Search

The global pandemic prompted universities to rethink how assessment might be reconfigured to better support student learning across different modes of delivery resulting in unprecedented, large-scale, and rapid institutional change. Significantly, there has been a dearth of empirical studies examining the nuances of staff experiences of how they have managed and negotiated assessment change throughout the pandemic context. In this article we aim to bridge this gap. We are four colleagues at different UK higher education institutions who have all been involved in leading the sustained assessment response to the pandemic within our own organisations. We use collaborative autoethnography (CAE) to explore and analyse our approaches to enabling large-scale assessment change with the aim of locating sharable lessons for educational developers and others leading change efforts in higher education. We articulate key lessons generated from our collaborative exploration that we believe may be useful to other education developers and/or academic practitioners who seek to change the assessment landscape within a course, faculty, or institution. The lessons presented offer an alternative frame for managing future-facing assessment change in higher education that is sensitive to both the practice realities of practitioners and the impact subsequent change has on student learning and performance.

This study proposed using enamel surface texture and thickness for the objective detection and monitoring of erosive tooth wear (ETW), comparing them to the standard subjective Basic Erosive Wear Evaluation (BEWE). Thirty-two subjects (n = 597 teeth) were enrolled in this longitudinal observational clinical study. Enamel thickness (by cross-polarization optical coherence tomography, CP-OCT) and 3D dental microwear parameters, i.e., area-scale fractal complexity (Asfc), anisotropy (Str), and roughness (Sa) (by white-light scanning confocal profilometry), were obtained from buccal surfaces. Buccal, occlusal, and lingual surfaces were scored for BEWE and the maximum score per tooth (BEWEMax) was determined at baseline and 12 months (M12). Data outcome relationships were evaluated (alpha = 0.05). Enamel thickness decreased (p < 0.001), BEWE scores, Sa, and Str increased (p < 0.001), while Asfc did not change at M12. Baseline BEWEBuccal correlated strongly with BEWEMax (r = 0.86, p < 0.001) and moderately with BEWELingual (r = 0.42, p < 0.001), but not with enamel thickness (r = 0.03, p = 0.43). Change (Δ) in surface texture outcomes correlated poorly but significantly with ΔBEWEBuccal (r = -0.15-0.16, p < 0.001) and did not correlate with Δenamel thickness (r = 0.02-0.09, p > 0.06). Teeth with BEWE progression revealed a greater increase in ΔSa and ΔStr. These findings suggest that enamel surface roughness can potentially determine ETW severity, and CP-OCT may be relevant for clinically monitoring enamel thickness.

Abstract B cells are important in tuberculosis (TB) immunity, but their role in the human lung is understudied. Here, we characterize B cells from lung tissue and matched blood of patients with TB and found they are decreased in the blood and increased in the lungs, consistent with recruitment to infected tissue, where they are located in granuloma associated lymphoid tissue. Flow cytometry and transcriptomics identify multiple B cell populations in the lung, including those associated with tissue resident memory, germinal centers, antibody secretion, proinflammatory atypical B cells, and regulatory B cells, some of which are expanded in TB disease. Additionally, TB lungs contain high levels of Mtb-reactive antibodies, specifically IgM, which promotes Mtb phagocytosis. Overall, these data reveal the presence of functionally diverse B cell subsets in the lungs of patients with TB and suggest several potential localized roles that may represent a target for interventions to promote immunity or mitigate immunopathology.

The reprocessing of radiation belt electron flux measurements into phase space density (PSD) as a function of the adiabatic invariants is a widely-used method to address major questions regarding electron energization and loss in the outer radiation belt. In this reprocessing, flux measurements j (α, E) at local pitch angles α, energies E, and optionally magnetometer measurements B, are combined with a global magnetic field model to express the phase space density f (L*) in terms of the third invariant Φ ∝ 1/L* at fixed first and second invariants M and K. While the general framework of the calculation is agreed upon, implementation details vary amongst the literature, and the issue of magnetic field model dependence is rarely addressed. This work reviews the steps of the calculation with lists of commonly used implementation options. For the first time, analysis is presented to display the effect of doing the calculation with different implementation options and with different backing models (including both empirical and MHD-driven models). The results are summarized to inform evaluation of existing results and future efforts calculating and analyzing radiation belt electron phase space density. Three events are analyzed, and while differences are found, the primary structural interpretations of the phase space density analysis exhibit model independence.

Abstract Background People with opioid use disorder (OUD) are frequently in contact with the court system and have markedly higher rates of fatal opioid overdose. Opioid intervention courts (OIC) were developed to address increasing rates of opioid overdose among court defendants by engaging court staff in identification of treatment need and referral for opioid-related services and building collaborations between the court and OUD treatment systems. The study goal was to understand implementation barriers and facilitators in referring and engaging OIC clients in OUD treatment. Methods Semi-structured interviews were conducted with OIC stakeholders (n = 46) in 10 New York counties in the United States, including court coordinators, court case managers, and substance use disorder treatment clinic counselors, administrators, and peers. Interviews were recorded and transcribed and thematic analysis was conducted, guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, employing both inductive and deductive coding. Results Results were conceptualized using EPIS inner (i.e., courts) and outer (i.e., OUD treatment providers) implementation contexts and bridging factors that impacted referral and engagement to OUD treatment from the OIC. Inner factors that facilitated OIC implementation included OIC philosophy (e.g., non-punitive, access-oriented), court organizational structure (e.g., strong court staff connectedness), and OIC court staff and client characteristics (e.g., positive medications for OUD [MOUD] attitudes). The latter two also served as barriers (e.g., lack of formalized procedures; stigma toward MOUD). Two outer context entities impacted OIC implementation as both barriers and facilitators: substance use disorder treatment programs (e.g., attitudes toward the OIC and MOUD; operational characteristics) and community environments (e.g., attitudes toward the opioid epidemic). The COVID-19 pandemic and bail reform were macro-outer context factors that negatively impacted OIC implementation. Facilitating bridging factors included staffing practices that bridged court and treatment systems (e.g., peers); barriers included communication and cultural differences between systems (e.g., differing expectations about OIC client success). Conclusions This study identified key barriers and facilitators that OICs may consider as this model expands in the United States. Referral to and engagement in OUD treatment within the OIC context requires ongoing efforts to bridge the treatment and court systems, and reduce stigma around MOUD.

