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Some problems in clinic function recur because of unexpected value differences between patients, faculty, and residents. Cultural consensus analysis (CCA) is a method used by anthropologists to identify groups with shared values. After conducting an ethnographic study and using focus groups, we developed and validated a CCA tool for use in clinics. Using this instrument, we identified distinct groups with 6 important value differences between those groups. An analysis of these value differences suggested specific and pragmatic interventions to improve clinic functioning. The instrument has also performed well in preliminary tests at another clinic.

The purpose of this qualitative study was to explore chronic sorrow as a relapse trigger among female victims of child abuse seeking treatment for substance abuse relapse. A purposive convenience sample of 12 women was interviewed using qualitative description to provide insight into their perceptions of relapse triggers. In addition to chronic sorrow, three common themes were interwoven in the narrative stories of these women: mothering loss, blocking feelings, and relapse triggers. Feelings described as relapse triggers included loneliness, sadness, anger, and frustration. The information gleaned from these women can be incorporated into the treatment of women and children in an effort to better prepare them for these recurrent feelings and triggers that could result in substance abuse and relapse.Copyright © 2009 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

The purpose of this article is to provide a blueprint for nursing programs to create or modify baccalaureate critical care courses. The benefits of providing a critical care course include offering students an in-depth experience in a specialty area, reinforcing previously learned medical-surgical content, and improving students' critical thinking skills. In addition, hospitals are given the opportunity to interact with students while also recruiting them into a high-demand area. [ABSTRACT FROM AUTHOR]

Background: There is considerable debate regarding the appropriate treatment of the extruded talus regardless of the presence of a fracture. The purpose of this study was to report the clinical results, complications, and functional outcome following reimplantation of the traumatically extruded talus.Methods: A database of 119 patients with an open injury of the talus occurring between 1995 and 2003 at a level-I trauma center was reviewed to identify patients with a complete talar extrusion. Demographic, imaging, and treatment data were obtained from a review of the medical records. Follow-up was undertaken during clinic visits or by telephone. Preoperative and follow-up radiographs were reviewed to identify posttraumatic arthritis, osteonecrosis, or talar collapse, and the Musculoskeletal Functional Assessment was used to assess functional outcome.Results: Twenty-seven patients were identified. A minimum follow-up of one year (average, forty-two months) was obtained for nineteen patients. Infection and the need for a secondary surgical procedure were the primary determinants of clinical outcome. Two of the nineteen patients had documented infections: one had developed at two weeks and one, after a calcaneal osteotomy at nineteen months. Twelve patients had no subsequent surgery, and seven had subsequent procedures (range, one to four procedures). No patient underwent a delayed amputation. The average Musculoskeletal Functional Assessment score at the time of follow-up was 29.8 (range, 5 to 59). With the numbers studied, no association was found between functional outcome and the following variables: ipsilateral lower-extremity injury, associated talar fracture, secondary procedures, osteonecrosis, or age.Conclusions: While functional outcome is difficult to assess, salvage of the extruded talus appears to be a relatively safe operation, with a minimal risk of infection, which allows maximal flexibility in aftercare by preserving the most normal ankle anatomy possible. [ABSTRACT FROM AUTHOR]

We tested 41 bats for antibodies against Nipah and Hendra viruses to determine whether henipaviruses circulate in pteropid fruit bats (Pteropus giganteus) in northern India. Twenty bats were seropositive for Nipah virus, which suggests circulation in this species, thereby extending the known distribution of henipaviruses in Asia westward by >1,000 km. [ABSTRACT FROM AUTHOR]

