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Anthropogenic change is a global threat to wildlife and the biosphere's health. Wildlife faces growing threats from anthropogenic activities, especially infrastructure. Protected areas (PAs) are not exempt, particularly those that experience high traffic volumes on public road passages both within and on their peripheries. Globally, studies have found that public roads in PAs cause large numbers of wildlife-vehicle collisions (WVCs), threatening the stability of these wildlife refugia. As vehicle traffic density is increasing globally, particularly in Africa, where little research on the ecological impact of linear infrastructure has been done, the impact of roads on wildlife in protected areas must be determined. We determined the effect of public roads on vertebrate mortalities in the protected areas of Hluhluwe-iMfolozi Park (HiP) and iSimangaliso Wetland Park (ISWP), KwaZulu-Natal Province, South Africa, collected monthly in 2022 and 2023. Species composition of vertebrate mortalities, and heat maps of mortalities, combined with a suite of ecological factors, were used to identify drivers of wildlife-vehicle collisions. A total of 1606 road mortalities were recorded, with small-bodied vertebrates (< 5 kg) comprising most of the identified species. Amphibians experienced the highest number of mortalities, 1066 individuals, while birds had the highest species diversity in the mortality record with 31 identified species. High mortality levels were concentrated in areas with unsloped road surfaces and increased vehicle traffic within HiP, while the surrounding habitat had a larger influence on mortalities within ISWP. Our results showed that intervention is needed along portions of the two public roads in both protected areas, particularly during the wet season, with mortality rates as high as 13 carcasses per km. Mitigation measures should be implemented to reduce the number of wildlife mortalities along the roads in both locations, with specific measures to mitigate small vertebrate road mortalities. All planned mitigation measures should focus on the sections identified as high mortalities zones.

BackgroundPeripheral nerve injuries (PNIs) are associated with significant physical and psychological challenges, impacting both functional recovery and quality of life. Despite the physical focus of traditional treatments, psychological factors play a crucial role in the outcomes of PNI repair and recovery.ObjectivesThis systematic review aims to evaluate the impact of psychological and social factors on the repair and recovery of peripheral nerve injuries.MethodsA comprehensive literature search was conducted in PubMed/Medline, EMBASE, and Cochrane databases, covering studies from January 1985 to December 2022. A total of 36,190 records were identified, and after screening with Rayyan AI and applying inclusion criteria, 111 articles were selected for review.ResultsThe review highlights that pre-existing psychological conditions, as well as psychological responses to the injury and treatment, significantly influence recovery outcomes in PNI patients. Psychological interventions, when integrated into standard care, may improve functional recovery and quality of life.ConclusionsPsychosocial factors are critical in the management of PNIs and should be incorporated into treatment algorithms to enhance patient outcomes. Future research should focus on developing and integrating psychological support strategies in PNI treatment protocols.

Plastic bronchitis is a rare disease with serious morbidity. We report a case of a 48-year-old male smoker with a past medical history of diabetes, emphysema, recurrent respiratory infections, a worsening productive cough, and increased oxygen requirement over the past 3 months. Often described in the pediatric population, it is important to maintain plastic bronchitis in the differential when considering unresolving pulmonary conditions with chronic sputum production. Lipid infiltration on histology is diagnostic and often requires surgical biopsy for adequate tissue analysis. A lymphangiogram can be both confirmatory and therapeutic depending on the institutional availability of image-guided selective lymphatic embolization.

Introduction: Hypnosis-based apps geared toward smoking cessation are among the most downloaded by individuals wanting to reduce or stop smoking. However, to date, there are few evaluations regarding the use or efficacy of hypnosis apps for smoking cessation. Finito is an empirically-based mHealth app developed by Mindset Health designed to provide users with a three-week hypnotherapy program to quit smoking. This study aimed to examine demographic and clinical characteristics of Finito app users and conduct a preliminary analysis of survey data from participants of the program. Method: Finito app users were asked to voluntarily complete an online survey regarding their experience with the program, current smoking habits, app usability, relevant improvement, and demographic information. Retrospective data analyses were conducted to provide descriptive and inferential findings from the responses. Results: A total of 120 individuals responded to the survey. Respondents originated from over five different countries and approximately 72.5% reported completing the full Finito program. Approximately 58.3% of participants reported that they accomplished their goal with Finito with 50.8% of all respondents reporting that they quit smoking and an additional 25.8% reporting that their smoking was reduced. Among a variety of secondary outcomes, saving money was the most frequently reported secondary benefit with 46.7% of respondents endorsing that item. Conclusion: Our preliminary survey results suggest that Finito may be a useful, pleasant, and cost-effective tool in a patient’s journey to quit smoking. The majority of app users reported that they achieved their goal with Finito and completion of the program was associated with goal achievement. The Finito app may be effective in the dissemination and delivery of a helpful hypnotherapy intervention across a diverse population.

Summary: Histopathological heterogeneity in the human pancreas is well documented; however, functional evidence at the tissue level is scarce. Herein, we investigate in situ glucose-stimulated islet and carbachol-stimulated acinar cell secretion across the pancreas head (PH), body (PB), and tail (PT) regions in donors without diabetes (ND; n = 15), positive for one islet autoantibody (1AAb+; n = 7), and with type 1 diabetes (T1D;

Compared with notifiable disease surveillance, claims-based algorithms estimate higher Lyme disease incidence, but their accuracy is unknown. We applied a previously developed Lyme disease algorithm (diagnosis code plus antimicrobial drug prescription dispensing within 30 days) to an administrative claims database in Massachusetts, USA, to identify a Lyme disease cohort during July 2000–June 2019. Clinicians reviewed and adjudicated medical charts from a cohort subset by using national surveillance case definitions. We calculated positive predictive values (PPVs). We identified 12,229 Lyme disease episodes in the claims database and reviewed and adjudicated 128 medical charts. The algorithmʼs PPV for confirmed, probable, or suspected cases was 93.8% (95% CI 88.1%–97.3%); the PPV was 66.4% (95% CI 57.5%–74.5%) for confirmed and probable cases only. In a high incidence setting, a claims-based algorithm identified cases with a high PPV, suggesting it can be used to assess Lyme disease burden and supplement traditional surveillance data.

Climate change will affect all life. Sociologists contribute to major climate change reports and are interested in how people are engaging these documents. Major climate change reports coming from the Intergovernmental Panel on Climate Change and the National Climate Assessment are used by scientists, policy makers, and localities to assess climate vulnerability and create climate action plans. Although sociologists have been at the forefront of understanding climate change perception, there is limited understanding about how the public interacts with these reports or whether they are even aware of them. The author uses survey data ( n = 1,013) to assess public awareness of these reports. The results suggest that conservative think tanks may be doing a better job at marketing reports to advance their agendas. This is important information as scientists continue to think about how to reach the public to advance mitigation and adaptation efforts and counter climate denialism.

