Search

Abstract Huppke–Brendel syndrome (HBS) is an autosomal recessive disorder caused by SLC33A1 mutations, a gene coding for the acetyl‐CoA transporter‐1 (AT‐1). So far it has been described in nine pediatric and one adult patient. Therapeutic trials with copper histidinate failed to achieve any clinical improvement. Here, we describe the clinical characteristics of two novel patients, one of them diagnosed by gene analysis and his sib postmortally based on clinical characteristics. We demonstrate a therapeutic trial with acetylation therapy, consisting of N‐acetylcysteine and ketogenic diet, in one of them. We provide biochemical data on N‐acetylated amino acids in cerebrospinal fluid (CSF) and plasma before and after starting this treatment regimen. Our results indicate that ketogenic diet and N‐acetylcysteine do not seem to normalize the concentrations of N‐acetylated amino acids in CSF or plasma. The overall metabolic pattern shows a trend toward lowered levels of N‐acetylated amino acids in CSF and to a lesser extent in plasma. Although there are some assumptions, the function of AT‐1 is still not clear and further studies are needed to better understand mechanisms underlying this complex disorder.

Abstract Non‐native grazers compete with native species across the globe. We present a novel approach to study the composition of the herbaceous understory across three study areas within the Great‐Basin with different historic and contemporary grazing regimes. We surveyed the landscape using distance sampling for livestock and horse feces as an index of use. In addition, we surveyed the herbaceous understory of random sites as well as sites chosen by female Greater sage‐grouse to nest and brood their chicks. We used a novel Bayesian hierarchical modeling framework to link vegetation metrics with the spatial–temporal distribution of horses and livestock while accounting for observation error. When livestock and feral horses were not present, we found that Greater sage‐grouse use sites with higher percentages of perennial grasses and forbs to build their nests and brood their chicks compared with what was available to them. As livestock increased, we found evidence for decreases in the percentage of perennial grasses, forbs, cheatgrass (Bromus tectorum), and increases in the amount of bare ground. These effects were consistent at available sites and brood sites; however, we found less evidence for an impact of livestock at nest sites. As feral horses increased, we observed similar results at available sites, but at sites chosen by females to nest and brood their chicks, we observed increases in the amount of invasive cheatgrass as feral horses increased, which could reflect attempts by Greater sage‐grouse to compensate for reductions in protective cover. We present a noninvasive approach to assess space use that can be applied to other species. More importantly, we document that grazing by non‐native ungulates impacts components of the plant community important to Greater sage‐grouse reproduction. We provide spatial–temporal maps of livestock and feral horse use to aid managers attempting to balance the needs of livestock producers, feral horses, Greater sage‐grouse, and ecosystem function.

Abstract Polycystic kidney diseases (PKD) are genetic disorders which disrupt kidney architecture and function. Autosomal recessive PKD (ARPKD) is a rare form of PKD, caused by mutations in PKHD1, and clinically more severe than the more common autosomal dominant PKD (ADPKD). Prior studies have implicated Hedgehog (Hh) signaling in ADPKD, with increased levels of Hh components in experimental ADPKD and reduced cystogenesis following pharmacological Hh inhibition. In contrast, the role of the Hh pathway in ARPKD is poorly understood. We hypothesized that Hh pathway activity would be elevated during ARPKD pathogenesis, and its modulation may slow disease progression. We utilized Cpk mice which phenocopy ARPKD and generated a PKHD1‐mutant spheroid model in human collecting ducts. Significantly elevated levels of the Hh transcriptional effector Gli3 were found in Cpk mice, a finding replicated in PKHD1‐mutant spheroids. In Cpk mice, total GLI3 and GLI3 repressor protein levels were also increased. Reduction of increased Gli3 levels via heterozygous genetic deletion in Cpk mice did not affect cyst formation. Additionally, lowering GLI3 transcripts to wildtype levels did not influence PKHD1‐mutant spheroid size. Collectively, these data suggest attenuation of elevated Gli3 does not modulate murine and human models of ARPKD.

Abstract Background Fitness assessment of horses remains challenging. Heart rate variability (HRV) can be used to monitor human athlete's training, but its value is unknown in horses. Hypothesis The linear domain HRV variables are affected by fitness. Animals Twelve healthy untrained thoroughbreds were randomly split into a training group (6 weeks of incremental racetrack training) and a control group (no training). Methods Linear domain HRV variables were analyzed (high frequency [HF], low frequency [LF], their normalized units [Hfnu, Lfnu], root mean square of successive differences between beats [RMSSD], Poincaré plot features [SD1 and SD2]) while resting overnight before (baseline) and after 2, 4 and 6 weeks of training. V̇O2max and echocardiographic indexes were measured at baseline and after 6 weeks. Changes in HRV variables over time (ANOVA), and correlation with V̇O2max (Pearson's chi‐squared test) were tested (P

Abstract Network approaches to psychopathology have become increasingly common in mental health research, with many theoretical and methodological developments quickly gaining traction. This article illustrates contemporary practices in applying network analytical tools, bridging the gap between network concepts and their empirical applications. We explain how we can use graphs to construct networks representing complex associations among observable psychological variables. We then discuss key network models, including dynamic networks, time‐varying networks, network models derived from panel data, network intervention analysis, latent networks, and moderated models. In addition, we discuss Bayesian networks and their role in causal inference with a focus on cross‐sectional data. After presenting the different methods, we discuss how network models and psychopathology theories can meaningfully inform each other. We conclude with a discussion that summarizes the insights each technique can provide in mental health research.

Abstract Anthropogenic climate change will drive extensive mass loss across both the Antarctic (AIS) and Greenland Ice Sheets (GrIS), with the potential for global climate system feedbacks, especially in polar regions. Historically, the high‐latitude North Atlantic and Southern Ocean have been critical regions for anthropogenic heat and carbon uptake, but our understanding of how this uptake will be altered by future freshwater discharge is incomplete. We assess each ice sheet's impact on global ocean anthropogenic heat and carbon storage for a high‐emission scenario over the 21st‐century using a coupled Earth system model. We explore the impact of contemporaneous mass loss from both ice sheets on anthropogenic heat and carbon storage and quantify their linear and nonlinear contributions. Notably, added freshwater reduces ocean heat and carbon storage by 2,100, and the sum of individual freshwater effects differ from those induced by simultaneous freshwater discharge from both ice sheets. Combined AIS and GrIS freshwater engenders distinct anthropogenic storage anomalies—particularly in the high‐latitude Southern Ocean and North Atlantic. From 2080 to 2100, GrIS freshwater exerts primary control on the temporal evolution of global ocean heat storage, while global ocean carbon storage is modulated by the linear AIS and GrIS freshwater impacts. Nonlinear impacts of simultaneous ice sheet discharge have a non‐negligible contribution to the evolution of global ocean heat storage. Further, anthropogenic heat changes are realized more quickly in response to ice sheet discharge than anthropogenic carbon. Our results highlight the need to incorporate both ice sheets actively in climate models to accurately project future global climate.