Background: The standard malaria rapid diagnostic test (RDT) and newer ultra-sensitive RDT (uRDT) target Plasmodium falciparum histidine rich protein-2 (HRP2), which persists post-treatment. The duration of test positivity has not previously been studied in a low transmission setting., Methods: We conducted a longitudinal cohort study in a low transmission setting in Namibia. RDT-positive individuals identified through passive and active case detection were treated and followed weekly for testing by RDT and uRDT, HRP2 quantification, quantitative PCR (qPCR) of parasitemia, and quantitative reverse transcriptase PCR (RT-PCR) of gametocytemia, until RDT and uRDT were negative for two consecutive weeks. Determinants of persistent positivity were identified using Cox proportional hazards models., Findings: Among 137 participants with complete follow-up and no evidence of resurgence during follow-up, median duration of positivity was 42 days (range: 3-98 range) for RDT, compared to 67 days (range 12-105) for uRDT. In a sub-analysis of those with laboratory data before treatment (n = 60), drug resistance did not explain persistent positivity. Younger age (<15 years versus ≥15 years: aHR: 1.85, 95% CI 1.04-3.30, and 1.67, 95% CI 0.96-2.89, for RDT and uRDT, respectively), higher initial parasite density (highest versus lowest tertile: aHR 0.11, 95% CI 0.04-0.32 and 0.19, 95% CI 0.07-0.48 for RDT and uRDT, respectively), and persistent parasitemia (≥7 days versus reference of <7 days, aHR 0.39, 95% CI 0.20-0.76, and 0.40, 95% CI 0.21-0.76 for RDT and uRDT, respectively) were associated with longer duration of positivity., Interpretation: Duration of RDT/uRDT positivity was more than double compared to reports from higher endemic settings, potentially due to lower population immunity to clear parasite DNA and antigen. Prolonged duration of positivity compromises their use to detect current infection, but increased detection of recent infection can facilitate surveillance and inform elimination efforts., Funding: The project was funded by the Bill and Melinda Gates Foundation (A128488 and INV1135840), Horchow Family Fund (5300375400), and Chan Zuckerberg Biohub., Competing Interests: Declaration of interests All authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Combined impacts from anthropogenic pressures and climate change threaten coastal ecosystems and their capacity to protect communities from hazards. One approach towards improving coastal protection is to implement "nature-based solutions" (NBS), which are actions working with nature to benefit nature and humans. Despite recent increases in global implementation of NBS projects for coastal protection, substantial gaps exist in our understanding of NBS performance. To help fill this gap, we systematically mapped the global evidence base on the ecological, physical, economic, and social performance of NBS interventions related to coastal protection. We focused on active NBS interventions, such as restoring or creating habitat, adding structure, or modifying sediment in six shallow biogenic ecosystems: salt marsh, seagrass, kelp forest, mangrove, coral reef, and shellfish reef., Methods: We identified potentially relevant articles on the performance of NBS for coastal protection using predefined and tested search strategies across two indexing platforms, one bibliographic database, two open discovery citation indexes, one web-based search engine, and a novel literature discovery tool. We also searched 45 organizational websites for literature and solicited literature from 66 subject matter experts. Potentially relevant articles were deduplicated and then screened by title and abstract with assistance from a machine learning algorithm. Following title and abstract screening, we conducted full text screening, extracted relevant metadata into a predefined codebook, and analyzed the evidence base to determine the distribution and abundance of evidence and answer our research questions on NBS performance., Results: Our search captured > 37,000 articles, of which 252 met our eligibility criteria for relevance to NBS performance for coastal protection and were included in the systematic map. Evidence stemmed from 31 countries and increased from the 1980s through the 2020s. Active NBS interventions for coastal protection were most often implemented in salt marshes (45%), mangrove forests (26%), and shellfish reefs (20%), whereas there were fewer NBS studies in seagrass meadows (4%), coral reefs (4%), or kelp beds (< 1%). Performance evaluations of NBS were typically conducted using observational or experimental methods at local spatial scales and over short temporal scales (< 1 year to 5 years). Evidence clusters existed for several types of NBS interventions, including restoration and addition of structures (e.g., those consisting of artificial, hybrid, or natural materials), yet evidence gaps existed for NBS interventions like alteration of invasive species. Evaluations of NBS performance commonly focused on ecological (e.g., species and population, habitat, community) and physical (e.g., waves, sediment and morphology) outcomes, whereas pronounced evidence gaps existed for economic (e.g., living standards, capital) and social (e.g., basic infrastructure, health) outcomes., Conclusions: This systematic map highlights evidence clusters and evidence gaps related to the performance of active NBS interventions for coastal protection in shallow, biogenic ecosystems. The synthesized evidence base will help guide future research and management of NBS for coastal protection so that active interventions can be designed, sited, constructed, monitored, and adaptively managed to maximize co-benefits. Promising avenues for future research and management initiatives include implementing broad-scale spatial and temporal monitoring of NBS in multidisciplinary teams to examine not only ecological and physical outcomes but also economic and social outcomes, as well as conducting further synthesis on evidence clusters that may reveal measures of effect for specific NBS interventions. Since NBS can deliver multiple benefits, measuring a diverse suite of response variables, especially those related to ecosystem function, as well as social and economic responses, may help justify and improve societal benefits of NBS. Such an approach can help ensure that NBS can be strategically harnessed and managed to meet coastal protection goals and provide co-benefits for nature and people., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Predators regulate communities through top-down control in many ecosystems. Because most studies of top-down control last less than a year and focus on only a subset of the community, they may miss predator effects that manifest at longer timescales or across whole food webs. In southeastern US salt marshes, short-term and small-scale experiments indicate that nektonic predators (e.g., blue crab, fish, terrapins) facilitate the foundational grass, Spartina alterniflora, by consuming herbivorous snails and crabs. To test both how nekton affect marsh processes when the entire animal community is present, and how prior results scale over time, we conducted a 3-year nekton exclusion experiment in a Georgia salt marsh using replicated 19.6 m 2 plots. Our nekton exclusions increased densities of plant-grazing snails and juvenile deposit-feeding fiddler crab and, in Year 2, reduced predation on tethered juvenile snails, indicating that nektonic predators control these key macroinvertebrates. However, in Year 3, densities of mesopredatory benthic mud crabs increased threefold in nekton exclusions, erasing the tethered snails' predation refuge. Nekton exclusion had no effect on Spartina biomass, likely because the observed mesopredator release suppressed grazing snail densities and elevated densities of fiddler crabs, whose burrowing alleviates soil stresses. Structural equation modeling supported the hypotheses that nektonic predators and mesopredators control invertebrate communities, with nektonic predators having stronger total effects on Spartina than mud crabs by controlling densities of species that both suppress (grazers) and facilitate (fiddler crabs) plant growth. These findings highlight that salt marshes can be resilient to multiyear reductions in nektonic predators if mesopredators are present and that multiple pathways of trophic control manifest in different ways over time to mediate community dynamics. These results highlight that larger scale and longer-term experiments can illuminate community dynamics not previously understood, even in well-studied ecosystems such as salt marshes., (© 2024 The Ecological Society of America.)

