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Historical exclusion of females in research has been, in part, due to the perceived influence of natural menstrual (NAT) and oral contraceptive pill (OCP) cycles on vascular outcomes. NAT and OCP cycle phases may influence brachial artery (BA) endothelial function, however, findings are mixed. Minimal research has examined arterial stiffness, smooth muscle, and lower limb endothelial function. The purpose of this study was to investigate the influence of NAT and OCP cycles on cardiovascular outcomes and cellular regulation. Forty-nine premenopausal females (n = 17 NAT, n = 17 second generation OCP, n = 15 third generation OCP) participated in two randomized order visits in the low (LH, early follicular/placebo) and high (HH, midluteal/active) hormone cycle phases. BA and superficial femoral artery (SFA) endothelial function [flow-mediated dilation (FMD) test], smooth muscle function (nitroglycerine-mediated dilation test), and carotid and peripheral (pulse wave velocity) arterial stiffness were assessed. Cultured female human endothelial cells were exposed to participant serum for 24 h to examine endothelial nitric oxide synthase (eNOS) and estrogen receptor-α (ERα) protein content. BA FMD was elevated in the HH vs. LH phase, regardless of group (HH, 7.7 ± 3.5%; LH, 7.0 ± 3.3%; P = 0.02); however, allometric scaling for baseline diameter resulted in no phase effect (HH, 7.6 ± 2.6%; LH, 7.1 ± 2.6%; P = 0.052, d = 0.35). SFA FMD, BA, and SFA smooth muscle function, arterial stiffness, and eNOS and ERα protein content were unaffected. NAT and OCP phases examined have minimal influence on vascular outcomes and ERα-eNOS pathway, apart from a small effect on BA endothelial function partially explained by differences in baseline artery diameter. NEW & NOTEWORTHY: Comprehensive evaluation of the cardiovascular system in naturally cycling and second and third generation OCP users indicates no major influence of hormonal phases examined on endothelial function and smooth muscle function in the arteries of the upper and lower limbs, arterial stiffness, or underlying cellular mechanisms. Study findings challenge the historical exclusion of female participants due to potentially confounding hormonal cycles; researchers are encouraged to consider the hormonal environment in future study design. [ABSTRACT FROM AUTHOR]

Background: There is a discrepancy in the surgical and endoscopic literature for managing duodenal perforations. Although often managed conservatively, surgical repair is the standard treatment for duodenal perforations. This contrasts with the gastroenterology literature, which now recommends endoscopic repair of duodenal perforations, which are more frequently iatrogenic from the growing field of advanced endoscopic procedures. This study aims to provide a scoping review to summarize the current literature content and quality on endoscopic repair of duodenal perforations. Methods: The protocol for performing this scoping review was outlined by the Joanna Briggs Institute. All studies that reported primary outcomes of patients who had undergone endoscopic repair of duodenal perforations before February 2022, regardless of perforation etiology or repair type were reviewed, with studies after 1999 meeting inclusion criteria. The study excluded articles that did not report clinical outcomes of endoscopic repair, articles that did not describe where in the gastrointestinal tract the endoscopic repair occurred, pediatric patients, and animal studies. Results: 7606 abstracts were screened, with 474 full articles reviewed and 152 studies met inclusion criteria. 560 patients had duodenal perforations repaired endoscopically, with a technical success rate of 90.4% and a survival rate of 86.7%. Most of these perforations (74.5%) were iatrogenic from endoscopic procedures or surgery. Only one randomized control trial (RCT) was found, and 53% of studies were case reports. Conclusion: These results suggest that endoscopic repair could emerge as a viable first-line treatment for duodenal perforation and highlight the need for more high-quality research in this topic. [ABSTRACT FROM AUTHOR]

Forecasting species' responses to climate change is critical and challenging. One commonly used approach is space-for-time substitution (SFTS), which takes the hypothesis that the biotic–climate relationships observed over space are causal, and uses this spatial relationship to predict responses over time. The underlying assumptions have seldom been tested; if not supported, the resulting predictions can be biased and have a high degree of uncertainty. We currently cannot discern for which type of species the SFTS approach is likely to be more reliable. We argue that the way forward is to test the underlying assumptions by evaluating contexts and species using a comparative approach, through improvements in the quality of biological data, and through the integration of experimental and modelling approaches to the distribution of species. To anticipate species' responses to climate change, ecologists have largely relied on the space-for-time-substitution (SFTS) approach. However, the hypothesis and its underlying assumptions have been poorly tested. Here, we detail how the efficacy of using the SFTS approach to predict future locations will depend on species' traits, the ecological context, and whether the species is declining or introduced. We argue that the SFTS approach will be least predictive in the contexts where we most need it to be: forecasting the expansion of the range of introduced species and the recovery of threatened species. We highlight how evaluating the underlying assumptions, along with improved methods, will rapidly advance our understanding of the applicability of the SFTS approach, particularly in the context of modelling the distribution of species. [ABSTRACT FROM AUTHOR]

