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Subarachnoid hemorrhage (SAH) is a devastating type of stroke, leading to high mortality and morbidity rates. Cerebral vasospasm and delayed cerebral ischemia (DCI) are common complications following SAH that contribute significantly to the poor outcomes observed in these patients. Intrathecal (IT) nicardipine delivered via an existing external ventricular drain is an off‐label intervention that has been shown to be correlated with reduced DCI and improved patient outcomes. The current study aims to characterize the population pharmacokinetic (popPK) properties of intermittent IT nicardipine. Following informed consent, serial cerebrospinal fluid (CSF) samples were obtained from 16 SAH patients (50.4 ± 9.3 years old; 13 females) treated with IT nicardipine every 6 h (q6h, n = 8) or every 8 h (q8h, n = 8) for an average of 72 ± 21 doses. High‐performance liquid chromatography was used to quantify CSF concentration from each sample. Our popPK analysis showed that the CSF pharmacokinetics of IT nicardipine in the cohort was adequately described by a two‐compartment model with a lag time. Model parameter estimates were reliable (relative standard error <50%). Intracranial pressure influenced both the total clearance and the central volume of nicardipine (i.e., negative correlation, P <−.001). Calculated PK parameters were similar between q6h and q8h dosing regimens. Despite a small cohort of SAH patients, we successfully developed a popPK model to describe the nicardipine disposition kinetics in the CSF following IT administration. These findings may help inform future clinical trials designed to examine the optimal dosing of IT nicardipine. [ABSTRACT FROM AUTHOR]

This essay considers the Immigration Act of 1924, otherwise known as the Johnson-Reed Act (JRA), within historical and contemporary contexts of anti-miscegenation and Indigenous erasure that are undercurrents of citizenship and immigration processes. By using a framework of settler colonialism carried out by the U.S. nation-state, we explore connections among racialized peoples in U.S. American empire and the push for racial purity through systems of blood quantum and anti-miscegenation laws. With attention to how colonialism from the continental USA flows to locales such as Guåhan/Guam, a place enacting sovereignty despite occupation and colonial possession, we consider how immigration and citizenship are wielded as tools of U.S. American militarization. Ultimately, we argue that critiquing miscegenation and militarism is necessary to overcome racial and colonial violences of empire. [ABSTRACT FROM AUTHOR]

Ebola virus (EBOV) infection results in Ebola virus disease (EVD), an often severe disease with a nonspecific presentation. Since its recognition, periodic outbreaks of EVD continue to occur in sub-Saharan Africa. The 2013–2016 West African EVD outbreak was the largest recorded, resulting in a substantial cohort of EVD survivors with persistent health complaints and variable immune responses. In this study, we characterize humoral immune responses in EVD survivors and their contacts in Eastern Sierra Leone. We found high levels of EBOV IgG in EVD survivors and lower yet substantial antibody levels in household contacts, suggesting subclinical transmission. Neutralizing antibody function was prevalent but variable in EVD survivors, raising questions about the durability of immune responses from natural infection with EBOV. Additionally, we found that certain discrete symptoms—ophthalmologic and auditory—are associated with EBOV IgG seropositivity, while an array of symptoms are associated with the presence of neutralizing antibody. [ABSTRACT FROM AUTHOR]

Climate change has brought about credible changes in arid landscapes which have resulted in further challenges for pastoralists who require good quality rangeland resources to sustain their livestock. This study assessed local level coping and adaptivemanagement strategies by pastoralists in Namibia and South Africa using a capital assets approach, and also explored non-climate related barriers that increase their vulnerability to climate change. A case study approach was used, which included focus group discussions and semi-structured interviews. The main findings of the research indicate that pastoralists have been exposed to increased temperature extremes and droughts of varying duration over time which reduced the quality and quantity of forage and resulted in losses of income and animal health. The 46 different coping and adaptation strategies used by pastoralists included financial (n =15), natural (n = 15), human (n =12), physical (n = 2) and social (n = 2) capital. Of these, 61% of the strategies were common between the two countries. Strategies included income diversification, supplementary feeding and livestock mobility. Pastoralists had to overcome a hierarchy of barriers to implement their coping and adaptation strategies, which were largely related to human capital in Namibia and to natural capital in South Africa. These barriers included a lack of access to grazing lands, land degradation and the loss of traditional knowledge to manage livestock and rangeland resources. Policy development should take these barriers into account while building on the foundation of existing adaptation strategies to reduce the vulnerability to climate change of pastoralists in dryland regions. [ABSTRACT FROM AUTHOR]

Noonan syndrome (NS) is mostly an autosomal dominant genetic disorder that affects between 1 in 1000 and 1 in 2500 people. Type 1 Chiari malformations (CM1) have an estimated prevalence of <1 in 1000 people. Though NS typically spares the posterior fossa, there have been 11 past instances of patients with NS having a concurrent CM1 that have been published in the literature. Each of these 11 cases occurred sporadically, in an isolated individual with no published family history of CM1. This case report presents a three generational family with four members having both NS and concurrent CM1. All affected family members share a pathogenic variant in PTPN11. A literature review was performed to identify and compile data regarding all past published cases of NS and CM1 occurring concurrently. Since 1982, a dozen case reports have detailed NS with concurrent CM1. Where molecular genetic data was presented, seven had a variant in PTPN11, and only one had a variant in another gene. The clustering of NS with CM1 within a single family that shares the same genotype, along with the exclusion of both NS and CM1 in other family members, may indicate that CM1 is a part of the NS phenotype. [ABSTRACT FROM AUTHOR]

Breakthrough symptoms are thought to occur in roughly half of all gastroesophageal reflux disease (GERD) patients despite maximal acid suppression (proton pump inhibitor, PPI) therapy. Topical alginates have recently been shown to enhance mucosal defense against acid-pepsin insult during GERD. We aimed to examine potential alginate protection of transcriptomic changes in a cell culture model of PPI-recalcitrant GERD. Immortalized normal-derived human esophageal epithelial cells underwent pretreatment with commercial alginate-based anti-reflux medications (Gaviscon Advance or Gaviscon Double Action), a matched-viscosity placebo control, or pH 7.4 buffer (sham) alone for 1 min, followed by exposure to pH 6.0 + pepsin or buffer alone for 3 min. RNA sequencing was conducted, and Ingenuity Pathway Analysis was performed with a false discovery rate of ≤0.01 and absolute fold-change of ≥1.3. Pepsin-acid exposure disrupted gene expressions associated with epithelial barrier function, chromatin structure, carcinogenesis, and inflammation. Alginate formulations demonstrated protection by mitigating these changes and promoting extracellular matrix repair, downregulating proto-oncogenes, and enhancing tumor suppressor expression. These data suggest molecular mechanisms by which alginates provide topical protection against injury during weakly acidic reflux and support a potential role for alginates in the prevention of GERD-related carcinogenesis. [ABSTRACT FROM AUTHOR]

