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Hunger is an ancient drive, yet the molecular nature of pressures of this sort and how they modulate physiology are unknown. We find that hunger modulates aging in Drosophila. Limitation of branched-chain amino acids (BCAAs) or activation of hunger-promoting neurons induced a hunger state that extended life span despite increased feeding. Alteration of the neuronal histone acetylome was associated with BCAA limitation, and preventing these alterations abrogated the effect of BCAA limitation to increase feeding and extend life span. Hunger acutely increased feeding through usage of the histone variant H3.3, whereas prolonged hunger seemed to decrease a hunger set point, resulting in beneficial consequences for aging. Demonstration of the sufficiency of hunger to extend life span reveals that motivational states alone can be deterministic drivers of aging. [ABSTRACT FROM AUTHOR]

The 2016 Mw 7.8 Kaikōura earthquake induced groundwater level changes throughout New Zealand. Water level changes were recorded at 433 sites in compositionally diverse, young, shallow aquifers, at distances of between 4 and 850 km from the earthquake epicentre. Water level changes are inconsistent with static stress changes but do correlate with peak ground acceleration (PGA). At PGAs exceeding ~2 m/s2, water level changes were predominantly persistent increases. At lower PGAs, there were approximately equal numbers of persistent water level increases and decreases. Shear-induced consolidation is interpreted to be the predominant mechanism causing groundwater changes at accelerations exceeding ~2 m/s2, whereas permeability enhancement is interpreted to predominate at lower levels of ground acceleration. Water level changes occur more frequently north of the epicentre, as a result of the fault's northward rupture and resulting directivity effects. Local hydrogeological conditions also contributed to the observed responses, with larger water level changes occurring in deeper wells and in well-consolidated rocks at equivalent PGA levels. [ABSTRACT FROM AUTHOR]

The endothelin receptor type A (EDNRA) signaling pathway is essential for the establishment of mandibular identity during development of the first pharyngeal arch. We report four unrelated individuals with the syndrome mandibulofacial dysostosis with alopecia (MFDA) who have de novo missense variants in EDNRA . Three of the four individuals have the same substitution, p.Tyr129Phe. Tyr129 is known to determine the selective affinity of EDNRA for endothelin 1 (EDN1), its major physiological ligand, and the p.Tyr129Phe variant increases the affinity of the receptor for EDN3, its non-preferred ligand, by two orders of magnitude. The fourth individual has a somatic mosaic substitution, p.Glu303Lys, and was previously described as having Johnson-McMillin syndrome. The zygomatic arch of individuals with MFDA resembles that of mice in which EDNRA is ectopically activated in the maxillary prominence, resulting in a maxillary to mandibular transformation, suggesting that the p.Tyr129Phe variant causes an EDNRA gain of function in the developing upper jaw. Our in vitro and in vivo assays suggested complex, context-dependent effects of the EDNRA variants on downstream signaling. Our findings highlight the importance of finely tuned regulation of EDNRA signaling during human craniofacial development and suggest that modification of endothelin receptor-ligand specificity was a key step in the evolution of vertebrate jaws. [ABSTRACT FROM AUTHOR]

For many taxa, determining conservation status and priority is impeded by lack of adequate taxonomic and range data. For these problematic groups, we propose combining molecular techniques with careful geographic sampling to evaluate the validity, extent and phylogenetic relatedness of the proposed units of diversity. We employed such a strategy to document monophyletic lineages, range extents and phylogenetic relatedness for talus snails (genus Sonorella) in the Pinaleño Mountains of Arizona, an isolated range that has the most vertical relief of any of the sky islands in Arizona. Three of the four species found in the Pinaleño Mountains have been considered candidate species for protection under the Endangered Species Act. Further, one of these taxa, Sonorella macrophallus, is of particular concern and was protected under an USFS conservation agreement until 2004, due to its presumed endemicity to a narrow portion of one canyon. We collected a large dataset of 12S and COI mitochondrial DNA, and subsamples of reproductive morphology from specimens collected throughout the Pinaleños and from adjacent ranges (e.g. the Huachucas, Chiricahuas and Santa Catalinas). We generated a phylogeny based on the mitochondrial data, and matched clades with named species utilizing reproductive morphology. Our results show that both S. macrophallus and Sonorella imitator are relatively widespread across the Pinaleños while Sonorella grahamensis and Sonorella christenseni are restricted to very small areas. These results dramatically change our previous knowledge about range extents, especially for S. macrophallus. Given these results, land managers may need to reassess the status of all four Sonorella species. Finally, all Sonorella species from the Pinaleños are more closely related to each other than to other taxa on other ranges. This result strongly suggests that diversification of the four Sonorella species in the Pinaleños occurred in situ. [ABSTRACT FROM AUTHOR]