ABSTRACT Introduction Multicancer detection tests (MCDs) are blood‐based tests designed to detect multiple cancer types. It is currently unclear whether these cancer screening tests improve mortality. To understand awareness of MCDs among providers and patients, as well as explore how they perceive the benefits, harms, and acceptability of MCDs, we have undertaken a focus group study in primary care physicians (PCPs) and laypersons to explore knowledge, attitudes, and expectations of cancer screening using MCDs. Methods We conducted six focus groups with 45 PCP participants and 12 focus groups with 80 layperson participants. Participants were identified via a consumer research firm and found eligible following the completion of a screener survey. Moderators used a semi‐structured guide containing open‐ended questions and prompts to facilitate the discussion. Recordings were transcribed and coded line by line using a codebook developed based on questions and emerging discussion concepts, and emergent themes were identified. Results Both PCP and layperson participants felt the that benefits of MCDs included ease of use and potential ability to detect cancers early. However, they felt that additional data is needed to overcome some of the concerns related to MCDs. PCP participants expressed concerns related to lack of practice guidelines, cost of diagnostic follow‐ups, privacy and insurance issues, fear/anxiety related to confirmation of MCD results, and malpractice liability related to perceived false negative test results. Layperson participants expressed concerns related to costs, insurance coverage, and privacy, as well as anxiety over the confirmation of a positive test result. Conclusions There is a major need for more rigorous data regarding MCDs to inform the development of guidelines for use as cancer screening tools.

Abstract While surgical resection is a mainstay of cancer treatment, many tumors are unresectable due to stage, location, or comorbidities. Ablative therapies, which cause local destruction of tumors, are effective alternatives to surgical excision in several settings. Ethanol ablation is one such ablative treatment modality in which ethanol is directly injected into tumor nodules. Ethanol, however, tends to leak out of the tumor and into adjacent tissue structures, and its biodistribution is difficult to monitor in vivo. To address these challenges, this study presents a cutting‐edge technology known as Light‐Activatable Sustained‐Exposure Ethanol Injection Technology (LASEIT). LASEIT comprises a three‐part formulation: (1) ethanol, (2) benzoporphyrin derivative, which enables fluorescence‐based tracking of drug distribution and the potential application of photodynamic therapy, and (3) ethyl cellulose, which forms a gel upon injection into tissue to facilitate drug retention. In vitro drug release studies showed that ethyl cellulose slowed the rate of release in LASEIT by 7×. Injections in liver tissues demonstrated a 6× improvement in volume distribution when using LASEIT compared to controls. In vivo experiments in a mouse pancreatic cancer xenograft model showed LASEIT exhibited significantly stronger average radiant efficiency than controls and persisted in tumors for up to 7 days compared to controls, which only persisted for less than 24 h. In summary, this study introduced LASEIT as a novel technology that enabled real‐time fluorescence monitoring of drug distribution both ex vivo and in vivo. Further research exploring the efficacy of LASEIT is strongly warranted.

Abstract Previous studies based on animal models have raised concerns about salbutamol use in ozone air pollution with regard to ozone related lung injury. We conducted a double‐blind, randomized, placebo‐controlled crossover study including 18 subjects diagnosed with EIB by a eucapnic voluntary hyperpnea (EVH) test. Participants completed 30 min of standardized moderate to vigorous exercise in four conditions: ozone plus salbutamol; room air plus salbutamol; ozone plus placebo medication; and room air plus placebo medication. Spirometry, fraction of exhaled nitric oxide, and symptoms were measured before, immediately after, 30 min after and 1 h after exercise. Measurements between the four conditions were compared using percent change from pre to post exercise. There was a statistically significant difference between the salbutamol and placebo medication groups for spirometric variables including FEV1 (Estimate = 6.3, 95% CI: 4.23–8.37, p

Abstract The maternal roosting behavior of migratory, tree‐dwelling bat species remains poorly understood. From 2016 to 2020 we radio‐tagged 53 adult female silver‐haired bats (Lasionycteris noctivagans) and tracked them to their day roosts to evaluate roosting habits in a cottonwood (Populus) forest in the floodplain of the Bitterroot River in western Montana. We investigated roost tree characteristics of maternity colonies such as canopy closure, tree size, and decay stage, as well as the daily roost fidelity of tagged bats. Additionally, we marked 55 bats with passive integrated transponder (PIT) tags to assess interannual fidelity to summer habitat. We tracked bats to 94 unique roost trees. Based on previous studies, we expected silver‐haired bat maternity colonies to roost in tall, large diameter trees. We modeled roosting probability as a function of tree height, day of year, and the interaction of these terms. We found bats preferred taller trees earlier in the year, but overall roosting probability decreased throughout the season and tree height had lesser influence on roosting probability later in the year. Bats used tall trees with high canopy closure in early stages of decay during periods of pregnancy and lactation, while the effect of these tree attributes lessened later in the season, perhaps after lactation when energetic constraints were reduced for adult females to prepare for migration by entering torpor during the day. Bats used an average of 5.2 roost trees during the young rearing period and remained in the same roost for an average of 1.5 consecutive days. While daily roost fidelity was low, we documented interannual fidelity to summer habitat from nine individuals. We found silver‐haired bat roosting preferences vary with time, are tree‐specific, and policies targeting conservation of the species should manage flood regimes to promote cottonwood establishment, height growth, and a mosaic of riparian habitats.

Abstract Estimating animal abundance has a key role to play in ecology and conservation, but survey methods are always challenged by imperfect detection. Among the techniques applied to deal with this issue, Double Observer (DO) is increasing in popularity due to its cost‐effectiveness. However, the effort of using DO for surveying large territories can be significant. A DO‐based survey method that allows accurate abundance estimations with reduced effort would increase the applicability of the method. This would have positive effects on the conservation of species which are challenging to survey such as mountain ungulates. We used computer simulations based on real data and a field test to assess the reliability of the DO and of a new proposed survey procedure, the Double Observer Adjusted Survey (DOAS). DOAS is based on total block counts adjusted with some DO surveys conducted in a proportion of the total area only. Such DO surveys are then used to estimate detection probability with a mark‐recapture‐derived approach. We found that full DO is much more accurate than simple block counts for abundance estimations. DOAS is a less demanding alternative to full DO and can produce comparable abundance estimates, at the cost of a slightly lower precision. However, in the DOAS overall detectability has to be estimated within a sufficient number of sites (around a quarter of the total) to obtain a higher precision and avoid large overestimations. Practical implications. DO methods could increase the reliability of abundance estimations in mountain ungulates and other gregarious species. Full DO in particular could allow researchers to obtain unbiased estimations with high precision and its usage is therefore suggested instead of block counts in wildlife monitoring. Given the high costs of full DO, the DOAS procedure could be a viable and cost‐effective survey strategy to improve abundance estimates when resources are scarce.

Background The percentage of women

Abstract Nanoparticle‐stabilized, bicontinuous interfacially jammed emulsion gels (bijels) find potential applications as battery, separation membrane, and chemical reactor materials. Decreasing the liquid domain sizes of bijels to sub‐micrometer dimensions requires surfactants, complicating bijel synthesis and postprocessing into functional nanomaterials. This work introduces surfactant‐free bijels with sub‐micrometer domains, solely stabilized by nanoparticles. To this end, the covalent surface functionalization of silica nanoparticles is characterized by thermogravimetric analysis, mass spectrometry, Fourier‐transform infrared spectroscopy, and contact angle measurements. Bijels are generated with the functionalized nanoparticles via solvent transfer induced phase separation (STrIPS), enabling the optimization of nanoparticle functionalization and surface ionization. Nanoparticles of intermediate functionalization and controlled negative surface charge stabilize bijels with sub‐micrometer liquid domains. This remarkable control over bijel synthesis provides urgently needed progress to facilitate the widespread implementation of bijels as nanomaterials in research and applications.