Background COVID-19 vaccine effectiveness (VE) studies leveraging systematic surveillance in sub-Saharan Africa are limited. We assessed the effectiveness of two vaccines (Pfizer BNT162b2 and Johnson & Johnson Ad26.COV2.S) against SARS-CoV-2-associated hospitalization in South African adults aged ≥18 years. Methods We conducted a test-negative case-control study using pneumonia surveillance data in South Africa. Inpatients with physician-diagnosed lower respiratory tract infection or suspected COVID-19, testing SARS-CoV-2 positive or negative from June 2021–March 2022, were cases or controls, respectively. Fully vaccinated individuals received one Ad26.COV2.S dose or two BNT162b2 doses ≥14-days before enrollment. VE was estimated using multivariable logistic regression for Delta- and Omicron BA.1/BA.2-predominant periods, stratified by age and HIV status. Results The study included 925 cases and 1890 controls; 38 (4%) cases and 186 (10%) controls were fully vaccinated with BNT162b2, and 30 (3%) cases and 94 (5%) controls with Ad26.COV2.S. The vaccine effectiveness of BNT162b2 against SARS-CoV-2-associated hospitalization over Delta and Omicron BA.1/BA.2 periods was 91% (95% CI: 52%, 98%) and 33% (-16%, 86%), respectively. The vaccine effectiveness of Ad26.COV2.S against hospitalization over Delta and Omicron BA.1/BA.2 periods was 72% (-36% ,94%), and -19% (-130%, 39%), respectively. The vaccine effectiveness of BNT162b2 against hospitalization over the Delta period was 94% (50%, 99%) and 89% (27%, 98%) among adults aged ≥60 years and HIV-uninfected, respectively. Conclusions The BNT162b2 vaccine was effective against SARS-CoV-2-associated hospitalization during the Delta period for adults aged ≥18 years, ≥60 years and those HIV-uninfected. VE for Ad26.COV2.S was inconclusive, potentially due to limited sample size or residual confounding. These findings highlight the utility of sentinel surveillance for estimating VE. [ABSTRACT FROM AUTHOR]

The purpose of this study was to quantify the total energy expenditure (TEE) of international female rugby union players. Fifteen players were assessed over 14 days throughout an international multi-game tournament, which represented two consecutive one-match microcycles. Resting metabolic rate (RMR) and TEE were assessed by indirect calorimetry and doubly labelled water, respectively. Physical activity level (PAL) was estimated (TEE:RMR). Mean RMR, TEE, and PAL were 6.60 ± 0.93 MJ·day−1 (1578 ± 223 kcal·day−1), 13.51 ± 2.28 MJ·day−1 (3229 ± 545 kcal·day−1), and 2.0 ± 0.3 AU, respectively. There was no difference in TEE (13.74 ± 2.31 (3284 ± 554 kcal·day−1) vs. 13.92 ± 2.10 MJ·day−1 (3327 ± 502 kcal·day−1); p = 0.754), or PAL (2.06 ± 0.26 AU vs. 2.09 ± 0.23 AU; p = 0.735) across microcycles, despite substantial decreases in training load (total distance: −8088 m, collisions: −20 n, training duration: −252 min). After correcting for body composition, there was no difference in TEE (13.80 ± 1.74 (3298 ± 416 adj. kcal·day−1) vs. 13.16 ± 1.97 (3145 ± 471 adj. kcal·day−1) adj. MJ·day−1, p = 0.190), RMR (6.49 ± 0.81 (1551 ± 194 adj. kcal·day−1) vs. 6.73 ± 0.83 (1609 ± 198 adj. kcal·day−1) adj. MJ·day−1, p = 0.633) or PAL (2.15 ± 0.14 vs. 1.87 ± 0.26 AU, p = 0.090) between forwards and backs. For an injured participant (n = 1), TEE reduced by 1.7 MJ·day−1 (−401 kcal·day−1) from pre-injury. For participants with illness (n = 3), TEE was similar to pre-illness (+0.49 MJ·day−1 (+117 kcal·day−1)). The energy requirements of international female rugby players were consistent across one-match microcycles. Forwards and backs had similar adjusted energy requirements. These findings are critical to inform the dietary guidance provided to female rugby players. [ABSTRACT FROM AUTHOR]

Microglia are critical responders to amyloid beta (Aβ) plaques in Alzheimer's disease (AD). Therefore, the therapeutic targeting of microglia in AD is of high clinical interest. While previous investigation has focused on the innate immune receptors governing microglial functions in response to Aβ plaques, how microglial innate immune responses are regulated is not well understood. Interestingly, many of these microglial innate immune receptors contain unique cytoplasmic motifs, termed immunoreceptor tyrosine‐based activating and inhibitory motifs (ITAM/ITIM), that are commonly known to regulate immune activation and inhibition in the periphery. In this review, we summarize the diverse functions employed by microglia in response to Aβ plaques and also discuss the innate immune receptors and intracellular signaling players that guide these functions. Specifically, we focus on the role of ITAM and ITIM signaling cascades in regulating microglia innate immune responses. A better understanding of how microglial innate immune responses are regulated in AD may provide novel therapeutic avenues to tune the microglial innate immune response in AD pathology. [ABSTRACT FROM AUTHOR]

Background: There are currently no guidelines on peri-arthroscopic management of immunosuppressive (IS) treatment in rheumatic disease patients. Purpose: The purpose of this study is to characterize the rheumatic disease patient population undergoing arthroscopy, compare the incidence of postoperative complications among patients who either remained on IS perioperatively, held IS perioperatively or were not on IS at baseline, and compare the incidence of postoperative complications by rheumatic disease type, medication type, and procedure. Methods: We conducted a retrospective review of all arthroscopic sports medicine surgeries in patients with a rheumatic disease diagnosis at our institution over an 11-year period. Patients on IS at baseline were grouped into those who remained on IS perioperatively or held all IS before the date of their surgery. These two groups were compared to patients who were not on IS at baseline. Incidence of postoperative complications was calculated for the three cohorts and by medication class, rheumatic disease type, and procedure risk. Analysis of variance (ANOVA), chi-squared, and Fisher's exact tests were used to determine the statistical significance of between-group differences in postoperative complication incidence. Results: We identified 1,316 rheumatic disease patients undergoing arthroscopy, with 214 of them taking IS medications at baseline. In total, 8.4% (n = 110) remained on IS perioperatively, 7.9% (n = 104) held IS perioperatively, and 83.7% (n = 1102) were not on IS at baseline. In all cohorts, seven patients experienced postoperative complications; six of whom experienced infections. Two (1.82%) occurred in patients remaining on IS perioperatively, zero infections occured in patients who held all IS, and four (0.36%) occured in patients who were not on any IS at baseline. There was no statistically significant difference in postoperative infections or complication rates among the three cohorts or further subgroups. Conclusion: The risk of postoperative complications including infectious, major, and minor complications in patients on IS at the time of arthroscopy is low and acceptable. [ABSTRACT FROM AUTHOR]

