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International Online Collaboration Competencies (IOCCs) are considered essential for global virtual teams, yet no consensus exists on what experts consider as IOCCs and which competencies are involved. To develop a framework to support higher education in designing learning tasks and evaluation instruments for the acquisition of IOCCs, a three-round consensus study was conducted among a purposive sample of academic and field experts in international online collaboration. The final IOCCs framework includes a definition of IOC and 34 IOCCs within six competency domains: (1) information and communication technology, (2) international and intercultural, (3) communication and language, (4) collaboration, (5) management and organization, and (6) domain-specific. The framework may be a benchmark for program development for Internationalization of the Curriculum (IoC), evaluation, and continuous professional development. Further research is needed to evaluate how this IOCCs framework can be integrated into higher education settings to teach and evaluate IOCCs.

Lama Sultan,1,2 Nynke de Jong,3 Basim Alsaywid,4,5 Muhammad Anwar Khan,6 Jascha de Nooijer7 1Department of Clinical Nutrition, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Jeddah, KSA, Saudi Arabia; 2School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands; 3Department of Health Services Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, NL, Saudi Arabia; 4Urology Department, King Faisal Specialist Hospital & Research Center, Riyadh, KSA, Saudi Arabia; 5Education and Research Skills Directory, Saudi National Institute of Health, Riyadh, KSA, Saudi Arabia; 6College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, KSA, Saudi Arabia; 7Department of Health Promotion, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, NetherlandsCorrespondence: Lama Sultan, Department of Clinical Nutrition, Ministry of National Guard Health Affairs- Jeddah, King Abdulaziz Medical City, Mail Code 6660, P.O. Box.9515, Jeddah, 21423, Kingdom of Saudi Arabia, Tel +966553343478, Email sultanla@mngha.med.sa; lama.sultan@hotmail.comBackground: Palliative care teams provide support to patients and their caregivers during terminal illness, which requires interprofessional collaboration. One of the foundational skills is to assist patients with decision-making. This can be facilitated through interprofessional shared decision-making (IP-SDM). So far, IP-SDM education frameworks have only been used to a limited extent in the area of palliative care.Aim: This study aims to explore perceptions and practices of faculty members, health professionals, and students toward IP-SDM education in palliative care and to indicate associated factors to implement an IP-SDM in undergraduate health professions education in palliative care settings.Methods: We used a cross-sectional study design in which the data was obtained via an online self-administered questionnaire adapted from existing validated tools. The questionnaire was distributed to faculty members and health professionals (n = 125) and students (n = 334) at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The sampling technique was a non-probability convenience sampling. Bivariate statistics, such as independent sample t-tests, one-way ANOVA, correlation coefficient, and linear multiple regression were conducted.Findings: The response rate was 54% (85 faculty members and health professionals and 164 students). Perceptions on IP-SDM did not differ between participants. From those who had previous experience with IP-SDM, the mean practices score was slightly higher for faculty members and health professionals (M = 83.1, SD = 15.9) than for students (M = 74.1, SD = 11.5), which was significant (p < 0.05). Factors such as gender, age, discipline, nationality, level of education, years of study, and previous experience that were associated with perceptions and practices were varied among participants.Conclusion: The findings show high levels of perception with low levels of practice of IP-SDM in palliative care. Other factors that could be associated with the topic should be addressed in further studies.Keywords: health professions education, interprofessional shared decision-making, palliative care

AimCompetency frameworks are essential for analyzing capabilities of Schools of Public Health to adequately prepare public health (PH) professionals to address contemporary challenges. This study maps the competency profiles of PH training programs in Israel using a novel curriculum mapping tool.MethodsThis study assessed all five Israeli Health Education Institutions (HEIs) offering MPH or Bachelors in Public Health (BPH) degrees across 57 competencies in six domains to determine the extent to which competencies were addressed in the curriculum. The competencies list was based on the Association of Schools of Public Health in the European Region (ASPHER) List of Core Competences for the Public Health Professional, adapted for Israeli HEIs.ResultsThe core curricula in the four MPH programs addressed 45–84% of all competencies. The BPH program addressed 79% of competencies. In MPH programs, the core curricula addressed most or all competencies in the Methods and the Socioeconomic Determinants of Health domains. Competencies in the domains of Environmental Determinants of Health, Health Policy, Economics & Organization, and Health Promotion and Prevention were less comprehensively addressed in most core curricula. Students’ opportunities to broaden their exposure to competencies outside the core curricula were context dependent.DiscussionThe curriculum competencies mapping tool that was developed served to assess both strengths and shortcomings in PH education in Israel. The findings demonstrate a highly variable array of PH curriculum models in Israeli HEIs, as well as overall shortcomings in the Environmental, Health Policy Economics and Organization, and Health Promotion and Prevention domains. This analysis has already led to reassessment of the curriculum, and will continue to guide the next steps to increase the harmonization of PH training curricula and to better meet PH challenges in Israel.

