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Accumulated carbon dioxide in the atmosphere is one of the driving factors in ocean acidification as oceanic absorption of carbon dioxide alters ocean chemistry. Lower concentrations of carbonate ions and higher concentrations of hydrogen ions in the water adversely affect marine organisms, including sea urchin larvae, that use calcium carbonate in their skeletal structures. While there is a wide body of literature demonstrating an impact of lowered pH on sea urchin larval development and survival, it is unclear if the method of pH manipulation and the species being studied influences the results. To address this, we compared two commonly employed pH manipulation methods, hydrochloric acid addition and carbon dioxide bubbling, for impacts on sea urchin development in Lytechinus variegatus. We also compared the effects of projected acidic ocean pH on larval development in L. variegatus and Arbacia punctulata. Regardless of species and pH manipulation method survivorship and aspects of skeletal features decreased as pH decreased. Counts of developmental abnormalities increased with decreasing pH. However, changes in size of specific skeletal features and prevalence of types of abnormalities observed varied with both pH manipulation method and species. Our results are consistent with previous studies showing a decrease in survivorship and skeletal size with lowered pH but indicate that the methods used to study effects of acidification on sea urchin larval development can affect the experimental outcomes and hinder making broad conclusions. Keywords: Sea urchin larval development, decrease ocean pH, L. variegatus, A. punctulata, INTRODUCTION Increased environmental carbon dioxide from anthropogenic activities poses a major threat to global climate and diversity and is the driving factor in ocean acidification (Keeling 1997). Carbon dioxide (C[O.sub.2]) [...]

In the present study, we explored the relationships between attachment styles, reflective functioning, and dimensions of emotion regulation in mothers of children diagnosed with combined type of ADHD. Participants were 336 mothers, 168 with children diagnosed with ADHD and 168 with children without any diagnosis. Preliminary results showed that mothers of children with ADHD had slightly lower levels of reflective functioning and cognitive reappraisal than mothers of children without ADHD did. Moreover, mothers of children with ADHD reported lower levels of secure attachment and a slightly higher levels of dismissing and anxious attachment than mothers of children without ADHD did. Focusing on the group of mothers of children with ADHD, the results showed that anxious and dismissing attachments were negatively associated with reflective functioning and that cognitive reappraisal partially mediated the relationship between the two attachment styles (anxious and dismissing) and reflective functioning. Theoretical and practical implications are provided., Author(s): Ugo Pace [sup.1] , Giulio D'Urso [sup.1] , Caterina Buzzai [sup.1] , Alessia Passanisi [sup.1] , Carla Zappulla [sup.2] Author Affiliations: (1) https://ror.org/04vd28p53, grid.440863.d, 0000 0004 0460 360X, University [...]

Oyster reefs are a primary source of calcium carbonate in most estuaries and the habitat complexity provided by these reefs supports a diversity of estuarine life. The available surface area of hard substrate on an oyster reef is critical for population maintenance, as this substrate provides habitat for the settlement of new oyster recruits. On natural reefs, the primary substrates available for settlement by spat include live oysters, boxes (dead articulated valves), and cultch (single oyster shells and shell fragments). Data from a long-term oyster monitoring program from February 2016 to October 2020 were used to generate a monthly time series of the percent of total carbonate weight contributed by live oysters, boxes, and cultch at four reefs in the Mississippi Sound. These percentages vary spatially and temporally. When reefs were healthy, live oysters dominated the total carbonate. During the study period, two mass mortality events occurred. Following the 2016 mortality event, the substrate contributing the majority of the carbonate shifted from live oysters to cultch at all reefs sampled. Three reefs exhibited a modest population recovery following the mortality event only to be impacted by a second, more severe mass mortality event in 2019. Boxes usually had the highest number of spat per gram carbonate at all reefs. The potential surface area (PSA) of each substrate type was calculated by comparing the available surface area of each substrate type and the number of spat that settled on each substrate. Correction factors were generated to account for larval settlement preferences and used to either debit or credit the PSA to calculate effective surface areas (ESA) for each substrate type. Cultch offered the highest ESA at Pass Christian, and cultch ESA was higher than box ESA at Henderson Point and Between Bridges reefs. At Bay St. Louis, box ESA was twice that of cultch. These results suggest cultch and boxes are more valuable settlement substrates than live oysters in this region under the conditions present during the survey time frame, which was characterized by low oyster abundance and aperiodic mass mortality. The unbalanced ESA, in which live oyster ESA is underrepresented, represents an unhealthy condition and demonstrates that a critical period exists for reef recovery after mass mortality in which the timely coincidence of increased box ESA and larval availability is essential for rapid recovery from mass mortality. KEY WORDS: Crassostrea, effective surface area, oyster reef, recruitment, mass mortality, population dynamics, recovery, INTRODUCTION The desperate state of the eastern oyster (Crassostrea virginica) over much of its US East- and Gulf-coast range, the accompanying loss of reefal area, and the responding investment into [...]

The provision of surgical care in Canada requires substantial improvement. In this commentary, we use the US Institute of Medicine's framework for assessing the quality of health care to explore system-wide challenges that affect surgical outcomes in Canada. Challenges include surgical wait times, long travel times for surgery, human resource constraints, equitable access to surgery, limited collection of data about the surgical pathway, a lack of transparency in the reporting of surgical outcomes and a lack of incentives for hospital systems to achieve high-quality outcomes. We propose solutions supported by available literature to help overcome some of these challenges., The provision of surgical care in Canada requires substantial improvement. Although surgical skill plays an important role affecting patient outcomes, the majority of surgical errors occur outside the operating room [...]

