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Historically, most discussions about nonhuman animal experimentation consider what has become known as the 3 R's: refinement, reduction, and replacement. Refinement and reduction receive the most attention, but recent modeling advances suggest that suitable replacement of nonhuman animal testing would bolster human research and increase translatability to human health outcomes. This article discusses these modeling advances and advocates their use, especially as replacements to nonpredictive nonhuman animal protocols, and discusses growing momentum in biomedical research communities and federal agencies that favors replacement of animal testing. [ABSTRACT FROM AUTHOR]

The article discusses the use of extracorporeal cardiopulmonary resuscitation (ECPR) as a potential intervention for patients with refractory cardiac arrest. ECPR involves draining blood from the body, oxygenating it, and then returning it to the arterial system, providing better oxygen delivery than conventional CPR. The article highlights the need for a proactive approach to implementing ECPR in the UK, as it is currently underutilized. The article also discusses the selection criteria for ECPR and the challenges in implementing ECPR services. The authors emphasize the importance of developing institutional expertise and ensuring equitable access to ECPR services across the UK. [Extracted from the article]

Recombinant zoster vaccine has been recommended by the US Advisory Committee on Immunization Practices (ACIP) for the prevention of herpes zoster (HZ) in immunocompetent adults aged at least 50 years since 2018. In January 2022, this was extended to immunodeficient/immunosuppressed adults aged at least 19 years. Key study objectives were to assess specialists' knowledge of the ACIP HZ vaccination recommendations, their attitudes toward HZ vaccination, and HZ vaccination practices/barriers. This cross-sectional, web-based survey (conducted in March 2022) included US dermatologists, gastroenterologists, infectious disease specialists, oncologists, and rheumatologists who treat patients with psoriasis, inflammatory bowel disease, human immunodeficiency syndrome, solid tumors/hematological malignancies, and rheumatoid arthritis, respectively. Although most of the 613 specialists correctly identified the ACIP HZ vaccination recommendations for adults aged at least 50 years (84%) and immunodeficient/immunosuppressed adults aged at least 19 years (67%), only 29% knew that recombinant zoster vaccine is recommended for individuals who have previously received zoster vaccine live, and only 18% knew all current ACIP recommendations. For patients with the diseases listed, 84% of specialists thought that HZ is a serious risk, 75% that HZ vaccination is extremely/very important, and 69% were extremely/very likely to recommend HZ vaccination. Only 36% administer vaccines themselves, mainly because patients receive vaccinations from others. Barriers to vaccination included more urgent/acute issues, insufficient time, and lack of patient motivation/willingness. Full knowledge of the ACIP HZ vaccination recommendations among the surveyed specialists was low. There may be a need to educate specialists to improve adherence to these recommendations. [ABSTRACT FROM AUTHOR]

This article examines a complete collection of posts made within two of the largest online peer‐to‐peer breastmilk‐sharing communities in the United States, collected during the first month after the COVID‐19 vaccine became available to all U.S. adults. I propose that such communities support not only the circulation of human milk among strangers but also the circulation of widely shared attentional norms alongside interactional rules of relevance and concern. When collectively held attentional norms are violated, Goffmanian face‐saving maneuvers become visible. This case study engages studies of cultural cognition—in particular, those on collective rules of relevance and attention—to make sense of emergent cultural blind spots. [ABSTRACT FROM AUTHOR]

Apixaban, rivaroxaban, and warfarin have shown benefit for preventing major ischemic events—albeit with increased bleeding risk—among patients in the general population with atrial fibrillation (AF). However, data are scarce in patients with cirrhosis and AF. This study compared the effectiveness and safety of apixaban versus rivaroxaban and versus warfarin in patients with cirrhosis and AF. Visual Abstract. Comparative Effectiveness and Safety of Apixaban, Rivaroxaban, and Warfarin in Patients With Cirrhosis and Atrial Fibrillation: A Nationwide Cohort Study Apixaban, rivaroxaban, and warfarin have shown benefit for preventing major ischemic events—albeit with increased bleeding risk—among patients in the general population with atrial fibrillation (AF). However, data are scarce in patients with cirrhosis and AF. This study compared the effectiveness and safety of apixaban versus rivaroxaban and versus warfarin in patients with cirrhosis and AF. Background: Apixaban, rivaroxaban, and warfarin have shown benefit for preventing major ischemic events, albeit with increased bleeding risk, among patients in the general population with atrial fibrillation (AF). However, data are scarce in patients with cirrhosis and AF. Objective: To compare the effectiveness and safety of apixaban versus rivaroxaban and versus warfarin in patients with cirrhosis and AF. Design: Population-based cohort study. Setting: Two U.S. claims data sets (Medicare and Optum's de-identified Clinformatics Data Mart Database [2013 to 2022]). Participants: 1:1 propensity score (PS)–matched patients with cirrhosis and nonvalvular AF initiating use of apixaban, rivaroxaban, or warfarin. Measurements: Primary outcomes included ischemic stroke or systemic embolism and major hemorrhage (intracranial hemorrhage or major gastrointestinal bleeding). Database-specific and pooled PS-matched rate differences (RDs) per 1000 person-years (PY) and Cox proportional hazard ratios (HRs) with 95% CIs were estimated, controlling for 104 preexposure covariates. Results: Rivaroxaban initiators had significantly higher rates of major hemorrhagic events than apixaban initiators (RD, 33.1 per 1000 PY [95% CI, 12.9 to 53.2 per 1000 PY]; HR, 1.47 [CI, 1.11 to 1.94]) but no significant differences in rates of ischemic events or death. Consistently higher rates of major hemorrhage were found with rivaroxaban across subgroup and sensitivity analyses. Warfarin initiators also had significantly higher rates of major hemorrhage than apixaban initiators (RD, 26.1 per 1000 PY [CI, 6.8 to 45.3 per 1000 PY]; HR, 1.38 [CI, 1.03 to 1.84]), particularly hemorrhagic stroke (RD, 9.7 per 1000 PY [CI, 2.2 to 17.2 per 1000 PY]; HR, 2.85 [CI, 1.24 to 6.59]). Limitation: Nonrandomized treatment selection. Conclusion: Among patients with cirrhosis and nonvalvular AF, initiators of rivaroxaban versus apixaban had significantly higher rates of major hemorrhage and similar rates of ischemic events and death. Initiation of warfarin versus apixaban also contributed to significantly higher rates of major hemorrhagic events, including hemorrhagic stroke. Primary Funding Source: National Institutes of Health. [ABSTRACT FROM AUTHOR]