Sprint interval training (SIT) increases peak oxygen uptake (V̇O2peak) but the mechanistic basis is unclear. We have reported that 12 wk of SIT increased V̇O2peak and peak cardiac output (Q̇peak) and the changes in these variables were correlated. An exploratory analysis suggested that Q̇peak increased in males but not females. The present study incorporated best practices to examine the potential influence of biological sex on the Q̇peak response to SIT. Male and female participants (n = 10 each; 21 ± 4 y) performed 33 ± 2 sessions of SIT over 12 wk. Each 10-min session involved 3 × 20-s 'all-out' sprints on an ergometer. V̇O2peak increased after SIT (3.16 ± 1.0 vs. 2.89 ± 1.0 L/min, η2p = 0.53, p < 0.001) with no sex × time interaction (p = 0.61). Q̇peak was unchanged after training (15.2 ± 3.3 vs. 15.1 ± 3.0 L/min, p = 0.85), in contrast to our previous study. The peak estimated arteriovenous oxygen difference increased after training (204 ± 30 vs. 187 ± 36 ml/L, p = 0.006). There was no effect of training or sex on measures of endothelial function. We conclude that 12 wk of SIT increases V̇O2peak but the mechanistic basis remains unclear. The capacity of inert gas rebreathing to assess changes in Q̇peak may be limited and invasive studies that use more direct measures are needed. [ABSTRACT FROM AUTHOR]

There is some evidence that transient endothelial dysfunction induced by acute hyperglycemia may be attenuated by a single bout of aerobic exercise. However, the impact of aerobic exercise training on acute hyperglycemia-induced endothelial dysfunction has not been explored. The purpose of this study was to determine the impact of aerobic exercise training on the endothelial function response to acute hyperglycemia. Brachial artery flow-mediated dilation (FMD) was assessed in 24 healthy males (21 ± 1 years) pre-, 60 and 90 min post ingestion of 75 g of glucose. Participants completed a four-week control (CON; n = 13) or exercise training (EX; n = 11) intervention. The EX group completed four weeks of cycling exercise (30 min, 4×/week at 65% work rate peak). Cardiorespiratory fitness ( V. O2peak) increased and resting HR decreased in EX, but not CON post-intervention (p < 0.001). Glucose and insulin increased (p < 0.001) following glucose ingestion, with no significant difference pre- and post-intervention. In contrast to previous research, FMD was unaffected by glucose-ingestion, pre- and post-intervention in both groups. In conclusion, acute hyperglycemia did not impair endothelial function, before or after exercise training. Relatively high baseline fitness ( V. O2peak ~ 46 mL/kg/min) and young age may have contributed to the lack of impairment observed. Further research is needed to examine the impact of exercise training on hyperglycemia-induced impairments in endothelial function in sedentary males and females. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is possible for any pediatric patient with abdominal pain. At our tertiary care center, patients are transferred for surgical management with unnecessary or excessive imaging. We hypothesize that using the Alvarado score (AS) to clinically stage patients will identify patient groups that could be transferred prior to imaging. Methods: Retrospective review of pediatric patients transferred to our hospital for suspected appendicitis between 11/2020 and 3/2022 was performed. Variables collected included AS, imaging, and pathology. Alvarado score was calculated for each patient, and patients were grouped into low score, intermediate score, and high score groups. Positive predictive values (PPVs) were calculated for patients who underwent CT. Results: 196 patients (age 2-17, 58% male) were transferred with suspected appendicitis. CT was obtained in 67% of patients and was not significantly different between groups. The low-score group (n=35) had a rate of appendicitis of 14% and the PPV of CT was 33%. The intermediate-score group (n = 74) had a rate of appendicitis of 62% and the PPV of CT was 88%. In the high-score group (n = 87), the rate of appendicitis was 92% and PPV of CT was 98%. Discussion: Our data show that patients with low, intermediate, and high AS undergo CT at similar rates. We suggest that patients in the low score and high score groups may not benefit from reflexive CT given the likelihood of appendicitis based on the Alvarado score. We propose that CT in these groups be performed at the discretion of the pediatric center in order to expedite transfer and spare children excess radiation. [ABSTRACT FROM AUTHOR]