Objective To evaluate whether integrating breast and cervical cancer screening in Rwanda's Women's Cancer Early Detection Program led to early breast cancer diagnoses in asymptomatic women. Methods Launched in three districts in 2018-2019, the early detection programme offered clinical breast examination screening for all women receiving cervical cancer screening, and diagnostic breast examination for women with breast cancer symptoms. Women with abnormal breast examinations were referred to district hospitals and then to referral hospitals if needed. We examined how often clinics were held, patient volumes and number of referrals. We also examined intervals between referrals and visits to the next care level and, among women diagnosed with cancer, their initial reasons for seeking care. Findings Health centres held clinics > 68% of the weeks. Overall, 9763 women received cervical cancer screening and clinical breast examination and 7616 received breast examination alone. Of 585 women referred from health centres, 436 (74.5%) visited the district hospital after a median of 9 days (interquartile range, IQR: 3-19). Of 200 women referred to referral hospitals, 179 (89.5%) attended after a median of 11 days (IQR: 4-18). Of 29 women diagnosed with breast cancer, 19 were > 50 years and 23 had stage III or stage IV disease. All women with breast cancer whose reasons for seeking care were known (23 women) had experienced breast cancer symptoms. Conclusion in the short-term, integrating clinical breast examination with cervical cancer screening was not associated with detection of early-stage breast cancer among asymptomatic women. Priority should be given to encouraging women to seek timely care for symptoms. Recherche sur la mise en reuvre: integration des examens des seins dans le programme de depistage du cancer du col de l'uterus au Rwanda Objectif Evaluer si le fait d'integrer le depistage du cancer du sein et du col de l'uterus dans le Programme de detection precoce du cancer chez les femmes au Rwanda a permis de mieux diagnostiquer les cancers du sein chez les femmes asymptomatiques. Methodes Lance dans trois districts en 2018-2019, le programme de detection precoce proposait un examen clinique des seins a toutes les femmes effectuant un depistage du cancer du col de l'uterus et un examen diagnostique des seins a celles presentant des symptomes de cancer du sein. Les femmes ayant obtenu un resultat anormal lors de cet examen etaient ensuite transferees a des hopitaux de district et, si necessaire, a des hopitaux de reference. Nous nous sommes interesses a la frequence a laquelle les cliniques ont ete mises sur pied, au volume de patients et au nombre de transferts. Nous avons egalement analyse les intervalles entre les transferts et les visites au niveau de soins superieur et, pour les femmes atteintes d'un cancer, les raisons initiales qui les ont incitees a consulter. Resultats Les centres de sante ont organise des cliniques > 68% des semaines. De maniere generale, 9763 femmes ont ete soumises a un depistage du cancer du col de l'uterus et a un examen clinique des seins, tandis que 7616 d'entre elles n'ont fait l'objet que d'un examen des seins. Sur les 585 femmes transferees depuis les centres de sante, 436 (74,5%) se sont rendues dans l'hopital de district apres un delai median de neuf jours (ecart interquartile, EI: 3-19). Sur les 200 femmes renvoyees vers des hopitaux de reference, 179 (89,5%) s'y sont rendues apres un delai median de 11 jours (EI: 4-18). Enfin, sur les 29 femmes ayant recu un diagnostic de cancer du sein, 19 etaient agees de 50 ans et plus, et 23 souffraient d'un cancer de stade III ou IV. Toutes les femmes atteintes d'un cancer du sein ayant partage les raisons qui les ont poussees a consulter (23 femmes) avaient ressenti des symptomes de la maladie. Conclusion A court terme, integrer un examen clinique du sein lors d'un depistage du cancer du col de l'uterus n'a pas donne lieu a une detection precoce du cancer du sein chez les femmes asymptomatiques. La priorite est d'encourager les femmes a consulter rapidement des l'apparition de symptomes. Investigacion sobre la aplicacion: inclusion de las exploraciones mamarias en un programa de deteccion del cancer de cuello uterino, Ruanda Objetivo Evaluar si la integracion de la deteccion del cancer de mama y de cuello uterino en el Programa de Deteccion Temprana del Cancer en Mujeres de Ruanda permitio realizar diagnosticos tempranos de cancer de mama en mujeres asintomaticas. Metodos Lanzado en tres distritos entre 2018 y 2019, el programa de deteccion temprana ofrecia examenes clinicos de mama a todas las mujeres que se sometian al cribado del cancer de cuello uterino y examenes mamarios diagnosticos a las mujeres con sintomas de cancer de mama. Las mujeres con examenes de mama anormales eran derivadas a hospitales de distrito y, posteriormente, a hospitales de referencia si era necesario. Se examino la frecuencia de las consultas, el volumen de pacientes y el numero de derivaciones. Tambien se examinaron los intervalos entre las derivaciones y las visitas al siguiente nivel asistencial y, entre las mujeres diagnosticadas de cancer, sus motivos iniciales para buscar asistencia. Resultados Los centros sanitarios realizaron consultas >68% de las semanas. En total, 9763 mujeres se sometieron a deteccion del cancer de cuello uterino y examen clinico de las mamas, y 7616 solo a examen de las mamas. De 585 mujeres remitidas desde los centros sanitarios, 436 (74,5%) acudieron al hospital de distrito tras una mediana de 9 dias (rango intercuartilico, IQR: 3-19). De 200 mujeres remitidas a hospitales de referencia, 179 (89,5%) acudieron tras una mediana de 11 dias (IQR: 4-18). De 29 mujeres diagnosticadas de cancer de mama, 19 tenian [greater than or equal to] 50 anos y 23 presentaban enfermedad en estadio III o estadio IV. Todas las mujeres con cancer de mama, cuyos motivos de busqueda de atencion eran conocidos (23 mujeres) habian experimentado sintomas de cancer de mama. Conclusion A corto plazo, la integracion del examen clinico de las mamas con la deteccion del cancer de cuello uterino no se asocio con la deteccion temprana del cancer de mama entre las mujeres asintomaticas. Debe darse prioridad a animar a las mujeres a buscar atencion oportuna ante los sintomas., Introduction Breast cancer incidence is increasing rapidly in sub-Saharan Africa. Even though the age-standardized incidence rates of breast cancer in sub-Saharan Africa are still lower than in higher-income regions, women [...]