Children raised in chaotic households show affect dysregulation during later childhood. To understand why, we took day-long home recordings using microphones and autonomic monitors from 74 12-month-old infant-caregiver dyads (40% male, 60% white, data collected between 2018 and 2021). Caregivers in low-Confusion Hubbub And Order Scale (chaos) households responded to negative affect infant vocalizations by changing their own arousal and vocalizing in response; but high-chaos caregivers did not, whereas infants in low-chaos households consistently produced clusters of negative vocalizations around peaks in their own arousal, high-chaos infants did not. Their negative vocalizations were less tied to their own underlying arousal. Our data indicate that, in chaotic households, both communicating and responding are atypical: infants are not expressing their levels of arousal, and caregivers are under-responsive to their infants' behavioral signals., (© 2024 The Author(s). Child Development published by Wiley Periodicals LLC on behalf of Society for Research in Child Development.)

In July 2017, an investigation into the cause of neurological signs in a black flying fox (Pteropus alecto, family Pteropodidae) identified a putative novel hantavirus (Robina virus, ROBV, order Bunyavirales, family Hantaviridae, genus Mobatvirus) in its brain. Analysis of the evolutionary relationship between other hantaviruses using maximum-likelihood, a systematic Bayesian clustering approach, and a minimum spanning tree, all suggest that ROBV is most closely related to another Mobatvirus, Quezon virus, previously identified in the lung of a Philippine frugivorous bat (Rousettus amplexicaudatus, also family Pteropodidae). Subsequently, between March 2018 and October 2023, a total of 495 bats were opportunistically screened for ROBV with an experimental qRT-PCR. The total prevalence of ROBV RNA detected in Pteropus spp. was 4.2% (95% CI 2.8-6.4%). Binomial modelling identified that there was substantial evidence supporting an increase (P = 0.033) in the detection of ROBV RNA in bats in 2019 and 2020 suggesting of a possible transient epidemic. There was also moderate evidence to support the effect of season (P = 0.064), with peak detection in the cooler seasons, autumn, and winter, possibly driven by physiological and ecological factors similar to those already identified for other bat-borne viruses. This is Australia's first reported putative hantavirus and its identification could expand the southern known range of hantaviruses in Australasia., (© 2024. Crown.)

