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Employers face many dilemmas in effectively implementing work–life flexibility to support employees' personal lives. A key issue is that some employees hold jobs with limited opportunities for work–life flexibility, making them susceptible to burnout; yet most employers believe they can do little to mitigate this dynamic. Furthermore, even when employees hold jobs with greater access to work–life flexibility, some do not take advantage of their flexibility to more fully engage in work and/or home roles. These issues are further exacerbated when supervisors are unsure of their role in supporting work–life flexibility. We identify work–life supportive context as a key factor that provides solutions to these dilemmas. Drawing on job demands resources theory, we posit that, when organizations provide work–life supportive training to supervisors, it promotes a work–life supportive context (i.e., signaling that the organization is supportive of employees' managing their work–life interface), which mitigates burnout for those with limited work–life flexibility and promotes engagement in work and home roles for those with greater work–life flexibility. Results from a year‐long randomized field experiment suggest that, in contexts with trained supervisors and lower employee control over work schedules and boundaries (i.e., lower work–life flexibility), emotional exhaustion is reduced. In contexts with trained supervisors and higher employee control over work boundaries (i.e., higher work–life flexibility), family engagement increases. Surprisingly, irrespective of job access to work‐life flexibility, supervisor participation in work–life support training did not enhance employee work engagement. Implications of our findings for fostering work–life supportive contexts are considered. [ABSTRACT FROM AUTHOR]

Epstein–Barr virus (EBV) is an oncogenic virus associated with various malignancies, including classical Hodgkin lymphoma (cHL). Despite its known association, the specific role of humoral immune response to EBV remains poorly characterized in cHL. To address this, we conducted a study using a custom protein microarray to measure the antibody responses in cHL patients and matched healthy controls recruited from an East‐Asian hospital‐based case–control study. We identified 16 IgG antibodies significantly elevated in EBV‐positive cHL compared with controls, defining an "East‐Asian antibody signature of EBV‐positive cHL." We evaluated responses against these 16 antibodies in a distinct European population, leveraging data from our previous European cHL case–control study from the UK, Denmark, and Sweden. A subset of antibodies (14/16, 87.5%) from the "East‐Asian antibody signature of EBV‐positive cHL" exhibited significant associations with cHL in the European population. Conversely, we assessed the "European antibody signature of EBV‐positive cHL" identified in our prior study which consisted of 18 EBV antibodies (2 IgA, 16 IgG), in the East‐Asian population. A subset of these antibodies (15/18, 83.3%) maintained significant associations with cHL in the East‐Asian population. This cross‐comparison of antibody signatures underscores the robust generalizability of EBV antibodies across populations. Five anti‐EBV IgG antibodies (LMP‐1, TK, BALF2, BDLF3, and BBLF1), found in both population‐specific antibody signatures, represent a "core signature of EBV‐positive cHL." Our findings suggest that the antibody responses targeting these core EBV proteins reflect a specific EBV gene expression pattern, serving as potential biomarkers for EBV‐positive cHL independent of population‐specific factors. [ABSTRACT FROM AUTHOR]

The Core Concepts of Pharmacology (CCP) initiative is developing educational resources to transform pharmacology education into a concept‐based approach. This study evaluated the quality of global educator‐created MCQs in generating items for the pharmacology concept inventory (PCI) instrument and developed as a resource for learning pharmacology fundamental concepts. A panel of 22 global pharmacology experts recruited from the CCP initiative research team participated in the MCQ pilot database design and evaluation. The quality analysis framework of the MCQs in the pilot database included four assessment tools: item writing guidelines (IWGs), Bloom's taxonomy, the CCP, and the MCQ design format. A two‐phase evaluation process was involved, including inter‐rater agreement on item quality, followed by resolving conflicts that occurred in quality assessment. The chi‐square (χ2) test of independence and Cramer's V correlation tests were utilized to measure the relationship among quality assessment attributes. About 200 MCQs were gathered and 98% underwent expert evaluation. Nearly 80% addressed one or more CCP, with 52% designed using a context‐dependent format. However, only 40% addressed higher levels of Bloom's cognitive domain and 10% adhered to all IWGs. A strong positive correlation was observed between the context‐based item format and its effectiveness in assessing the higher cognitive domain, the main CCP and improved IWGs adherence. Context‐based item construction can assess the higher cognitive skills and fundamental pharmacology concepts, showing potential for rigorous PCI development. The pilot database will store items to create the PCI, aiding the development of a concept‐based pharmacology curriculum. [ABSTRACT FROM AUTHOR]

The objective of the study was to evaluate the effect of photobiomodulation (PBM) with laser on the inflammatory process in an experimental in vitro model of ACO. The groups were: (1) human bronchial epithelial cells (BEAS‐2B); (2) BEAS‐2B cells treated with dexamethasone; (3) BEAS‐2B cells irradiated with laser; (4) BEAS‐2B cells stimulated with cigarette smoke extract (CSE) + House Dust Mite (HDM); (5) BEAS‐2B cells stimulated with CSE + HDM and treated with dexamethasone; (6) BEAS‐2B cells incubated with CSE + HDM and irradiated with laser. After 24 h, cytokines were quantified. There was a reduction in TNF‐α, IL‐1β, IL‐6, IL‐4, IL‐5, IL‐13, IL‐17, IL‐21, IL‐23, and an increase in IL‐10 and IFN‐γ in cells from the laser‐irradiated ACO group compared to only ACO group. With these results, we can suggest that photobiomodulation acts in the modulation of inflammation observed in ACO, and may be a treatment option. [ABSTRACT FROM AUTHOR]

Ecosystems are increasingly challenged by the multiple facets of climate change, coupled with intensifying land‐use pressures. These co‐occurring stressors can interact in complex ways, but we lack an empirical understanding of the impact of higher‐order interactions on temporal patterns. Using 128 flow‐through circular stream mesocosms, we investigated the individual and combined effects of two climatic stressors (CO2 enrichment, flow variability) and two land‐use‐related stressors (siltation, light—as lack of shading) on algal communities and net ecosystem productivity (NPP) in a full‐factorial design. The sediment pulses coincided with high flow to mimic erosion events, whereas CO2 and light disturbances were applied continuously, as they would in nature. Sediment emerged as a key stressor for algal biomass. Land‐use stressors had more pervasive individual effects, whereas climate‐change‐related stressors were more important in up to three‐way interactions with other stressors. However, CO2 was a key driver of NPP, followed by sediment and light, whereas flow variability was only important in interactions with other stressors. The effects of sediment and flow on algal biomass depended strongly on their temporal patterns. The combined effect of an increasing number of stressors on algal biomass appeared to reach saturation with three active stressors, with no apparent additional effect caused by the fourth stressor. Synthesis. Sediment emerged as a key stressor in streams. Despite the mounting evidence and the multitude of available mitigation strategies, this problem persists worldwide. The complex interactions uncovered in our study illustrate context‐dependency that can be masked in two‐factor experiments. Our findings also highlighted that temporal patterns of individual and co‐occurring stressors can determine the ecological outcome. [ABSTRACT FROM AUTHOR]

Aim: Wallacea is a global biodiversity hotspot and Sulawesi is the largest island in this region, notable for a high proportion of endemic species. The Wakatobi archipelago, off the southeastern peninsular arm of Sulawesi, is home to several endemic bird species. Although islands are known to influence the morphology of their resident species, competitive interactions also exert strong influences on morphology. Here, we consider the contributions of both islands and competitors on two morphological traits of two bird species in a small passerine guild found on the Wakatobi islands. Location: Wakatobi archipelago, Sulawesi Tenggara, Indonesia. Taxon: Wakatobi White‐eye (Zosterops flavissimus) and Wakatobi Sunbird (Cinnyris infrenatus). Methods: Working with morphological measures (from netting studies), population density metrics (from transect surveys) and fundamental data from islands (area, distance from mainland and elevation), we investigated (by means of multiple linear regression) which terms best explained variation in the body size and bill size of two small passerine birds endemic to the Wakatobi islands. Results: Both island metrics and competitor presence/density were useful in describing the variation in body size of both bird species. However, only competitor presence/density was useful in describing variation in bill size of the birds. The best models describing variation in these traits included terms representing both interspecific and intraspecific competition. Main Conclusions: Our findings indicate that simple island metrics may be useful in predicting some of the variation in some functional traits of island species. However, in this example, simple island metrics were insufficient to explain the full variation in body size of endemic birds across the Wakatobi archipelago and were of no use in predicting the variation in their bill size. As bill morphology frequently dictates diet and feeding niche, it is a trait which may determine population divergence and speciation. If simple island metrics fail to describe such diversification, it is surely important to capture that information in other ways. [ABSTRACT FROM AUTHOR]

