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Indigenous communities in the North American Arctic are characterized by mixed economies that feature hunting, fishing, gathering, and trapping activities-and associated sharing practices-alongside the formal wage economy. The region is also undergoing rapid social, economic, and climate changes, including, in Canada, carbon taxation, which is impacting the cost of fuel used in local food harvesting. Because of the importance of local foods to nutrition, health, and well-being in Arctic Indigenous communities, there is an urgent need to better understand the sensitivity of Arctic food systems to social, economic, and climate changes and to develop plans for mitigating potential adverse effects. Here, we develop a Bayesian model to calculate the substitution value and carbon emissions of market replacements for local food harvests in the Inuvialuit Settlement Region, Canada. Our estimates suggest that under plausible scenarios, replacing locally harvested foods with imported market substitutes would cost over 3.1 million Canadian dollars per year and emit over 1,000 tons of CO 2 -equivalent emissions per year, regardless of the shipping scenario. In contrast, we estimate that gasoline inputs to harvesting cost approximately $295,000 and result in 315 to 497 tons of emissions. These results indicate that climate change policies that fail to account for local food production may undermine emissions targets and adversely impact food security and health in Arctic Indigenous communities, who already experience a high cost of living and high rates of food insecurity., Competing Interests: Competing interests statement:This article was developed from an impact report completed by E.R. under contract for the Inuvialuit Regional Corporation.

Competing Interests: Tracy Jansen Cheney: advisory board work for Gilead; Pierre Giguere: speaking honoraria and/or advisory board work for ViiV, Gilead, Merck, Pfizer; Deborah Kelly: speaking honoraria and/or advisory board work for ViiV, Gilead, Moderna; Dominic Martel: speaking honoraria and/or advisory board work for AbbVie, Gilead, Paladin and Pfizer; Carley Pozniak: speaking honoraria and advisory board work for Viiv, Gilead, Merck; Linda Robinson: speaker/educational honoraria, ViiV, Gilead, Merck; Jonathan Smith: advisory board work for ViiV; Alice Tseng: speaking honoraria and/or advisory board work for ViiV, Gilead, Merck, Pfizer.

Background: In British Columbia, antiretrovirals (ARVs) for HIV treatment (HIV-Tx) and pre-exposure prophylaxis (PrEP) are free-of-charge through publicly-funded Drug Treatment Programs (DTPs). When available, less costly generics are substituted for brand-name ARVs. We describe the incidence and type of product substitution issue (PSI) adverse drug reactions (ADRs) attributed to generic ARVs., Methods: Cohorts included DTP clients ≥19 years who received generic ARVs for HIV-Tx (abacavir-lamivudine, emtricitabine-tenofovir DF, efavirenz-emtricitabine-tenofovir DF, atazanavir or darunavir between 01 Jun 2017 and 30 Jun 2022) or PrEP (emtricitabine-tenofovir DF, 01 Apr 2018 to 30 Jun 2022). Demographic, ARV and ADR data were extracted from DTP databases and summarized by descriptive statistics. PSI incidence was calculated for each product during the year following brand-to-generic and generic-to-generic transitions (first-year-post-rollout), and compared between generic versions using generalized estimating equations. For context, incidence of any ARV product-related ADR was calculated in the same 1-year periods., Results: During first-year-post-rollout periods, 5339 HIV-Tx (83% male, median age 52 years) and 8095 PrEP (99% male, median 33 years) clients received generic ARVs, and reported 78 and 23 generic PSIs, respectively. PSI incidence was <1% for most generic ARVs, with mild-moderate symptoms including gastrointestinal upset, headache, dizziness, fatigue/malaise and skin rash. In HIV-Tx clients, the efavirenz-containing product had higher PSI incidence than other ARVs (2.2%, p = .004), due to more neuropsychiatric adverse reactions. Any ADR incidence was stable across measurement periods, and generic PSIs represented less than one third of all product-related ADRs., Conclusions: Generic substitution of antiretrovirals for HIV-Tx and PrEP was well tolerated, with ≤2% incidence of mild-moderate PSI ADRs., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JSGM’s Treatment as Prevention (TasP®) research, paid to his institution, has received support from the BC Ministry of Health, Health Canada, Canadian Institutes of Health Research, Public Health Agency of Canada, Genome Canada, Genome BC, Vancouver Coastal Health and VGH Foundation. Institutional grants have been provided by Gilead Sciences Inc, Janssen, Merck Sharp & Dohme LLC, and ViiV Healthcare. MH has received honoraria, administered by the institution, for consulting fees and advisory board participation from Gilead Sciences Canada, Merck Canada, and ViiV Healthcare. All other authors declare they have no conflicts of interest.