The isotopic and elemental composition of the fossil shells of foraminifera are often used for reconstructing past environments and climates. These so-called proxy relations are based on the effect of environmental conditions (e.g. seawater temperature, pH) on the isotopic ratio (e.g. δ11B or δ18O) or partitioning of elements (commonly expressed as El/Ca or DEl) during calcification. Whereas many studies focused on proxy-calibrations of divalent cations, incorporation of monovalent cations are less well constrained. Here we calibrate shell potassium content (K/Cacc) as a function of 1) seawater K+ concentration, 2) the ratio of potassium and calcium in seawater (K/Casw) and 3) temperature. Moreover, we analyze Na+ incorporation into the calcite as a function of seawater K+ and Ca2+ concentrations. First, we cultured specimens of the larger benthic foraminifer Amphistegina lessonii at four different seawater [Ca2+] and constant [K+], resulting in a range of K/Casw. Secondly, we cultured specimens of the same species at four different [Ca2+]sw and [K+]sw while keeping the ratio between these two ions constant. Finally, we tested the effect of temperature (from 18 to 28°C) on K-incorporation in this species. Measured K/Cacc values are not notably affected by [Ca2+]sw, while seawater [K+] positively influences potassium incorporation, resulting in a positive correlation between seawater K/Ca values and K/Cacc. Although the [Na+] in the culture media was constant throughout both experiments, incorporated Na responded positively to decreasing [Ca2+]sw, resulting in a positive correlation between sea water Na/Ca and Na/Cacc. The difference in the controls on K- and Na-incorporation suggests that the (biological) control on these ions differs. Part of the observed variability in element partitioning may be explained by differences in chemical speciation and crystallographic coordination in the calcite lattice.

BackgroundIntensive longitudinal methods offer a powerful tool for capturing daily experiences of individuals. However, its feasibility, effectiveness, and optimal methodological approaches for studying or monitoring experiences of oncology patients remain uncertain. ObjectiveThis scoping review aims to describe to what extent intensive longitudinal methods with daily electronic assessments have been used among patients with breast or lung cancer and with which methodologies, associated outcomes, and influencing factors. MethodsWe searched the electronic databases (PubMed, Embase, and PsycINFO) up to January 2024 and included studies reporting on the use of these methods among adults with breast or lung cancer. Data were extracted on population characteristics, intensive monitoring methodologies used, study findings, and factors influencing the implementation of these methods in research and clinical practice. ResultsWe identified 1311 articles and included 52 articles reporting on 41 studies. Study aims and intensive monitoring methodologies varied widely, but most studies focused on measuring physical and psychological symptom constructs, such as pain, anxiety, or depression. Compliance and attrition rates seemed acceptable for most studies, although complete methodological reporting was often lacking. Few studies specifically examined these methods among patients with advanced cancer. Factors influencing implementation were linked to both patient (eg, confidence with intensive monitoring system) and methodology (eg, option to use personal devices). ConclusionsIntensive longitudinal methods with daily electronic assessments hold promise to provide unique insights into the daily lives of patients with cancer. Intensive longitudinal methods may be feasible among people with breast or lung cancer. Our findings encourage further research to determine optimal conditions for intensive monitoring, specifically in more advanced disease stages.