Digital health is increasingly recognized for its value to enhance patient care and clinical care processes. People with chronic kidney disease often find dietary self‐management challenging. There is promising evidence that digital health interventions can support people with chronic kidney disease to self‐manage their diet, by providing more frequent access to nutritional information and dietitians and by facilitating regular monitoring and feedback. There is some emerging evidence of the impact of digital interventions in chronic kidney disease; however, more research is needed to provide meaningful interpretation of how digital interventions can enhance current practice. Importantly, a number of factors need to be considered when designing, developing, implementing, and evaluating the impact of digital interventions. Consideration of the nutrition service and patients' needs, motivation and digital literacy, type of digital intervention, and the ability to embed the digital intervention into current care processes are critical. This paper overviews the current literature on digital health and self‐management, factors to consider when embedding digital interventions and platforms into nutrition care and practical considerations for designing and implementing digital health interventions to enhance the nutritional care of people with chronic kidney disease. [ABSTRACT FROM AUTHOR]

Background: Long‐term renal function and survival after kidney transplantation rely on appropriate immunosuppressive treatment to prevent the risk of rejection. New biomarkers are needed to accurately assess the degree of immunosuppression in renal transplant recipients in order to avoid organ rejection and the development of opportunistic infections. Highly prevalent in humans, torque teno virus (TTV), which belongs to the family Anelloviridae, is a small, nonenveloped, single‐stranded DNA virus which has not been linked with any specific human illness, but which constitutes a major component of the human virome. Host antiviral responses allow TTV levels to be controlled; however, viral persistence remains, explaining the high prevalence in human populations, including healthy individuals. Important confounders of TTV load include time since transplantation, age, gender, obesity, and smoking status. Aims: TTV‐based guidance of immunosuppressive drug dosing could help with risk stratification, reducing the risk of infection, graft rejection and oncologic disease on an individual level, enabling long‐term patient and graft survival. Methods: Original studies were accessed by a systematic search from electronic databases including PubMed, ScienceDirect and Wiley Online Library. Results: The presented data mainly derive from adult transplant recipients showing an association between TTV plasma levels and the immune status of the host: High‐TTV load and high immunosuppression are associated with a risk of infection, and low‐TTV load and low immunosuppression indicate a risk of rejection. However, there is minimal information on pediatric transplant recipients with further research required in this cohort. To date, it has been demonstrated that longer posttransplant times are significantly associated with lower TTV levels in children with renal transplant. Meanwhile, an association between lower TTV loads and increased risk of graft reject during the first year of transplantation was also reported. More recently, Eibensteiner et al. revealed a robust, independent association between TTV plasma load and the onset of Cytomegalovirus and BK virus infections. Conclusion: Data from randomized controlled trials are still missing, even in adults, but a multicenter randomized controlled trial for TTV‐guided immunosuppression in adult kidney recipients (TTVguideIT) began in 2022. There is, therefore, great promise for TTV levels to be used as a biomarker that could potentially improve both graft and patient survival in transplantation. [ABSTRACT FROM AUTHOR]

Summary: Anti‐obesity medications (AOMs) have emerged as one element of comprehensive obesity clinical care intended to improve long‐term health outcomes for children and adolescents. The number of pediatric AOM clinical trials has burgeoned in recent years as new pharmacotherapeutics have been developed. Factors related to growth and development in children and adolescents can present unique challenges in terms of designing and conducting clinical trials investigating the safety and efficacy of AOMs. These barriers can delay the AOM development and evaluation process, increase the cost of performing trials, create challenges in the interpretation of results, influence the generalizability of the findings and present ethical dilemmas. In an effort to address these issues and provide guidance to streamline the process of designing and conducting pediatric AOM clinical trials, relevant key stakeholders convened a series of roundtable meetings to discuss, debate and achieve harmonization on design features. Stakeholder participants included a multidisciplinary group of international pediatric obesity experts, patient (parent) representatives and representatives from academic medicine, key regulatory agencies and industry. Topics of discussion included primary efficacy end‐points, secondary end‐points, eligibility criteria, trial run‐in and follow‐up phases, use of active comparators and guidelines for down‐titration and/or stopping rules for excessive weight reduction. Consensus recommendations were agreed upon. Regarding end‐points, emphasis was placed on moving away from BMI z‐score as a primary outcome, incorporating multiple alternative BMI‐related outcomes and measuring adiposity/body fat as a prominent secondary end‐point. Trial eligibility criteria were carefully considered to maximize generalizability while maintaining safety. The limited value of trial run‐in phases was discussed. It was also underscored that designing trials with extended follow‐up periods after AOM withdrawal should be avoided owing to ethical issues (including possible psychological harm) related to weight regain without providing the opportunity to access other treatments. The panel emphasized the value of the randomized, placebo‐controlled trial but recommended the thoughtful consideration of the use of active comparators in addition to, or instead of, placebo to achieve clinical equipoise when appropriate. Finally, the panel recommended that clinical trial protocols should include clear guidance regarding AOM down‐titration to avoid excessive weight reduction when applicable. [ABSTRACT FROM AUTHOR]

Aims: Advancements in type 1 diabetes (T1D) management, such as continuous glucose monitoring (CGM), have helped people achieve narrower glucose ranges, but associations between CGM and diabetes distress are unclear. Although higher HbA1c is associated with higher distress, associations with other glucose metrics are unknown. To better understand this relationship, we characterized diabetes distress in a sample of CGM users and compared differences in glucose metrics (measured via CGM) between those with higher versus lower distress. Methods: CGM users with T1D from the T1D Exchange Registry completed an online survey including diabetes distress (DDS‐2) and shared CGM data (N = 199). CGM metrics were computed from all available data within 3 months prior to survey completion. Participants were grouped by distress level: lower (DDS‐2 < 3, n = 120) or higher (DDS‐2 ≥ 3, n = 79). Welch's t‐tests were used to compare mean differences in CGM metrics between groups and MANCOVA was used to further probe mean differences. Results: Approximately 39.7% participants reported higher diabetes distress. Welch's t‐tests revealed participants with higher distress spent significantly more time in higher glucose ranges (above 180 mg/dL and above 250 mg/dL), less time in target glucose ranges (between 70 and 180 mg/dL and between 70 and 140 mg/dL) and had higher glucose management index values compared to those with lower distress (p < 0.01). MANCOVA models showed similar results. Conclusions: CGM users continue to experience diabetes distress. Moreover, higher distress appears to be associated with hyperglycaemia. These findings provide support for broader screening efforts for diabetes distress. [ABSTRACT FROM AUTHOR]