The strength of a discipline is reflected in the development of a set of concepts relevant to its practice domain. As an evolving professional discipline, nursing requires further development in this respect. Over the past two decades in North America there have emerged three different approaches to concept analysis in nursing scholarship: Wilsonian-derived, evolutionary, and pragmatic utility. The present paper compares and contrasts these three methods of concept in terms of purpose, procedures, philosophical underpinnings, limitations, guidance for researchers, and ability to contribute to nursing knowledge and disciplinary advancement. This work extends prior criticisms of concept analysis methods, especially as formulated by Morse and colleagues, by promoting further critical discussion regarding the direction and effectiveness of nursing efforts to meet the basic needs of disciplinary development. Its central thesis is that nursing concept analysis must advance beyond the Wilsonian-derived methods of Walker and Avant by devoting greater attention to understanding the domain of concepts to be analysed and deriving features from these contexts. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a concept analysis of ethical sensitivity. BACKGROUND: Ethical sensitivity enables nurses and other professionals to respond morally to the suffering and vulnerability of those receiving professional care and services. Because of its significance to nursing and other professional practices, ethical sensitivity deserves more focused analysis. DATA SOURCES: A criteria-based method oriented toward pragmatic utility guided the analysis of 200 papers and books from the fields of nursing, medicine, psychology, dentistry, clinical ethics, theology, education, law, accounting or business, journalism, philosophy, political and social sciences and women's studies. This literature spanned 1970 to 2006 and was sorted by discipline and concept dimensions and examined for concept structure and use across various contexts. The analysis was completed in September 2007. FINDINGS: Ethical sensitivity in professional practice develops in contexts of uncertainty, client suffering and vulnerability, and through relationships characterized by receptivity, responsiveness and courage on the part of professionals. Essential attributes of ethical sensitivity are identified as moral perception, affectivity and dividing loyalties. Outcomes include integrity preserving decision-making, comfort and well-being, learning and professional transcendence. Our findings promote ethical sensitivity as a type of practical wisdom that pursues client comfort and professional satisfaction with care delivery. CONCLUSION: The analysis and resulting model offers an inclusive view of ethical sensitivity that addresses some of the limitations with prior conceptualizations. [ABSTRACT FROM AUTHOR]

The ferric binding protein, FbpA, has been demonstrated to facilitate the transport of naked Fe3+ across the periplasmic space of several Gram-negative bacteria. The sequestration of iron by FbpA is facilitated by the presence of a synergistic anion, such as phosphate or sulfate. Here we report the sequestration of Fe3+ by FbpA in the presence of sulfate, at an assumed periplasmic pH of 6.5 to form FeFbpA-SO4 with K′eff = 1.7 × 1016 M-1 (at 20 °C, 50 mM MES, 200 mM KCI). The iron affinity of the FeFbpA-SO4 protein assembly is 2 orders of magnitude lower than when bound with phosphate and is the lowest of any of the FeFbpA-X assemblies yet reported. Iron reduction at the cytosolic membrane receptor may be an essential aspect of the periplasmic iron-transport process, and with an E½ of –158 mV (NHE), FeFbpA-SO4 is the most easily reduced of all FeFbpA-X assemblies yet studied. The variation of FeFbpA-X assembly stability (K′eff) and ease of reduction (E½) with differing synergistic anions Xn- are correlated over a range of 14 kJ, suggesting that the variations in redox potentials are due to stabilization of Fe3+ in FeFbpA-X by Xn-. Anion promiscuity of FbpA in the diverse composition of the periplasmic space is illustrated by the ex vivo exchange kinetics of FeFbpA-SO4 with phosphate and arsenate, where first-order kinetics with respect to FeFbpA-SO4 (k= 30 s-1) are observed at pH 6.5, independent of entering anion concentration and identity. Anion lability and influence on the iron affinity and reduction potential for FeFbpA-X support the hypothesis that synergistic anion exchange may be an important regulator in iron delivery to the cytosol. This structural and thermodynamic analysis of anion binding in FeFbpA-X provides additional insight into anion promiscuity and importance. [ABSTRACT FROM AUTHOR]