Obesity is an emerging public health problem. Chronic low-grade inflammation is considered a major promotor of obesity-induced secondary diseases such as cardiovascular and fatty liver disease, type 2 diabetes mellitus, and several cancer entities. Most preliminary studies on obesity-induced immune responses have been conducted in male rodents. Sex-specific differences between men and women in obesity-induced immune dysregulation have not yet been fully outlined but are highly relevant to optimizing prevention strategies for overweight-associated complications. In this study, we fed C57BL/6 female vs. male mice with either standard chow or an obesity-inducing diet (OD). Blood and spleen immune cells were isolated and analyzed by flow cytometry. Lean control mice showed no sex bias in systemic and splenic immune cell composition, whereas the immune responses to obesity were significantly distinct between female and male mice. While immune cell alterations in male OD mice were characterized by a significant reduction in T cells and an increase in myeloid-derived suppressor cells (MDSC), female OD mice displayed preserved T cell numbers. The sex-dependent differences in obesity-induced T cell dysregulation were associated with varying susceptibility to body weight gain and fatty liver disease: Male mice showed significantly more hepatic inflammation and histopathological stigmata of fatty liver in comparison to female OD mice. Our findings indicate that sex impacts susceptibility to obesity-induced T cell dysregulation, which might explain sex-dependent different incidences in the development of obesity-associated secondary diseases. These results provide novel insights into the understanding of obesity-induced chronic inflammation from a sex-specific perspective. Given that most nutrition, exercise, and therapeutic recommendations for the prevention of obesity-associated comorbidities do not differentiate between men and women, the data of this study are clinically relevant and should be taken into consideration in future trials and treatment strategies. [ABSTRACT FROM AUTHOR]

Background Posttraumatic stress disorder (PTSD) has significant morbidity and economic costs. This study describes the prevalence and characteristics of patients with PTSD using primary care electronic medical record (EMR) data. Methods This retrospective cross-sectional study used EMR data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). This study included 1,574 primary care providers located in 7 Canadian provinces. There were 689,301 patients that visited a CPCSSN provider between 1 January 2017 and 31 December 2019. We describe associations between PTSD and patient characteristics using descriptive statistics, chi-square, and multiple logistic regression models. Results Among the 689,301 patients included, 8,817 (1.3%, 95% CI 1.2–1.3) had a diagnosis of PTSD. On multiple logistic regression analysis, patients with depression (OR 4.4, 95% CI 4.2–4.7, P < 0.001), alcohol abuse/dependence (OR 1.7, 95% CI 1.6–1.9, P < 0.001), and/or drug abuse/dependence (OR 2.6, 95% CI 2.5–2.8, P < 0.001) had significantly higher odds of PTSD compared with patients without those conditions. Patients residing in community areas considered the most material deprived (OR 2.1, 95% CI 1.5–2.1, P < 0.001) or the most socially deprived (OR 2.8, 95% CI 2.7–5.3, P < 0.001) had higher odds of being diagnosed with PTSD compared with patients in the least deprived areas. Conclusions The prevalence of PTSD in Canadian primary care is 1.3% (95% CI 1.25–1.31). Using EMR records we confirmed the co-occurrence of PTSD with other mental health conditions within primary care settings suggesting benefit for improved screening and evidence-based resources to manage PTSD. [ABSTRACT FROM AUTHOR]

Introduction: In EVOLVE-MS-1 (NCT02634307), mean absolute lymphocyte count (ALC) on diroximel fumarate (DRF) declined from baseline by approximately 28% in year 1, then stabilized, similar to ALC decline observed with dimethyl fumarate (DMF). Prior studies reported that clinical efficacy of DMF was not substantially different in patients with and without lymphopenia. Methods: EVOLVE-MS-1—an open-label, 96-week, phase 3 study—assessed DRF safety and exploratory efficacy in patients with relapsing–remitting multiple sclerosis. This study analyzes efficacy-related outcomes comparing (1) patients with lymphopenia (≥ 1 ALC below lower limit of normal [LLN]) and without (all ALCs ≥ LLN); (2) across quartiles stratified by week 96 ALC decline from baseline: Q1 (≥ 47% decline); Q2 (30% to < 47% decline); Q3 (12% to < 30% decline); Q4 (< 12% decline). Results: Baseline characteristics were similar between patients without (n = 593) and with lymphopenia (n = 452). At week 96, adjusted annualized relapse rate (ARR; 95% confidence interval) was 0.14 (0.11–0.17) without lymphopenia and 0.12 (0.09–0.15) with lymphopenia. Estimated proportions with 12-week confirmed disability progression (CDP12) at week 96 were 10.2% without and 9.3% with lymphopenia. When stratified by quartiles (Q1–Q4), ARR at week 96 was 0.11 (Q1), 0.09 (Q2), 0.13 (Q3), and 0.17 (Q4). Estimated proportions with CDP12 at week 96 were 9.6% (Q1), 10.2% (Q2), 5.7% (Q3), and 10.9% (Q4). At week 96, no evidence of disease activity was achieved by 47.2% (Q1), 47.8% (Q2), 45.4% (Q3), and 37.3% (Q4) of patients. Conclusion: In DRF-treated patients in EVOLVE-MS-1, clinical and radiological measurements indicated reduced disease activity regardless of lymphopenia or magnitude of ALC decline from baseline; however, patients who had greater ALC declines appeared to have numerically lower ARR and higher proportions free from relapses and gadolinium-enhancing lesions compared with those with smallest decline. This supports prior evidence that, while lymphopenia may contribute to fumarate efficacy outcomes, it is not the primary mechanism of action. Trial Registration: ClinicalTrials.gov identifier NCT02634307. [ABSTRACT FROM AUTHOR]

The strategic selection of facility locations plays a critical role in optimizing operational efficiency, reducing costs, and enhancing customer satisfaction, thereby contributing significantly to the success and competitiveness of businesses. In this study, an interval-valued Pythagorean fuzzy decision-making framework is proposed to select the best location for the lumber drying industry. A four-level hierarchical model is devised with four main criteria, 16 subcriteria, and five alternatives. The opinions of different experts are gathered to obtain input data. The weights of the criteria are calculated using the interval-valued Pythagorean fuzzy analytic hierarchy process (AHP) method. The interval-valued Pythagorean fuzzy weighted aggregated sum product assessment (WASPAS) method is employed to evaluate the alternative locations. A sensitivity analysis is conducted to support the validity of the model results. The study concludes by revealing the optimal location for the lumber drying industry in Turkey. This study presents its novelty by formulating the lumber drying facility location selection problem as a complex fuzzy multicriteria decision-making problem and integrating the Pythagorean fuzzy AHP and WASPAS methods to solve the problem. [ABSTRACT FROM AUTHOR]

Walter Kintsch's contributions profoundly impacted research on the comprehension of text and discourse and on interdisciplinary cognitive science. Each of his theoretical advances produced a cascade of theoretical and empirical investigations by his own team and many other investigators, which validated and refined those advances. That pattern is examined here with reference to his proposals concerning the propositional representation of text, the construction-integration model, multidimensional situation models, and global memory search in text retrieval and comprehension. Walter's remarkable insights regarding cognitive science inspired all those around him both in their research endeavors and beyond. [ABSTRACT FROM AUTHOR]

Historically Black Colleges and Universities (HBCUs) have made notable social, cultural, and economic contributions to the African Diaspora, particularly since their inception in the United States. Being that HBCU athletic programs account for a small proportion of the intercollegiate athletic industry, these unique entities are often examined in the same vein as their Historically White Institution counterparts without a full account of the intergenerational adverse impacts of systemic racism. Since HBCUs are situated within the distinct context of Blackness, the researchers offer a reconceptualization through the theoretical lens of Black Critical Theory. This manuscript illuminates linkages across extant literature, while also presenting a budding theoretical framework in the study of sport, and sport organizations, that have deeply embedded relationships with communities, for example, HBCUs and the Black community, stickball and lacrosse within Indigenous communities, and the relationship between women and womens' sports leagues. Implications of this work are centered on promoting more critical reconceptualizations of sporting spaces that reflect the full diversity of the societies in which they exist. [ABSTRACT FROM AUTHOR]