IntroductionExposure to trauma among U.S. military veterans occurs at a high rate, often resulting in continued difficulty with emotional adjustment and a diagnosis of posttraumatic stress disorder (PTSD). The present study provides data from 184 U.S. military veterans who completed a manualized posttraumatic-growth oriented training program during an integrative seven-day retreat.MethodsData was collected at baseline, after program completion, and at 18-month follow-up.ResultsResults on primary outcomes indicated significant increases, with medium to large effect sizes, in growth related outcomes. Specifically, there was a significant increase in scores by 54% on the posttraumatic growth outcome measure (PTGI-X) from baseline (M = 50.2, SD = 31.1) to endpoint (M = 77.4, SD = 29.6), t(183) = −8.78, p < 0.001. Also, results indicate that immediately following training (Day 7), participants reported a significant decrease of 49% on the PCL-5 from baseline (M = 39.7, SD = 17.6) to endpoint (M = 20.1, SD = 13.2), t(183) = 11.75, p < 0.001. Depression subscale scores decreased by 60% from baseline (M = 8.0, SD = 5.2) to endpoint (M = 3.2, SD = 3.0), t(183) = 10.68, p < 0.001; Anxiety scores decreased by 28% from baseline (M = 5.8, SD = 4.3) to endpoint (M = 4.2, SD = 3.5), t(183) = 4.08, p < 0.001; and Stress scores decreased by 50% from baseline (M = 10.0, SD = 4.4) to endpoint (M = 5.0, SD = 3.3), t(183) = 12.21, p < 0.001. Eighteen-month follow-up data was available for 74 participants and indicated that all significant changes in growth-related outcomes were maintained. Further, all significant changes in symptomatology-related outcomes were also maintained at follow-up.DiscussionThese findings demonstrate both the immediate and the long-lasting impact of an integrative posttraumatic growth-oriented training program on psychological growth and PTSD symptom reduction among U.S. military veterans.

IntroductionDocumented use and investigation of hypnosis spans centuries and its therapeutic use has received endorsement by multiple medical associations. We conducted a comprehensive overview of meta-analyses examining the efficacy of hypnosis to provide a foundational understanding of hypnosis in evidence-based healthcare, insight into the safety of hypnosis interventions, and identification of gaps in the current research literature.MethodsIn our systematic review, meta-analyses of randomized controlled trials on the efficacy of hypnosis in patients with mental or somatic health problems compared to any control condition published after the year 2000 were included. A comprehensive literature search using Medline, Scopus, PsycINFO, The Cochrane Library, HTA Database, Web of Science and a manual search was conducted to identify eligible reviews. Methodological quality of the included meta-analyses was rated using the AMSTAR 2 tool. Effect estimates on various outcomes including at least three comparisons (k ≥ 3) were extracted and transformed into a common effect size metric (Cohen’s d). If available, information on the certainty of evidence for these outcomes (GRADE assessment) was obtained.ResultsWe included 49 meta-analyses with 261 distinct primary studies. Most robust evidence was reported for hypnosis in patients undergoing medical procedures (12 reviews, 79 distinct primary studies) and in patients with pain (4 reviews, 65 primary studies). There was a considerable overlap of the primary studies across the meta-analyses. Only nine meta-analyses were rated to have high methodological quality. Reported effect sizes comparing hypnosis against control conditions ranged from d = −0.04 to d = 2.72. Of the reported effects, 25.4% were medium (d ≥ 0.5), and 28.8% were large (d ≥ 0.8).DiscussionOur findings underline the potential of hypnosis to positively impact various mental and somatic treatment outcomes, with the largest effects found in patients experiencing pain, patients undergoing medical procedures, and in populations of children/adolescents. Future research should focus on the investigation of moderators of efficacy, on comparing hypnosis to established interventions, on the efficacy of hypnosis for children and adolescents, and on identifying patients who do not benefit from hypnosis.Clinical Trial Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023395514, identifier CRD42023395514

Abstract Crustaceans, which are highly susceptible to the effects of climate change, are critical for food security worldwide. Yet, management rarely evaluates the performance of alternative regulatory strategies under climate‐driven life history change. This limits the development of climate‐ready management plans, undermining fisheries sustainability. We compared the performance of alternative minimum legal size (MLS) regulations under shifts in growth and maturity for American lobster in the Gulf of Maine, the most valuable single‐species commercial fishery in the United States. Across the life history change scenarios examined, increasing MLS improved status indicators, while decreasing MLS eroded status indicators for spawning stock biomass, legal abundance, landings, and exploitation rate. Our results demonstrate that protecting the lobster stock by increasing MLS improves fishery output, highlighting that conservation and industry goals can be complementary. This study exemplifies the utility of MLS as a conservation measure for crustacean fisheries under climate change.

Carpometacarpal (CMC) fracture-dislocations are uncommon hand injuries, with few studies available regarding their treatment. The current operative treatment options include fixation with K-wires, mini-screws, or plates, though there is no standardized approach because of varying injury patterns and complications associated with each device. The INnate™ threaded intramedullary nail is a relatively novel treatment option that has shown promise in metacarpal fracture fixation by facilitating faster mobilization and recovery with enhanced rotational stability and no compression to prevent fracture displacement and shortening. This study assesses the efficacy of the INnate™ nail for fixation of CMC fracture-dislocations of the second through fifth joints.Nine patients with fourteen CMC fracture-dislocations treated with the INnate™ nail at the University Medical Center between 2019 and 2021 were enrolled in the study. We evaluated postoperative outcomes in terms of pain, total active range of motion (TAM), and return to normal activities.Of the nine patients, seven returned for follow-up. The average time to radiographic union was 11.5 weeks. At final follow-up, no patient reported pain (n = 6). Four patients had 100% TAM, 1 had 95% TAM, and 1 had 25% TAM. The average percentage of normal activity resumed was 84.0% (n = 5). No significant complications were reported. One patient had a dorsal spanning plate; hence, we were unable to record outcomes measures regarding the CMC injury. An additional patient had diminished ROM of the injured hand, but his last follow-up was only 1 month postop.Our pilot data overall suggest that the INnate™ threaded intramedullary nail has the potential to improve treatment algorithms for CMC fracture-dislocations.

IntroductionVasomotor symptoms, or hot flashes, are among the most common complaints for menopausal and postmenopausal women. As an alternative to hormone replacement therapy, paroxetine mesylate became the only non-hormonal treatment approved by the U.S. Food and Drug Administration (FDA), despite limited evidence for its efficacy. More specifically, there is uncertainty around paroxetine's unique benefit and the magnitude of the placebo response in clinical trials of paroxetine.MethodsRelevant databases were searched to identify randomized clinical trials examining the efficacy of paroxetine to treat hot flashes. The primary outcomes of interest were hot flash frequency and hot flash severity scores. Data was extracted from the published results, and risk of bias assessments were conducted.ResultsSix randomized clinical trials that included a total of 1,486 women were coded and analyzed. The results demonstrated that 79% of the mean treatment response for hot flash frequency is accounted for by a placebo response, resulting in a mean true drug effect of 21% at most. Additionally, 68% of the mean treatment response for hot flash severity is accounted for by a placebo response, resulting in a maximum true drug effect of 32%.DiscussionThe results herein call into question the actual efficacy of the only FDA approved, non-hormonal treatment for hot flashes by demonstrating that a placebo response accounts for the majority of treatment responses for reductions in both hot flash frequency and severity. The findings provide evidence to reevaluate the use of paroxetine to treat postmenopausal hot flashes and emphasize the importance of considering effective, alternative treatments for vasomotor symptoms.

Peripheral inflammatory macrophages are found to modulate daytime locomotion of zebrafish via recruiting neutrophils into the brain.