Summary: Background: Bacille Calmette-Guérin (BCG) vaccination has off-target (non-specific) effects that are associated with protection against unrelated infections and decreased all-cause mortality in infants. We aimed to determine whether BCG vaccination prevents febrile and respiratory infections in adults. Methods: This randomised controlled phase 3 trial was done in 36 healthcare centres in Australia, Brazil, the Netherlands, Spain, and the United Kingdom. Healthcare workers were randomised to receive BCG-Denmark (single 0.1 ml intradermal injection) or no BCG in a 1:1 ratio using a web-based procedure, stratified by stage, site, age, and presence of co-morbidity. The difference in occurrence of febrile or respiratory illness were measured over 12 months (prespecified secondary outcome) using the intention-to-treat (ITT) population. This trial is registered with ClinicalTrials.gov, NCT04327206. Findings: Between March 30, 2020, and April 1, 2021, 6828 healthcare workers were randomised to BCG-Denmark (n = 3417) or control (n = 3411; no intervention or placebo) groups. The 12-month adjusted estimated risk of ≥1 episode of febrile or respiratory illness was 66.8% in the BCG group (95% CI 65.3%–68.2%), compared with 63.4% in the control group (95% CI 61.8%–65.0%), a difference of +3.4 percentage points (95% CI +1.3% to +5.5%; p 0.002). The adjusted estimated risk of a severe episode (defined as being incapacitated for ≥3 consecutive days or hospitalised) was 19.4% in the BCG group (95% CI 18.0%–20.7%), compared with 18.8% in the control group (95% CI 17.4%–20.2%) a difference of +0.6 percentage points (95% CI −1.3% to +2.5%; p 0.6). Both groups had a similar number of episodes of illness, pneumonia, and hospitalisation. There were three deaths, all in the control group. There were no safety concerns following BCG vaccination. Interpretation: In contrast to the beneficial off-target effects reported following neonatal BCG in infants, a small increased risk of symptomatic febrile or respiratory illness was observed in the 12 months following BCG vaccination in adults. There was no evidence of a difference in the risk of severe disease. Funding: Bill & Melinda Gates Foundation, Minderoo Foundation, Sarah and Lachlan Murdoch, the Royal Children's Hospital Foundation, Health Services Union NSW, the Peter Sowerby Foundation, SA Health, the Insurance Advisernet Foundation, the NAB Foundation, the Calvert-Jones Foundation, the Modara Pines Charitable Foundation, the UHG Foundation Pty Ltd, Epworth Healthcare, the National Health and Medical Research Council, the Swiss National Science Foundation and individual donors.

Adiabatic motion is a fundamental reversible process for geomagnetically trapped particle populations, including particles comprising the ring current and radiation belts. During adiabatic motion, a particle’s trajectory in configuration space responds to sufficiently slow changes in the magnetospheric magnetic field. Previous research has highlighted expected patterns in adiabatic motion, such as radial motion or the Dst effect. In this work, we introduce a method we call Invariant Matching for quantifying adiabatic motion between a pair of magnetospheres. This method can be applied to both simulation and semi-empirical magnetic field models, is computationally efficient, and in particular does not require tracing the particle trajectories. In this work, we use the Tsyganenko et al., Journal of Geophysical Research: Space Physics, 2005, 110 (TS05) magnetic field model, and present adiabatic motion between a storm commencement, the time of the storm’s Dst minimum, and a nominal recovery time. We also analyze adiabatic motion which occurs in response to enhancements of individual major current systems (including the ring current, Chapman-Ferraro current, Birkeland current, and tail current). Our methodology yields vector fields quantifying the displacement of mirror points throughout the magnetosphere, prepared in a way appropriate for application to both outer radiation belt and ring current populations.

Summary: Background: The COVID-19 pandemic led to the rapid development and deployment of several highly effective vaccines against SARS-CoV-2. Recent studies suggest that these vaccines may also have off-target effects on the immune system. We sought to determine and compare the off-target effects of the adenovirus vector ChAdOx1-S (Oxford-AstraZeneca) and modified mRNA BNT162b2 (Pfizer-BioNTech) vaccines on immune responses to unrelated pathogens. Methods: Prospective sub-study within the BRACE trial. Blood samples were collected from 284 healthcare workers before and 28 days after ChAdOx1-S or BNT162b2 vaccination. SARS-CoV-2-specific antibodies were measured using ELISA, and whole blood cytokine responses to specific (SARS-CoV-2) and unrelated pathogen stimulation were measured by multiplex bead array. Findings: Both vaccines induced robust SARS-CoV-2 specific antibody and cytokine responses. ChAdOx1-S vaccination increased cytokine responses to heat-killed (HK) Candida albicans and HK Staphylococcus aureus and decreased cytokine responses to HK Escherichia coli and BCG. BNT162b2 vaccination decreased cytokine response to HK E. coli and had variable effects on cytokine responses to BCG and resiquimod (R848). After the second vaccine dose, BNT162b2 recipients had greater specific and off-target cytokine responses than ChAdOx1-S recipients. Interpretation: ChAdOx1-S and BNT162b2 vaccines alter cytokine responses to unrelated pathogens, indicative of potential off-target effects. The specific and off-target effects of these vaccines differ in their magnitude and breadth. The clinical relevance of these findings is uncertain and needs further study. Funding: Bill & Melinda Gates Foundation, National Health and Medical Research Council, Swiss National Science Foundation and the Melbourne Children’s. BRACE trial funding is detailed in acknowledgements.