Changes in precipitation due to climate change will have consequences for plant and herbivorous insect communities alike. Multiple hypotheses explain how changes in plant diversity and productivity can lead to changes in herbivore community composition. Yet as rainfall patterns change, the bottom‐up effects on the relationships between plant and herbivore communities are less well understood.Using a long‐term rainfall manipulation experiment in a remnant patch of Garry oak (Quercus garryana) savanna, we examined how plant diversity and productivity have responded to variation in soil moisture over 6 years. This highly endangered ecosystem is predicted to experience significantly wetter springs and drier summers by 2080. We also investigated plant‐mediated, indirect effects of manipulated rainfall on herbivore diversity and abundance, drawing on multiple hypotheses describing the relationships between plant and herbivore communities. For example, the more individuals hypothesis predicts that increased plant productivity results in increased herbivore abundance which, in turn, results in increased herbivore diversity.We found that plant productivity was influenced by soil moisture, but the direction and magnitude of the response varied across years, and found no support for plant diversity influencing productivity. We also found that the cover and productivity of grasses increased significantly with increasing precipitation. In addition to a direct negative effect on herbivore diversity, soil moisture had an indirect negative effect on herbivore abundance, via the negative effect of plant productivity on abundance, contradicting the more individuals hypothesis.Synthesis. Our results highlight that not only can drought result in significant reductions in plant productivity in this threatened ecosystem, but that these changes will also result in increases in herbivore abundance. In contrast, where soil moisture is higher, grasses will become more dominant resulting in decreased herbivore abundance. Ultimately, predicting how this system responds to changes in precipitation will depend on the ability to predict whether growing season soil moisture will be consistently drier or wetter in the future, a significant challenge. Going forward, investigating how variation in precipitation due to climate change affects the links between trophic levels, including how herbivores affect plant communities, remains critical for understanding ecosystem processes and stability. [ABSTRACT FROM AUTHOR]

Background: Ileocolic intussusception is considered a pediatric emergency, with concerns for risk of significant morbidity in children with a prolonged intussusception state. Emergent therapy is standard of care, as prior studies have shown poor outcomes in patients with long delays (> 24 h) before intervention. Various factors can result in shorter delays, and there are limited studies evaluating outcomes in these patients. This study aimed to determine if there were differences in reduction success rates associated with short in-hospital time delays.Objective: This study is to determine enema success rate and morbidity in patients with documented time delays between intussusception diagnosis and therapeutic enema.Materials and Methods: A retrospective evaluation of pediatric patients with intussusception at a single children's hospital between 2007 and 2019 was performed. Patient's records were reviewed for time of symptom onset, radiologic diagnosis, and attempted enema. Ultrasounds and radiographs were reviewed for bowel obstruction, free peritoneal fluid, trapped fluid around the intussusceptum, and absent bowel wall perfusion. Patients were evaluated for efficacy of reduction attempt, requirement for surgical reduction, and complications including bowel resection and bowel perforation.Results: There were 175 cases of ileocolic intussusception requiring enema reduction. Successful reduction occurred in 72.2% (13/18) of cases performed within 1 h of diagnosis; 74.3% (78/105) between 1 and3 h; 73.2% (30/41) between 3 and 6 h; and 81.2% (9/11) with greater than 6 h. Need for bowel resection was not associated with short delays between diagnosis and reduction attempts (p = .07).Conclusions: There was no difference in intussusception reduction efficacy or complication rate in patients with increasing time between imaging diagnosis of ileocolic intussusception and reduction attempt, including delay intervals up to 8 h. [ABSTRACT FROM AUTHOR]

All addictions have a recurring nature, but their comparative chronicity has never been directly investigated. The purpose of this study is to undertake this investigation. A secondary analysis was conducted on two large scale 5-year Canadian adult cohort studies. A subset of 1,088 individuals were assessed as having either substance use disorder, gambling disorder, excessive behaviors (e.g. shopping, sex/pornography), or two or more of these designations ('multiple addictions') during the course of these studies. Within each dataset comparisons were made between these four groups concerning the number of waves they had their condition; likelihood of having their condition in two or more consecutive waves; and likelihood of relapse following remission. Multiple addictions had significantly greater chronicity on all measures compared to single addictions. People with an excessive behavior designation had significantly lower chronicity compared to people with gambling disorder and a tendency toward lower chronicity compared to substance use disorder. Gambling disorder had equivalent chronicity to substance use disorder in one dataset but greater chronicity in the other. However, this latter difference is likely an artifact of the different time frames utilized. Having multiple addictions represents a more pervasive condition that is persistent for most individuals. Substance use disorder and gambling disorder have intermediate and roughly equivalent levels of chronicity, but considerable individual variability, transient for some, but more chronic for others. In contrast, excessive behaviors such as compulsive shopping are transient for most, and their comparatively lower levels of chronicity questions their designations as 'addictions'. [ABSTRACT FROM AUTHOR]