Background and Purpose: Studies were designed to examine the effects of dietary fats on metabolic effects of 3,4-methylenedioxymethamphetamine (MDMA, Ecstasy). These effects included hyperthermia, expression of uncoupling protein (UCP1 and 3) in brown adipose tissue or skeletal muscle and plasma free fatty acid (FFA) levels. Experimental Approach: Male Sprague-Dawley rats were fed either a high-fat diet (HFD, 60% kcal) or a lower fat isocaloric controlled diet (LFD, 10% kcal) for 28 days before MDMA challenge. Key Results: No significant differences were observed between LFD and HFD groups in terms of body weight, plasma thyroxine (T4) levels and expression of brown fat UCP1 or skeletal muscle UCP3 protein. HFD significantly raised levels of circulating FFA and potentiated the thermogenesis induced by MDMA (10 mg kg(-1), s.c.), compared to the effects of the LFD. Moreover, 30 and 60 min after MDMA administration, plasma FFA levels decreased in HFD animals, but were markedly elevated in the LFD group. Conclusions and Implications: These results indicate that high-fat feeding regulates MDMA-induced thermogenesis by augmenting the activation of UCP rather than its expression. [ABSTRACT FROM AUTHOR]

Aims. The aims of this paper are to add clarity to the discussion about paradigms for nursing research and to consider integrative strategies for the development of nursing knowledge. Background. Paradigms are sets of beliefs and practices, shared by communities of researchers, which regulate inquiry within disciplines. The various paradigms are characterized by ontological, epistemological and methodological differences in their approaches to conceptualizing and conducting research, and in their contribution towards disciplinary knowledge construction. Researchers may consider these differences so vast that one paradigm is incommensurable with another. Alternatively, researchers may ignore these differences and either unknowingly combine paradigms inappropriately or neglect to conduct needed research. To accomplish the task of developing nursing knowledge for use in practice, there is a need for a critical, integrated understanding of the paradigms used for nursing inquiry. Methods. We describe the evolution and influence of positivist, postpositivist, interpretive and critical theory research paradigms. Using integrative review, we compare and contrast the paradigms in terms of their philosophical underpinnings and scientific contribution. Findings. A pragmatic approach to theory development through synthesis of cumulative knowledge relevant to nursing practice is suggested. This requires that inquiry start with assessment of existing knowledge from disparate studies to identify key substantive content and gaps. Knowledge development in under-researched areas could be accomplished through integrative strategies that preserve theoretical integrity and strengthen research approaches associated with various philosophical perspectives. These strategies may include parallel studies within the same substantive domain using different paradigms; theoretical triangulation to combine findings from paradigmatically diverse studies; integrative reviews; and mixed method studies. Conclusion. Nurse scholars are urged to consider the benefits and limitations of inquiry within each paradigm, and the theoretical needs of the discipline. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To validate a novel device termed the equinometer, which is designed to accurately measure ankle dorsiflexion. DESIGN: Test retest reliability analysis using serial measurements of dorsiflexion endpoint in a group of normal individuals. SETTING: Motion analysis laboratory. PARTICIPANTS: Ten healthy individuals. PRIMARY OUTCOME MEASURE: The mean and standard deviation of the absolute difference in dorsiflexion endpoint for the group. RESULTS: The mean absolute change in dorsiflexion endpoint for the group was 0.45 degrees with a standard deviation of 0.43 degrees. CONCLUSIONS: With the use of the device described, the mean change in dorsiflexion endpoint was well within acceptable clinical limits. The reliability of measurements obtained with the equinometer exceeds that which has been published with other techniques and devices. [ABSTRACT FROM AUTHOR]

Interprets the result of the four surveys conducted by the United States Small Business Administration (SBA) on course offerings and pedagogies in entrepreneurship and small business management. Major teaching pedagogues used by 4-year colleges and 2-year community colleges; Growth in entrepreneurship and small business management course offerings.

Background: Fetal magnetic resonance imaging (MRI) is obtained for prenatal diagnosis and prognostication of skeletal dysplasias; however, related literature is limited.Objective: The purpose of this study was to define the utility of fetal MRI for skeletal dysplasias and to report MRI findings associated with specific diagnoses.Materials and Methods: This retrospective study was approved by the institutional review board; informed consent was waived. Women referred for suspected fetal skeletal dysplasia who underwent MRI between January 2003 and December 2018 were included. Definitive diagnoses were determined by genetic testing, autopsy, physical examination and/or postnatal/postmortem imaging. Fetal MRI examinations and reports were reviewed. Descriptive statistics were used to summarize imaging findings.Results: Eighty-nine women were referred for fetal MRI for possible skeletal dysplasia. Forty-three (48%) were determined to have a diagnosis other than skeletal dysplasia and nine were excluded for lack of specific skeletal dysplasia diagnosis. Thirty-seven cases of skeletal dysplasia with available fetal MRI and specific diagnosis were included for analysis. Diagnoses included achondrogenesis (n=2), achondroplasia (n=5), Boomerang dysplasia (n=1), campomelic dysplasia (n=2), Jeune syndrome (n=1), Kniest dysplasia (n=1), osteogenesis imperfecta (n=15) and thanatophoric dysplasia (n=10). A specific skeletal dysplasia diagnosis was mentioned in 17/37 (46%) of MRI imaging reports and correct for 14/17 (82%). MRI findings were reported for each specific skeletal dysplasia diagnosis.Conclusion: Fetal MRI is a useful diagnostic tool for skeletal dyplasias and excluded the diagnosis in nearly half of referred pregnancies. In addition to providing fetal lung volumes, fetal MRI demonstrates findings of the brain in achondroplasia and thanatophoric dysplasia, of the spine in achondroplasia and achondrogenesis, of the calvarium in osteogenesis imperfecta and thanatophoric dysplasia, and of the cartilage in Kniest dysplasia. [ABSTRACT FROM AUTHOR]