Peripheral nerve injuries (PNIs) often present with variable symptoms, making them difficult to diagnose, treat, and monitor. When neurologic compromise is inadequately assessed, suboptimal treatment decisions can result in lasting functional deficits. There are many available tools for evaluating pain and functional status of peripheral nerves. However, the literature lacks a detailed, comprehensive view of the data comparing the clinical utility of these modalities, and there is no consensus on the optimal algorithm for sensory and pain assessment in PNIs. We performed a systematic review of the literature focused on clinical data, evaluating pain and sensory assessment methods in peripheral nerves. We searched through multiple databases, including PubMed/Medline, Embase, and Google Scholar, to identify studies that assessed assessment tools and explored their advantages and disadvantages. A total of 66 studies were selected that assessed various tools used to assess patient's pain and sensory recovery after a PNI. This review may serve as a guide to select the most appropriate assessment tools for monitoring nerve pain and/or sensory function both pre- and postoperatively. As the surgeons work to improve treatments for PNI and dysfunction, identifying the most appropriate existing measures of success and future directions for improved algorithms could lead to improved patient outcomes.

All-sky maps of the thermal Sunyaev–Zel’dovich effect (SZ) tend to suffer from systematic features arising from the component-separation techniques used to extract the signal. In this work, we investigate one of these methods, known as needlet internal linear combination (NILC), and test its performance on simulated data. We show that NILC estimates are strongly affected by the choice of the spatial localization parameter (Γ), which controls a bias-variance trade-off. Typically, NILC extractions assume a fixed value of Γ over the entire sky, but we show there exists an optimal Γ that depends on the SZ signal strength and local contamination properties. Then we calculate the NILC solutions for multiple values of Γ and feed the results into a neural network to predict the SZ signal. This extraction method, which we call Deep-NILC, is tested against a set of validation data, including recovered radial profiles of resolved systems. Our main result is that Deep-NILC offers significant improvements over choosing fixed values of Γ.

Background:. Revision nerve decompression remains a challenge for surgeons. Avive Soft Tissue Membrane is processed human umbilical cord membrane that may reduce inflammation and scarring, thereby improving tissue gliding. Although synthetic conduits have been reported in revision nerve decompression, the use of Avive has not. Methods:. Prospective study of revision nerve decompression with Avive application. VAS pain, two-point discrimination, Semmes-Weinstein, pinch and grip strength, range of motion, Quick Disability of Arm, Shoulder & Hand (QuickDASH), and satisfaction were recorded. Using a propensity-matched cohort, VAS pain and satisfaction were retrospectively collected to compare with cohort outcomes. Results:. In the Avive cohort, 77 patients (97 nerves) were included. Mean follow-up was 9.0 months. Avive was applied to the median nerve in 47.4%, ulnar nerve in 39.2%, and radial nerve in 13.4%. VAS pain was 4.5 preoperatively and 1.3 postoperatively. S4 sensory recovery was achieved in 58% of patients, S3+ in 33%, S3 in 7%, S0 in 2%, and improvement from baseline in 87%. Strength improved in 92%. Mean total active motion was 94.8%. Mean QuickDASH score was 36.1, and 96% reported improved or resolved symptoms. Preoperative pain was not significantly different between Avive cohort and controls (P = 0.618). Postoperative pain was significantly lower in cohort patients (1.3 ± 2.2 versus 2.7 ± 3.0, P = 0.001). In the Avive cohort, more had improved or resolved symptoms (P < 0.0001). Clinically important improvement in pain was reported in 64.9% of Avive group patients versus 40.8% of controls (P = 0.002). Conclusion:. Avive contributes to improved outcomes in revision nerve decompression.

Background Peripheral nerve function is often difficult to assess given the highly variable presentation and subjective patient experience of nerve injury. If nerve assessment is incomplete or inaccurate, inappropriate diagnosis and subsequent treatment may result in permanent dysfunction. Objective As our understanding of nerve repair and generation evolves, so have tools for evaluating peripheral nerve function, recovery, and nerve-related impact on the quality of life. Provocative testing is often used in the clinic to identify peripheral nerve dysfunction. Patient-reported outcome forms provide insights regarding the effect of nerve dysfunction on daily activities and quality of life. Methods We performed a review of the literature using a comprehensive combination of keywords and search algorithms to determine the clinical utility of different provocative tests and patient-reported outcomes measures in a variety of contexts, both pre- and postoperatively. Results This review may serve as a valuable resource for surgeons determining the appropriate provocative testing tools and patient-reported outcomes forms to monitor nerve function both pre- and postoperatively. Conclusion As treatments for peripheral nerve injury and dysfunction continue to improve, identifying the most appropriate measures of success may ultimately lead to improved patient outcomes.

BackgroundClear health disparities have emerged in the rates of COVID-19 exposure, hospitalization, and death among Black, Hispanic, and American Indian (BHAI) individuals, relative to non-Hispanic White (NHW) individuals. BHAI populations have been disproportionately affected by lower behavioral health access and heightened negative mental health outcomes during the pandemic. ObjectiveThis project directly addresses health disparities in access to behavioral health care during the COVID-19 pandemic among BHAI populations via an adaptation of the established, initially validated, low-cost, mobile app Easing Anxiety Sensitivity for Everyone (EASE) among individuals with symptoms of elevated anxiety or depression or both. MethodsThe EASE trial is a 2-arm, prospective, randomized, blinded-assessor study with intention-to-treat analysis. Participants (N=800; n=200, 25%, Black; n=200, 25%, Hispanic; n=200, 25%, American Indian; and n=200, 25%, NHW) are randomized to receive either EASE or an active comparison condition for anxiety and depression. Participants compete an online prescreener, an enrollment call to provide informed consent, a baseline survey, a 6-month intervention period, and 3- and 6-month postbaseline assessments. Select participants also complete a 3- and 6-month postbaseline qualitative interview via phone or an online platform (eg, Zoom). Participants complete 2 scheduled daily ecological momentary assessments (EMAs) during the 6-month study period. These twice-daily EMAs guide a just-in-time approach to immediate, personalized behavioral health care. ResultsOutcomes include reductions in anxiety and depressive symptoms and functional impairment at 3 and 6 months postrandomization. We also will examine putative mechanisms (eg, anxiety sensitivity [AS] and COVID-19–specific stress and fear) of the intervention effects. Further, as treatment effects may differ across sociocultural factors, perceived discrimination, social support, and socioeconomic status (SES) will be evaluated as potential moderators of treatment effects on the primary outcomes. Process evaluation using data collected during the study, as well as individual interviews with participants, will complement quantitative data. ConclusionsData from this efficacy trial will determine whether EASE successfully improves symptoms of anxiety and depression and whether these improvements outperform an active comparison control app. If successful, findings from this study have the potential to decrease anxiety and depression symptoms among vulnerable populations determined to be most at risk of exacerbated, long-lasting negative health sequelae. Data from this study may be used to support an implementation and dissemination trial of EASE within real-world behavioral health and social service settings. Trial RegistrationClinicalTrials.gov NCT05074693; https://clinicaltrials.gov/ct2/show/NCT05074693 International Registered Report Identifier (IRRID)DERR1-10.2196/40713

Human–coyote sightings and interactions are becoming more frequent in urban areas across North and Central America. While many species have lost territory, the coyote range has expanded. Relatively recently, ecologists have coalesced around the idea that coexistence is the most promising avenue to reduce human–coyote conflict in urban areas. Despite this, calls for the eradication of coyotes continue. We apply and extend the theory of survival of the friendliest to evaluate how the media is framing coyotes and management strategies and what the implications of this framing might be. Through a content analysis of newspaper articles from three different urban areas in the US (Los Angeles, CA; Seattle, WA; and Boston, MA), from 2000 to 2022, we find that friendly language is used to promote coexistence, while unfriendly language (threat, hostile, unfriendly, and danger) is used to justify eradication. We also find considerable variation in the type of coverage and consistency with scientific consensus across cities, likely reflecting the cities’ varied histories and cultural understandings of the species. Given the media’s influence on the public’s views of coyotes and their support for management strategies, these findings suggest that the media plays a central role in shaping coyote–human relationships and management strategies.