Abstract Introduction Adherence to wearing prescribed footwear is paramount in reducing the risk of developing diabetes‐related foot ulcers, but adherence is often lower than optimal. This study aimed to investigate predictors of footwear adherence and variations in adherence and activity in people at risk of diabetes‐related foot ulceration. Methods Sixty people at high foot ulcer risk were included. We measured the proportion of weight‐bearing acitivity time the prescribed footwear was worn for seven days. Multiple linear regression and analysis of variance were used. Results Mean overall adherence was 63%. Adherence was lower at home than away from home (59% vs. 74%), while activity was higher at home (2.2 vs. 1.2 h/day). Adherence was similar across activities (61%–63%). No variable predicted the overall adherence. Higher Hba1c predicted lower adherence at home (β = −0.34, p = 0.045, R2 = 11.6%). More daily steps predicted lower adherence away from home (β = −0.30, p = 0.033, R2 = 9.3%). Adherence and activity were highest in mornings (71%, 1.1 h) and afternoons (71%, 1.5 h), and lower in evenings (40%, 0.8 h) and at nights (9%, 0.1 h). Adherence was similar on weekdays and weekend days (63% vs. 60%), but activity was higher on weekdays (3.4 vs. 3.0 h). Conclusion Adherence levels and predictors thereof differed between adherence at home and away from home, so we suggest to treat them as different concepts. Due to the low explained variance, future studies should focus on other predictors such as psychological variables.

Abstract The interaction of perfluorinated molecules, also known as “forever chemicals” due to their pervasiveness, with their environment remains an important yet poorly understood topic. In this work, the self‐assembly of perfluorinated molecules with multivalent hosts, pillar‐[5]‐arenes, is investigated. It is found that perfluoroalkyl diacids and pillar‐[5]‐arenes rapidly and strongly complex with each other at aqueous interfaces, forming solid interfacially templated films. Their complexation is shown to be driven primarily by fluorophilic aggregation and assisted by electrostatic interactions, as supported by the crystal structure of the complexes, and leads to the formation of quasi‐2D phase‐separated films. This self‐assembly process can be further manipulated using aqueous two‐phase system microdroplets, enabling the controlled formation of 3D micro‐scaffolds.

Abstract Introduction Adolescent girls and young women (AGYW) who may benefit from HIV pre‐exposure prophylaxis (PrEP) face high levels of common mental disorders (e.g. depression, anxiety). Common mental disorders can reduce PrEP adherence and increase HIV risk, yet mental health interventions have not been well‐integrated into PrEP delivery. Methods We conducted a four‐phase human‐centred design process, from December 2020 to April 2022, to understand mental health challenges among AGYW in Johannesburg, South Africa and barriers to integrated mental health and PrEP services. In the “Discover” phase, we conducted in‐depth interviews with AGYW and key informants (KIs) in Johannesburg. We conducted a rapid qualitative analysis, informed by the Consolidated Framework for Implementation Research (CFIR), to identify facilitators and barriers of integrated mental health and PrEP services and mapped barriers to potential implementation strategies. In the “Design” and “Build” phases, we conducted stakeholder workshops to iteratively adapt an evidence‐based mental health intervention, the Friendship Bench, and refine implementation strategies for South African PrEP delivery settings. In the “Test” phase, we piloted our adapted Friendship Bench package. Results Interviews with 70 Discover phase participants (48 AGYW, 22 KIs) revealed the importance of integrated mental health and PrEP services for South African AGYW. Interviewees described barriers and implementation strategies for mental health and PrEP services around the CFIR domains: intervention characteristics (e.g. challenges with AGYW “opening up”); outer Johannesburg setting (e.g. community stigma); inner clinic setting (e.g. judgemental healthcare providers); characteristics of counsellors (e.g. training gaps); and the implementation process (e.g. need for demand creation). The Design and Build workshops included 13 AGYW and 15 KIs. Implementation barriers related to the quality and accessibility of public‐sector clinic services, lay counsellor training, and community education and demand creation activities were prioritized. This led to 12 key Friendship Bench adaptations and the specification of 10 implementation strategies that were acceptable and feasible in initial pilot testing with three AGYW. Conclusions Using a human‐centred approach, we identified determinants and potential solutions for integrating mental health interventions within PrEP services for South African AGYW. This design process centred stakeholders’ perspectives, enabling rapid development of an adapted Friendship Bench intervention implementation package.

ABSTRACT Introduction Sellar masses are common intracranial neoplasms. Their clinical manifestations vary widely and include headache. We aimed to determine whether the prevalence and characteristics of headache in patients with sellar tumours differ from the general population and to investigate the effect of tumour resection on this complaint. Methods We performed a prospective, controlled study in a single tertiary centre and included 57 patients that underwent transsphenoidal resection for a sellar mass (53% females, mean age 53.5 ± 16.4) and 29 of their partners (controls; 45% females, mean age 54.8 ± 14.9). Outcome measures were prevalence, characteristics and impact of headache 1 month preoperatively and at neurosurgical follow‐up 3 months postoperatively. Results Preoperatively, the prevalence of regular headache (≥1 time per month) was higher in patients than in controls (54% vs. 17%, p

Abstract Marine scientific trawl surveys are commonly used to assess the distribution and population size of fisheries‐related species, yet the method is effort‐intensive and can be environmentally destructive. Sequencing environmental DNA (eDNA) from water samples can reveal the presence of organisms in a community without capturing them; however, we expect the detectability of taxa to differ between eDNA and trawl surveys, and understanding how species traits and population variables contribute to detection differences can help calibrate our expectations from each form of sampling. Here, we coupled eDNA metabarcoding and capture trawl surveys in British Columbia, Canada, to examine species traits that explain recurrent differences in detectability between the two methods, including habitat, body size, and biomass. At the regional scale, 17 of 23 fish species (74%) captured by the trawl were detected by eDNA metabarcoding, and 39 additional species were detected by eDNA sampling only. We found that eDNA metabarcoding disproportionately detected trawl‐caught species with greater local biomass (i.e., greater biomass in the adjacent trawl). Fish detected only in eDNA had a greater range of body lengths and a broader range of habitat preferences outside the trawls' target size and sampling areas. Our results suggest that with our level of sampling, eDNA metabarcoding can adequately recapitulate detection of fish communities detected by trawl surveys, but with a bias toward fish of high population biomass and greater inclusion of fish from outside the trawled area.

Abstract Calls for using marine protected areas (MPAs) to achieve goals for nature and people are increasing globally. While the conservation and fisheries impacts of MPAs have been comparatively well‐studied, impacts on other dimensions of human use have received less attention. Understanding how humans engage with MPAs and identifying traits of MPAs that promote engagement is critical to designing MPA networks that achieve multiple goals effectively, equitably and with minimal environmental impact. In this paper, we characterize human engagement in California's MPA network, the world's largest MPA network scientifically designed to function as a coherent network (124 MPAs spanning 16% of state waters and 1300 km of coastline) and identify traits associated with higher human engagement. We assemble and compare diverse indicators of human engagement that capture recreational, educational and scientific activities across California's MPAs. We find that human engagement is correlated with nearby population density and that site “charisma” can expand human engagement beyond what would be predicted based on population density alone. Charismatic MPAs tend to be located near tourist destinations, have long sandy beaches and be adjacent to state parks and associated amenities. In contrast, underutilized MPAs were often more remote and lacked both sandy beaches and parking lot access. Synthesis and applications: These results suggest that achieving MPA goals associated with human engagement can be promoted by developing land‐based amenities that increase access to coastal MPAs or by locating new MPAs near existing amenities during the design phase. Alternatively, human engagement can be limited by locating MPAs in areas far from population centres, coastal amenities or sandy beaches. Furthermore, managers may want to prioritize monitoring, enforcement, education and outreach programmes in MPAs with traits that predict high human engagement. Understanding the extent to which human engagement impacts the conservation performance of MPAs is a critical next step to designing MPAs that minimize tradeoffs among potentially competing objectives. Read the free Plain Language Summary for this article on the Journal blog.