The calcium/calmodulin-dependent protein kinase type 2 (CAMK2) family consists of four different isozymes, encoded by four different genes— CAMK2A, CAMK2B, CAMK2G , and CAMK2D —of which the first three have been associated recently with neurodevelopmental disorders. CAMK2D is one of the major CAMK2 proteins expressed in the heart and has been associated with cardiac anomalies. Although this CAMK2 isoform is also known to be one of the major CAMK2 subtypes expressed during early brain development, it has never been linked with neurodevelopmental disorders until now. Here we show that CAMK2D plays an important role in neurodevelopment not only in mice but also in humans. We identified eight individuals harboring heterozygous variants in CAMK2D who display symptoms of intellectual disability, delayed speech, behavioral problems, and dilated cardiomyopathy. The majority of the variants tested lead to a gain of function (GoF), which appears to cause both neurological problems and dilated cardiomyopathy. In contrast, loss-of-function (LoF) variants appear to induce only neurological symptoms. Together, we describe a cohort of individuals with neurodevelopmental disorders and cardiac anomalies, harboring pathogenic variants in CAMK2D , confirming an important role for the CAMK2D isozyme in both heart and brain function. CAMK2 disorder is a relatively new disorder where three of the four CAMK2s (CAMK2A, B, and G) are shown to cause neurodevelopmental disorders. In this paper we describe a cohort of eight individuals with neurodevelopmental disorders and cardiac abnormalities, having CAMK2D variants, proving all CAMK2s are important for normal development. [ABSTRACT FROM AUTHOR]

The Fst toxin of the Enterococcus faecalis pAD1-encoded par addiction module functions intracellularly to kill plasmid-free segregants. Previous results had shown that Fst induction results in membrane permeabilization and cessation of macromolecular synthesis, but only after 45 min. Electron micrographs of toxin-induced cells showed no obvious membrane abnormalities but did reveal defects in nucleoid segregation and cell division, begging the question of which is the primary effect of Fst. To distinguish the possibilities, division septae and nucleoids were visualized simultaneously with fluorescent vancomycin and a variety of DNA stains. Results showed that division and segregation defects occurred in some cells within 15 min after induction. At these early time points, affected cells remained resistant to membrane-impermeant DNA stains, suggesting that loss of membrane integrity is a secondary effect caused by ongoing division and/or segregation defects. Fst-resistant mutants showed greater variability in cell length and formed multiple septal rings even in the absence of Fst. Fst induction was also toxic to Bacillus subtilis. In this species, Fst induction caused only minor division abnormalities, but all cells showed a condensation of the nucleoid, suggesting that effects on the structure of the chromosomal DNA might be paramount. [ABSTRACT FROM AUTHOR]

