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Abstract Background In this “Advancing simulation practice” article, we offer an expose of the involvement of real patients in Objective Structured Clinical Examinations (OSCEs), inviting educators who traditionally involve solely SPs in their summative OSCEs to consider the practice. The need for standardisation in summative assessments can make educators understandably wary to try this, even if the rhetoric to involve real patients is accepted. We offer this as an instance of the tussle between standardisation and validity experienced throughout health professions education. Main text We offer our experience and empirical evidence of this simulation practice, based on an institutional ethnographic examination of the involvement of real patients in summative OSCEs from an undergraduate medical school in the UK. Our critique demonstrates the merits of this approach as an assessment environment closer to the real clinical environments where these soon-to-be doctors interact in a more authentic way with real patients and their illness experiences. We balance this against the extra work required for all involved and suggest the biggest challenge is in the reorientation work required for both Faculty and students who are institutionalised to expect standardisation above all in assessment. Conclusion We advocate for involving real patients in summative OSCEs and hope that readers may feel compelled and empowered to foster this shift in mindset required to introduce this practice into their assessments.

The Gulf of Mexico supports many seabird species, yet data gaps describing species composition and habitat use are prevalent. We used vessel-based observations from the Gulf of Mexico Marine Assessment Program for Protected Species to identify and characterize distinct seabird assemblages in the northern Gulf of Mexico (within the U.S. Exclusive Economic Zone; nGoM). Using cluster analysis of 17 seabird species, we identified assemblages based on seabird relative density. Vessel-based surveys documented the location, species, and number of seabirds across the nGoM between 2017-2019. For each assemblage, we identified the (co-)dominant species, spatial distribution, and areas of greater relative density. We also assessed the relationship of the total relative density within each assemblage with environmental, spatial, and temporal covariates. Of the species assessed, 76% (n = 13) breed predominantly outside the nGoM basin. We identified four seabird assemblages. Two assemblages, one dominated by black tern and the other co-dominated by northern gannet/laughing gull, occurred on the continental shelf. An assemblage dominated by sooty tern occurred along the continental slope into pelagic waters. The fourth assemblage had no dominant species, was broadly distributed, and was composed of observations with low relative density ('singles' assemblage). Differentiation of assemblages was linked to migratory patterns, residency, and breeding location. The spatial distributions and relationships of the black tern and northern gannet/laughing gull assemblages with environmental covariates indicate associations with river outflows and ports. The sooty tern assemblage overlapped an area prone to mesoscale feature formation. The singles assemblage may reflect commuting and dispersive behaviors. These findings highlight the importance of seasonal migrations and dynamic features across the seascape, shaping seabird assemblages. Considering the potential far-ranging effects of interactions with seabirds in the nGoM, awareness of these unique patterns and potential links with other fauna could inform future monitoring, research, restoration, offshore energy, and aquaculture development in this highly industrialized sea.

ObjectiveTo investigate the association between denture wearing and airflow limitation in men in Northern Ireland enrolled in the Prospective Epidemiological Study of Myocardial Infarction (PRIME) study.MethodsA case-control design was used to study partially dentate men. Cases were men aged 58-72 years who were confirmed as denture wearers. Controls were never denture wearers who were matched by age (± 1 month) and smoking habit to the cases. The men had a periodontal assessment and completed a questionnaire detailing their medical history, dental history and behaviours, social circumstances, demographic background and tobacco use. Physical examination and spirometry measurements of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were also undertaken. Spirometry data for edentulous men who wore complete dentures were compared with that recorded for the partially dentate men studied.ResultsThere were 353 cases who were partially dentate and were confirmed denture wearers. They were matched for age and smoking habit to never denture wearer controls. The cases had an FEV1 that was on average 140 ml lower than the controls, p = 0.0013 and a 4% reduction in percent predicted FEV1, p = 0.0022. Application of the GOLD criteria indicated that 61 (17.3%) of the cases had moderate to severe airflow limitation compared with 33 (9.3%) of controls, p = 0.0051. Fully adjusted multivariable analysis showed that partially dentate men who were denture wearers were significantly more likely (p = 0.01) to have moderate to severe airflow reduction with an adjusted odds ratio (OR) of 2.37 (95% confidence intervals 1.23-4.55). In the 153 edentulous men studied moderate to severe airflow limitation was recorded in 44 (28.4%), which was significantly higher than in the partially dentate denture wearers (p = 0.017), and the men who had never worn a denture (pConclusionDenture wearing was associated with an increased risk of moderate to severe airflow limitation in the cohort of middle-aged Western European men studied.

