of 14 138 invasive Streptococcus pneumoniae isolates collected in Canada from 2011 to 2020. Methods Antimicrobial susceptibility testing was performed using the CLSI M07 broth microdilution reference method. MICs were interpreted using 2022 CLSI M100 breakpoints. Results In 2020, 90.1% and 98.6% of invasive pneumococci were penicillin-susceptible when MICs were interpreted using CLSI meningitis or oral and non-meningitis breakpoints, respectively; 96.9% (meningitis breakpoint) and 99.5% (non-meningitis breakpoint) of isolates were ceftriaxone-susceptible, and 99.9% were levofloxacin-susceptible. Numerically small, non-temporal, but statistically significant differences (P < 0.05) in the annual percentage of isolates susceptible to four of the 13 agents tested was observed across the 10-year study: chloramphenicol (4.4% difference), trimethoprim-sulfamethoxazole (3.9%), penicillin (non-meningitis breakpoint, 2.7%) and ceftriaxone (meningitis breakpoint, 2.7%; non-meningitis breakpoint, 1.2%). During the same period, annual differences in percent susceptible values for penicillin (meningitis and oral breakpoints) and all other agents did not achieve statistical significance. The percentage of isolates with an MDR phenotype (resistance to ≥3 antimicrobial classes) in 2011 and 2020 (8.5% and 9.4%) was not significantly different (P = 0.109), although there was a significant interim decrease observed between 2011 and 2015 (P < 0.001) followed by a significant increase between 2016 and 2020 (P < 0.001). Statistically significant associations were observed between resistance rates to most antimicrobial agents included in the MDR analysis (penicillin, clarithromycin, clindamycin, doxycycline, trimethoprim/sulfamethoxazole and chloramphenicol) and patient age, specimen source, geographic location in Canada or concurrent resistance to penicillin or clarithromycin, but not biological sex of patients. Given the large isolate collection studied, statistical significance did not necessarily imply clinical or public health significance in some analyses. Conclusions Invasive pneumococcal isolates collected in Canada from 2011 to 2020 generally exhibited consistent in vitro susceptibility to commonly tested antimicrobial agents.

Objectives To investigate the levels of MDR in the predominant serotypes of invasive Streptococcus pneumoniae isolated in Canada over a 10 year period. Methods All isolates were serotyped and had antimicrobial susceptibility testing performed, in accordance with CLSI guidelines (M07-11 Ed., 2018). Complete susceptibility profiles were available for 13 712 isolates. MDR was defined as resistance to three or more classes of antimicrobial agents (penicillin MIC ≥2 mg/L defined as resistant). Serotypes were determined by Quellung reaction. Results In total, 14 138 invasive isolates of S. pneumoniae were tested in the SAVE study (S. pneumoniae Serotyping and Antimicrobial Susceptibility: Assessment for Vaccine Efficacy in Canada), a collaboration between the Canadian Antimicrobial Resistance Alliance and Public Health Agency of Canada—National Microbiology Laboratory. The rate of MDR S. pneumoniae in SAVE was 6.6% (902/13 712). Annual rates of MDR S. pneumoniae decreased between 2011 and 2015 (8.5% to 5.7%) and increased between 2016 and 2020 (3.9% to 9.4%). Serotypes 19A and 15A were the most common serotypes demonstrating MDR (25.4% and 23.5% of the MDR isolates, respectively); however, the serotype diversity index increased from 0.7 in 2011 to 0.9 in 2020 with a statistically significant linear increasing trend (P Conclusions Although current vaccine coverage of MDR S. pneumoniae in Canada is high, the increasing diversity of serotypes observed among the MDR isolates highlights the ability of S. pneumoniae to rapidly evolve.