A robust immune response is required for resistance to pulmonary tuberculosis (TB), the primary disease caused by Mycobacterium tuberculosis (Mtb). However, pharmaceutical inhibition of T cell immune checkpoint molecules can result in the rapid development of active disease in latently infected individuals, indicating the importance of T cell immune regulation. In this study, we investigated the potential role of CD200R during Mtb infection, a key immune checkpoint for myeloid cells. Expression of CD200R was consistently downregulated on CD14+ monocytes in the blood of subjects with active TB compared to healthy controls, suggesting potential modulation of this important anti-inflammatory pathway. In homogenized TB-diseased lung tissue, CD200R expression was highly variable on monocytes and CD11b+HLA-DR+ macrophages but tended to be lowest in the most diseased lung tissue sections. This observation was confirmed by fluorescent microscopy, which showed the expression of CD200R on CD68+ macrophages surrounding TB lung granuloma and found expression levels tended to be lower in macrophages closest to the granuloma core and inversely correlated with lesion size. Antibody blockade of CD200R in a biomimetic 3D granuloma-like tissue culture system led to significantly increased Mtb growth. In addition, Mtb infection in this system reduced gene expression of CD200R. These findings indicate that regulation of myeloid cells via CD200R is likely to play an important part in the immune response to TB and may represent a potential target for novel therapeutic intervention.

The use of documentary, and in turn the value of documentary, is well established in formal education contexts. In addition to an established pedagogical value, this article examines the cultural and economic value of documentary in education through both national legislative reviews (the Australian Law Reform Commission's (ALRC's) "Copyright and the Digital Economy") and a specific learning resource in the form of study guides. Within this research, study guides function as a means to explore the plurality of ways in which documentary may be valued through several stakeholders invested in sustaining educational engagement with the form. Most notably among these stakeholders is copyright collection agency Screenrights, which bridges the valuing of documentary between screen and education sectors alongside national funding agency Screen Australia and the Australian Teachers of Media (ATOM), an independent, non-profit, professional association promoting the study of media in education. ATOM in particular is synonymous with the creation of study guides for documentary films. Investigating the educative, cultural and economic value of study guides offers a discrete albeit valuable study of the ways in which documentary functions within Australian education contexts.

Tuberculosis (TB) remains a persistent epidemic, and the emergence of drug-resistant Mycobacterium tuberculosis (Mtb) presents a global healthcare threat. While some new agents have been successfully introduced, innovative technologies to evaluate emerging anti-TB compounds are required to inform transformative approaches. Mtb is an obligate human pathogen, and consequently utilizing models that are consistent with human disease is likely to be critical. We have developed a human 3-dimensional (3-D) cell culture model that reflects human disease gene expression patterns and causes Mtb to become pyrazinamide sensitive in vitro. Here, we identify key differences in virulence between the standard laboratory strain, Mtb H37Rv, and clinical isolates. We demonstrate that Mtb H37Rv is attenuated in the 3-D system, more susceptible to antibiotics and hyperinflammatory compared to clinical isolates. Prolonged in vitro culture of a clinical strain leads to attenuation. We then characterise antibiotic sensitivity of multi-drug-resistant Mtb within the 3-D model and define relative bactericidal activity. Finally, we demonstrate that verapamil increases efficacy of bedaquiline and delamanid antibiotic therapy. Taken together, our findings suggest that studying virulent clinical strains in an advanced cell culture system is a powerful adjunct to established methodologies to evaluate new interventions for TB.

IntroductionThe objective of this study was to utilize the data generated by the City of Toronto, Street Needs Assessment conducted in 2021 to explore the prevalence, causes, experiences, and characteristics of 2-spirit, lesbian, gay, bisexual, transgender, queer, and questioning (2SLGBTQ+) individuals experiencing homelessness in Toronto, Ontario, Canada.MethodsData was collected by the City of Toronto during its Street Needs Assessment in April 2021. The Street Needs Assessment is a needs assessment survey and Point-in-Time count of people experiencing homelessness across the city of Toronto. Homelessness included any individual who was sleeping outdoors or staying in City-administered emergency/transitional shelters and shelter motels/hotels on the night of data collection. The Street Needs Assessment survey was administered to clients by trained shelter and outreach staff using a computer or mobile device. To ensure that survey questions were 2SLGBTQ+ inclusive, questions on sexual orientation, gender identity, and 2SLGBTQ+ identity were included in the survey.ResultsTwo hundred and eighty-eight 2SLGBTQ+ individuals completed the survey. Compared to non-2SLGBTQ+ individuals experiencing homelessness, 2SLGBTQ+ respondents were younger at the time of survey completion and when they first experienced homelessness, were more likely to have been in foster care or a group home, reported higher rates of conflict with and/or abuse by a parent/guardian as their main pathway into homelessness, and were more likely to experience chronic homelessness.ConclusionOur study results demonstrate that Street Needs Assessments and Point-in-Time counts can be used to examine homelessness in marginalized populations, including 2SLGBTQ+ individuals and that sexual orientation and gender identity questions need to be included on future government surveys. The consistency of findings from this study and previous research suggests that 2SLGBTQ+ individuals experience a significant need for population-based housing and social support services aimed at meeting the needs of 2SLGBTQ+ populations.

BackgroundMost justice-involved youth are supervised in community settings, where assessment and linkage to substance use (SU) treatment services are inconsistent and fragmented. Only 1/3 of youth with an identified SU need receive a treatment referral and even fewer initiate services. Thus, improving identification and linkage to treatment requires coordination across juvenile justice (JJ) and behavioral health (BH) agencies. The current study examines the comparative effectiveness of two bundled implementation intervention strategies for improving SU treatment initiation, engagement, and continuing care among justice-involved youth supervised in community settings. Exploration, Preparation, Implementation, Sustainment (EPIS) served as the conceptual framework for study design and selection/timing of implementation intervention components, and the BH Services Cascade served as the conceptual and measurement framework for identifying and addressing gaps in service receipt.MethodsPart of a larger Juvenile-Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) Cooperative, this study involved a multisite, cluster-randomized control trial where sites were paired then randomly assigned to receive Core (training teams on the BH Services Cascade and data-driven decision making; supporting goal selection) or Core+Enhanced (external facilitation of implementation teams) intervention components. Youth service records were collected from 20 JJ community supervision agencies (in five states) across five study phases (baseline, pre-randomization, early experiment, late experiment, maintenance). Implementation teams comprised of JJ and BH staff collaboratively identified goals along the BH Cascade and used data-driven decision-making to implement change.ResultsResults suggest that Core intervention components were effective at increasing service receipt over time relative to baseline, but differences between Core and Core+Enhanced conditions were non-significant. Time to service initiation was shorter among Core+Enhanced sites, and deeper Cascade penetration occurred when external facilitation (of implementation teams) was provided. Wide variation existed in the degree and nature of change across service systems.ConclusionsFindings demonstrate the criticality of early EPIS phases, demonstrating that strategies provided during the formative exploration and preparation phases produced some improvement in service receipt, whereas implementation-focused activities produced incremental improvement in moving youth farther along the Cascade.