Perianal Crohn's disease (CD) is a complex manifestation of CD that affects approximately 10% of patients. The spectrum of disease is quite variable, ranging from relatively mild disease to severe, aggressive manifestations that result in frequent hospitalizations, multiple surgeries, and poor quality of life. Despite significant recent advances in surgical and medical management, treatment remains challenging and frequently requires a multidisciplinary medical-surgical approach. The goal of this article is to review the current literature regarding the work-up, treatment, and future directions of therapy. Crucial features of effective management include the precise identification of manifestations, control of sepsis, limiting rectal inflammation, frequently with use of antitumor necrosis factor agents, and avoidance of extensive surgery. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic sigmoidectomy is the preferred approach in the elective surgical management of diverticulitis. However, it is unclear if the benefits of laparoscopy persist when operative times are prolonged. We aimed to investigate if the recovery benefits associated with laparoscopy are retained when operative times are long.Methods: A retrospective review of a prospectively maintained database of patients who underwent elective laparoscopic sigmoidectomy from 2010-2015 at a single academic tertiary institution was performed. Operative times among laparoscopic completed cases were divided into quartiles, and patient outcomes were compared between the groups.Results: A total of 466 patients (median age: 58 ± 11.6 years, 58% females) underwent sigmoidectomy: 430 completed laparoscopically and 36 (7.7%) converted. Median operative time in laparoscopically completed cases was 188 min (IQR 154-230). There were no differences in morbidity (P = 0.52) or readmission rates (P = 0.22) among the quartiles. The 2nd and 4th operative time quartiles were associated with significantly longer length of stay (LOS) when compared to the fastest quartile (P = 0.003 and P = 0.002, respectively), but there was no increase in LOS as operative times progressed between the 2nd, 3rd, and 4th quartiles. LOS after conversion was longer but did not reach statistical significance when compared to laparoscopically completed operations in the longest quartile (5.0 vs 6.5 days, P = 0.075) CONCLUSIONS: Our data do not support preemptive conversion of laparoscopic sigmoidectomy to avoid prolonged operative times. As long as progress is safely being made, surgeons are justified to continue pursuing laparoscopic completion. [ABSTRACT FROM AUTHOR]

Background: Computed tomography imaging routinely detects incidental findings; most research focuses on malignant findings. However, benign diseases such as hiatal hernia also require identification and follow-up. Natural language algorithms can help identify these non-malignant findings. Methods: Imaging of adult trauma patients from 2010 to 2020 who underwent CT chest/abdomen/pelvis was evaluated using an open-source natural language processor to query for hiatal hernias. Patients who underwent subsequent imaging, endoscopy, fluoroscopy, or operation were retrospectively reviewed. Results: 1087(10.6%) of 10 299 patients had incidental hiatal hernias: 812 small (74.7%) and 275 moderate/large (25.3%). 224 (20.7%) had subsequent imaging or endoscopic evaluation. Compared to those with small hernias, patients with moderate/large hernias were older (66.3 ± 19.4 vs 79.6 ± 12.6 years, P <.001) and predominantly female (403[49.6%] vs 199[72.4%], P <.001). Moderate/large hernias were not more likely to grow (small vs moderate/large: 13[7.6%] vs 8[15.1%], P =.102). Patients with moderate/large hernias were more likely to have an intervention or referral (small vs moderate/large: 6[3.5%] vs 7[13.2%], P =.008). No patients underwent elective or emergent hernia repair. Three patients had surgical referral; however, only one was seen by a surgeon. One patient death was associated with a large hiatal hernia. Conclusions: We demonstrate a novel utilization of natural language processing to identify patients with incidental hiatal hernia in a large population, and found a 10.6% incidence with only 1.2%. (13/1087) of these receiving a referral for follow-up. While most incidental hiatal hernias are small, moderate/large and symptomatic hernias have high risk of loss-to-follow-up and need referral pipelines to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Aging is associated with increased risk of cardiovascular and cerebrovascular events, which are preceded by early, negative remodeling of the vasculature. Low physical activity is a well-established risk factor associated with the incidence and development of disease. However, recent physical activity literature indicates the importance of considering the 24-h movement spectrum. Therefore, the purpose of this review was to examine the impact of the 24-h movement spectrum, specifically physical activity (aerobic and resistance training), sedentary behavior, and sleep, on cardiovascular and cerebrovascular outcomes in older adults, with a focus on recent evidence (<10 yr) and sex-based considerations. The review identifies that both aerobic training and being physically active (compared with sedentary) are associated with improvements in endothelial function, arterial stiffness, and cerebrovascular function. Additionally, there is evidence of sex-based differences in endothelial function: a blunted improvement in aerobic training in postmenopausal women compared with men. While minimal research has been conducted in older adults, resistance training does not appear to influence arterial stiffness. Poor sleep quantity or quality are associated with both impaired endothelial function and increased arterial stiffness. Finally, the review highlights mechanistic pathways involved in the regulation of vascular and cerebrovascular function, specifically the balance between pro- and antiatherogenic factors, which mediate the relationship between the 24-h movement spectrum and vascular outcomes. Finally, this review proposes future research directions: examining the role of duration and intensity of training, combining aerobic and resistance training, and exploration of sex-based differences in cardiovascular and cerebrovascular outcomes. [ABSTRACT FROM AUTHOR]