Long wait times for elective surgery in Canada have been a persistent problem for many years and the recent pandemic has made the situation substantially worse. Current evidence suggests that ambulatory surgery centres are more cost-effective and efficient in the delivery of ambulatory surgical services than larger institutions. We explore the merits of a network of publicly funded ambulatory surgery centres., Health care systems in Canada have been plagued by long wait times for elective surgery for many years, and the recent pandemic has made the situation substantially worse. The Canadian [...]

Populations of the eastern oyster (Crassostrea virginica) have experienced declines from overfishing and disease throughout much of its US range, though development of maximum sustainable yield (MSY) management criteria has been elusive. This is due in part to the discordance between oyster spawning stock and recruits, as the classic stock- recruitment model does not account for the requirement of shell substrate on which recruits settle. This issue was recently addressed with the development of a surface area-recruitment model, which is herein incorporated into a simulation analysis to estimate MSY-based reference points for C. virginica in the Delaware Bay. Simulations demonstrate that at low natural mortality, fishing mortality (F) may be sustainable at values between 10% and 15%; however, if disease or other mortality-enhancing processes occur, the margin of error in fishing is small and may quickly lead to population and reef collapse, emphasizing a precautionary F < 10%. The MSY-based reference points generated here provide rebuilding goals for the oyster fishery and reef management on fished and unfished reefs and the framework from which shell-planting can be incorporated and optimized in the future. Si les populations d'hurtres americaines (Crassostrea virginica) ont connu des declins dus a la surpeche et aux maladies dans la majeure partie de l'aire de repartition americaine de l'espece, l'elaboration de criteres de gestion bases sur le rendement equilibre maximal (REM) demeure problematique. Cela est du en partie a la discordance entre le stock reproducteur d'hurtres et les recrues, le modele stock-recrutement classique ne tenant pas compte de l'exigence d'un substrat de coquilles pour l'etablissement des recrues. L'elaboration recente d'un modele reliant la superficie au recrutement tente de resoudre ce probleme, et nous integrons ce modele a une analyse de simulation pour estimer des points de reference bases sur le REM pour C. virginica dans la baie du Delaware. Les simulations demontrent que, quand la mortalite naturelle est faible, la mortalite par peche (F) peut etre durable a des valeurs entre 10% et 15%, mais que si des maladies ou d'autres processus qui rehaussent la mortalite ont cours, la marge d'erreur associee a la peche est faible et pourrait rapidement mener a l'effondrement de la population et des recifs, d'ou l'importance, pour une approche prudente, de valeurs de F < 10%. Les points de reference bases sur le REM issus de la presente etude offrent des objectifs de reconstitution pour la peche a l'hurtre et la gestion des recifs exploites et non exploites, ainsi qu'un cadre a partir duquel le depot de coquilles peut etre incorpore et optimise. [Traduit par la Redaction], Introduction The use of biological reference points for sustainable management of commercial fisheries is well ensconced in the management of US federal fisheries, wherein achieving maximum sustainable yield (MSY) is [...]

PURPOSE To describe demographic and clinical characteristics of chronic obstructive pulmonary disease patients managed in US primary care. METHODS This was an observational registry study using data from the Chronic Obstructive Pulmonary Disease (COPD) Optimum Patient Care DARTNet Research Database from which the Advancing the Patient Experience COPD registry is derived. Registry patients were aged [greater than or equal to]35 years at diagnosis. Electronic health record data were collected from both registries, supplemented with patient-reported information/outcomes from the Advancing the Patient Experience registry from 5 primary care groups in Texas, Ohio, Colorado, New York, and North Carolina (June 2019 through November 2020). RESULTS: Of 17,192 patients included, 1,354 were also in the Advancing the Patient Experience registry. Patients were predominantly female (56%; 9,689/17,192), White (64%; 9,732/15,225), current/ex-smokers (80%; 13,784/17,192), and overweight/obese (69%; 11,628/16,849). The most commonly prescribed maintenance treatments were inhaled corticosteroid with a long-acting [[beta].sub.2]-agonist (30%) and inhaled corticosteroid with a long-acting muscarinic antagonist (27%). Although 3% (565/17,192) of patitents were untreated, 9% (1,587/17,192) were on short-acting bronchodilator monotherapy, and 4% (756/17,192) were on inhaled corticosteroid monotherapy. Despite treatment, 38% (6,579/17,192) of patients experienced 1 or more exacerbations in the last 12 months. These findings were mirrored in the Advancing Patient Experience registry with many patients reporting high or very high impact of disease on their health (43%; 580/1,322), a breathlessness score 2 or more (45%; 588/1,315), and 1 or more exacerbation in the last 12 months (50%; 646/1,294). CONCLUSIONS Our findings highlight the high exacerbation, symptom, and treatment burdens experienced by COPD patients managed in US primary care, and the need for more real-life effectiveness trials to support decision making at the primary care level. Key words: APEX; characterization; electronic medical records; patient reported outcomes; primary care, INTRODUCTION Chronic obstructive pulmonary disease (COPD) represents an important public health challenge that is preventable and treatable. (1) For the 16 million Americans who live with it, COPD carries a [...]

ABSTRACT: Catherine of Siena shows a particular penchant for Christ's blood piety, and her Letters reveal how many images connected to an experiential imitation of Christ's Passion are at the [...]