Abstract Background Despite the heightened risk for substance use (SU) among youth in the juvenile justice system, many do not receive the treatment that they need. Objectives The purpose of this study is to examine the extent to which youth under community supervision by juvenile justice agencies receive community-based SU services and the factors associated with access to such services. Methods Data are from a nationally representative sample of Community Supervision (CS) agencies and their primary behavioral health (BH) partners. Surveys were completed by 192 CS and 271 BH agencies. Results SU services are more often available through BH than CS for all treatment modalities. EBPs are more likely to be used by BH than by CS. Co-location of services occurs most often in communities with fewer treatment options and is associated with higher interagency collaboration. Youth are more likely to receive services in communities with higher EBP use, which mediates the relationship between the availability of SU treatment modalities and the proportion of youth served. Conclusion Findings identify opportunities to strengthen community systems and improve linkage to care.

Summary: Background: Recurrences of herpes simplex virus (HSV) in the orofacial region (herpes labialis or cold sores) impact quality-of-life. We aimed to study whether the bacille Calmette-Guérin (BCG) vaccine can attenuate cold sore recurrences through off-target immunomodulatory effects. Methods: In this nested randomised controlled trial within the multicentre, phase 3 BRACE trial, 6828 healthcare workers were randomised in 36 sites in Australia, the Netherlands, Spain, the United Kingdom and Brazil, to receive BCG-Denmark or no BCG (1:1 ratio using a web-based procedure) and followed for 12 months with 3-monthly questionnaires. Exclusion criteria included contraindication to BCG vaccine or previous vaccination with BCG within the past year, any other live-attenuated vaccine within the last month, or any COVID-specific vaccine. The intervention group received one intradermal dose of 0.1 mL of BCG-Denmark corresponding to 2−8 x 105 colony forming units of Mycobacterium bovis, Danish strain 1331. The primary outcome was the difference in restricted mean survival time (i.e., time to first cold-sore recurrence), in participants with frequent recurrent herpes labialis (≥4 recurrences/year), analysed by intention-to-treat. Secondary outcomes addressed additional questions, including analyses in other sub-populations. Adverse events were monitored closely during the first 3 months and were reported in all participants who received one dose of study drug according to intervention received. The BRACE trial is registered with ClinicalTrials.gov, NCT04327206. Findings: Between March 30, 2020 and February 18, 2021, 84 individuals with frequent recurrent cold sores were randomly assigned to BCG (n = 38) or control (n = 46). The average time to first cold-sore recurrence was 1.55 months longer in the BCG group (95% CI 0.27–2.82, p = 0.02) than the control group (hazard ratio 0.54, 95% CI 0.32–0.91; intention-to-treat). The beneficial effect of BCG was greater in the as-treated population (difference 1.91 months, 95% CI 0.69–3.12, p = 0.003; hazard ratio 0.45, 95% CI 0.26–0.76). In prespecified subgroup analyses, only sex modified the treatment effect (interaction p = 0.007), with benefit restricted to males. Over 12 months, a greater proportion of participants in the BCG group compared with the control group reported a decrease in duration (61% vs 21%), severity (74% vs 21%), frequency (55% vs 21%), and impact on quality of life (42% vs 15%) of cold sore recurrences. In participants who had ever had a cold sore, there was also a decrease in self-reported burden of recurrences in the BCG group. In participants who had never had a cold sore, there was an increased risk of a first episode in the BCG group (risk difference 1.4%; 95% CI 0.3–2.6%, p = 0.02). There were no safety concerns. Interpretation: BCG-Denmark vaccination had a beneficial effect on herpes labialis, particularly in males with frequent recurrences, but may increase the risk of a first cold sore. Funding: Bill & Melinda Gates Foundation, the Minderoo Foundation, Sarah and Lachlan Murdoch, the Royal Children's Hospital Foundation, Health Services Union NSW, the Peter Sowerby Foundation, SA Health, the Insurance Advisernet Foundation, the NAB Foundation, the Calvert-Jones Foundation, the Modara Pines Charitable Foundation, the UHG Foundation Pty Ltd, Epworth Healthcare, and individual donors.

Abstract Tuberculosis (TB) of the central nervous system (CNS) is a deadly disease characterized by extensive tissue destruction, driven by molecules such as Matrix Metalloproteinase-2 (MMP-2) which targets CNS-specific substrates. In a simplified cellular model of CNS TB, we demonstrated that conditioned medium from Mycobacterium tuberculosis-infected primary human monocytes (CoMTb), but not direct infection, unexpectedly down-regulates constitutive microglial MMP-2 gene expression and secretion by 72.8% at 24 hours, sustained up to 96 hours (P < 0.01), dependent upon TNF-α. In human CNS TB brain biopsies but not controls the p38 pathway was activated in microglia/macrophages. Inhibition of the p38 MAP kinase pathway resulted in a 228% increase in MMP-2 secretion (P < 0.01). In contrast ERK MAP kinase inhibition further decreased MMP-2 secretion by 76.6% (P < 0.05). Inhibition of the NFκB pathway resulted in 301% higher MMP-2 secretion than CoMTb alone (P < 0.01). Caspase 8 restored MMP-2 secretion to basal levels. However, this caspase-dependent regulation of MMP-2 was independent of p38 and NFκB pathways; p38 phosphorylation was increased and p50/p65 NFκB nuclear trafficking unaffected by caspase 8 inhibition. In summary, suppression of microglial MMP-2 secretion by M.tb-infected monocyte-dependent networks paradoxically involves the pro-inflammatory mediators TNF-α, p38 MAP kinase and NFκB in addition to a novel caspase 8-dependent pathway.