Climate change has brought about credible changes in arid landscapes which have resulted in further challenges for pastoralists who require good quality rangeland resources to sustain their livestock. This study assessed local level coping and adaptivemanagement strategies by pastoralists in Namibia and South Africa using a capital assets approach, and also explored non-climate related barriers that increase their vulnerability to climate change. A case study approach was used, which included focus group discussions and semi-structured interviews. The main findings of the research indicate that pastoralists have been exposed to increased temperature extremes and droughts of varying duration over time which reduced the quality and quantity of forage and resulted in losses of income and animal health. The 46 different coping and adaptation strategies used by pastoralists included financial (n =15), natural (n = 15), human (n =12), physical (n = 2) and social (n = 2) capital. Of these, 61% of the strategies were common between the two countries. Strategies included income diversification, supplementary feeding and livestock mobility. Pastoralists had to overcome a hierarchy of barriers to implement their coping and adaptation strategies, which were largely related to human capital in Namibia and to natural capital in South Africa. These barriers included a lack of access to grazing lands, land degradation and the loss of traditional knowledge to manage livestock and rangeland resources. Policy development should take these barriers into account while building on the foundation of existing adaptation strategies to reduce the vulnerability to climate change of pastoralists in dryland regions. [ABSTRACT FROM AUTHOR]

Climate change has brought about credible changes in arid landscapes which have resulted in further challenges for pastoralists who require good quality rangeland resources to sustain their livestock. This study assessed local level coping and adaptivemanagement strategies by pastoralists in Namibia and South Africa using a capital assets approach, and also explored non-climate related barriers that increase their vulnerability to climate change. A case study approach was used, which included focus group discussions and semi-structured interviews. The main findings of the research indicate that pastoralists have been exposed to increased temperature extremes and droughts of varying duration over time which reduced the quality and quantity of forage and resulted in losses of income and animal health. The 46 different coping and adaptation strategies used by pastoralists included financial (n =15), natural (n = 15), human (n =12), physical (n = 2) and social (n = 2) capital. Of these, 61% of the strategies were common between the two countries. Strategies included income diversification, supplementary feeding and livestock mobility. Pastoralists had to overcome a hierarchy of barriers to implement their coping and adaptation strategies, which were largely related to human capital in Namibia and to natural capital in South Africa. These barriers included a lack of access to grazing lands, land degradation and the loss of traditional knowledge to manage livestock and rangeland resources. Policy development should take these barriers into account while building on the foundation of existing adaptation strategies to reduce the vulnerability to climate change of pastoralists in dryland regions. [ABSTRACT FROM AUTHOR]

Haemoglobin (Hb) is a vital oxygen carrier in vertebrates. Low blood Hb levels may indicate anaemia or genetic disorders, while its presence in the lower digestive system suggests colon cancer. Detecting and quantifying human Hb is essential for medical diagnostics. A nanobody‐based sandwich‐ELISA test was recently developed utilising llama‐derived nanobodies NbE11 and NbB9. These nanobodies specifically bind to human Hb without cross‐reacting with Hb from other vertebrates. Here, we determine the crystal structure of NbE11 in complex with human Hb. NbE11 binds Hb with high affinity, predominantly binding the β‐Hb subunit. Structural differences between human Hb and other vertebrates at the NbE11 binding interface likely explain the assay's lack of cross‐reactivity, providing insights for developing Hb binding diagnostics. [ABSTRACT FROM AUTHOR]

First year, university transfer students experience challenges typically addressed with mentoring. Peer mentoring provides a culturally relevant approach to reduce disparities in educational achievements. This study seeks to understand the experiences of peer mentors and the impact on their relationships with first-year transfer students attending a Hispanic Serving Institution. Using a case study approach, our research finds that peer mentors were ill-equipped to handle challenges associated with having a transfer student mentee. Our findings suggest training requires improvement and better consideration of peer mentor-mentee pairings with due to the dynamic issues caused by incongruency in age or gender, lack of relatability to or lack of proper knowledge for mentees with backgrounds differing the mentors, and mentors experiencing imposter syndrome. [ABSTRACT FROM AUTHOR]

This systematic review provides investigation into the evolution of Supply Chain Management (SCM) practices from Industry 4.0 to Industry 5.0 in South African enterprises, with a specific focus on the integration of Blue Ocean Strategy. Industry 5.0 marks a significant shift towards more personalised, sustainable, and humancentric industrial practices, leveraging advanced technologies to improve operational efficiency and address environmental concerns. The research aims to investigate how SCM practices in South African firms are transforming under the influence of Industry 5.0 paradigms and to assess how the Blue Ocean Strategy can bolster competitiveness, operational efficiency, and sustainable growth. Adopting a comprehensive methodology, this study systematically reviewed peer-reviewed articles from 2019 to 2023. Employing the PRISMA framework for structured literature review, and thematic analysis using Atlas-ti 24 software, the research scrutinised the evolution of SCM practices, focusing on technological adoption, strategic innovation, and sustainability integration. The findings reveal that South African firms are progressively adopting Industry 5.0 technologies, integrating them within SCM to improve flexibility, responsiveness, and sustainability. The application of Blue Ocean Strategy is identified as a catalyst for creating uncontested market spaces and driving innovation, which not only improves the firms' market position but also aligns with sustainable business practices. However, challenges such as technological integration complexity, high transition costs, and the need for skilled human resources are notable impediments. This research significantly contributes to academic literature by providing a nuanced understanding of the SCM evolution in the context of Industry 5.0 within emerging markets, particularly focusing on South African enterprises. It also offers practical insights for industry practitioners on leveraging Blue Ocean Strategy alongside Industry 5.0 technologies to achieve competitive advantage and sustainable growth. The study underlines the need for policy interventions to support technological adaptation and capacity building in the SCM sector, suggesting avenues for future research on overcoming the barriers to Industry 5.0 adoption. [ABSTRACT FROM AUTHOR]