Introduction: One third of the multiple sclerosis (MS) population consists of peri- or postmenopausal women. Many symptoms of menopause overlap those of MS. Some studies show increased speed of disability progression after menopause, while others indicate an unaltered trajectory., Objective: Determine the association between menopause and MS disease course., Methods: Cohort study with clinical data collected prospectively. Self-reported age of menopause, smoking and parity collected retrospectively., Results: We included 559 peri-/postmenopausal women and 386 similarly aged men. There was no significant difference in EDSS progression (slope coef 0.03, 0.02-0.08, p = 0.208) or annual relapse rate (ARR) (0.10, 0.29-0.10, p = 0.324) in the 5 years before and after menopause. Women's EDSS progressed slower than men's after menopause (coef -0.02, 95% CI -0.04 to -0.002, p = 0.032), but there was no difference in ARR [coef. -0.01, 95% CI -0.04 to -0.01, p = 0.262]. Women who reached menopause before MS onset had shorter time to diagnosis than women who reached menopause after onset (3.1 years (3.1) vs. 7.4 years (8.1), p < 0.001). Women who reached menopause before diagnosis had an even longer time to diagnosis (8.8 (9.3) vs. 5.5 (6.3), p < 0.001)., Conclusions: There were no significant differences in EDSS progression or ARR before and after menopause. In fact, men progressed faster than women, suggesting there is no negative impact of menopause on disease progression, as measured by EDSS and relapses., (© 2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Kagami-Ogata syndrome (KOS) is a clinically recognizable syndrome in the neonatal period. It is characterized by specific skeletal anomalies and facial dysmorphisms. It is typically caused by paternal uniparental disomy of chromosome 14, while epimutations and microdeletions are less commonly reported causes. In the pediatric setting, KOS is a well delineated syndrome. However, there is a dearth of literature describing the natural history of the condition in adults. Herein, we describe a 35-year-old man, the first adult with KOS reported due to paternal uniparental disomy 14, and review reports of KOS in other affected adults. This highlights the variability in neurocognitive phenotypes, the presence of connective tissue abnormalities, and the uncertainties around long-term cancer risk., (© 2024 The Authors. American Journal of Medical Genetics Part A published by Wiley Periodicals LLC.)

