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Background: For many trans folks, gender-affirming hormone therapy (GAHT) is a desired affirming procedure that has been linked with positive health outcomes, however literature has had little focus on the journeys of trans people as they access GAHT. Aim: To understand trans people's journey of accessing GAHT to delineate supports necessary to better engage trans individuals into gender-affirming care. Method: This study conducted semi-structured interviews with a sample of 15 Australian trans adults who participated in a larger study investigating the effects of a cyproterone acetate titration protocol. Findings: A four-factor thematic structure was created from the data. Theme one describes early cognizance of being trans and the pivotal moments in their trans realization. The second theme explores the rapid engagement with community to begin accessing information and affirming healthcare, including GAHT. The third theme explores barriers to engaging in GAHT and theme four reflects on advice participants have for other trans people who are considering GAHT. Conclusion: Findings from this study emphasize the importance of providing support to young trans people to help reconcile their gender identity and assist them to engage into care as early as possible. It also highlights the key role that community plays in providing links to affirming information and providers of GAHT – but also emphasizes the importance of considering how to engage with community who may be missed. The experience of accessing GAHT is personal and contextual, but signaling of affirming safe spaces and access to salient information may be key strategies to better support trans people choosing to access GAHT. [ABSTRACT FROM AUTHOR]

It is well established that university students are vulnerable to poor mental health. Although increased gratitude has been shown to reduce stress among students, a clearer understanding of key mechanisms underpinning this relationship are needed to better inform theoretical models and potential interventions targeted at improving well‐being in university students. The present study provides the first direct test of whether capacity for emotion regulation mediates the relationship of gratitude with stress at the beginning and middle of the academic semester. This study is also the first to assess this relationship in a cross‐lagged panel mediation model. We used a repeated measures design and a total of 343 undergraduate students completed two online surveys with validated measures of gratitude, stress, and emotion regulation—one at the beginning and the second in the middle of the academic semester. Results showed that emotion regulation mediated the relationship between gratitude and stress at the beginning of semester, and again 6 weeks later. A Clogg's z‐score test suggested that the strength of the indirect effect significantly increased across the two time points. A post‐hoc cross‐lagged panel model found that high gratitude at the beginning of the semester predicted low stress in the middle of the semester via emotion regulation. These data provide novel evidence that emotion regulation may serve as a key protective factor against undergraduate stress. The results provide evidence to support leading theories on how gratitude can reduce stress and promote well‐being in university students. They also highlight the practical importance of strengthening emotion regulation abilities in university students and can be used to inform future targeted interventions to improve well‐being in university students. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Children and adolescents with autism spectrum disorder and/or intellectual disability often present to emergency departments with behaviours of concern: irritability, aggression and self‐injurious behaviour. The objective of this study was to design, implement and evaluate a new model of care to support these patients and their families following presentation to reduce the need for re‐presentation.We designed and evaluated a new model of care for these patients, comprising consultations with a developmental paediatrician and a child psychiatrist, referral to a specialist behavioural service and 6 weeks of care coordination by a clinical nurse consultant. Using a quality improvement framework, iterative improvements were made to the model via a series of plan–do–study–act cycles. Re‐presentation rates were compared with a control group of patients who presented with behaviours of concern but were not recruited into the study. Participating families and treating clinicians were surveyed at 2 and 6 weeks post‐enrolment to gather qualitative feedback about their experience of the model.A total of 31 families participated in the study. Three‐ and 6‐month re‐presentation rates were 48.7% and 36.3% lower than the control group. Qualitative evaluation of the model by both families and clinicians was positive. The model was feasible and acceptable. Families reported feeling heard and understood, and that the intervention was helpful and provided a positive path forwards.The findings suggest that a simple model of care can be successfully implemented and provide meaningful benefits for families of children with behaviours of concern, including reduced crisis‐oriented help‐seeking. [ABSTRACT FROM AUTHOR]

AbstractGender-affirming hormone therapy (GAHT) comes with many physical, psychological, and social changes that are often considered in isolation. This research uses a socioecological lens with a sample of 15 Australian transfeminine individuals to investigate the changes experienced during GAHT. Semi-structured interviews were conducted in 2022, with verbatim transcripts analysed using deductive thematic analysis with Bronfenbrenner’s Socioecological Model (SEM) as a framework. Analyses revealed two themes intersecting multiple levels of the SEM. Theme 1 contained two sub-themes and broadly encapsulated how interactions with others influenced GAHT experiences. Sub-theme 1 spoke to how stigma creates positive or negative experiences (through the macrosystem, the exosystem, and proximal processes), while sub-theme 2 described how GAHT causes internal changes that promoted stronger interpersonal relationships (person and proximal processes). Theme 2 described how changes occurred over time, with some changes being temporary, and others being delayed (person and time). These themes highlight the interconnected nature of the physical, psychological, and social changes and experiences that can occur during GAHT. Best-practice care for trans people undergoing GAHT needs to be multi-faceted and holistic in order to embed support across different SEM components. [ABSTRACT FROM AUTHOR]

