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Abstract Aerobic and resistance exercise during and after cancer treatment are important for health-related outcomes, however treatment-specific barriers may inhibit adherence. We explored the effect of lower-frequency exercise training on fitness, body composition, and metabolic markers (i.e. glucose and lipids) in a group of recently diagnosed breast cancer patients. Fifty-two females ≥ 18 years with stage I–IIIB breast cancer were instructed to attend 2 cardiovascular and strength training sessions/week over 12 weeks, but program length was expanded as needed to accommodate missed sessions. Pre- and post-intervention, we measured: (1) cardiovascular fitness, (2) isometric strength, (3) body composition (dual-energy X-ray absorptiometry), and (4) fasting glucose, insulin, c-peptide, and lipids. Pre-intervention, participants were 53 ± 10 years old (mean ± SD) and overweight (BMI: 27.5 ± 5.4 kg m−2, 40.1 ± 6.5% body fat). Forty participants completed the program over a median 20 weeks (range: 13–32 weeks, median frequency: 1.2 sessions/week), over which predicted VO2peak improved by 7% (2.2[0.1–4.4] mL/kg/min) (delta[95% CI]), and strength increased by 7–9% (right arm: 2.3[0.1–4.5] N m; right leg: 7.9[2.1–13.7] N m; left leg: 7.8[1.9–13.7] N m). Body composition and metabolic markers were unchanged. An exercise frequency of 1.2 sessions/week stimulated significant improvements in fitness, and may represent a practical target for patients during active treatment.

Abstract Background Food may trigger Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms. Therefore, an elimination diet (ED) might be an effective treatment for children with ADHD. However, earlier studies were criticized for the nature of the control group, potential confounders explaining the observed effects, unsatisfactory blinding, potential risks of nutritional deficiencies and unknown long term and cost-effectiveness. To address these issues, this paper describes the rationale, study design and methods of an ongoing two arm randomized controlled trial (RCT) comparing the short (5 week) and long term (1 year) effects of an elimination diet and a healthy diet compared with care as usual (CAU) in children with ADHD. Methods A total of N = 162 children (5–12 years) with ADHD will be randomized to either an ED or a healthy diet. A comparator arm including N = 60 children being solely treated with CAU (e.g. medication) is used to compare the effects found in both dietary groups. The two armed RCT is performed in two youth psychiatry centers in the Netherlands, with randomization within each participating center. The primary outcome measure is response to treatment defined as a ≥ 30% reduction on an ADHD DSM-5 rating scale (SWAN) and/or on an emotion dysregulation rating scale (SDQ: dysregulation profile). This is assessed after 5 weeks of dietary treatment, after which participants continue the diet or not. Secondary outcome measures include the Disruptive Behavior Diagnostic Observational Schedule (DB-DOS), parent and teacher ratings of comorbid symptoms, cognitive assessment (e.g. executive functions), school functioning, physical measurements (e.g. weight), motor activity, sleep pattern, food consumption, nutritional quality of the diet, adherence, parental wellbeing, use of health care resources and cost-effectiveness. Assessments take place at the start of the study (T0), after five weeks (T1), four months (T2), eight months (T3) and 12 months of treatment (T4). T0, T1 and T4 assessments take place at one of the psychiatric centers. T2 and T3 assessments consist of filling out online questionnaires by the parents only. Discussion This RCT will likely contribute significantly to clinical practice for ADHD by offering insight into the feasibility, nutritional quality, (cost-)effectiveness and long term effects of dietary treatments for ADHD. Trial registration www.trialregister.nl , NTR5434 . Registered at October 11th, 2015.

Abstract Background The post-COVID syndrome (PCS) has a large impact on an individual’s daily life. The wide variety of symptoms in PCS patients and the fact that it is still relatively new makes it difficult for general practitioners (GPs) to recognize, diagnose and treat patients with PCS, leading to difficulties in assessing and fulfilling healthcare needs. It is largely unknown what the experiences of Dutch patients and GPs are with PCS and, therefore, we gained insight into the different aspects of living with PCS and the associated healthcare needs. Methods Semi-structured interviews were performed with 13 self-reported PCS patients (varying in sex, age, education, and health literacy) and 6 GPs (varying in gender, age, and type of practice) between January-July 2022. Patients and GPs were most likely unrelated (not in the same practices). The data have been analysed using the Thematic Analysis method. Results Experiences appeared to vary between two types of PCS patients that emerged during the interviews: (1) individuals with good pre-existing health status (PEHS) who are severely affected by PCS and have difficulty recovering and (2) individuals with poorer PEHS whose health became even poorer after COVID-19 infection. The interviews with PCS patients and GPs revealed two main themes, in which the types of patients differed: (1) aspects of living with PCS; individuals with good PEHS mainly experience symptoms when overstimulated, while individuals with poorer PEHS generally feel exhausted continuously. (2) Healthcare experiences; GPs emphasized that individuals with good PEHS seem to benefit from support in distributing their energy by careful planning of daily activities, whereas individuals with poorer PEHS require support in activation. Patients and GPs emphasised the importance of taking patients seriously and acknowledging their symptoms. Finally, the patients interviewed indicated that some GPs doubted the existence of PCS, resulting in insufficient recognition. Conclusion Awareness of the differences in needs and experiences of the two types of PCS patients could contribute to more appropriate care. Acknowledgement of PCS by GPs as a real syndrome is important for patients and plays an important role in coping with or recovering from PCS. A multidisciplinary person-centred approach is important and can be coordinated by a GP.