Abstract Background More than 52,000 casualties have been documented in post-9/11 conflicts. Service members with extremity injuries (EIs) or traumatic brain injury (TBI) may be at particular risk for long-term deficits in mental and physical health functioning compared with service members with other injuries. Methods The present study combined medical records with patient reports of mental health and health-related quality of life (HRQOL) for 2,537 service members injured in overseas contingency operations who participated in the Wounded Warrior Recovery Project. Combined parallel-serial mediation models were tested to examine the pathways through which injury is related to mental and physical health conditions, and long-term HRQOL. Results Results revealed that injury was indirectly related to long-term HRQOL via its associations with physical health complications and mental health symptoms. Relative to TBI, EI was associated with a higher likelihood for a postinjury diagnosis for a musculoskeletal condition, which were related to lower levels of later posttraumatic stress disorder (PTSD) symptoms, and higher levels of physical and mental HRQOL. Similarly, EI was related to a lower likelihood for a postinjury PTSD diagnosis, and lower levels of subsequent PTSD symptoms, and therefore higher physical and mental HRQOL relative to those with TBI. Despite this, the prevalence of probable PTSD among those with EI was high (35%). Implications for intervention, rehabilitation, and future research are discussed.

Abstract Elasmobranchs (sharks, skates and rays) are of broad ecological, economic, and societal value. These globally important fishes are experiencing sharp population declines as a result of human activity in the oceans. Research to understand elasmobranch ecology and conservation is critical and has now begun to explore the role of body-associated microbiomes in shaping elasmobranch health. Here, we review the burgeoning efforts to understand elasmobranch microbiomes, highlighting microbiome variation among gastrointestinal, oral, skin, and blood-associated niches. We identify major bacterial lineages in the microbiome, challenges to the field, key unanswered questions, and avenues for future work. We argue for prioritizing research to determine how microbiomes interact mechanistically with the unique physiology of elasmobranchs, potentially identifying roles in host immunity, disease, nutrition, and waste processing. Understanding elasmobranch–microbiome interactions is critical for predicting how sharks and rays respond to a changing ocean and for managing healthy populations in managed care.

Background: Direct-to-consumer devices allow patients to record electrocardiograms (ECG) and detect atrial fibrillation (AF). Clinical adoption of these devices has been limited owing to the lack of efficient workflow. Objective: To assess a new care model for following patients after AF ablation that uses a smartphone ECG coupled with a novel cloud-based platform. Methods: This was a pilot study to describe AF detection, healthcare utilization, use of additional ECGs and cardiac monitors, and changes in anxiety after AF ablation. Patients presenting 3–4 months after early successful AF ablation were randomized into a control group with standard clinical follow-up or a self-monitoring group using smartphone ECG (Kardia Mobile, KM) coupled with a cloud-based platform (KardiaPro, KP) that alerted the physician when AF was detected and followed for 6 months Results: A total of 100 patients were randomized: 51 to the KM/KP group and 48 to the control group (1 withdrew). AF was detected in 18 patients (18.2%), 11 (21.6%) in the KM/KP group and 7 (14.6%) in the control group (P = .42). AF detection occurred at a median of 68 and 91 days in the KM/KP and control groups, respectively (P = .93). These differences were not statistically significant. Healthcare utilization and changes in anxiety were similar between the groups. More patients required additional ECGs or cardiac monitors in the control group (27.1%) compared to the KM/KP group (5.9%) (P = .004). Conclusions: Smartphone ECG with a cloud-based platform can be incorporated into the care of post–AF ablation patients without increasing anxiety and with less need for additional traditional monitors.

China contributes the largest catches to global marine wild-capture fisheries. The majority of them are harvested from China Seas which are highly productive, but are facing heavy fisheries exploitation. The status of exploited fisheries stocks in China Seas have remained largely unknown due to severe data-limited conditions, which hindered their sustainable use and effective management. Although the off-the-shelf use of catch-only methods (COMs) has been cautioned because of their poor estimation performance, such methods have been increasingly applied to infer the status of exploited stocks in China Seas without performance evaluation. In this study, we established an empirical approach to evaluate the performance of a suite of COMs in predicting stock biomass status for the data-limited fisheries in the East China Sea (ECS) from data-rich stocks with similar characteristics in the RAM Legacy Stock Assessment Database (RLSADB). The results confirmed that ensemble approaches performed better than the individual COMs in estimating the mean of stock biomass status for data-rich stocks selected from RLSADB. By contrast, mechanistic COMs demonstrated more accurate estimates when predicting the trend of stock biomass status. The stock status of commercial fisheries in ECS estimated by three mechanistic COMs (Catch-MSY, CMSY, and OCOM) was likely too optimistic for most species. We suggest that China establish its national database and develop and implement regular monitoring programs to satisfy formal statistical stock assessment for its coastal fisheries.

The world’s largest extant fish, the whale shark Rhincodon typus, is one of the most-studied species of sharks globally. The discovery of predictable aggregation sites where these animals gather seasonally or are sighted year-round – most of which are coastal and juvenile-dominated – has allowed for a rapid expansion of research on this species. The most common method for studying whale sharks at these sites is photographic identification (photo-ID). This technique allows for long-term individual-based data to be collected which can, in turn, be used to evaluate population structure, build population models, identify long-distance movements, and assess philopatry and other population dynamics. Lagged identification rate (LIR) models have fewer underlying assumptions than more traditional capture mark recapture approaches, making them more broadly applicable to marine taxa, especially far-ranging megafauna species like whale sharks. However, the increased flexibility comes at a cost. Parameter estimations based on LIR can be difficult to interpret and may not be comparable between areas with different sampling regimes. Using a unique data-set from the Philippines with ~8 years of nearly continuous survey effort, we were able to derive a metric for converting LIR residency estimates into more intuitive days-per-year units. We applied this metric to 25 different sites allowing for the first quantitatively-meaningful comparison of sightings-derived residence among the world’s whale shark aggregations. We validated these results against the only three published acoustic residence metrics (falling within the ranges established by these earlier works in all cases). The results were then used to understand residency behaviours exhibited by the sharks at each site. The adjusted residency metric is an improvement to LIR-based population modelling, already one of the most widely used tools for describing whale shark aggregations. The standardised methods presented here can serve as a valuable tool for assessing residency patterns of whale sharks, which is crucial for tailored conservation action, and can cautiously be tested in other taxa.