Abstract Objective Primary care practitioners are crucial to engaging people in Australia's national cervical screening program. From July 2022, practitioners have been able to offer all screen‐eligible people the choice to collect their own self‐collected sample; an option introduced to increase equity. This study explored how practitioners are intending to incorporate universal access to self‐collection into their clinical care. Methods Semi‐structed interviews with 27 general practitioners, nurses, and practice managers from 10 practices in Victoria, Australia conducted between May and August 2022. Interviews were deductively coded, informed by the Consolidated Framework for Implementation Research. The Diffusion of Innovations theory was used to categorise intention to provide self‐collection. Results Participants were supportive of universal access to self‐collection, citing benefits for screen‐eligible people and that it overcame the limited adaptability of the previous policy. Most participants' practices (n = 7, 70%) had implemented or had plans to offer the option for self‐collection to all. Participants deliberating whether to provide universal access to self‐collection held concerns about the correct performance of the self‐test and the perceived loss of opportunity to perform a pelvic examination. Limited time to change practice‐level processes and competing demands within consultations were anticipated as implementation barriers. Conclusions The extent to which self‐collection can promote equity within the program will be limited without wide‐spread adoption by practitioners. Communication and education that addresses concerns of practitioners, along with targeted implementation support, will be critical to ensuring that self‐collection can increase participation and Australia's progression towards elimination of cervical cancer.

Abstract Aim To examine Registered Nurses (RNs') and nursing students' perspectives on factors contributing to moral distress and the effects on their health, well‐being and professional and career intentions. Design Joanna Briggs Institute mixed‐methods systematic review and thematic synthesis. Registered in Prospero (Redacted). Methods Five databases were searched on 5 May 2021 for studies published in English since January 2010. Methodological quality assessment was conducted in parallel with data extraction. Results Searches yielded 2343 hits. Seventy‐seven articles were included. Most were correlational design and used convenience sampling. Studies were mainly from North America and Asia and situated in intensive and critical care settings. There were common, consistent sources of moral distress across continents, specialities and settings. Factors related to perceived inability or failure to enact moral agency and responsibility in moral events at individual, team and structural levels generated distress. Moral distress had a negative effect on RNs health and psychological well‐being. Patient or Public Contribution No patient or public contribution to this systematic review.

Abstract Background Awareness of prescribing practices helps identify opportunities to improve antibiotic use (AU). Objectives To estimate AU prevalence in dogs and cats in U.S. veterinary teaching hospitals (VTHs) and identify antibiotic drugs commonly prescribed, indications for use, and evidence of bacterial infection. Animals Medical record data were collected from dogs and cats examined at 14 VTHs. Methods Data were collected from VTH medical records of dogs and cats examined by primary care, urgent care, emergency and critical care, internal medicine, and surgery services on a single day during August 13‐September 3, 2020. Data included signalment; clinical service; inpatient or outpatient status; clinical conditions; diagnostic tests; evidence of bacterial infection; intended reason for AU; name and route of antibiotics prescribed. Results Of 883 dogs and cats, 322 (36.5%) were prescribed at least 1 antibiotic. Among 285 antibiotics administered systemically intended for treatment of infection, 10.9% were prescribed without evidence of infection. The most common class of antibiotics presribed for systemic administration was potentiated penicillin for dogs (115/346, 33.3%) and cats (27/80, 33.8%). For dogs and cats, first‐generation cephalosporins (93/346, 26.9% and 11/80, 13.8%, respectively) and fluoroquinolones (51/346, 14.7% and 19/80, 23.8%, respectively) was second or third most‐prescribed. Common AU indications included skin, respiratory, and urinary conditions, and perioperative use. Conclusions and Clinical Importance Collaborative data collection provides a sustainable methodology to generate national AU prevalence estimates and bring attention to areas requiring additional research and detailed data collection. These efforts can also identify practice improvement opportunities in settings where future veterinarians are trained.

Abstract Landscape‐scale bioacoustic projects have become a popular approach to biodiversity monitoring. Combining passive acoustic monitoring recordings and automated detection provides an effective means of monitoring sound‐producing species' occupancy and phenology and can lend insight into unobserved behaviours and patterns. The availability of low‐cost recording hardware has lowered barriers to large‐scale data collection, but technological barriers in data analysis remain a bottleneck for extracting biological insight from bioacoustic datasets. We provide a robust and open‐source Python toolkit for detecting and localizing biological sounds in acoustic data. OpenSoundscape provides access to automated acoustic detection, classification and localization methods through a simple and easy‐to‐use set of tools. Extensive documentation and tutorials provide step‐by‐step instructions and examples of end‐to‐end analysis of bioacoustic data. Here, we describe the functionality of this package and provide concise examples of bioacoustic analyses with OpenSoundscape. By providing an interface for bioacoustic data and methods, we hope this package will lead to increased adoption of bioacoustics methods and ultimately to enhanced insights for ecology and conservation.

Abstract Objectives Derived from classical conditioning theory and rooted in motivational mechanisms, cue reactivity paradigms (CRPs) are used in addictions research to measure participants' propensities for substance‐relevant responses (e.g., craving) during exposure to substance‐relevant cues (e.g., drug paraphernalia). CRPs are also useful in PTSD‐addiction comorbidity research, allowing the study of affective and substance‐relevant responses to trauma cues. However, studies using traditional CRPs are time‐consuming with high attrition rates due to repeat testing. Thus, we sought to test whether a single session semi‐structured trauma interview could serve as a CRP in terms of eliciting theorized cue exposure effects on craving and affect measures. Method Fifty regular cannabis users with trauma histories provided detailed descriptions of their most traumatic lifetime experience, and a neutral experience, according to an established interview protocol. Linear mixed models examined the effect of cue type (trauma vs. neutral) on affective and craving responses. Results As hypothesized, the trauma interview elicited significantly greater cannabis craving (and alcohol craving among the drinkers), and, greater negative affect among those with more severe PTSD symptoms, compared to the neutral interview. Conclusion Results suggest an established semi‐structured interview may function effectively as a CRP for use in trauma and addictions research.

Abstract Practice‐based research networks (PBRNs) support the translation and evaluation of evidence‐based practices and interventions on a large scale and have primarily been used in primary care settings. Few pharmacy PBRNs exist. Our objective is to describe the composition and characteristics of the Rural Research Alliance of Community Pharmacies (RURAL‐CP), which is the first PBRN exclusively for rural community pharmacies. For each enrolled pharmacy, a pharmacist liaison completed a survey that assessed the pharmacy's operational characteristics, including business operations, human resource management, division of clinical responsibilities, technology and enhanced services, organizational context, and research priorities. Additionally, up to five other pharmacy staff members completed a brief survey on organizational context. Descriptive statistics were calculated. As of May 2023, there were 126 pharmacies across seven southeastern states that were enrolled in RURAL‐CP. Most pharmacies (91%) were independent pharmacies and operated 6 days per week (82%). On average, pharmacies employed 10 staff members and most trained student pharmacists. Pharmacies offered valuable services in their community, including immunizations, naloxone dispensing, and medication delivery. Blood glucose testing was the most common point‐of‐care (POC) test offered, and most pharmacies were interested in expanding POC offerings, particularly A1c testing and cholesterol screening. RURAL‐CP pharmacies have, on average, relatively strong organizational contexts and readiness for change. Pharmacists' top research priorities were expansion of clinical services, reimbursement, patient adherence, and addressing diabetes and hypertension. Although not generalizable to all rural pharmacies, results indicate that rural pharmacies deliver many important services in their communities and are interested in increasing services provided.