Background: App-based contemplative interventions, such as mindfulness-based interventions, have gained popularity for the promotion of mental health; however, the understanding of underlying intervention-specific mechanisms remains limited, especially related to novel inter-relational dyadic practices. Methods: We tested (n = 253) seven putative mechanisms underlying two brief (daily 12-min) online mental interventions: attention-focused mindfulness and socio-emotional partner-based, both supported by weekly online coaching. Weekly self-reports of rumination, worry, psychological flexibility, affective control, social support, acceptance, and mindfulness were obtained over 10 weeks of intervention, and depression, anxiety, and resilience were assessed as pre- and post-intervention outcomes. Results: Significant week-to-week reductions in rumination and increases in psychological flexibility were observed in both interventions. Only attention-based practice led to temporal reductions in worry, and only socio-emotional dyadic practice led to temporal increases in affective control. Mediation analyses with slopes of weekly variables as mediators detected no significant indirect effects. However, exploratory moderation analyses revealed that intervention-related reductions in depressive symptomatology and anxiety vulnerability and increases in resilience were predicted by weekly increases in acceptance and affective control in the socio-emotional dyadic group, and by weekly reductions in rumination and worry in the mindfulness group. Limitations of the study include reliance on brief self-report measures, relatively small sample size, and absence of long-term follow-up assessments indicating the need for future well-powered longitudinal studies comparing intervention modalities. Conclusions: We present preliminary evidence for practice-specific active ingredients of contemplative interventions, which can be leveraged to enhance their efficiency for mental health. [ABSTRACT FROM AUTHOR]

The Material Point Method (MPM) is an established and powerful numerical method particularly useful for simulating large-scale, rapid soil deformations. Therefore, it is often used for the numerical investigation of mass movement hazards such as landslides, debris flows, or avalanches. It combines the benefits of both mesh-free and mesh-based continuum-based discretization techniques by discretizing the physical domain with Lagrangian moving particles carrying the history-dependent variables while the governing equations are solved at the Eulerian background grid, which brings many similarities with commonly used finite element methods. However, due to this hybrid nature, the material boundaries do not usually coincide with the nodes of the computational grid, which complicates the imposition of boundary conditions. Furthermore, the position of the boundary may change at each time step and, moreover, may be defined at arbitrary locations within the computational grid that do not necessarily coincide with the body contour, leading to different interactions between the material and the boundary. To cope with these challenges, this paper presents a novel element-wise formulation to weakly impose non-conforming Dirichlet conditions using Lagrange multipliers. The proposed formulation introduces a constant Lagrange multiplier approximation within the constrained elements in combination with a methodology to eliminate superfluous constraints. Therefore, in combination with simple element-wise interpolation functions classically utilized in MPM (and FEM) to approximate the unknown field, a suitable Lagrange multiplier discretization is obtained. In this way, we obtain a robust, efficient, and user-friendly boundary imposition method for immersed methods specified herein for implicit MPM. Furthermore, the extension to frictionless slip conditions is derived. The proposed methodologies are assessed by comparing the numerical results with both analytical and experimental data to demonstrate their accuracy and wide range of applications. [ABSTRACT FROM AUTHOR]

Simple Summary: For patients with solid tumor brain metastases that progress after whole-brain radiotherapy, there are limited treatment options. The aim of our prospective trial was to examine the usage of bevacizumab as salvage therapy in this specific patient population, with primary endpoints being radiologic response, survival, safety, and quality of life. Our data show that bevacizumab was well tolerated, maintained quality of life, and improved overall survival with radiologic response. Patients with solid tumor brain metastases that progress after whole-brain radiation have limited options. This prospective trial investigated the efficacy, safety, and tolerability of bevacizumab as salvage therapy in this population. Eligible patients received bevacizumab 10 mg/kg intravenously every 2 weeks until progression. The primary endpoint was radiologic response using Response Assessment in Neuro-Oncology (RANO) criteria. The secondary endpoints were progression-free survival (PFS), overall survival (OS), duration of response, and safety. Quality of life (QOL) was studied using the Functional Assessment of Cancer Therapy-Brain (FACT-Br) scale. Twenty-seven patients were enrolled, with twenty-four having evaluable data for response. The majority of histologies (n = 21, 78%) were breast cancer. The remaining histologies were non-small-cell lung cancer (n = 4, 15%), neuroendocrine cancer (n = 1, 3%), and papillary fallopian serous adenocarcinoma (n = 1, 3%). Eighteen patients had radiologic response, with two patients demonstrating partial response (8.33%) and sixteen patients demonstrating stable disease (66.7%). The median duration of response was 203 days. PFS at 6 months was 46%, median PFS was 5.3 m, and median OS was 9.5 m. Treatment was well tolerated, with six patients experiencing grade 3 lymphopenia and hypertension. There was one grade 3 thromboembolism. QOL was not negatively impacted. Bevacizumab is a safe and feasible salvage treatment with durable response and favorable overall survival for patients with progressive brain metastases after whole-brain radiation. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) is characterized by progressive neuroinflammation and neurodegeneration from disease onset that, if left untreated, can result in the accumulation of irreversible neurological disability. Early intervention with high-efficacy therapies (HETs) is increasingly recognized as the best strategy to delay or mitigate disease progression from the earliest stages of the disease and to prevent long-term neurodegeneration. Although there is growing clinical and real-world evidence supporting early HET intervention, foregoing this strategy in favor of a traditional escalation approach prioritizing lower-efficacy disease-modifying therapies remains a common approach in clinical practice. This review explores potential health care professional- and patient-related barriers to the early use of HETs in patients with MS in the United States. Barriers can include regulatory and reimbursement restrictions; knowledge gaps and long-term safety concerns among health care professionals; and various individual, cultural, and societal factors affecting patients. Potential strategies for overcoming these barriers and encouraging early HET use are proposed. [ABSTRACT FROM AUTHOR]

In education, low-income and racially minoritized students in urban districts are often constructed as 'dependent' – weak in their social positions but deserving of educational opportunity. This social construction of 'urban' students has been central to school choice politics and policymaking in the United States. In this study, I interrogate one particular aspect of this social construction: the way low-income and racially minoritized students are represented in quantitative data. I use school choice in Detroit, Michigan as an illustrative case; I conduct a critical discourse analysis of exchanges between former United States Secretary of Education Betsy DeVos and members of Congress about school choice, and the quantitative research referenced during those exchanges. The study demonstrates how dominant conceptions of 'urban' education in the United States influence the production of data and research on school choice, and in turn the role those quantifications play in school choice discourse. [ABSTRACT FROM AUTHOR]

This manuscript is a consensus document of an expert panel on the Evaluation and Treatment of Gastrointestinal Bleeding in Patients Taking Anticoagulants Presenting to the Emergency Department, sponsored by the American College of Emergency Physicians. [ABSTRACT FROM AUTHOR]