One way to support mental health among LGBTQI+ adolescents is by bystander intervention during bias-based bullying. We use an adolescent-focused socio-ecological framework to identify what characterizes an active bystander in bias-based bullying toward LGBTQI+ individuals. Using PRIMSA guidelines, seven databases yielded 6777 papers which were refined to 23 overall—11 on adolescent peer defending behavior, and 12 on school professional's (SP) defending behavior. For adolescents, friendship with victims and peers, social norms, intrapersonal attitudes, and school professional's self-efficacy were associated with active bystanding. There is a shared responsibility in school environments to defend LGBTQI+ adolescents in bullying incidents to improve long-term mental and physical health trajectories for this community. [ABSTRACT FROM AUTHOR]

To explore what aromanticism is, common misconceptions about this identity, and the experiences people have connecting with an aromantic identity. An online, international open-ended survey with a convenience sample of aromantic individuals (N = 1642) analyzed with thematic analysis. To identify as aromantic involves a spectrum of experiences with romance commonly tied to experiencing stigma. Connecting with an aromantic identity allows for a greater understanding of the self and a connection to a community. Future research is needed to explore the experiences and perspectives of this community to gather better understanding of their needs and how to prevent/limit stigmatizing experiences. [ABSTRACT FROM AUTHOR]

Objectives: Digital mental health interventions are a promising therapeutic modality to provide psychological support to LGBTQIA+ (lesbian, gay, bisexual, trans, Queer, intersex, asexual, plus other gender, sexual, and romantic minority identities) people. The aim of this narrative review is to explore how the LGBTQIA+ community has been engaged in the design of digital mental health interventions, how content has been tailored to the LGBTQIA+ community, and features identified as important by LGBTQIA+ participants. Methods: A total of 33 studies were included in this review from a larger yield of 1933 identified from systematic searches of five databases (PsycINFO, PubMed, Scopus, CINAHAL, and Medline). Data were analyzed narratively and using content analysis. Results: Only half of the studies reported engaging the LGBTQIA+ community in intervention designs. Interventions have been tailored in a variety of ways to support LGBTQIA+ individuals—such as through affirming imagery, recruitment through LGBTQIA+ networks, and designing content to focus specifically on LGBTQIA+ issues. A range of features were identified as important for participants, namely how content was tailored to LGBTQIA+ experiences, providing connection to community, and links to other relevant LGBTQIA+ resources. While not a primary aim, results also showed that a wide range of digital modalities can significantly improve a range of mental health problems. Conclusion: Digital interventions are an acceptable and effective form of therapeutic intervention, but future research needs to focus on meaningful engagement of community members to inform design and implementation. [ABSTRACT FROM AUTHOR]

Growing evidence shows that online mental health interventions for university students are a cost-effective means for addressing mental health problems among university students. This study presents data on the numbers and characteristics of students who engaged in an online mental health promotion intervention called YOLO in the context of a university-wide rollout of the program before and after the onset of the COVID-19 pandemic. Participants completed a questionnaire assessing socio-demographics and mental health (wellbeing and distress). A total of 240 students accessed the program over a 12-month period and of these, 164 provided reliable data. YOLO was accessed by students representing diverse socio-demographics including domestic vs. international student status, degree level, faculty, ethnicity, and age, although there was an over-representation of females (77.2%). Students who accessed YOLO pre-COVID-19 did not substantially differ across most mental health dimensions from those who accessed it during-COVID-19, although more students reported mild-moderate anxiety symptoms during-COVID than pre-COVID-19. The only socio-demographics significantly associated with mental health were age and degree level. Younger age was related to higher anxiety and 3rd and 4th year undergraduate students reported poorer mental health comparative to students in other years. Additionally, a higher proportion of these students accessed YOLO during-COVID-19 than at pre-COVID-19. The present data along with findings from other studies that have evaluated YOLO, suggest that online mental health promotion programs that do not require in-person contact are an important and necessary resource for all university students. What is already known about this topic: (1) University students report high levels of mental distress. (2) Universities often lack capacity to provide support to all students. (3) Online, mental health programs may be a valuable tool to provide support. What this topic adds: (1) University students' self-reported psychological distress did not increase significantly pre and during COVID-19, however third-year and fourth-year students reported the most psychological distress during COVID-19. (2) The YOLO program was used by students of multiple cultural backgrounds, ages, enrolment statuses, and disciplines. (3) The YOLO online program may be one useful program Universities can use to support students' psychological wellbeing. [ABSTRACT FROM AUTHOR]

Background: Lateral canthal webbing is a known complication of blepharoplasty, which occurs when the lateral aspect of the upper blepharoplasty incision is taken below the equator of the lateral canthus. Removing excessive eyelid skin laterally can also result in a lateral canthal web. Currently, there is no standard approach for addressing this complication. Methods: Retrospective review of single surgeon practice between 2011 and 2019. All patients underwent revision surgery using the proposed single Z-plasty technique. Results: Twenty-three patients referred for lateral canthal web were included in the study. All patients had previous upper lid blepharoplasty, with the initial procedure occurring 8–63 months prior to the referral for revision. The majority of the blepharoplasties occurred in Ontario (n = 19), but some patients also underwent surgery in Alberta (n = 1), British Columbia (n = 1), and United States (n = 1). The initial surgeries were performed by a variety of specialities including plastic surgery (n = 16), otolaryngology (n = 4), ophthalmology (n = 2), and family medicine (n = 1). Following revision surgery using the single Z-plasty technique, all patients reported a subjective increase in functional and aesthetic satisfaction. No further revision surgery was required for any of these patients. Conclusion: The single Z-plasty technique is simple, robust, and could be easily incorporated into any cosmetic practice to address this complication of blepharoplasty. [ABSTRACT FROM AUTHOR]