In the Arctic, seasonal variation in the accessibility of the land, sea ice and open waters influences which resources can be harvested safely and efficiently. Climate stressors are also increasingly affecting access to subsistence resources. Within Inuit communities, people differ in their involvement with subsistence activities, but little is known about how engagement in the cash economy (time and money available) and other socio-economic factors shape the food production choices of Inuit harvesters, and their ability to adapt to rapid ecological change. We analyse 281 foraging trips involving 23 Inuit harvesters from Kangiqsujuaq, Nunavik, Canada using a Bayesian approach modelling both patch choice and within-patch success. Gender and income predict Inuit harvest strategies: while men, especially men from low-income households, often visit patches with a relatively low success probability, women and high-income hunters generally have a higher propensity to choose low-risk patches. Inland hunting, marine hunting and fishing differ in the required equipment and effort, and hunters may have to shift their subsistence activities if certain patches become less profitable or less safe owing to high costs of transportation or climate change (e.g. navigate larger areas inland instead of targeting seals on the sea ice). Our finding that household income predicts patch choice suggests that the capacity to maintain access to country foods depends on engagement with the cash economy. This article is part of the theme issue 'Climate change adaptation needs a science of culture'.

The purpose of this article was to report on the findings of the note frequency and velocity measures during Improvised Active Music Therapy (IAMT) sessions with individuals with Parkinson's disease (PD). In this single-subject multiple baseline design across subjects, the article reports the note frequency (note count) and velocity of movement (mean note velocity) played by three right-handed participants while playing uninterrupted improvised music on a simplified electronic drum-set. During baseline, the music therapist played rhythmic accompaniment on guitar using a low-moderate density of syncopation. During treatment, the Music Therapist introduced rhythms with a moderate-high density of syncopation. The music content of the sessions was transformed into digital music using a musical instrument digital interface. Results of this study indicated that all participants exhibited an increase in note count during baseline until reaching a plateau at treatment condition and were found to be significantly positively correlated with the Music Therapist's note count. All participants played more notes with upper extremity (UE) across conditions than with lower extremity. All participants also scored similar total mean velocity across conditions. Two participants demonstrated higher mean note velocity with UE than right foot, whereas the other participant did not demonstrate this difference. Two participants also exhibited greater mean note velocity variability with left foot within and across conditions. More research is required to identify commonalities in note count and mean note velocity measures in individuals with PD during IAMT sessions., (© The Author(s) 2023. Published by Oxford University Press on behalf of American Music Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The population of people living with HIV is aging, and with aging come emergent comorbidities, including osteoporosis, for which screening and treatment are becoming increasingly important. Osteoporosis prevalence among those living with HIV is 3 times greater than among HIV-uninfected controls., Objective: To assess and describe osteoporosis risk factors, screening, diagnosis, and treatment for people 50 years of age or older living with HIV and receiving care at a multidisciplinary HIV primary care clinic., Methods: A retrospective chart review of people 50 years of age or older living with HIV was conducted at the John Ruedy Clinic in Vancouver, British Columbia, between June 1, 2016, and June 1, 2019. Patients who had had fewer than 2 yearly follow-up appointments were excluded., Results: A total of 146 patients were included in the analysis; most were male ( n = 134, 92%), and the median age was 55 years. Patients had a median of 3 osteoporosis risk factors (in addition to age and HIV infection), and 145 patients had at least 1 risk factor. All screening for osteoporosis was conducted by dual-energy X-ray absorptiometry (DXA). Thirty-nine (27%) of the patients were screened with DXA, 92 (63%) were not screened, and 15 (10%) already had a diagnosis of osteoporosis. The DXA screening identified osteoporosis in an additional 10 patients and osteopenia in 22 patients. Treatments for patients with osteoporosis included bisphosphonates ( n = 15, 60%) and vitamin D or calcium (or both), without any other medications ( n = 4, 16%). In the overall study population, 32 (22%) of the patients were taking calcium and 46 (32%) were taking vitamin D., Conclusions: Many patients aged 50 years or older and receiving HIV care at the John Ruedy Clinic had or were at risk for osteoporosis. An opportunity exists to increase screening and treatment of these individuals. A multidisciplinary team may be crucial in achieving this goal., Competing Interests: Competing interests: None declared., (2022 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.)