To assess and monitor the motor development of infants in a residential care facility for children. Methods: This longitudinal study was conducted in Governador Valadares, Minas Gerais, between January 2016 and November 2023 in a residential care facility for children. Data on birth, health conditions, and institutionalization of infants were collected from the records of the institution. The motor development was assessed using the Alberta Infant Motor Scale at admission and every two months. Results: A total of 28 infants (57.14% female) with age of 13.70 ± 7.39 months at institutionalization were included. The most frequent causes of institutionalization included neglect, abandonment, and caregiver use of alcohol or drugs (or both). Most infants who presented delayed motor development at the initial assessment improved satisfactorily during the period of institutionalization. Conclusion: The motor development of infants in a residential care facility for children improved. They acquired age-appropriate motor skills when placed in an environment with adequate resources and stimuli, including early physiotherapeutic intervention. These findings highlight the importance of an enriched environment in facilitating infant development in institutional settings. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate patient reported outcomes and radiographic arthritic changes of transtibial anterior cruciate ligament reconstruction (ACLR) with either bone-patellar tendon-bone (BPTB) or hamstrings (HS) auto-grafts at a minimum of 15-year follow-up. Methods: Ninety-four patients (51 of the HS group, 43 of BPTB group) who were operated between the years 2000 to 2005 in two tertiary referral hospitals were contacted and invited to a retrospective evaluation. The interview included subjective outcomes using the Lysholm knee scoring questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Tegner activity level scale, Visual Analogue Scale (VAS) for pain and patients' satisfaction scale. Knee examination included measurements of motion and stability. Knee radiographs were evaluated for osteoarthritic changes according to the Kellgren-Lawrence (KL) score. Results: The average evaluation time from surgery was 18.6 years. Subjectively, there was no significant difference between groups except for a better post-operative level of activity and satisfaction in the HS group. Objectively, there was no significant difference between groups in knee stability and range of motion. Most patients had grade KL ≤ 1 radiographic osteoarthritits changes and there was no significant difference between groups. Recurrent complete tear of the reconstructed graft occurred in 3 patients of each group. In both groups 84% had no further surgery while the indications for further surgery were mostly a meniscal tear or tibial hardware removal. Conclusions: Very long-term outcomes and clinical stability of transtibial HS or BPTB graft ACL reconstruction are good with low rate of graft failure and radiographic osteoarthritis. [ABSTRACT FROM AUTHOR]

Background: Tourette syndrome (TS) and Chronic Tic Disorder (CT) are neurodevelopmental conditions involving motor and/or phonic tics. Youth with tics may encounter feelings of isolation, diminished self-esteem and quality of life, and academic difficulties. A growing body of scientific literature suggests sex differences in youth with tics, but findings have been mixed so far. Because symptom severity peaks around puberty, understanding sex differences in tic manifestations and associated symptoms during this critical period is essential. Therefore, we aimed to assess sex differences related to tic symptoms, action planning styles, quality of life, and externalizing/internalizing symptoms in youth with tics. Methods: Our sample consisted of 66 youths with tics (19 girls) aged 7–14 (mean = 10 years). Youths were assessed with clinical interviews, as well as self- and parent-reported inventories evaluating tic symptoms, psychological profiles, and quality of life. Results: While no differences in tic symptoms were found, girls exhibited lower functional inflexibility, reduced overall functional planning effectiveness, and higher impairment in the psychological well-being subscale than boys. Additionally, girls had reduced general life satisfaction and social self-esteem. Boys reported more explosive outbursts, higher levels of hyperactivity, and more difficulties with self-concept. Conclusions: Our analyses suggested differences in several manifestations associated with tics. This introduces new perspectives that refine our understanding of sex differences. A better understanding of sex differences in tic disorders may eventually improve outcomes for all individuals living with these conditions. [ABSTRACT FROM AUTHOR]

School choice policies can, by design or in implementation, give schools and districts discretion over enrollment. In this study, I examine the effect of local discretion over inter-district open enrollment on non-resident enrollment. I use longitudinal data on open enrollment patterns and policies in the metropolitan Detroit area. I find that when districts set more restrictive open enrollment policies, they enroll fewer new non-resident students overall, due to a decrease in new Black, Hispanic, and low-income non-resident students specifically. When districts allow inter-district open enrollment, racial and socioeconomic segregation within those districts do not change, and racial isolation slightly increases. My findings suggest that regulating enrollment policies to reduce discretionary exclusion can increase access to inter-district choice for some low-income and racially minoritized students, but that these kinds of policy changes are unlikely to reduce racial segregation and socioeconomic stratification more broadly. [ABSTRACT FROM AUTHOR]

Low-dose app-based contemplative interventions for mental health are increasingly popular, but heterogeneity in intervention responses indicates that a personalized approach is needed. We examined whether different longitudinal resilience–vulnerability trajectories, derived over the course of the COVID-19 pandemic, predicted differences in diverse mental health outcomes after mindfulness and socio-emotional dyadic online interventions. The CovSocial project comprised a longitudinal assessment (phase 1) and an open-label efficacy trial (phase 2). A community sample of 253 participants received 12 min daily app-based socio-emotional dyadic or mindfulness-based interventions, with weekly online coaching for 10 weeks. Before and after the intervention, participants completed validated self-report questionnaires assessing mental health. Stress reactivity profiles were derived from seven repeated assessments during the COVID-19 pandemic (January 2020 to March/April 2021) and were categorized into resilient (more plasticity) or vulnerable (less plasticity) stress recovery profiles. After both interventions, only individuals with resilient stress reactivity profiles showed significant improvements in depression symptomatology, trait anxiety, emotion regulation, and stress recovery. Those with vulnerable profiles did not show significant improvements in any outcome. Limitations of this study include the relatively small sample size and potential biases associated with participant dropout. Brief app-based mental interventions may be more beneficial for those with greater levels of stress resiliency and plasticity in response to stressors. More vulnerable individuals might require more intense and personalized intervention formats. [ABSTRACT FROM AUTHOR]

This article discusses the importance of improving the quality of multiple-choice questions in assessments to measure current learning rather than prior learning. The use of multiple-choice questions is common in many assessment plans and has various benefits, such as evaluating large classes and being useful for adaptive learning platforms. The article provides guidelines for faculty to improve the quality of multiple-choice questions, including clarity, logical arrangement of answer choices, simplicity in language, and maintaining item independence. By implementing these improvements, instructors can identify gaps in student understanding and make improvements in pedagogy. The goal is to promote equitable evaluation practices and drive rapid and equitable improvements in pedagogy. [Extracted from the article]

Through their products and services, businesses have a meaningful impact on their customers' health. When markets reward products that induce unhealthy behaviors, like poor diet and limited physical activity, they fuel the chronic disease epidemic. For market mechanisms to reward positive, and to punish negative, influences on healthy behaviors, companies' influences will need to be measured. Inspired by the technique of health impact assessment, we propose an approach to measuring these influences, based on examining usage patterns and the activities that result from a given product or service and then mapping those experiences to a core set of health behaviors. [ABSTRACT FROM AUTHOR]