Abstract Objectives CAR‐T cells are being investigated as a novel immunotherapy for glioblastoma, but clinical success has been limited. We recently described fibroblast activation protein (FAP) as an ideal target antigen for glioblastoma immunotherapy, with expression on both tumor cells and tumor blood vessels. However, CAR‐T cells targeting FAP have never been investigated as a therapy for glioblastoma. Methods We generated a novel FAP targeting CAR with CD3ζ and CD28 signalling domains and tested the resulting CAR‐T cells for their lytic activity and cytokine secretion function in vitro (using real‐time impedance, flow cytometry, imaging and bead‐based cytokine assays), and in vivo (using a xenograft mimicking the natural heterogeneity of human glioblastoma). Results FAP‐CAR‐T cells exhibited target specificity against model cell lines and potent cytotoxicity against patient‐derived glioma neural stem cells, even when only a subpopulation expressed FAP, indicating a bystander killing mechanism. Using co‐culture assays, we confirmed FAP‐CAR‐T cells mediate bystander killing of antigen‐negative tumor cells, but only after activation by FAP‐positive target cells. This bystander killing was at least partially mediated by soluble factors and amplified by IL‐2 which activated the non‐transduced fraction of the CAR‐T product. Finally, a low dose of intravenously administered FAP‐CAR‐T cells controlled, without overt toxicity, the growth of subcutaneous tumors created using a mixture of antigen‐negative and antigen‐positive glioblastoma cells. Conclusions Our findings advance FAP as a leading candidate for clinical CAR‐T therapy of glioblastoma and highlight under‐recognised antigen nonspecific mechanisms that may contribute meaningfully to the antitumor activity of CAR‐T cells.

Abstract Background Sarcopenia, the age‐associated decline in skeletal muscle mass and strength, has long been considered a disease of muscle only, but accumulating evidence suggests that sarcopenia could originate from the neural components controlling muscles. To identify early molecular changes in nerves that may drive sarcopenia initiation, we performed a longitudinal transcriptomic analysis of the sciatic nerve, which governs lower limb muscles, in aging mice. Methods Sciatic nerve and gastrocnemius muscle were obtained from female C57BL/6JN mice aged 5, 18, 21 and 24 months old (n = 6 per age group). Sciatic nerve RNA was extracted and underwent RNA sequencing (RNA‐seq). Differentially expressed genes (DEGs) were validated using quantitative reverse transcription PCR (qRT‐PCR). Functional enrichment analysis of clusters of genes associated with patterns of gene expression across age groups (adjusted P‐value 2; false discovery rate [FDR]

Abstract Background The first HPV‐vaccine eligible cohorts in the Netherlands will enter the cervical screening program in 2023. However, a substantial number of young women already have had a cervical sample taken before entry into the regular screening program. This study was initiated to explore early effects of HPV vaccination on detection of cytological abnormalities in cervical samples of women younger than the screening age. Methods Results of cervical samples were obtained from the Dutch National Pathology Databank (PALGA) and were linked to the women's HPV vaccination status from the national vaccination registry (Praeventis) (N = 42,171). Occurrence of low‐grade and high‐grade squamous intraepithelial lesions or worse (LSIL and HSIL+) and high‐risk HPV positive tests (hrHPV) in the first cervical sample were compared between vaccinated and unvaccinated women by multivariable logistic regression analysis, corrected for age at cervical sampling and age of vaccination (12/13 years, ≥ = 14 years). Results For fully vaccinated women (three‐ or two‐dose schedule), statistically significant reductions were seen for all outcomes compared to unvaccinated women (hrHPV: adjusted OR, 0.70, 95% CI, 0.63–0.79; LSIL: 0.70, 0.61–0.80; HSIL+: 0.39, 0.30–0.51). Conclusions By linking nation‐wide registries on pathology and vaccination, we show significant beneficial early effects of HPV‐vaccination on LSIL, HSIL+, CIN3/AIS/carcinoma and hrHPV detection in young women upto 24 years of age who have a cervical sample taken before entry into the cervical cancer screening program.

Abstract Many medicines are used “off‐label” in children outside the terms of the license. Feasible pediatric clinical trials are a challenge to design. Conect4children (c4c) is an Innovative Medicines Initiative project to set up a pan‐European pediatric clinical trial network aiming to facilitate the development of new medicines for children. To optimize pediatric trial development by promoting innovative trial design, c4c set up a European multidisciplinary advice service, including the voice of young patients and families, tailored to industry and academia. A network of experts was established to provide multidisciplinary advice to trial sponsors. Experts were selected to join clinical and innovative methodology expert groups. A patient and public involvement (PPI) database, to include the expert opinion of patients and parents/carers was formed. A stepwise process was developed: (1) sponsors contact c4c, (2) scoping interview takes place, (3) ad hoc advice group formed, (5) advice meeting held, and (6) advice report provided. Feedback on the process was collected. Twenty‐four clinical and innovative methodology expert groups (>400 experts) and a PPI database of 135 registrants were established. As of September 30, 2022, 36 advice requests were received, with 25 requests completed. Clinical and methodology experts and PPI representatives participated in several advice requests. Sponsors appreciated the advice quality and the multidisciplinary experts from different countries, including experts not known before. Experts and PPI participants were generally satisfied with the process. The c4c project has shown successful proof of concept for a service that presents a new framework to plan innovative and feasible pediatric trials.

Abstract Purpose Deficits in speech understanding constitute one of the most severe consequences of hearing loss. Here we investigate the clinical and genetic risk factors for symmetric deterioration of speech recognition thresholds (SRT) among cancer survivors treated with cisplatin. Methods SRT was measured using spondaic words and calculating the mean of measurements for both ears with symmetric SRT values. For clinical associations, SRT‐based hearing disability (SHD) was defined as SRT≥15 dB hearing loss and clinical variables were derived from the study dataset. Genotyped blood samples were used for GWAS with rank‐based inverse normal transformed SRT values as the response variable. Age was used as a covariate in association analyses. Results SHD was inversely associated with self‐reported health (p = 0.004). Current smoking (p = 0.002), years of smoking (p = 0.02), BMI (p

Abstract Background Bladder cancer (BC) treatments are known to be invasive; nevertheless, research into the long‐term effects is limited and in the context of sexual function often male focussed. Female sexual dysfunction (FSD) has been reported in up to 75% of female patients. This systematic scoping review examines the literature on sexual consequences of BC in female patients. Objective This study aimed to systematically evaluate the evidence on female sexual function in BC to identify areas of unmet need and research priorities. Evidence Acquisition We performed a critical review of PubMed, PsychMed, CINAHL, MEDLINE and the Cochrane Library in March 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) extension for Scoping Reviews statement following Levac et al. methodology. Identified reports were reviewed according to the Critical Appraisal Skills Programme (CASP) criteria. 45 publications were included. Evidence Synthesis There was an inconsistent use of patient‐reported outcome measures (PROMs), with commonly used PROMs having a narrow symptom focus. However, common symptoms emerged: loss of desire, orgasmic disorders, vaginal dryness, dyspareunia, difficult intromission, reduced clitoral sensation, psychological concerns related to diagnosis, fear of contamination and body image. Sexual activity was reduced in most groups, despite women expressing a motivation to retain sexual function. The degree of symptom distress associated with FSD is underreported. Evidence emerged regarding a gap for women in clinician counselling and follow‐up. Conclusions The patient's perspective of FSD in BC patients is poorly understood and under‐addressed in clinical practice. There have been very few qualitative studies of FSD in BC. Any intervention designed to address the problem must start with greater understanding of both the patients' and clinicians' perspective. Lay Summary We examined the evidence on sexual consequences of BC in women. It is apparent that despite common themes of sexual dysfunction emerging, the problem is poorly understood and addressed in clinical practice.