In this paper we describe K2, a comprehensive simulation model of Earth’s radiation belts that includes a wide range of relevant physical processes. Global MHD simulations are combined with guiding-center test-particle methods to model interactions with ultra low-frequency (ULF) waves, substorm injections, convective transport, drift-shell splitting, drift-orbit bifurcations, and magnetopause shadowing, all in self-consistent MHD fields. Simulation of local acceleration and pitch-angle scattering due to cyclotron-scale interactions is incorporated by including stochastic differential equation (SDE) methods in the MHD-particle framework. The SDEs are driven by event-specific bounce-averaged energy and pitch-angle diffusion coefficients. We present simulations of electron phase-space densities during a simplified particle acceleration event based on the 17 March 2013 event observed by the Van Allen Probes, with a focus on demonstrating the capabilities of the K2 model. The relative wave-particle effects of global scale ULF waves and very-low frequency (VLF) whistler-mode chorus waves are compared, and we show that the primary acceleration appears to be from the latter. We also show that the enhancement with both ULF and VLF processes included exceeds that of VLF waves alone, indicating a synergistic combination of energization and transport processes may be important.

Printed electronics is simultaneously one of the most intensely studied emerging research areas in science and technology and one of the fastest growing commercial markets in the world today. For the past decade the potential for organic electronic (OE) materials to revolutionize this printed electronics space has been widely promoted. Such conviction in the potential of these carbon-based semiconducting materials arises from their ability to be dissolved in solution, and thus the exciting possibility of simply printing a range of multifunctional devices onto flexible substrates at high speeds for very low cost using standard roll-to-roll printing techniques. However, the transition from promising laboratory innovations to large scale prototypes requires precise control of nanoscale material and device structure across large areas during printing fabrication. Maintaining this nanoscale material control during printing presents a significant new challenge that demands the coupling of OE materials and devices with clever nanoscience fabrication approaches that are adapted to the limited thermodynamic levers available. In this review we present an update on the strategies and capabilities that are required in order to manipulate the nanoscale structure of large area printed organic photovoltaic (OPV), transistor and bioelectronics devices in order to control their device functionality. This discussion covers a range of efforts to manipulate the electroactive ink materials and their nanostructured assembly into devices, and also device processing strategies to tune the nanoscale material properties and assembly routes through printing fabrication. The review finishes by highlighting progress in printed OE devices that provide a feedback loop between laboratory nanoscience innovations and their feasibility in adapting to large scale printing fabrication. The ability to control material properties on the nanoscale whilst simultaneously printing functional devices on the square metre scale is prompting innovative developments in the targeted nanoscience required for OPV, transistor and biofunctional devices.

Abstract Background Most justice-involved youth are supervised in community settings, where assessment and linkage to substance use (SU) treatment services are inconsistent and fragmented. Only 1/3 of youth with an identified SU need receive a treatment referral and even fewer initiate services. Thus, improving identification and linkage to treatment requires coordination across juvenile justice (JJ) and behavioral health (BH) agencies. The current study examines the comparative effectiveness of two bundled implementation intervention strategies for improving SU treatment initiation, engagement, and continuing care among justice-involved youth supervised in community settings. Exploration, Preparation, Implementation, Sustainment (EPIS) served as the conceptual framework for study design and selection/timing of implementation intervention components, and the BH Services Cascade served as the conceptual and measurement framework for identifying and addressing gaps in service receipt. Methods Part of a larger Juvenile-Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) Cooperative, this study involved a multisite, cluster-randomized control trial where sites were paired then randomly assigned to receive Core (training teams on the BH Services Cascade and data-driven decision making; supporting goal selection) or Core+Enhanced (external facilitation of implementation teams) intervention components. Youth service records were collected from 20 JJ community supervision agencies (in five states) across five study phases (baseline, pre-randomization, early experiment, late experiment, maintenance). Implementation teams comprised of JJ and BH staff collaboratively identified goals along the BH Cascade and used data-driven decision-making to implement change. Results Results suggest that Core intervention components were effective at increasing service receipt over time relative to baseline, but differences between Core and Core+Enhanced conditions were non-significant. Time to service initiation was shorter among Core+Enhanced sites, and deeper Cascade penetration occurred when external facilitation (of implementation teams) was provided. Wide variation existed in the degree and nature of change across service systems. Conclusions Findings demonstrate the criticality of early EPIS phases, demonstrating that strategies provided during the formative exploration and preparation phases produced some improvement in service receipt, whereas implementation-focused activities produced incremental improvement in moving youth farther along the Cascade.

Mycobacterium tuberculosis senses IFN-γ via the membrane protein MmpL10, which results in stimulation of bacterial respiration and virulence gene expression, worsens infection and paradoxically prevents the formation of isoniazid tolerant persisters.