Since the industrial revolution the ocean has become noisier. The global increase in shipping is one of the main contributors to this. In some regions, shipping contributed to an increase in ambient noise of several decibels, especially at low frequencies (10 to 100 Hz). Such an increase can have a substantial negative impact on fish, invertebrates, marine mammals and birds interfering with key life functions (e.g. foraging, mating, resting, etc.). Consequently, engineers are investigating ways to reduce the noise emitted by vessels when designing new ships. At the same time, since the industrial revolution (starting around 1760) greenhouse gas emissions have increased the atmospheric carbon dioxide fraction x(CO2) by more than 100 μmol mol-1. The ocean uptake of approximately one third of the emitted CO2 decreased the average global surface ocean pH from 8.21 to 8.10. This decrease is modifying sound propagation, especially sound absorption at the frequencies affected by shipping noise lower than 10 kHz, making the future ocean potentially noisier. There are also other climate change effects that may influence sound propagation. Sea surface warming might alter the depth of the deep sound speed channel, ice melting could locally decrease salinity and more frequent storms and higher wind speed alter the depth of the thermocline. In particular, modification of the sound speed profile can lead to the appearance of new ducts making specific depths noisier. In addition, ice melting and the increase in seawater temperature will open new shipping routes at the poles increasing anthropogenic noise in these regions. This review aims to discuss parameters that might change in the coming decades, focusing on the contribution of shipping, climate change and economic and technical developments to the future underwater soundscape in the ocean. Examples are given, contrasting the open ocean and the shallow seas. Apart from the changes in sound propagation, this review will also discuss the effects of water quality on ship-radiated noise with a focus on propeller cavitation noise.

The chemical composition of foraminiferal shells is a well-known tool in paleoceanography to reconstruct past environments and climate. Their application is based on the relation between environmental variables and the concentration of elements incorporated or stable isotope fractionation during calcification. The vast majority of these so-called proxy relationships are based on the foraminiferal order of the Rotaliida, which, for example, encompasses all living planktonic species. However, there are more orders of foraminifera with calcifying members, some of which have fundamentally different biomineralization pathways, such as the Nodosariida, the Polymorphinida and the Vaginulinida. All these belong to the class of the Nodosariata and produce calcite shells, which may serve as carriers of paleoenvironmental and climate signals. The microstructures of these shells and overall morphology of these foraminifera strongly deviate from the Rotaliida, suggesting that their elemental and stable isotopic composition do not necessarily respond similarly to environmental parameters. A potential advantage of the Nodosariata is that they appear considerably earlier in the fossil record (Carboniferous) than the Rotaliida (Jurassic), thereby possibly extending the range of foraminifer-based paleoceanographic reconstructions considerably. To test the potential application of Nodosariata foraminifera as paleoproxies, we investigated incorporation of 5 elements in 11 species as a function of environmental parameters from a transect sampled in the Gulf of Mexico. Their element composition (B / Ca, Na / Ca, Mg / Ca, Sr / Ca and Ba / Ca) shows a distinct geochemical signature for these foraminifera, different to that of members of other foraminiferal orders. Results also show an increase in Mg / Ca values with increasing temperature, similar to that known for the Rotaliida, which suggest that Nodosariata shells might be useful for paleotemperature reconstructions. The difference in Mg / Ca–temperature calibration in Nodosariata compared to Rotaliida, with the large differences in their morphology, shell microstructures and overall geochemical composition, suggests that the Mg / Ca-to-temperature relationship is partly independent of the exact calcification mechanism. We compare Mg / Ca–temperature sensitivities across foraminiferal orders and describe a relationship between the average Mg / Ca and the sensitivity of the Mg / Ca–temperature calibration. For other elements, the variability across orders is smaller compared to that in Mg / Ca, which results in more similar El / Ca–environmental calibrations.

The chemical composition of mollusk shells is a useful tool in (paleo)climatology since it captures inter- and intra-annual variability in environmental conditions. Trace element and stable isotope analysis with improved sampling resolution now allows in situ determination of the composition of mollusk shell volumes precipitated at daily to sub-daily time intervals. Here, we discuss hourly resolved Mg / Ca, Mn / Ca, Sr / Ca, and Ba / Ca profiles measured by laser ablation inductively coupled plasma – mass spectrometry (ICP-MS) through shells of the photosymbiotic giant clams (Tridacna maxima, T. squamosa, and T. squamosina) and the non-photosymbiotic scallop Pecten maximus. Precise sclerochronological age models and spectral analysis allowed us to extract daily and tidal rhythms in the trace element composition of these shells. We find weak but statistically significant expressions of these periods and conclude that this cyclicity explains less than 10 % of the sub-annual variance in trace element profiles. Tidal and diurnal rhythms explain variability of, at most, 0.2 mmol mol−1 (∼ 10 % of mean value) in Mg / Ca and Sr / Ca, while ultradian Mn / Ca and Ba / Ca cyclicity has a median amplitude of less than 2 µmol mol−1 mol mol−1 (∼ 40 % and 80 % of the mean of Mn / Ca and Ba / Ca, respectively). Daily periodicity in Sr / Ca and Ba / Ca is stronger in Tridacna than in Pecten, with Pecten showing stronger tidal periodicity. One T. squamosa specimen which grew under a sunshade exhibits among the strongest diurnal cyclicity. Daily cycles in the trace element composition of giant clams are therefore unlikely to be driven by variations in direct insolation but rather reflect an inherent biological rhythmic process affecting element incorporation. Finally, the large amount of short-term trace element variability unexplained by tidal and daily rhythms highlights the dominance of aperiodic processes in mollusk physiology and/or environmental conditions over shell composition at the sub-daily scale. Future studies should aim to investigate whether this remaining variability in shell chemistry reliably records weather patterns or circulation changes in the animals' environment.