Abstract Ayahuasca is a psychedelic plant brew originating from the Amazon rainforest. It is formed from two basic components, the Banisteriopsis caapi vine and a plant containing the potent psychedelic dimethyltryptamine (DMT), usually Psychotria viridis. Here we review the history of ayahuasca and describe recent work on its pharmacology, phenomenological responses, and clinical applications. There has been a significant increase in interest in ayahuasca since the turn of the millennium. Anecdotal evidence varies significantly, ranging from evangelical accounts to horror stories involving physical and psychological harm. The effects of the brew on personality and mental health outcomes are discussed in this review. Furthermore, phenomenological analyses of the ayahuasca experience are explored. Ayahuasca is a promising psychedelic agent that warrants greater empirical attention regarding its basic neurochemical mechanisms of action and potential therapeutic application.

Abstract Onobrychis viciifolia (hereafter sainfoin) is an autotetraploid (2n = 4x = 28), allogamous insect‐pollinated perennial legume originating from the Caucasus that has historically been cultivated as a forage. As a perennial legume, sainfoin has the potential to improve the sustainability of agriculture and food systems in multiple ways. Sainfoin can provide continuous living cover and biological nitrogen fixation to enhance soil fertility and health. It can also provide ecosystem services as a resource for pollinators and wildlife in addition to nitrogen fixation. Building on this history of valuable uses, The Land Institute is developing sainfoin as a pulse crop for human use. With the goal of supporting human diets with a sustainable, perennial protein source and nutrient‐dense crop, this innovation requires a thorough understanding of the chemical composition of sainfoin seeds to ensure safety and potential nutritional quality. Using seeds from commercial sainfoin varieties developed for forage production, grown by commercial sainfoin seed growers in the western United States, this study evaluates seed composition as part of an ongoing investigation into sainfoin's potential as a novel pulse. We found crude protein content (38.78%) comparable with soybean and lupine, fat content (6.96%) comparable with lupine and chickpea, and starch (7.1%) and dietary fiber content (48.96%) comparable with lupine. Phytic acid content was higher than pulses (1790.89 mg). Ash (3.81%), iron (64.14 ppm), and zinc contents (61.63 ppm) were in the higher end of the range for pulses. This study indicates that sainfoin could become a novel, nutrient‐dense crop for human nutrition. Future studies are required to further characterize seed composition and safety and demonstrate how common legume processing techniques may influence nutritional quality.

Background Differences in quality of life (QoL) after coronary artery bypass grafting (CABG) compared with percutaneous coronary intervention (PCI) are not well characterized. We aimed to compare the short‐ and long‐term effects of CABG versus PCI on QoL. Methods and Results We performed a systematic review and meta‐analysis of randomized controlled trials comparing CABG versus PCI using the Seattle Angina Questionnaire (SAQ)‐Angina Frequency, SAQ‐QoL, SAQ‐Physical Limitations, EuroQoL‐5D, and Short‐Form Questionnaire. We calculated mean changes within each group from baseline to 1, 6, 12, and 36 to 60 months (latest follow‐up) and the weighted mean differences between groups using inverse‐variance methods. A total of 10 760 patients were enrolled in 5 trials. From baseline to 12 months and 36 to 60 months, the mean change in SAQ‐Angina Frequency was >22 points (95% CI, 21.0–25.6) after both PCI and CABG. The mean difference in SAQ‐Angina Frequency was similar between procedures at 1 month and at 36 to 60 months but favored CABG at 12 months (1.97 [95% CI, 0.68–3.26]). SAQ‐QoL favored PCI at 1 month (−2.92 [95% CI, −4.66 to −1.18]) and CABG at 6 (2.50 [95% CI, 1.02–3.97]), 12 (3.30 [95% CI, 1.78–4.82]), and 36 to 60 months (3.17 [95% CI, 0.54 5.80). SAQ‐Physical Limitations (−12.61 [95% CI, −16.16 to −9.06]) and EuroQoL‐5D (−0.07 [95% CI, −0.08 to −0.07) favored PCI at 1 month. Short‐Form Questionnaire‐Physical Component favored CABG at 12 months (1.18 [95% CI, 0.46–1.90]). Conclusions Both PCI and CABG improved long‐term disease‐specific and generic QoL.

Abstract Grasslands are globally distributed and naturally occurring; however, in Europe, most grasslands are anthropogenically created or altered by livestock grazing or mowing. Low‐intensity use and management have led to species‐rich communities in European grasslands. The intensification of crop production and livestock farming with stabling throughout the year has led to an abandonment of grasslands that are no longer economically profitable. In this study, we looked at the influence of grassland abandonment on biodiversity. We hypothesized that abandonment of grasslands decreases the overall biodiversity, but has different effects depending on the focal taxonomic group (i.e., vascular plants, insects, or birds). We also hypothesized that the type of management before abandonment, the type of grassland, and the time after abandonment would influence grassland biodiversity. We conducted a Web of Science search, with pre‐defined terms, to find articles that compared biodiversity of managed and abandoned grasslands in Europe. We screened the articles and included 39 studies in a subsequent meta‐analysis. We found that overall biodiversity was reduced after abandonment; however, the biodiversity reduction in the grasslands differed among taxonomic groups. Plant species diversity was significantly lower after abandonment (plant summary effect size: −0.25 [−0.34; −0.16]), whereas the diversity of insects and birds showed no significant trend, but a visual trend toward an increase. None of the other environmental variables (type of management, type of grassland, or the time after abandonment) had a significant influence on the biodiversity of the grasslands. We conclude that maintaining grassland management is crucial to support biodiversity conservation in European grasslands.

Abstract Multidecadal satellite observations indicate that the Antarctic Ice Sheet (AIS) is losing mass at an accelerating rate, which has the potential to impact many aspects of the climate system. While previous studies demonstrated the importance of AIS freshwater (FW) discharge for regional and global climate processes using climate model experiments, many have applied unrealistic FW forcings. Here, we explore potential Southern Ocean (SO) impacts of realistic AIS mass loss over the 21st century in the Community Earth System Model version 2 by applying observation‐based historical and ice sheet model‐based future AIS FW forcing. The added FW reduces wintertime deep convective area by 72% while retaining 83% more sea ice. Congruent with other studies, we find the increased FW discharge extensively impacts local and remote SO surface and subsurface temperature and stratification. These results demonstrate the necessity of accounting for AIS mass loss in global climate models for projecting future climate.

Objective The objective of this cross‐sectional study was to investigate the impact of the COVID‐19 pandemic on physical activity (PA) levels of patients with rheumatic and musculoskeletal diseases (RMDs) and to examine factors associated with decreased PA. Methods A sample of adult patients with RMDs (n = 7,776) was identified through electronic medical records from an academic health care system in North Carolina. Invitations to participate in an online survey were sent between July 2020 and September 2020 to assess self‐reported changes in PA during the COVID‐19 pandemic. Descriptive statistics, age‐adjusted prevalence odds ratios (PORs), and 95% confidence intervals (CIs) were computed to examine patient characteristics associated with decreased PA. Results A total of 893 eligible participants completed the survey (mean age 57.8 ± 14.9 years, 75.8% female). The most common primary diagnoses reported among participants included rheumatoid arthritis (27.3%), osteoarthritis (16.0%), and systemic lupus erythematosus (SLE) (13.0%). More than half of participants (56.8%) reported engaging in less PA since the pandemic began. Factors associated with engaging in less PA included lower self‐reported general health (POR, 2.21; CI, 1.64‐2.97) and a diagnosis of SLE (POR, 1.57; CI, 1.03‐2.38). Comorbidities associated with decreased PA included chronic pain (POR, 1.38; CI, 1.04‐1.82), depression (POR, 1.48; CI, 1.09‐2.01), and hypertension (POR, 1.44; CI, 1.10‐1.90). Conclusion The COVID‐19 pandemic has exacerbated barriers to PA in patients with RMDs. There is a critical need to provide resources, support, and multifaceted programs to encourage PA in patients with RMDs during the COVID‐19 pandemic.