ObjectivesTo estimate the incidence of, and investigate risk factors for, postpartum haemorrhage (PPH) requiring transfer to obstetric care following birth in midwifery units (MU) in the UK; to describe outcomes for women who experience PPH requiring transfer to obstetric care.MethodsWe conducted a national population-based case-control study in all MUs in the UK using the UK Midwifery Study System (UKMidSS). Between September 2019 and February 2020, 1501 women with PPH requiring transfer to obstetric care following birth in an MU, and 1475 control women were identified. We used multivariable logistic regression, generating adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to investigate risk factors for PPH requiring transfer to obstetric care.ResultsThe incidence of PPH requiring transfer to obstetric care following birth in an MU was 3.7% (95% CI 3.6%-3.9%). Factors independently associated with PPH requiring transfer to obstetric care were smoking during pregnancy (aOR = 0.73; 95% CI 0.56-0.94), nulliparity (aOR = 1.96; 95% CI 1.66-2.30), previous PPH (aOR = 2.67; 95% CI 1.67-4.25), complications in a previous pregnancy other than PPH (aOR = 2.40; 95% CI 1.25-4.60), gestational age ≥41 weeks (aOR = 1.36; 95% CI 1.10-1.69), instrumental birth (aOR = 2.69; 95% CI 1.53-4.72), third stage of labour ≥60 minutes (aOR = 5.56; 95% CI 3.93-7.88), perineal trauma (aOR = 4.67; 95% CI 3.16-6.90), and birthweight 3500-3999g (aOR = 1.71; 95% CI 1.42-2.07) or ≥4000g (aOR = 2.31; 95% CI 1.78-3.00). One in ten (10.6%) cases received a blood transfusion and one in five (21.0%) were admitted to higher level care.ConclusionsThe risk factors identified in this study align with those identified in previous research and with current guidelines for women planning birth in an MU in the UK. Maternal outcomes after PPH were broadly reassuring and indicative of appropriate management. NHS organisations should ensure that robust guidelines are in place to support management of PPH in MUs.

ObjectivesMost research about outcomes following postpartum haemorrhage (PPH) has focused on immediate outcomes. There are fewer studies investigating longer-term maternal morbidity following PPH, resulting in a significant knowledge gap. This review aimed to synthesize the evidence about the longer-term physical and psychological consequences of primary PPH for women and their partners from high income settings.MethodsThe review was registered with PROSPERO and five electronic databases were searched. Studies were independently screened against the eligibility criteria by two reviewers and data were extracted from both quantitative and qualitative studies that reported non-immediate health outcomes of primary PPH.ResultsData were included from 24 studies, of which 16 were quantitative, five were qualitative and three used mixed-methods. The included studies were of mixed methodological quality. Of the nine studies reporting outcomes beyond five years after birth, only two quantitative studies and one qualitative study had a follow-up period longer than ten years. Seven studies reported outcomes or experiences for partners. The evidence indicated that women with PPH were more likely to have persistent physical and psychological health problems after birth compared with women who did not have a PPH. These problems, including PTSD symptoms and cardiovascular disease, may be severe and extend for many years after birth and were more pronounced after a severe PPH, as indicated by a blood transfusion or hysterectomy. There was limited evidence about outcomes for partners after PPH, but conflicting evidence of association between PTSD and PPH among partners who witnessed PPH.ConclusionThis review explored existing evidence about longer-term physical and psychological health outcomes among women who had a primary PPH in high income countries, and their partners. While the evidence about health outcomes beyond five years after PPH is limited, our findings indicate that women can experience long lasting negative impacts after primary PPH, including PTSD symptoms and cardiovascular disease, extending for many years after birth.Prospero registrationPROSPERO registration number: CRD42020161144.

Machining composite to achieve the desired surface and sub-surface condition, whether through conventional or non-conventional techniques, presents persistent challenges due to their anisotropic thermal characteristics. These challenges escalate when dealing with ceramic matrix composites (CMC) due to their high melting and boiling temperature. This study investigates the surface and sub-surface characteristics of SiC-Al 2 O 3 CMC laser-cut components, produced using a 2 kW quasi-continuous wave laser. The influence of laser parameters such as focal position, cutting speed, number of cutting passes, average power, and assist gas type on surface and sub-surface characteristics have been investigated in detail. The laser cut samples were analysed using white light interferometer, Scanning Electron Microscopy (SEM), Energy Dispersive X-ray Spectroscopy (EDX) and 3D X-ray Computer Tomography (XCT) for both surface and sub-surface characteristics. The effect of laser process parameters on the surface composition, surface topology, and sub-surface thermal defects have been studied in detail. The results revealed that multi-pass cutting (16 pass) can be used to achieve lower thermal affected zone (~200 µm) and reduced surface roughness with an overall cutting speed of 625 mm/min. No delamination was observed with multi-pass cutting. Nitrogen was found to be the most suitable assist gas, as it prevented oxide layer formation across the laser cut SiC-Al 2 O 3 CMC surface. [ABSTRACT FROM AUTHOR]

Polycrystalline diamond (PCD) is an important material in the tool industry due to its superior wear resistance and strength. Picosecond laser machining enables accurate cutting, geometric profiling, and precise dimensional features to be produced on PCD. The industrialisation of this manufacturing process necessitates the development of laser systems and process strategies that facilitate high throughput and quality. This paper investigates the feasibility of using a 300 W picosecond laser to machine PCD. It examines the influence of fluence, average power, pulse duration and number of passes on the material removal rate and surface quality. The surface integrity after machining is ascertained using a surface profilometer, optical microscopy and Raman spectroscopy. The results have shown that a high material removal rate of 33 mm3/min (0.11 mm3/min W) at a surface roughness of 2.3 μm is achievable using a fluence of 0.9 J/cm2 at 41.3 MHz and 300 W average power. Raman's analysis of the machined sample suggests a laser-induced graphitisation which is prevalent at high pulse overlap, peak power, and the number of passes. Overall, the study strengthens the idea that with optimised process parameters, a balance is established between productivity and high surface integrity. [ABSTRACT FROM AUTHOR]

This study proposed using enamel surface texture and thickness for the objective detection and monitoring of erosive tooth wear (ETW), comparing them to the standard subjective Basic Erosive Wear Evaluation (BEWE). Thirty-two subjects (n = 597 teeth) were enrolled in this longitudinal observational clinical study. Enamel thickness (by cross-polarization optical coherence tomography, CP-OCT) and 3D dental microwear parameters, i.e., area-scale fractal complexity (Asfc), anisotropy (Str), and roughness (Sa) (by white-light scanning confocal profilometry), were obtained from buccal surfaces. Buccal, occlusal, and lingual surfaces were scored for BEWE and the maximum score per tooth (BEWEMax) was determined at baseline and 12 months (M12). Data outcome relationships were evaluated (alpha = 0.05). Enamel thickness decreased (p < 0.001), BEWE scores, Sa, and Str increased (p < 0.001), while Asfc did not change at M12. Baseline BEWEBuccal correlated strongly with BEWEMax (r = 0.86, p < 0.001) and moderately with BEWELingual (r = 0.42, p < 0.001), but not with enamel thickness (r = 0.03, p = 0.43). Change (Δ) in surface texture outcomes correlated poorly but significantly with ΔBEWEBuccal (r = −0.15–0.16, p < 0.001) and did not correlate with Δenamel thickness (r = 0.02–0.09, p > 0.06). Teeth with BEWE progression revealed a greater increase in ΔSa and ΔStr. These findings suggest that enamel surface roughness can potentially determine ETW severity, and CP-OCT may be relevant for clinically monitoring enamel thickness.