The integration of Artificial Intelligence (AI) within supply chain management (SCM) has precipitated a significant transformation in business processes, particularly in emerging economies like South Africa. This systematic literature review explores the extent of AI's influence on SCM practices across various industries within the South African context, underpinning the potential of AI to improve operational efficiency, strategic decision-making, and innovation. This review thoroughly followed the PRISMA guidelines. The findings reveal that AI significantly contributes to the advancement of SCM by improving accuracy in demand forecasting, optimising resource allocation, and facilitating real-time decision-making. This review synthesizes current research, offering a comprehensive overview of AI's transformative potential in SCM within South Africa. It also suggests areas for future research, particularly in addressing the challenges of AI implementation and exploring its impact on sustainable SCM practices. The implications for both practitioners and policymakers include prioritising digital infrastructure development, ethical AI integration, and encouraging public-private partnerships to support AI-driven innovations in supply chain networks. Future research should prioritise the development of practical methods that specifically target the demands and obstacles of incorporating AI into supply chains in South Africa, with the aim of promoting fair and sustainable growth. [ABSTRACT FROM AUTHOR]

This study evaluates the disruptions in South African pharmaceutical supply chains, focusing on resilience mechanisms and risk factors essential for maintaining continuity and efficiency amidst various disruptions. It leverages a comprehensive literature review and qualitative insights from interviews with 25 local experts, employing a phenomenological approach to explore the strategic experiences and adaptations to supply chain challenges. Findings highlight the significance of diversified sourcing, strategic adaptability, and local production enhancement in ensuring supply chain robustness and pharmaceutical availability. The research underscores the importance of robust risk management, strategic foresight, and local capability investment, offering practical insights for stakeholders to enhance supply chain resilience. Contributing valuable perspectives to supply chain management discourse, it enriches the understanding of resilience and risk mitigation in the pharmaceutical sector, providing a basis for informed strategic planning and policymaking to safeguard against future disruptions. [ABSTRACT FROM AUTHOR]

Citizen science is a rapidly growing field, particularly among young scientists. In this case study, we review a year-long citizen science initiative hosted at Western University, Canada, which aimed to document and highlight biodiversity on campus while simultaneously seeking to improve community engagement with the environment. Using the popular citizen science platform iNaturalist, we facilitated data collection and community engagement through a combination of informal field surveys, undergraduate-level course assignments, social media, and passive data submission. Throughout the first year of the initiative, nearly 300 community members submitted 3716 observations of 1225 species, including observations of 103 species documented on iNaturalist for the first time in the region, and other species of ecological significance. This citizen science project underscores the strengths and utility of citizen science and provides a framework for other higher education institutions to develop similar initiatives. [ABSTRACT FROM AUTHOR]

Objective: The increasing prevalence of and inequities in childhood obesity demand improved access to effective treatment. The SmartMoves curriculum used in Bright Bodies, a proven‐effective, intensive health behavior and lifestyle treatment (IHBLT), was disseminated to ≥30 US sites from 2003 to 2018. We aimed to identify barriers to and facilitators of IHBLT implementation/sustainment. Methods: We surveyed and interviewed key informants about experiences acquiring/implementing SmartMoves. In parallel, we analyzed and then integrated survey findings and themes from interviews using the constant comparative method. Results: Participants from 16 sites (53%) completed surveys, and 12 participants at 10 sites completed interviews. The 11 sites (63%) that implemented SmartMoves varied in both use of training opportunities/materials and fidelity to program components. In interviews, demand for obesity programming, organizational priorities, and partnerships facilitated implementation. Seven sites discontinued SmartMoves prior to the COVID‐19 pandemic. Funding insecurity and insufficient staffing emerged as dominant barriers to implementation/sustainment discussed by all interviewees, and some also noted participants' competing demands and the program's fit with population as challenges. Conclusions: System‐ and organizational‐level barriers impeded sustainment of an evidence‐based IHBLT program. Adequate funding could enable sufficient staffing and training to promote fidelity to the intervention's core functions and adaptation to fit local populations/context. [ABSTRACT FROM AUTHOR]

The coffee berry borer, Hypothenemus hampei (Ferrari) (Coleoptera: Scolytidae), is one of the most important coffee pests, and is present in almost all countries producing this crop, causing annual losses of US$350 million. Natural factors regulate H. hampei populations in coffee crops. Ecological life table analysis is a robust tool that allows the estimation of the mortality caused by these factors. Therefore, the main objective of this study was to determine the critical stage and the key mortality factors affecting H. hampei in the field. Data for constructing life tables were collected over 2 years in six coffee plantations in the regions of Paula Cândido and Viçosa, Minas Gerais State, Brazil. The average mortality of H. hampei was 75.34% ± 5.85%. The mortality at each developmental stage was 24.32% ± 2.83% (eggs), 7.29% ± 1.01% (first instar), 11.58% ± 1.46% (second instar), 9.68% ± 1.10% (third instar), 7.45% ± 1.01% (pupa), and 15.02% ± 1.29% (adult; n = 124). The mortality factors observed and quantified in this study were parasitism by Prorops nasuta (Hymenoptera: Bethylidae), predation by ants (Crematogaster spp., Pheidole spp. and Solenopsis spp.), physiological disorders and fungal infection by Beauveria bassiana and Metarhizium anisopliae. The critical mortality stage of H. hampei was the adult stage. The key factors for mortality of H. hampei adults were predatory ants, followed by B. bassiana and malformations (these insects had deformities in the head, wings, legs, or abdomen). This information is essential to conserve the activities of natural enemies and, thus maintain H. hampei natural mortality factors in coffee plantations, reducing damage to the crops and the need for excessive insecticide interventions. [ABSTRACT FROM AUTHOR]

Since April 2019, CA Bridge has worked with emergency departments (EDs) in diverse geographic and emergency care settings across California to scale up low-threshold buprenorphine access, patient navigation programs, harm reduction services, and take-home naloxone. Between April 2019 and June 2023, 268 (81.0%) of 331 acute care hospitals in California received funding and technical assistance from CA Bridge and completed data reporting. These hospitals provided navigation services during 279 025 patient encounters and gave patients buprenorphine in 89 549 ED visits. (Am J Public Health. 2024;114(9):874–878. https://doi.org/10.2105/AJPH.2024.307710) [ABSTRACT FROM AUTHOR]