Background: The evolution of warfare has resulted in a surge of high-energy blast injuries predominantly involving the lower extremities. Once thought to impact only forward-deployed military, such mechanisms of injury are becoming a harsh reality even in civilian territory. Proficiency in surgical techniques for extremity damage control is vital for surgeons, regardless of specialty. To evaluate and train surgical residents and attending surgeons in critical limb-salvage techniques, Theater Hospital Operations Replication (THOR) has been proposed as a high-fidelity training platform to enhance extremity surgery teaching practices and assess proficiency in fasciotomy, vascular shunting, and knee-spanning external fixation in a simulated, resource-limited environment., Questions/purposes: Given the importance of proficiency and efficiency in surgeon ability to perform fasciotomies, vascular shunting, and placement of external fixators, in this study, we proposed two research questions: (1) Does repetition-based training within the THOR model improve surgeon knowledge and technical skill? (2) Are there differences in skill outcome when utilizing the THOR model based on surgical specialty (orthopaedic versus general) and/or level in training (attending versus resident)?, Methods: This was an observational learning outcome study performed in the bioskills lab at a single institution, the Naval Medical Center Portsmouth, in which 26 surgeons completed a same-day course consisting of pretraining assessment, cadaver training on three damage-control surgery techniques in a high-fidelity THOR environment, and post-training assessment. The surgeons were either general surgeons or orthopaedic surgeons and consisted of both residents and attending surgeons. Subjects underwent a pretraining knowledge assessment, followed by two rounds of performing simulated surgery. The first round of surgery included guidance and instruction from board-certified orthopaedic surgeons. After a short break for the subjects to review the material, the second round was completed without instruction. To answer our first question of how repetition-based training impacts surgical skill, our metrics included: Objective Structured Assessment of Technical Skills (OSATS) scores (range 1 to 5, scored lowest to highest, where higher scores represent optimal skill performance), procedural accuracy, a 10-question knowledge assessment administered before and after training (scored 0 to 10, where higher scores represent competency of the anatomy and procedure steps), and total procedure time. To address our second question, data on demographic characteristics were collected on all participants, which included surgical specialty, year in training, and gender., Results: The general surgery residents' cohort demonstrated improvement in both mean ± SD OSATS scores (2.4 ± 0.7 before training versus 3.6 ± 0.6 after training, mean difference 1.2 [95% CI 0.4 to 2.0]; p = 0.01) and procedure duration (23 ± 7 minutes before training versus 16 ± 5 minutes after training, mean difference 6 minutes [95% CI 4 to 9]; p = 0.001) for external fixator procedures after THOR. Similar results were seen in fasciotomies after THOR. The orthopaedic surgery residents' cohort showed similar improvements in reducing procedure duration when performing knee-spanning external fixator surgery, as well as exhibited improvements during vascular shunting procedures in both mean ± SD OSATS scores (previously 3.3 ± 0.9 versus 4.0 ± 0.9, mean difference 0.7 [95% CI 0.2 to 1.2]; p = 0.01) and procedure duration (23 ± 5 minutes versus 14 ± 8 minutes, mean difference 10 minutes [95% CI 4 to 15]; p = 0.003) after THOR. When we compared the cohorts, general surgery attending surgeons demonstrated an improvement in vascular shunting procedure duration after instruction with the THOR model (19 ± 3 minutes versus 12 ± 4 minutes, mean difference 7 minutes [95% CI 1 to 13]; p = 0.03) and in overall knowledge scores (4.3 + 0.5 versus 8.0 ± 1.6, mean difference 3.8 [95% CI 0.5 to 7.0]; p = 0.04). The orthopaedic surgery attending surgeons yielded no improvement for any metric, pretraining and post-training. Using the prescores as a covariate, for almost all metrics analyzed, there were no differences between surgeon groups based on specialty after completing the repeated training., Conclusion: Use of the high-fidelity THOR training model improved proficiency in the examined sample of extremity damage-control procedures, thus demonstrating its efficacy in enhancing surgical skills and short-interval knowledge retention while simultaneously highlighting the importance of cadaver simulation training in enhancing surgical preparedness for complex trauma., Clinical Relevance: The high-fidelity THOR training model represents a promising modality for preparing surgeons for extremity combat trauma management in resource-limited, high-stress environments. Whether in a wartime environment or in the civilian sector, efficient and skilled intervention are crucial in managing patient morbidity. Differences of a few minutes per procedure can mean all the difference in damage control, especially when compounded in situations where vascular shunting, knee-spanning external fixation, and lower leg four-compartment fasciotomy have to be performed together by both orthopaedic and general surgeons. The observational period in this study spanned 1 day and thus does not provide information on retention of long-term skills or knowledge. A follow-on study can assess how time from initial training to final evaluation impacts overall skill competency and knowledge., Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2024 by the Association of Bone and Joint Surgeons.)

Background: Childhood obesity is an escalating crisis in the United States. Health policy may impact this epidemic which disproportionally affects underserved populations., Aim: The aim was to use the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to assess health policy impact on preventing or treating school-aged children (5 > 18 years) with obesity in underserved populations., Methods: A scoping review of 842 articles was conducted. Twenty-four articles met the inclusion criteria and underwent data extraction., Results: Twelve studies included subgroup analysis, with four suggesting an impact of policy on at-risk groups. None of the 24 studies fully applied the RE-AIM framework. Policies positively impacted childhood obesity in 12 studies across the sample., Linking Evidence to Action: Our review revealed inconsistent evidence for the effectiveness of policy on childhood obesity, perhaps due to the lack of focus on the social determinants of health. In addition, many studies did not evaluate the outcomes for underserved populations. Therefore, we propose more attention to social determinants in future legislation and evaluation of policy effectiveness on underserved populations. Findings identify an urgent need for the design, implementation, and evaluation of policies specifically directed to address the inequities of racism, social injustices, and social determinants of health that impact childhood obesity in the United States. Future work needs to identify who was reached by the policy, who benefitted from the policy, and how policies were implemented to address obesity-related health disparities. Nurses should advocate for the evaluation of childhood obesity policies, particularly in underserved populations, to determine effectiveness. Nurses, particularly those trained in population and community health and research, should advocate for policy research that considers inequities rather than controls for these variables. Multi-layered interventions can then be tailored to sub-populations and evaluated more effectively., (© 2024 Sigma Theta Tau International.)