Objectives To investigate the lineages and genomic antimicrobial resistance (AMR) determinants of the 10 most common pneumococcal serotypes identified in Canada during the five most recent years of the SAVE study, in the context of the 10-year post-PCV13 period in Canada. Methods The 10 most common invasive Streptococcus pneumoniae serotypes collected by the SAVE study from 2016 to 2020 were 3, 22F, 9N, 8, 4, 12F, 19A, 33F, 23A and 15A. A random sample comprising ∼5% of each of these serotypes collected during each year of the full SAVE study (2011–2020) were selected for whole-genome sequencing (WGS) using the Illumina NextSeq platform. Phylogenomic analysis was performed using the SNVPhyl pipeline. WGS data were used to identify virulence genes of interest, sequence types, global pneumococcal sequence clusters (GPSC) and AMR determinants. Results Of the 10 serotypes analysed in this study, six increased significantly in prevalence from 2011 to 2020: 3, 4, 8, 9N, 23A and 33F (P ≤ 0.0201). Serotypes 12F and 15A remained stable in prevalence over time, while serotype 19A decreased in prevalence (P Conclusions Continued genomic surveillance of S. pneumoniae in Canada is essential to monitor for the appearance of new and evolving lineages, including antimicrobial-resistant GPSC5 and GPSC162.

Background As pneumococci evolve under vaccine, antimicrobial and other selective pressures, it is important to track isolates covered by established (PCV10, PCV13 and PPSV23) and new (PCV15 and PCV20) vaccine formulations. Objectives To compare invasive pneumococcal disease (IPD) isolates from serotypes covered by PCV10, PCV13, PCV15, PCV20 and PPSV23, collected in Canada from 2011 to 2020, by demographic category and antimicrobial resistance phenotype. Methods IPD isolates from the SAVE study were initially collected by members of the Canadian Public Health Laboratory Network (CPHLN) as part of a collaboration between the Canadian Antimicrobial Resistance Alliance (CARA) and the Public Health Agency of Canada (PHAC). Serotypes were determined by quellung reaction, and antimicrobial susceptibility testing was performed using the CLSI broth microdilution method. Results A total of 14 138 invasive isolates were collected from 2011 to 2020, with 30.7% of isolates covered by the PCV13 vaccine, 43.6% of isolates covered by the PCV15 vaccine (including 12.9% non-PCV13 serotypes 22F and 33F), and 62.6% of isolates covered by the PCV20 vaccine (including 19.0% non-PCV15 serotypes 8, 10A, 11A, 12F and 15B/C). Non-PCV20 serotypes 2, 9N, 17F and 20, but not 6A (present in PPSV23) represented 8.8% of all IPD isolates. Higher-valency vaccine formulations covered significantly more isolates by age, sex, region and resistance phenotype including MDR isolates. Coverage of XDR isolates did not significantly differ between vaccine formulations. Conclusions When compared with PCV13 and PCV15, PCV20 covered significantly more IPD isolates stratified by patient age, region, sex, individual antimicrobial resistance phenotypes and MDR phenotype.

This paper explores a 24-hr training cycle and how clinicians contribute to an athlete’s transition from recovery to readiness. The cycle is divided into three phases: immediate, intermediate, and extended. Phase break down is meant to provide wellness prioritization for the athlete and how the clinician can facilitate sustainable performance during a competitive season.

Wetland hydrologic connections to downstream waters influence stream water quality. However, no systematic approach for characterizing this connectivity exists. Here using physical principles, we categorized conterminous US freshwater wetlands into four hydrologic connectivity classes based on stream contact and flowpath depth to the nearest stream: riparian, non-riparian shallow, non-riparian mid-depth and non-riparian deep. These classes were heterogeneously distributed over the conterminous United States; for example, riparian dominated the south-eastern and Gulf coasts, while non-riparian deep dominated the Upper Midwest and High Plains. Analysis of a national stream dataset indicated acidification and organic matter brownification increased with connectivity. Eutrophication and sedimentation decreased with wetland area but did not respond to connectivity. This classification advances our mechanistic understanding of wetland influences on water quality nationally and could be applied globally.