This paper responds to calls for new theoretical frameworks within which to examine transport history and bring it into contact with other disciplines with a view to overcoming some of its alleged previous preoccupations with Anglocentric economic data. It offers three interconnected ideas from other fields, historical institutionalism, hybridity and institutional logics and it proposes that these tools can assist historians in making sense of the qualitative material from archival records. The paper also suggests that by explicitly framing the history of public transport as a political process, historians can engage with a wider social ecology of interest groups than those represented by economic interests. Whilst recognising the assumptions inherent in an institutional approach and the limitations of the scope of the author's own research, the paper argues that these frameworks can nevertheless be used widely and effectively. [ABSTRACT FROM AUTHOR]

Political ideology has been linked to beliefs regarding sexual harassment and assault (SH&A). Using data from the January 2018 Stop Street Sexual Harassment online poll (N = 2,009), this study examined associations of political identity and political ideology with self-reported experiences of being the victim of SH&A. SH&A experiences were coded into four mutually exclusive groups: none, non-physically aggressive harassment, physically aggressive harassment, or sexual assault. Sex-stratified logistic regression models assessed associations of interest, adjusting for participant demographics. Among women, more conservative political ideology was negatively associated with reports of sexual assault, odds ratio (OR) = 0.85, 95% confidence interval (CI) = [0.74, 0.98]. Among males, more conservative political ideology was negatively associated with reports of physically aggressive sexual harassment (OR = 0.85, 95% CI = [0.73, 0.98]), and greater Republican affiliation was negatively associated with reports of sexual assault (OR = 0.82, 95% CI = [0.68, 0.99]). Conservative and Republican women and men are thus less likely to report more severe forms of SH&A, which may explain differences in beliefs on these issues. Research is needed to determine if political differences are due to reporting biases or differential vulnerabilities. [ABSTRACT FROM AUTHOR]

• Healthcare providers consider digital, self-guided programs to be useful for the LGTBQIA+ community. • Providers felt programs may help provide support to those typically with access challenges and be a useful therapeutic adjunct. • Concerns were described around tailoring to LGBTQIA+ identities and potential for harm. • Providers advocate for programs to include affirming language, consideration of LGBTQIA+ challenges, community connection, and access to wider health information and services. Digital, self-guided mental health programs are a promising avenue for mental health support for LGBTQIA+ (lesbian, gay, bisexual, trans, Queer, intersex, asexual plus additional sexuality, gender, and romantic identities) people – however, healthcare providers (HCPs) perspectives on programs are largely unknown. The aim of this study was to explore these perspectives. A cross-sectional online survey was distributed across Australia, with a final sample of 540 HCPs from a range of disciplines. Most respondents (419, 81.2 %), reported that digital, self-guided mental health programs would be useful, but 74.5 % (n = 380) also reported that they had concerns. Thematic analysis of open-text responses showed that HCPs believe programs may help overcome access barriers and could be useful as part of a wider care journey. Others were concerned about patient safety, and whether programs could be appropriately tailored to LGBTQIA+ experiences. Content analysis of open-text responses showed affirming language and imagery, content on LGBTQIA+ people's unique challenges, wider health information, and connections to community were important to include in programs. HCPs advocated for programs that offered broad and sub-population specific information. These findings show that HCPs are enthusiastic about digital, self-guided mental health programs, but care should be taken to address key concerns to facilitate future implementation. [ABSTRACT FROM AUTHOR]

Governments issue "stay-at-home" orders to reduce the spread of contagious diseases, but the magnitude of such orders' effectiveness remains uncertain. In the United States these orders were not coordinated at the national level during the coronavirus disease 2019 (COVID-19) pandemic, which creates an opportunity to use spatial and temporal variation to measure the policies' effect. Here, we combine data on the timing of stay-at-home orders with daily confirmed COVID-19 cases and fatalities at the county level during the first seven weeks of the outbreak in the United States. We estimate the association between stay-at-home orders and alterations in COVID-19 cases and fatalities using a difference-in-differences design that accounts for unmeasured local variation in factors like health systems and demographics and for unmeasured temporal variation in factors like national mitigation actions and access to tests. Compared to counties that did not implement stay-at-home orders, the results show that the orders are associated with a 30.2 percent (11.0 to 45.2) average reduction in weekly incident cases after one week, a 40.0 percent (23.4 to 53.0) reduction after two weeks, and a 48.6 percent (31.1 to 61.7) reduction after three weeks. Stay-at-home orders are also associated with a 59.8 percent (18.3 to 80.2) average reduction in weekly fatalities after three weeks. These results suggest that stay-at-home orders might have reduced confirmed cases by 390,000 (170,000 to 680,000) and fatalities by 41,000 (27,000 to 59,000) within the first three weeks in localities that implemented stay-at-home orders. [ABSTRACT FROM AUTHOR]