Introduction: Although 3 in 4 breast cancer survivors report significant sexual concerns following treatment, few receive support for these concerns. Delivering sexual health care to breast cancer survivors via the Internet could overcome many of the barriers to in-person interactions, including limited availability of resources and stigma. Prior research on telehealth interventions for breast cancer survivors' sexual health has limitations. First, survivors continue to endorse time burden as a leading reason for declining telehealth sexual health interventions. Second, prior trial designs have not been able to determine which intervention components work best for which survivors. This knowledge is crucial to refine and personalize sexual health care for survivors. Objective: Use the Multiphase Optimization Strategy (MOST) methodological framework to achieve the following aims: (1) develop an Internet intervention for breast cancer-related sexual health that is optimized for greatest impact; and (2) determine how intervention components work (i.e., mediators) and for whom they work best (i.e., moderators). Methods: 320 partnered, post-treatment female breast cancer survivors who endorse at least one bothersome sexual symptom (i.e., pain with sex, vaginal dryness, low sexual desire, difficulty with orgasm) related to their breast cancer treatment will be enrolled. Recruitment will be conducted via a US-national community oncology research program representing more than 1,000 individual practice locations. In this factorial trial, participants will be randomized to receive a combination of 4 intervention components: psychoeducation about cancer-related sexual morbidity, training for communication with their health care team, training for communication with their partners, and intimacy promotion skills training. These components were selected as they are supported by our intervention research, are consistent with survivorship guidelines, and align with survivors' preferences found in our qualitative research. Components will be implemented using a robust Internet intervention platform with tailoring and highly-engaging elements like animation, video, and automated email prompts. Survivors will complete assessments at baseline (pre-randomization) and 3- and 6-month post-assessments. First, the impact of intervention components on survivors' sexual distress (Female Sexual Distress Scale-Desire, Arousal, Orgasm) and sexual functioning (Female Sexual Function Inventory) will be tested. Next, a select set of mediators (i.e., sexual functioning knowledge, sexual communication self-efficacy with clinicians and partner, emotional intimacy with partner) and moderators (i.e., menopausal status, adjuvant endocrine therapy use, psychological distress, relationship duration and satisfaction) will be evaluated. Results: Institutional review board approvals are in progress, with clinical trial registration to follow. Data collection is anticipated to begin in Spring 2024 and be completed in 2027. Conclusions: Findings from this trial will accelerate the development of more effective sexual health interventions for breast cancer survivors by determining how intervention components work and for whom various components work best. By identifying the combination of intervention components likely to provide breast cancer survivors the greatest sexual health benefit for the least burden, this study will result in the first Internet intervention optimized for maximum impact for the undertreated, prevalent, and distressing problem of breast cancer-related sexual morbidity. Disclosure: Any of the authors act as a consultant, employee or shareholder of an industry for: AHC: grants from Janssen, Relmada Therapeutics, Inc., and Sage Therapeutics; personal fees from Acadia, Alkermes, Allergan, AMAG Pharmaceuticals, Inc., Fabre-Kramer, Ovoca Bio plc, Pure Tech Health, Sage Therapeutics, Takeda/Lundbeck, WCG MedAvante-ProPhase, Ballantine Books/Random House, Changes in Sexual Functioning Questionnaire, Guilford Publications; personal fees and other from S1 Biopharma; and other from Euthymics and Mediflix LLC. GL: consultant or research affiliation with Agios Pharmaceuticals, Inc; Denovo Biopharma; IN8bio; Incyte Corporation; Novocure Inc.; oblato; ONO Pharma; Sumitomo Dainippon Pharma Co., Ltd. LR: financial and/or business interest in BeHealth Solutions and is a consultant to Mahana Therapeutics. [ABSTRACT FROM AUTHOR]

Whole exome sequencing continues to end the diagnostic odyssey for a number of patients and expands our knowledge of phenotypes associated with gene mutations. We describe an 11-year-old female patient with a constellation of symptoms including congenital cataracts, gut dysmotility, sensory neuropathy, and bifrontal polymicrogyria. Whole exome sequencing was performed and identified a de novo heterozygous missense mutation in the ATPase motor domain of cytoplasmic dynein heavy chain 1 (DYNC1H1), which is known to be involved in neuronal migration and retrograde axonal transport. The mutation was found to be highly damaging by multiple prediction programs. The residue is highly conserved, and reported mutations in this gene result in a variety of phenotypes similar to that of our patient. We report only the second case of congenital cataracts and the first of gut dysmotility in a patient with DYNC1H1, thus expanding the spectrum of disease seen in DYNC1H1 dyneinopathies. [ABSTRACT FROM AUTHOR]

This study aimed to understand the veterinary-client relationship and perspectives in organic dairy production systems. Twenty-three organic dairy producers and 12 veterinarians were interviewed using semi-structured, one-on-one interviews. Consultation with local veterinarians was typically infrequent, as there was greater reliance on other producers and organic industry professionals for advice on dairy herd health management, perhaps due to a shared focus on organic farming principles. Organic producers generally consulted local veterinarians most frequently to develop vaccine protocols, address animal health emergencies, and gain reproductive services. Common reasons organic producers cited for not regularly consulting a local veterinarian included the cost of veterinary services and a perception that local veterinarians have limited experience with organic systems and products. Some producers also expressed the idea that infrequent veterinarian usage is indicative of a healthy herd. Meanwhile, local veterinarians reported that organic dairy producers often delayed consulting them about individual cases until animal health problems were severe. Local veterinarians also identified challenges in servicing organic herds, such as the lack of standardized regulations between different organic certifiers and limited safety and efficacy data for many herd health products used by organic producers. In addition, their formal training generally did not include organic herd health strategies. Organic dairy clients were typically a small fraction of the overall workload for local veterinarians, which precluded their ability to accumulate experience. In contrast, a handful of specialized veterinarians in the organic milk processing industry work more frequently with organic producers and have published most of the available resource materials on organic dairy herd health. Veterinary-client partnerships could be improved through more open communication and discussion of the challenges identified in this study and through participatory research and outreach engagement that includes local veterinarians, organic certifiers, organic industry veterinarians, and producers. [ABSTRACT FROM AUTHOR]