Abstract Background Blast injury emerged as a primary source of morbidity among US military personnel during the recent conflicts in Iraq and Afghanistan, and led to an array of adverse health outcomes. Multimorbidity, or the presence of two or more medical conditions in an individual, can complicate treatment strategies. To date, there is minimal research on the impact of multimorbidity on long-term patient-reported outcomes. We aimed to define multimorbidity patterns in a population of blast-injured military personnel, and to examine these patterns in relation to long-term quality of life (QOL). Methods A total of 1972 US military personnel who sustained a blast-related injury during military operations in Iraq and Afghanistan were identified from clinical records. Electronic health databases were used to identify medical diagnoses within the first year postinjury, and QOL was measured with a web-based assessment. Hierarchical cluster analysis methods using Ward’s minimum variance were employed to identify clusters with related medical diagnosis categories. Duncan’s multiple range test was used to group clusters into domains by QOL. Results Five distinct clusters were identified and grouped into three QOL domains. The lowest QOL domain contained one cluster with a clinical triad reflecting musculoskeletal pain, concussion, and mental health morbidity. The middle QOL domain had two clusters, one with concussion/anxiety predominating and the other with polytrauma. The highest QOL domain had two clusters with little multimorbidity aside from musculoskeletal pain. Conclusions The present study described blast-related injury profiles with varying QOL levels that may indicate the need for integrated health services. Implications exist for current multidisciplinary care of wounded active duty and veteran service members, and future research should determine whether multimorbidity denotes distinct post-blast injury syndromes.

Use of race adjustment in estimating glomerular filtration rate (eGFR) has been challenged given concerns that it may negatively impact the clinical care of Black patients, as it results in Black patients being systematically assigned higher eGFR values than non-Black patients. We conducted a systematic review to assess how well eGFR, with and without race adjustment, estimates measured GFR (mGFR) in Black adults globally. A search across multiple databases for articles published from 1999 to May 2021 that compared eGFR to mGFR and reported outcomes by Black race was performed. We included studies that assessed eGFR using the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPICr) creatinine equations. Risk of study bias and applicability were assessed with the QUality Assessment of Diagnostic Accuracy Studies-2. Of 13,167 citations identified, 12 met the data synthesis criteria (unique patient cohorts in which eGFR was compared to mGFR with and without race adjustment). The studies included patients with and without kidney disease from Africa (n = 6), the United States (n = 3), Europe (n = 2), and Brazil (n = 1). Of 11 CKD-EPI equation studies, all assessed bias, 8 assessed accuracy, 6 assessed precision, and 5 assessed correlation/concordance. Of 7 MDRD equation studies, all assessed bias, 6 assessed accuracy, 5 assessed precision, and 3 assessed correlation/concordance. The majority of studies found that removal of race adjustment improved bias, accuracy, and precision of eGFR equations for Black adults. Risk of study bias was often unclear, but applicability concerns were low. Our systematic review supports the need for future studies to be conducted in diverse populations to assess the possibility of alternative approaches for estimating GFR. This study additionally provides systematic-level evidence for the American Society of Nephrology—National Kidney Foundation Task Force efforts to pursue other options for GFR estimation.

Introduction The extracellular matrix (ECM) plays an integral role in wound healing. It provides both structure and growth factors that allow for the organised cell proliferation. Large or complex tissue defects may compromise host ECM, creating an environment that is unfavourable for the recovery of anatomical function and appearance. Acellular dermal matrices (ADMs) have been developed from a variety of sources, including human (HADM), porcine (PADM) and bovine (BADM), with multiple different processing protocols. The objective of this report is to provide an overview of current literature assessing the clinical utility of ADMs across a broad spectrum of applications. Methods PubMed, MEDLINE, EMBASE, Scopus, Cochrane and Web of Science were searched using keywords ‘acellular dermal matrix’, ‘acellular dermal matrices’ and brand names for commercially available ADMs. Our search was limited to English language articles published from 1999 to 2020 and focused on clinical data. Results A total of 2443 records underwent screening. After removing non-clinical studies and correspondence, 222 were assessed for eligibility. Of these, 170 were included in our synthesis of the literature. While the earliest ADMs were used in severe burn injuries, usage has expanded to a number of surgical subspecialties and procedures, including orthopaedic surgery (e.g. tendon and ligament reconstructions), otolaryngology, oral surgery (e.g. treating gingival recession), abdominal wall surgery (e.g. hernia repair), plastic surgery (e.g. breast reconstruction and penile augmentation), and chronic wounds (e.g. diabetic ulcers). Conclusion Our understanding of ADM’s clinical utility continues to evolve. More research is needed to determine which ADM has the best outcomes for each clinical scenario. Lay Summary Large or complex wounds present unique reconstructive and healing challenges. In normal healing, the extracellular matrix (ECM) provides both structural and growth factors that allow tissue to regenerate in an organised fashion to close the wound. In difficult or large soft-tissue defects, however, the ECM is often compromised. Acellular dermal matrix (ADM) products have been developed to mimic the benefits of host ECM, allowing for improved outcomes in a variety of clinical scenarios. This review summarises the current clinical evidence regarding commercially available ADMs in a wide variety of clinical contexts.

Introduction: When the metacarpal bones sustain severe osseous injury requiring reconstruction, functional recovery relies on the precise distribution of tension throughout full range of motion. While the small scale of hand structures compounds the effects of altering normal anatomy, literature lacks consensus recommendations for the acceptable degree of length alteration and/or appropriate methods of length estimation in reconstructive procedures. Length asymmetry has been reported in human metacarpal bones; however, studies assessing this phenomenon in living subjects with attention to functional implications or length prediction are lacking. Methods: Hand X-rays were obtained for 34 patients aged 25–80 without history of metacarpal trauma, joint degeneration, or pathologic bone metabolism. A scaled bivariate model predicted metacarpal length using an ipsilateral paired metacarpal and matching contralateral ratio: Estimate_Dx_R = Median_Dy_R * (Median_Dx_L/Median_Dy_L). A second set of predictions used the contralateral metacarpal as a control. Pearson correlation coefficients, paired t -tests, and chi-square tests evaluated the symmetry between bilateral metacarpal lengths and paired metacarpal ratios as well as the accuracy of each predictive method. Results: The contralateral control and target metacarpal differed significantly in digits 1, 2, 3, and 5. No significant difference in matched metacarpal ratios of the right and left hands was found. For all digits except 5D, bivariate model predictions generated were more strongly correlated with actual target length. Chi-square tests did not detect a significant difference in predictive value of the two models. Conclusion: The scaled bivariate model we describe may be useful and economic in generating accurate length estimates of metacarpals for reconstructive procedures.

Flare frequency distributions represent a key approach to addressing one of the largest problems in solar and stellar physics: determining the mechanism that counterintuitively heats coronae to temperatures that are orders of magnitude hotter than the corresponding photospheres. It is widely accepted that the magnetic field is responsible for the heating, but there are two competing mechanisms that could explain it: nanoflares or Alfvén waves. To date, neither can be directly observed. Nanoflares are, by definition, extremely small, but their aggregate energy release could represent a substantial heating mechanism, presuming they are sufficiently abundant. One way to test this presumption is via the flare frequency distribution, which describes how often flares of various energies occur. If the slope of the power law fitting the flare frequency distribution is above a critical threshold, α = 2 as established in prior literature, then there should be a sufficient abundance of nanoflares to explain coronal heating. We performed >600 case studies of solar flares, made possible by an unprecedented number of data analysts via three semesters of an undergraduate physics laboratory course. This allowed us to include two crucial, but nontrivial, analysis methods: preflare baseline subtraction and computation of the flare energy, which requires determining flare start and stop times. We aggregated the results of these analyses into a statistical study to determine that α = 1.63 ± 0.03. This is below the critical threshold, suggesting that Alfvén waves are an important driver of coronal heating.