Introduction People with advanced cancer can experience a wide range of multidimensional symptoms or concerns, but little is known about when and how these fluctuate in daily life. Experience sampling methods (ESMs) involve repeated self-reports in people’s natural contexts aimed at uncovering everyday life experiences. ESM has limited recall bias and good ecological validity but might be burdensome to patients. This study aims to pretest and evaluate the feasibility and clinical utility of a validated ESM and use it to explore everyday experiences of people living with advanced breast or lung cancer.Methods and analysis In step 1, we will optimise our ESM method by pretesting it through usability interviews and a pilot ESM study. In step 2, we will evaluate and use the ESM method through an observational ESM study to investigate the daily experiences of people with advanced breast or lung cancer. Step 2 also includes interviews with healthcare professionals to determine the clinical utility of ESM in oncology. Participants will complete a digital questionnaire ten times per day, measuring momentary experiences in the physical, psychological, social, spiritual-existential domains and context. Multilevel regression models will analyse fluctuations and temporal relations among measured experiences and context. Analyses also include evaluation of compliance and participation rates. We will apply content analysis to the usability interviews and follow-up interviews of the pilot ESM study.Ethics and dissemination We obtained approval from the ethics committees of the University Hospitals of Brussels (BUN: 1432023000043) and Ghent (ONZ-2023-0136). Results will be published in open-access, peer-reviewed journals and presented at conferences. If ESM appears feasible in this population, it could offer new insights into the daily experiences and help optimise support for people with advanced cancer.

The COVID-19 pandemic has been forcing people to work remotely in virtual teams around the globe. Global virtual teamwork will continue, and people are not sufficiently prepared for this, resulting in reduced team commitment and lower performance. Higher education institutions need to equip their graduates with International Online Collaboration Competencies (IOCCs), but research into these is fragmented, lacking even a definition of these competencies. This study was systematically reviewing empirical studies on IOCCs. 516 studies were reviewed, and data from 14 full texts were analyzed. Six competence domains emerged from the literature. Most studies focused on single domains of IOCCs, and none of the studies covered all domains. Results indicate that this preliminary framework for higher education students provides a first overview of the fragmented literature on IOCCs. Methods to teach and evaluate IOCCs acquisition are underdeveloped but urgently needed to equip professionals for global virtual teamwork.

Since the industrial revolution, oceans have become substantially noisier. The noise increase is mainly caused by increased shipping, resource exploration, and infrastructure development affecting marine life at multiple levels, including behavior and physiology. Together with increasing anthropogenic noise, climate change is altering the thermal structure of the oceans, which in turn might affect noise propagation. During this century, we are witnessing an increase in seawater temperature and a decrease in ocean pH. Ocean acidification will decrease sound absorption at low frequencies (500 km). In the case of the Northeast Atlantic Ocean, this sub-surface duct will only be present during winter, leading to similar total mean square pressure level (SPLtot) values in the summer for both (2018 to 2022) and (2094 to 2098). We observed a strong and similar correlation for the two climate change scenarios, with an increase of the top 200 m SPLtot and a slowdown of Atlantic Meridional Overturning Circulation (AMOC) leading to an increase of SPLtot at the end of the century by 7 dB.