Objective To compare and identify risk factors for distal adding-on (AO) or distal junctional kyphosis (DJK) in adolescent idiopathic scoliosis (AIS) treated by anterior- (ASF) and posterior spinal fusion (PSF) to L3. Methods AIS patients undergoing ASF versus PSF to L3 from 2000–2010 were analyzed. Distal AO and DJK were deemed poor radiographic results. New stable (SV) and neutral vertebra (NV) scores were defined for this study. The total stability (TS) score was the sum of the SV and NV scores. Results Twenty of 42 (ASF group: 47.6%) and 8 of 72 patients (PSF group: 11.1%) showed poor radiographic outcome. Fused vertebrae, correction rate of main curve, coronal reduction rate of L3 were significantly higher in PSF group. Multiple logistic regression results indicated that preoperative SV-3 at L3 in standing and side benders (odds ratio [OR], 2.7 and 3.7, respectively), TS score -5, -6 at L3 (OR, 4.9), rigid disc at L3–4 (OR, 3.7), lowest instrumented vertebra (LIV) rotation > 15° (OR, 3.3), LIV deviation > 2 cm from center sacral vertical line (OR, 3.1) and ASF (OR, 13.4; p

The northern Gulf of Mexico (nGoM) is a globally important region for oil extraction and supports a diverse assemblage of marine birds. Due to their frequent contact with surface waters, diverse foraging strategies, and the ease with which oil adheres to feathers, seabirds are particularly susceptible to hydrocarbon contamination. Given the chronic and acute exposure of seabirds to oiling and a lack of studies that focus on the exposure of seabirds to oiling in sub-tropical and tropical regions, a greater understanding of the vulnerability of seabirds to oil in the nGoM appears warranted. We present an oil vulnerability index for seabirds in the nGoM tailored to the current state of knowledge using new, spatiotemporally expensive vessel-based seabird observations. We use information on the exposure and sensitivity of seabirds to oil to rank seabird vulnerability. Exposure variables characterized the potential to encounter oil and gas (O&G). Sensitivity variables characterized the potential impact of seabirds interacting with O&G and are related to life history and productivity. We also incorporated uncertainty in each variable, identifying data gaps. We found that the percent of seabirds’ habitat defined as highly suitable within 10 km of an O&G platform ranged from 0%-65% among 24 species. Though O&G platforms only overlap with 15% of highly suitable seabird habitat, overlap occurs in areas of moderate to high vulnerability of seabirds, particularly along the shelf-slope. Productivity-associated sensitivity variables were primarily responsible for creating the gradient in vulnerability scores and had greater uncertainty than exposure variables. Highly vulnerable species (e.g., Northern gannet (Morus bassanus)) tended to have high exposure to the water surface via foraging behaviors (e.g., plunge-diving), older age at first breeding, and an extended incubating and fledging period compared to less vulnerable species (e.g., Pomarine jaeger (Stercorarius pomarinus)). Uncertainty related to productivity could be reduced through at-colony monitoring. Strategic seabird satellite tagging could help target monitoring efforts to colonies known to use the nGoM, and continued vessel-based observations could improve habitat characterization. As offshore energy development in the nGoM continues, managers and researchers could use these vulnerability ranks to identify information gaps to prioritize research and focal species.

High levels of stress among occupational therapy graduate students have led to the adoption of unhealthy coping habits such as poor nutrition, little exercise, and disrupted sleep. In response, many institutions have explored programming and even curricular changes to support student well-being. However, very few are built upon a strong theoretical foundation to address holistic well-being. Therefore, this paper describes how logic modeling was used to develop a student well-being program based on Facilitating Learning and Occupational Well-Being Using Research-Based Initiatives for Student Health (FLOURISH), a theoretical approach rooted in the Person-Environment-Occupation Performance Model. A well-being program delivered via a virtual community of practice for entry-level students at a Midwestern occupational therapy program was created to decrease stress and enhance overall well-being for the performance of learning. The program consisted of eight 50-minute sessions that met once per week and included topics of physical, mental, sociocultural, environmental, and occupational well-being. The student well-being program is one viable option that shows promise to empower students with a theoretical approach to address personal and professional well-being, which has the potential to translate into professional practice. In this article, we describe the well-being program and the theoretical approach in detail and illustrate how it can be used to improve occupational therapy student well-being.