This study combined a social network analysis and whole-genome sequencing (WGS) to test for general patterns of contagious spread of a mycobacterial infection for which pathways of disease acquisition are not well understood. Our population included 275 cases diagnosed with avian mycobacteriosis that were nested in a source population of 16,430 birds at San Diego Zoo Wildlife Alliance facilities from 1992 through mid-2014. Mycobacteria species were determined using conventional methods and whole genome sequencing (WGS). Mycobacterium avium avium (MAA) and Mycobacterium genavense were the most common species of mycobacteria identified and were present in different proportions across bird taxa. A social network for the birds was constructed from the source population to identify directly and indirectly connected cases during time periods relevant to disease transmission. Associations between network connectivity and genetic similarity of mycobacteria (as determined by clusters of genotypes separated by few single nucleotide polymorphisms, or SNPs) were then evaluated in observed and randomly generated network permutations. Findings showed that some genotypes clustered along pathways of bird connectivity, while others were dispersed throughout the network. The proportion of directly connected birds having a similar mycobacterial genotype was 0.36 and significant (p<0.05). This proportion was higher (0.58) and significant for MAA but not for M. genavense. Evaluations of SNP distributions also showed genotypes of MAA were more related in connected birds than expected by chance; however, no significant patterns of genetic relatedness were identified for M. genavense, although data were sparse. Integrating the WGS analysis of mycobacteria with a social network analysis of their host birds revealed significant genetic clustering along pathways of connectivity, namely for MAA. These findings are consistent with a contagious process occurring in some, but not all, case clusters. [ABSTRACT FROM AUTHOR]

Background: In the specialty of Otolaryngology – Head and Neck Surgery, intranasal corticosteroids are the mainstay treatment for inflammatory processes within the nasal cavity. All too often, physician prescribing patterns are based on previous training, personal experience, and interactions with industry. The purpose of this commentary is to review the nuances of each intranasal corticosteroid. Commentary: There are nine intranasal corticosteroids approved for use in Canada. Each are discussed in detail, including their indication, bioavailability, effects on intranasal environment, and factors around patient adherence. Off-label use of budesonide irrigations is also discussed and cost information is presented in reference format for all available intranasal corticosteroids. Conclusion: Although the efficacy of each intranasal corticosteroid has been shown to be similar, prescribing should be tailored based on bioavailability, intranasal environment, and factors that impact patient adherence such as dosing, cost and tolerability. [ABSTRACT FROM AUTHOR]

Introduction: During adolescence, exposure to nicotine or cannabis independently induces effects on neuromaturation and later cognitive function. However, the potential effect of both drugs under co-use conditions has become of increasing concern given the prevalence of e-cigarettes, legalization of cannabis, and availability of synthetic "spice" cannabinoid agonists.Aims and Methods: The current studies investigated the effects of exposure to a cannabinoid receptor agonist (WIN55,212-2) and/or nicotine over a discrete time period in mid-adolescence on later intravenous nicotine self-administration in adult male and female mice. We further examined whether cannabinoid agonist administration in adulthood would alter nicotine reinforcement, with either acute or chronic pairing across 7 days.Results: We found that adult males exhibited increased nicotine self-administration at a lower, rewarding nicotine dose following adolescent cannabinoid exposure, either alone or with nicotine coadministration. In contrast, adult females demonstrated an opposing effect in which adolescent cannabinoid and nicotine coexposure resulted in decreased nicotine intake compared with the nicotine only and control groups. Furthermore, after maintaining nicotine self-administration across sessions, pretreatment with a low dose of the cannabinoid agonist decreased nicotine intake in both male and female control mice, and this lowering effect was evidenced after both acute and chronic treatment. However, the cannabinoid agonist was ineffective in altering nicotine intake in mice previously exposed to nicotine, cannabinoid agonist, or both during adolescence.Conclusions: These data provide evidence that adolescent drug exposure can alter later nicotine reinforcement in a sex-specific manner and can further modulate the effectiveness of interventions in reducing nicotine intake during adulthood.Implications: These studies demonstrate a significant impact of nicotine, cannabinoids, or coexposure on developmental processes during adolescence. Differential effects were observed within each sex, with opposing results found for cannabinoid exposure on nicotine intake in males and females. Intriguingly, we also evidenced resistance to the lowering effects of a cannabinoid agonist on nicotine intake in adulthood based on adolescent drug exposure. Thus, these findings have important implications for our understanding of the impact of nicotine and cannabinoids (eg, Δ9-tetrahydrocannabinol (THC) and synthetic "spice" cannabinoids) during development, with further implications for the effectiveness of therapeutic interventions based on prior drug exposure in youth. [ABSTRACT FROM AUTHOR]