Objectives: With our diverse training, theoretical and empirical toolkits, and rich data, evolutionary and biological anthropologists (EBAs) have much to contribute to research and policy decisions about climate change and other pressing social issues. However, we remain largely absent from these critical, ongoing efforts. Here, we draw on the literature and our own experiences to make recommendations for how EBAs can engage broader audiences, including the communities with whom we collaborate, a more diverse population of students, researchers in other disciplines and the development sector, policymakers, and the general public. These recommendations include: (1) playing to our strength in longitudinal, place-based research, (2) collaborating more broadly, (3) engaging in greater public communication of science, (4) aligning our work with open-science practices to the extent possible, and (5) increasing diversity of our field and teams through intentional action, outreach, training, and mentorship., Conclusions: We EBAs need to put ourselves out there: research and engagement are complementary, not opposed to each other. With the resources and workable examples we provide here, we hope to spur more EBAs to action., (© 2021 Wiley Periodicals LLC.)

Objective: Human dimensions of climate change research in the Arctic often proposes ways for local communities to adapt to changes to their environment, foregrounding problems posed by climate change while treating social, political, and economic factors as background conditions. We explore the relevance of this research paradigm for Inuit by examining how Inuit from Kangiqsujuaq present and discuss the major issues facing their community., Methods: We thematically code and analyze the responses of 107 Inuit to three free-response questions about the problems facing their community and the best things about their community. The data were collected as part of a questionnaire for a project focused on food security and food sharing conducted in Kangiqsujuaq, Nunavik, in 2013 to 2014., Results: Few respondents mentioned issues relating to climate change among the most pressing problems faced by their community. Rather, a suite of interconnected social and economic issues, particularly substance abuse and the cost of living, emerged as the main concerns of Kangiqsujuarmiut. However, the environment was a central theme in respondents' favorite thing about their community., Conclusions: In light of the concerns identified by Inuit, we argue that much research on climate change makes incorrect a priori assumptions and consequently fails to capture aspects of Arctic socioecological systems that are essential for how Inuit are responding to climate change. An inductive, open-ended approach can help produce research more relevant to communities., (© 2020 The Authors. American Journal of Human Biology published by Wiley Periodicals LLC.)

The idea of adaptation, in which an organism or population becomes better suited to its environment, is used in a variety of disciplines. Originating in evolutionary biology, adaptation has been a central theme in biological anthropology and human ecology. More recently, the study of adaptation in the context of climate change has become an important topic of research in the social sciences. While there are clearly commonalities in the different uses of the concept of adaptation in these fields, there are also substantial differences. We describe these differences and suggest that the study of climate-change adaptation could benefit from a re-integration with biological and evolutionary conceptions of human adaptation. This integration would allow us to employ the substantial theoretical tools of evolutionary biology and anthropology to understand what promotes or impedes adaptation. The evolutionary perspective on adaptation focuses on diversity because diversity drives adaptive evolution. Population structures are also critical in facilitating or preventing adaptation to local environmental conditions. This suggests that climate-change adaptation should focus on the sources of innovation and social structures that nurture innovations and allow them to spread. Truly innovative ideas are likely to arise on the periphery of cohesive social groups and spread inward. The evolutionary perspective also suggests that we pay careful attention to correlated traits, which can distort adaptive trajectories, as well as to the importance of risk management in adaptations to variable or uncertain environments. Finally, we suggest that climate-change adaptation could benefit from a broader study of how local groups adapt to their dynamic environments, a process we call "autochthonous adaptation.", (© 2020 Wiley Periodicals LLC.)