Background: Fusobacterium bacteria are fastidious commensals in the human oropharyngeal microbiome. As pathogens, Fusobacterium are associated with diverse infectious and inflammatory conditions, including Lemierre's syndrome, colorectal cancer, and inflammatory bowel disease. Portal and mesenteric thromboses associated with Fusobacterium are case-reportable; due to the rarity of these reports, the full spectrum of presentations and outcomes remains unknown. Case presentation: A 71-year-old man presented with two weeks of abdominal pain and night sweats. He was found to have extensive portal and mesenteric venous thromboses and pancolitis. Initial workup for hypercoagulable risk factors was negative; after discharge, blood cultures became positive for Fusobacterium nucleatum. The patient was treated with antibiotics and anticoagulation with complete resolution of symptoms, thromboses, and colitis. Conclusions: This report demonstrates the protean nature of Fusobacterium-associated disease, which in this patient was portal and mesenteric venous thromboses without oropharyngeal disease. We discuss the modes of transmission, mechanisms of infection, and what remains unknown about the causes and consequences of Fusobacterium-associated disease. This report also demonstrates that cases with atypical abdominal thromboses, despite a negative comprehensive workup, deserve a high suspicion for other causal factors that are not part of standard diagnostic evaluation.

The study objectives were to determine whether ovarian morphology can distinguish between women with regular menstrual cycles, normo-androgenic anovulation (NA-Anov), and PCOS and whether body mass index (BMI)-specific thresholds improved diagnostic potential. Women with PCOS (biochemical and/or clinical hyperandrogenism and irregular cycles; N = 66), NA-Anov (irregular cycles without clinical and/or biochemical hyperandrogenism; N = 64), or regular cycles (controls; cycles every 21–35 days in the absence of clinical or biochemical hyperandrogenism; N = 51) were evaluated. Participants underwent a reproductive history, physical exam, transvaginal ultrasound, and a fasting blood sample. Linear regression analyses were used to assess the impact of BMI on ovarian morphology across groups. The diagnostic performance of ovarian morphology for anovulatory conditions, and by BMI (lean: 2; overweight: ≥25 kg/m2), was tested using Receiver Operating Characteristic (ROC) curves. Follicle number per ovary (FNPO) and ovarian volume (OV), but not follicle number per cross-section (FNPS), increased across controls, NA-Anov, and PCOS. Overall, FNPO had the best diagnostic performance for PCOS versus controls (AUCROC = 0.815) and NA-Anov and controls (AUCROC = 0.704), and OV to differentiate between PCOS and NA-Anov (AUCROC = 0.698). In lean women, FNPO best differentiated between PCOS and controls (AUCROC = 0.843) and PCOS versus NA-Anov (AUCROC = 0.710). FNPS better distinguished between NA-Anov and controls (AUCROC = 0.687), although diagnostic performance was lower than when thresholds were generated using all participants. In women with overweight and obesity, OV persisted as the best diagnostic feature across all analyses (PCOS versus control, AUCROC = 0.885; PCOS versus NA-Anov, AUCROC = 0.673; NA-Anov versus controls, AUCROC = 0.754). Ovarian morphology holds diagnostic potential to distinguish between NA-Anov and PCOS, with marginal differences in diagnostic potential when participants were stratified by BMI suggesting that follicle number may provide better diagnostic performance in lean women and ovarian size in those with overweight.

Thrombocytopenia is common in patients with advanced liver disease. These patients frequently require invasive diagnostic or therapeutic procedures in the setting of thrombocytopenia. A common platelet goal before such procedures is ≥50,000/μL, but target levels vary by provider and the procedure. Platelet transfusion has disadvantages, including safety and cost. No other short‐term options for ameliorating thrombocytopenia before procedures were available until the thrombopoietin receptor agonists were recently approved. Avatrombopag and lusutrombopag can be used in certain patients with thrombocytopenia due to advanced liver disease undergoing elective invasive procedures; these new agents are highly effective in carefully selected patients, and real world data of safety and efficacy are awaited.

In the United States, single smokeless tobacco use continues to increase in conjunction with the dual use of smokeless tobacco and other nicotine products. Problematically, much of the tobacco prevention literature and funding inundates tobacco users with smoking tobacco information while neglecting to provide them any information about smokeless tobacco. Meanwhile, American tobacco companies continually market new and dissolvable tobacco products targeted at non-smokers. New data suggests that smokeless tobacco use is, also, increasing in West Virginia and, in order to address this increased use, the West Virginia Extension Service recently partnered with the Division of Tobacco Prevention in the West Virginia Department of Health and Human Resources to develop a comprehensive spit tobacco curriculum for West Virginia students between third and sixth grade. This article details the development and assessment of the spit tobacco prevention curriculum and the resulting report from the initial pilot of the program. The curriculum was piloted across six counties with the participation of schools, after-school programs and 4-H clubs. After implementation, survey results demonstrate that youth have increased awareness of the health effects of smokeless tobacco. Throughout the article, we explore West Virginia's Cooperative Extension Service's response to this emerging public health issue and release a call to action for the National Cooperative Extension Services to join us in spit tobacco prevention.