This cross-sectional investigation studied differences in insulin resistance across levels of physical activity in 6,500 US adults who were randomly selected as part of the National Health and Nutrition Examination Survey (NHANES). Another important objective was to determine the influence of abdominal obesity on the physical activity and insulin resistance relationship. MET-minutes were utilized to quantify total activity based on participation in 48 different physical activities. Two strategies were employed to categorize levels of physical activity: one was based on relative MET-minutes (quartiles), and the other approach was based on the US physical activity guidelines. Insulin resistance was indexed using the homeostatic model assessment (HOMA). Abdominal obesity was indexed using waist circumference. Effect modification was tested by dividing waist circumferences into sex-specific quartiles and then evaluating the relationship between physical activity and HOMA-IR within each quartile separately. Results showed that relative physical activity level was associated with HOMA-IR after controlling for demographic and demographic and lifestyle covariates (F = 11.5, P < 0.0001 and F = 6.0, P = 0.0012 , respectively). Adjusting for demographic and demographic and lifestyle covariates also resulted in significant relationships between guideline-based activity and HOMA-IR (F = 8.0, P < 0.0001 and F = 4.9, P = 0.0017 , respectively). However, statistically controlling for differences in waist circumference with the other covariates nullified the relationship between total physical activity and HOMA-IR. Effect modification testing showed that when the sample was delimited to adults with abdominal obesity (Quartile 4), relative (F = 5.6, P = 0.0019) and guideline-based physical activity (F = 3.7, P = 0.0098) and HOMA-IR were significantly associated. Physical activity and HOMA-IR were not related within the other three quartiles. In conclusion, it appears that differences in physical activity may play a meaningful role in insulin resistance in those with abdominal obesity, but total activity does not seem to account for differences in insulin resistance among US adults with smaller waists. [ABSTRACT FROM AUTHOR]

Background Casual sex during travel is a major preventable factor in the global transmission of sexually transmissible infections (STI). Pre-travel consults present an excellent opportunity for practitioners to educate travellers about sexual and reproductive health (SRH) and safety. This scoping review aims to explore and understand the extent to which SRH is included in pre-travel consultations. Methods PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus, Medline and Web of Science were systematically searched for primary research articles exploring whether health care practitioners (HCP) included SRH in pre-travel consultations. Extracted findings were synthesized and presented in narrative form. Results Findings across 13 articles suggest HCPs infrequently broached SRH in pre-travel consultations with HCP discomfort, and lack of time and resources presented as key barriers. Urban practice settings, HCP experience, training in travel medicine and traveller characteristics such as sexual orientation were positively associated with discussions about SRH. SRH advice reported was general in nature, primarily focusing on safer sex, condoms or unspecified STI advice. Risk assessments based solely on age or stereotypes around sexual preferences led to key aspects of SRH care being missed for some (e.g. SRH was less likely to be discussed with older travellers). Conclusions HCPs frequently miss opportunities to integrate SRH into pre-travel consultations. Strategies to promote HCP confidence and awareness present a promising means to boost the frequency and quality of SRH advice disseminated. Integrating culturally safe and responsive SRH history-taking and advice into pre-travel consultations may contribute to global reductions in STI transmission and promote traveller SRH well-being. [ABSTRACT FROM AUTHOR]

Methamphetamine or “meth” is a sympathomimetic amine of the amphetamine-type substances (ATS) class with an extremely high potential for abuse. Illicitly abused neurostimulants like cocaine and meth predispose patients to the aneurysmal formation with reported rupture at a younger age and in much smaller sized aneurysms. However, very rapid growth of aneurysm within less than 2 weeks with methamphetamine abuse is very rarely observed or reported. In this report, we present a patient with repeated and recurrent meth abuse who demonstrated rapid growth of a pericallosal aneurysm over the period of less than two weeks. The pathophysiology of stroke related to meth and ATS abuse is multifactorial with hypertension, tachycardia, and vascular disease postulated as major mechanisms. The rapid growth of an aneurysm has a high risk of aneurysmal rupture and SAH, which is a neurosurgical emergency and therefore warrants careful consideration and close monitoring. This case confirms the dynamic temporal effects of methamphetamine use on intracranial vessels and this specific neurostimulants association to rapid aneurysmal formation. In light of vascular pathologies the possibility of drug-induced pseudoaneurysm should also be considered in young patients with history of meth abuse. [ABSTRACT FROM AUTHOR]