Abstract Objectives Microtia and aural atresia are congenital ear anomalies with a wide‐ranging spectrum of phenotypes and varied functional and psychosocial consequences for patients. This study seeks to analyze the management of microtia‐atresia patients at our center over a 20‐year period and to propose recommendations for advancing microtia‐atresia care at a national level. Methods We performed a retrospective analysis of data from patients presenting to the Massachusetts Eye and Ear (Boston, MA) for initial otolaryngology consultation for congenital microtia and/or aural atresia between 1999 and 2018. Results Over the 20‐year study period, 229 patients presented to our microtia‐atresia center at a median age of 7 years. The severity of microtia was most commonly classified as grade III (n = 87, 38%), 61% (n = 140) of patients had complete atresia, the median Jahrsdoerfer grading scale score was 6 (range 0–10), and 81 patients (35%) underwent surgery for microtia repair. For hearing rehabilitation, 30 patients (64%) underwent bone conduction device implantation and 17 patients (36%) underwent atresiaplasty. The implementation of an interdisciplinary, longitudinal care model resulted in an increase in patient (r = 0.819, p

Abstract Background Over a quarter of people have an anxiety disorder at some point in their life, with many first experiencing difficulties during childhood or adolescence. Despite this, gaps still exist in the current evidence base of the multiple consequences of childhood anxiety problems and their costs. Methods A systematic review of Medline, PsycINFO, EconLit and the National Health Service Economic Evaluation Database was conducted for longitudinal and economic studies reporting on the association between childhood anxiety problems and at least one individual‐, family‐ or societal‐level outcome or cost. All studies were synthesised narratively. For longitudinal studies, ‘effect direction’ was used as a common metric, with random effects meta‐analysis undertaken where possible. Results Eighty‐three studies met inclusion criteria and were synthesised narratively. We identified 788 separate analyses from the longitudinal studies, which we grouped into 15 overarching outcome domains. Thirteen of the studies were incorporated into 13 meta‐analyses, which indicated that childhood anxiety disorders were associated with future anxiety, mood, behaviour and substance disorders. Narrative synthesis also suggested associations between anxiety problems and worse physical health, behaviour, self‐harm, eating, relationship, educational, health care, employment, and financial outcomes. ‘Effect direction’ was conflicting in some domains due to a sparse evidence base. Higher economic costs were identified for the child, their families, healthcare providers and wider society, although evidence was limited and only covered short follow‐up periods, up to a maximum of 2 years. Total annual societal costs per anxious child were up to £4040 (2021 GBP). Conclusions Childhood anxiety problems are associated with impaired outcomes in numerous domains, and considerable economic costs, which highlight the need for cost‐effective interventions and policies to tackle them. More economic evidence is needed to inform models of the long‐term, economic‐related, consequences of childhood anxiety problems.

Abstract Quantifying animal abundance, density, and distributions affords the opportunity to understand the effects of landscape structure and change on species of conservation interest, but estimating these parameters can be difficult for rare and cryptic species. Noninvasive sampling methods, such as remote cameras or scat DNA, can mitigate the challenges of studying rare and cryptic species while also minimizing effects on species of conservation interest or concern. Data derived from these methods can be integrated into robust, contemporary quantitative methods, including spatial capture–recapture (SCR) models, which provide a hierarchical framework for jointly estimating animal abundance, distribution, and, consequently, density. Herein, we developed an integrated SCR model to estimate the abundance, density, and distribution of a large carnivore of conservation interest, the cougar (Puma concolor), in a rugged and remote protected area, Yosemite National Park, California, USA. We combined spatial encounter data from DNA‐based individual identification of scats with detection count data derived from remote cameras to estimate cougar density and detection probability in Yosemite. We further estimated how cougar density and detection probability varied as a result of vegetation, topography, anthropogenic and natural linear features, and survey effort. Using data collected in 2019 and 2020, we estimated a median of 31 (SD = 3.96, 95% credible intervals = 24–39) cougars in Yosemite across the two years, with higher densities associated with productive, vegetated areas. We found detection probability by scent detection teams was higher for females than males and positively correlated with survey effort, proximity to trails, and distance farther from roads and streams. Our study illustrates the utility of noninvasive survey methods that yield individual identities in rugged and remote environments, where capture and handling of cryptic, low‐density animals is logistically challenging and cost prohibitive. Integrated modeling approaches, as used here, allow ecologists to leverage empirical data using a robust quantitative framework that can effectively address conservation objectives. Through this work, we demonstrate the importance of large, contiguous, and heterogeneous ecosystems to the ecology of wide‐ranging species that occur in dynamic landscapes.

Abstract Background Gestational diabetes mellitus (GDM) is experienced at a higher rate in women from culturally and linguistically diverse (CALD) backgrounds. The aim of this systematic review is to describe the experiences of women with GDM from CALD backgrounds and compare their experiences to women with GDM from non‐CALD backgrounds. Materials and Methods MEDLINE, EMBASE, PsycINFO, Scopus, WOS and CINAHL databases were searched for qualitative and quantitative studies which included data on the experiences of CALD background women with GDM during all stages of pregnancy. Quality appraisal utilized checklists for analytical cross‐sectional studies and qualitative research. Thematic analysis was performed using nVivo software. Results Of the 3054 studies identified, 24 studies met the inclusion criteria. Data synthesis produced five key themes: (1) Response to diagnosis, (2) Experiences with self‐management, (3) Interactions with the healthcare system, (4) Mental health challenges and (5) Facilitators and barriers to support. Women with GDM from CALD and non‐CALD backgrounds similarly expressed mental health challenges, feeling burdened by recommendations, and challenges interacting with healthcare professionals (HCP). The major difference in experience was the cultural relevance of recommendations, especially related to diet recommendations. Conclusion Gestational diabetes mellitus is a burdensome diagnosis for CALD and non‐CALD women, with CALD women uniquely experiencing a lack of culturally relevant recommendations for self‐management. The similarities and differences in experience call for optimisation of GDM management and support for women with GDM.

Abstract The detrimental effects of environmental change on human and non‐human diversity are acutely manifested in urban environments. While urban greenspaces are known to mitigate these effects and support functionally diverse ecological communities, evidence of the ecological outcomes of urban greening remains scarce. We use a longitudinal observational design to provide empirical evidence of positive ecological changes brought about by greening actions. We collected a plant–insect interactions data set 1 year before, and for 3 years after, a greenspace received a small greening action within a densely urbanised municipality. We then assessed how (i) insect species richness; (ii) the probabilities of occurrence, survival and colonisation of the insect community; and (iii) the plant–insect network structure varied across the 4 years of the study. As we understand, this is the first study to apply statistical and network analytical frameworks to quantitatively track how positive ecological changes accrue over time at a site after the implementation of a specific urban greening action. We show how a small greening action quickly led to large positive changes in the richness, demographic dynamics and network structure of a depauperate insect community. An increase in the diversity and complexity of the plant community led to, after only 3 years, a large increase in insect species richness, a greater probability of occurrence of insects within the greenspace and a higher number and diversity of interactions between insects and plant species. We demonstrate how large positive ecological changes may be derived from investing in small greening actions and how these contribute to bring indigenous species back to greenspaces where they have become rare or been extirpated by urbanisation. Our findings provide crucial evidence that supports best practice in greenspace design and contributes to re‐invigorate policies aimed at mitigating the negative impacts of urbanisation on people and other species.