The aim of the present study was to explore the level of perceived workload of university professors and to evaluate related psychosocial risks, such as addiction to work, psychological distress, and work-life conflicts. A total of 252 professors, balanced for gender (Mean age = 48.1; DS: 5.1) from 10 different universities across Europe participated in the research. Participants completed the University's Work Environment Survey, the Dutch Workaholism Scale, and The General Health Questionnaire. The results showed that workload, when linked to bureaucratic university practices, is a predisposing factor to a negative perception of work-related well-being among university professors., Author(s): Francesco Pace [sup.1] , Giulio D'Urso [sup.2] , Carla Zappulla [sup.1] , Ugo Pace [sup.2] Author Affiliations: (1) grid.10776.37, 0000 0004 1762 5517, University of Palermo, , Palermo, Italy [...]

Background: Moving toward a funding standard similar to that for clinical services for roles essential to the functioning of education, research and leadership services within divisions of general surgery is necessary to strengthen divisional resilience. We aimed to identify roles and underlying tasks in these services central to sustainable functioning of Canadian academic divisions of general surgery. Methods: Between June 2018 and October 2020, we used a 4-step modified Delphi method (online survey, face-to-face nominal group technique [n = 12], semistructured telephone interview [n = 8] and nominal group technique [n = 12]) to achieve national consensus from an expert panel of all 17 heads of academic divisions of general surgery in Canada on the roles and accompanying tasks essential to education, research and leadership services within an academic division of general surgery. We used 70% agreement to determine consensus. Results: The expert panel agreed that a framework for role allocation in education, research and leadership services was relevant and necessary. Consensus was reached for 7 roles within the educational service, 3 roles within the research service and 5 roles within the leadership service. Conclusion: Our framework represents a national consensus that defines role standards for education, research and leadership services in Canadian academic divisions of general surgery. The framework can help divisions build resiliency, and enable sustained and deliberate advances in these services. Contexe : Il est nécessaire d'opérer une transition vers un modèle de financement standard, similaire à celui qui est appliqué aux services cliniques, pour les rôles essentiels au fonctionnement des services d'éducation, de recherche et de leadership à l'intérieur des divisions de chirurgie générale afin de rendre ces dernières plus résilientes. Nous avons voulu identifier les rôles et les tâches afférentes à ces services indispensables au fonctionnement durable des divisions de chirurgie générale dans les facultés de médecine canadienne. Méthodes : Entre juin 2018 et octobre 2020, nous avons utilisé une méthode Delphi modifiée en 4 étapes (sondage en ligne, technique de groupe nominal en personne [n = 12], entrevue téléphonique semi-structurée [n = 8] technique de groupe nominal [n = 12]) pour obtenir le consensus national d'un comité d'experts formé des 17 chefs de division de chirurgie générale au Canada au sujet des rôles et diverses tâches afférentes aux services dévolus à l'enseignement, à la recherche et au leadership dans les divisions de chirurgie générale. Nous avons utilisé un seuil d'assentiment de 70% pour déterminer le consensus. Résultats : Le comité d'experts a convenu qu'il était pertinent et nécessaire d'établir un cadre d'attribution des rôles en éducation, recherche et leadership. Un consensus a été atteint pour 7 rôles du segment éducation, 3 rôles du segment recherche et 5 rôles du segment leadership. Conclusion : Notre cadre représente un consensus national et définit les normes applicables aux rôles essentiels aux services en éducation, en recherche et en leadership dans les divisions de chirurgie générale au Canada. Ce cadre peut rendre les divisions plus résilientes, et favoriser leur développement de manière soutenue et délibérée., Academic divisions of general surgery in Canada are defined by 3 mandates that are core to their mission statements: 1) delivering excellent clinical care, 2) maintaining an accredited training program [...]

Purpose: This longitudinal study assessed continuity and stability of productive language (vocabulary and grammar) and discourse features (turn-taking; asking and responding to questions) during mother-child play. Method: Parent-child language use in 119 Spanish-speaking, Mexican immigrant mothers and their children at two ages (M = 2.5 and 3.6 years) was evaluated from transcriptions of interactions. Results: Child productive language significantly increased over the year, whereas mothers showed commensurate increases in vocabulary diversity but very little change in grammatical complexity. Mother-child discourse was characterized by discontinuity: Mothers decreased their turn length and asked fewer questions while children increased on both measures. Rates of responding to questions remained high for both mothers and children even as children increased and mothers decreased over time. Mothers and children showed significant rankorder stability in productive language and measures of discourse. Mothers' rate of asking questions and children's responses to questions during the first interaction predicted children's receptive vocabulary a year later. Conclusions: As children become more sophisticated communicators, language input remains important, with discourse features growing in relevance. Children's early opportunities to respond to parents' questions in the context of play benefit their language skills. This work extends the evidence base from monolingual English-speaking families and is interpreted in the context of prior research on parenting practices in U.S. families of Mexican origin., Current theories of language development highlight the transition from toddlerhood to the early preschool years as pivotal for semantic and syntactic development and children's acquisition of conversational discourse skills (Clark, [...]