Abstract. The La Sal daisy, Erigeron mancus, is endemic to treeline ecotone and alpine meadow habitats of the La Sal Mountains in Utah, an insular, laccolithic mountain range on the Colorado Plateau in southeastern Utah. From 2009 to 2011 we established elevational transects through upper spruce-fir forest, treeline ecotone, and alpine meadow habitats on Laurel Ridge in the Middle Mountain group of the La Sal Mountains to measure (1) periodic changes in E. mancus population density, (2) changes in the elevation of the E. mancus population centroid, (3) changes in patch size occupied by E. mancus, and (4) changes in frequency of occurrence in herbaceous plant species associated with E. mancus along these transects. We measured both E. mancus density and vascular plant species composition within 1-m × 1-m square frames in mid-July, near peak alpine plant flowering time. The E. mancus population density on Mt. Laurel ridge did not significantly change from 2009 to 2015, but the species was most abundant in alpine meadow habitat for both years. Changes in patch width, centroid elevation, and frequency of occurrence of 30 associated plant species were also not statistically significant. Like E. mancus, most species show changes in frequency of occurrence between upper spruce-fir forest, treeline ecotone, and alpine meadow habitats. Individual plants of E. mancus are probably long-lived perennials, so changes in population density and distribution due to global warming are expected to be gradual and/or have an unknown lag time. Although there is no evidence of ongoing change in the Laurel Ridge population of E. mancus, having this information will provide a solid statistical basis for determining significant future changes. [ABSTRACT FROM AUTHOR]

The aim of this study is to examine the development of four tropical cyclones (TCs) in the North Atlantic basin in late August and early September 2010. This period is of interest because four consecutive easterly waves emerged from West Africa and resulted in a multiple TC event (MTCE) over the North Atlantic. The first two TCs--Danielle and Earl--quickly developed into TCs east of 40°W and eventually intensified into major hurricanes. Conversely, the last two TCs--Fiona and Gaston--developed more slowly reaching only weak tropical storm intensity at their peak. The close proximity and differing evolution of these four TCs provides a unique opportunity to examine how these TCs interacted with each other and their surrounding environment, which influenced their development as they moved westward across the North Atlantic. The results showed that concurrent extratropical cyclogenesis events over the western and eastern North Atlantic and the recurvature of TC Danielle produced increased meridional flow over the midlatitude North Atlantic. This increased meridional flow resulted in subsynoptic-scale regions of increased vertical wind shear in the subtropics, which delayed Earl's development and led to Fiona's demise. Additionally, increased meridional flow in midlatitudes contributed to anomalous drying of the subtropics. This dry air was entrained into Gaston's circulation leading to reduced convection and weakening. These TC-TC and TC-environment interactions highlight the difficult challenge of forecasting TC genesis and position posed by MTCEs in a rapidly evolving synoptic-scale flow. [ABSTRACT FROM AUTHOR]

[Display omitted] • A multi-physics, multicriteria design approach developed for material selection of intraoral stents for head and neck cancer (HNC) radiation therapy. • Candidate materials assessed using Raman spectroscopy and mechanical testing pre- and post-treatments to saliva and radiation exposure. • Leaching for toxicity assessed using NMR spectroscopy. • Overall, ethylene vinyl acetate (EVA) was deemed as a non-toxic appropriate candidate to reduce/avoid significant side effects for HNC patients. Radiation therapy (RT) plays a key role in curative-intent treatments for head and neck cancer (HNC). Despite the advancements in RT, high doses of radiation can disrupt the oral cavity homeostasis and result in undesired reactions. Thus, intraoral stents (IOSs) are utilized for patients during RT to prevent unnecessary irradiation to surrounding tissues. However, no studies have compared commonly used IOS materials and their potential toxicity. Therefore, the objective of this study is to perform a detailed assessment of ten IOS materials in order to select the top-ranked material for HNC patients undergoing RT. Thus, beam attenuation measurements, and Raman spectroscopy and mechanical testing were conducted pre- and post-artificial saliva, RT, and artificial saliva and RT exposure. Finally, through a multi-criteria decision making (MCDM) analysis using Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS), our study demonstrated that Ethylene Vinyl Acetate (EVA) was the top-ranked material. The saliva samples were also tested via nuclear magnetic resonance (NMR) spectroscopy, which showed no leaching of irradiated materials. Taken together, these data suggest that EVA is an appropriate IOS material that can be utilized during RT to reduce significant morbidity for HNC patients and improve their quality of life. [ABSTRACT FROM AUTHOR]

Social interactions increasingly take place online. Friendships and other offline social ties have been repeatedly associated with human longevity, but online interactions might have different properties. Here, we reference 12 million social media profiles against California Department of Public Health vital records and use longitudinal statistical models to assess whether socialmedia use is associatedwith longer life. The results show that receiving requests to connect as friends online is associated with reduced mortality but initiating friendships is not. Additionally, online behaviors that indicate face-to-face social activity (like posting photos) are associated with reduced mortality, but online-only behaviors (like sending messages) have a nonlinear relationship, where moderate use is associated with the lowest mortality. These results suggest that online social integration is linked to lower risk for a wide variety of critical health problems. Although this is an associational study, it may be an important step in understanding how, on a global scale, online social networks might be adapted to improve modern populations' social and physical health. [ABSTRACT FROM AUTHOR]