Objective: The current study examined whether differences in the branding and description or mode of training materials influence drivers' understanding and expectations of a partial driving automation system. Background: How technology is described might influence consumers' understanding and expectations, even if all information is accurate. Method: Ninety drivers received training about a real partial driving automation system with a fictitious name. Participants were randomly assigned to a branding condition (system named AutonoDrive, training emphasized capabilities; or system named DriveAssist, training emphasized limitations) and training mode (quick-start brochure; video; or in-person demonstration). No safety-critical information was withheld nor deliberately misleading information provided. After training, participants drove a vehicle equipped with the system. Associations of drivers' expectations with branding condition and training mode were assessed using between-subjects comparisons of questionnaire responses obtained pre- and post-drive. Results: Immediately after training, those who received information emphasizing the system's capabilities had greater expectations of the system's function and crash avoidance capability in a variety of driving scenarios, including many in which the system would not work, as well as greater willingness to utilize the system's workload reduction benefits to take more risks. Most but not all differences persisted after driving the vehicle. Expectations about collision avoidance differed by training mode pre-drive but not post-drive. Conclusion: Training that emphasizes a partial driving automation system's capabilities and downplays its limitations can foster overconfidence. Application: Accuracy of technical information does not guarantee understanding; training should provide a balanced view of a system's limitations as well as capabilities. [ABSTRACT FROM AUTHOR]

Floral features, the pollination process, the breeding system, and fruiting success are documented in the Andean terrestrial orchid Gomphichis valida. Studies were performed at the Department of Ancash, Peru, at ca. 4250 m a.s.l., from June to November 2022. The breeding system was studied through controlled pollinations in plants excluded from pollinators (bagged). Natural pollination was studied in the field and through photos and videos. The flowers are nectariferous and non‐protandrous and present the longest lifespan reported so far for a neotropical terrestrial orchid (53–80 days). This species is pollinator dependent (unable to set fruit and seed without the agency of pollinators) and self‐compatible. The observed pollinators belong to three functional groups that appeared successively (in order of appearance): hummingbirds (Chalcostigma stanleyi), bumblebees (Bombus coccineus and Bombus rubicundus), and solitary Halictidae bees (Augochlorella sp.). All recorded pollinators probe the flowers for nectar. The pollinaria adhere to the bee mouthparts and onto the lateral side of the hummingbird bill. Bumblebees were the most frequent and efficient functional group (up to 62.07% of the observed pollination events), followed by Halictidae (31.03%) and hummingbirds (6.90%). Natural fruiting success is high (66.66%–94.49%). Such high natural fruiting success is unexpected at high altitudes, but it is likely explained by a combination of factors, including the long floral lifespan, nectar secretion, and self‐compatibility. This is the first report of hummingbirds as pollinators of Cranichidinae orchids, and G. valida is, to the best of our knowledge, a neotropical orchidoid orchid with the most generalist pollination biology recorded so far. [ABSTRACT FROM AUTHOR]

Miniaturized neuromodulation systems could improve the safety and reduce the invasiveness of bioelectronic neuromodulation. However, as implantable bioelectronic devices are made smaller, it becomes difficult to store enough power for long-term operation in batteries. Here, we present a battery-free epidural cortical stimulator that is only 9 millimeters in width yet can safely receive enough wireless power using magnetoelectric antennas to deliver 14.5-volt stimulation bursts, which enables it to stimulate cortical activity on-demand through the dura. The device has digitally programmable stimulation output and centimeter-scale alignment tolerances when powered by an external transmitter. We demonstrate that this device has enough power and reliability for real-world operation by showing acute motor cortex activation in human patients and reliable chronic motor cortex activation for 30 days in a porcine model. This platform opens the possibility of simple surgical procedures for precise neuromodulation. [ABSTRACT FROM AUTHOR]

In order to industrialize proton exchange membrane (PEM) fuel cells and balance of plant components, simulations are utilized to minimize costs during development and maximize performance. A key component in the anode path is the ejector, which is often optimized by 2D CFD to maximize the entrainment ratio. However, most turbulence models for 2D CFD simulations do not accurately predict the ejector's entrainment ratio across the entire operating range. This study involves validating various turbulence models using experimental data from two distinct ejectors. The optimal turbulence model, identified as the Reynolds Stress Model, achieves an average deviation of 6.1% in the entrainment ratio between simulation and experiment for both ejectors. This represents a significant improvement compared to traditional k-ε and k-ω turbulence models. The proposed turbulence model minimizes deviations in actual operation, thereby reducing testing and development costs, and contributing to the rapid industrialization of PEM fuel cell technology. • 2D CFD effectively predicts the entrainment ratio of ejectors for PEM fuel cells. • Two ejectors are validated over the entire operating range for the anode path. • Reynolds Stress Model (RSM) outperforms eddy viscosity models such as k-ε and k-ω. • RSM predicts shock waves more accurately due to anisotropy in Reynolds stresses. • The average deviation of 6.1% proves that simulation and experiment are valid. [ABSTRACT FROM AUTHOR]

Background: Total knee arthroplasty (TKA) is one of the most common inpatient and outpatient surgical procedures performed in the United States and is predicted to increase 401% by 2040. Surgical site infections (SSIs) at an incidence rate of approximately 2% are costly post-operative complications in TKA. Intra-operative surgical irrigants are used to decrease contaminating microbial bioburden within the surgical site to prevent SSI. The primary objective of this retrospective study was to evaluate the impact of a novel surgical irrigant called XPERIENCE® Advanced Surgical Irrigation (XP; Next Science, Jacksonville, FL) on SSI incidence in primary TKA performed at an ambulatory surgery center (ASC). Patients and Methods: Primary TKAs were performed at a free-standing ASC. The novel surgical irrigant was used intra-operatively to rinse away debris and micro-organisms from the surgical site. Retrospective data collation included SSI rates, complication rates, and re-admissions due to SSI within 90 days of index surgery. Results: Among the 524 primary TKA surgeries, one peri-prosthetic joint infection (PJI) was diagnosed within 90 days of index surgery and one superficial incisional SSI was diagnosed within 30 days of index surgery. The PJI was attributed to an exogenously acquired upper respiratory tract infection rather than due to the failure of intra-operative regimes. The 0.19% PJI incidence rate indicated significant efficacy of XP in decreasing PJI. An overall complication rate of 7.82% was noted with none of the complications associated with usage of the novel surgical irrigant. Conclusions: XPERIENCE is a promising intra-operative antimicrobial irrigant that can be easily incorporated into a broader infection prevention strategy. [ABSTRACT FROM AUTHOR]