Abstract Background Sepsis is characterized by a dysregulated immune response to infection. The complement system plays an important role in the host defence to pathogens. However, exaggerated complement activation might contribute to a hyperinflammatory state. The interplay between complement activation and inflammation in relationship with adverse outcomes in sepsis patients is unclear. Methods Secondary analysis of complement factors in a prospective study in 209 hospitalized sepsis patients, of whom the majority presented with shock. Concentrations of complement factors C3, C3a, C3c, C5, C5a, and soluble terminal complement complex were assessed in ethylenediaminetetraacetic acid plasma samples collected within 24 h after sepsis diagnosis using enzyme-linked immunosorbent assays. Results The concentration of complement factors in plasma of severely ill sepsis patients indicated profound activation of the complement system (all P 0.05) in this cohort of patients with high disease severity. Conclusions Once an infection progresses to severe sepsis or septic shock, the complement pathway is already profoundly activated and is no longer related to a dysregulated inflammatory response, nor to clinical outcome. This implies that in this patient category with severe disease, the complement system is activated to such an extent that it no longer has predictive value for clinical outcome.

Abstract Background Little is known about the nature and intensity of palliative care needs of hospitalised older people. We aimed to describe the palliative care symptoms, concerns, and well-being of older people with frailty and complex care needs upon discharge from hospital to home, and to examine the relationship between palliative care symptoms and concerns, and well-being. Methods Cross-sectional study using baseline survey data of a pilot randomised controlled trial. Hospital staff identified patients (≥ 70 years) about to be discharged home, with a clinical frailty score of 5 to 7 and complex needs based on physician-assessment. Patients completed structured interviews, using the Integrated Palliative Care Outcome Scale (IPOS), ICEpop CAPability measure for supportive care (ICECAP-SCM) and IPOS Views on Care quality of life item. We calculated descriptive statistics. Results We assessed 37 older people with complex needs (49% women, mean age 84, standard deviation 6.1). Symptoms rated as causing severe problems were weakness (46%) and poor mobility (40%); 75% reported that their family felt anxious at least occasionally. Of the 17 IPOS items, 41% of patients rated five or more symptoms as causing severe problems, while 14% reported that they were not severely affected by any symptom. 87% expressed feeling supported. There was a negative correlation between symptoms (IPOS) and well-being (ICECAP); r = -0.41. Conclusion We identified a large variety of symptoms experienced by older people identified as having frailty and complex needs upon hospital discharge. Many were severely affected by multiple needs. This population should be considered for palliative care follow-up at home.

Abstract Background Sepsis is a heterogeneous syndrome due to a variable range of dysregulated processes in the host immune response. Efforts are made to stratify patients for personalized immune-based treatments and better prognostic prediction. Using gene expression data, different inflammatory profiles have been identified. However, it remains unknown whether these endotypes mirror inflammatory proteome profiling, which would be more feasible to assess in clinical practice. We aim to identify different inflammatory endotypes based on circulating proteins in a cohort of moderately ill patients with severe infection (Sepsis-2 criteria). Methods In this prospective study, 92 inflammatory plasma markers were profiled using a targeted proteome platform and compared between patients with severe infection (Sepsis-2 criteria) and healthy controls. To identify endotypes with different inflammatory profiles, we performed hierarchical clustering of patients based on the differentially expressed proteins, followed by clinical and demographic characterization of the observed endotypes. Results In a cohort of 167 patients with severe infection and 192 healthy individuals, we found 62 differentially expressed proteins. Inflammatory proteins such as TNFSF14, OSM, CCL23, IL-6, and HGF were upregulated, while TRANCE, DNER and SCF were downregulated in patients. Unsupervised clustering identified two different inflammatory profiles. One endotype showed significantly higher inflammatory protein abundance, and patients with this endotype were older and showed lower lymphocyte counts compared to the low inflammatory endotype. Conclusions By identifying endotypes based on inflammatory proteins in moderately ill patients with severe infection, our study suggests that inflammatory proteome profiling can be useful for patient stratification.