Sociology plays a key role in empathy development, which is central to addressing complex social problems. However, little is known about what types of courses work best to enhance empathy. In parallel, sociological animal studies (SAS) has evolved as a relatively new subfield focused on assessing human and animal relationships. SAS research suggests that our interactions with animals enhance empathy development. Combining these literatures, we assess if SAS compared to non-SAS courses impact affective and cognitive empathy for humans and animals differently. Findings reveal that students who take SAS courses demonstrate greater postcourse human and animal empathy even when controlling for precourse levels of empathy and other factors that drive empathy development. Although SAS remains on the periphery of the discipline, this study suggests that it should be a central component of the sociological curriculum.

Recent fMRI research shows that perceptual and cognitive representations are instantiated in high-dimensional multivoxel patterns in the brain. However, the methods for detecting these representations are limited. Topological data analysis (TDA) is a new approach, based on the mathematical field of topology, that can detect unique types of geometric features in patterns of data. Several recent studies have successfully applied TDA to study various forms of neural data; however, to our knowledge, TDA has not been successfully applied to data from event-related fMRI designs. Event-related fMRI is very common but limited in terms of the number of events that can be run within a practical time frame and the effect size that can be expected. Here, we investigate whether persistent homology—a popular TDA tool that identifies topological features in data and quantifies their robustness—can identify known signals given these constraints. We use fmrisim, a Python-based simulator of realistic fMRI data, to assess the plausibility of recovering a simple topological representation under a variety of conditions. Our results suggest that persistent homology can be used under certain circumstances to recover topological structure embedded in realistic fMRI data simulations. How do we represent the world? In cognitive neuroscience it is typical to think representations are points in high-dimensional space. In order to study these kinds of spaces it is necessary to have tools that capture the organization of high-dimensional data. Topological data analysis (TDA) holds promise for detecting unique types of geometric features in patterns of data. Although potentially useful, TDA has not been applied to event-related fMRI data. Here we utilized a popular tool from TDA, persistent homology, to recover topological signals from event-related fMRI data. We simulated realistic fMRI data and explored the parameters under which persistent homology can successfully extract signal. We also provided extensive code and recommendations for how to make the most out of TDA for fMRI analysis.

Abstract Background Harmful gambling is a complex issue with diverse antecedents and resulting harms that have been studied from multiple disciplinary perspectives. Although previous bibliometric reviews of gambling studies have found a dominance of judgement and decision-making research, no bibliometric review has examined the concept of “harm” in the gambling literature, and little work has quantitatively assessed how gambling research priorities differ between countries. Methods Guided by the Conceptual Framework of Harmful Gambling (CFHG), an internationally relevant framework of antecedents to harmful gambling, we conducted a bibliometric analysis focusing on research outputs from three countries with different gambling regulatory environments: Canada, Australia, and New Zealand. Using a Web of Science database search, 1424 articles published from 2008 to 2017 were retrieved that could be mapped to the eight CFHG factors. A subsample of articles (n = 171) containing the word “harm” in the title, abstract, or keywords was then drawn. Descriptive statistics were used to examine differences between countries and trends over time with regard to CFHG factor and harm focus. Results Psychological and biological factors dominate gambling research in Canada whereas resources and treatment have received more attention in New Zealand. A greater percentage of Australia and New Zealand publications address the gambling environment and exposure to gambling than in Canada. The subset of articles focused on harm showed a stronger harms focus among New Zealand and Australian researchers compared to Canadian-authored publications. Conclusions The findings provide preliminary bibliometric evidence that gambling research foci may be shaped by jurisdictional regulation of gambling. Countries with privately operated gambling focused on harm factors that are the operators’ responsibility, whereas jurisdictions with a public health model focused on treatment and harm reduction resources. In the absence of a legislated requirement for public health or harm minimisation focus, researchers in jurisdictions with government-operated gambling tend to focus research on factors that are the individual’s responsibility and less on the harms they experience. Given increased international attention to gambling-related harm, regulatory and research environments could promote and support more diverse research in this area.

Abstract Few multifocal hand chondrosarcomas have been reported. To our knowledge, this report is the first to describe multifocal hand chondrosarcoma in a patient with no evidence of prior enchondroma, Ollier's disease, or Maffucci syndrome.

Background: Treatment of patients with traumatic axonotmesis presents challenges. Processed human umbilical cord membrane has been recently developed with improved handling and resorption time compared to other amniotic membrane wraps, and may be beneficial in nerve reconstruction. This study evaluates postoperative outcomes after traumatic peripheral nerve injury after placement of commercially available processed human umbilical cord membrane. Methods: We performed a prospective, single-center pilot study of patients undergoing multi-level surgical reconstruction for exposed, non-transected peripheral nerve. Functional outcomes including pain, range of motion, pinch and grip strength, and the QuickDASH and SF-36 patient-reported outcome measures were recorded, when possible, at the 1-week and 3, 6, and 9 months postop visit. One-tailed paired t -tests were performed to evaluate outcome improvement at final follow-up. Results: Twenty patients had processed human umbilical cord membrane placement without surgical complications. Mean follow-up was 7.5 months (range: 3–10 months) and mean age was 39 years (range: 15–65). Twelve (67%) patients were male, and the majority of placement sites were in the upper extremity (85%). Mean preoperative visual analog scale pain score was significantly reduced at most recent follow-up, as were QuickDASH scores. All patients had improved functional outcomes at the 9-month follow-up, and SF-36 outcomes at 9 months showed improvement across all dimensions. Conclusion: This study indicates that processed human umbilical cord membrane may be a useful adjunct in nerve surgery with noted improvements in postoperative function, pain, and patient-reported outcome measures. Future studies are needed to assess long-term outcomes after traumatic nerve injury treated with processed human umbilical cord membrane.

Otitis media (OM) is the most common paediatric disease and leads to significant morbidity. Although understanding of underlying disease mechanisms is hampered by complex pathophysiology, it is clear that epithelial abnormalities underpin the disease. The mechanisms underpinning epithelial remodelling in OM remain unclear. We recently described a novel in vitro model of mouse middle ear epithelial cells (mMEECs) that undergoes mucociliary differentiation into the varied epithelial cell populations seen in the middle ear cavity. We now describe genome wide gene expression profiles of mMEECs as they undergo differentiation. We compared the gene expression profiles of original (uncultured) middle ear cells, confluent cultures of undifferentiated cells and cells that had been differentiated for 7 days at an air liquid interface (ALI). >5000 genes were differentially expressed among the three groups of cells. Approximately 4000 genes were differentially expressed between the original cells and day 0 of ALI culture. The original cell population was shown to contain a mix of cell types, including contaminating inflammatory cells that were lost on culture. Approximately 500 genes were upregulated during ALI induced differentiation. These included some secretory genes and some enzymes but most were associated with the process of ciliogenesis. The data suggest that the in vitro model of differentiated murine middle ear epithelium exhibits a transcriptional profile consistent with the mucociliary epithelium seen within the middle ear. Knowledge of the transcriptional landscape of this epithelium will provide a basis for understanding the phenotypic changes seen in murine models of OM.