Aims: To estimate the strength of association between psychiatric disorders and substance use disorders (SUD), and cannabis use and cannabis use disorder (CUD) during early pregnancy. Design: Observational study. Setting: Kaiser Permanente Northern California, USA. Participants: 299 496 pregnancies from 227 555 individuals screened for cannabis use by self‐report and a urine toxicology test at entrance to prenatal care in Kaiser Permanente Northern California during January 2011–December 2021 (excepting year 2020). The sample was 62.5% non‐White, with a mean (standard deviation) age of 31.1 (5.5) years; 6.8% used cannabis; 0.2% had a CUD. Measurements: Exposure variables included electronic health record‐based psychiatric diagnoses of attention deficit hyperactivity, anxiety, bipolar, depressive, personality, posttraumatic stress and psychotic disorders; and alcohol, opioid, stimulant and tobacco use disorders, during the two years prior to pregnancy up to the day before the prenatal substance use screening date. Outcome variables were any cannabis use, frequency of self‐reported cannabis use and CUD during early pregnancy. Findings Psychiatric disorder prevalence ranged from 0.2% (psychotic) to 14.3% (anxiety), and SUD ranged from 0.3% (stimulant/opioid) to 3.8% (tobacco). Psychiatric disorders were associated with cannabis use and CUD, with the strongest association for any use found for bipolar disorder (adjusted odds ratio [aOR] = 2.83; 95% confidence interval [CI] = 2.53–3.17) and the strongest association for CUD found for psychotic disorders (aOR = 10.01, 95% CI = 6.52–15.37). SUDs were associated with cannabis use and CUD, with the strongest association for any use found for tobacco use disorder (aOR = 4.03, 95% CI = 3.82–4.24) and the strongest association for CUD found for stimulant use disorder (aOR = 21.99, 95% CI = 16.53–29.26). Anxiety, bipolar, depressive disorders and tobacco use disorder were associated with greater odds of daily than monthly or less cannabis use. Conclusions: Psychiatric disorders and substance use disorders appear to be associated with elevated odds of any and frequent cannabis use as well as cannabis use disorder during early pregnancy. In most cases, the associations with cannabis outcomes were stronger for substance use disorders than other psychiatric disorders. [ABSTRACT FROM AUTHOR]

This article discusses the controversy surrounding pre-operative opioid tapering and its potential to advance personalized, patient-centered pain medicine. The use of opioids for chronic non-cancer pain management is common, but it is associated with negative outcomes in the peri-operative period, such as respiratory failure and surgical site infections. The article presents the findings of a pilot study that assessed the feasibility of a pharmacist-led opioid tapering program before elective hip or knee arthroplasty. The study found high adherence to the program and positive outcomes in terms of physical functioning and quality of life. However, the study has limitations, and further research is needed to determine the effectiveness of pre-operative opioid tapering in a broader patient population. [Extracted from the article]

Dominance is a primary determinant of social dynamics and resource access in social animals. Recent studies show that dominance is also reflected in the gene regulatory profiles of peripheral immune cells. However, the strength and direction of this relationship differs across the species and sex combinations investigated, potentially due to variation in the predictors and energetic consequences of dominance status. Here, we investigated the association between social status and gene expression in the blood of wild meerkats (Suricata suricatta; n = 113 individuals), including in response to lipopolysaccharide, Gardiquimod (an agonist of TLR7, which detects single‐stranded RNA in vivo) and glucocorticoid stimulation. Meerkats are cooperatively breeding social carnivores in which breeding females physically outcompete other females to suppress reproduction, resulting in high reproductive skew. They therefore present an opportunity to disentangle the effects of social dominance from those of sex per se. We identify a sex‐specific signature of dominance, including 1045 differentially expressed genes in females but none in males. Dominant females exhibit elevated activity in innate immune pathways and a larger fold‐change response to LPS challenge. Based on these results and a preliminary comparison to other mammals, we speculate that the gene regulatory signature of social status in the immune system depends on the determinants and energetic costs of social dominance, such that it is most pronounced in hierarchies where physical competition is important and reproductive skew is large. Such a pattern has the potential to mediate life history trade‐offs between investment in reproduction versus somatic maintenance. [ABSTRACT FROM AUTHOR]

BACKGROUND: Disparities in school attendance exist for children with medical complexity (CMC) due to COVID‐19. Longitudinal changes in family‐reported school safety perceptions and predictors of full‐time, in‐person school attendance are unknown. METHODS: This was a prospective, longitudinal cohort study with 3 survey waves (June 2021‐June 2022) among English‐ and Spanish‐speaking families of CMC aged 5 to 17 years and pre‐pandemic school attendance. Changes in Health Belief Model perceptions and full‐time in‐person school attendance were estimated using multivariate generalized linear modeling with repeated measures. RESULTS: Among 1601 respondents (52.9% of 3073 invited), 86.8% participated in all 3 surveys. School safety perceptions improved with time; however, perceived susceptibility to COVID‐19 increased. Full‐time in‐person school attendance rose from 48.4% to 90.0% from wave 1 to 3 (p <.0001), and was associated with motivation, benefits, and cues. For example, families with low compared to high motivation for in‐person attendance had 76% versus 98% predicted probability for child's school attendance, respectively at wave 3 (p <.0001). IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Probability of full‐time in‐person school attendance was associated with several health belief model perceptions. School health policy and programs may benefit from promoting family motivation, benefits, and cues during future respiratory illness epidemics including COVID‐19. CONCLUSIONS: In‐person school attendance improved for CMC over time. Opportunities exist to continue optimizing in‐person attendance and family‐perceived safety for CMC at school. [ABSTRACT FROM AUTHOR]

Despite remarkable advances in immunotherapy, melanoma remains a significant cause of cancer mortality. Many factors concerning melanoma mortality are poorly understood, posing an obstacle to optimal care. We conducted a retrospective observational cohort study of 183 patients with metastatic melanoma who died following immunotherapy treatment to investigate sites of metastases at death, settings of death, and mechanisms of death. The median time from metastatic diagnosis to death was 16.1 months (range 0.3–135.1 months). Most patients experienced hospitalization within 3 months before death (80.3%), with 31.7% dying while hospitalized, 31.2% while in inpatient hospice, and 29.4% while in home hospice. The most common sites of metastases at death were distant lymph nodes (62.8%), lung (57.9%), liver (50.8%), brain (38.8%), and bone (37.7%). The most common causes of death were progressive failure to thrive (57.5%), respiratory failure (22.4%), and infection (21.8%); the vast majority (87.9%) of patients died from melanoma‐specific causes. Overall, 10.9% of patients in our cohort had survival >5 years after metastatic diagnosis, and 76.2% of long‐term survivors died due to melanoma. This study describes factors associated with melanoma mortality, highlighting an ongoing need for therapeutic advancements. [ABSTRACT FROM AUTHOR]

Most melanomas progress from radial to vertical growth phase before spreading locoregionally and distally. Much is still unknown about the metabolic changes in the tumor cells and their microenvironment during this metastatic progression. We aimed to gain new insight into the molecular characteristics of melanoma in regard to spatial lipidomics to deliver new knowledge regarding tumor metastatic progression. We included 10 fresh tumor samples from 10 patients including two in situ melanomas, two invasive primary melanomas, and six metastatic melanomas (four in‐transit metastases and two distant metastases). In addition, we analyzed four healthy skin controls from the same patients. Time‐of‐flight imaging secondary ion mass spectrometry (ToF‐SIMS) enabled detailed spatial‐lipidomics that could be directly correlated with conventional histopathological analysis of consecutive H&E‐stained tissue sections. Significant differences in the lipid profiles were found in primary compared to metastatic melanomas, notably an increase in phosphatidylethanolamine lipids relative to phosphatidylinositol lipids and an increase in GM3 gangliosides in the metastatic samples. Furthermore, analysis of the data from in transit versus distant metastases samples highlighted that specific phospholipids, and a difference in the long versus shorter chain GM3 gangliosides, discriminated the metastatic routes. Further studies are warranted to verify these preliminary findings. Lipidomic changes could serve as a novel biomarker for tumor progression and even serve as a target for novel treatments. Furthermore, analyzing the lipid profiles could help to differentiate between primary and metastatic melanomas in challenging cases. [ABSTRACT FROM AUTHOR]