Indirect climate effects on tree fecundity that come through variation in size and growth (climate-condition interactions) are not currently part of models used to predict future forests. Trends in species abundances predicted from meta-analyses and species distribution models will be misleading if they depend on the conditions of individuals. Here we find from a synthesis of tree species in North America that climate-condition interactions dominate responses through two pathways, i) effects of growth that depend on climate, and ii) effects of climate that depend on tree size. Because tree fecundity first increases and then declines with size, climate change that stimulates growth promotes a shift of small trees to more fecund sizes, but the opposite can be true for large sizes. Change the depresses growth also affects fecundity. We find a biogeographic divide, with these interactions reducing fecundity in the West and increasing it in the East. Continental-scale responses of these forests are thus driven largely by indirect effects, recommending management for climate change that considers multiple demographic rates.

We examine the relationship between niche construction theory (NCT) and human behavioral ecology (HBE), two branches of evolutionary science that are important sources of theory in archeology. We distinguish between formal models of niche construction as an evolutionary process, and uses of niche construction to refer to a kind of human behavior. Formal models from NCT examine how environmental modification can change the selection pressures that organisms face. In contrast, formal models from HBE predict behavior assuming people behave adaptively in their local setting, and can be used to predict when and why people engage in niche construction. We emphasize that HBE as a field is much broader than foraging theory and can incorporate social and cultural influences on decision-making. We demonstrate how these approaches can be formally incorporated in a multi-inheritance framework for evolutionary research, and argue that archeologists can best contribute to evolutionary theory by building and testing models that flexibly incorporate HBE and NCT elements., (© 2021 The Authors. Evolutionary Anthropology: Issues, News, and Reviews published by Wiley Periodicals LLC.)

Human adaptation depends on the integration of slow life history, complex production skills, and extensive sociality. Refining and testing models of the evolution of human life history and cultural learning benefit from increasingly accurate measurement of knowledge, skills, and rates of production with age. We pursue this goal by inferring hunters' increases and declines of skill from approximately 23,000 hunting records generated by more than 1800 individuals at 40 locations. The data reveal an average age of peak productivity between 30 and 35 years of age, although high skill is maintained throughout much of adulthood. In addition, there is substantial variation both among individuals and sites. Within study sites, variation among individuals depends more on heterogeneity in rates of decline than in rates of increase. This analysis sharpens questions about the coevolution of human life history and cultural adaptation., (Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution NonCommercial License 4.0 (CC BY-NC).)

We analyze a network of needle-sharing ties among 117 people who inject drugs (PWID) in rural Puerto Rico, using exponential random graph modeling to examine whether network members engage in partner restriction to lower their risk of contracting HIV or hepatitis C (HCV), or in informed altruism to prevent others from contracting these infections. Although sharing of used syringes is a significant risk factor for transmission of these diseases among PWID, we find limited evidence for partner restriction or informed altruism in the network of reported needle-sharing ties. We find however that sharing of needles is strongly reciprocal, and individuals with higher injection frequency are more likely to have injected with a used needle. Drawing on our ethnographic work, we discuss how the network structures we observe may relate to a decision-making rationale focused on avoiding withdrawal sickness, which leads to risk-taking behaviors in this poor, rural context where economic considerations often lead PWID to cooperate in the acquisition and use of drugs., Competing Interests: The authors have declared that no competing interests exist.