Concordance between partner reports of Intimate Partner Violence (IPV) is generally low, but self-reporting of IPV and concordance between partners among expectant parents in marginalized communities has not been explored, nor have associations among each partner's reports of IPV and their behaviors in observed conflict discussions. This study will examine these gaps. One hundred and thirty-eight low-income, unmarried, Black, coparenting dyads expecting their first child together (136 mothers and 136 fathers) completed the Revised-Conflict Tactics Scale and a video recorded and coded conflict discussion. There was low concordance between parent's reports of IPV overall with moderate levels of concordance for coparents who were living together and had more harmonious relationships. Linear regression analyses indicated only mothers' reports of fathers' psychological and physical IPV but not fathers' reports of IPV were significantly associated with observed negative communication. Neither coparents' reports of psychological or physical IPV were associated with positive communication during a conflict discussion. These findings suggest that at the time of parenthood transitions, mothers' reports of fathers' IPV behaviors may be more robust in their association with negative/unhealthy couple communication patterns than fathers' reports and should be used when making safety determinations with families., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

Background: Safer conception services are needed to minimize HIV transmission among HIV sero-discordant couples desiring pregnancy. Few studies have evaluated the choices couples make when they are offered multiple safer conception methods or real-world method acceptability. This paper addresses an important knowledge gap regarding factors that influence the choice of safer conception methods, couples' actual experiences using safer conception methods, and why some couples switch safer conception methods., Methods: Between February and June 2019, we conducted semi-structured in-depth interviews among 14 men and 17 women, representing 17 couples who exited the SAFER study-a pilot safer conception study for HIV sero-discordant couples in Zimbabwe that offered couples a choice of ART with monthly viral load monitoring (ART/VL), oral PrEP, vaginal insemination, and semen washing. All couples in SAFER had used at least two safer conception methods., Results: We found that safer conception method choice often centered around a desire for intimacy, condomless sex, and certainty in the conception process, particularly for men. Method-related attributes such as familiarity, perceived ease of use, side effects, and perceived level of effectiveness in preventing HIV and achieving pregnancy influenced method choice, switching, and satisfaction. Concerns were expressed about each safer conception method and couples were willing to try different methods until they found method(s) that worked for them. The majority of participants reported having positive experiences using safer conception, especially those using ART/VL + PrEP, citing that they were able to attempt pregnancy for the first time with peace of mind and experienced joy and satisfaction from being able to achieve pregnancy safely., Conclusions: The differences in method preferences and experiences voiced by participants in this study and in other studies from the region point to the importance of having a variety of safer conception options in the service delivery package and addressing concerns about paternity, intimacy, and method-related attributes to enable HIV sero-discordant couples to safely achieve their reproductive goals., (© 2024. The Author(s).)

Optical emitters in hexagonal boron nitride (hBN) are promising probes for single-molecule sensing platforms. When engineered in nanoparticle form, they can be integrated as detectors in nanodevices, yet positional control at the nanoscale is lacking. Here we demonstrate the functionalization of DNA origami nanopores with optically active hBN nanoparticles (NPs) with nanometer precision. The NPs are active under three wavelengths of visible illumination and display both stable and blinking emission, enabling their accurate localization by using wide-field optical nanoscopy. Correlative opto-structural characterization reveals deterministic binding of bright, multicolor hBN NPs at the pore rim due to π-π stacking interactions at site-specific locations on the DNA origami. Our work provides a scalable, bottom-up approach toward deterministic assembly of solid-state emitters on arbitrary structural elements based on DNA origami. Such a nanoscale arrangement of optically active components can advance the development of single-molecule platforms, including optical nanopores and nanochannel sensors.