Background: Likewise work experience, heart rate variability (HRV) has repeatedly been correlated with improved performance under real life and simulator conditions. Using HRV as a correlate of workload, it is meaningful to assess the impact of work experience. To understand the impact of work experience on HRV metrics, we examined differences in HRV among experts and beginners during simulated endovascular neuroradiological procedures. Methods: Six inexperienced radiologists (beginners) and five experts in neurological endovascular intervention each performed 10 diagnostic angiographies on a Vascular Interventional System Trainer (VIST) simulator (Mentice AB, SW). Beyond total time, fluoroscopy time, and amount of contrast medium used, heart rate variability and the NASA-task load index were gathered as correlates of workload. The t-Test for independent samples as well as Mann-Whitney-U tests were applied for group-wise comparison between beginners and experts. Multivariate regression was used to assess the influence of age and expert status. Results: Ten participants completed all scenarios; one participant only completed the first five scenarios. Accordingly, 105 simulations were analyzed (beginners N = 60; experts N = 45, respectively). The heart rate variability of experts and beginners significantly differed in three time domain HRV metrics (decreased RMSSD, NN50, pNN50 in experts; all p < 0.05) as well as with respect to its distribution in the frequency spectrum (LF/HF ratio; p < 0.001, increased high frequency components in experts). Conclusions: The HRV of beginners and expert neurointerventionalists significantly differed during simulated endovascular neuroradiological procedures. Experts presented decreased HRV, this could be a cardiovascular surrogate to the effort the subjects expend on their performance. It is in line with previous studies on vagal influences on the heart and cognitive-executive performance. [ABSTRACT FROM AUTHOR]

Supply chain issues disrupt veterinary care and cause downstream consequences that alter the practice of veterinary medicine. Antimicrobials are just 1 class of pharmaceuticals that have been impacted by supply chain issues over the last couple of years. Since February 2021, 2 sponsors/manufacturers of penicillin products have reported shortages in the active pharmaceutical ingredient. With the release of the 2021 Summary Report on Antimicrobials Sold or Distributed for Use in Food-Producing Animals by the FDA, a key finding was a 19% decrease in penicillin sales and distribution from 2020 to 2021. Herein, we provide our clinicians' professional perspective regarding how drug shortages, specifically that of penicillin, might contribute to misconstrued patterns in antimicrobial use and what can be done by veterinarians and the FDA to minimize the impact of an antimicrobial drug shortage on animal health and well-being. [ABSTRACT FROM AUTHOR]

Section 1332 of the Affordable Care Act (ACA) provides states unprecedented flexibility to alter federal health policy. The authors analyze state waiver activity from 2019 to 2023, applying a comparative approach to understand waivers proposed by Georgia, Colorado, Washington, Oregon, and Nevada. Much of the waiver activity during this period focused on reinsurance programs. During the Trump administration, the most innovative waiver application was from Georgia, which sought to restructure and decentralize its individual market, moving away from the framework established by the ACA. While the Biden administration suspended Georgia's efforts, Democratic-led states have focused implementing waiver programs supporting and expanding on the ACA. This has included adopting public-option insurance plans offered by private insurers and expanding eligibility for qualified health plans for previously ineligible groups. The authors' analysis offers insights into contemporary health politics, policy durability, and the role of the administrative presidency. [ABSTRACT FROM AUTHOR]

In this study, for the first time, we explored a dataset of functional magnetic resonance images collected during focused attention and open monitoring meditation before and after a five-day psilocybin-assisted meditation retreat using a recently established approach, based on the Mapper algorithm from topological data analysis. After generating subject-specific maps for two groups (psilocybin vs. placebo, 18 subjects/group) of experienced meditators, organizational principles were uncovered using graph topological tools, including the optimal transport (OT) distance, a geometrically rich measure of similarity between brain activity patterns. This revealed characteristics of the topology (i.e. shape) in space (i.e. abstract space of voxels) and time dimension of whole-brain activity patterns during different styles of meditation and psilocybin-induced alterations. Most interestingly, we found that (psilocybin-induced) positive derealization, which fosters insightfulness specifically when accompanied by enhanced open-monitoring meditation, was linked to the OT distance between open-monitoring and resting state. Our findings suggest that enhanced meta-awareness through meditation practice in experienced meditators combined with potential psilocybin-induced positive alterations in perception mediate insightfulness. Together, these findings provide a novel perspective on meditation and psychedelics that may reveal potential novel brain markers for positive synergistic effects between mindfulness practices and psilocybin. [ABSTRACT FROM AUTHOR]

Objective: Loop ligation of the appendix is a challenging surgical skill and well suited to be trained in a simulator. We aimed to develop an affordable and easy-to-build simulator and test its training effect. Design and participants: Different materials were tested, and the best training modality was identified by researching the literature. The developed simulator training was tested on 20 surgical novices. Results: A video was produced including an instruction on how to build the simulator and a step-by-step tuition on how to ligate the appendix. The Peyton approach was utilized to guide learners. Training with the simulator leads to reliable skill acquisition. All participants improved significantly in completing the task successfully during the structured learning. Conclusion: We succeeded in developing a simulator for loop ligation of the appendix during laparoscopic appendectomy. Participants significantly improve in handling the loops. The transferability of the skill learned during simulation to the operating room will be subject of a follow-up study. [ABSTRACT FROM AUTHOR]

Historical coal mining practices have caused various soil and water hazards, particularly through the dumping of mine waste. The primary environmental risk associated with this waste is the leaching of toxic metals from dumps of spoil or refuse into the subsurface soil or into nearby water resources. The extent of metal release is controlled via the oxidative dissolution of pyrite and potential re-sequestration through secondary Fe oxides. The characterization of the dominant Fe-bearing phase and the distribution of trace metals associated with these phases was determined via electron microscopy, synchrotron-based X-ray micro-fluorescence (μ-XRF) element and redox mapping from shallow mine soils from an impacted watershed in Appalachian Ohio. The dominant Fe-bearing phases were: (1) unweathered to partially weathered pyrite; (2) pseudomorphic replacement of pyrite with Fe(III) oxides; (3) fine-grained Fe oxide surface coatings; and (4) discrete Fe(III) oxide grains. Thicker secondary coatings and larger particles were sulfate rich, whereas smaller grains and thinner coatings were sulfate poor. The discrete Fe oxide grains exhibited the highest concentrations of Cr, Mn, Ni, and Cu, and sub-grain-scale concentration trends (Mn > Cr > Ni > Cu) were consistent with bulk soil properties. Predicting future metal transport requires an understanding of metal speciation and distribution from the sub-grain scale to the pedon scale. [ABSTRACT FROM AUTHOR]

The occupation of commercial fishing is recognized as a comparatively stressful and hazardous job characterized by a myriad of risks to health, including high rates of job‐related injury, morbidity, and mortality. Nonetheless, systematic study of fisher health is limited. This paper examines a particularly understudied aspect of illness among fishers: the physical and social contexts, pathways, and potential for adverse disease interactions. The focus of the paper is on a biosocial disease process called syndemics, which increases the health burdens of this population. The paper is presented as an initial testing of the hypothesis that a "lens" of syndemics improves occupational health research and advocacy for commercial fishermen who face a substantial burden of biosocial challenges. [ABSTRACT FROM AUTHOR]