Objective: Identify the proportion of patients undergoing elective neck dissection (END) in surgically managed supraglottic squamous cell carcinoma (SCCa), assess associations between patient, tumor, and treatment factors with END, and assess associations between neck management and overall survival (OS). Study Design: Retrospective study. Setting: National Cancer Database (NCDB) 2019 Participant User File. Methods: Patients with previously untreated, clinically node‐negative (cN0) supraglottic SCCa treated with partial laryngectomy were queried from NCDB. Patients without known neck management and who underwent total laryngectomy were excluded. Patient and tumor factors associated with END were evaluated by logistic regression analysis. Univariable Cox proportional hazard analysis was used to examine associations between patient factors and OS, and factors with P <.05 were included on multivariable analysis. Results: A total of 1352 patients met eligibility criteria. Eight hundred eleven (60%) patients had END performed with occult nodal metastasis identified in 177 (22%) patients. END was more likely to be performed at academic centers than nonacademic centers (odds ratio: [1.66], 95% confidence interval [CI]: 1.32‐2.09, P <.001). On multivariable analysis, patients who underwent adjuvant radiation had worse OS (hazard ratio [HR]: 1.45, 95% CI: 1.13‐3.29, P =.017). END was associated with improved OS overall on univariable analysis (HR: 0.83, 95% CI: 0.69‐0.98, P =.026), but not on multivariable analysis. Conclusion: In this NCDB study, 22% of cN0 supraglottic SCCa patients had occult nodal metastatic disease. Despite this, 40% of patients do not receive END at the time of primary resection. Patients who receive END for supraglottic SCCa are more likely to avoid adjuvant radiation without impacting OS. [ABSTRACT FROM AUTHOR]

Objective: Examine associations between military blast exposures on hearing loss and self‐reported hearing difficulties among Active‐Duty Service Members (ADSM) and Veterans from the Noise Outcomes in Servicemembers Epidemiology (NOISE) study. Study Design: Cross‐sectional. Setting: Multi‐institutional tertiary referral centers. Methods: Blast exposure was assessed with a comprehensive blast questionnaire. Outcome measures included pure‐tone hearing thresholds; Speech Recognition in Noise Test; Hearing Handicap Inventory for Adults (HHIA); and Speech, Spatial and Qualities of Hearing Scale (SSQ)‐12. Results: Twenty‐one percent (102/494) of ADSM and 36.8% (196/533) of Veterans self‐reported blast exposure. Compared to ADSM without blast exposure, blast‐exposed ADSM had increased odds of high frequency (3‐8 kHz) and extended‐high frequency (9‐16 kHz) hearing loss (odds ratio [OR] = 2.5, CI: 1.3, 4.7; OR = 3.7, CI: 1.9, 7.0, respectively). ADSM and Veterans with blast exposure were more likely than their nonblast exposed counterparts to report hearing difficulty on the HHIA (OR = 1.9, CI: 1.1, 3.3; OR = 2.1, CI: 1.4, 3.2, respectively). Those with self‐reported blast exposure also had lower SSQ‐12 scores (ADSM mean difference = −0.6, CI: −1.0, −0.1; Veteran mean difference: −0.9, CI: −1.3, −0.5). Conclusion: Results suggest that blast exposure is a prevalent source of hearing injury in the military. We found that among ADSM, blast exposure was associated with hearing loss, predominately in the higher frequencies. Blast exposure was associated with poorer self‐perceived hearing ability in ADSM and Veterans. IRB: #FWH20180143H Joint Base San Antonio (JBSA) Military Healthcare System; #3159/9495 Joint VA Portland Health Care System (VAPORHCS) Oregon Health and Science University (OHSU). [ABSTRACT FROM AUTHOR]

Societal Impact Statement: Trees in urban environments provide us with shade, heat mitigation, flood abatement, noise and pollution reduction, pollination, beauty, and much more. However, many of these benefits are strongly connected to tree size and vitality, with larger, healthier trees providing ecosystem services more effectively, which means that selecting the right tree for site and function is crucial in order to gain all benefits from our urban trees. Summary: Trees play a major role in the Earth's biogeochemical processes, influencing soil production, hydrological, nutrient and carbon cycles, and the global climate. They store about 50% of the world's terrestrial carbon stocks, and provide habitats for a wide range of other species, supporting at least half of the Earth's known terrestrial plants and animals. Trees are not only found in forests and other natural ecosystems, but also in urban environments. Most of the human population is concentrated in cities, towns and villages, so urban trees are critical to meet on‐going and future social, economic and environmental challenges. However, many urban tree populations are strongly challenged by a changing climate, outbreaks of pests and pathogens and an urban development with increasingly dense cities and a high proportion of impermeable surface materials. The importance of intraspecific variation needs to be better acknowledged in this context, since poor matching of trees and the local climate and growing conditions can lead to extensive loss of valuable trees. By using the right genetic plant material for the challenging urban environments, a more resilient tree population with a greater diversity and higher capacity for delivering ecosystem services can be gained. Here, we wish to discuss the need to consider intraspecific variation when planning resilient tree populations for urban environments and how seed banks and botanical garden play important roles in efforts to improve the matching of genetic plant material for future environmental challenges. Strategies to enrich urban tree diversity and increase resilience are outlined. [ABSTRACT FROM AUTHOR]

Aims: Compensatory coping, or maladaptive alterations in behavior with the intention of preventing or managing symptoms, is increasingly being explored as a key factor in how people respond to bladder conditions. Preliminary investigations have identified relations between coping behaviors and psychological distress in urologic conditions, including interstitial cystitis/bladder pain syndrome (IC/BPS). However, previous explorations of coping have not accounted for heterogeneity in coping behaviors or addressed the likelihood that some coping behaviors may be more adaptive than others. This study sought to examine how two specific types of coping behaviors, primary control coping and disengaged coping, are related to distress and symptoms in IC/BPS, and to explore the potential role of pain phenotype in this relationship. Materials and Methods: A secondary data analysis was conducted with a large community data set (N = 677 women with IC/BPS) and employed descriptive and inferential statistics to characterize coping patterns and explore novel predictors of distress. Results: Results indicated that almost all participants engaged in at least one compensatory coping behavior within the last week. Both types of coping behaviors correlated with psychological symptoms, and when controlling for relevant clinical variables (i.e., age and severity of urinary symptoms), disengaged coping behaviors were significantly associated with psychological distress. Further, the addition of pain phenotype to multiple regression models resulted in a more effective predictive model when considering the relation between coping behaviors and depression. Conclusions: By investigating more deeply the relationship between coping and distress, understanding of potential risk factors and mechanisms is increased, offering valuable insights for intervention strategies for IC/BPS patients. [ABSTRACT FROM AUTHOR]

Chronic hepatitis B (CHB) is the leading cause of hepatocellular carcinoma (HCC) globally. We described and evaluated the outcomes of patients with CHB‐HCC in Canada. In this retrospective cross‐sectional cohort study, data were analysed from CHB mono‐infected subjects seen between 1 January 2012 and 31 December 2022, and entered the Canadian Hepatitis B Network Registry. Descriptive analysis and chi‐squared modelling were used to compare cohorts, followed by multivariable survival analysis regarding survival post‐diagnosis. Statistical analyses were completed in R version 2.2. Of the 6711 patients with CHB who met inclusion criteria, 232 (3.5%) developed HCC. Compared with the CHB cohort, the majority of CHB‐HCC cohort were male, SEA and HBeAg negative and born in endemic area (80% vs. 56%, 73% vs. 55%, 84% vs. 54%, 64% vs. 40% and all p < 0001). Overall, median HBV DNA level was log 2.54 (IQR: 0–4.04). Advanced liver disease, defined as minimum Fibrosis stage F3, was seen in 9.4% of overall cohort, but 92% of HCC cohort. At diagnosis, median tumour size was 2.5 cm (IQR: 1.7–4.0) and mean tumour number was 1.33 (SD: 1.33), with 81% of patients BCLC 0‐A. Fifty‐three per cent of patients were diagnosed with HCC as part of surveillance protocols. The survival rate after HCC diagnosis was 78.7%, during the median follow‐up of 52.9 months (IQR: 17–90). In multivariable analysis, survival was significantly correlated with diagnosis through the screening programme. In this large cohort of patients with CHB‐HCC, the majority of patients were detected with early‐stage HCC and received treatment with curative intent, resulting in strong survival rates. [ABSTRACT FROM AUTHOR]