Abstract Background Justice-involved youth have high rates of suicidal behavior and co-morbid psychiatric disorders, yet low rates of service use. Implementation efforts aimed at supporting cross-agency linkage protocols may be useful components of interventions promoting behavioral healthcare service access for youths on probation. The purpose of this study was to develop clear referral Pathways for three suicide risk classifications of youth, across 10 counties in a single state through a community-academic partnership in New York state, a strategic planning process between county Probation departments and community Behavioral Health. Results We sought to clarify service destinations for youth in three classes of risk for suicidal behavior: Class I (Crisis, Imminent Risk); Class II (Crisis, Non-Imminent Risk); and Class III (Non-Crisis but in Need of Service). Prior to Pathway Meetings, there was a low degree of agreement between Probation and Behavioral Health leadership for the appropriate service destination for youths in crisis, whether at imminent risk (Class I: 57.8% overlap) or at lower than imminent risk (Class II: 45.6% overlap). Options for referral destinations for Classes I and II decreased significantly (indicating greater overlap) as a result of Pathway Meetings [(Class I: from 2.5 to 1.1 (t(9) = 3.28, p

Introduction: Readiness to change is a key component of substance use behavioral change; yet little is known about readiness to change among justice-involved young adults. This study 1) describes readiness to change alcohol and drug use and 2) examines predictors of readiness to change alcohol and drug use among justice-involved young adults. Method: Justice-involved young adults (18–24 years; n = 137) who were positive on a validated alcohol and/or drug screening tool completed an interview assessing substance use, readiness to change, and reasons to quit. A multivariable linear regression model examined whether reasons to change and substance use severity, and interactions between these, predicted readiness. Results: More than half of participants were contemplating or had decided to quit/cut down substance use. Personal reasons to quit were positively related to readiness to change; interpersonal reasons were negatively associated. Conclusions: This study contributes information needed to design motivational interventions for substance use among justice-involved young adults. Personal reasons to quit using drugs are a potential intervention target.

Efforts to model and predict energetic electron fluxes in the radiation belts are highly sensitive to local wave-particle interactions. In this study, we use multi-point measurements of precipitating and trapped electron fluxes to investigate the dynamic variation of chorus wave-particle interactions during the 17 March 2013 storm. Quasilinear theory characterizes the chorus wave-particle interaction as a diffusive process, with the diffusion coefficients depending on the particle energy and pitch angle, as well as the background plasma parameters such as the wave intensity and plasma density. These plasma parameters in the radiation belts are spatially localized and time-varying, so we construct event-specific diffusion coefficients using MEPED (onboard POES/MetOp) measurements of electron fluxes at low Earth orbit. This new method provides realistic diffusion coefficients for chorus waves that account for changes in the wave intensity, the plasma density, and the magnetic field strength in the outer radiation belt. We show that the inferred chorus intensity is significantly lower than previous estimates that use MEPED observations since the same amount of increased precipitation by 30–300 keV electrons can be explained by a change in the plasma density. This technique therefore allows for us to create time varying, global maps of the plasma-gyrofrequency ratio (fpe/fce), and therefore plasma density, in the outer radiation belts using the MEPED measurements. The global density estimates compare reasonably well to in situ density measurements from RBSP-B.

In this study an automated composite layup end effector is presented which is the first to be able to find defects in real time during layup using tactile shape sensing. Based around an existing sensor concept developed by the Bristol Robot Laboratory known as the ‘TacTip’, a new end effector is developed, replacing the soft gel core of the original sensor was replaced by a much firmer elastomer, enabling it to apply up to 400N of compaction force. In this paper it is shown to successfully detect typical defects such as wrinkles, foreign objects, layup errors or incorrect material types while simultaneously compacting preimpregnated composite materials over complex mould shapes.

This paper aims to provide a tentative roadmap for ensuring that higher education policy makers and practitioners are apprised of what might be done to advance a concept of socially just assessment praxis. It extends current thinking around the notion of social justice approaches to assessment by further developing the conceptual framework proposed in McArthur's recent work (2016). It does so by extending understandings of how a socially just perspective might be realised. Drawing upon recent conceptual developments within both Universal Design for Learning (UDL) and Culturally Sustaining Pedagogy (CSP), the paper proposes a typology for praxis and organisational change. Crucially, this typology focuses upon enhancing learning outcomes for all learners, but it is particularly concerned with enhancing educational experiences and learning outcomes for students that have been systematically marginalised by the normative procedural practices that have traditionally informed the nature of supposedly objective assessment.

Given the dire consequences of the present global climate crisis, the need for alternative ecologically based economic models could not be more urgent. The economic and environmental concerns of the circular economy are well-developed in the literature. However, there remains a gap in research concerning the circular economy’s impact on culture and social equity. The underdeveloped social and cultural pillars of the circular economy, along with universal policy goals calling for a context- and need-based framework, makes it necessary to bridge natural and social science objectives in the circular economy. Islands can serve as model systems for studying the circular economy. We examine how Hawaiʻi, through the philosophy of aloha ʻāina, the Hawaiian ancestral circular economy, and contemporary community approaches toward advancing Indigenous economic justice can be one model system for understanding principles of circularity and policy advocacy. We introduce the concept of the ancestral circular economy and how aspects of this Indigenous institution can inform the development of universal circular economy policy goals. Furthermore, we present aloha ʻāina as a framework for reciprocal care between human–environment relations while addressing the social and cultural pillars that aid in the development of these dimensions of the circular economy.