Hormonal contraceptives are one of the most widely used prescriptions for premenopausal women worldwide. Although the risk of venous and arterial cardiovascular events (e.g., deep vein thrombosis, arterial clotting) with hormonal contraceptives, specifically oral contraceptive pills, has been established, the literature on early risk indicators, such as peripheral vascular structure and function has yet to be consolidated. The purpose of this review is to summarize literature examining the impact of different hormonal contraceptives on vascular function and structure, including consideration of phasic differences within a contraceptive cycle, and to propose future directions for research. It is evident that hormonal contraceptive use appears to impact both macrovascular and microvascular endothelial function, with phasic differences in some contraceptive types dependent on progestin type, the ratio of ethinyl estradiol-to-progestin, and route of administration. However, hormonal contraceptives do not appear to impact smooth muscle function in the macrovasculature or microvasculature, arterial stiffness, or vascular structure. Underlying mechanisms for observed impacts and areas of future research are discussed. This review provides timely consolidation of research examining hormonal contraceptives and peripheral vascular function and structure and provides guidance on considerations for hormonal contraceptive use in study design. [ABSTRACT FROM AUTHOR]

Hormonal contraceptives are one of the most widely used prescriptions for premenopausal women worldwide. Although the risk of venous and arterial cardiovascular events (e.g., deep vein thrombosis, arterial clotting) with hormonal contraceptives, specifically oral contraceptive pills, has been established, the literature on early risk indicators, such as peripheral vascular structure and function has yet to be consolidated. The purpose of this review is to summarize literature examining the impact of different hormonal contraceptives on vascular function and structure, including consideration of phasic differences within a contraceptive cycle, and to propose future directions for research. It is evident that hormonal contraceptive use appears to impact both macrovascular and microvascular endothelial function, with phasic differences in some contraceptive types dependent on progestin type, the ratio of ethinyl estradiol-to-progestin, and route of administration. However, hormonal contraceptives do not appear to impact smooth muscle function in the macrovasculature or microvasculature, arterial stiffness, or vascular structure. Underlying mechanisms for observed impacts and areas of future research are discussed. This review provides timely consolidation of research examining hormonal contraceptives and peripheral vascular function and structure and provides guidance on considerations for hormonal contraceptive use in study design. [ABSTRACT FROM AUTHOR]

Fluctuations in endogenous hormones estrogen and progesterone during the menstrual cycle may offer vasoprotection for endothelial and smooth muscle (VSM) function. While numerous studies have been published, the results are conflicting, leaving our understanding of the impact of the menstrual cycle on vascular function unclear. The purpose of this systematic review and meta-analysis was to consolidate available research exploring the role of the menstrual cycle on peripheral vascular function. A systematic search of MEDLINE, Web of Science, and EMBASE was performed for articles evaluating peripheral endothelial and VSM function across the natural menstrual cycle: early follicular (EF) phase versus late follicular (LF), early luteal, mid luteal, or late luteal. A meta-analysis examined the effect of the menstrual cycle on the standardized mean difference (SMD) of the outcome measures. Analysis from 30 studies (n = 1,363 women) observed a "very low" certainty of evidence that endothelial function increased in the LF phase (SMD: 0.45, P = 0.0001), with differences observed in the macrovasculature but not in the microvasculature (SMD: 0.57, P = 0.0003, I² = 84%; SMD: 0.21, P = 0.17, I² = 34%, respectively). However, these results are partially explained by differences in flow-mediated dilation [e.g., discrete (SMD: 0.86, P = 0.001) vs. continuous peak diameter assessment (SMD: 0.25, P = 0.30)] and/or menstrual cycle phase methodologies. There was a "very low" certainty that endothelial function was largely unchanged in the luteal phases, and VSM was unchanged across the cycle. The menstrual cycle appears to have a small effect on macrovascular endothelial function but not on microvascular or VSM function; however, these results can be partially attributed to methodological differences. [ABSTRACT FROM AUTHOR]

In Jordan mansaf has become a national symbol, consumed on major social occasions, served in various forms to tourists and visitors, and imbued with a set of historical and socio-cultural associations. Across historical Syria (Bilād ash-Shām) and northern Arabia dishes similar to what is now considered mansaf have been made and consumed in different historical contexts and have often been linked with ideas of hospitality and protection given to guests and strangers, whose alterity is negotiated and incorporated through the sharing of food. In Jordan particularly, the image of a 'Bedouin' feast dish of domestically produced pastoralist ingredients carries a rich symbology of hospitality and welcome, resonant of imagined historical continuities and a shared cultural heritage. This lends the modern 'national dish' symbolic power as a tool of nation-building in the fraught and complex environment of modern Jordan, where many claimed identities and solidarities coincide and compete. Far from being a timeless or unchanged relic of an imagined pre-modern desert life, mansaf, its ingredients and the way it is made, served, eaten and deployed have emerged out of a particular set of historical contingencies and are tied closely to projects of identity formation and state-building within the Hashemite Kingdom of Jordan. Focusing on this historical constructed-ness and changing practices of making, serving and talking about mansaf, as well as the social relations it reflects, enacts and (re)produces, this article seeks to use the dish as a lens to examine questions of changing political economy and sociality in Jordan. [ABSTRACT FROM AUTHOR]