Background: Monkey pox (Mpox) is a zoonotic viral illness that is endemic to Africa. In contrast to earlier years, the current Mpox outbreak has had an unusually rapid worldwide spread in terms of the number of cases, and most of these cases were among Men who have Sex with Men (MSM). The study aims to assess the knowledge, attitude, practice of infection prevention, and stigma of Mpox disease among members of the MSM community. Methods: The study was a cross-sectional design. A self-administered questionnaire was given to 498 respondents. Results: The mean age of the respondents was 30 years; twenty-three (4.6%) of the total respondents identified themselves as female gender. Urban dwellers were 344 (69.1%). Respondents had a good knowledge of both Mpox disease and transmission; an average knowledge of Mpox symptoms; and an average attitude towards prevention and the practice of prevention of Mpox. Age was found to be significantly associated with knowledge of transmission (p-value). Mpox infection was evaluated as a low-risk event by most responses, but the existence of both community stigma and self-stigma if infected were rated as high. Conclusion: The knowledge of Mpox disease and its transmission was good, while the attitude and practice of infection prevention was average. However, the existence of community and self-stigmatization was high; which perhaps may result in the possibility of an iceberg phenomenon of Mpox disease in the MSM community. Community sensitization, advocacy, and key population-friendly services are recommended for the MSM community to improve their general access to healthcare and reduce stigmatisation.

Purpose/Objective(s) A United States (US) radiation oncology (RO) curriculum, developed by key stakeholders using best practices for curriculum inquiry, is needed to guide residency education and qualifying examinations. Competency-based training, including entrustable professional activities (EPAs), provides an outcomes-based approach to modern graduate medical education. This study developed the first list of US RO EPAs and curricular content domains (CDs) to guide resident training and assessment in the modern era. Materials/Methods The Radiation Oncology Education Collaborative Study Group (ROECSG) Core Curriculum Project Leadership Committee (LC) developed initial EPAs and CDs. Following recruitment of stakeholders, a Delphi process was used for consensus. In the first Delphi, EPAs and CDs were reviewed for inclusion/exclusion, clarity, level of training (EPAs only), and time allocation (CDs only). Participants submitted additional EPAs/CDs for consideration. Any EPA or CD one standard deviation below the median underwent LC review. All participants completing the first Delphi were invited to the second. New EPAs or EPAs undergoing major revisions were re-reviewed. Percent allocated curriculum time was finalized for CDs and for a single subdomain (SD). Results 186 participants representing diverse RO stakeholder groups volunteered to participate. 114 completed the first Delphi (61.3%): 6/9 CDs met consensus, 1 CD was removed, 2 CDs were combined (Table 1). Of 114 invited, 77 participants completed the second Delphi (67.5%). Of 55 initial EPAs, 52 final EPAs met consensus. 4 SDs of a single CD (Applied Sciences) were reviewed and met consensus. Consensus on percent time allocated per CD and SD was reached (Table 1). Conclusion Deliberative curriculum inquiry was successfully used to develop a consensus on US RO CDs/SDs and EPAs. These data can guide educational time in training programs and help inform weighting for qualifying examinations. CDs are not exclusive; educators must ensure all CDs are considered when delivering curriculum content, regardless of the primary CD. RO-specific EPAs can guide clinical training and resident assessment. The Delphi should be used to reach consensus recommendations for SD content breakdown. Given the evolving nature of RO and the need for curriculum renewal, the Delphi process will be repeated on an interval basis.

With an increasing rate of global warming and unstable climatic conditions concerns with regards to epidemiology of plant viruses are on the rise. Studies suggest accelerating climatic changes shall severely affect the management of pest and diseases in cultivated crops. Tomato Leaf Curl Virus (TLCV) is an economically affecting viral infections of tomato (Lycopersicum esculentum). The disease causes severe yield loss and major economic impairment. The current study was therefore taken up to understand the influence of agro climatic zones on diversity of TLCV in Tomato plants. Samples of TLCV infected Tomato plants exhibiting varying symptoms were collected from seven different agro climatic zones of Gujarat followed by isolation of viral particles, molecular characterization and development of phylogenetic tree. Interestingly the molecular analysis of the isolated viral samples indicated little influence of climatic conditions on the types of TLCV infecting the tomato plants.

Quality improvement training during residency is a crucial component of post-graduate medical education and is one of the Association of American Medical Colleges Cross-Continuum Competencies and the six Accreditation Council for Graduate Medical Education domains of clinical competency. No national standard curriculum exists when it comes to training emergency medicine residents. A novel residency-focused QI curriculum was implemented to help emergency medicine residents develop foundational skills in QI and to translate these skills into practical projects that span multiple disciplines. The curriculum was effective, is readily adaptable to the resident physician and medical student levels, and supports the national trend toward implementing education in QI earlier in physician training.