A sustainable fisheries model for the estimation of harvests of oysters, maintenance of cultch, and restoration of reefs has been applied across the northern Gulf of Mexico. Oyster density and size, and cultch density are provided from surveys by State agencies. The model simulates oyster growth and mortality, and cultch loss. Reef shell mass is increased when oysters die in place and diminished when oysters are removed by fishing. Harvest is estimated as sacks of live oysters that can be removed while retaining reef quality (i.e., reef cultch mass, oyster density). Application of oyster density and cultch density standards (OCS) for fishing at maximum sustained yield shows little sustainable harvest on Public Grounds in the northern Gulf of Mexico. Model heuristics focus discovery of negative and positive feedbacks to reef demise or persistence. Oyster reef dynamics are viewed as persistent processes within negative and positive feedback loops, and occasional shifts between them. A negative feedback loop is set up on poor-quality reefs. Lack of cultch and a paucity of adult oysters diminish recruitment and shell replenishment. In the absence of recruitment, natural shell loss ultimately drives the reef to extinction. A positive feedback loop is set up on reefs with adequate cultch and an abundance of oysters. There, oysters set. survive critical early stages in boxes and reef interstices, reproduce, grow to a large size, and die in place. Harvests on high-quality reefs beyond that which maintains reef cultch and spawning stock, and consequential recruitment failure cause a shift from a positive to a negative feedback loop. Likewise, restricting harvests and planting cultch on poor-quality reefs, together with successful recruitment, promotes a shift from a negative to a positive state. Results of no-net loss of cultch (NNL) and OCS simulations suggest two distinct management approaches. The NNL promotes the sustainability of reef shell and assumes that a stable shell bed promotes a stable living resource, whereas OCS explicitly promotes the sustainability of cultch and stock at msy (maximum-sustainable-yield). Furthermore, OCS, which incorporates optimal reef cultch and oyster density standards, provides restoration benchmarks. Achieving sustainability at msy will simultaneously promote habitat restoration, restoration of ecosystem services, and a sustainable oyster fishery. KEY WORDS: Crassostrea virginica, maximum sustainable yield, reference points, cultch management, fishery management, eastern oyster, INTRODUCTION The eastern oyster Crassostrea virginica, is responsible for creating one of the primary habitat types in the estuaries of the northern Gulf of Mexico. The animal supports a commercial [...]

Waller Creek is a flood-prone stream that runs through the center of Austin, Texas. To quote Joseph Jones, an English professor who published a 1982 treatise on the waterway, Waller [...]

Background: Aboriginal people have higher prevalence rates of diabetes than non-Aboriginal people in the same geographic locations, and diabetic foot ulcer (DFU) complication rates are also presumed to be higher. The aim of this systematic review and meta-analysis was to compare DFU outcomes in Aboriginal and non-Aboriginal populations. Methods: We searched PubMed, Embase, CINAHL and the Cochrane Library from inception to October 2018. Inclusion criteria were all types of studies comparing the outcomes of Aboriginal and non-Aboriginal patients with DFU, and studies from Canada, the United States, Australia and New Zealand. Exclusion criteria were patient age younger than 18 years, and studies in any language other than English. The primary outcome was the major amputation rate. We assessed the risk of bias using the ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions) tool. Effect measures were reported as odds ratio (OR) with 95% confidence interval (CI). Results: Six cohort studies with a total of 244 792 patients (2609 Aboriginal, 242 183 non-Aboriginal) with DFUs were included. The Aboriginal population was found to have a higher rate of major amputation than the non-Aboriginal population (OR 1.85, 95% CI 1.04-3.31). Four studies were deemed to have moderate risk of bias, and 2 were deemed to have serious risk of bias. Conclusion: Our analysis of the available studies supports the conclusion that DFU outcomes, particularly the major amputation rate, are worse in Aboriginal populations than in non-Aboriginal populations in the same geographic locations. Rurality was not uniformly accounted for in all included studies, which may affect how these outcome differences are interpreted. The effect of rurality may be closely intertwined with ethnicity, resulting in worse outcomes. Contexte : Le taux de prevalence du diabete chez les Autochtones depasse celui chez les Allochtones des memes regions geographiques. On presume qu'il en va de meme pour le taux de complications d'un ulcere du pied diabetique (UPD). Le but de cette revue systematique et de cette meta-analyse etait de comparer les issues d'UPD dans les populations autochtones et allochtones. Methodes : Nous avons interroge PubMed, Embase, CINAHL et la Bibliotheque Cochrane, de leur creation jusqu'a octobre 2018. Les criteres d'inclusion etaient tous les types d'etudes comparant les resultats de patients autochtones et allochtones atteints d'UPD, et la realisation au Canada, aux Etats-Unis, en Australie ou en Nouvelle-Zelande. Les patients de moins de 18 ans et les etudes dans une langue autre que l'anglais ont ete exclus. L'issue primaire etait le taux d'amputation majeure. Nous avons evalue le risque de biais a l'aide de l'outil ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions). Les mesures de l'effet sont donnees sous forme de rapport de cotes (RC) avec intervalle de confiance (IC) de 95 %. Resultats : Nous avons inclus 6 etudes de cohortes totalisant 244 792 patients atteints d'UPD (2609 Autochtones et 242 183 Allochtones). La population autochtone presentait un taux d'amputation majeure plus eleve que celle allochtone (RC 1,85; IC de 95 % 1,04-3,31). Le risque de biais etait juge modere pour 4 etudes et important pour les 2 autres. Conclusion : Notre analyse des etudes disponibles confirme l'hypothese voulant que les issues d'UPD, en particulier le taux d'amputation majeure, soient pires chez les Autochtones que chez les Allochtones d'une meme region. La prise en compte de la ruralite variait entre les etudes, ce qui pourrait fausser l'interpretation des disparites. Il est possible que l'incidence de la ruralite soit plus etroitement liee a l'ethnicite, causant ainsi une hausse des issues defavorables., The health outcomes of Aboriginal populations in Canada, Australia, New Zealand and the United States have been frequently studied and discussed. These populations have higher disease prevalence rates than the [...]