Dry eye disease is a multifactorial condition characterised by tear film instability, hyperosmolarity and ocular surface inflammation. Understanding the epidemiology of dry eye disease and recognising both modifiable and non-modifiable risk factors can assist eye care practitioners in assessing, treating, and managing patients with the condition. This review considers current knowledge surrounding its incidence and prevalence, as well as associated demographic, systemic, ocular, and iatrogenic, and lifestyle-related modifiable risk factors. Population-based prevalence estimates vary according to the diagnostic criteria used to define dry eye disease, as well as severity and demographic characteristics of the population. Considering recent data and variable population demographics, conservative prevalence estimates suggest that 10–20% of the population over 40 years of age report moderate to severe symptoms and/or seek treatment for dry eye disease. Individuals with specific non-modifiable demographic risk factors may be at increased risk of developing dry eye disease. Advanced age, female sex and East Asian ethnicity have been identified as key non-modifiable demographic features predisposing individuals to dry eye disease. Systemic conditions that have been associated with an increased risk of dry eye disease include migraine, Sjögren syndrome, connective tissue disorders, mental health disorders, diabetes mellitus and androgen deficiency. Medications that may contribute to this risk include antidepressants, antihistamines, and hormone replacement therapy. Ocular and iatrogenic risk factors of dry eye disease include blepharitis, Demodex infestation, ocular surgery, blink completeness, contact lens wear, and topical ophthalmic medications. A range of modifiable lifestyle factors that can increase the risk of dry eye disease have also been identified, including low humidity environments, digital screen use, quality of sleep, diet, and eye cosmetic wear. Dry eye is a common disease affecting millions globally. Increasing knowledge regarding its associated risk factors can better prepare the eye care practitioner to successfully manage patients with this ocular surface disease. [ABSTRACT FROM AUTHOR]

Aim: To compare the incidence of adverse events (AEs) related to antiobesity medications (AOMs; glucagon‐like peptide‐1 receptor agonists [GLP‐1RAs] vs. non‐GLP‐1RAs) after bariatric surgery. Methods: This single‐centre retrospective cohort included patients (aged 16–65 years) who had undergone laparoscopic Roux‐en‐Y gastric bypass or sleeve gastrectomy (cohort entry date) and initiated AOMs. Participants were categorized as users of US Food and Drug Administration (FDA)‐approved, off‐label, or GLP‐1RA AOMs if documented as receiving the medication on or after cohort entry date. Non‐GLP‐1RA AOMs were phentermine, orlistat, topiramate, canagliflozin, dapagliflozin, empagliflozin, naltrexone, bupropion/naltrexone and phentermine/topiramate. GLP‐1RA AOMs included: semaglutide, dulaglutide, exenatide and liraglutide. The primary outcome was AE incidence. Logistic regression was used to determine the association of AOM exposure with AEs. Results: We identified 599 patients meeting our inclusion criteria, 83% of whom were female. Their median (interquartile range [IQR]) age was 47.8 (40.9–55.4) years. The median duration of surgery to AOM exposure was 30 months. GLP‐1RAs use was not associated with higher odds of AEs: adjusted odds ratio (aOR) 1.1 (95% confidence interval [CI] 0.5–2.6) and aOR 1.1 (95% CI 0.6–2.3) for GLP‐1RA versus FDA‐approved and off‐label AOM use, respectively. AOM initiation ≥12 months after surgery was associated with lower risk of AEs compared to <12 months (aOR 0.01 [95% CI 0.0–0.01]; p < 0.001). Conclusion: Our results showed that GLP‐1RA AOMs were not associated with an increased risk of AEs compared to non‐GLP‐1RA AOMs in patients who had previously undergone bariatric surgery. Prospective studies are needed to identify the optimal timeframe for GLP‐1RA initiation. [ABSTRACT FROM AUTHOR]

Background The RTS,S/AS01E (RTS,S) malaria vaccine is recommended for children in malaria endemic areas. This phase 2b trial evaluates RTS,S fractional- and full-dose regimens in Ghana and Kenya. Methods In total, 1500 children aged 5–17 months were randomized (1:1:1:1:1) to receive RTS,S or rabies control vaccine. RTS,S groups received 2 full RTS,S doses at months 0 and 1 and either full (groups R012-20, R012-14-26) or fractional doses (one-fifth; groups Fx012-14-26, Fx017-20-32). Results At month 32 post-dose 1, vaccine efficacy against clinical malaria (all episodes) ranged from 38% (R012-20; 95% confidence interval [CI]: 24%–49%) to 53% (R012-14-26; 95% CI: 42%–62%). Vaccine impact (cumulative number of cases averted/1000 children vaccinated) was 1344 (R012-20), 2450 (R012-14-26), 2273 (Fx012-14-26), and 2112 (Fx017-20-32). To account for differences in vaccine volume (fractional vs full dose; post hoc analysis), we estimated cases averted/1000 RTS,S full-dose equivalents: 336 (R012-20), 490 (R012-14-26), 874 (Fx012-14-26), and 880 (Fx017-20-32). Conclusions Vaccine efficacy was similar across RTS,S groups. Vaccine impact accounting for full-dose equivalence suggests that using fractional-dose regimens could be a viable dose-sparing strategy. If maintained through trial end, these observations underscore the means to reduce cost per regimen thus maximizing impact and optimizing supply. Clinical Trials Registration NCT03276962 (ClinicalTrials.gov). [ABSTRACT FROM AUTHOR]

This study examines the motivations for sharing misinformation on social media platforms in Nigeria. The study conceptualises social media platforms as digital commons and draws on twelve focus group discussions involving ninety-two participants from the three regional nodes of Nigeria (north, east, west). The findings suggest that sharing misinformation about patriotism, altruism, ethnicity, religion, and regional differences on social media has the potential to abuse the digital commons. However, while the digital commons are universal, their abuse is mediated by contextual realities that are specific to the Nigerian context. Also, there are indications that network ties influence Nigerian audiences' response to misinformation on social media. Furthermore, we discuss the implications of our findings for a transitional democracy such as Nigeria. [ABSTRACT FROM AUTHOR]

Acute febrile illness (AFI) is a common reason for healthcare seeking and hospitalization in Sub-Saharan Africa and is often presumed to be malaria. However, a broad range of pathogens cause fever, and more comprehensive data on AFI etiology can improve clinical management, prevent unnecessary prescriptions, and guide public health interventions. We conducted surveillance for AFI (temperature ≥38.0°C <14 days duration) among hospitalized patients of all ages at four sites in Kenya (Nairobi, Mombasa, Kakamega, and Kakuma). For cases of undifferentiated fever (UF), defined as AFI without diarrhea (≥3 loose stools in 24 hours) or lower respiratory tract symptoms (cough/difficulty breathing plus oxygen saturation <90% or [in children <5 years] chest indrawing), we tested venous blood with real-time PCR-based TaqMan array cards (TAC) for 17 viral, 8 bacterial, and 3 protozoal fever-causing pathogens. From June 2017 to March 2019, we enrolled 3,232 AFI cases; 2,529 (78.2%) were aged <5 years. Among 3,021 with outcome data, 131 (4.3%) cases died while in hospital, including 106/2,369 (4.5%) among those <5 years. Among 1,735 (53.7%) UF cases, blood was collected from 1,340 (77.2%) of which 1,314 (98.1%) were tested by TAC; 715 (54.4%) had no pathogens detected, including 147/196 (75.0%) of those aged <12 months. The most common pathogen detected was Plasmodium, as a single pathogen in 471 (35.8%) cases and in combination with other pathogens in 38 (2.9%). HIV was detected in 51 (3.8%) UF cases tested by TAC and was most common in adults (25/236 [10.6%] ages 18–49, 4/40 [10.0%] ages ≥50 years). Chikungunya virus was found in 30 (2.3%) UF cases, detected only in the Mombasa site. Malaria prevention and control efforts are critical for reducing the burden of AFI, and improved diagnostic testing is needed to provide better insight into non-malarial causes of fever. The high case fatality of AFI underscores the need to optimize diagnosis and appropriate management of AFI to the local epidemiology. [ABSTRACT FROM AUTHOR]