Human behaviour will continue to play an important role as the world grapples with public health threats. In this paper, we draw from the emerging evidence on behaviour adoption during diverse public health emergencies to develop a framework that contextualises behaviour adoption vis-à-vis a combination of top-down, intermediary and bottom-up approaches. Using the COVID-19 pandemic as a case study, we operationalise the contextual framework to demonstrate how these three approaches differ in terms of their implementation, underlying drivers of action, enforcement, reach and uptake. We illustrate how blended strategies that include all three approaches can help accelerate and sustain protective behaviours that will remain important even when safe and effective vaccines become more widely available. As the world grapples with the COVID-19 pandemic and prepares to respond to (re)emerging public health threats, our contextual framework can inform the design, implementation, tracking and evaluation of comprehensive public health and social measures during health emergencies.

Because dyspnoea is seldom experienced by healthy people, it can be hard for clinicians and researchers to comprehend the patient’s experience. We collected patients’ descriptions of dyspnoea in their own words during a parent study in which 156 hospitalised patients completed a quantitative multidimensional dyspnoea questionnaire. These volunteered comments describe the severity and wide range of experiences associated with dyspnoea and its impacts on a patients’ life. They provide insights not conveyed by structured rating scales. We organised these comments into the most prominent themes, which included sensory experiences, emotional responses, self-blame and precipitating events. Patients often mentioned air hunger (‘Not being able to get air is the worst thing that could ever happen to you.’), anxiety, and fear (‘Scared. I thought the world was going to end, like in a box.’). Their value in patient care is suggested by one subject’s comment: ‘They should have doctors experience these symptoms, especially dyspnoea, so they understand what patients are going through.’ Patients’ own words can help to bridge this gap of understanding.

The authors outline an innovative certificate program that promotes the Multicultural and Social Justice Counseling Competencies (MSJCC; Ratts, Singh, Massar-McMillan, Butler, & McCullough, 2015) and how counselor education programs can commit to a social justice approach. In addition, the authors provide a detailed summary of the certificate program that requires counselors-in-training to move beyond a multicultural understanding of diverse cultural worldviews so that they commit to becoming social change agents and take action on issues of equality and justice. Limitations and implications for counselor educators are presented.

Abstract Background Although breastfeeding duration in New Zealand’s indigenous Māori is shorter than in non-Māori, we know little about barriers or motivators of breastfeeding in this community. The aim of this analysis was to identify predictors for extended duration of breastfeeding amongst participants drawn from predominantly Māori communities in regional Hawke’s Bay. Methods Mother/baby dyads were recruited from two midwifery practices serving predominantly Māori women in mostly deprived areas, for a randomised controlled trial comparing the risks and benefits of an indigenous sleeping device (wahakura) and a bassinet. Questionnaires were administered at baseline (pregnancy) and at one, three and six months postnatal. Several questions relating to breastfeeding and factors associated with breastfeeding were included. The data from both groups were pooled to examine predictors of breastfeeding duration. Results Māori comprised 70.5% of the 197 participants recruited. The median time infants were fully breastfed was eight weeks and Māori women were more likely to breastfeed for a shorter duration than New Zealand European women with an odds-ratio (OR) of 0.45 (95% CI 0.24, 0.85). The key predictors for extended duration of breastfeeding were the strong support of the mother’s partner (OR = 3.64, 95% CI 1.76, 7.55) or her mother for breastfeeding (OR = 2.47, 95% CI 1.27, 4.82), longer intended duration of maternal breastfeeding (OR = 1.02, 95% CI 1.00, 1.03) and being an older mother (OR = 1.07, 95% CI 1.02, 1.12). The key predictors for shorter duration of breastfeeding were pacifier use (OR = 0.28, 95% CI 0.17, 0.46), daily cigarette smoking (OR = 0.51, 95% CI 0.37, 0.69), alcohol use (OR = 0.54, 95% CI 0.31, 0.93) and living in a more deprived area (OR 0.40, 95% CI 0.22, 0.72). Conclusions Breastfeeding duration in this group of mainly Māori women was shorter than the national average. Increasing the duration of breastfeeding by these mothers could be further facilitated by ante and postnatal education involving their own mothers and their partners in the support of breastfeeding and by addressing pacifier use, smoking and alcohol use.