The Brief Jail Mental Health Screen (BJMHS) is one of the most popular screening tools used at the time of jail admission to identify adults with current mental health needs. Prior work has documented the accuracy of the screen primarily in large urban or semi-urban correctional facilities according to diagnostic criteria established in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The current study was designed to evaluate the precision of the BJMHS in a smaller rural jail setting according to the current DSM-5 criteria in a sample of 210 adults. Responses from the BJMHS were collected and merged with diagnostic indications gathered from the Comprehensive Addictions and Psychological Evaluation. Mental health conditions were highly prevalent with 80% of participants presenting symptoms. The BJMHS accurately identified less than half (40%) of those with a mental health condition. The high false-negative rate of the BJMHS left many adults in need of services without the necessary diagnostic evaluation. Recommendations are provided to help increase the accuracy needed to correctly identify these needs in rural jail populations, which represent those incarcerated in most local detention centers in the U.S. [ABSTRACT FROM AUTHOR]

Episodic memories may become suppressed, both incidentally and intentionally. Incidental suppression is a result of a competition induced by interfering items or responses. In contrast, intentional suppression is said to result from conscious attempts to suppress certain memory items, and should thus not depend on competition induced by interfering items or responses. However, intentional suppression is typically engendered using the Think/No-Think paradigm, in which participants are required to retrieve some target items and to suppress others. Therefore, rather than intentional suppression, forgetting in this paradigm may reflect incidental suppression of No-Think items induced by interference via prior retrieval of the Think items. To distinguish between these possibilities, we tested participants (n= 40) using an adjusted suppression paradigm, which did not include the Think condition (ExcludeThink paradigm) and compared it with the standard suppression paradigm (IncludeThink paradigm; n= 39) which included a think condition. We found that suppression was not observed in the ExcludeThink paradigm, but only in the IncludeThink paradigm. These results indicate that interference via prior retrieval is necessary to induce forgetting. [ABSTRACT FROM AUTHOR]

Background: Thiopurines are commonly used to treat inflammatory bowel disease but withdrawal due to side effects are common. Thioguanine has been suggested to be better tolerated than conventional thiopurines. Objectives: We studied drug-survival of low dose of thioguanine in real-life clinical practice in comparison to conventional thiopurines. Design: Retrospective observational study. Methods: All patients born 1956 and later, and who at least once started thiopurine treatment between 2006 and 2022 were included. A medical chart review was performed that noted drug-survival for every thiopurine treatment attempt. The Mantel–Cox rank test was used to test differences in drug-survival for different thiopurines. Blood chemistry analysis and faecal calprotectin levels were registered for the first 5 years of treatment. Results: In the study population, there was 379 initiated thiopurine treatments (210 for Crohn's disease and 169 for ulcerative colitis) in 307 patients with inflammatory bowel disease (IBD). Low-dose thioguanine (median dose 11 mg; 25–75th percentile 7–19 mg) had been initiated in 31 patients. Overall, when including all thiopurine attempts, thioguanine had the longest drug-survival [Mantel–Cox rank test: thioguanine versus azathioprine p = 0.014; thioguanine versus 6-mercaptopurine (6-MP) p < 0.001]. For second-line thiopurine treatment thioguanine had longer drug-survival than 6-MP (Mantel–Cox rank test: p = 0.006). At 60 months, 86% of the patients who started low-dose thioguanine were still on treatment compared to 42% of the patients who started 6-MP (p = 0.022). The median 6-thioguanine nucleotide levels in patients treated with thioguanine was 364 pmol/8 × 108. Patients on thioguanine treatment showed significantly lower values of median mean corpuscular volume at follow-up than patients treated with azathioprine and 6-MP. Patients treated with 6-MP showed significantly lower levels of FC in the third year of treatment compared to patient treated with azathioprine (59 versus 109 µg/g; p = 0.023), but there was no significant difference in FC levels for thioguanine compared to azathioprine (50 versus 109 µg/g; p = 0.33). Conclusion: Treatment with a low dose of thioguanine is well-tolerated in patients with IBD and had a significantly higher drug-survival than conventional thiopurines. Plain language summary: Low-dose of the immunomodulator drug thioguanine are well tolerated by patients with inflammatory bowel disease Thiopurines are commonly used to treat inflammatory bowel disease but it is common that patients end treatment due to side-effects. The thiopurine thioguanine has been suggested to be better tolerated than other thiopurines. We aimed to study if a low-dose of thioguanine had been tolerated better and used longer than other thiopurines in patients with inflammatory bowel disease at our clinic. In the study population there was 379 initiated thiopurine treatments in 307 patients with inflammatory bowel disease. Among those patients a low-dose thioguanine had been initiated in 31 patients. Overall, when including all thiopurine attempts, thioguanine had longest drug-survival of all thiopurines. For second line thiopurine treatment thioguanine had longer drug-survival than the thiopurine 6-mercaptopurine that are usually used as second line thiopurine treatment. At 60 months, 86% of the patients who started low dose thioguanine was still on treatment compared to 42% of the patients who started 6-mercaptopurine.There was a similar response on inflammatory markers the first five years from starting treatment with thioguanines compared to conventional used thiopurines. We conclude that treatment with a low-dose of thioguanine is well tolerated in patients with inflammatory bowel disease and have a significantly higher drug survival than conventional thiopurines. [ABSTRACT FROM AUTHOR]

Introduction: Ataxia telangiectasia (A-T) is an autosomal recessive neurodegenerative disease with widespread systemic manifestations and marked variability in clinical phenotypes. In this study, we sought to determine whether transcriptomic profiling of peripheral blood mononuclear cells (PBMCs) defines subsets of individuals with A-T beyond mild and classic phenotypes, enabling identification of novel features for disease classification and treatment response to therapy. Methods: Participants with classic A-T (n = 77), mild A-T (n = 13), and unaffected controls (n = 15) were recruited from two outpatient clinics. PBMCs were isolated and bulk RNAseq was performed. Plasma was also isolated in a subset of individuals. Affected individuals were designated mild or classic based on ATM mutations and clinical and laboratory features. Results: People with classic A-T were more likely to be younger and IgA deficient and to have higher alpha-fetoprotein levels and lower % forced vital capacity compared to individuals with mild A-T. In classic A-T, the expression of genes required for V(D)J recombination was lower, and the expression of genes required for inflammatory activity was higher. We assigned inflammatory scores to study participants and found that inflammatory scores were highly variable among people with classic A-T and that higher scores were associated with lower ATM mRNA levels. Using a cell type deconvolution approach, we inferred that CD4 + T cells and CD8 + T cells were lower in number in people with classic A-T. Finally, we showed that individuals with classic A-T exhibit higher SERPINE1 (PAI-1) mRNA and plasma protein levels, irrespective of age, and higher FLT4 (VEGFR3) and IL6ST (GP130) plasma protein levels compared with mild A-T and controls. Conclusion: Using a transcriptomic approach, we identified novel features and developed an inflammatory score to identify subsets of individuals with different inflammatory phenotypes in A-T. Findings from this study could be used to help direct treatment and to track treatment response to therapy. [ABSTRACT FROM AUTHOR]

This essay uses the occasion of tribute to return to Steve Schwarze's "Environmental Melodrama" and Gregory Desilet and Edward C. Appel's later essay representing arguably the most important theoretical engagement with Schwarze's ideas to date. I identify unresolved dilemmas in the relation between affect, rationality, and rhetoric of resistance emerging from this exchange, and propose a corrective. This article contends that Desilet and Appel offer some insightful critiques of Schwarze's argument, but that pitfalls in their overall refiguring of melodrama's affectivity must be resolved if the study of what Schwarze calls melodrama and they term comic-filtered factional framing is to coherently and productively advance. [ABSTRACT FROM AUTHOR]