Background Hospital- onset bacteraemia and fungaemia (HOB) is being explored as a surveillance and quality metric. The objectives of the current study were to determine sources and preventability of HOB in hospitalised patients in the USA and to identify factors associated with perceived preventability. Methods We conducted a cross- sectional study of HOB events at 10 academic and three community hospitals using structured chart review. HOB was defined as a blood culture on or after hospital day 4 with growth of one or more bacterial or fungal organisms. HOB events were stratified by commensal and non- commensal organisms. Medical resident physicians, infectious disease fellows or infection preventionists reviewed charts to determine HOB source, and infectious disease physicians with training in infection prevention/hospital epidemiology rated preventability from 1 to 6 (1=definitely preventable to 6=definitely not preventable) using a structured guide. Ratings of 1--3 were collectively considered 'potentially preventable' and 4--6 'potentially not preventable'. Results Among 1789 HOB events with noncommensal organisms, gastrointestinal (including neutropenic translocation) (35%) and endovascular (32%) were the most common sources. Overall, 636/1789 (36%) non- commensal and 238/320 (74%) commensal HOB events were rated potentially preventable. In logistic regression analysis among non- commensal HOB events, events attributed to intravascular catheter- related infection, indwelling urinary catheter- related infection and surgical site infection had higher odds of being rated preventable while events with neutropenia, immunosuppression, gastrointestinal sources, polymicrobial cultures and Discussion Factors identified as associated with higher or lower preventability should be used to guide inclusion, exclusion and risk adjustment for an HOB- related quality metric. [ABSTRACT FROM AUTHOR]

At a high cost to the community and taxpayers, offenders frequently return to correctional facilities shortly after being released. In South Africa, the management of recidivism has not been researched extensively, and recidivism as a phenomenon has received scant attention. This study explores how the Department of Correctional Services in South Africa manages recidivism using the perspectives of staff and external stakeholders. A qualitative study was conducted with 19 Department of Correctional Services employees and ten external stakeholders. The findings postulate that South Africa's Department of Correctional Services (1) lacks defined policy guidelines, processes, or structure for addressing recidivism; (2) suggests a gap in the system as departments work independently within the Justice, Crime Prevention and Security Cluster (JCPS), which includes, among others, the Departments of Police, Home Affairs, Justice and Correctional Services; (3) recommends that the computer systems of the JCPS be integrated to manage recidivism, and the use of a criminal record number for the detection of recidivists; (4) identifies a need for the development of policy, policy procedures, and guidelines for managing repeat offending; and (5) a need for coherent research on the management of recidivism of offenders within the Department of Correctional Services in South Africa. [ABSTRACT FROM AUTHOR]

Introduction: Medical and nonmedical ketamine use is increasing in the United States. This will likely lead to an increase in emergency department (ED) visits in individuals experiencing associated side effects. Physicians will need to be able to effectively recognize and manage ketamine-related complications. Case Report: A 31-year-old male with a three-year history of inhalational, intramuscular, and intravenous nonmedical ketamine use presented to the ED twice within a week with symptoms of severe atraumatic back pain, abdominal pain, and dyspepsia. A comprehensive workup, including advanced imaging, was unrevealing for identifiable causes, and the patient was discharged with instructions for primary care follow-up for further evaluation. The patient used information shared on Reddit, an online forum and social network, to identify that the cause of his pain was related to chronic ketamine use. Subsequently, upon discontinuation of ketamine, the pain improved in 24 hours. The patient selfnavigated to addiction treatment. Conclusion: Emergency physicians should consider sequelae of chronic ketamine use as a possible cause for gastrointestinal and urologic symptoms in the ED. In addition to thorough examination and assessment for other acute medical problems, patients should be offered education, symptomatic treatment, and linkage to harm reduction and substance use disorder treatment services. [ABSTRACT FROM AUTHOR]

Purpose of Review: Communicating effectively with patients having a traditional, alternative or complementary medicine-related health-belief model is challenging in today's cross-cultural society. This narrative review explores the integrative medicine setting of care, focusing on insights from the integrative oncology daily practice, while addressing the relevance to the mental health setting. The way in which healthcare providers can enhance cultural-sensitive communication with patients and informal caregivers; recognize and respect health-beliefs to bridge cultural gaps; and generate an open, non-judgmental and mindful dialogue are discussed. Recent Findings: Identifying cross-cultural barriers to healthcare provider-patient communication is important in order to address the potential for conflict between conventional and "alternative" health beliefs; difficulties in creating a shared-decision making process; disagreement on therapeutic goals and treatment plan; and finally, the potential for non-compliance or non-adherence to the conventional oncology treatment. Summary: Acquiring intercultural competencies is needed at all stages of medical education, and should be implemented in medical and nursing curricula, as well as during specialization and sub-specialization. As with patient-centered paradigms of care, integrative medicine entails a dual patient-centered and sensitive-cultural approach, based on a comprehensive bio-psycho-social-spiritual model of care. [ABSTRACT FROM AUTHOR]

This case uses a financial accounting context to help instructors incorporate data analytics in the accounting curriculum. The case's flexible design allows it to be used in a data analytics or financial accounting course for instructors with little to no data analytics experience. For an analytics course, students extract, transform, and load fixed asset and depreciation data from a company's five sites. Students will then validate the accuracy and completeness of the data by creating visualizations. The case can be accomplished using any data analytics tool; Teaching Notes are presented using Power BI. The case and Teaching Notes include modifications for a financial accounting course where students are given data visualizations to identify depreciation anomalies (where no analytics software is required). An extension for audit courses is also discussed. The case serves to develop students' analytics skills while simultaneously reinforcing their understanding of depreciation concepts. [ABSTRACT FROM AUTHOR]

This editorial discusses the benefits of bringing academic research into the accounting classroom and the obstacles that prevent faculty from doing so. The author argues that incorporating research findings into the curriculum can enhance critical thinking, engage students, and demonstrate the relevance of accounting choices. However, limited class time, unfamiliarity with research outside of one's own area, and the lack of accessible materials pose challenges. The author suggests using learning strategies, such as turnkey materials, to bridge the gap between teaching and research. These strategies should present research findings in a student-friendly manner and include resources for faculty. The author concludes by highlighting the benefits for faculty in terms of research impact, professional development, and contributing to accounting education. [Extracted from the article]