Mpox presents typically with macular papular body rashes with similar-looking sores in genital or oral areas. It may be missed, or wrongly managed as sexually transmitted infections (STI), especially in settings where symptom-based treatment practices are sufficient for care. We describe a 40-year-old cisgender male, heterosexual Nigerian who developed some rash in the genital region associated with penile swelling. It was suspected to be syphilis and managed with presumptive antibiotics. Laboratory investigation (PCR) confirmed that it was a Mpox disease, and VDRLT was negative. Notably, in this case, the early symptoms were a paradigm case of Mpox disease presenting as an STI, which syndromically conformed more to an STI than the case definition for a suspected case of Mpox in our setting. Consequently, the expected early containment activities were delayed. This increased the potential of further disease spread. An Update of the standard case definition as well as a reclassification of the disease as a possible STI is recommended for enhanced surveillance, increased case detection, and reduction in the burden of unrecognized cases.

The sub-classification of invasive breast cancer into Integrated Clusters by a combined analysis of genomic change and expression profiling has revealed novel cancer drivers. The integrated Cluster 2 breast cancer sub-group represents a cohort with aggressive, largely estrogen receptor positive tumours with a high relapse rate. It is characterized by an amplification of chromosome 11 at the heart of which is a little studied gene which codes for the protein Adipocyte-Associated Methionine Domain Containing (AAMDC). Initial cell line and murine studies demonstrated oncogenic behaviours for AAMDC including increased proliferation and invasion, increased colony formation and anti-estrogen resistance. Downstream gene expression analysis showed the protein to modulate cholesterol biosynthesis, one carbon metabolism and mTOR signaling. To assess the clinical impact of differing levels and sub-localizations of AAMDC, immunohistochemistry for AAMDC was carried out using tissue microarrays from a cohort of 420 patients with invasive breast cancer. Expression was noted in a number of sub-cellular localizations including diffuse cytoplasm, nucleus and nuclear envelope. Using both dichotomous and continuous scoring, no significant association for any expression site with standard prognostic factors was identified including size, lymph node status, grade or receptor statuses. However, both cytoplasmic and nuclear envelope expressions correlated with significantly worse overall survival (p=0.04 and p=0.04 respectively) whereas nuclear expression showed a trend to better survival (p=0.06). Distant relapse and breast cancer deaths were lowest where there was nuclear expression but no nuclear envelope expression (4.7% and 4.7% respectively) but significantly higher for the reverse expression pattern (18.9%, p=0.02 and 17.6%, p=0.03 respectively). Considering the pre-clinical impact of AAMDC on genes involved in cholesterol biosynthesis, we studied the effects of statin prescription in the early disease setting in the context of AAMDC expression. Statins were found to be generally protective of relapse across the group. Only nuclear envelope AAMDC expression interacted, with a hazard ratio (HR) of 0.33 for distant relapse with high expressors, compared to a HR of 0.90 in low expression (p=0.02 for difference). Similarly, considering one carbon metabolism, we explored the impact of the anti-metabolite drug capecitabine compared to other chemotherapy treatments, largely taxane-based, in the metastatic setting. Again, only nuclear envelope expression interacted with median progression-free survivals on capecitabine of 2.0 v 12.2 months for low and high nuclear envelope expression respectively, p=0.03. In summary, AAMDC nuclear envelope expression correlates with poor prognosis which may be mitigated by statin administration in the early disease setting. This expression pattern also confers sensitivity to flurouracil-based metastatic treatment. Citation Format: Andrew D. Redfern, Indunil Weerasena, Lisa Spalding, Monique Ong, Emily Golden, Eleanor Woodward, Pilar Blancafort. Nuclear envelope Expression of the Oncogene Adipocyte-Associated Methionine Domain Containing Conveys Inferior Prognosis but Increased Sensitivity to Statins and Fluorouracil-Based Therapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-13-13.