Introduction: Although 3 in 4 breast cancer survivors report significant sexual concerns following treatment, few receive support for these concerns. Delivering sexual health care to breast cancer survivors via the Internet could overcome many of the barriers to in-person interactions, including limited availability of resources and stigma. Prior research on telehealth interventions for breast cancer survivors' sexual health has limitations. First, survivors continue to endorse time burden as a leading reason for declining telehealth sexual health interventions. Second, prior trial designs have not been able to determine which intervention components work best for which survivors. This knowledge is crucial to refine and personalize sexual health care for survivors. Objective: Use the Multiphase Optimization Strategy (MOST) methodological framework to achieve the following aims: (1) develop an Internet intervention for breast cancer-related sexual health that is optimized for greatest impact; and (2) determine how intervention components work (i.e., mediators) and for whom they work best (i.e., moderators). Methods: 320 partnered, post-treatment female breast cancer survivors who endorse at least one bothersome sexual symptom (i.e., pain with sex, vaginal dryness, low sexual desire, difficulty with orgasm) related to their breast cancer treatment will be enrolled. Recruitment will be conducted via a US-national community oncology research program representing more than 1,000 individual practice locations. In this factorial trial, participants will be randomized to receive a combination of 4 intervention components: psychoeducation about cancer-related sexual morbidity, training for communication with their health care team, training for communication with their partners, and intimacy promotion skills training. These components were selected as they are supported by our intervention research, are consistent with survivorship guidelines, and align with survivors' preferences found in our qualitative research. Components will be implemented using a robust Internet intervention platform with tailoring and highly-engaging elements like animation, video, and automated email prompts. Survivors will complete assessments at baseline (pre-randomization) and 3- and 6-month post-assessments. First, the impact of intervention components on survivors' sexual distress (Female Sexual Distress Scale-Desire, Arousal, Orgasm) and sexual functioning (Female Sexual Function Inventory) will be tested. Next, a select set of mediators (i.e., sexual functioning knowledge, sexual communication self-efficacy with clinicians and partner, emotional intimacy with partner) and moderators (i.e., menopausal status, adjuvant endocrine therapy use, psychological distress, relationship duration and satisfaction) will be evaluated. Results: Institutional review board approvals are in progress, with clinical trial registration to follow. Data collection is anticipated to begin in Spring 2024 and be completed in 2027. Conclusions: Findings from this trial will accelerate the development of more effective sexual health interventions for breast cancer survivors by determining how intervention components work and for whom various components work best. By identifying the combination of intervention components likely to provide breast cancer survivors the greatest sexual health benefit for the least burden, this study will result in the first Internet intervention optimized for maximum impact for the undertreated, prevalent, and distressing problem of breast cancer-related sexual morbidity. Disclosure: Any of the authors act as a consultant, employee or shareholder of an industry for: AHC: grants from Janssen, Relmada Therapeutics, Inc., and Sage Therapeutics; personal fees from Acadia, Alkermes, Allergan, AMAG Pharmaceuticals, Inc., Fabre-Kramer, Ovoca Bio plc, Pure Tech Health, Sage Therapeutics, Takeda/Lundbeck, WCG MedAvante-ProPhase, Ballantine Books/Random House, Changes in Sexual Functioning Questionnaire, Guilford Publications; personal fees and other from S1 Biopharma; and other from Euthymics and Mediflix LLC. GL: consultant or research affiliation with Agios Pharmaceuticals, Inc; Denovo Biopharma; IN8bio; Incyte Corporation; Novocure Inc.; oblato; ONO Pharma; Sumitomo Dainippon Pharma Co., Ltd. LR: financial and/or business interest in BeHealth Solutions and is a consultant to Mahana Therapeutics. [ABSTRACT FROM AUTHOR]