Evolutionary ecologists have shown that relatives are important providers of support across many species. Among humans, cultural reckonings of kinship are more than just relatedness, as they interact with systems of descent, inheritance, marriage and residence. These cultural aspects of kinship may be particularly important when a person is determining which kin, if any, to call upon for help. Here, we explore the relationship between kinship and cooperation by drawing upon social support network data from two villages in South India. While these Tamil villages have a nominally male-biased kinship system (being patrilocal and patrilineal), matrilateral kin play essential social roles and many women reside in their natal villages, letting us tease apart the relative importance of genetic relatedness, kinship and residence in accessing social support. We find that people often name both their consanguineal and affinal kin as providing them with support, and we see some weakening of support with lesser relatedness. Matrilateral and patrilateral relatives are roughly equally likely to be named, and the greatest distinction instead is in their availability, which is highly contingent on post-marital residence patterns. People residing in their natal village have many more consanguineal relatives present than those who have relocated. Still, relocation has only a small effect on an individual's network size, as non-natal residents are more reliant on the few kin that they have present, most of whom are affines. In sum, marriage patterns have an important impact on kin availability, but the flexibility offered by the broadening of the concept of kin helps people develop the cooperative relationships that they rely upon, even in the absence of genetic relatives. This article is part of the theme issue 'The evolution of female-biased kinship in humans and other mammals'.

Acts of prosociality, such as donating to charity, are often analysed in a similar way to acts of conspicuous advertising; both involve costly signals revealing hidden qualities that increase the signaller's prestige. However, experimental work suggests that grand gestures, even if prosocial, may damage one's reputation for trustworthiness and cooperativeness if they are perceived as prestige enhancing: individuals may gain some types of cooperative benefits only when they perform prosocial acts in particular ways. Here, we contrast subtle, less obviously costly, interpersonal forms of prosocial behaviour with high-cost displays to a large audience, drawing on the example of food sharing in subsistence economies. This contrast highlights how highly visible prosocial displays may be effective for attracting new partners, while subtle signals may be crucial for ensuring trust and commitment with long-term partners. Subtle dyadic signals may be key to understanding the long-term maintenance of interpersonal networks that function to reduce unanticipated risks.

Background: Posttransplant lymphoproliferative disorder (PTLD) is a major complication following kidney transplantation., Objective: We undertook this study to characterize PTLD in kidney transplant patients in British Columbia with regard to incidence, patient and graft survival, histological subtypes, treatment modalities, and management of immunosuppression., Design: Retrospective cohort analysis., Setting: British Columbia., Patients: All adult patients who underwent kidney transplantation in British Columbia between January 1, 1996, and December 31, 2012, were included. Patients less than 18 years of age at the time of first transplant and multiple organ transplant recipients were excluded from analysis., Measurements: Patients with lymphoproliferative disorders that occurred subsequent to kidney transplantation were considered to have developed PTLD., Methods: Cases of PTLD were identified by cross-referencing data abstracted from the provincial transplant agency's clinical database with the provincial cancer agency's lymphoma registry. Patients were followed up for the development of PTLD until December 31, 2012, and for outcomes of death and graft failure until December 31, 2014. Data collection was completed via an electronic chart review., Results: Of 2217 kidney transplant recipients, 37 (1.7%) developed PTLD. Nine cases were early-onset PTLD, occurring within 1 year of transplant; of these cases, 6 were known/presumed Epstein-Barr virus mismatch, compared with only 2 of 28 late-onset cases. Patient survival for early-onset PTLD was 100% at 2 years post diagnosis. Late-onset PTLD had survival rates of 71.4% and 67.9% at 1 and 2 years, respectively. PTLD was associated with significantly decreased patient survival ( P = .031) and graft survival (uncensored for death, P = .017), with median graft survival of PTLD and non-PTLD patients being 9.5 and 16 years, respectively. Immunosuppressant therapy was reduced in the majority of patients; additional therapies included rituximab monotherapy, CHOP-R, radiation, and surgery., Limitations: Limitations to this study include its retrospective nature and the unknown adherence of patients to prescribed immunosuppressant regimens. In addition, cumulative doses of immunosuppression received and the degree of immunosuppression reduction for PTLD management were not effectively captured., Conclusions: The incidence of PTLD in British Columbia following kidney transplantation was low and consistent with rates reported in the literature. The incidence of late-onset PTLD and its association with reduced patient and graft survival warrant further analysis of patients' long-term immunosuppression., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Social institutions that facilitate sharing and redistribution may help mitigate the impact of resource shocks. In the North American Arctic, traditional food sharing may direct food to those who need it and provide a form of natural insurance against temporal variability in hunting returns within households. Here, network properties that facilitate resource flow (network size, quality, and density) are examined in a country food sharing network comprising 109 Inuit households from a village in Nunavik (Canada), using regressions to investigate the relationships between these network measures and household socioeconomic attributes. The results show that although single women and elders have larger networks, the sharing network is not structured to prioritize sharing towards households with low food availability. Rather, much food sharing appears to be driven by reciprocity between high-harvest households, meaning that poor, low-harvest households tend to have less sharing-based social capital than more affluent, high-harvest households. This suggests that poor, low-harvest households may be more vulnerable to disruptions in the availability of country food.