BackgroundSome of those infected with SARS-CoV-2 suffer from post-COVID syndrome (PCS). However, an uniform definition of PCS is lacking, causing uncertainty about the prevalence and nature of this syndrome. We aimed to improve understanding of PCS by operationalizing different classifications and to explore clinical subtypes.MethodsWe used data from Nivel Primary Care database from 2019-2020 which consists of electronic health records (EHR) from general practices (GPs) combined with sociodemographic data for n = 10,313 individuals infected with the SARS-CoV-2. In addition, data from n = 276 individuals who had been infected with the SARS-CoV-2 in 2021, collected via a longitudinal survey, was used. In the GP-EHR data, we operationalized two classifications of PCS (based on symptoms and diagnosis recorded in GP-EHR data and healthcare utilization 3-12 months after acute infection) to calculate frequency and characteristics and compared this to the survey results. In a subgroup of the EHR data we conducted community detection analyses to explore clinical subtypes of PCS.ResultsThe frequency of PCS was 15% with on average 4.6 symptoms for which the GP was consulted using the narrow definition and 32% with on average 6.8 symptoms for the broad definition. Across all methods and classifications, the mean age of individuals with PCS was around 53 years and they were more often female. There were small sex differences in the type of symptoms and overall symptoms were persistent for 6 months. The community detection analysis revealed three possible clinical subtypes.DiscussionWe showed that frequency rates of PCS differ between methods and data sources, but characteristics of the affected individuals are relatively stable. Overall, PCS is a heterogeneous syndrome affecting a substantial group of individuals who need adequate care. Future studies should focus on care trajectories and qualitative measures such as quality of life of individuals living with PCS.

The recent emergence of generative AI technologies is beginning to shape workforce hiring practices. The shift towards skills-based hiring over degree-based hiring has sparked concerns over the ability of college graduates to be prepared for their career roles. One approach to equip students to work with technology and adapt to rapidly changing environments is the development of an entrepreneurial mindset. One way to cultivate entrepreneurial thinking is through the participatory action research methodology, photovoice. This study explores how photovoice promotes discovery, evaluation, and exploitation of opportunities in university engineering classrooms. For this study, a literature review was conducted to identify, evaluate, and interpret available research. For the review, a five-step process was used. This process included defining a search criterion, constructing a Boolean logic search query, inserting the query into multiple academic search engines/databases, screening and selecting articles, and categorizing and mapping the literature. The review’s findings were organized based on the type of study, participants, duration of study and photovoice interventions used, study outcomes, and entrepreneurial mindset development. The results discussed in this paper offer insights, guidance, recommendations, and future directions for engineering education research.

Integrated care demands a workforce that is confident, capable and compassionate. This is dependent on a willingness to work inter-professionally and understand the roles, standards and values of other professional groups. However, there are few examples of integrated care initiatives within higher education that aim to build the knowledge and skills required to support effective integrated, people-centred care. While satisfying, working in the helping professions is emotionally challenging and for students’ these challenges are often underestimated. Some students struggle through their studies with many failing to complete and others drop out in the early years of their careers. Understanding what supports students to thrive in their professional roles is essential to retention of a highly skilled integrated workforce. To address this challenge, this paper outlines a conceptual framework designed to promote a pedagogical environment focused on creating the conditions for integrated working. The framework is based on the “student lifecycle”, from starting to see the benefits of a career in the helping professions, developing a sense of belonging through to thriving and succeeding as future practitioners. It outlines how students are supported to develop emotional resilience, inter-professional empathy and reflexivity to help them stay and stay well in their careers.

As photovoltaics (PV), also known as solar electricity, has been growing over the years, the energy markets have been gradually moving toward decentralization. However, recent media accusations suggest that decentralized renewable energy is slowly becoming unpopular because of the hidden fees being charged to owners of installed PV systems. In response, this paper investigates the potential for alternative approaches to incentivize owners using peer-to-peer (P2P) sharing. This study provides an analytical comparison between the use of the P2P mechanism, the net-metering mechanism, and a combination of these in the commercial sector. Through the use of a simulation, this case study presents the possible outcomes of the implementation of these models in a microgrid. Using technical and economic indexes the comparison was made by looking at the following indexes: peak power, energy balance, economic benefit, and transaction index. Based on a microgrid of 28 commercial buildings, readings of consumption were taken at intervals of one hour, and a Python model was made to find PV size and compare trading mechanisms. It was found that the combination of P2P and net-metering had the best overall performance, followed by net-metering itself, with the best season being all for both, and summer for net-metering by itself. This shows that a P2P model implemented in a microgrid helps create more energy balance, although the combination would achieve the highest performance. This study can be used by policymakers for proposing renewable energy policies and regulations that are more beneficial to all prosumers and consumers.