The shape of the spectral energy distribution (SED) of active galaxies in the extreme-ultraviolet (EUV)-soft X-ray band (13.6 eV-1 keV) is uncertain because obscuration by dust and gas can hamper our view of the continuum. To investigate the shape of the SED in this energy band, we have generated a set of photoionization models which reproduce the small dispersion found in correlations between high-ionization mid-infrared emission lines in a sample of hard X-ray-selected active galactic nuclei (AGNs). Our calculations show that a broken power-law continuum model is sufficient to reproduce the [Nev]14.32 µm/[Ne III], [Nev]24.32/µm/[OIV]25.89 µm, and [OIV]25.89µm/[NeIII] ratios and does not require the addition of a "big bump" EUV model component. We constrain the EUV-soft X-ray slope, αi, to be between 1.5 and 2.0 and derive a best fit of αi ~ 1.9 for Seyfert 1 galaxies, consistent with previous studies of intermediate-redshift quasars. If we assume a blue bump model, most sources in our sample have derived temperatures between TBB = 105.18 K and 105.7 K, suggesting that the peak of this component spans a large range of energies extending from ~600 Å to 1900 A. In this case, the best-fitting peak energy that matches the mid-infrared line ratios of Seyfert 1 galaxies occurs between ~700 and 1000 Å. Despite the fact that our results do not rule out the presence of an EUV bump, we conclude that our power-law model produces enough photons with energies >4 Ry to generate the observed amount of mid-infrared emission in our sample of Burst Alert Telescope AGNs. [ABSTRACT FROM AUTHOR]

The article presents a fatal case of a laboratory acquired infection with a strain of Yersinia (Y.) pestis in a 60-year-old male university researcher. Pathology findings for the case were consistent with septicemic plague but inconsistent with pneumonic plague, suggesting a transdermal or mucosal route of infection. The clinical course and visualization of Y. pestis in the blood vessels strongly support gram negative sepsis. The case suggests that inconsistent use of hand gloves could have resulted in an inadvertent transdermal Y. pestis exposure.

The article reports on the 2009 pandemic influenza A (H1N1) virus infection in the U.S. The highest rate of confirmed cases were mostly among kids and young adults. There have been reported deaths from this virus especially those people that have been diagnosed with other sickness. In response to those reports, the Chicago Department of Public Health (CDPH) enhanced the monitoring for influenza A (H1N1) virus infections. The agency also issued a health alert to physicians recommending testing for persons with influenza-like illness (ILI).

Organic dairy producers have distinct perspectives, approaches, challenges, and experiences when managing herd health, but little research has been conducted to develop a deeper understanding of producer decision-making related to disease-prevention and treatment strategies. We used 23 semi-structured interviews with organic dairy producers to better understand their perceived herd health challenges and overall disease-prevention strategies; decision-making and attitudes related to vaccination; and approaches to the treatment of infectious diseases using alternative or conventional antimicrobial therapies. Organic dairy producers reported improvements in overall animal health after they transitioned from a conventional to an organic system. Outdoor access, a balanced forage-based diet, and animal and environmental cleanliness were reported as the predominant disease-prevention measures. Over half of producers vaccinated their animals, and almost all preferred to use vaccines sparingly. Among producers who did not use vaccines, reasons cited were low perceived risk for infectious disease and minor vaccine safety concerns, yet many were not opposed to using vaccines in the future. Non-antimicrobial therapies were viewed as alternative effective treatment strategies for most common infectious diseases. Producers used antimicrobials very rarely and generally reserved them for severe cases when alternative treatments failed. Because US organic standards prohibit selling milk from cows that have ever been treated with antimicrobials, producers described the decision to use antimicrobials as extremely challenging and involved balancing considerations of economics, convenience, and animal welfare. This research fosters a better understanding of organic dairy producers' disease-prevention and treatment strategies and could be used by veterinarians and other animal health specialists to facilitate services for organic clients. [ABSTRACT FROM AUTHOR]

The article presents a case study of a researcher who died from a laboratory-acquired infection with an attenuated strain of the bacterium Yersinia pestis in Chicago, Illinois in September 2009. The patient presented with fever, cough and shortness of breath. He initially received diuretics for suspected congestive heart failure and later with intravenous antibiotics for suspected infection. Gram-negative sepsis is said to be the cause of his death based on certain factors. The need for researchers to use higher level of biosafety practices is tackled. INSET: Untitled.