PREMISE: Spatial variation in selective pressures can lead to intraspecific variation in life history, favoring some life histories and constraining others depending on the vulnerability of life stages. We examined how spatial variation in herbivory and climate influences flowering size and the occurrence of semelparity (reproducing once) versus iteroparity (reproducing multiple times) in the introduced range of an invasive plant, houndstongue (Cynoglossum officinale). Houndstongue is a short‐lived, semelparous perennial in its native range. In its introduced range, we previously documented increased rates of iteroparity and a higher median threshold flowering size compared to the native range. We hypothesized that the recent introduction of a specialist biocontrol insect (a root‐boring weevil, Mogulones crucifer) would decrease threshold flowering size and reduce the proportion of iteroparous plants because M. crucifer preferentially attacks large individuals and may reduce overwinter survival. METHODS: We surveyed 24 sites across the northwestern United States to quantify the frequency of semelparity versus iteroparity and to estimate weevil abundance and used demographic data collected from six sites to estimate median threshold flowering size. RESULTS: We found that sites with greater winter precipitation and no weevils had a greater proportion of iteroparous plants. Sites with higher weevil attack had a lower median threshold flowering size. CONCLUSIONS: The variation in frequency of flowering and threshold flowering size that we documented in North American houndstongue populations, and the relationships between this variation and herbivory and climate, provide evidence for how selective pressures covary with the life histories of invasive plants. [ABSTRACT FROM AUTHOR]

The Sustainable Development Goals map out a better future for all that can only be met through education focused on human rights and social justice. [ABSTRACT FROM AUTHOR]

In a rapidly expanding population of patients with chronic kidney disease, including 2 million people requiring renal replacement therapy, cardiovascular mortality is 15 times greater than the general population. In addition to traditional cardiovascular risk factors, more poorly defined risks related to uremia and its treatments appear to contribute to this exaggerated risk. In this context, the microcirculation may play an important early role in cardiovascular disease associated with chronic kidney disease. Experimentally, the uremic environment and dialysis have been linked to multiple pathways causing microvascular dysfunction. Coronary microvascular dysfunction is reflected in remote and more easily studied vascular beds such as the skin. There is increasing evidence for a correlation between systemic microvascular dysfunction and adverse cardiovascular outcomes. Systemic microcirculatory changes have not been extensively investigated across the spectrum of chronic kidney disease. Recent advances in non‐invasive techniques studying the microcirculation in vivo in man are increasing the data available particularly in patients on hemodialysis. Here, we review current knowledge of the systemic microcirculation in dialysis populations, explore whether non‐invasive techniques to study its function could be used to detect early stage cardiovascular disease, address challenges faced in studying this patient cohort and identify potential future avenues for research. [ABSTRACT FROM AUTHOR]

Health system responsiveness is an indicator that can be used for evaluating how well healthcare systems respond to people's needs in non-clinical areas such as communication, autonomy and confidentiality. This study analyses health system responsiveness from the perspective of community-dwelling adults aged 50 and over in China, Ghana, India, the Russian Federation and South Africa using cross-sectional data from the World Health Organization Study on global AGEing and adult health. The aim is to assess and compare how individual, health condition and healthcare factors impact differently on outpatient and inpatient responsiveness. Poor responsiveness is measured according to participants' responses to questions on a five-point Likert scale. Five univariate and multiple logistic regression models test associations between individual, health condition and healthcare factors and poor responsiveness. The final model adjusts for country. Key results are that travel time is a major contributor to poor responsiveness across all countries. Similarly there are wealth inequalities in responsiveness. However no clear difference in responsiveness was observed in presentations for chronic versus other types of conditions. This study provides an interesting baseline on older patients' perceived treatment within outpatient and inpatient facilities in five diverse low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Little information exists regarding Ebola vaccine rVSVΔG-ZEBOV-GP and pregnancy. The Sierra Leone Trial to Introduce a Vaccine against Ebola (STRIVE) randomized participants without blinding to immediate or deferred (18-24 weeks postenrollment) vaccination. Pregnancy was an exclusion criterion, but 84 women were inadvertently vaccinated in early pregnancy or became pregnant <60 days after vaccination or enrollment. Among immediate vaccinated women, 45% (14/31) reported pregnancy loss, compared with 33% (11/33) of unvaccinated women with contemporaneous pregnancies (relative risk 1.35, 95% CI 0.73-2.52). Pregnancy loss was similar among women with higher risk for vaccine viremia (conception before or <14 days after vaccination) (44% [4/9]) and women with lower risk (conception >15 days after vaccination) (45% [10/22]). No congenital anomalies were detected among 44 live-born infants examined. These data highlight the need for Ebola vaccination decisions to balance the possible risk for an adverse pregnancy outcome with the risk for Ebola exposure. [ABSTRACT FROM AUTHOR]