Cortical stimulation is emerging as an experimental tool in basic research and a promising therapy for a range of neuropsychiatric conditions. As multielectrode arrays enter clinical practice, the possibility of using spatiotemporal patterns of electrical stimulation to induce desired physiological patterns has become theoretically possible, but in practice can only be implemented by trial-and-error because of a lack of predictive models. Experimental evidence increasingly establishes traveling waves as fundamental to cortical information-processing, but we lack an understanding of how to control wave properties despite rapidly improving technologies. This study uses a hybrid biophysical-anatomical and neural-computational model to predict and understand how a simple pattern of cortical surface stimulation could induce directional traveling waves via asymmetric activation of inhibitory interneurons. We found that pyramidal cells and basket cells are highly activated by the anodal electrode and minimally activated by the cathodal electrodes, while Martinotti cells are moderately activated by both electrodes but exhibit a slight preference for cathodal stimulation. Network model simulations found that this asymmetrical activation results in a traveling wave in superficial excitatory cells that propagates unidirectionally away from the electrode array. Our study reveals how asymmetric electrical stimulation can easily facilitate traveling waves by relying on two distinct types of inhibitory interneuron activity to shape and sustain the spatiotemporal dynamics of endogenous local circuit mechanisms.SIGNIFICANCE STATEMENTElectrical brain stimulation is becoming increasingly useful to probe the workings of brain and to treat a variety of neuropsychiatric disorders. However, stimulation is currently performed in a trial-and-error fashion as there are no methods to predict how different electrode arrangements and stimulation paradigms will affect brain functioning. In this study, we demonstrate a hybrid modeling approach, which makes experimentally testable predictions that bridge the gap between the microscale effects of multielectrode stimulation and the resultant circuit dynamics at the mesoscale. Our results show how custom stimulation paradigms can induce predictable, persistent changes in brain activity, which has the potential to restore normal brain function and become a powerful therapy for neurological and psychiatric conditions.

Background: CD4+ T cells are a critical component of effective immune responses to varicella zoster virus (VZV), but their functional properties during the reactivation acute vs latent phase of infection remain poorly defined. Methods: Here we assessed the functional and transcriptomic properties of peripheral blood CD4+ T cells in persons with acute herpes zoster (HZ) compared to those with a prior history of HZ infection using multicolor flow cytometry and RNA sequencing. Results: We found significant differences between the polyfunctionality of VZV-specific total memory, effector memory, and central memory CD4+ T cells in acute vs prior HZ. VZV-specific CD4+ memory T-cell responses in acute HZ reactivation had higher frequencies of IFN-γ and IL-2 producing cells compared to those with prior HZ. In addition, cytotoxic markers were higher in VZV-specific CD4+ T cells than non-VZV-specific cells. Transcriptomic analysis of ex vivo total memory CD4+ T cells from these individuals showed differential regulation of T-cell survival and differentiation pathways, including TCR, cytotoxic T lymphocytes (CTL), T helper, inflammation, and MTOR signaling pathways. These gene signatures correlated with the frequency of IFN-γ and IL-2 producing cells responding to VZV. Conclusions: In summary, VZV-specific CD4+ T cells from acute HZ individuals had unique functional and transcriptomic features, and VZV-specific CD4+ T cells as a group had a higher expression of cytotoxic molecules including Perforin, Granzyme-B, and CD107a.

We characterise the properties and evolution of Bright Central Galaxies (BCGs) and the surrounding intracluster light (ICL) in galaxy clusters identified in overlapping regions of the Dark Energy Survey and Atacama Cosmology Telescope Survey (DES-ACT), covering the redshift range $0.20$14.4. We also measure the stellar mass - halo mass (SMHM) relation for the BCG+ICL system and find that the slope, $\beta$, which characterises the dependence of $M_{\rm 200m,SZ}$ on the BCG+ICL stellar mass, increases with radius. The outskirts are more strongly correlated with the halo than the core, which supports that the BCG+ICL system follows a two-phase growth, where recent growth ($z, Comment: 19 pages, 12 Figures, 3 Tables. Submitted to MNRAS on 9/7/2022 -- Metadata typo corrected