Spastic paraplegia 50 (SPG50) is an ultrarare childhood-onset neurological disorder caused by biallelic loss-of- function variants in the AP4M1 gene. SPG50 is characterized by progressive spastic paraplegia, global Developmental delay, and subsequent intellectual disability, secondary microcephaly, and epilepsy. We preformed preclinical studies evaluating an adeno-associated virus (AAV)/AP4M1 gene therapy for SPG50 and describe in vitro studies that demonstrate transduction of patient-derived fibroblasts with AAV2/AP4M1, resulting in phenotypic rescue. To evaluate efficacy in vivo, Ap4m1- KO mice were intrathecally (i.t.) injected with 5 * [10.sup.11], 2.5 * [10.sup.11], or 1.25 * [10.sup.11] vector genome (vg) doses of AAV9/AP4M1 at P7-P10 or P90. Age- and dose-dependent effects were observed, with early intervention and higher doses achieving the best therapeutic benefits. In parallel, three toxicology studies in WT mice, rats, and nonhuman primates (NHPs) demonstrated that AAV9/AP4M1 had an acceptable safety profile up to a target human dose of 1 * [10.sup.15] vg. Of note, similar degrees of minimal-to-mild dorsal root ganglia (DRG) toxicity were observed in both rats and NHPs, supporting the use of rats to monitor DRG toxicity in future i.t. AAV studies. These preclinical results identify an acceptably safe and efficacious dose of i.t.- administered AAV9/AP4M1, supporting an investigational gene transfer clinical trial to treat SPG50., Introduction Hereditary spastic paraplegia 50 (SPG50; OMIM: 612936) is an ultrarare childhood-onset neurological disorder characterized by progressive spastic paraplegia, global Developmental delay, and subsequent intellectual disability, secondary microcephaly, early-onset epilepsy, [...]

The ocean quahog, Arctica islandica, is a commercially important species on the northwestern Atlantic continental shelf. This species can live over 200 years with ages varying widely per 5-mm size class (shell length), making study of age-related demographics difficult. To determine how the demography of this species differs across its range, including age frequencies, age-at-length relationships, and sex ratios, ocean quahogs from multiple sites distributed from the Mid-Atlantic Bight to Georges Bank were studied. The age and length frequencies from two populations collected in 2019 from New Jersey, north and south of Hudson Canyon (39.840556 N, 72.821667 W and 39.33 N, 73.545 W, respectively), were analyzed and compared to two other populations from Long Island (40.09658 N, 73.01057 W) and Georges Bank (40.72767 N, 67.79850 W), previously collected in 2015 and 2017. Sex-specific differences were also analyzed to determine how said differences influenced a range of demographic metrics. Though some similarities in recruitment trends exist, likely caused by large-geographic-scale environmental conditions, each site contains a distinct population with distinct demographics. Recruitment is consistent over hundreds of years, but year-to-year and decadal-length variations are apparent. One age-length key may potentially be used to represent Long Island and northern New Jersey, but the remaining sites are significantly dissimilar. Sex ratios also vary, potentially caused by differential survival of one sex during certain times in the past. Mortality rates for Georges Bank are distinctly higher compared to the other populations. Based on these results, the use of separate age-length keys would seem necessary for each population and each sex., Author(s): Jillian R. Sower [sup.1] , Eric N. Powell [sup.1] , Roger Mann [sup.2] , Kathleen M. Hemeon [sup.1] [sup.3] , Sara M. Pace [sup.1] , Theresa E. Redmond [sup.2] [...]

The boreal bivalve Arctica islandica is an important fishery in the United States (US), yet very little is known about the resiliency of this species to fishing activity due to limited understanding of localized population demographics. Demographics including age frequency, recruitment patterns, mortality rates, and sexual dimorphism were evaluated for a population sampled off Long Island (LI, 40.09658°N 73.01057°W) and compared with samples from Georges Bank (GB, 40.72767°N, 67.79850°W) collected in 2015 and 2017, where GB was described in a previous study. This study supports evidence that this species is sexually dimorphic. Earlier assumptions of prolonged lapses in recruitment were not substantiated for either the GB or LI populations; yearly cohorts were observed for the past century, and both populations presented recruitment pulses in approximately 8-y periods. Estimated ages from this study are older than previously reported for the US Mid-Atlantic with the oldest animal represented by a 310-year-old male collected from LI. Simulated total mortality was higher at GB than LI, and higher for GB females than GB males, with simulated mean longevity estimates greater at LI than GB. The population sex ratio at GB was 1:1.1 (female:male), whereas the LI ratio was 1:1.4 and relatively deficient in large females. Recruitment into the populations occurs routinely with substantial hiatuses being rare and substantive year classes occurring at least decadally with lesser, but contributing, recruitment in most years in between. Routine recruitment may insulate this species from risks posed by overfishing to an extent not typical for other long-lived species., Author(s): Kathleen M. Hemeon [sup.1] [sup.3] , Eric N. Powell [sup.1] , Sara M. Pace [sup.1] , Roger Mann [sup.2] , Theresa E. Redmond [sup.2] Author Affiliations: (1) grid.267193.8, 0000 [...]

Ocean quahogs (Arctica islandica) are the longest lived bivalve on Earth. Individuals on the deep continental shelf off Georges Bank can survive for centuries, and in the colder, boreal waters of Iceland, ages over 500 y can be reached. Ocean quahog landings in the United States represent a $24 million industry, yet assessment models operate with no age data because of the substantial sample size required to develop adequate population age distributions for such a long-lived species, the unknown error associated with age estimates, and the extensive time and financial investment required to create production-scale age datasets. Inclusion of age data for this species requires precision metrics to evaluate aging uncertainty such as percent agreement, percent error, coefficient of variation, and tests of bias. To move forward using error-validated age-composition data, a 3-fold error protocol was developed using a large dual-reader dataset (n = 610) from Georges Bank. First, a proxy age-validation study was performed to corroborate an aging method, followed by error evaluation in the context of age-reader bias, precision, and error frequency. Error thresholds were established for each of the three error methods. Georges Bank samples ranged from 33 to 261 y of age and met the predetermined error thresholds for bias (conditionally because of significant and nonsignificant results), precision (average coefficient of variation less than 7%), and error frequency (less than 10%). Consequently, age estimates were deemed acceptable to support age frequency analyses. Precision and bias error were greatest for the youngest animals and, in the context of age-reader bias, error rates were higher for young male ocean quahogs than for young females. Improved age validation of young, sex-differentiated A. islandica will constrain aging error and guide refinement of both aging and age-error protocols. KEY WORDS: ocean quahog, Aretha islandica, error, precision, bias, age-reader, INTRODUCTION Calcified structures (e.g., fish otoliths, vertebrae, coral skeletons. and bivalve shells) are commonly used to age animals in the marine realm (Hudson 1981, Pentilla & Dery 1988, Richardson 2001). [...]