Adult cognitive neuroscience has guided the study of human brain development by identifying regions associated with cognitive functions at maturity. The activity, connectivity, and structure of a region can be compared across ages to characterize the developmental trajectory of the corresponding function. However, developmental differences may reflect both the maturation of the function and also its organization across the brain. That is, a function may be present in children but supported by different brain regions, leading its maturity to be underestimated. Here we test the presence, maturity, and localization of adult functions in children using shared response modeling, a machine learning approach for functional alignment. After learning a lower-dimensional feature space from fMRI activity as adults watched a movie, we translated these shared features into the anatomical brain space of children 3–12 years old. To evaluate functional maturity, we correlated this reconstructed activity with children’s actual fMRI activity as they watched the same movie. We found reliable correlations throughout cortex, even in the youngest children. The strength of the correlation in the precuneus, inferior frontal gyrus, and lateral occipital cortex predicted chronological age. These age-related changes were driven by three types of developmental trajectories: emergence from absence to presence, consistency in anatomical expression, and reorganization from one anatomical region to another. We also found evidence that the processing of pain-related events in the movie underwent reorganization across childhood. This data-driven, naturalistic approach provides a new perspective on the development of functional neuroanatomy throughout childhood.

Multi-drug resistant (MDR) Acinetobacter baumannii (Ab) and Acinetobacter spp. present monumental global health challenges. These organisms represent model Gram-negative pathogens with known antibiotic resistance and biofilm-forming properties. Herein, a novel, nontoxic biocide, AB569, consisting of acidified nitrite (A-NO2-) and ethylenediaminetetraacetic acid (EDTA), demonstrated bactericidal activity against all Ab and Acinetobacter spp. strains, respectively. Average fractional inhibitory concentrations (FICs) of 0.25 mM EDTA plus 4 mM A-NO2- were observed across several clinical reference and multiple combat wound isolates from the Iraq/Afghanistan wars. Importantly, toxicity testing on human dermal fibroblasts (HDFa) revealed an upper toxicity limit of 3 mM EDTA plus 64 mM A-NO2-, and thus are in the therapeutic range for effective Ab and Acinetobacter spp. treatment. Following treatment of Ab strain ATCC 19606 with AB569, quantitative PCR analysis of selected genes products to be responsive to AB569 revealed up-regulation of iron regulated genes involved in siderophore production, siderophore biosynthesis non-ribosomal peptide synthetase module (SBNRPSM), and siderophore biosynthesis protein monooxygenase (SBPM) when compared to untreated organisms. Taken together, treating Ab infections with AB569 at inhibitory concentrations reveals the potential clinical application of preventing Ab from gaining an early growth advantage during infection followed by extensive bactericidal activity upon subsequent exposures.

The extent to which brain functions are localized or distributed is a foundational question in neuroscience. In the human brain, common fMRI methods such as cluster correction, atlas parcellation, and anatomical searchlight are biased by design toward finding localized representations. Here we introduce the functional searchlight approach as an alternative to anatomical searchlight analysis, the most commonly used exploratory multivariate fMRI technique. Functional searchlight removes any anatomical bias by grouping voxels based only on functional similarity and ignoring anatomical proximity. We report evidence that visual and auditory features from deep neural networks and semantic features from a natural language processing model, as well as object representations, are more widely distributed across the brain than previously acknowledged and that functional searchlight can improve model-based similarity and decoding accuracy. This approach provides a new way to evaluate and constrain computational models with brain activity and pushes our understanding of human brain function further along the spectrum from strict modularity toward distributed representation.

A reliable aggregation of whale sharks (Rhincodon typus) takes place in waters surrounding the remote South Atlantic island of St. Helena from December to May each year, peaking in January. Using photographic identification (photo-ID), a total of 277 individual sharks were identified over the course of the study, consisting of a 1.1:1 sex ratio of male and female sharks, ranging from 5 to 12 m in total length, with 86% of males and 51% of females likely to be mature. Modified maximum likelihood methods of the photo-ID data estimated ∼102 individual whale sharks at any one time, each residing within the study site for a mean of 19 days with a decline to complete absence at ∼75 days following initial identification. Interannual periodicity was observed for some (n = 34) sharks at the site. Eyewitness accounts of mating behavior have been reported by reliable local observers on two separate occasions, which comprise the first observations of copulation in this species and are consistent with the size and sex demographics of the population. Horizontal movements away from the island proved difficult to track, due to deep-diving behavior that either damaged or caused premature detachment of the archival satellite tags, however, some individuals showed large scale movement away from the island towards both Africa and South America. Acoustic telemetry showed that animals use the habitats around the entire island, but are focused on the leeward side, particularly from James Bay to Barn Cap. Due to its likely role in the reproductive ecology of the whale shark, St. Helena represents a critical habitat for this endangered species and deserves concerted research and conservation efforts.

Engineered allosteric regulation of protein activity provides significant advantages for the development of robust and broadly applicable tools. However, the application of allosteric switches in optogenetics has been scarce and suffers from critical limitations. Here, we report an optogenetic approach that utilizes an engineered Light-Regulated (LightR) allosteric switch module to achieve tight spatiotemporal control of enzymatic activity. Using the tyrosine kinase Src as a model, we demonstrate efficient regulation of the kinase and identify temporally distinct signaling responses ranging from seconds to minutes. LightR-Src off-kinetics can be tuned by modulating the LightR photoconversion cycle. A fast cycling variant enables the stimulation of transient pulses and local regulation of activity in a selected region of a cell. The design of the LightR module ensures broad applicability of the tool, as we demonstrate by achieving light-mediated regulation of Abl and bRaf kinases as well as Cre recombinase.

Background:. Primary malignant tumors of the sternum are rare among bone tumors. Even with radical resection, the survival rate for sternal tumors remains low. Resection often results in significant bone defects in the chest wall, and reconstruction must provide adequate protection for pulmonary and respiratory structures. Flexible materials have historically been used for sternal reconstructions following failed sternotomies in cardiac surgery. Although these have had some success, they fail to provide adequate support for patients undergoing reconstruction secondary to tumor resection, who are otherwise healthy and active. Although rigid materials offer greater protection, they frequently cause chronic pain and respiratory complications. More recently, bone grafts have been used to reconstruct sternal defects, and the limited published reports are promising. Methods:. We present the case of a patient diagnosed with an extramedullary solitary bone plasmacytoma who underwent a sternal resection and reconstruction with an autogenous bone graft taken from the iliac crest and secured in place with 5 plates (3 sternal and 2 mandibular). Results:. At 9-month follow-up, bone marrow biopsy showed no evidence of multiple myeloma. X-ray, computed tomography, and Pulmonary Function Test (PFT) scans confirmed graft stability, and the patient has returned to normal activities. Conclusions:. Sternal resection and reconstruction is an effective method for treating extramedullary solitary plasmacytoma when radiation is ineffective. In cases of significant segmental defects, iliac crest bone graft may be a viable option for repairing sternal defects following tumor resection.