Background: In patients with cholangiocarcinoma (CC), management of biliary obstruction commonly involves either up-front percutaneous transhepatic biliary drainage (PTBD) or initial endoscopic retrograde cholangiopancreatography (ERCP) with stent placement. The objective of the study was to compare the efficacy and of initial ERCP with stent placement with efficacy of initial PTBD in management of biliary obstruction in CC.Methods: A single-center database of patients with unresectable CC treated between 2006 and 2017 was queried for patients with biliary obstruction who underwent either PTBD or ERCP. Groups were compared with respect to patient, tumor, procedure, and outcome variables.Results: Of 87 patients with unresectable CC and biliary obstruction, 69 (79%) underwent initial ERCP while 18 (21%) underwent initial PTBD. Groups did not differ significantly with respect to age, gender, or tumor location. Initial procedure success did not differ between the groups (94% ERCP vs 89% PTBD, p = 0.339). Total number of procedures did not differ significantly between the two groups (ERCP median = 2 vs. PTC median = 2.5, p = 0.83). 21% of patients required ERCP after PTBD compared to 25% of patients requiring PTBD after ERCP (p = 1.00). Procedure success rate (97% ERCP vs. 93% PTBD, p = 0.27) and rates of cholangitis (22% ERCP vs. 17% PTBD, p = 0.58) were similar between the groups. Number of hospitalizations since initial intervention did not differ significantly between the two groups (ERCP median = 1 vs. PTC median = 3.5, p = 0.052).Conclusions: In patients with CC and biliary obstruction, initial ERCP with stent placement and initial PTBD both represent safe and effective methods of biliary decompression. Initial ERCP and stenting should be considered for relief of biliary obstruction in such patients in centers with advanced endoscopic capabilities. [ABSTRACT FROM AUTHOR]

Head and neck cancer (HNC) caregivers are especially vulnerable to poor outcomes because the HNC patients are at high risk for physical and functional impairments. This study examines contextual and stress process variables potentially associated with HNC caregivers’ physical and psychological well‐being. Patient‐caregiver variables included socio‐demographics, primary stressors (caregiving, patient clinical characteristics, HNC‐related symptoms/dysfunction), secondary stressors (caregiver employment, childcare responsibilities and sleep duration <7 hr), appraisal, and response (physical activity). General linear models modeled caregiver well‐being, along with depression and anxiety. A total of 33 patient‐caregiver dyads were included. Most caregivers were female (81.8%) and patient spouses/partners (72.7%). Factors significantly associated with better caregiver physical well‐being included caregiver older age, <2 comorbidities, ≥7 hr of sleep, ≥3 days/week physical activity, and patient swallowing and speech dysfunction. Factors significantly associated with better caregiver mental health functioning were less patient social dysfunction and less perceived caregiving burden. Short nighttime sleep, higher caregiver burden, and <3 days/week physical activity were also significantly related to caregivers’ depression and anxiety. Results suggested caregiver behaviors and perceived burden, along with patient HNC concerns are linked with caregiver well‐being. These behavioral, cognitive, and patient factors should be incorporated into caregiver screening tools or targeted with behavioral interventions to improve caregiver well‐being. [ABSTRACT FROM AUTHOR]

In 2016, an international group of experts developed a proforma to standardise reporting PAS characteristics. Methods Case-control series of ultrasound studies for subjects with PAS, using control cohort matched for risk factors and image quality. Control cohort created using subjects without PAS, matched 1:1 for previa, # prior Caesarean, prior dilation and curettage (D&C), I in vitro i fertilisation (IVF). [Extracted from the article]

Healthcare policies such as standard 7 of the National Service Framework for Children, Young People and Maternity Services and the new NMC standards for pre-registration nursing programmes emphasise the need for universities and their partner trusts to engage with patients and the public in developing both nurse training courses and services. This article describes a two-arm study into the views and experiences of children with regard to hospitals. Conducted as part of an ongoing commitment to the reconfiguration of children's services and the development of a new undergraduate children's nursing programme, the study collected data from 61 children in two children's hospitals in the south of England and from eight members of a city youth parliament. Aims: The study sought to involve child users in service planning through two objectives: 1) to ascertain the views of children and young people on what skills, knowledge and attitudes, children's nurses of the future will need to care for sick children and their families; and 2) to seek the views of young people on what children think about before being admitted to hospital, and subsequently as inpatients. Method: The study used a draw and write/tell technique. The main outcome measures were description and analysis of those attributes which children believe nurses of the future should possess, and of those factors which inhibit or enhance childhood hospital admission. Results: A number of themes emerged from analysis of the data: notably that children's nurses of the future should be skilled in both verbal and non-verbal communication, as well as having fundamental clinical skills. Issues relating to children about to be admitted to hospital included being scared or worried, and fear of the unknown, while concerns after admission to hospital related to the care environment, social needs, and individual/personal needs and requirements. Conclusions: This patient and public involvement study revealed a number areas that children and young people believe to be important for the future training of children's nurses. Additionally, the factors which children consider inhibit or enhance the experience of hospital admission have been identified. [ABSTRACT FROM AUTHOR]