Background: With evidence for large nocebo effects in pain, guidelines for nocebo‐minimizing strategies regarding side effect disclosure are emerging. While the ethical implications and effectiveness of such strategies have been the subject of investigations, the perspective of healthcare users are missing despite the stakes for patient autonomy. Methods: In an online survey, 2766 adults (≥18 years) from a general population sample in Europe and North America responded to questions related to nocebo familiarity, nocebo beliefs and attitudes towards side effect disclosure. Results: Only 474 (17%) were familiar with nocebo terminology, while 1379 (50%) were familiar with the concept of nocebo side effects. Belief in nocebo side effects was not well‐established; 738 (31%) agreed that side effect information could increase side effect occurrence. Nocebo belief was associated with more negative attitudes towards side effect disclosure and 1962 (73%) indicated that positive framing was an acceptable way of disclosing side effect information. In general, the majority of participants (65–76%) held positive attitudes towards the disclosure of all potential side effects and 2309 (84%) favoured patient autonomy over nonmaleficence. Although the general patterns were similar in the European and North American sample, the latter showed stronger nocebo belief and stronger positive attitudes towards side effect disclosure. Conclusions: The study found a consistent, moderate association between nocebo belief and attitudes towards nondisclosure, alongside positive attitudes towards the use of framing. Together with the discovered discrepancy between nocebo familiarity and nocebo belief, these findings have implications for the implementation of nocebo education and risk framing strategies. Significance Statement: This is the first large‐scale, general population‐based study to contribute to the scientific discussion about nocebo side effects from the perspective of healthcare users. The findings have implications for the discussion on how to handle the medical and ethical problem of nocebo side effects in clinical practice. [ABSTRACT FROM AUTHOR]

Background: People with intellectual disabilities commonly experience multiple barriers to 'going out'. Aims: This paper explores what barriers prevented people from going out, and if the extent and nature of going out changed over time for people with intellectual disabilities as the COVID‐19 pandemic progressed. Methods: Data are drawn from a wider study that explored, at four time points, the experiences of people with intellectual disabilities through the COVID‐19 pandemic in the United Kingdom. Findings: The number of people leaving the house for almost all reasons increased over time through the pandemic, except for some outdoor participation and exercise. However, there was a significant decrease in outdoor exercise at the final time point of the study. Reliance on other people and a lack of availability of support were identified as barriers. Conclusion: A combination of factors restricted the extent to which people were going out even after COVID‐19 protections were lifted. [ABSTRACT FROM AUTHOR]

Lyme borreliosis (LB), the most common tick‐borne disease in Europe, is endemic to southern coastal Norway. LB commonly presents as erythema migrans, which can disseminate, resulting in more severe disease such as Lyme neuroborreliosis or arthritis. In Norway, public health LB surveillance is conducted via mandatory reporting of laboratory‐confirmed disseminated cases. From 2012 to 2022, Norway's surveillance‐reported incidence of laboratory‐confirmed disseminated LB increased by 78%. Although surveillance provides estimates of the incidence of disseminated LB, this study sought to estimate the incidence of symptomatic LB to better understand Norway's LB disease burden. Two studies were identified that, when combined, estimated an LB seroprevalence of 6.8% in the general adult population in southern Norway. Utilizing data from these seroprevalence studies, public health surveillance, and results from literature searches indicating that 37% of seroconverted LB cases are symptomatic and that the duration of LB antibody detection ranges from 10 to 20 years, we estimated that there were 315–630 symptomatic LB cases per 100,000 adult population in five southern coastal counties in Norway in 2022 and 24–48 cases of symptomatic LB for every public health surveillance‐reported LB case in adults in these five counties in Norway. [ABSTRACT FROM AUTHOR]

Xylose is an abundant, inexpensive and readily available carbohydrate common in minimally processed feedstocks such as seaweed and algae. While a wide variety of marine microbes have evolved to utilize seaweed and algae, only a few currently have the requisite characteristics and genetic engineering tools necessary to entertain the use of these underutilized feedstocks. The rapidly growing Gram‐negative halophilic bacterium Vibrio natriegens is one such chassis. In this study, we engineered and tested xylose induction in V. natriegens as a tool for scalable bioproduction applications. First, we created a sensing construct based on the xylose operon from Escherichia coli MG1665 and measured its activity using a fluorescent reporter and identified that cellular import plays a key role in induction strength and that expression required the XylR transcription factor. Next, we identified that select deletions of the promoter region enhance gene expression, limiting the effect of carbohydrate repression when xylose is used as an inducer in the presence of industrially relevant carbon sources. Lastly, we used the optimized constructs to produce the biopolymer melanin using seawater mimetic media. One of these formulations utilized a nori‐based seaweed extract as an inducer and demonstrated melanin yields comparable to previously optimized methods using a more traditional and costly inducer. Together, the results demonstrate that engineering xylose induction in V. natriegens can provide an effective and lower cost option for timed biosynthesis in scalable biomanufacturing applications using renewable feedstocks. [ABSTRACT FROM AUTHOR]

Background: Post‐treatment surveillance recommendations for oropharyngeal cancer do not vary with p16 status despite the differences in outcomes. The optimal algorithm personalizing follow‐up for these patients remains undefined. Here, we evaluate the feasibility and utility of incorporating electronic patient‐reported outcomes (ePROs) and circulating tumor DNA (ctDNA) into routine surveillance for patients treated for p16+ oropharynx cancer. Methods: A prospective registry was developed in which ePROs and ctDNA were incorporated into routine surveillance among patients with oropharynx cancer. ePROs were emailed monthly for 1 year and blood HPV ctDNA testing was performed every 3–6 months. The primary objective was to assess patient compliance with ePRO‐based surveillance with adequate compliance defined as ≥85% of patients completing monthly ePROs. Sensitivity, specificity, and positive/negative predictive values to detect recurrence were calculated for ePROs, HPV ctDNA, or the combination. Results: Of 122 patients who initially expressed interest, 76 completed the electronic consent process and 44/76 (58%) were compliant with monthly surveys over 1 year; thus adequate compliance was not achieved. Technical difficulties associated with ePRO receipt through email largely limited participation. Provider feedback was significantly associated with heightened ePRO compliance. One hundred and six patients had ctDNA testing with a mean number of three tests per patient. Sensitivity to detect recurrence was 75% for the combination of ePROs and ctDNA. Conclusion: Despite lower than anticipated compliance with ePROs, our findings show promise for incorporation of HPV ctDNA into surveillance paradigms for HPV‐related oropharynx cancer with suggestions of methods to optimize ePRO formats for personalized surveillance. [ABSTRACT FROM AUTHOR]

We apply a machine learning approach to automatically infer two key attributes – the location of fault or shear zone structures and the thickness of the overburden – in an 18 km2 study area within and surrounding the Archean Fenelon gold deposit in Quebec, Canada. Our approach involves the inversion of carefully curated borehole lithological and structural observations truncated at 480 m below the surface, combined with magnetic and Light Detection and Ranging survey data. We take a computationally low‐cost approach in which no underlying model for geological consistency is imposed. We investigated three contrasting approaches: (1) an inferred fault model, in which the borehole observations represent a direct evaluation of the presence of fault or shear zones; (2) an inferred overburden model, using borehole observations on the overburden‐bedrock contact; (3) a model with three classes – overburden, faulted bedrock and unfaulted bedrock, which combines aspects of (1) and (2). In every case, we applied all 32 standard machine learning algorithms. We found that Bagged Trees, fine K‐nearest neighbours and weighted K‐nearest neighbour were the most successful, producing similar accuracy, sensitivity and specificity metrics. The Bagged Trees algorithm predicted fault locations with approximately 80% accuracy, 70% sensitivity and 73% specificity. Overburden thickness was predicted with 99% accuracy, 77% sensitivity and 93% specificity. Qualitatively, fault location predictions compared well to independently construct geological interpretations. Similar methods might be applicable in other areas with good borehole coverage, providing that criteria used in borehole logging are closely followed in devising classifications for the machine learning training set and might be usefully supplemented with a variety of geophysical survey data types. [ABSTRACT FROM AUTHOR]