Efforts to measure and regulate groundwaters and irrigators are notoriously ineffective. The starting point of this article, therefore, is to question the continued faith in techno-managerial solutions to groundwater depletion. We discuss the potential of the conceptual vocabulary of ‘care’ to complement, refresh and expand ways of talking about and doing groundwater governance. Mobilizing a diverse range of examples from places where pressures on aquifers are particularly acute, we do this by exploring what care entails in everyday practices of groundwater use and management. We show that foregrounding care nuances and sometimes challenges stories of users unavoidably depleting aquifers when given the chance and means to do so. Irrigators may display concern about the longer-term sustainability of the aquifers on which their livelihoods depend, even when their own pumping practices are unsustainable. In spite of pressures to intensify and individualize, farmers sometimes do hold on to or creatively develop collective rules to fairly share groundwater and use it sustainably, complementing strategies to make do with what is available with investments in conservation and recharge. Attention to care, moreover, highlights the ongoing processes of tinkering that governing groundwater always entails. The ability to tinker hinges on intimate and often embodied knowledge of a watery place. Accepting the care involved in governing groundwater, our analysis therefore concludes, prompts a re-consideration of what is and who has water expertise, with important implications for the role of ‘outside’ experts. More than a new theory, we propose embracing care as an analytical sensibility, with the study of practices of care serving as one promising way to widen the conceptual and political space for understanding and doing human-groundwater relations.

Immunotherapy profoundly changed the landscape of cancer therapy by providing long-lasting responses in subsets of patients and is now the standard of care in several solid tumor types. However, immunotherapy activity beyond conventional immune checkpoint inhibition is plateauing, and biomarkers are overall lacking to guide treatment selection. Most studies have focused on T cell engagement and response, but there is a growing evidence that B cells may be key players in the establishment of an organized immune response, notably through tertiary lymphoid structures. Mechanisms of B cell response include antibody-dependent cellular cytotoxicity and phagocytosis, promotion of CD4+ and CD8+ T cell activation, maintenance of antitumor immune memory. In several solid tumor types, higher levels of B cells, specific B cell subpopulations, or the presence of tertiary lymphoid structures have been associated with improved outcomes on immune checkpoint inhibitors. The fate of B cell subpopulations may be widely influenced by the cytokine milieu, with versatile roles for B-specific cytokines B cell activating factor and B cell attracting chemokine-1/CXCL13, and a master regulatory role for IL-10. Roles of B cell-specific immune checkpoints such as TIM-1 are emerging and could represent potential therapeutic targets. Overall, the expanding field of B cells in solid tumors of holds promise for the improvement of current immunotherapy strategies and patient selection.

The demand for sustainable development is rapidly increasing with the need to create cleaner and greener products for consumers and producers alike. In line with this need, sustainability has become integral to entrepreneurship research. Although sustainability-focused entrepreneurship programs are offered at higher education institutions, gaps remain in identifying novel approaches to combining sustainability and entrepreneurship in university programs. To overcome these gaps, this study provides an approach to redefining how sustainability-based entrepreneurship can be taught in a virtual environment using a cross-institution initiative involving instructors and students from multiple countries and disciplinary backgrounds to provide students with opportunities to solve complex sustainability-based problems affecting society. A post-assessment survey (including open-ended questions related to skill development, intercultural learning, virtual learning, and debrief) was administered to better understand student perceptions of learning and engagement. The qualitative data were analyzed using thematic inductive analysis resulting in three key themes (learning outcomes, supportive learning environment, and intercultural challenges). The Discussion and Conclusion sections highlight implications for practitioners, contributions to the literature, and limitations/future research. Pedagogical strategies for educators and program designers are provided.

Groundwater is essential for early-season agriculture in many arid regions. In such regions, however, groundwater recharge is generally low, leading to groundwater degradation. State responses are seldom effective in addressing this issue, which leads to fatalist narratives of the unsustainability of profitable agricultural growth and the collapse of aquifers. We argue that such narratives make it difficult to recognise more promising instances in which communities find solutions to groundwater degradation. We call for a fine-grained analysis of the social practices around the use of groundwater, which, we argue, represent a process of commoning. We do so while recognising that the collective action of communities is embedded in an intricate set of relations with other stakeholders including the state, and that the positive environmental and transformative social change that is often associated with commoning cannot be taken for granted at the outset. Building on the case of the arid Drâa Valley in Morocco where watermelon production has expanded rapidly, we illustrate how the process of commoning evolves through different social practices, including: 1) the use of new farming practices that reveal the potential of the aquifer; 2) the representation of the aquifer as severely degraded and the development of a narrative around it being a collective good to be protected against outsiders; 3) the defining and negotiating of rules to control groundwater access and use; and 4) the engagement in negotiations and the resolving of conflicts. Our analysis shows that commoning, as performed by young local farmers, is about extending the lifespan of the aquifer for agricultural production rather than preserving it indefinitely; however, an examination of commoning practices also reveals the capacity of the community to change the course of the future.

Fossil fuels, the predominant energy source in the United States, have been identified as major contributors to environmental pollution through the release of harmful emissions. As a countermeasure, there has been an increasing focus on the exploration and development of cleaner energy alternatives to alleviate the environmental degradation caused by fossil fuels and to satisfy the growing energy needs. This study conducted scenario analyses to evaluate the impact of integrating solar energy into specific US power grids on reducing carbon emissions. The analysis encompassed electrical systems within California, New England, New York, and the Southwest, utilizing datasets from the Energy Information Administration and National Renewable Energy Laboratory. The Energy Information Administration dataset includes information on net generation according to each source and carbon emissions according to fuel type, whereas the National Renewable Energy Laboratory dataset provides hourly projections for 6000 theoretical photovoltaic installations and detailed solar energy output data every five minutes over a year. Our findings indicated a notable decrease in carbon dioxide emissions following the introduction of solar power facilities. The most significant reductions were observed in the Southwest and California, attributed to solar plant integration. Conversely, New York and New England were identified as regions requiring additional policy measures and incentives to meet the emission reduction goals.