This essay utilizes Foucault's concept of the "technology of the self" to argue the ethical content of Ruth's actions. In this way, my essay challenges reading the book of Ruth in a way that supports the Western and Christian technology of self and moral principle of self-sacrifice. Paying careful attention to the three episodes of contract-making in the book of Ruth (1:16-17, 3:9-13, 4:1-12), it is evident that Ruth's actions demonstrate profound resourcefulness and care of oneself rather than self-sacrifice. This hermeneutical lens of "care of oneself" is constituted in the three elements of immanence, vigilant introspection and distance. The character of Ruth possesses the virtue of חֶ֔סֶד , repeatedly and secretly transgresses norms and expectations and creates an ethic that benefits and transforms her self and others. [ABSTRACT FROM AUTHOR]

As in many Sub-Saharan African countries, the health system in Somalia is not operating at the capacity needed to lift childhood vaccination coverage to ninety percent or above, as recommended by United Nations Children’s Fund. Current national estimates of coverage for the six major vaccine preventable childhood diseases range from thirty to sixty percent. Infectious disease outbreaks continue to pose significant challenges for the country’s health authorities. This important qualitative study, conducted in Galkayo District, Somalia, investigates limiting factors associated with childhood vaccination uptake from the perspective of both communities and health care workers. Qualitative information was collected through six focus group discussions with parents (n = 48) and five one-to-one interviews with health workers (n = 15) between March and May 2017, in three settings in the Galkayo District – Galkayo city, Bayra and Bacadwayn. From a health system perspective, the factors are: awareness raising, hard to reach areas, negative attitudes and perceived knowledge of health workers, inadequate supplies and infrastructure, and missed vaccination opportunities. From the perspective of individuals and communities the factors are: low trust in vaccines, misinterpretation of religious beliefs, vaccine refusals, Somalia’s patriarchal system and rumours and misinformation. Parents mostly received immunization information from social mobilizers and health facilities. Fathers, who are typically family decision-makers, were poorly informed. The findings highlight the need for in-service training to enable health workers to improve communication with parents, particularly fathers, peripheral communities and local religious leaders. Enhancing knowledge and awareness of vaccination among parents is crucial. Fathers’ involvement is lacking. This may be boosted by highlighting fathers’ obligation to protect their children’s health through vaccination. It is also important that men engage with the wider community in decision-making and advance towards the global vaccination targets. [ABSTRACT FROM AUTHOR]

As in many Sub-Saharan African countries, the health system in Somalia is not operating at the capacity needed to lift childhood vaccination coverage to ninety percent or above, as recommended by United Nations Children's Fund. Current national estimates of coverage for the six major vaccine preventable childhood diseases range from thirty to sixty percent. Infectious disease outbreaks continue to pose significant challenges for the country's health authorities. This important qualitative study, conducted in Galkayo District, Somalia, investigates limiting factors associated with childhood vaccination uptake from the perspective of both communities and health care workers. Qualitative information was collected through six focus group discussions with parents (n = 48) and five one-to-one interviews with health workers (n = 15) between March and May 2017, in three settings in the Galkayo District – Galkayo city, Bayra and Bacadwayn. From a health system perspective, the factors are: awareness raising, hard to reach areas, negative attitudes and perceived knowledge of health workers, inadequate supplies and infrastructure, and missed vaccination opportunities. From the perspective of individuals and communities the factors are: low trust in vaccines, misinterpretation of religious beliefs, vaccine refusals, Somalia's patriarchal system and rumours and misinformation. Parents mostly received immunization information from social mobilizers and health facilities. Fathers, who are typically family decision-makers, were poorly informed. The findings highlight the need for in-service training to enable health workers to improve communication with parents, particularly fathers, peripheral communities and local religious leaders. Enhancing knowledge and awareness of vaccination among parents is crucial. Fathers' involvement is lacking. This may be boosted by highlighting fathers' obligation to protect their children's health through vaccination. It is also important that men engage with the wider community in decision-making and advance towards the global vaccination targets. [ABSTRACT FROM AUTHOR]