Objective: Bladder cancer is rare in young patients and some authors have concluded that this group have a favourable outcome. We aimed to analyse our experience with such patients. Patients and Methods: Patients aged 50 years or younger were identified via a retrospective review of pathology samples between 2016 and 2020. Data regarding demographics, symptoms, stage, grade, size and multifocality at initial transurethral resection, recurrence rate and progression were analysed. Results: 60 patients with an average age of 42 were identified. The majority of patients presented with intermediate-risk non-muscle invasive bladder cancer (NMIBC). Four patients presented with muscle invasive and three with metastatic disease. There were seven deaths. Forty-nine patients with NMIBC were followed-up for an average of 5 years and 2 months. 41% of our cohort did not have a recurrence and only four moved up the risk stratification. No patients under 40 presented with muscle invasive disease and the majority had intermediate risk NMIBC. Conclusion: Young patients typically present with intermediate-risk NMIBC which rarely progresses. Very high-risk disease and aggressive variants do occur and may benefit from upfront cystectomy. The rate of muscle-invasive disease increases with age and rarely occurs under 40. Until more data is readily available, the management of this cohort of patients should follow the well-established guidelines. Level of evidence: 4 (case series) [ABSTRACT FROM AUTHOR]

Abstract Background Justice-involved young adults (JIYA) aged 18–24 are at significant risk for HIV and problematic substance use (SU) but are unlikely to know their HIV status or be linked to HIV or SU treatment and care. Intensive efforts to increase screening and improve linkage to HIV and SU services for JIYA are needed that address youth as well as justice and health/behavioral health system-level barriers. Methods MoveUp is a four-session intervention that integrates evidence-based protocols to promote HIV and STI testing, HIV and SU behavioral risk reduction and engagement in treatment for JIYA. MoveUp is delivered onsite at an alternative sentencing program (ASP) by HIV testing outreach workers from a youth-focused medical and HIV treatment program. N = 450 youth are randomized following baseline assessment into two groups: MoveUp or standard of care. Youth are followed for 12 months following the intervention; unprotected sexual behavior, substance use, HIV and STI testing as well as treatment linkage will be assessed at 3, 6, 9 and 12-months. Discussion This study is one of the first to systematically test an integrated screen/testing, prevention intervention and linkage-to-care services program (MoveUp), using evidence-based approaches to address the overlapping HIV/STI and substance use epidemics in JIYA by providing on-site services to identify HIV/STI and SU risk and treatment need within justice-settings as well as linkage to services in the community. This approach, capitalizing on health and justice partnerships, represents an innovation that can capitalize on missed opportunities for engaging JIYA in health care.

Abstract Background This study examined the national availability of substance use prevention (SUP) within juvenile justice (JJ) and their primary behavioral health (BH) providers, and the relationships between the availability of SUP and agency-level measures of organizational structure, staffing, and youth characteristics. A three-stage national probability sampling process was used to select participants for a national survey that included, among other facets of community supervision (CS) and BH practices, questions on agency characteristics, youth characteristics, whether the agency/provider directly provided SUP services, and whether the agency/provider directly provided substance use and/or mental health treatment. This paper focuses on SUP services along with agency/provider and youth characteristics related to providing SUP. Results The response rate for both CS agencies (n = 195) and BH providers (n = 271) was 96%. Complex samples logistic regression initially examined univariate associations of each variable and identified candidates for a final multivariate model. Overall, only one-third of CS and BH providers reported offering SUP services, with BH providers being significantly more likely than CS agencies to provide SUP services. In addition, likelihood of SUP was significantly lower among agencies where the substance use distribution of the caseload was below the median. Controlling for master’s level staff and the substance use distribution, CS agencies were about 67% less likely to offer SUP when compared to BH providers. Conclusions Given the high rates of substance use among justice-involved youth and that substance use is an established risk for several negative behaviors, outcomes, and health conditions, these findings suggest that evidence-based prevention services should likely be expanded in justice settings, and perhaps included as part of CS programs, even when youth do not initially present with SU service needs.

The MMS satellites encountered a Kelvin-Helmholtz instability (KHI) period in the early non-linear phase at the post-noon flank magnetopause on 8 Sep 2015. The adjacent magnetosheath was characterized by a pre-dominantly northward Bz > 0 magnetic field with weakly positive in-plane components in a GSM coordinate system. Ion velocity distribution functions indicate at least 17 KH vortex intervals with two typically D-shaped ion beam distributions, commonly associated with reconnection exhausts, that stream in both directions along a mostly northward magnetic field at 350–775 km/s with a median 525 km/s ion beam speed. The counter-streaming ion beams are superposed on a core population of slowly drifting magnetosheath ions with a field-aligned 50–200 km/s speed. Each interval lasted no more than 5.25 s with a median duration of 1.95 s corresponding to in-plane spatial scales 3 < ΔS < 22 di assuming a constant 1 di = 61 km ion inertial scale and a tailward VKH∼258 km/s KH vortex propagation speed along the MMS trajectory. The counter-streaming ions are predominantly observed in the warm KH vortex region between the cold magnetosheath proper and the hot isotropic ion temperature of a low-latitude boundary layer as the MMS constellation traverses a KH vortex. The in-plane spatial scales and the locations of the observed counter-streaming ion beams generally agree with the predictions of twice-reconnected magnetic fields at two mid-latitude reconnection (MLR) regions in a two-fluid three-dimensional numerical simulation previously reported for this KH event. MMS typically recorded a higher phase space density of the fast parallel ion beam that we associate with a tailward reconnection exhaust from the southern MLR (SMLR) and a lower phase space density of the fast anti-parallel ion beam that we associate with a tailward reconnection exhaust from the northern MLR (NMLR) of similar speed. This is either consistent with MMS being closer to the SMLR region than the NMLR region, or that the KHI conditions may have favored reconnection in the SMLR region for the observed in-plane magnetosheath magnetic field as predicted by a two-fluid three-dimensional numerical simulation.