Abstract Background We aimed to determine the safety and efficacy of nintedanib, an oral anti-angiogenic tyrosine kinase inhibitor, in combination with pembrolizumab, an anti-PD1 immunotherapy, in patients with advanced solid tumors (PEMBIB trial; NCT02856425). Methods In this monocentric phase Ib dose escalation cohort, we evaluated escalating doses of nintedanib (Dose level 1 (DL1) = 150 mg bid [bis in die, as twice a day]; DL2 = 200 mg bid, oral delivery) in combination with pembrolizumab (200 mg Q3W, IV). Patients received a 1-week lead-in dose of nintedanib monotherapy prior starting pembrolizumab. The primary objective was to establish the maximum tolerated dose (MTD) of the combination based on dose limiting toxicity (DLT) occurrence during the first 4 weeks. Secondary objectives were to assess the anti-tumor efficacy and to identify the associated immune and angiogenic parameters in order to establish the recommended nintedanib dose for expansion cohorts. Flow cytometry (FC), Immuno-Histo-Chemistry (IHC) and electrochemiluminescence multi-arrays were prospectively performed on baseline & on-treatment tumor and blood samples to identify immune correlates of efficacy. Results A total of 12/13 patients enrolled were evaluable for DLT (1 patient withdrew consent prior receiving pembrolizumab). Three patients at 200 mg bid experienced a DLT (grade 3 liver enzymes increase). Four patients developed grade 1–2 immune related adverse events (irAE). Eight patients died because of cancer progression. Median follow-up was 23.7 months (95%CI: 5.55–40.5). Three patients developed a partial response (PR) (ORR = 25%) and five patients (42%) had durable clinical benefit (DCB), defined as PR or stable disease (SD) ≥ 6 months. At baseline, patients with DCB had higher plasma levels of Tie2, CXCL10, CCL22 and circulating CD4+ PD1+ OX40+ T cells than patients without DCB. Patients with DCB presented also with more DC-LAMP+ dendritic cells, CD3+ T cells and FOXP3+ Tregs in baseline tumor biopsies. For DCB patients, the nintedanib lead-in monotherapy resulted in higher blood CCL3, Tregs and CCR4+ CXCR3+ CXCR5− memory CD4 T cells. After the first pembrolizumab infusion, patients with DCB showed lower IL-6, IL-8, IL-27 plasma levels. Conclusion Nintedanib 150 mg bid is the recommended dose for combination with pembrolizumab and is currently investigated in multiple expansion cohorts. Early tumoral and circulating immune factors were associated with cancer outcome under nintedanib & pembrolizumab therapy. Trial registration ClinicalTrials.gov, NCT02856425 . Registered August 4, 2016 — Prospectively registered.

Oases in North Africa have undergone significant change over the past 30 years, contributing to the emergence of new issues and practices. Irrigated farms are increasingly developing outside of historical oases, in lands previously reserved for extensive livestock. This article is a contribution to the knowledge of these issues in the Toudgha Valley in south-eastern Morocco. Its objective is to analyse the heterogeneity of these expanding farms without limiting the issues to a model of land grabbing by large investors. Based on a qualitative survey of 49 farms, our results show that there are three types of farms. The first is a small farms where people move to look for housing and new work opportunities at other farms. The second is a medium farms where farmers seek to reproduce three-layered crop production and have more land than in historical oases. The last type is a large farms where investors settle and intensify their production. This typology, far from being fixed, allows us to reflect on the dynamics of these extensions.

Abstract Background Proenkephalin A 119-159 (penKid) has been suggested as a marker of renal failure and poor outcome. We aimed to investigate the association of penKid on ICU admission with organ dysfunction and mortality in a mixed ICU population. In this retrospective, observational study, admission penKid levels from prospectively collected blood samples of consecutive patients admitted to four Swedish ICUs were analysed. The association of penKid with day-two sequential organ failure assessment (SOFA) scores and 30-day mortality was investigated using (ordinal) logistic regression. The predictive power of penKid for 30-day mortality and dialysis was assessed using the area under the receiver operating characteristic curve (AUC). Results Of 1978 included patients, 632 fulfilled the sepsis 3-criteria, 190 had a cardiac arrest, and 157 had experienced trauma. Admission penKid was positively associated with 30-day mortality with an odds ratio of 1.95 (95% confidence interval 1.75–2.18, p < 0.001), and predicted 30-day mortality in the entire ICU population with an AUC of 0.71 (95% confidence interval 0.68–0.73) as well as in the sepsis, cardiac arrest and trauma subgroups (AUCs of 0.61–0.84). Correction for admission plasma creatinine revealed that penKid correlated with neurological dysfunction. Conclusion Plasma penKid on ICU admission is associated with day-two organ dysfunction and predictive of 30-day mortality in a mixed ICU-population, as well as in sepsis, cardiac arrest and trauma subgroups. In addition to being a marker of renal dysfunction, plasma penKid is associated with neurologic dysfunction in the entire ICU population, and cardiovascular dysfunction in sepsis.

The gut microbiota has been reported to regulate the efficacy of cancer therapy. Here, the authors show that short-chain fatty acids, which are generated through bacterial fermentation, increases immune tolerance leading to resistance to anti-CTLA-4 immunotherapy in mice and patients with metastatic melanoma.