Although next‐generation sequencing has enabled diagnoses for many patients with Mendelian disorders, the majority remain undiagnosed. Here, we present a sibling pair who were clinically diagnosed with Escobar syndrome, however targeted gene testing was negative. Exome sequencing (ES), and later genome sequencing (GS), revealed compound heterozygous TTN variants in both siblings, a maternally inherited frameshift variant [(NM_133378.4):c.36812del; p.(Asp12271Valfs*10)], and a paternally inherited missense variant [(NM_133378.4):c.12322G > A; p.(Asp4108Asn)]. This result was considered nondiagnostic due to poor clinical fit and limited pathogenicity evidence for the missense variant of uncertain significance (VUS). Following initial nondiagnostic RNA sequencing (RNAseq) on muscle and further pursuit of other variants detected on the ES/GS, a reanalysis of noncanonical splice sites in the muscle transcriptome identified an out‐of‐frame exon retraction in TTN, near the known VUS. Interim literature included reports of patients with similar TTN variants who had phenotypic concordance with the siblings, and a diagnosis of a congenital titinopathy was given 4 years after the TTN variants had been initially reported. This report highlights the value of reanalysis of RNAseq with a different approach, expands the phenotypic spectrum of congenital titinopathy and also illustrates how a perceived phenotypic mismatch, and failure to consider known variants, can result in a prolongation of the diagnostic journey. [ABSTRACT FROM AUTHOR]

Aims: In October 2023, the Tennessee Department of Health identified an outbreak of Shiga toxin‐producing Escherichia coli (STEC) O157:H7 infections among elementary school students who attended school field trips to the same farm animal exhibit. Our aim was to determine STEC source and prevent additional illnesses by initiating epidemiologic, laboratory and environmental investigations. Methods and Results: We identified cases using laboratory‐based surveillance and by surveying caregivers of children who attended the exhibit. Probable cases were defined as illness with abdominal cramps or diarrhoea after attendance; confirmed cases were laboratory‐confirmed STEC infection in an attendee or household contact. A site visit was conducted, and event organizers were interviewed. Human stool, animal faeces and environmental samples were tested for STEC O157:H7 by real‐time polymerase chain reaction (PCR), culture and whole‐genome sequencing (WGS). Approximately 2300 elementary school students attended the animal exhibit during 2 days. Field trip activities included contact with different farm animal species, drinking pasteurized milk outside animal enclosures and eating lunch in a separate building onsite. We received survey responses from 399 caregivers for 443 (19%) animal exhibit attendees. We identified 9 confirmed and 55 probable cases with illness onset dates during 26 September to 12 October. Seven children aged 1–7 years were hospitalized. Four children aged 1–6 years experienced haemolytic uraemic syndrome; none died. Laboratory testing identified STEC O157:H7 by culture from eight human stool samples with 0–1 allele difference by WGS. Three environmental samples had Shiga toxin (stx 2) genes detected by PCR, but no STEC isolates were recovered by culture. Conclusions: This is the largest reported STEC O157:H7 outbreak associated with an animal exhibit in Tennessee. We identified opportunities for educating school staff, event organizers and families about zoonotic disease risks associated with animal contact and published prevention measures. [ABSTRACT FROM AUTHOR]

Aims: We conducted a One Health investigation to assess the source and transmission dynamics of SARS‐CoV‐2 infection in African lions (Panthera leo) at Utah's Hogle Zoo in Salt Lake City from October 2021 to February 2022. Methods and Results: Following observation of respiratory illness in the lions, zoo staff collected pooled faecal samples and individual nasal swabs from four lions. All specimens tested positive for SARS‐CoV‐2 by reverse transcription‐polymerase chain reaction (RT‐PCR). The resulting investigation included: lion observation; RT‐PCR testing of lion faeces every 1–7 days; RT‐PCR testing of lion respiratory specimens every 2–3 weeks; staff interviews and RT‐PCR testing; whole‐genome sequencing of viruses from lions and staff; and comparison with existing SARS‐CoV‐2 human community surveillance sequences. In addition to all five lions, three staff displayed respiratory symptoms. All lions recovered and no hospitalizations or deaths were reported among staff. Three staff reported close contact with the lions in the 10 days before lion illness onset, one of whom developed symptoms and tested positive for SARS‐CoV‐2 on days 3 and 4, respectively, after lion illness onset. The other two did not report symptoms or test positive. Two staff who did not have close contact with the lions were symptomatic and tested positive on days 5 and 8, respectively, after lion illness onset. We detected SARS‐CoV‐2 RNA in lion faeces for 33 days and in lion respiratory specimens for 14 weeks after illness onset. The viruses from lions were genetically highly related to those from staff and two contemporaneous surveillance specimens from Salt Lake County; all were delta variants (AY.44). Conclusions: We did not determine the sources of these infections, although human‐to‐lion transmission likely occurred. The observed period of respiratory shedding was longer than in previously documented SARS‐CoV‐2 infections in large felids, indicating the need to further assess duration and potential implications of shedding. [ABSTRACT FROM AUTHOR]

Background: Cervical auscultation (CA) involves listening to swallowing and respiratory sounds and/or vibrations to detect oropharyngeal aspiration (OPA). CA has shown promising diagnostic test accuracy when used with the clinical swallowing examination and is gaining popularity in clinical practise. There has not been a review to date analysing the accuracy of CA in paediatric and adult populations with meta‐analyses. Objectives: To determine the accuracy of CA in detecting OPA in paediatric and adult populations, when compared to instrumental assessments. Search Methods: Databases searched included MEDLINE, PubMed, Embase, CINAHL, AustHealth, Cochrane and Web of Science. The search was restricted between 01 October 2012 and 01 October 2022. Selection Criteria: Inclusion criteria included (a) all clinical populations of all ages, (b) who have had an instrumental assessment and (c) CA. All study types were included. Data Collection and Analysis: Studies were reviewed independently by two authors. The methodological quality of the studies was analysed using the QUADAS‐2. Main Results: Ten studies met the inclusion criteria for this review and meta‐analyses. The pooled diagnostic performance of CA in detecting OPA was 0.91 for sensitivity and 0.79 for specificity. The area under the curve summary receiver operating curve (sROC) was estimated to be 0.86, thereby indicating good discrimination of OPA. Most studies scored high for risk of bias in at least one domain in the QUADAS‐2, likely attributed to a lack of high‐quality prospectively designed studies. Conclusions: There are promising diagnostic test accuracies for the use of CA in detection of OPA. Future research could include using CA in specific clinical populations and settings, and identifying standardised criteria for CA. [ABSTRACT FROM AUTHOR]

This research presents the findings of a petrographic analysis conducted on pre‐colonial Ceramics from Aruba, focusing on understanding ceramic mineral resources and production. The study compared ceramics from nine sites with a selection of clay sources from the island. Petrographic analysis identified the existence of three different mineralogical compositions. Two groups of undecorated vessels were likely manufactured using locally sourced clay materials. Group 1 ceramics show a connection with the weathering of quartz‐diorite intrusions in the northwest part of the island and suggest the exploitation of multiple, geographically close sources with similar compositions. Group 2 ceramics are related to clay sources found in the southeast of Aruba, with a mixed geological composition, including limestone, volcanic tuff and quartz‐diorite. In contrast, Group 3 ceramics are mostly decorated and belong to the Early Urumaco Period. They display a distinct composition characterized by a calcareous matrix with clay pellets, clay streaks and the presence of shell fragments added as temper. The extensive clay preparation practice leaves uncertainties concerning the origin of ceramics from Group 3. The study also highlights clay selection and use patterns, indicating that different clay sources were interchangeably utilized by communities across Aruba. [ABSTRACT FROM AUTHOR]