BackgroundSuccessful management of public health challenges requires developing and nurturing leadership competencies. We aimed to evaluate the effectiveness of training simulations to assess public health leadership and decision-making competencies during emergencies as an effective learning and training method.MethodsWe examined the effects of two simulation scenarios on public health school students in terms of their experience (compared to face-to-face learning) and new skills acquired for dealing with similar emergent situations in the future. A mixed-methods design included developing a validated and pre-tested questionnaire with open-and closed-ended questions that examined the simulation impact and the degree of student satisfaction with the conditions in which it was conducted. Semi-structured in-depth interviews were conducted with the students after going through the simulations. The questionnaire results were evaluated using descriptive analytics. The interviews were analyzed using thematic analyses. All data were collected during June 2022.ResultsThe questionnaire results indicate that students strengthened their interpersonal communication skills and learned about the importance of listening to the opinions of others before formulating their positions. Four themes emerged from 16 in-depth interviews, according to Kolb’s experimental learning cycle. Students emphasized the effectiveness of experiential learning versus traditional classroom learning. The simulation scenarios were felt to realistically convey critical issues regarding leadership, decision-making, and teamwork challenges. They effectively conveyed the importance of building a culture of conducting substantive and respectful discussions.ConclusionSimulation is a powerful pedagogical training tool for public health leadership competencies. Simulations were seen to be advantageous over face-to-face learning in imparting a range of leadership skills and hands-on practice. We recommend integrating simulations in all public health leadership training programs.

IntroductionGrowth experiments present a powerful tool for determining the effect of environmental parameters on growth and carbonate composition in biogenic calcifiers. For successful proxy calibration and biomineralization studies, it is vital to identify volumes of carbonate precipitated by these organisms at precise intervals during the experiment. Here, we investigate the use of strontium labelling in mollusc growth experiments.MethodsThree bivalve species (Cerastoderma edule, Mytilus edulis and Ostrea edulis) were grown under monitored field conditions. The bivalves were regularly exposed to seawater with elevated concentrations of dissolved strontium chloride (SrCl2). In addition, the size of their shells was determined at various stages during the experiment using calliper measurements and digital photography. Trace element profiles were measured in cross sections through the shells of these molluscs using laser ablation ICPMS and XRF techniques.ResultsOur results show that doses of dissolved strontium equivalent to 7-8 times the background marine value (~0.6 mmol/L) are sufficient to cause reproducible peaks in shell-incorporated strontium in C. edule and M. edulis shells. No negative effects were observed on shell calcification rates. Lower doses (3-5 times background values) resulted in less clearly identifiable peaks, especially in M. edulis. Strontium spiking labels in shells of O. edulis are more difficult to detect, likely due to their irregular growth.DiscussionStrontium spiking is a useful technique for creating time marks in cultured shells and a reproducible way to monitor shell size during the growing season while limiting physical disturbance of the animals. However, accurate reconstructions of growth rates at high temporal resolution require frequent spiking with high doses of strontium.

It has been hypothesized that global temperature trends are tightly linked to tropical thermocline depth, and that thermocline shoaling played a crucial role in the intensification of late Pliocene Northern Hemisphere glaciation. The Pliocene thermocline evolution in the Pacific Ocean is well documented and supports this hypothesis, but thermocline records from the tropical Atlantic Ocean are limited. We present new planktonic foraminiferal Mg/Ca, δ18O, and δ13C records from the late Pliocene interval at Ocean Drilling Program Site 959 in the Eastern Equatorial Atlantic (EEA), which we use to reconstruct ocean temperatures and relative changes in salinity and thermocline depth. Data were generated using surface-dwelling Globigerinoides ruber and subsurface-dwelling Neogloboquadrina dutertrei. Reduced gradients between the surface and subsurface records indicate deepening of the EEA thermocline at the end of the mid-Piacenzian Warm Period (mPWP; ∼ 3.3–3.0 Ma). We connect our late Pliocene records to previously published early Pliocene δ18O data from Site 959 and compare these to the Site 1000 in the Caribbean Sea. Over the course of the Pliocene, thermocline changes in the EEA and Caribbean Sea follow similar patterns, with prominent step-wise thermocline deepening between ∼ 5.5 and 4.0 Ma and gradual shoaling up to the mPWP, followed by minor deepening at the end of the mPWP. The tropical thermocline depth evolution of the tropical Atlantic differs from the Pacific, which is characterized by gradual basin-wide shoaling across the Pliocene. These results potentially challenge the hypothesized link between tropical thermocline depth and global climate. The mechanisms behind the periodically divergent Pacific and Atlantic thermocline movements remain speculative. We suggest that they are related to basin geometry and heterogenous temperature evolutions in regions from where thermocline waters are sourced. A positive feedback loop between source region temperature and tropical cyclone activity may have amplified tropical thermocline adjustments.