Abstract Background Environmental cleanliness is one of the contributing factors for surgical site infections in the operating rooms (ORs). To decrease environmental contamination, pulsed xenon ultraviolet (PX-UV), an easy and safe no-touch disinfection system, is employed in several hospital environments. The positive effect of this technology on environmental decontamination has been observed in patient rooms and ORs during the end-of-day cleaning but so far, no study explored its feasibility between surgical cases in the OR. Methods In this study, 5 high-touch surfaces in 30 ORs were sampled after manual cleaning and after PX-UV intervention mimicking between-case cleaning to avoid the disruption of the ORs’ normal flow. The efficacy of a 1-min, 2-min, and 8-min cycle were tested by measuring the surfaces’ contaminants by quantitative cultures using Tryptic Soy Agar contact plates. Results We showed that combining standard between-case manual cleaning of surfaces with a 2-min cycle of disinfection using a portable xenon pulsed ultraviolet light germicidal device eliminated at least 70% more bacterial load after manual cleaning. Conclusions This study showed the proof of efficacy of a 2-min cycle of PX-UV in ORs in eliminating bacterial contaminants. This method will allow a short time for room turnover and a potential reduction of pathogen transmission to patients and possibly surgical site infections.

A substantial number of health-professional graduate students do not follow the national recommendation of obtaining at least seven hours of sleep per day. Decreased sleep duration and quality are strongly associated with daytime sleepiness and dysfunction, academic burnout, low academic performance, and mental health symptoms and disorders. However, limited research exists on sleep health among occupational therapy (OT) graduate students. Thus, the purpose of this study was to explore OT graduate student perspectives on sleep and to measure their sleep duration, quality, and practices to inform sleep promotion strategies for increased student well-being. A mixed-method study with a cross-sectional design was conducted. Occupational therapy graduate student participants engaged in a focus group and completed the Sleep Practices and Attitudes Questionnaire (SPAQ) along with a survey of demographic characteristics. Nineteen participants completed all aspects of the study. Participants slept an average of 6.75 hours per weekday night and rated their sleep quality an average of 3.47 out of 5 on a Likert scale (1: restless; 5: restful). The majority of participants (68.4%; n=13) reported feeling unrefreshed upon waking, and 78.9% (n=15) reported tiredness during the day. Three major themes emerged from the focus group data: 1) sleep prioritization and practice, 2) sleep knowledge versus action, and 3) occupational balance. This study is one of the first to assess sleep health among OT graduate students. Findings contribute to sleep health literature and may guide programming in sleep health promotion and graduate student well-being.

Focused thoracic ultrasound has become essential in the guidance and direction of pleural interventions to reduce unwanted complications and as a result now forms a crucial component of physician training. Current training standards along with assessment methods vary widely, and are often not robust enough to ensure adequate competence. This review assesses the current state of training and assessment of thoracic ultrasound competence in various settings, allowing comparison with alternative competency based programmes. Future directions for training and assessment of thoracic ultrasound competence are discussed.

Fetal macrosomia is associated with a number of health complications for both mother and infant in the immediate, short, and long-term. Maternal obesity and excessive gestational weight gain (GWG) have long been associated with fetal macrosomia, however the impact of maternal lifestyle factors such as dietary intake and energy balance, in combination with the timing and composition of weight gain, have been less studied. It is also clear that although maternal obesity and excessive GWG increase the risk of fetal macrosomia independently, the risk is magnified with the presence of both risk factors, suggesting that interventions to control GWG may be particularly important for obese women. Association studies examining the relationship between fetal nutrient availability, epigenetic modifications, and infant anthropometrics are also required. This review provides an overview of the current evidence examining the role of maternal lifestyle factors on the prevalence of fetal macrosomia and identifies areas where further research is required in order to inform the design of appropriate intervention strategies.

Urinary continence can be achieved in up to 90% of patients with bladder exstrophy. However, select patients remain incontinent despite modern reconstruction. Repeat operations for continence combined with the congenital pelvic abnormalities of exstrophy put patients at risk for urinary fistula formation. We report the use of a rectus muscle flap in the repair of two concomitant vesicocutaneous and urethrocutaneous fistulae in a patient with classic bladder exstrophy.

During 2018, four free-ranging conures, from a naturalized flock in San Francisco, presented with a characteristic set of neurologic signs that had been reported in other individuals from this flock. The cause of morbidity or mortality in historic cases has not been identified. From these four subjects, fresh feces were collected during their initial days of hospitalization and submitted to the University of Georgia Infectious Diseases Laboratory and Center for Applied Isotope Studies for bromethalin and desmethyl-bromethalin quantitation. Using High Performance Liquid Chromatography, the laboratory detected bromethalin, a non-anticoagulant, single-dose rodenticide, in fecal samples from three subjects; half of these samples were also positive for desmethyl-bromethalin, bromethalin's active metabolite. In three subjects that died, the UGA laboratory screened brain and liver samples and found bromethalin in all samples; desmethyl-bromethalin was detected in all but one brain sample, which was below the detection limit. Our findings suggest the conures are more resistant to bromethalin than are other species in which bromethalin has been studied, and/or that the conures may be ingesting the toxin at a sublethal dose. More data is needed to better assess the long-term effects of bromethalin on animals exposed at the subacute/chronic levels, and also to better understand the compartmentalization of bromethalin and desmethyl-bromethalin in a wider variety of species.