Background The phase II NIVOREN GETUG-AFU 26 study reported safety and efficacy of nivolumab in patients with metastatic clear cell renal cell carcinoma (m-ccRCC) in a ‘real-world setting’. We conducted a translational-research program to determine whether specific circulating immune-cell populations and/or soluble factors at baseline were predictive of clinical outcomes in patients with m-ccRCC treated with nivolumab within the NIVOREN study.Methods Absolute numbers of 106 circulating immune-cell populations were prospectively analyzed in patients treated at a single institution within the NIVOREN trial with available fresh-whole-blood, using dry formulation panels for multicolor flow cytometry. In addition, a panel of 14 predefined soluble factors was quantified for each baseline plasma sample using the Meso-Scale-Discovery immunoassay. The remaining patients with available plasma sample were used as a validation cohort for the soluble factor quantification analysis. Tumor immune microenvironment characterization of all patients included in the translational program of the study was available. The association of blood and tissue-based biomarkers, with overall survival (OS), progression-free survival (PFS) and response was analyzed.Results Among the 44 patients, baseline unswitched memory B cells (NSwM B cells) were enriched in responders (p=0.006) and associated with improved OS (HR=0.08, p=0.002) and PFS (HR=0.54, p=0.048). Responders were enriched in circulating T follicular helper (Tfh) (p=0.027) and tertiary lymphoid structures (TLS) (p=0.043). Circulating NSwM B cells positively correlated with Tfh (r=0.70, p

ObjectiveTo examine the effect of family and perceived organizational support on the relationship between nurse adaptability and their experience with COVID-related PTSD (post-traumatic stress disorder) symptoms in frontline nurses working on COVID-19 units.BackgroundProximity to and survival of life-threatening events contribute to a diagnosis of PTSD, which is characterized by avoidance of reminders of trauma, intrusive thoughts, flashbacks of events, sleep disturbances, and hypervigilance. Using the job-demands and resource model, we examined the effect of adaptability, family support, and perceived organizational support on PTSD symptoms for nurses during the COVID-19 pandemic. Specifically, we tested whether perceptions of environmental supports—i.e., family and organizational support—moderated the relationship between nurse adaptability and COVID-related PTSD symptoms.MethodsA sample of frontline nurses working on COVID-19 units during the COVID-19 pandemic in Texas (N = 277) participated in this cross-sectional, observational study. Frontline Nurses reported demographic information and completed surveys designed to measure adaptability, perceived organizational support, family support, and COVID-related PTSD symptoms.ResultsAdaptability was significantly positively correlated (medium effects) to perceived organizational and family support (r = 0.51 and 0.56, respectively, p < 0.01). Adaptability and perceived organizational support were also negatively correlated with COVID-related PTSD symptoms (medium effects). Adaptability was negatively correlated with COVID-related PTSD symptoms, supporting Hypothesis 1 (r = −0.43, p < 0.01). Perceived organizational support was also significantly negatively correlated with COVID-19-related PTSD symptoms (r = −0.30, p < 0.01). Family support was not significantly correlated with COVID-related PTSD but was positively related to experiencing COVID-related PTSD after other variables were accounted for.ConclusionFindings suggest that individual adaptability and organizational support may reduce PTSD severity in frontline nurses working during a crisis; however, family support may increase PTSD symptoms. We provide suggestions for strengthening individual adaptability and healthcare leadership including remaining highly engaged to show support by providing rapid communication, remaining calm during difficult circumstances, and maintaining a consistent, physical presence during difficult times. Moreover, our results suggest additional support for nurses with families to adapt to crisis.

Background Programmed cell death protein-1 (PD-1) expression has been associated with activation and exhaustion of both the CD4 and CD8 populations in advanced non-small cell lung cancer (aNSCLC). Nevertheless, the impact of the balance between circulating CD8+PD-1+ and CD4+PD-1+ in patients treated with immune checkpoint blockers (ICB) is unknown.Methods The CD8+PD-1+ to CD4+PD-1+ ratio (PD-1-Expressing Ratio on Lymphocytes in a Systemic blood sample, or ‘PERLS’) was determined by cytometry in fresh whole blood from patients with aNSCLC before treatment with single-agent ICB targeting PD-1 or programmed cell death-ligand 1 (PD-L1 (discovery cohort). A PERLS cut-off was identified by log-rank maximization. Patients treated with ICB (validation cohort) or polychemotherapy (control cohort) were classified as PERLS+/− (above/below cut-off). Circulating immune cell phenotype and function were correlated with PERLS. A composite score (good, intermediate and poor) was determined using the combination of PERLS and senescent immune phenotype as previously described in aNSCLC.Results In the discovery cohort (N=75), the PERLS cut-off was 1.91, and 11% of patients were PERLS+. PERLS + correlated significantly with median progression-free survival (PFS) of 9.63 months (95% CI 7.82 to not reached (NR)) versus 2.69 months (95% CI 1.81 to 5.52; p=0.03). In an independent validation cohort (N=36), median PFS was NR (95% CI 7.9 to NR) versus 2.00 months (95% CI 1.3 to 4.5; p=0.04) for PERLS + and PERLS−, respectively; overall survival (OS) followed a similar but non-significant trend. In the pooled cohort (N=111), PERLS + correlated significantly with PFS and OS. PERLS did not correlate with outcome in the polychemotherapy cohort. PERLS did not correlate with clinical characteristics but was significantly associated with baseline circulating naïve CD4+ T cells and the increase of memory T cells post-ICB treatment. Accumulation of memory T cells during treatment was linked to CD4+ T cell polyfunctionality. The composite score was evaluated in the pooled cohort (N=68). The median OS for good, intermediate and poor composite scores was NR (95% CI NR to NR), 8.54 months (95% CI 4.96 to NR) and 2.42 months (95% CI 1.97 to 15.5; p=0.001), respectively. The median PFS was 12.60 months (95% CI 9.63 to NR), 2.58 months (95% CI 1.74 to 7.29) and 1.76 months (95% CI 1.31 to 4.57; p