Students’ sense of school belonging is associated with healthier psychological functioning and improved academic outcomes. Currently, most research on school belonging has been conducted in the United States, United Kingdom, Australia, and New Zealand, resulting in school belonging practices and interventions largely biased towards Western school systems and cultures. This study sought to identify Indian students' perceptions of teacher‐level and school‐level factors that could contribute to a sense of school belonging. Open‐ended survey questions were used to qualitatively explore how teacher‐ and school‐level practices contributed to the school belonging of 93 Indian students aged 12–19. Data analysis followed manifest content analysis, identifying themes within teacher‐level and school‐level domains of enquiry. Results reveal valuable insights into factors influencing school belonging from the students’ perspective. These findings can inform the development of targeted interventions to support Indian students in rebuilding their sense of school belonging, improving their wellbeing, and enhancing their academic success. The research also contributes to a broader understanding of school belonging practices and their cultural sensitivity, benefiting educators, policymakers, and researchers worldwide. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Location Taxa Methods Results Main Conclusions The purported defining features of chimpanzee (Pan troglodytes) biogeography are sometimes simplistic and contradictory, yet we rely on these metrics to shape conservation and management planning for this endangered ape. We analysed the cover and configuration of woody vegetation at the northern margins of the species' range in Senegal to elucidate key predictors of chimpanzee biogeography.Southeastern Senegal.Western chimpanzee (Pan troglodytes verus).We combined reconnaissance surveys and interviews with published accounts of chimpanzee presence to verify previous estimates of the range limits of the species. High‐resolution, multispectral satellite images were used to quantify the configuration of trees and shrubs at each site. Woody vegetation cover and physiognomy, river density and road density were compared within and outside of the species range with generalised linear mixed models.Our surveys and interviews support the current estimates of the northern limits of the species range. Chimpanzee‐occupied sites had more patchily‐distributed vegetation, greater patch edge complexity, and slightly higher river density than unoccupied sites. Unoccupied sites had more woody vegetation cover and higher road density. Of all predictors, roads had the highest impact on chimpanzee occupancy.In line with previous findings, anthropogenic modifications of the landscape had a strong impact on chimpanzee occupancy, but surprisingly, woody vegetation cover was negatively associated with chimpanzee occupancy in this region. Instead, more specific metrics of vegetation configuration were positively associated with chimpanzee site occupancy, indicating that precise measures are needed for assessing chimpanzee biogeography at the landscape scale. [ABSTRACT FROM AUTHOR]

ABSTRACT Global progress in combatting climate change is being slowed by intergroup conflict and tribalism. Addressing the intergroup tensions of today is a pre‐requisite for avoiding violent intergroup tensions in the future, tensions that may threaten societal structures we currently take for granted. This paper highlights five sources of intergroup conflict that compromise humans’ ability to effectively and swiftly respond to climate change: political tribalism, populist suspicion of elites, regional differences within nations, international conflicts, and tensions between and within activist identities. We then draw on established and emerging social psychological theorising to describe five strategies for constructively managing this intergroup conflict: maintaining climate justice, reducing disinformation and silencing bad‐faith actors, maintaining cohesion among progressive forces, focusing on trusted messengers, and empathic communication. Throughout we underscore the extent to which policy making and strategic communication can play roles in depolarising debate about climate change. [ABSTRACT FROM AUTHOR]

Background Aims Materials and Methods Results Conclusions Women with substance use disorders (SUD) use less contraception, and experience higher rates of unintended pregnancy, compared to women without SUD. Contraception is discussed at the six‐week postnatal appointment, which many women with SUD do not attend. Therefore, it is important women have the opportunity to formulate contraception plans before discharge from the birth admission.To assess postpartum contraception plans, including initiation and method of interest, among women with SUD and compare these to women without SUD.All births from January 2011 to September 2019 from one New South Wales local health district were analysed. Data included maternal demographics, SUD, and contraception plans. Chi‐squared statistics and multivariate multinomial regression analyses were used to compare outcomes for women with and without SUD.Of 59 195 mothers, 429 (0.7%) had a SUD. There were 50.1% of women with SUD and 56.2% without SUD (P = 0.03) who had no documented plan for contraception. There were 37.3% of women with SUD and 42.4% without SUD (P = 0.06) who had a prescription for contraception or a referral to discuss contraception. There were 12.5% of women with SUD and 1.4% without SUD (P < 0.001) who initiated contraception in hospital.Although postpartum contraception initiation was higher among women with SUD, half of all women (with or without SUD) were discharged without a plan for contraception initiation. Embedding provision of postpartum contraception into maternity care, or investigating other opportunities, may improve access for all women, including those with SUD. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Global disparities in valvular surgery services exist. Cost‐effectiveness analysis (CEA) and cost‐utility analysis can be used to guide national investment decisions. This scoping review aims to synthesize economic evaluations for valvular surgery by income settings and provide recommendations.A systematic literature review identified primary CEAs or CUAs in English comparing surgical management strategies for valvular heart disease. MEDLINE, Embase, CINAHL, Web of Science, and Business Source Complete were searched using keywords “valvular surgery,” “valve disease,” “cost‐effectiveness,” and “cost‐benefit analysis”. Articles comparing outcomes or costs only were excluded. Search results were uploaded and screened on COVIDENCE. Variables from eligible articles were charted in a spreadsheet.Twenty articles were eligible, six from low‐ and middle‐income countries (LMICs) and 14 from high‐income countries (HICs). In HICs, the top conditions were degenerative aortic valve disease (7/14) and mitral valve disease (4/14) compared to congenital (2/6) and rheumatic heart diseases (2/6) in LMICs. HICs evaluated new technologies and techniques, whereas LMICs compared different valve types or surgery versus no intervention. Most articles used published studies (12/20) or databases (7/20) to conduct their CEA and quality‐adjusted life years was the most common effectiveness measure (12/20). Comparator interventions were cost‐effective in all LMIC articles and in 8/14 for HICs.Economic evaluations are mostly conducted in HICs and for adult conditions. More analyses in LMICs are needed. This can be facilitated by maintaining databases, documenting costs, and implementing quality of life assessments. [ABSTRACT FROM AUTHOR]

The six major bovine milk proteins are encoded by highly polymorphic chromosomes. Genetic variation has become a topic of interest and controversy in recent years due to supposed adverse health effects, beginning with the A2 variant of β‐casein. The functional implications of genetic variants have been well characterised, specifically heat stability and coagulation (i.e. rennet and acid) properties of milk, which have found that the B variant of β‐casein, κ‐casein and β‐lactoglobulin are the most beneficial. Genetic variants of milk proteins provide considerable potential to create new dairy products to add value to milk. [ABSTRACT FROM AUTHOR]

The study aimed to standardize the cryodehydration technique for bovine fetal hearts, focusing on optimizing protocols for each developmental stage to preserve morphological characteristics. We analyzed 29 bovine fetal hearts categorized into early, middle, and late developmental stages. These hearts underwent cryodehydration until a 60%–70% reduction in original fluid volume was achieved. Biometric data were recorded and statistically analyzed using Pearson correlation tests for age versus weight and age versus number of cryodehydration sessions. Morphometric comparisons before and after cryodehydration were performed using paired t‐tests. In Group I, hearts exhibited well‐defined structures, including the atrium cordis, ventriculus cordis, auricula atrii, aorta, truncus pulmonalis, and ramus coronaries arteria, which were preserved in Groups II and III. Additionally, in Group I the heart had a conical or flat apex cordis, whereas those in Groups II and III had a more pronounced apex. The average number of cryodehydration sessions required was 9.38 (±1.2) days for Group I, 12.37 (±1.4) days for Group II, and 15 days for Group III. A positive correlation was found between age and sample weight, indicating that more developed hearts were heavier. Similarly, there was a positive correlation between gestational age and the number of cryodehydration sessions, suggesting that more advanced stages required more cryodehydration sessions. Paired t‐tests demonstrated high statistical significance in the morphometric parameters before and after cryodehydration, indicating a loss of mass during dehydration. However, there was no alteration in the macroscopic structure of the hearts, which remained morphologically preserved. In conclusion, cryodehydration shows promise for preserving and analyzing the external morphological characteristics of bovine fetal cardiac development. It also provides lightweight, odorless, and easy‐to‐handle specimens ideal for detailed morphological studies and offers a unique perspective for investigating cardiac morphology in biological research contexts. [ABSTRACT FROM AUTHOR]