Objectives: Intravenous fluid (IV) therapy is an important component of care for many hospital patients, especially in perioperative and acute care settings. However, errors in fluid composition and dosing can be life-threatening. To achieve competent professional performance, i.e., accurate and fluent, it is vitally important that medical students receive effective training in IV fluid therapy. Methods: In this study, we explored how Precision Teaching (PT), a behaviour analytic teaching method, can enhance outcomes of usual medical education techniques. A total of 178 third-year medical students participated in the study during the IV fluid therapy training week. All students completed a multiple-choice test pre- and post-training. In addition to standard IV fluid therapy teaching, the experimental intervention group (n=83 students) used SAFMEDS (Say All Fast MinuteEvery Day Shuffled) cards approximately 3-5 times per day for 5 days. The other 95 students (control group) received teaching as usual, but did not undergo the additional training. Results: Results show that the SAFMEDS boosted performance of the intervention group on the MCQ by 20 percentage points when compared to the control group. Fluency (accuracy and speed) of performance on SAFMED trials increased markedly during the intervention week and there was evidence that weaker students benefitted in particular. Conclusions: Implications for medical education are outlined.

North American Black Terns (Chlidonias niger) breed primarily in the Prairie Pothole region of southern Canada and the northern United States, winter in Central and South American waters, and often migrate through the northern Gulf of Mexico (nGoM). This species has exhibited long-term population declines and is exposed to a myriad of anthropogenic threats in the nGoM, including oil spills, with an estimated 800-1,000 injured during the Deepwater Horizon oil spill, yet historical studies of Black Terns' use of the nGoM are sparse, with inconsistent spatial and temporal coverage. Using vessel-based observations collected from 2017 to 2019, we characterize Black Tern spatial and temporal occurrence in marine waters of the nGoM. We develop 2 separate habitat models: one describing spatial and temporal aspects of Black Terns occurrence and the other describing the relative density when present. In 10 months of survey effort, January-October, we observed Black Terns in 7 (Mar-May and Jul-Oct), predominantly on the continental shelf at Key words: habitat models, migration, nonbreeding, seasonality, vessel-based observations. (French)--Les guifettes noires d'Amerique du Nord (Chlidonias niger) se reproduisent principalement dans la region des Prairies Pothole du sud du Canada et du nord des Etats-Unis, hivernent dans les eaux d'Amerique centrale et du Sud et migrent souvent a travers le nord du golfe du Mexique (nGoM). Cette espece a montre des declins de population a long terme et est exposee a une myriade de menaces anthropiques dans le nGoM, y compris les marees noires, avec environ 800 a 1 000 individus blesses lors de la maree noire de Deepwater Horizon, mais des etudes historiques sur l'utilisation du nGoM par les guifettes noires sont rares, avec une couverture spatiale et temporelle incoherente. A l'aide d'observations basees sur des navires recueillies de 2017 a 2019, nous caracterisons l'occurrence spatiale et temporelle de la guifette noire dans les eaux marines du nGoM. Nous developpames deux modeles d'habitat distincts: l'un decrivant les aspects spatiaux et temporels de l'occurrence des guifettes noires et l'autre decrivant la densite relative lorsqu'elles sont presentes. Au coure des 10 mois d'enquetes, de janvier a octobre, nous observames des guifettes noires en sept mois (de mars a mai et de juillet a octobre), principalement sur le plateau continental a Mots-cles: migration, modeles d'habitat, non-reproduction, observations basees sur des navires, saisonnalite., The North American Black Terns (Chlidonias niger) are the only obligate wetland-breeding terns in the New World. Black Terns breed primarily in the Prairie Pothole Region with small populations distributed [...]

This case study examines new literacy opportunities and practices of 28 Latino/a children from grades one to seven in a South Texas colonia, or unincorporated area. Data sources were 24-hour literacy logs, two rounds of interviews, and participant observations. The children reported limited school work related to digital literacies; the technology they accessed outside of school focused on entertainment, communication with friends, and mostly non-challenging video games. We discuss participants’ ingenious ways of circumventing any lack of access, their underlying social practices of community sharing, and Thirdspace possibilities of the tutorial center that respondents attended.