Background: The federal Cannabis Act came into force on Oct. 17, 2018, in Canada, making Canada only the second country in the world to legalize the cultivation, acquisition, possession and consumption of cannabis and its by-products. This provided a unique opportunity to evaluate the impact of this legislation on drug-related trauma. Methods: We performed a prospective observational study on the use of cannabis and other illicit drugs in the trauma population at a lead Canadian trauma centre in London, Ontario, in the 3 months before (July 1 to Sept. 30, 2018) and 3 months after (Nov. 1, 2018, to Jan. 31, 2019) the legalization of cannabis in Canada. We defined cannabis use as a positive cannabinoid screen result at the time of assessment by the trauma team. We also screened for opioids, amphetamines and cocaine. Results: A total of 210 patients were assessed by our trauma service between July 1 and Sept. 30, 2018, and 141 patients were assessed between Nov. 1, 2018, and Jan. 31, 2019. Motor vehicle collisions were the most common cause of trauma both before (101 [48.1%]) and after (67 [47.5%]) legalization. The mean Injury Severity Score was 17.6 (standard deviation [SD] 13.0) and 19.7 (SD 14.8), respectively. Drug screens were done in 88 patients (41.9%) assessed before legalization and 99 patients (70.2%) assessed after legalization. There was no difference in the rate of positive cannabinoid screen results before and after legalization (22 [25%] v. 22 [22%]). There was a trend toward higher rates of positive cannabinoid screen results (2/10 [20%] v. 5/8 [62%]) and positive toxicology screen results (5/10 [50%] v. 6/8 [75%]) after legalization among patients with penetrating trauma, but our sample was too small to achieve statistical significance. Conclusion: We found no difference in the rates of positive cannabinoid screen results among patients assessed at our trauma centre in the 3 months before and the 3 months after legalization of cannabis; however, there was a trend toward an increase in the rates of positive results of toxicology screens and cannabinoid screens among those with penetrating trauma. These preliminary single-centre data showing no increased rates of cannabis use in patients with trauma after legalization are reassuring. Contexte: La Loi federate sur le cannabis est entree en vigueur ici le 17 octobre 2018, faisant du Canada le second pays a legaliser la culture, l'acquisition, la possession et la consommation du cannabis et de ses produits derives. Cette situation fournit une occasion unique d'evaluer l'impact de cette loi sur les traumatismes lies aux drogues. Methodes: Nous avons procede a une etude d'observation prospective sur la con-sommation du cannabis et d'autres drogues illicites chez une population de victimes de traumatismes dans un grand centre canadien de traumatologie de London, en Ontario, au cours des 3 mois precedant (1er juillet au 30 septembre 2018) et des 3 mois suivant (1er novembre 2018 au 31 janvier 2019) la legalisation du cannabis au Canada. La consommation de cannabis etait confirmee par l'obtention de resultats positifs aux tests de depistage des cannabino'ides demandes par l'equipe de traumatologie. Nous avons aussi effectue un depistage des opio'ides, des amphetamines et de la cocaine. Resultats: En tout, notre service de traumatologie a vu 210 patients entre le 1er juillet et le 30 septembre 2018, et 141 entre le 1er novembre 2018 et le 31 janvier 2019. Les accidents de la route ont ete la plus frequente cause de traumatisme avant (101 [48,1 %]) et apres (67 [47,5 %]) la legalisation. L'indice moyen de gravite des blessures a ete de 17,6 (ecart-type [E.-T.] 13,0) et 19,7 (E.-T. 14,8), respectivement. Un depistage de drogues a ete effectue chez 88 patients (41,9 %) vus avant la legalisation et chez 99 patients (70,2 %) vus apres la legalisation. On n'a observe aucune difference quant aux taux de resultats positifs aux tests de depistage des cannabino'ides enregistres avant et apres la legalisation (22 [25 %] c. 22 [22 %]). Les taux de resultats positifs aux tests de depistage des cannabino'ides (2/10 [20 %] c. 5/8 [62 %]) et aux tests toxicologiques (5/10 [50 %] c. 6/8 [75 %]) ont eu tendance a etre plus eleves apres la legalisation chez les patients victimes de traumatismes penetrants, mais notre echantillon etait trop petit pour atteindre une portee statistique. Conclusion: Nous n'avons observe aucune difference quant aux taux de resultats positifs au depistage des cannabino'des au cours des 3 mois precedant et suivant la legalisation du cannabis; par contre, les taux de resultats positifs aux tests de depistage des drogues et du cannabis ont eu tendance a etre plus eleves chez les victimes de trau-matismes penetrants. Ces donnees preliminaires provenant d'un seul centre qui ne montrent pas d'augmentation des taux de consommation de cannabis chez les poly-traumatises sont rassurantes., On Oct. 17, 2018, the federal Cannabis Act came into force in Canada, making this country only the second country in the world to legalize the cultivation, acquisition, possession and [...]