ABSTRACT Background/Objective Methods Results Conclusions The demand for pediatric dermatology services in the U.S. is high, especially at large academic healthcare centers. eConsultation programs provide a solution to poor in‐person access by offering diagnostic and management support to primary care providers (PCPs). To determine the real‐world utility of eConsultation in pediatric dermatology within a closed system at a major academic center, we assessed the outcomes, diagnostic and management concordance, and predictors of eConsult completion of an asynchronous provider‐to‐provider pediatric dermatology eConsult program.Retrospective cohort study of 900 consecutive outpatient pediatric dermatology eConsult referrals from PCPs at a tertiary academic center from 2017 to 2021.Of 900 eConsult referrals, 621 (69%) were completed without the need for in‐person dermatology follow‐up. 46 (5%) were completed but required follow‐up. 233 eConsult referrals (26%) were declined, primarily due to medical complexity. Thirty referrals (3%) were declined because of inadequate clinical photos. The PCP communicated eConsult recommendations to the patient/family on an average of 1.6 days (SD 3) after receiving the completed eConsult. eConsults for adolescents were less likely to be completed compared to infants (p = 0.03). Diagnostic and management concordance between PCP and dermatologist was 78% and 67%, respectively.Provider‐to‐provider eConsultation provides rapid speciality guidance to PCPs managing low‐complexity skin conditions in pediatric outpatients. The lower rate of management plan concordance compared to diagnostic concordance suggests that eConsultation improves outpatient skin management by PCPs. [ABSTRACT FROM AUTHOR]

Diabetes (DM) patients have an increased risk (~50%) for sudden cardiac death (SCD), mostly as a result of ventricular arrhythmias. The molecular mechanisms involved remain partially defined. The potent proinflammatory lipid mediator leukotriene (LT) B4, is pathologically elevated in DM compared to nondiabetic patients, resulting in increased LTB4 accumulation in heart, leading to an increased risk for life‐threatening proarrhythmic signatures. We used electrophysiology, immunofluorescence, and confocal microscopy approaches to evaluate LTB4 cellular effects in guinea pig heart and ventricular myocytes. We have observed that LTB4 is increased in multiple mouse models (C57BL/6 J/Lepob/ob and PANIC‐ATTAC) of DM, promotes profound cellular arrhythmogenesis (spontaneous beats and early after depolarizations, EADs), and severely depresses the rapidly activating delayed rectifier K current (hERG1/IKr) density in HEK293 cells and guinea pig ventricular myocytes. We have further found that guinea pigs challenged with LTB4 displayed a significantly prolonged QT interval, and that this can be prevented with LTB4R inhibition, suggesting that preventing such LTB4R effects may be therapeutically beneficial in DM. Our data suggests that a further elucidation of LTB4 vulnerable substrates, and how this leads to ventricular arrhythmias, is likely to lead to continued improvements in management options, and the development of new therapies for prevention of SCD in DM patients. [ABSTRACT FROM AUTHOR]

Insects have long played a role in forensic investigations and can be used to estimate minimum time since death, corpse translocation, and link an individual to a crime scene. Bed bugs (Cimex lectularius) are wingless ectoparasitic insects of potential forensic utility, given that all mobile life stages feed on vertebrate blood. Successful profiling of autosomal short tandem repeats (STRs) from human DNA isolated from bed bugs has been previously reported. This proof‐of‐concept study looked to expand this work and determine any possible limitations of using bed bugs for both rapid stain identification (RSID™) for human blood and Y‐STR profiling. To achieve this, bed bugs were fed either human male only or human pooled (female:male) blood for 30 min and subsequently collected at 12‐h intervals up to 108 h post‐blood meal (PBM). RSID™ blood testing was successful from the bed bug carcass remaining after DNA isolation, regardless of blood meal type and time of collection PBM. Complete Y‐STR profiles were generated from bed bugs <60 h PBM. As the time PBM increased, DNA quantity decreased, while the degradation index increased. Collection of bed bugs at a crime scene could provide a valuable source of human blood for Y STR profiling and be used to link an individual to a crime scene or for potential male suspect exclusion. Future studies should look to replicate the results of this proof‐of‐concept study with larger numbers of bed bugs, more diverse blood donors, and additional STR profiling kits. [ABSTRACT FROM AUTHOR]

Aims: Molecular classification according to The Cancer Genome Atlas (TCGA) improves endometrial endometrioid carcinoma (EEC) prognostication and has specific treatment implications; however, original data were skewed towards low‐grade and low‐stage tumours. Herein, we molecularly classify EECs metastatic at the time of diagnosis or with subsequently documented recurrent/metastatic disease to examine correlation with clinical outcomes. Methods: TCGA categories include POLE‐mutated, microsatellite instability (MSI), p53 abnormal (p53 abnl) and no specific molecular profile (NSMP). POLE targeted sequencing at exons 9, 11, 13 and 14 and immunohistochemistry (IHC) for PMS2, MSH6 and p53 were performed to establish molecular classification. Results: The distribution in our cohort of 141 EECs was similar to that generally reported in EEC, with nine POLE‐mutated (6%), 45 MSI (32%), 16 p53 abnl (11%) and 71 NSMP (50%), with similar distributions between low‐ and high‐stage cohorts. We demonstrate that when stratified by molecular subtype, disease‐specific survival from the time of high‐stage (stages III–IV) presentation or time of recurrence in low‐stage (stages I–II) disease among metastatic and/or recurrent EEC is strongly associated with TCGA classification (high‐stage P = 0.02, low‐stage P = 0.017). Discordant molecular classification between primary and metastatic/recurrent tumours occurred in four of 105 (3.8%) patients, two related to PMS2/MSH6 IHC and two related to p53 IHC. Conclusions: We demonstrate that molecular classification is prognostically relevant not only at the time of diagnosis, but also at the time of recurrence and in the metastatic setting. Rare subclonal alterations occur and suggest a role for confirming TCGA classification in recurrent/metastatic tumours. [ABSTRACT FROM AUTHOR]

Rationale: Stable isotope analysis of bone provides insight into animal foraging and allows for ecological reconstructions over time, however pre‐treatment is required to isolate collagen. Pre‐treatments typically consist of demineralization to remove inorganic components and/or lipid extraction to remove fats, but these protocols can differentially affect stable carbon (δ13C) and nitrogen (δ15N) isotope values depending on the chemicals, tissues, and/or species involved. Species‐specific methodologies create a standard for comparability across studies and enhance understanding of collagen isolation from modern cetacean bone. Methods: Elemental analyzers coupled to isotope ratio mass spectrometers were used to measure the δ13C and δ15N values of powdered killer whale (Orcinus orca) bone that was intact (control) or subjected to one of three experimental conditions: demineralized, lipid‐extracted, and both demineralized and lipid‐extracted. Additionally, C:N ratios were evaluated as a proxy for collagen purity. Lastly, correlations were examined between control C:N ratios vs. historical age and control C:N ratios vs. sample characteristics. Results: No significant differences in the δ15N values were observed for any of the experimental protocols. However, the δ13C values were significantly increased by all three experimental protocols: demineralization, lipid extraction, and both treatments combined. The most influential protocol was both demineralization and lipid extraction. Measures of the C:N ratios were also significantly lowered by demineralization and both treatments combined, indicating the material was closer to pure collagen after the treatments. Collagen purity as indicated via C:N ratio was not correlated with historical age nor sample characteristics. Conclusions: If only the δ15N values from killer whale bone are of interest for analysis, no pre‐treatment seems necessary. If the δ13C values are of interest, samples should be both demineralized and lipid‐extracted. As historical age and specimen characteristics are not correlated with sample contamination, all samples can be treated equally. [ABSTRACT FROM AUTHOR]