Objectives: 17β‐estradiol (E2) is a steroidal hormone with immunomodulatory functions that play a role in infectious and inflammatory diseases. E2 was recently identified as the leading upstream regulator of differentially expressed genes in a comparative RNA sequencing study of pediatric patients with otitis media (OM) versus OM‐free counterparts and may therefore play a role in the inflammatory response to bacterial otopathogens during pediatric OM. This study examined the effect of E2 on bacterial‐induced inflammatory cytokine expression in an in vitro pediatric OM model. Methods: An immortalized middle ear (ME) epithelial cell line, ROM‐SV40, was developed from a pediatric recurrent OM patient. The culture was exposed to E2 at physiological levels for 1–48 h prior to 6 h‐stimulation with nontypeable Haemophilus influenzae (NTHi) whole cell lysate. TNFA, IL1B, IL6, and IL8 were assayed by qPCR and ELISA. Results: E2 pretreatment (24 h) abrogated NTHi induction of IL6; a longer pretreatment (1–10 nM, 48 h) abrogated IL1B induction (p < 0.05). E2 pretreatment (5 nM, 48 h) abrogated NTHi‐induced IL8 secretion (p = 0.017). Conclusion: E2 pretreatment partially rescued NTHi‐induced cytokine production by ME epithelia. These data support a role for E2 in moderating the excessive inflammatory response to middle ear infection that contributes to OM pathophysiology. Levels of Evidence: NA Laryngoscope, 134:3815–3819, 2024 [ABSTRACT FROM AUTHOR]

Background: Extracellular vesicles (EVs) are amongst the most promising candidates for developing blood-based biomarkers. However, patient sample availability is a key barrier to translational research whilst most biobanks store samples of 1.5mL volume or less. To date, there is no consensus on the most suitable method of EV separation and current techniques frequently require large volumes of biofluids, complicated technology, technical expertise, or significant operating costs, which prevents their widespread adoption by less EV-focussed laboratories. Therefore, there is a need for an easy and reproducible method that separates representative EVs from clinically relevant 1mL volumes of plasma prior to subsequent biomarker identification. Methods: In this study, EVs were separated from a clinically relevant 1mL volume of human plasma using four different separation techniques: size exclusion chromatography (SEC), differential ultracentrifugation, precipitation, and immunoaffinity magnetic bead capture. The EVs were characterised using several orthogonal techniques (protein quantification, nanoparticle tracking analysis, transmission electron microscopy, Western blot, single particle interferometric reflectance imaging sensing, and mass spectrometry-based proteomics) to comprehensively compare the separated samples. Results: We provide examples of anticipated results highlighting that SEC-processed samples have greater protein quantification yield, greater particle yield of the expected size for EVs, and sufficient EV purity, which facilitates effective EV cargo assessment by proteomics. Moreover, we confirm significant overlap with known EV-related proteins within the Vesiclepedia database. Additionally, using single particle interferometric reflectance imaging sensing (Leprechaun®), we identify that SEC has the most representative surface tetraspanin distribution of the separated EV population compared to unprocessed plasma. Discussion: Given that SEC requires minimal expertise, no complicated technology and can separate EVs within 90 min, this comparison reinforces SEC as a clinically relevant EV separation method from 1mL of plasma making it suitable for widespread implementation. [ABSTRACT FROM AUTHOR]

Popular evapotranspiration (ET) partitioning methods make assumptions that might not be well‐suited to dryland ecosystems, such as high sensitivity of plant water‐use efficiency (WUE) to vapor pressure deficit (VPD). Our objectives were to (a) create an ET partitioning model that can produce fine‐scale estimates of transpiration (T) in drylands, and (b) use this approach to evaluate how climate controls T and WUE across ecosystem types and timescales along a dryland aridity gradient. We developed a novel, semi‐mechanistic ET partitioning method using a Bayesian approach that constrains abiotic evaporation using process‐based models, and loosely constrains time‐varying WUE within an autoregressive framework. We used this method to estimate daily T and weekly WUE across seven dryland ecosystem types and found that T dominates ET across the aridity gradient. Then, we applied cross‐wavelet coherence analysis to evaluate the temporal coherence between focal response variables (WUE and T/ET) and environmental variables. At yearly scales, we found that WUE at less arid, higher elevation sites was primarily limited by atmospheric moisture demand, and WUE at more arid, lower elevation sites was primarily limited by moisture supply. At sub‐yearly timescales, WUE and VPD were sporadically correlated. Hence, ecosystem‐scale dryland WUE is not always sensitive to changes in VPD at short timescales, despite this being a common assumption in many ET partitioning models. This new ET partitioning method can be used in dryland ecosystems to better understand how climate influences physically and biologically driven water fluxes. Plain Language Summary: We developed a new model to better understand how plants use and lose water in drylands and applied it to seven dryland sites. Our model partitions evapotranspiration—the total water lost to the atmosphere from the Earth's surface— into its components. Evapotranspiration consists of both evaporation from wet surfaces, such as wet soil, and the water lost from plants when they photosynthesize. Currently, models assume a strong relationship between the efficiency with which plants use water ("water‐use efficiency") and the dryness of the atmosphere, but this violates what we know about how plants function in drylands. For example, in drylands many plants are adapted to very dry conditions and their water use can be less sensitive to increasing atmospheric dryness compared to plants from wet environments. Using this new model, we found that plant water‐use efficiency is only correlated with atmospheric dryness some of the time and that evapotranspiration is primary controlled by water lost from plants. This model allows us to better understand the importance of timescale and ecosystem type in governing plant water‐use dynamics and more accurately assess the potential impact of changing climate conditions on dryland water fluxes and ecosystem processes. Key Points: A new evapotranspiration partitioning model (DEPART) was developed using eddy covariance flux tower measurements in a Bayesian frameworkThis method produces daily estimates of transpiration and weekly estimates of plant water‐use efficiency at the ecosystem scaleThis method reveals water‐use efficiency is limited by moisture supply in more arid climates and moisture demand in less arid climates [ABSTRACT FROM AUTHOR]