New Findings: •What is the central question of this study?This is the first study to examine the impact of acute hyperglycaemia on arterial stiffness across the early and late follicular phases of the menstrual cycle.•What is the main finding and its importance?Central and peripheral arterial stiffness were not impacted by acute hyperglycaemia. This indicates that premenopausal women might experience protection against deleterious effects of acute hyperglycaemia, regardless of menstrual cycle phase. This research furthers our understanding of the interaction between nutrient intake, hormonal fluctuation and vascular function in premenopausal women. Acute hyperglycaemia may result in transient increases in arterial stiffness. However, research in healthy premenopausal women is lacking, and the impact of menstrual phase [early follicular (EF; low oestrogen) and late follicular (LF; high oestrogen)] on vulnerability to acute hyperglycaemia‐induced changes in arterial stiffness is unknown. We hypothesized that an acute hyperglycaemia‐induced increase in arterial stiffness in the EF phase would be attenuated in the LF phase. Seventeen healthy, naturally menstruating women [21 ± 1 years of age (mean ± SD)] participated in three experimental visits. During two visits, in the EF and LF phase, arterial stiffness was assessed via central and peripheral (arm and leg) pulse wave velocity (PWV) before and 15, 45, 75 and 105 min after consuming an oral glucose challenge (75 g glucose in 300 ml of solution). Blood samples were taken to assess glucose, insulin, oestrogen and progesterone concentrations. During a third visit in the EF phase, participants ingested 300 ml of water as a time control for PWV. Despite significant increases in blood glucose and insulin (P < 0.001), both central and peripheral arm PWV remained unchanged across time and phase, indicating that neither acute hyperglycaemia nor menstrual phase had an impact on central or peripheral arm arterial stiffness. There was a small effect of phase for peripheral leg PWV, where PWV was lower in the LF phase (P = 0.04, Cohen's d = 0.39); however, and in contrast to recent results in young men, peripheral leg PWV was unaffected by hyperglycaemia. These results suggest that premenopausal women might experience protection from acute hyperglycaemia‐induced increases in arterial stiffness. [ABSTRACT FROM AUTHOR]

In contemporary video games and consoles, on social media apps, and - at a smaller scale - with emojis, users engage in a cyborgian modification process when they choose the physical and aesthetic traits of their digital representation. They customize their characters to fulfill real-life desires, attract certain social interactions, or embody aspects contrary to themselves. For Black people, the choice to authentically craft the phenotypic and cultural markers of their specific identity markers depends upon the game, and often their options are minimal or comical. Spherical afros, straight-back cornrows, cylinder ponytailed locs, and two to three brown skin tone options leave users with a sense of wearing ill-fitting clothes. Their characters often appear as if they were badly-colored compared to the default white characters. This article explores the difficulty of a Black femme gamer to mirror their IRL hairstyle in digital spaces because of system designers' limited conceptions of Black hair, and the built-in limitations of game engine algorithms. Twistouts and goddess braids are hardly found in the default settings for many virtual spaces. This lack of choice in digital representation leads to users' acquiescence to embodying certain traits in virtual spaces, and the inevitable erasure of the nuances of Blackness in virtual spaces. If character creation does not fully humanize Black people, the digital environments construct a pernicious digital divide. Once again, Black people are excluded from the mythological progress forward and find themselves playing catch-up to complete immersion into the expected virtuality of life. Their presence in virtual spaces remains managed by a futures industry that does not envision Black people as the primary users of technology. [ABSTRACT FROM AUTHOR]

This article explores the trace of the religious other in late nineteenth- and early twentieth-century literature by considering the ways in which the religious is figured in, and religious hermeneutic practices inform, modernist literature. It is argued that the religious other runs underneath language and disrupts its surface, yet the figuring of the relationship between the religious other and language in terms of time and space points to a paradox: the religious other is made manifest in language and yet it is impossible to say where and what the religious other is.

The article focuses on effective team communication is a critical element of ED performance and trainees are encouraged to develop skills in leading resuscitation and trauma teams through effective prebriefing, recaps and handovers. Topics include the conversations that support team reflection on clinical practice, and the impact of clinical debriefing can be powerful by improving performance, encouraging learning and mitigating psychological distress.

Eco-evolutionary theory suggests that rapid evolution can accelerate range expansion speed. In addition to average speed, recent experimental studies reveal that evolution can also influence the amount of variability across replicates of spreading populations, but in contrasting ways. Here we develop a predictive framework, drawing on ideas from population genetics and spread theory, to understand when, why, and in what direction evolution will modify the variability of range expansion. Our framework revolves around the balance of variance-generating (drift) and variance-reducing (selective) evolutionary processes, and factors that may tip this balance, including population size at the leading edge and mating system. We suggest hypotheses to clarify contrasting experimental results and highlight a way forward for studying eco-evolutionary dynamics of range expansion. Outcomes of range expansions are variable; evolution can increase or decrease that variation. Expansion outcomes reflect a balance of variance-generating and variance-reducing evolutionary processes. Mating system and edge population size may determine whether evolution increases or decreases variance. These ideas can be tested with mathematical modeling, additional experiments, and data from natural range expansions. [ABSTRACT FROM AUTHOR]