Background: Sex workers, those who trade sex for monetary or nonmonetary items, experience high rates of HIV transmission but have not been adequately included in HIV prevention and Pre-Exposure Prophylaxis (PrEP) adherence program development research. Community-empowered (C.E.) approaches have been the most successful at reducing HIV transmission among sex workers. Centering Healthcare (Centering) is a C.E. model proven to improve health outcomes and reduce health disparities in other populations, such as pregnant women, people with diabetes, and sickle cell disease. However, no research exists to determine if Centering can be adapted to meet the unique HIV prevention needs of sex workers. Objective: We aim to explain the process by which we collaboratively and iteratively adapted Centering to meet the HIV prevention and PrEP retention needs of sex workers. Methods: We utilized the Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, Testing (ADAPT-ITT) framework, a model for adapting evidence-based interventions. We applied phases one through six of the ADAPT-ITT framework (Assessment, Decision, Adaptation, Production, Topical Experts, Integration) to the design to address the distinct HIV prevention needs of sex workers in Chicago. Study outcomes corresponded to each phase of the ADAPT-ITT framework. Data used for adaptation emerged from collaborative stakeholder meetings, individual interviews (n = 36) and focus groups (n = 8) with current and former sex workers, and individual interviews with care providers (n = 8). In collaboration with our community advisory board, we used a collaborative and iterative analytical process to co-produce a culturally adapted 3-session facilitator's guide for the Centering Pre-exposure Prophylaxis (C-PrEP +) group healthcare model. Results: The ADAPT-ITT framework offered structure and facilitated this community-empowered innovative adaptation of Centering Healthcare. This process culminated with a facilitator's guide and associated materials ready for pilot testing. Conclusions: In direct alignment with community empowerment, we followed the ADAPT-ITT framework, phases 1–6, to iteratively adapt Centering Healthcare to suit the stated HIV Prevention and PrEP care needs of sex workers in Chicago. The study represents the first time Centering has been adapted to suit the HIV prevention and PrEP care needs of sex workers. Addressing a gap in HIV prevention care for sex workers, Centering PrEP harnesses the power of community as it is an iteratively adapted model that can be piloted and replicated regionally, nationally, and internationally. [ABSTRACT FROM AUTHOR]

Schistosomiasis is a neglected tropical disease affecting over 150 million people. Hotspots of Schistosoma transmission—communities where infection prevalence does not decline adequately with mass drug administration—present a key challenge in eliminating schistosomiasis. Current approaches to identify hotspots require evaluation 2–5 y after a baseline survey and subsequent mass drug administration. Here, we develop statistical models to predict hotspots at baseline prior to treatment comparing three common hotspot definitions, using epidemiologic, survey-based, and remote sensing data. In a reanalysis of randomized trials in 589 communities in five endemic countries, a regression model predicts whether Schistosoma mansoni infection prevalence will exceed the WHO threshold of 10% in year 5 (“prevalence hotspot”) with 86% sensitivity, 74% specificity, and 93% negative predictive value (NPV; assuming 30% hotspot prevalence), and a regression model for Schistosoma haematobium achieves 90% sensitivity, 90% specificity, and 96% NPV. A random forest model predicts whether S. mansoni moderate and heavy infection prevalence will exceed a public health goal of 1% in year 5 (“intensity hotspot”) with 92% sensitivity, 79% specificity, and 96% NPV, and a boosted trees model for S. haematobium achieves 77% sensitivity, 95% specificity, and 91% NPV. Baseline prevalence is a top predictor in all models. Prediction is less accurate in countries not represented in training data and for a third hotspot definition based on relative prevalence reduction over time (“persistent hotspot”). These models may be a tool to prioritize high-risk communities for more frequent surveillance or intervention against schistosomiasis, but prediction of hotspots remains a challenge. [ABSTRACT FROM AUTHOR]

Green sturgeon (Acipenser medirostris) and white sturgeon (A. transmontanus) are closely related, sympatric species that inhabit the San Francisco estuary. Green sturgeon have a more marine life history but both species spawn in the Sacramento River and reside for some duration in San Francisco Bay. These sturgeons are of conservation concern, yet little is known about their dietary competition when they overlap in space and time. To examine evidence of dietary differentiation, we collected whole blood and blood plasma from 26 green sturgeon and 35 white sturgeon in San Francisco Bay. Using carbon and nitrogen stable isotope analyses, we compared their relative trophic levels and foraging locations along the freshwater to marine gradient. Sampling blood plasma and whole blood allowed comparison of dietary integration over shorter and longer time scales, respectively. Plasma and whole blood δ13C values confirmed green sturgeon had more marine dietary sources than white sturgeon. Plasma δ15N values revealed white sturgeon fed at lower trophic levels than green sturgeon recently, however, whole blood δ15N values demonstrated the two species fed at the same trophic level over longer time scales. Larger individuals of both species had higher δ13C values than smaller individuals, reflecting more marine food sources in adulthood. Length did not affect δ15N values of either species. Isotope analyses supported the more marine life history of green than white sturgeon and potentially highlight a temporary trophic differentiation of diet between species during and preceding the overlapping life stage in San Francisco Bay. [ABSTRACT FROM AUTHOR]

Toxicokinetic–toxicodynamic (TKTD) models simulate organismal uptake and elimination of a substance (TK) and its effects on the organism (TD). The Reduced General Unified Threshold model of Survival (GUTS‐RED) is a TKTD modeling framework that is well established for aquatic risk assessment to simulate effects on survival. The TKTD models are applied in three steps: parameterization based on experimental data (calibration), comparing predictions with independent data (validation), and prediction of endpoints under environmental scenarios. Despite a clear understanding of the sensitivity of GUTS‐RED predictions to the model parameters, the influence of the input data on the quality of GUTS‐RED calibration and validation has not been systematically explored. We analyzed the performance of GUTS‐RED calibration and validation based on a unique, comprehensive data set, covering different types of substances, exposure patterns, and aquatic animal species taxa that are regularly used for risk assessment of plant protection products. We developed a software code to automatically calibrate and validate GUTS‐RED against survival measurements from 59 toxicity tests and to calculate selected model evaluation metrics. To assess whether specific survival data sets were better suited for calibration or validation, we applied a design in which all possible combinations of studies for the same species–substance combination are used for calibration and validation. We found that uncertainty of calibrated parameters was lower when the full range of effects (i.e., from high survival to high mortality) was covered by input data. Increasing the number of toxicity studies used for calibration further decreased parameter uncertainty. Including data from both acute and chronic studies as well as studies under pulsed and constant exposure in model calibrations improved model predictions on different types of validation data. Using our results, we derived a workflow, including recommendations for the sequence of modeling steps from the selection of input data to a final judgment on the suitability of GUTS‐RED for the data set. Environ Toxicol Chem 2024;43:197–210. © 2023 Bayer AG and The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC. [ABSTRACT FROM AUTHOR]