Introduction: Musculoskeletal injuries affect nearly a million service members annually within the DoD, ultimately costing the U.S. Military half a billion dollars in direct patient costs and a significant loss to fleet readiness as many members are assigned days on limited duty (LIMDU) until they are deemed medically fit to return to duty (RTD). The new approach implemented by Navy Medicine in 2022, called "condition-based LIMDU," aims to drastically impact the time in which Sailors and Marines spend under a provider's care by assigning LIMDU days based on a standardized set of guidelines. This study provides a quantitative analysis on LIMDU duration, before and after implementation of the new condition-based LIMDU paradigm, to increase the understanding on the effectiveness and impact to fleet readiness and to assess the accuracy of suggested patient outcome timelines., Materials and Methods: De-identified and aggregated data were obtained from the Naval Medical Forces Atlantic's (NMFL) LIMDU Sailor and Marine Readiness Tracker System (SMART) program for all active duty military patients with ICD-10 code for musculoskeletal conditions. Only closed LIMDU cases in which active duty patients were given a final status of RTD were included. This study analyzed top musculoskeletal ICD-10 codes, optimum period (weeks), maximum period (weeks), and average days on LIMDU assigned at NMFL centers (medical and non-medical) for fiscal years 2021 (FY21) and 2022 (FY22). As well as descriptive statistics, t-test analysis was used to test if there was a difference between FY21 and FY22 and at what point the difference was no longer significant. Critical value method was then used to compare the top five most common musculoskeletal injuries to determine the accuracy of recommended LIMDU days to actual average assigned LIMDU per injury type. A color-coded compliance chart was created based on the results., Results: The results showed that for RTD population, the implementation of condition-based LIMDU significantly decreased average days assigned on LIMDU by 33%. In fact, there is a 35-day (5-week) difference before we can confidently say that the difference between FY21 and FY22 is no longer statistically significant. This significant decrease in LIMDU days, before and after implementation, is a trend consistent at both medical and non-medical NMFL centers; however, medical centers reported significantly more assigned LIMDU days for both years. The five most common injuries of FY21 and FY22 were low back pain, pain in shoulder, pain in hip, pain in knee, and pain in ankle. Before implementation, all five of these injury types far exceeded the recommended amount of LIMDU days. With the new condition-based LIMDU paradigm, the average assigned LIMDU days for pain in hip, pain in knee, and pain in ankle were all found to be in compliance with the recommended LIMDU days within a 99% confidence level., Conclusions: The new condition-based LIMDU paradigm is successful in its aim to improve fleet readiness by returning Sailors and Marines to full duty status significantly faster. Regular assessment of ICD-10 diagnosis codes and update to recommended LIMDU assignment timelines should be conducted to maximize the effectiveness and accuracy for all medical conditions., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

There is increasing evidence that therapy and intervention services delivered by telehealth are effective at reducing a variety of mental health symptoms. Limited studies have indicated online services can reduce intimate partner violence (IPV), but none have tested in-person compared to telehealth-delivered interventions for men who have used IPV. Clinical outcome data from 311 parents (192 fathers and 119 linked coparent mothers) engaged in the Fathers for Change (F4C) intervention following referral by child protective services for IPV were examined to determine if in-person delivery of the intervention differed in terms of client treatment engagement and retention or outcomes. Parents who enrolled during a 1-year period prior to the COVID pandemic received their F4C therapy in person, while those who enrolled during the pandemic received their intake and most of their sessions via telehealth delivery. Parents reported significantly greater symptoms of depression, anxiety, and stress prior to treatment if they enrolled prior to COVID than if they enrolled during the pandemic. There were few differences in completion rates or outcomes based on in-person compared to telehealth delivery. Fathers were slightly more likely to complete treatment and attended a significantly higher percentage of their sessions when it was delivered by telehealth during COVID. Fathers reported significantly lower stress scores posttreatment when they received COVID telehealth delivery compared to prior to COVID in-person delivery of F4C. These findings suggest that telehealth may be an appropriate and viable option for the delivery of IPV interventions for families., (© 2024 John Wiley & Sons Ltd.)

Understanding how climate and local stressors interact is paramount for predicting future ecosystem structure. The effects of multiple stressors are often examined in small-scale and short-term field experiments, limiting understanding of the spatial and temporal generality of the findings. Using a 22-year observational dataset of plant and grazer abundance in a southeastern US salt marsh, we analyzed how changes in drought and grazer density combined to affect plant biomass. We found: (1) increased drought severity and higher snail density both correlated with lower plant biomass; (2) drought and snail effects interacted additively; and, (3) snail effects had a threshold, with additive top-down effects only occurring when snails were present at high densities. These results suggest that the emergence of multiple stressor effects can be density dependent, and they validate short-term experimental evidence that consumers can augment environmental stress. These findings have important implications for predicting future ecosystem structure and managing natural ecosystems., (© 2024 The Ecological Society of America.)