University of California Health (UCH) provided a system-wide, rapid response to the humanitarian crisis of unaccompanied children crossing the southern U.S. border in the midst of the COVID-19 pandemic in 2021. In collaboration with multiple federal, state, and local agencies, UCH mobilized a multidisciplinary team to deliver acute general and specialty pediatric care to unaccompanied children at 2 Californian emergency intake sites (EISs). The response, which did not disrupt normal UCH operations, mobilized the capacities of the system and resulted in a safe and developmentally appropriate environment that supported the physical and mental health of migrant children during this traumatic period. The capacities of UHC's 6 academic health centers ensured access to trauma-informed medical care and culturally sensitive psychological and social support. Child life professionals provided access to exercise, play, and entertainment. Overall, 260 physicians, 42 residents and fellows, 4 nurse practitioners participated as treating clinicians and were supported by hundreds of staff across the 2 EISs. Over 5 months and across both EISs, a total of 4,911 children aged 3-17 years were cared for. A total of 782 children had COVID-19, most infected prior to arrival. Most children (3,931) were reunified with family or sponsors. Continuity of care after reunification or placement in a long-term shelter was enhanced by use of an electronic health record. The effort provided an educational experience for residents and fellows with instruction in immigrant health and trauma-informed care. The effort benefitted from UCH's recent experience of providing a system-wide response to the COVID-19 pandemic. Lessons learned are reported to encourage the alignment and integration of academic health centers' capacities with federal, state, and local plans to better prepare for and respond to the accelerating need to care for those in the wake of disasters and humanitarian crises.

Background: The uptake of Pre-Exposure Prophylaxis (PrEP) has revolutionized the fight against the Human Immunodeficiency Virus (HIV) epidemic. Consistent obstacles remain that have influenced the slow uptake of PrEP in the United States of America (USA). In order to address these barriers, pharmacists must be included in the dispensing and management of PrEP through collaborative pharmacy practice agreements (CPPAs). Our aim for this study was to characterize pharmacists’ perceptions of initiating PrEP through a CPPA in the state of Tennessee. Methods: This qualitative study was conducted in the USA in 2021 with pharmacists practicing in Tennessee. A framework and specific questions guided the thematic analysis. The words and phrases were coded inductively and later collapsed into categories and placed into emergent themes. Results: Two themes illustrate the voices of practicing pharmacists’ integration in the dispensing and management of PrEP: (1) Learning from other states and previous successful CPPAs to advance and expand innovative models of patient care and (2) advocacy through public policy change to empower pharmacists to initiate PrEP. Conclusion: This qualitative study focused on exploring pharmacists’ perceptions on the opportunity of initiating PrEP through a CPPA in Tennessee. These findings highlight the preparedness of pharmacists to advocate for easier initiative of PrEP in pharmacies across Tennessee, whether through relaxing existing CPPA regulation or pursuing independent prescriptive authority for pharmacists.

Who protects individual liberties and human dignity from domination by the State, by Civil Society or by individuals is a question under debate in China as well as the West, not from the point of view of Liberalism, but from the point of view of ‘Relationality’. Liberalism posits the individual as the measure of these matters but the ‘individual’ in question is an abstraction. Relationality posits social relations as the measure of these matters. Persons are not abstractions. They combine several different social ‘roles’, and each role includes obligations as well as rights. These roles limit the individual’s freedom of action. There are no unipersonal societies. Liberalism also posits rights as an abstraction: ‘All men are created equal’. Relationality posits rights in a context of mutual recognition of rights and responsibilities. Rights only exist if they can in fact be exercised. From the point of view of Relationality, therefore, a person’s ability to exercise her or his rights must be seen in the light of a concept of Justice and there must be an agency that can guarantee this Justice, the exercise of these rights, while it guarantees the fulfilment of social obligations. Is this the role of the State? of Civil Society? of the Market? To truly discuss these matters in a transcultural context, we would need to look for common ground, not take as ‘self-evident’ the classical Liberal perception of the individual. Understanding the underlying political philosophy of China’s concept of ‘responsive authoritarianism’ does not mean endorsing it. But understanding this idea and its ramifications does provide room for amplifying the basic question of who protects individual liberties and human dignity.