Simple Summary: Uterine leiomyosarcoma (uLMS) is a rare and aggressive malignancy with treatments that have limited efficacy and often have significant toxicities. We previously demonstrated the presence of Notch signaling in uLMS as well as decreased cell viability and Notch expression after exposure to the gamma secretase inhibitor MK-0752. The aim of this study was to assess the combination of MK-0752 and chemotherapeutics commonly used for the treatment of uLMS. Using two human uLMS cell lines, SK-UT-1B and SK-LMS-1, we demonstrated synergism between MK-0752 and docetaxel, doxorubicin, and gemcitabine using MTT assays. These synergistic combinations were used in transwell invasion assays, cell cycle flow cytometry, proliferation assays, and RNA sequencing. We found decreased invasion, an increase in the apoptotic sub-G1 cell cycle population, and differentially expressed genes and altered KEGG pathways after combination treatment. The combinations of MK-0752 and doxorubicin, MK-0752 and docetaxel, and MK-0752 with gemcitabine and docetaxel are potential novel therapeutic approaches for uLMS. Due to limited effective therapeutics for uterine leiomyosarcoma (uLMS), the impact of the gamma secretase inhibitor (GSI) MK-0752 with common chemotherapeutics was explored in uLMS. MTT assays were performed on two human uLMS cell lines, SK-UT-1B and SK-LMS-1, using MK-0752, docetaxel, doxorubicin, and gemcitabine, individually and in combination, to determine cell viability after treatment. Synergistic combinations were used in transwell invasion assays, cell cycle flow cytometry, proliferation assays, and RNA sequencing. In SK-UT-1B, MK-0752 was synergistic with doxorubicin and gemcitabine plus docetaxel. In SK-LMS-1, MK-0752 was synergistic with all individual agents and with the combination of gemcitabine plus docetaxel. MK-0752, gemcitabine, and docetaxel decreased invasion in SK-UT-1B 2.1-fold* and in SK-LMS-1 1.7-fold*. In SK-LMS-1, invasion decreased 1.2-fold* after treatment with MK-0752 and docetaxel and 2.2-fold* after treatment with MK-0752 and doxorubicin. Cell cycle analysis demonstrated increases in the apoptotic sub-G1 population with MK-0752 alone in SK-UT-1B (1.4-fold*) and SK-LMS-1 (2.7-fold**), along with increases with all combinations in both cell lines. The combination treatments had limited effects on proliferation, while MK-0752 alone decreased proliferation in SK-LMS-1 (0.63-fold**). Both MK-0752 alone and in combination altered gene expression and KEGG pathways. In conclusion, the combinations of MK-0752 with either doxorubicin, docetaxel, or gemcitabine plus docetaxel are potential novel therapeutic approaches for uLMS. (* p < 0.05, ** p < 0.01). [ABSTRACT FROM AUTHOR]

In the quest for effective environmental governance, the integration of legal and cultural pluralism within conservation strategies emerges as a critical factor, especially in regions marked by rich ethnic diversity and complex historical legacies. This paper explores the symbiotic relationship between state conservation efforts and the engagement of local communities, with a particular focus on the Indigenous Maroon communities in the Blue and John Crow Mountains (BJCMs) of Jamaica. It underscores the imperative of aligning conservation objectives with the aspirations and traditional practices of these communities to foster sustainable ecosystems and safeguard Indigenous autonomy. Central to this discourse is the development of collaborative frameworks that respect and incorporate the legal and cultural dimensions of pluralism, thereby facilitating a co-managed approach to environmental stewardship. This study emphasizes the role of collaboration and trust as pivotal elements in cultivating a mutual understanding of the interdependencies between state law and Indigenous law. This research advocates for a reciprocal exchange of knowledge between the state and community members, aiming to empower the latter with the resources necessary for effective environmental protection while respecting their legal autonomy. This approach not only enhances conservation initiatives overall, but also ensures that these efforts are informed by the rich cultural heritage and traditional ecological knowledge of the Maroon communities. By examining the conservation practices and governance challenges faced by the Maroons in the BJCMs, this paper reveals the nuanced dynamics of implementing state-led conservation laws in areas characterized by cultural and legal pluralism. The findings highlight the necessity for state regulatory frameworks to enable collaborative governance models that complement, rather than undermine, the traditional governance structures of the Maroons. This research contributes to the broader discourse on environmental governance by illustrating the potential of culturally informed conservation strategies to address environmental threats while respecting and reinforcing the social fabric of Indigenous communities. [ABSTRACT FROM AUTHOR]

Important metapopulation dynamics are disrupted by factors such as habitat loss, climate change, and human-induced mortality, culminating in isolated wildlife populations and threatening species survival. Source populations, where birth rates exceed mortality and connectivity facilitates dispersal, contrast with sink populations, where mortality outstrips births, risking localised extinction. Recolonisation by individuals from source populations is pivotal for species survival. The leopard is the last free-roaming apex predator in South Africa and plays an important ecological role. In the Eastern and Western Cape provinces in South Africa, leopard populations have low densities and fragmented population structures. We identified a leopard population that, after being locally extinct for a century, appeared to recolonise an 'island' of mountainous habitat. We aimed to understand potential factors driving this recolonisation using recent camera trapping surveys and historical statutory destruction permits. We employed spatially explicit capture–recapture (SECR) methods to estimate the leopard density and explore potential factors which best explain density. We found that the recently recolonised Piketberg population now exhibits some of the highest densities reported in the region (~1.8 leopards/100 km2; CI 1.4–2.5). Livestock, human presence, elevation, and the camera trap grid appeared to explain leopard detection rates. When considering the historic data, the re-emergence of leopards in the Piketberg coincided with the cessation of the extensive state-sponsored and state-enabled culling of the species, and the change in land use from livestock production to crop agriculture, which likely contributed to the recolonisation. Elucidating these factors deepens our understanding of leopard metapopulation dynamics in relation to land use and species management and highlights the crucial role of private land and state agencies and associated policies in species persistence. [ABSTRACT FROM AUTHOR]

Purpose of the review: Children and adolescents with cancer, along with their parents and other informal caregivers, often report using complementary and alternative medicine (CAM) during active oncology and hemato-oncology treatment. Some adopt an "alternative" approach to conventional medical care, which often entails the use of these practices without the knowledge of the treating pediatrician. In contrast, many others search for consultation provided by a pediatric integrative oncology (IO) practitioner working with the conventional medical team. IO seeks to provide evidence-based complementary medicine therapies, many of which have been shown to augment conventional supportive and palliative care, while ensuring the patient's safety. The present narrative review examines the current state of and future direction for the IO setting of care. Recent findings: A large body of published clinical research supports the effectiveness of leading Pediatric IO modalities, while addressing potential safety-related concerns. Summary: Despite the growing amount of clinical research supporting the beneficial effects and implementation of Pediatric IO models of care, there is still a need for further studies in order to establish clinical guidelines in the treatment of children and adolescents with cancer. Such IO-directed guidelines will need to address both the effectiveness and the safety of the CAM modalities being used in pediatric oncology and hemato-oncology settings, promoting a better understanding among pediatric healthcare professionals and helping them understand the indications for referral to the IO treatment service. [ABSTRACT FROM AUTHOR]