Context • A variety of rehabilitation-based interventions are currently available for individuals with physical impairments resulting from neurological conditions, including physiotherapy, occupational therapy, and speech language pathology. Many individuals find participation in those therapies to be challenging. Alternative therapies have emerged as beneficial adjunctive treatments for individuals undergoing neurological rehabilitation, including music therapy (MT). Objective • The study intended to identify and collate systematically the evidence on MT interventions that address physical improvements in a rehabilitative setting. Design • The research team performed a literature review, searching electronic databases from their inception to April 2014, including Embase, CINAHL, PubMed, Scopus, and ProQuest. The review included original studies that examined the use of active MT as an intervention that promotes physical improvements for adults >18 y of age. Articles were excluded if the studies focused primarily on psychosocial, emotional, or spiritual therapeutic goals. The review identified the studies' outcome measures for different populations and the MT approaches and interventions and obtained a general description of the clinical sessions, such as the frequency and duration of the therapy, interventions performed, sessions designs, populations, equipment used, and credentials of the therapists. Results • Eleven studies identified 2 major categories for the delivery of MT sessions: individual and group. One study included group sessions, and 10 studies included individual sessions. The studies included a total of 290 participants, 32 in the group MT, and 258 in the individual MT. The one study that used group therapy was based on active MT improvisation. For the individual therapy, 2 studies had investigated therapeutic instrument music performance and 8 used music-supported therapy. Conclusions • The findings of the review suggested that active MT can improve motor skills and should be considered as a potential adjunctive treatment.

Purpose: To evaluate over almost 2 decades the success of a component of cataract surgery that represents a critical step in reducing the incidence of posterior capsule opacification (PCO); namely, the efficacy of cortical cleanup., Setting: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina, USA., Methods: Accessioned from the early 1980s to 1997, 3320 eyes obtained postmortem with posterior chamber intraocular lenses were analyzed with respect to formation of a postoperative Soemmering's ring. This anatomic lesion, the precursor of clinical PCO, represents an important and measurable indication of the quality of cortical cleanup. Its formation was documented using Miyake-Apple posterior photographic analysis., Results: The quality and thoroughness of cortical cleanup and overall effectiveness in eliminating retained and/or regenerating cortical cells, as measured by scoring of Soemmering's rings, showed virtually no net change since the early 1980s. The intensity of Soemmering's ring was higher in the most recent specimens than in those in the early 1980s., Conclusion: The results indicate that renewed attention to cortical cleanup in cataract surgery is warranted for significant reduction in incidence or the elimination of PCO. More attention to the hydrodissection (cortical cleaving hydrodissection) step of the procedure is likely a practical, immediately implementable, and inexpensive remedy.

One hundred women who had surgical intervention indicated for pelvic masses, were studied prospectively, all of them were investigated and treated in the obstetrical and gynecology Department of the Hospital del Salvador between January 1988 to January 1989. Pelvic tumors were classified following the scheme at the University of Tokyo's Obstetrician and Gynecology Department, which was designated to correlate the echographic image with the tumors histology and especially to distinguish preoperatively the benign or malign nature of the mass. The early diagnosis of ovarian cancer in the general population was not the objective. The classification divides the tumors in 6 groups with two o three subgroups for each one of them the probability of the tumors being benign was high for those in the group one to four (the predictive value of non malignancy was 98.4%) and the possibility of malignancy was high especially in the group 6 (the predictive value for malignancy was 63.6%).