Kathy M Hageman1, Etienne Karita2, Kayitesi Kayitenkore2, Roger Bayingana2, Ariane van der Straten3, Rob Stephenson4, Martha Conkling5, Amanda Tichacek1, Lawrence Mwananyanda5, William Kilembe5, Alan Haworth6, Elwyn Chomba6, Susan A Allen11Rwanda Zambia HIV Research Group, Emory University, Atlanta, Georgia, USA; 2Projet San Francisco, Kigali, Rwanda; 3Women’s Global Health Imperative, RTI International, San Francisco, USA; 4Rollins School of Public Health, Emory University, Atlanta, Georgia, USA; 5Zambia Emory HIV Research Project, Lusaka, Zambia; 6University Teaching Hospital, Lusaka, Zambia Objective: To compare responses to a sexual behavioral survey of spouses in cohabiting heterosexual relationships in Kigali, Rwanda.Design: Cross-sectional survey.Methods: Husbands and wives in 779 cohabiting couples were interviewed separately with parallel questionnaires. Participants were recruited from a three-year old cohort of 1458 antenatal clinic attendees enrolled in a prospective study in 1988. Analyses compared responses at the gender- and couple-level for agreement and disagreement.Results: Couples were in disagreement more than agreement. Women reported occasionally refusing sex, suggesting condom use, and believing married men were unfaithful. Men reported being in a faithful relationship, greater condom use, and being understanding when his wife refused sex. Agreement included relationship characteristics, safety of condoms, and whether condoms had ever been used in the relationship. Disagreement included the preferred timing of next pregnancy, desire for more children, and whether a birth control method was currently used and type of method.Conclusions: Rwandan husbands and wives differed in sexual behavior and reproductiverelated topics. Couple-level reporting provides the most reliable measure for relationship aspects as couples’ agreement cannot be assumed among cohabiting partnerships. Furthermore, HIV prevention programs for couples should incorporate communication skills to encourage couple agreement of HIV-related issues.Keywords: HIV, couples, counseling and testing, agreement and disagreement, sexual behavior, condom use, and pregnancy

The distribution of α6/α3 integrin in adhesion complexes at the basal membrane in human normal and cancer prostate glands was analyzed in 135 biopsies from 61 patients. The levels of the polarized α6/α3 integrin expression at the basal membrane of prostate tumor glands were determined by quantitative immunohistochemistry. The α6/α3 integrin expression was compared with Gleason sum score, pathological stage, and preoperative serum prostate-specific antigen (PSA). The associations were assessed by statistical methods. Eighty percent of the tumors expressed the α6 or α3 integrin and 20% was integrin-negative. Gleason sum score, but not serum PSA, was associated with the integrin expression. Low Gleason sum score correlated with increased integrin expression, high Gleason sum score with low and negative integrin expression. Three prostate tumor phenotypes were distinguished based on differential integrin expression. Type I coexpressed both α6 and α3 subunits, type II exclusively expressed a6 integrin, and type III expressed α3 integrin only. Fifteen cases were further examined for the codistribution of vinculin, paxillin, and CD 151 on frozen serial sections using confocal laser scanning microscopy. The α6/α3 integrins, CD151, paxillin, and vinculin were present within normal glands. In prostate carcinoma, α6 integrin was colocalized with CD 151, but not with vinculin or paxillin. In tumor phenotype I, the α6 subunit did not colocalize with the α3 subunit indicating the existence of two different adhesion complexes. Human prostate tumors display on their cell surface the α6β1 and/or α3β1 integrins. Three tumor phenotypes associated with two different adhesion complexes were identified, suggesting a reorganization of cell adhesion structures in prostate cancer.

Haemophilus influenzae (Hi) can cause meningitis and other serious invasive disease. Encapsulated Hi is classified into six serotypes (a-f) based on chemical composition of the polysaccharide capsule; unencapsulated strains are termed nontypeable Hi (NTHi). Hi serotype b (Hib) was the most common cause of bacterial meningitis in children in the pre-Hib vaccine era, and secondary transmission of Hi among children (e.g., to household contacts and in child care facilities) (1,2) led to the Advisory Committee on Immunization Practices (ACIP) recommendation for antibiotic chemoprophylaxis to prevent Hib disease in certain circumstances.* High Hib vaccination coverage since the 1990s has substantially reduced Hib disease, and other serotypes now account for most Hi-associated invasive disease in the United States (3). Nevertheless, CDC does not currently recommend chemoprophylaxis for contacts of persons with invasive disease caused by serotypes other than Hib and by NTHi (non-b Hi). Given this changing epidemiology, U.S. surveillance data were reviewed to investigate secondary cases of invasive disease caused by Hi. The estimated prevalence of secondary transmission was 0.32% among persons with encapsulated Hi disease (≤60 days of one another) and 0.12% among persons with NTHi disease (≤14 days of one another). Isolates from all Hi case pairs were genetically closely related, and all patients with potential secondary infection had underlying medical conditions. These results strongly suggest that secondary transmission of non-b Hi occurs. Expansion of Hi chemoprophylaxis recommendations might be warranted to control invasive Hi disease in certain populations in the United States, but further analysis is needed to evaluate the potential benefits against the risks, such as increased antibiotic use.