Clinical trials of novel therapeutics in the United States have not been adequately representative of diverse populations, particularly racial and ethnic minorities. The challenges and consequences of underrepresentation in clinical trial recruitment are exemplified by the case of belimumab, a biologic treatment for systemic lupus erythematosus (SLE), a disease that is more prevalent in patients of Black African ancestry and of Hispanic/Latino ethnicity than in other patient populations. Although belimumab was found to be effective in phase 2 and 3 clinical trials in the general population, post hoc analyses of efficacy data in patients of Black African ancestry showed inconsistent results. Consequently, a cautionary statement regarding belimumab use in this population was added to the product label. To alleviate concerns that belimumab may not be safe and effective for patients of Black African ancestry, the Efficacy and Safety of Belimumab in Black Race Patients with SLE (EMBRACE) study was conducted in a post‐marketing commitment to the Food and Drug Administration. The study recruited only patients who self‐identified as being of Black race; its findings led to the removal of the cautionary labeling of belimumab use in patients of Black African ancestry. Our manuscript highlights the critical lessons learned from the successes and failures of the EMBRACE study. It also provides suggestions for overcoming health disparities, highlighting strategies for conducting well‐designed clinical trials to overcome systematic barriers to diversity in recruitment, with a focus on enacting long‐term support to ensure equity in the process, products, and benefits from drug development and clinical trials.

Abstract Introduction Question prompt lists (QPLs) have been found to support patients to ask questions and improve the information they receive from doctors. However, some QPL tools, which have been available online for almost 15 years, have little published data on their impact in real‐world settings. This study's aim was to understand patients' attitudes and experiences accessing health information and to assess the impact of introducing two generic QPLs over 3 months. Methods A longitudinal qualitative study consisting of three semi‐structured interviews over a three‐month period was conducted with 31 purposively selected participants, adults ≥18 years, recruited online and through social media. Participants were introduced to two different QPLs currently available online (‘Question Builder’; ‘AskShareKnow’). Inductive thematic analysis of a total of 92 semi‐structured telephone interviews was conducted during May–November 2020. Results Three main themes are described. (1) Participants described barriers and facilitators to accessing health information: navigating a complex health system; difficulty asking questions of their healthcare professionals and that they value doctors with good communication skills. (2) QPLs helped some participants recognize the role of question‐asking in consultations, made them feel more empowered and helped them prepare and prioritize. (3) Participants wanted QPLs to be easier to use, be accessible when needed and that question‐asking and QPLs should be normalized in medical consultations. Conclusions Well‐designed and easily accessible QPLs can empower people to ask questions and be more involved in decisions about their health care. Endorsement of question‐asking in consultations by healthcare professionals and providing QPL tools at the point of contact with health services will be key to realizing the potential of QPLs. Patient or Public Contribution This study was completed in conjunction with a reference group consisting of a consumer representative, representatives from the Australian Commission on Safety and Quality in Health Care, Healthdirect Australia Ltd., and the research team.

Objective Acceptance and commitment therapy (ACT) has demonstrated effectiveness in addressing symptoms of anxiety and depression, frequently experienced by patients with systemic lupus erythematosus (SLE). The goal of this pilot study was to develop and assess the feasibility and acceptability of a novel web‐based ACT skills training program tailored for patients with lupus: ACT for Lupus. The program served as a complementary approach to support the management of symptoms and stressors during the COVID‐19 pandemic. Methods This study employed a single‐group pretest‐posttest design. Participants with a diagnosis of SLE were primarily recruited through an institutional healthcare system between November 25, 2020 and December 17, 2020 and through an online national lupus organization listserv. Participants were invited to attend two 1‐hour webinars delivered over a 2‐week period. Educational ACT‐based content was tailored for patients with lupus and delivered by an experienced clinical psychologist specializing in ACT. Surveys assessed patient‐reported outcomes of anxiety, depression, and quality of life and evaluated program feedback, usability, and satisfaction. Results A total of 83 participants submitted the baseline survey, with 21 participants designated as study completers. The program was well received by participants, who reported feasibility and acceptability of the intervention, as reflected by high usability ratings. Participants reported favorable experiences with the program. Feedback included suggestions to include additional lupus‐tailored content, increase the range and scope of sessions and activities, and improve program flexibility and availability to avoid scheduling conflicts. Conclusion This study provides preliminary evidence for an adapted, ACT‐based virtual skills training program as a feasible and acceptable intervention to support the well‐being of patients with lupus.

Abstract Highly seasonal environments can increase competition among herbivores for nutrients, affecting rates of reproduction and survival. There is concern about the impacts of non‐native ungulates on Greater Sage‐grouse in the Great Basin of North America. We estimated nesting propensity, the annual proportion of females attempting a nest, for Greater Sage‐grouse in relation to the abundance of ungulates using 7 years of data from the northwestern Great Basin, USA. We focused on nesting because it is the necessary first major investment required for the production of new recruits. We used a Bayesian multistratum model to investigate the effects of weather and sympatric non‐native herbivores, free‐roaming horses and domestic cattle, on reproductive rates and female survival of adult and yearling sage‐grouse. Adults nested at a higher rate (0.931, 95% CI, 0.904–0.953) than yearlings (0.867, 95% CI, 0.802–0.922) under average conditions of covariates other than age. If the first nest failed, renesting rates were similar between adults (0.349, 95% CI, 0.292–0.410) and yearlings (0.353, 95% CI, 0.217–0.507). Females in better body condition at the start of the season nested at higher rates, and moderately snowy winters led to the highest nesting propensity during the following spring. Drier conditions led to low rates of nesting, particularly in areas with dense cattle grazing. Female survival was lower for nesting females, indicating a survival cost of reproduction. Areas with abundant free‐roaming horses had slightly higher nesting propensity, though other research suggests negative impacts later in the breeding cycle. Sage‐grouse face life history trade‐offs that may be shifting due to changing climatic conditions. Our work suggests that the effects of competition with non‐native ungulates on sage‐grouse life histories may be exacerbated by adverse weather.

Abstract Animal fitness is closely linked to accessing and capitalizing on local resources such as prey and shelter. Resources vary in quality, thus individuals may demonstrate selectivity for particular resource types. We examined resource selection in roost selection patterns of temperate bats on Prince Edward Island. To complement existing work examining roost structural characteristics, we evaluated whether roost selection by little brown myotis (Myotis lucifugus) could be explained by landscape characteristics. Given a sample of roosts identified through radio telemetry, community reports and a randomly selected sample of comparison structures, we determined that a combination of proximity to forest and open wetland best explained roost selection. Roost selection appears to reflect the optimization of time and energy budgets, and the proportion of maternity roosts within the sample suggests that these constraints may be more acute in reproductive females. Given the importance of roosts for reproductive success in females, future work should seek to quantify the role of physical characteristics on roost structure selection and the preservation of suitable roosting structures.

Abstract Synthetic biology offers exciting possibilities to deal with local and global challenges over the coming decades. As we make greater use of biological engineering, it will be increasingly important to balance potential risks and benefits. The rate, scale, and diffusion of relevant capabilities will make this challenging. There will be a growing need for flexible risk management approaches, which can be rapidly adapted as technology and societal needs change. This study details efforts by the International Genetically Engineered Machine (iGEM) competition in creating and implementing an adaptive risk management approach. It concludes with key lessons and challenges: working with hazardous materials, such as dangerous pathogens, toxins and chemicals; managing risks to plants, animals and the environment; use of samples from people, animals, and the environment; improving the hazards identified; variations in risk perception and tolerance; variation in terminology that complicates interpretation of risk management plans; and connections with broader societal or ethical questions, such as animal use, gender and sexuality, or benefit sharing.