Within a growing drug discovery company, scientists acquire (either through in house synthesis or purchase) then store, retrieve, and ship solid compound samples daily between multiple locations. The efficient management and tracking of this entire process to support drug discovery is a significant challenge. This article describes a decentralized and cost-effective inventory facility that simplifies the solid compound storage and retrieval process. Standardized storage cabinets from the market are utilized, providing a cost-effective physical infrastructure. The cabinets can be distributed across storage rooms at multiple sites and arranged into spaces with a variety of dimensions, allowing the system to be retrofitted into existing facilities and scaled up easily. We can provide storage close to work areas at each location, minimizing both unnecessary movement of staff and transportation of substances. We have applied a systematic barcoding method to the compound batch identifier that correlates with its compound location. This simplifies the compound registration process as well as the process of finding and returning compounds. Additionally, a centralized electronic platform has been employed to store, update and track solid compound information, such as properties, location and quantity. Compound shipment may be initiated from different sites, and a centralized electronic platform assists the information retrieval process, ensuring each location possesses up-to-date information. The electronic platform we present streamlines the management of compound registration, location tracking, weight updates and shipment information, facilitating seamless record sharing among all stakeholders. Every step of the process can be tracked in real time by the project team. The platform can be flexibly configured to adapt to an evolving set of storage locations, with all information and processes being audited., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

There is increasing consumer demand for alternative animal protein products that are delicious and sustainably produced to address concerns about the impacts of mass-produced meat on human and planetary health. Cultured meat has the potential to provide a source of nutritious dietary protein that both is palatable and has reduced environmental impact. However, strategies to support the production of cultured meats at the scale required for food consumption will be critical. In this review, we discuss the current challenges and opportunities of using edible scaffolds for scaling up the production of cultured meat. We provide an overview of different types of edible scaffolds, scaffold fabrication techniques, and common scaffold materials. Finally, we highlight potential advantages of using edible scaffolds to advance cultured meat production by accelerating cell growth and differentiation, providing structure to build complex 3D tissues, and enhancing the nutritional and sensory properties of cultured meat.

Sports participation confers many health benefits yet greatly increases injury risk. Long-term health outcomes in former athletes and transition to life after competitive sports are understudied. Ending a sport may pose physical and psychosocial challenges. The purpose was to determine the lived experiences of former competitive athletes and how their sports participation impacted their long-term health and well-being. Former college varsity athletes participated in semistructured interviews focusing on their experiences, including past and current health, the impact of injuries, activity, exercise, diet and transition to life after competitive sport. Thematic analysis was completed using a collaborative, iterative process. Thirty-one (16 female, 15 male) former college athletes aged 51.3±7.4 years were interviewed. Six themes emerged: (1) lifelong athlete identity; (2) structure, support and challenges of the college athlete experience; (3) a big transition to life beyond competitive sport; (4) impact of competitive sport on long-term health; (5) facilitators and barriers to long-term health after sport and (6) transferable life skills. Continuing sports eased the transition for many but often delayed their postathlete void. Challenges included managing pain and prior injury (eg, If I didn't have my knee injury, I would definitely be more active ), reducing energy needs and intake (eg, When I was an athlete, I could eat anything; and unfortunately, that's carried into my regular life), lack of accountability, changed identity and lost resources and social support. Participants suggested a programme, toolkit, mentoring or exit course to facilitate the transition. While former athletes benefit from transferrable life skills and often continue sports and exercise, they face unique challenges such as managing pain and prior injury, staying active, reducing energy intake and changing identity. Future research should develop and evaluate a toolkit, programme and other resources to facilitate life after ending competitive sports under 'normal' conditions (eg, retirement) and after a career-ending injury., Competing Interests: Competing interests: The authors have nothing to disclose except for grant funding as acknowledged above., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Ecosystem restoration can increase the health and resilience of nature and humanity. As a result, the international community is championing habitat restoration as a primary solution to address the dual climate and biodiversity crises. Yet most ecosystem restoration efforts to date have underperformed, failed, or been burdened by high costs that prevent upscaling. To become a primary, scalable conservation strategy, restoration efficiency and success must increase dramatically. Here, we outline how integrating ten foundational ecological theories that have not previously received much attention - from hierarchical facilitation to macroecology - into ecosystem restoration planning and management can markedly enhance restoration success. We propose a simple, systematic approach to determining which theories best align with restoration goals and are most likely to bolster their success. Armed with a century of advances in ecological theory, restoration practitioners will be better positioned to more cost-efficiently and effectively rebuild the world's ecosystems and support the resilience of our natural resources., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)