BackgroundInvasive species threaten the productivity and stability of natural and managed ecosystems. Predicting the spread of invaders, which can aid in early mitigation efforts, is a major challenge, especially in the face of climate change. While ecological niche models are effective tools to assess habitat suitability for invaders, such models have rarely been created for invasive pest species with rapidly expanding ranges. Here, we leveraged a national monitoring effort from 543 sites over 3 years to assess factors mediating the occurrence and abundance of brown marmorated stink bug (BMSB, Halyomorpha halys), an invasive insect pest that has readily established throughout much of the United States.ResultsWe used maximum entropy models to estimate the suitable habitat of BMSB under several climate scenarios, and generalized boosted models to assess environmental factors that regulated BMSB abundance. Our models captured BMSB distribution and abundance with high accuracy, and predicted a 70% increase in suitable habitat under future climate scenarios. However, environmental factors that mediated the geographical distribution of BMSB were different from those driving abundance. While BMSB occurrence was most affected by winter precipitation and proximity to populated areas, BMSB abundance was influenced most strongly by evapotranspiration and solar photoperiod.ConclusionOur results suggest that linking models of establishment (occurrence) and population dynamics (abundance) offers a more effective way to forecast the spread and impact of BMSB and other invasive species than simply occurrence-based models, allowing for targeted mitigation efforts. Implications of distribution shifts under climate change are discussed. © 2022 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Cocaine-cue associations induce synaptic plasticity with long lasting molecular and cellular changes in the amygdala, a site crucial for cue-associated memory mechanisms. The underlying neuroadaptations can include marked alterations in signaling via dopamine (DA) receptors (DRs) and metabotropic glutamate (Glu) receptors (mGluRs). Previously, we reported that DR antagonists blocked forms of synaptic plasticity in amygdala slices of Sprague-Dawley rats withdrawn from repeated cocaine administration. In the present study, we investigated synaptic plasticity induced by exogenous DA and its dependence on mGluR signaling and a potential role for phospholipase D (PLD) as a downstream element linked to mGluR and DR signaling. Utilizing a modified conditioned place preference (CPP) paradigm as a functional behavioral measure, we studied the neurophysiological effects after two-weeks to the last cocaine conditioning. We recorded, electrophysiologically, a DR-induced synaptic potentiation in the basolateral to lateral capsula central amygdala (BLA-lcCeA) synaptic pathway that was blocked by antagonists of group I mGluRs, particularly, the PLD-linked mGluR. In addition, we observed 2-2.5 fold increase in PLD expression and 3.7-fold increase in basal PLD enzyme activity. The enhanced PLD activity could be further stimulated (9.3 fold) by a DA D1-like (D1/5R) receptor agonist, and decreased to control levels by mGluR1 and PLD-linked mGluR antagonists. Diminished CPP was observed by infusion of a PLD-linked mGluR antagonist, PCCG-13, in the amygdala 15 minutes prior to testing, two weeks after the last cocaine injection. These results imply a functional interaction between D1/5Rs, group I mGluRs via PLD in the amygdala synaptic plasticity associated with cocaine-cues.

In this work, we compare two methods for evaluating and quantifying pulmonary airspace enlargement in a mouse model of chronic cigarette smoke exposure. Standard stereological sample preparation, sectioning, and imaging of mouse lung tissues were performed for semi-automated acquisition of mean linear intercept (L(m)) data. After completion of the L(m) measurements, D(2), a metric of airspace enlargement, was measured in a blinded manner on the same lung images using a fully automated technique developed in-house. An analysis of variance (ANOVA) shows that although L(m) was able to separate the smoke-exposed and control groups with statistical significance (p = 0.034), D(2) was better able to differentiate the groups (p

BackgroundThe COVID-19 pandemic has likely had a negative impact on rehabilitation and quality of life (QoL) research in multiple sclerosis (MS).MethodWe explored perceived barriers to research among 87 researchers, representing 18 countries, both prior to and since COVID-19.ResultsA Wilcoxon signed-rank test found that significantly more researchers reported experiencing barriers to research since the onset of the pandemic compared to pre-COVID-19 (p