Many brain pathologies are associated with liver damage, but a direct link has long remained elusive. Here, we establish a new paradigm for interrogating brain-periphery interactions by leveraging zebrafish for its unparalleled access to the intact whole animal for in vivo analysis in real time after triggering focal brain inflammation. Using traceable lipopolysaccharides (LPS), we reveal that drainage of these inflammatory macromolecules from the brain led to a strikingly robust peripheral infiltration of macrophages into the liver independent of Kupffer cells. We further demonstrate that this macrophage recruitment requires signaling from the cytokine IL-34 and Toll-like receptor adaptor MyD88, and occurs in coordination with neutrophils. These results highlight the possibility for circulation of brain-derived substances to serve as a rapid mode of communication from brain to the liver. Understanding how the brain engages the periphery at times of danger may offer new perspectives for detecting and treating brain pathologies.

The potential links between infections and neurodegenerative disorders are unclear. Here, Wu et al. present a mouse model of low-grade candidemia characterized by highly localized cerebritis, accumulation of amyloid precursor protein and beta peptides, and mild memory impairment that resolves with fungal clearance.

With advances in methods for collecting and analyzing fMRI data, there is a concurrent need to understand how to reliably evaluate and optimally use these methods. Simulations of fMRI data can aid in both the evaluation of complex designs and the analysis of data. We present fmrisim, a new Python package for standardized, realistic simulation of fMRI data. This package is part of BrainIAK: a recently released open-source Python toolbox for advanced neuroimaging analyses. We describe how to use fmrisim to extract noise properties from real fMRI data and then create a synthetic dataset with matched noise properties and a user-specified signal. We validate the noise generated by fmrisim to show that it can approximate the noise properties of real data. We further show how fmrisim can help researchers find the optimal design in terms of power. The fmrisim package holds promise for improving the design of fMRI experiments, which may facilitate both the pre-registration of such experiments as well as the analysis of fMRI data.

Although there has been a significant increase in the delivery of evidence-supported, trauma-informed care over the past few years, there has been less discussion around the consideration of the broader cultural, political, and societal factors that contextualize client trauma and that also need to be recognized and understood to promote healing and prevent future trauma. In support of sharing some best practices and lessons learned, this article provides a case study of one agency that has used the Sanctuary Model®, an evidence-supported, trauma-informed organizational change model, to introduce the practice of cultural humility with staff as a facilitator of improved service delivery for clients from culturally marginalized communities. The model supports these endeavors through the adherence to the seven commitments, a set of organizational values for creating a trauma-informed community, allowing for all voices to be heard and considered and providing opportunities to begin the repair of previous experiences of inequity and suppression. Through the board of directors, leadership, and staff, the organization transformed its culture into one that truly supports and embraces diversity, equity, and inclusion in its operation for the benefit of both staff and clients alike.

In the context of ongoing antagonism on college campuses, attacks on Critical Race Theory, and widespread backlash against racial justice initiatives, this paper underscores the growing need to recognize co-optation and other counterinsurgent strategies used against racial justice to make room for transformative scholarship. By presenting qualitative interviews from 15 white HBCU students, we illustrate how diversity research, advocacy, and organizing previously used to advocate for racial justice has instead constructed distorted understandings of race and racism and has been used to expand ideologies of whiteness. The findings show what CRT scholars have cautioned about for decades—when left uninterrupted, ahistorical approaches to racial diversity programming and research may lend to the co-optation of justice-focused diversity language and the appropriation of BIPOC strategies of resistance. This not only inhibits and detracts from racial justice work, but can function to expand white supremacy. We relate these narratives to an emerging racial backlash whereby white people attempt to distort understandings of structural racism to claim a “persecuted” status—a delusion that we argue warrants a new ideological frame. We posit this work lays the foundation for advancing equity in one of the most counterinsurgent eras in higher education (Matias & Newlove, 2017).

Advanced brain imaging analysis methods, including multivariate pattern analysis (MVPA), functional connectivity, and functional alignment, have become powerful tools in cognitive neuroscience over the past decade. These tools are implemented in custom code and separate packages, often requiring different software and language proficiencies. Although usable by expert researchers, novice users face a steep learning curve. These difficulties stem from the use of new programming languages (e.g., Python), learning how to apply machine-learning methods to high-dimensional fMRI data, and minimal documentation and training materials. Furthermore, most standard fMRI analysis packages (e.g., AFNI, FSL, SPM) focus on preprocessing and univariate analyses, leaving a gap in how to integrate with advanced tools. To address these needs, we developed BrainIAK (brainiak.org), an open-source Python software package that seamlessly integrates several cutting-edge, computationally efficient techniques with other Python packages (e.g., Nilearn, Scikit-learn) for file handling, visualization, and machine learning. To disseminate these powerful tools, we developed user-friendly tutorials (in Jupyter format; https://brainiak.org/tutorials/) for learning BrainIAK and advanced fMRI analysis in Python more generally. These materials cover techniques including: MVPA (pattern classification and representational similarity analysis); parallelized searchlight analysis; background connectivity; full correlation matrix analysis; inter-subject correlation; inter-subject functional connectivity; shared response modeling; event segmentation using hidden Markov models; and real-time fMRI. For long-running jobs or large memory needs we provide detailed guidance on high-performance computing clusters. These notebooks were successfully tested at multiple sites, including as problem sets for courses at Yale and Princeton universities and at various workshops and hackathons. These materials are freely shared, with the hope that they become part of a pool of open-source software and educational materials for large-scale, reproducible fMRI analysis and accelerated discovery.

The global pandemic of antibiotic resistance is an ever-burgeoning public health challenge, motivating the development of adjunct bactericidal therapies. Nitric oxide (NO) is a potent bioactive gas that induces a variety of therapeutic effects, including bactericidal and biofilm dispersion properties. The short half-life, high reactivity, and rapid diffusivity of NO make therapeutic delivery challenging. The goal of this work was to characterize NO-loaded microbubbles (MB) stabilized with a lipid shell and to assess the feasibility of antibacterial therapy in vitro. MB were loaded with either NO alone (NO-MB) or with NO and octafluoropropane (NO-OFP-MB) (9:1 v/v and 1:1 v/v). The size distribution and acoustic attenuation coefficient of NO-MB and NO-OFP-MB were measured. Ultrasound-triggered release of the encapsulated gas payload was demonstrated with 3-MHz pulsed Doppler ultrasound. An amperometric microelectrode sensor was used to measure NO concentration released from the MB and compared to an NO-OFP-saturated solution. The effect of NO delivery on the viability of planktonic (free living) Staphylococcus aureus (SA) USA 300, a methicillin-resistant strain, was evaluated in a 96 well-plate format. The co-encapsulation of NO with OFP increased the total volume and attenuation coefficient of MB. The NO-OFP-MB were destroyed with a clinical ultrasound scanner with an output of 2.48 MPa peak negative pressure (in situ MI of 1.34) but maintained their echogenicity when exposed to 0.02 MPa peak negative pressure (in situ MI of 0.01. The NO dose in NO-MB and NO-OFP-MB was more than 2-fold higher than the NO-OFP-saturated solution. Delivery of NO-OFP-MB increased bactericidal efficacy compared to the NO-OFP-saturated solution or air and OFP-loaded MB. These results suggest that encapsulation of NO with OFP in lipid-shelled MB enhances payload delivery. Furthermore, these studies demonstrate the feasibility and limitations of NO-OFP-MB for antibacterial applications.