Packera franciscana (Greene) W.A. Weber and Á. Löve (Asteraceae) (San Francisco Peaks ragwort) is an alpine-zone endemic of the San Francisco Peaks in northern Arizona. Previous studies have shown that P. franciscana is patchily distributed in alpine-zone talus habitats. The purpose of this study was to describe the relationship between snow duration and P. franciscana abundance. We established trailside transects through P. franciscana habitat along the Weatherford Trail to estimate the abundance of P. franciscana ramets. Snow-free and snowbed sample segments were chosen based on a 17 May 2013 snow photograph taken from within the Inner Basin of the San Francisco Peaks caldera. The section of the Weatherford Trail under snow on 17 May 2013 had a 5-year arithmetic mean of 1.53 ramets ⋅ m-2 (SE 0.37)-much less dense than the snow-free section which had a 5-year arithmetic mean of 7.17 ramets ⋅ m-2 (SE 1.09). The steep upper portion of talus slopes is known to move downslope faster than mid- and lower slope portions due to gravitational processes working on surface particle size, slope angle, and frost heave/needle ice during moist periods. Needle ice is known to uproot seedlings in other species. Active talus shift may inhibit P. franciscana colonization and growth on upper talus slopes via high seedling mortality in the snowbed zone during spring snowmelt. [ABSTRACT FROM AUTHOR]

Nonnegative matrix factorization (NMF), which can lead to nonsubtractive parts-based representation, has been demonstrated to be effective for dimensionality reduction of hyperspectral imagery (HSI). However, existing NMF methods applied to HSI use only a single spectral feature and do not take into consideration spatial information, such as texture or morphological features, while it has been widely acknowledged that exploiting multiple features can improve performance. Consequently, a variant of orthogonal NMF, which can not only achieve a nonnegative factorization but also exploit the complementary information that arises among heterogeneous features, is proposed for hyperspectral dimensionality reduction. The proposed method, which couples orthogonal NMF with a previous multiple-features-combining algorithm, yields a discriminative low-dimensional feature representation that matches the intuition that parts should sum to produce a whole. An efficient multiplicative updating procedure is derived, and its local convergence is guaranteed theoretically. Experimental results on two hyperspectral data sets demonstrate the effectiveness of the proposed method. [ABSTRACT FROM AUTHOR]

Faith development theory was pioneered originally in the 1970s (Fowler, 1974) and 1980s (Fowler, 1981) as a framework for understanding the evolution of how human beings conceptualize God, or a Higher Being, and how the influence of that Higher Being has an impact on core values, beliefs, and meanings in their personal lives and in their relationships with others. Because of the formative influence of this theoretical work in both religious and spiritual development (including multiple references in this volume), it merits full articulation and a recounting of its origins. This chapter gives the early history of the author’s faith development theory and introduces readers to its key concepts, with special emphasis on those stages most commonly seen in children and adolescents. It also reviews some of the critical and constructive assessments of faith development theory by scholars in the field, through the lenses of several volumes of collected articles. [ABSTRACT FROM AUTHOR]

The recent increase in the use of nicotine products by teenagers has revealed an urgent need to better understand the impact of nicotine on the adolescent brain. Here, we sought to examine the actions of extracellular ATP as a neurotransmitter and to investigate whether ATP and nicotinic signaling interact during adolescence. With the GRABATP (G-proteincoupled receptor activation-based ATP sensor), we first demonstrated that nicotine induces extracellular ATP release in the medial habenula, a brain region involved in nicotine aversion and withdrawal. Using patch-clamp electrophysiology, we then demonstrated that activation of the ATP receptors P2X or P2Y1 increases the neuronal firing of cholinergic neurons. Surprisingly, contrasting interactive effects were observed with nicotine exposure. For the P2X receptor, activation had no observable effect on acute nicotine-mediated activity, but during abstinence after 10 d of nicotine exposure, coexposure to nicotine and the P2X agonist potentiated neuronal activity in female, but not male, neurons. For P2Y1 signaling, a potentiated effect of the agonist and nicotine was observed with acute exposure, but not following extended nicotine exposure. These data reveal a complex interactive effect between nicotinic and ATP signaling in the adolescent brain and provide mechanistic insights into extracellular ATP signaling with sex-specific alterations of neuronal responses based on prior drug exposure. [ABSTRACT FROM AUTHOR]

The distinction between classical Hodgkin lymphoma (HL) and anaplastic large cell lymphoma (ALCL) is not problematic in most instances. In rare situations, HL may present with a sinusoidal infiltrative pattern that may mimic ALCL. It is important to use a battery of immunohistochemical stains to differentiate between these two entities as therapy and clinical behavior are different. We present a case of a young woman who presents with the very unusual intrasinusoidal infiltrative pattern. [ABSTRACT FROM AUTHOR]

Population size and density estimates have traditionally been acceptable ways to track species' response to changing environments; however, species' population centroid elevation has recently been an equally important metric. Packera franciscana (Greene) W.A. Weber and Á. Löve (Asteraceae; San Francisco Peaks ragwort) is a single mountain endemic plant found only in upper treeline and alpine talus habitats of the San Francisco Peaks in northern Arizona and is listed by the U.S. Fish and Wildlife Service as a Threatened species under the Endangered Species Act. We used 2 recreational trails, which pass through its elevational distribution in the Kachina Peaks Wilderness Area, as sampling transects to estimate population density and distribution because it was not possible to sample further from the trail due to loose volcanic talus and consequent disturbance of P. franciscana plants. Between-year comparisons of ramet density, population centroid elevations, and mid-September flowering or fruiting counts were not significantly different for the Humphrey's Peak Trail in 2010-2011 or the Weatherford Trail from 2009 to 2013. Use of a zero-inflated negative binomial response variable distribution allowed statistical inference for both sampling hits and misses, which gives ecologists and land managers an additional method to monitor changes in distribution and abundance. Population density and elevation of the population centroid estimates for P. franciscana appear to be stable; therefore, the 5-year Weatherford Trail data set may be used as a baseline to track future plant migration on a fine spatiotemporal scale, an approach that could apply to other threatened alpine species. [ABSTRACT FROM AUTHOR]