While coral reefs in Australia have historically been a showcase of conventional management informed by research, recent declines in coral cover have triggered efforts to innovate and integrate intervention and restoration actions into management frameworks. Here we outline the multi-faceted intervention approaches that have developed in Australia since 2017, from newly implemented in-water programs, research to enhance coral resilience and investigations into socio-economic perspectives on restoration goals. We describe in-water projects using coral gardening, substrate stabilisation, coral repositioning, macro-algae removal, and larval-based restoration techniques. Three areas of research focus are also presented to illustrate the breadth of Australian research on coral restoration, (1) the transdisciplinary Reef Restoration and Adaptation Program (RRAP), one of the world’s largest research and development programs focused on coral reefs, (2) interventions to enhance coral performance under climate change, and (3) research into socio-cultural perspectives. Together, these projects and the recent research focus reflect an increasing urgency for action to confront the coral reef crisis, develop new and additional tools to manage coral reefs, and the consequent increase in funding opportunities and management appetite for implementation. The rapid progress in trialling and deploying coral restoration in Australia builds on decades of overseas experience, and advances in research and development are showing positive signs that coral restoration can be a valuable tool to improve resilience at local scales (i.e., high early survival rates across a variety of methods and coral species, strong community engagement with local stakeholders). RRAP is focused on creating interventions to help coral reefs at multiple scales, from micro scales (i.e., interventions targeting small areas within a specific reef site) to large scales (i.e., interventions targeting core ecosystem function and social-economic values at multiple select sites across the Great Barrier Reef) to resist, adapt to and recover from the impacts of climate change. None of these interventions aim to single-handedly restore the entirety of the Great Barrier Reef, nor do they negate the importance of urgent climate change mitigation action.

Abstract Technology and innovation are essential for students to not only learn and understand the technical skills, but also identify a problem, discover a solution, and communicate the value proposition. In this study, innovation-thinking frameworks were integrated into undergraduate transdisciplinary engineering and technology classrooms with a topic of food science and technology, exploring design within the area of new product development. The qualitative analysis, conducted using NVivo, indicated that the food science and technology focused educational experiences had the potential of transforming student self-reported perspectives related to metacognitive reflection, connecting the topics to the real-world and communicating. The findings offer exciting insights into the benefit of integrating self-regulated learning, visualization, and communication technology into future food-related education programs.

In 2019, the United Nations Environment Assembly requested that the United Nations Environment Programme (UNEP) and the International Coral Reef Initiative (ICRI) define best practices for coral restoration. Guidelines led by the UNEP were prepared by a team of 20 experts in coral reef management, science, and policy to catalog the best-available knowledge in the field and provide realistic recommendations for the use of restoration as a reef management strategy. Here, we provide a synthesis of these guidelines. Specifically, we present (1) a case for the value of coral reef restoration in the face of increasing frequency and intensity of disturbances associated with climate change, (2) a set of recommendations for improving the use of coral reef restoration as a reef management strategy, tailored to goals and current methods. Coral reef restoration can be a useful tool to support resilience, especially at local scales where coral recruitment is limited, and disturbances can be mitigated. While there is limited evidence of long-term, ecologically relevant success of coral reef restoration efforts, ongoing investments in research and development are likely to improve the scale, and cost-efficiency of current methods. We conclude that coral reef restoration should not be seen as a “silver bullet” to address ecological decline and should be applied appropriately, with due diligence, and in concert with other broad reef resilience management strategies.

In this paper we present a situated analysis of the implications of the COVID-19 pandemic on the life of small-scale farmers and agricultural laborers in India, Algeria, and Morocco. We draw on data collected through phone interviews since April 2020. Inspired by feminist scholars, we analyze our findings thinking with—and entangling—the concepts of intersectionality, resilience and care. We firstly document the material impacts of the lockdown measures, focusing particularly on the experiences of single women farmers and laborers, whose livelihood and well-being have been notably compromised. Secondly, we unfold how different agricultural actors have come up with inventive ways to respond to the unexpected situation which they are facing. In doing so, we highlight the importance of considering the multiple and entangled socionatural challenges, uncertainties, and marginalizations that different agricultural actors experience, as well as the transformative potential of their inventive practices, which are often motivated and informed by notions of care.

This article examines the entrepreneurial behaviour of the youth in urban and rural settings in Morocco. Based on the European research project SAHWA (2013–2016), and using a mixed methodology approach (ethnographic fieldwork and survey), an attempt is made to understand the strategies young Moroccans resort to in order to turn their situation of "marginalisation" in society into entrepreneurial initiatives. What does entrepreneurship mean for young people in Morocco, and how do they forge and employ their entrepreneurial strategies to live and survive? The survey and the three case studies set out in this paper show that despite being able to launch and develop both agricultural and commercial businesses, young Moroccans remain extremely vulnerable.