Health professionals often need to work together to provide team-based care. With increasing healthcare complexities and manpower shortages, more health professionals are working in multiple, fluid teams instead of one stable team, to provide care to patients. However, there is currently no validated instrument to measure the quality of interprofessional collaboration in fluid teams. One approach is to assess team members' perceived level of teamness (qualities that make clinical teams effective). This study aimed to examine the validity evidence of using the Assessment for Collaborative Environment (ACE-15) in fluid teams and investigate if teamness varies among health professions and clinical settings. Content and response process validity were gathered through consulting experts and cognitive interviews, resulting in revisions to 11 of 15 items in ACE-15. Through exploratory factor analysis of 194 responses on the revised ACE-15, a 13-item instrument, ACE-13F, with strong validity evidence for use in fluid teams was developed. A two-factor fixed effect ANOVA model revealed that the clinical setting that health professionals work in has a significant impact on the level of teamness (F[3,170] = 6.15, p <.001, η2 = 0.09). ACE-13F can be used as a rapid instrument to measure interprofessional collaboration in fluid healthcare teams. [ABSTRACT FROM AUTHOR]

Rising atmospheric CO2 shifts the marine inorganic carbonate system and decreases seawater pH, a process often abbreviated to ‘ocean acidification’. Since acidification decreases the saturation state for crystalline calcium carbonate (e.g., calcite and aragonite), rising dissolved CO2 levels will either increase the energy demand for calcification or reduce the total amount of CaCO3 precipitated. Here we report growth of two large benthic photosymbiont-bearing foraminifera, Heterostegina depressa and Amphistegina lessonii, cultured at four different ocean acidification scenarios (400, 700, 1000 and 2200 ppm atmospheric pCO2). Using the alkalinity anomaly technique, we calculated the amount of calcium carbonate precipitated during the incubation and found that both species produced the most carbonate at intermediate CO2 levels. The chamber addition rates for each of the conditions were also determined and matched the changes in alkalinity. These results were complemented by micro-CT scanning of selected specimens to visualize the effect of CO2 on growth. The increased chamber addition rates at elevated CO2 concentrations suggest that both foraminifera species can take advantage of the increased availability of the inorganic carbon, despite a lower saturation state. This adds to the growing number of reports showing the variable response of foraminifera to elevated CO2 concentrations, which is likely a consequence of differences in calcification mechanisms.

Coral reefs are declining worldwide. The abundance of corals has decreased alongside a rise of filter feeders, turf, and algae in response to intensifying human pressures. This shift in prevalence of functional groups alters the biogeochemical processes in tropical water ecosystems, thereby influencing reef functioning. An urgent challenge is to understand the functional consequences of these shifts to develop suitable management strategies that aim at preserving the biological functions of reefs. Here, we quantify biogeochemical processes supporting key reef functions (i.e. net community calcification (NCC) and production (NCP) and nutrient recycling) in situ for five different benthic assemblages currently dominating shallow degraded Caribbean reef habitats. To this end, a transparent custom-made enclosure was placed over communities dominated by either one of five functional groups – coral, turf and macroalgae, bioeroding sponges, cyanobacterial mats, or sand – to determine chemical fluxes between these communities and the overlying water, during both day and night. To account for the simultaneous influence that distinct biogeochemical processes have on measured variables, the rates were then derived by solving a model consisting of differential equations describing the contribution of each process to the measured chemical fluxes. Inferred rates were low compared to those known for reef flats worldwide. Reduced accretion potential was recorded, with negative or very modest net community calcification rates for all communities. Net production during the day was also low, suggesting limited accumulation of biomass through photosynthesis and remineralisation of organic matter at night was relatively high in comparison, resulting in net heterotrophy over the survey period for most communities. Estimated recycling processes (i.e. nitrification and denitrification) were high but did not fully counterbalance nutrient release from aerobic mineralisation, rendering all substrates sources of nitrogen. Results suggest similar directions and magnitudes of key biogeochemical processes of distinct communities on this shallow Curaçaoan reef. We infer that the amount and type of organic matter released by abundant algal turfs and cyanobacterial mats on this reef likely enhances heterotroph activity and stimulates the proliferation of less diverse copiotrophic microbial populations, rendering the studied reef net heterotrophic and drawing the biogeochemical “behaviour” of distinct communities closer to each other.