Using a discovery and replication sample from a U.S. representative data set, we show that a functional polymorphism on the MAOA gene is associated with credit card borrowing behavior. For the combined sample of approximately 12,000 individuals we find that having one or both MAOA alleles of the less transcriptionally efficient type raises the average likelihood of reporting credit card debt by about 4%. These results suggest that behavioral models benefit from integrating genetic variation and that economists should consider the welfare consequences of possible discrimination by lenders on the basis of genotype. [ABSTRACT FROM AUTHOR]

Field detection of changes in occurrence, distribution, or abundance of alpine plant species is predicated on knowledge of which species are in specific locations. The alpine zone of the Southern Rocky Mountain Region has been systematically inventoried by the staff and floristics graduate students from the Rocky Mountain Herbarium over the last 27 years. It is centered on the mountain ranges of Colorado and extends north to the Medicine Bow Mountains in southeast Wyoming and south into the Sangre de Cristo Range in north central New Mexico. It also includes the La Sal Mountains of Utah and the San Francisco Peaks in northern Arizona. The alpine meadow and treeline ecotone flora of the Southern Rocky Mountains includes 609 unique taxa of vascular plants comprising 581 species. The richest families are Asteraceae (104 species), Poaceae (58 species), Cyperaceae (57 species), and Brassicaceae (42 species). The central Colorado subregion is the most taxon rich (499) with richness tapering off to the north, southeast, and southwest. Non-endemic alpine zone taxa occur more frequently elsewhere in the Rocky Mountain Cordillera Floristic Region (515) than in the Madrean (373), Circumboreal (226), or North American Atlantic Floristic Regions (120). Levels of endemism within the flora of the alpine zone in the Southern Rocky Mountains range from single mountains (7) to the flora as a whole (59) including 25 taxa endemic to both the Southern Rockies and to its alpine zone. This checklist is based on vouchered specimens and should be most useful to botanists and land managers determining what taxa are likely to occur within their area of interest. [ABSTRACT FROM AUTHOR]

More than any other species, humans form social ties to individuals who are neither kin nor mates, and these ties tend to be with similar people. Here, we show that this similarity extends to genotypes. Across the whole genome, friends' genotypes at the single nucleotide polymorphism level tend to be positively correlated (homophilic). In fact, the increase in similarity relative to strangers is at the level of fourth cousins. However, certain genotypes are also negatively correlated (heterophilic) in friends. And the degree of correlation in genotypes can be used to create a "friendship score" that predicts the existence of friendship ties in a hold-out sample. A focused gene-set analysis indicates that some of the overall correlation in genotypes can be explained by specific systems; for example, an olfactory gene set is homophilic and an immune system gene set is heterophilic, suggesting that these systems may play a role in the formation or maintenance of friendship ties. Friends may be a kind of "functional kin." Finally, homophilic genotypes exhibit significantly higher measures of positive selection, suggesting that, on average, they may yield a synergistic fitness advantage that has been helping to drive recent human evolution. [ABSTRACT FROM AUTHOR]

Objective: We validate an online, personalized mortality risk measure called “RealAge” assigned to 30 million individuals over the past 10 years. Methods: 188,698 RealAge survey respondents were linked to California Department of Public Health death records using a one-way cryptographic hash of first name, last name, and date of birth. 1,046 were identified as deceased. We used Cox proportional hazards models and receiver operating characteristic (ROC) curves to estimate the relative scales and predictive accuracies of chronological age, the RealAge score, and the Framingham ATP-III score for hard coronary heart disease (HCHD) in this data. To address concerns about selection and to examine possible heterogeneity, we compared the results by time to death at registration, underlying cause of death, and relative health among users. Results: The RealAge score is accurately scaled (hazard ratios: age 1.076; RealAge-age 1.084) and more accurate than chronological age (age c-statistic: 0.748; RealAge c-statistic: 0.847) in predicting mortality from hard coronary heart disease following survey completion. The score is more accurate than the Framingham ATP-III score for hard coronary heart disease (c-statistic: 0.814), perhaps because self-reported cholesterol levels are relatively uninformative in the RealAge user sample. RealAge predicts deaths from malignant neoplasms, heart disease, and external causes. The score does not predict malignant neoplasm deaths when restricted to users with no smoking history, no prior cancer diagnosis, and no indicated health interest in cancer (p-value 0.820). Conclusion: The RealAge score is a valid measure of mortality risk in its user population. [ABSTRACT FROM AUTHOR]