Background: Companion animals may reduce depression and loneliness in socially isolated homebound older adults. However, whether owning a cat or dog is more beneficial in this population remains unknown. Materials and Methods: Pet attachment and the levels of depressive symptoms and loneliness were examined in 39 homebound older adults who exclusively owned a cat(s) or a dog(s). Cat owners (n = 12) and dog owners (n=27) were assessed for depressive symptoms (Geriatric Depression Scale-Short Form), loneliness (R-UCLA Loneliness Scale), and attachment to pets (Likert scale). Results: Cat owners reported significantly lower levels of depressive symptoms than dog owners (t= 2.12; p = 0.04). There were no significant differences between cat owners and dog owners in regards to levels of loneliness (t = -0.83; p = 0.41). Both cat owners and dog owners reported a high level of attachment to pets (Median=10 of 10). Conclusions: Although this study provides preliminary evidence that owning a cat to which one is attached is associated with lower levels of depressive symptoms than owning a dog to which one is attached in homebound older adults, the findings should be replicated with longitudinal studies. Findings from such studies may assist homebound older adults in selecting either a cat or dog as a companion pet.

Coral reef ecosystems are under increasing pressure from local and regional stressors and a changing climate. Current management focuses on reducing stressors to allow for natural recovery, but in many areas where coral reefs are damaged, natural recovery can be restricted, delayed or interrupted because of unstable, unconsolidated coral fragments, or rubble. Rubble fields are a natural component of coral reefs, but repeated or high-magnitude disturbances can prevent natural cementation and consolidation processes, so that coral recruits fail to survive. A suite of interventions have been used to target this issue globally, such as using mesh to stabilise rubble, removing the rubble to reveal hard substrate and deploying rocks or other hard substrates over the rubble to facilitate recruit survival. Small, modular structures can be used at multiple scales, with or without attached coral fragments, to create structural complexity and settlement surfaces. However, these can introduce foreign materials to the reef, and a limited understanding of natural recovery processes exists for the potential of this type of active intervention to successfully restore local coral reef structure. This review synthesises available knowledge about the ecological role of coral rubble, natural coral recolonisation and recovery rates and the potential benefits and risks associated with active interventions in this rapidly evolving field. Fundamental knowledge gaps include baseline levels of rubble, the structural complexity of reef habitats in space and time, natural rubble consolidation processes and the risks associated with each intervention method. Any restoration intervention needs to be underpinned by risk assessment, and the decision to repair rubble fields must arise from an understanding of when and where unconsolidated substrate and lack of structure impair natural reef recovery and ecological function. Monitoring is necessary to ascertain the success or failure of the intervention and impacts of potential risks, but there is a strong need to specify desired outcomes, the spatial and temporal context and indicators to be measured. With a focus on the Great Barrier Reef, we synthesise the techniques, successes and failures associated with rubble stabilisation and the use of small structures, review monitoring methods and indicators, and provide recommendations to ensure that we learn from past projects.

Coral reef ecosystems have suffered an unprecedented loss of habitat-forming hard corals in recent decades. While marine conservation has historically focused on passive habitat protection, demand for and interest in active restoration has been growing in recent decades. However, a disconnect between coral restoration practitioners, coral reef managers and scientists has resulted in a disjointed field where it is difficult to gain an overview of existing knowledge. To address this, we aimed to synthesise the available knowledge in a comprehensive global review of coral restoration methods, incorporating data from the peer-reviewed scientific literature, complemented with grey literature and through a survey of coral restoration practitioners. We found that coral restoration case studies are dominated by short-term projects, with 60% of all projects reporting less than 18 months of monitoring of the restored sites. Similarly, most projects are relatively small in spatial scale, with a median size of restored area of 100 m2. A diverse range of species are represented in the dataset, with 229 different species from 72 coral genera. Overall, coral restoration projects focused primarily on fast-growing branching corals (59% of studies), and report survival between 60 and 70%. To date, the relatively young field of coral restoration has been plagued by similar 'growing pains' as ecological restoration in other ecosystems. These include 1) a lack of clear and achievable objectives, 2) a lack of appropriate and standardised monitoring and reporting and, 3) poorly designed projects in relation to stated objectives. Mitigating these will be crucial to successfully scale up projects, and to retain public trust in restoration as a tool for resilience based management. Finally, while it is clear that practitioners have developed effective methods to successfully grow corals at small scales, it is critical not to view restoration as a replacement for meaningful action on climate change.

Military veterans transitioning from active duty to civilian life often face challenges during the reintegration process. Reintegration can become more difficult when a veteran is coping with posttraumatic stress disorder (PTSD) and its sequelae. Interventions are urgently needed to support veterans during times of transition. Animal-assisted interventions (AAI) show promise in reducing stress, depression, and improving wellbeing in marginalized populations. Equine-assisted interventions (EAI), in particular, are gaining momentum as a treatment option for veterans with PTSD. To synthesize current evidence on the use of EAI as a treatment option in military veterans formally diagnosed with PTSD. A comprehensive, electronic review of the literature was performed. Inclusion criteria were original quantitative or qualitative research, written in English, use of human participants, published through July 2019. The total number of studies included was nine. Main findings were that the efficacy of EAI on PTSD symptoms were equally mixed with both significant and non-significant findings. Data largely trended in the hypothesized direction for improving mental health states, resiliency, social function, quality of life, biological and behavioral measures, however, overall findings did not reach statistical significance. The investigation of EAI as an adjunct treatment for PTSD in military veterans may be effective, however, we cannot make a clear determination based on current evidence. Although findings largely trended in the hypothesized direction, most were not significant (except for PTSD symptoms) and warrant additional research to understand the effectiveness of EAI as an adjunct treatment in military veterans with PTSD.