The ongoing Coronavirus Disease 2019 (COVID-19) pandemic is caused by the highly infectious Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). There is an urgent need for biomarkers that will help in better stratification of patients and contribute to personalized treatments. We performed targeted proteomics using the Olink platform and systematically investigated protein concentrations in 350 hospitalized COVID-19 patients, 186 post-COVID-19 individuals, and 61 healthy individuals from 3 independent cohorts. Results revealed a signature of acute SARS-CoV-2 infection, which is represented by inflammatory biomarkers, chemokines and complement-related factors. Furthermore, the circulating proteome is still significantly affected in post-COVID-19 samples several weeks after infection. Post-COVID-19 individuals are characterized by upregulation of mediators of the tumor necrosis (TNF)-α signaling pathways and proteins related to transforming growth factor (TGF)-ß. In addition, the circulating proteome is able to differentiate between patients with different COVID-19 disease severities, and is associated with the time after infection. These results provide important insights into changes induced by SARS-CoV-2 infection at the proteomic level by integrating several cohorts to obtain a large disease spectrum, including variation in disease severity and time after infection. These findings could guide the development of host-directed therapy in COVID-19.

BackgroundThe complement system is an essential component of our innate defense and plays a vital role in the pathogenesis of many diseases. Assessment of complement activation is critical in monitoring both disease progression and response to therapy. Complement analysis requires accurate and standardized sampling and assay procedures, which has proven to be challenging.ObjectiveWe performed a systematic analysis of the current methods used to assess complement components and reviewed whether the identified studies performed their complement measurements according to the recommended practice regarding pre-analytical sample handling and assay technique. Results are supplemented with own data regarding the assessment of key complement biomarkers to illustrate the importance of accurate sampling and measuring of complement components.MethodsA literature search using the Pubmed/MEDLINE database was performed focusing on studies measuring the key complement components C3, C5 and/or their split products and/or the soluble variant of the terminal C5b-9 complement complex (sTCC) in human blood samples that were published between February 2017 and February 2022. The identified studies were reviewed whether they had used the correct sample type and techniques for their analyses.ResultsA total of 92 out of 376 studies were selected for full-text analysis. Forty-five studies (49%) were identified as using the correct sample type and techniques for their complement analyses, while 25 studies (27%) did not use the correct sample type or technique. For 22 studies (24%), it was not specified which sample type was used.ConclusionA substantial part of the reviewed studies did not use the appropriate sample type for assessing complement activation or did not mention which sample type was used. This deviation from the standardized procedure can lead to misinterpretation of complement biomarker levels and hampers proper comparison of complement measurements between studies. Therefore, this study underlines the necessity of general guidelines for accurate and standardized complement analysis

Background Recognition of precapillary pulmonary hypertension (PH) has significant implications for patient management. However, the low a priori chance to find this rare condition in community hospitals may create a barrier against performing a right heart catheterization (RHC). This could result in misclassification of PH and delayed diagnosis/treatment of precapillary PH. Therefore, we investigated patient characteristics and echocardiographic parameters associated with the decision whether to perform an RHC in patients with incident PH in 12 Dutch community hospitals. Methods and Results In total, 275 patients were included from the OPTICS (Optimizing PH Diagnostic Network in Community Hospitals) registry, a prospective cohort study with patients with incident PH; 157 patients were diagnosed with RHC (34 chronic thromboembolic PH, 38 pulmonary arterial hypertension, 81 postcapillary PH, 4 miscellaneous PH), while 118 patients were labeled as probable postcapillary PH without hemodynamic confirmation. Multivariable analysis showed that older age (>60 years), left ventricular diastolic dysfunction grade 2–3, left atrial dilatation were independently associated with the decision to not perform an RHC, while presence of prior venous thromboembolic events or pulmonary arterial hypertension‐associated conditions, right atrial dilatation, and tricuspid regurgitation velocity ≥3.7 m/s favor an RHC performance. Conclusions Older age and echocardiographic parameters of left heart disease were independently associated with the decision to not perform an RHC, while presence of prior venous thromboembolic events or pulmonary arterial hypertension‐associated conditions, right atrial dilation, and severe PH on echocardiography favored an RHC performance. As such, especially elderly patients may be at an increased risk of diagnostic delays and missed diagnoses of treatable precapillary PH, which could lead to a worse prognosis.