Disability disclosure contains significant implications when considering democratic educational opportunities for students with disabilities in higher education. Especially for graduate students with disabilities, there is minimal research on their experiences with disability disclosure. In a collaborative autoethnography, two doctoral students with disabilities engage in a critical dialogue about how disability disclosure operates within everyday interactions. Through dialogue and praxis, our narratives highlight how acts of disability disclosure continuously construct the notion of disability, democracy, citizenship, and empowerment in higher education. In turn, critical reexaminations of disability disclosure may present insight into future directions that will ensure equal educational opportunities, attainment and achievements for all.

The underrepresentation of American Indian (AI) students pursuing higher education opportunities continues to persist. This study sought to measure the perceived changes in participants’ self-efficacy and confidence in navigating the college environment as a result of their participation in a mentoring program and addressed the research question “How does mentoring contribute to changes in tribal college students reported self-efficacy?” Nineteen participants who had participated in a semester-long mentoring program were given a retrospective pre- then post-program survey to measure changes in participants’ perceived confidence in navigational and informational skills related to college success. Participants reported a significantly higher level of awareness in the post-program survey than they did in the pre-program survey across all of the mentoring program goals with the exception of one goal. In addition, there were no reported differences in AI and non-AI participants’ and Science, Technology, Engineering, and Mathematics (STEM)/non-STEM responses on the five scaled variables for the mentoring survey. Providing support early on in a student’s educational career allows for the establishment of student connections with peers, support personnel, and resources that they can turn to for help in academics or setting goals. Additionally, early support provides encouragement and a sense of belief in themselves, which is critical to student success.

Higher education provides plenty of opportunity for theory and in many cases, even the ability to apply theory in a laboratory setting. Yet, there remains limited opportunity for students to learn by doing through participation in authentic learning experiences. The purpose of this paper is to provide one potential solution for integrating authentic learning into the engineering classroom by cultivating the entrepreneurial mindset. As entrepreneurship serves as an integral part of the economy, developing an entrepreneurial mindset through authentic learning experiences is essential for engineers. While online discussion prompts represent a useful way for educators to facilitate student learning, less is known about how to facilitate online discussions in a way that truly cultivates an entrepreneurial mindset for engineering students. In this paper, the key intentions of entrepreneurially-minded learning are reviewed, and a guide for creating online discussions applicable to any engineering course is presented. Example online discussion prompts incorporating the entrepreneurial mindset are then shared from an Introduction to Engineering course. Results from a mixed methods survey instrument suggests positive impacts towards student perceptions of online discussions and development of the entrepreneurial mindset. Recommendations for effectively and efficiently facilitating online discussions for entrepreneurially-minded learning in the engineering classroom are offered.

Outbreaks of the crown-of-thorns starfish (Acanthaster cf. solaris, COTS) are one of the primary causes of coral decline in the Indo-Pacific region. Effective methods to control COTS outbreaks may therefore be one of the most direct and immediate ways to reduce coral loss. However, the cost and logistical challenges associated with current control methods have undermined the effectiveness of many control efforts. In this study, we tested the feasibility of using powdered citric acid, which is widely available and low-cost, as an injection chemical for COTS control. We tested what combination of concentration, number of injections, volume, and water type were most efficient at killing COTS. All COTS injected in two or four sites died, irrespectively of the concentration of citric acid used, while single injections failed at reaching 100% mortality. The fastest combination was the injection of 150 g·L−1 citric acid solution in four injection sites (5 mL per site), which killed the starfish in 26.4 ± 4 h. These results suggest that injections of powdered citric acid are an effective, economical, and widely available alternative to current COTS control methods.

Introduction: Although many homebound older adults cope well using various resources, including religious coping strategies, some experience prolonged and unresolved psychosocial distress resulting in biological disruptions, such as hypercortisolism and increased inflammation, which are suggested mechanisms of decreased executive function. Purpose: To examine relationships of religious coping, psychosocial factors (stress, depression, loneliness), salivary biomarkers (cortisol, C-reactive protein (CRP), Interleukin-1β), and executive function. Methods: Data were collected cross-sectionally from 88 older adults (mean age 75.3). Religious coping, stress, depression, loneliness, and cognitive function were measured with standardized instruments, and saliva samples were collected for salivary cortisol, CRP, and IL-1β. Results: Negative religious coping significantly and positively correlated with stress, depression, and loneliness (r = 0.46, r = 0.21, r = 0.47, all p < 0.05); positive religious coping significantly and negatively correlated with depression and loneliness (r = −0.29, r = −0.23, both p < 0.05); and greater loneliness significantly predicted greater CRP (p < 0.05). For executive function, IL-1β showed a significant positive correlation (r = 0.23, p = < 0.05). Discussion: Our findings fill gaps related to biobehavioral interactions of religious coping and cognitive health in the aging population. Future research should include additional psychosocial and biobehavioral variables in larger samples of diverse and vulnerable populations. Collective findings may be able to identify particularly vulnerable subgroups of population, ultimately with tailored interventions to prevent cognitive decline.