The phenomenon of hating is becoming common in adolescence, but it has been rarely investigated. The study aimed to examine the relationships between hating behaviors, maladaptive personality traits, and cognitive distortions, and to explore whether cognitive distortions might intervene in the relationship between personality traits and hating. Method: Participants (200 boys and 202 girls) completed the Hating Adolescents Test (HAT), the Personality Inventory for DSM-5-Brief Form-Children (PID-5), and the How I Think Questionnaire (HITQ). Results: Preliminary results showed significant gender differences in the study's variables: boys reported higher scores than girls on hating and on cognitive distortion minimizing, whereas no significant differences emerged on maladaptive personality traits. The mediation model showed that the cognitive distortion blaming others mediated the relationship between psychoticism and hating. Conclusions: Data suggested a mediating role of cognitive distortion blaming others in the relationship between psychoticism trait and hating behaviors., Author(s): Ugo Pace [sup.1] , Giulio D'Urso [sup.1] , Carla Zappulla [sup.2] Author Affiliations: (1) grid.440863.d, 0000 0004 0460 360X, Kore University of Enna, , Cittadella Universitaria, 94100, Enna, Italy [...]

Defects in DNA repair frequently lead to neurodevelopmental and neurodegenerative diseases, underscoring the particular importance of DNA repair in long-lived post-mitotic neurons.sup.1,2. The cellular genome is subjected to a constant barrage of endogenous DNA damage, but surprisingly little is known about the identity of the lesion(s) that accumulate in neurons and whether they accrue throughout the genome or at specific loci. Here we show that post-mitotic neurons accumulate unexpectedly high levels of DNA single-strand breaks (SSBs) at specific sites within the genome. Genome-wide mapping reveals that SSBs are located within enhancers at or near CpG dinucleotides and sites of DNA demethylation. These SSBs are repaired by PARP1 and XRCC1-dependent mechanisms. Notably, deficiencies in XRCC1-dependent short-patch repair increase DNA repair synthesis at neuronal enhancers, whereas defects in long-patch repair reduce synthesis. The high levels of SSB repair in neuronal enhancers are therefore likely to be sustained by both short-patch and long-patch processes. These data provide the first evidence of site- and cell-type-specific SSB repair, revealing unexpected levels of localized and continuous DNA breakage in neurons. In addition, they suggest an explanation for the neurodegenerative phenotypes that occur in patients with defective SSB repair. DNA single-strand breaks in neurons accumulate at high levelsin functional enhancers., Author(s): Wei Wu [sup.1] , Sarah E. Hill [sup.2] , William J. Nathan [sup.1] [sup.3] , Jacob Paiano [sup.1] , Elsa Callen [sup.1] , Dongpeng Wang [sup.1] , Kenta Shinoda [...]

This study examined attitudes toward transracial adoption held by 104 African American master of social work (MSW) students. Consistent with previous studies, the students considered transracial adoption to be a [...]

Context: The PeRson EmPowered Asthma RElief (PREPARE) study was a pragmatic open-label randomized trial that tested a patient empowered approach to using inhaled corticosteroids together with short-acting bronchodilators as rescue therapy to reduce exacerbations in two highly impacted groups with asthma. This study used a mixed modal survey approach (i.e., mail, phone, online) to ensure equitable and convenient access to monthly surveys and optimize response rates. Respondents selected their preference for completing surveys. This sub-study examines respondent characteristics by selection of survey modality. Objectives: 1). Describe respondent characteristics by main modality used to complete surveys. 2). Explore differences in respondent characteristics across survey modalities. Study Design and Analysis: Sub-study of the PREPARE study, describing characteristics of the cohort by survey modality choice are presented. Dataset: Baseline assessment and monthly surveys. Population Studied: Adults, 18-75 years, who self-identified as African American/Black (AA/B) or Hispanic/Latinx (H/L) and had a clinical diagnosis of moderate to severe asthma. Total of 603 AA/B and 598 H/L participants enrolled at 19 family medicine and subspecialty sites in the U.S. and Puerto Rico. Intervention/Instrument: Baseline assessment included respondent characteristics. Monthly surveys assessed asthma symptoms, exacerbations, missed work/school or usual activities, and medication use. Respondents were asked to complete 13-15 monthly surveys. Outcome Measures: Baseline respondent characteristics, survey modality selection, and survey completion rates. Results: Overall, a >90% survey response rate was achieved. The majority of participants (68%) filled out most of their surveys online, 27% by telephone, 3% by paper. Survey modality choice differed by responders' race/ethnicity, language, age, education, and income. Conclusions: Providing options to complete survey had a positive impact on response rates. Findings from this study show that there are differences in survey modality utilization and respondents characteristics. Online and telephone survey options were widely utilized; mail option was selected infrequently and could be dropped in the future., Presenters Brian Manning, MPH, Maureen Fagan, DNP, FNP-BC, FAAN, Jean Kruse, Joel Shields, MA, Elizabeth Staton, MSTC, Wilson Pace, MD, FAAFP, Juan Carlos Cardet, MD, MPH, Alicia Brooks-Greisen, Anne Fuhlbrigge, [...]

Stock-recruitment relationships (SRR) are used by many resource managers as a metric to evaluate stock reproductive potential and rebuilding capacity when harvested. This relationship is more evident in traditional finfish stock assessment models where larvae are frequently limited by the abundance of spawning adults, whereas invertebrate resources are much more confounding and often do not express a clear spawning SRR. Oysters in particular appear to be limited more strongly by post-settlement mortality as larvae are regularly demonstrated to be present in high abundance in response to timely shell plants; yet unexpectedly, a brood SRR appears to be present. Because of the unique life history of oysters which provide their own habitat through reef accretion, a posit is that the quantity and quality of such habitat are crucial determinants of recruitment to the stock, and habitat quality acts as a surrogate for brood stock in the stock-recruit relationship. An extensive dataset from Delaware Bay with a 65-y time series was analyzed to assess the relationship between available Crassostrea virginica natural reef materials and subsequent spat ( KEY WORDS: Crassostrea virginica, stock-recruitment relationship, shell surface area, salinity, Delaware Bay. substrate preference, INTRODUCTION Stock-recruitment relationships (SRR) are pivotal parameters used in most modern fishery assessments to estimate stock resiliency (Ricker 1954, Beverton & Holt 1957, Paulik 1973, Ricker 1975, Hilborn & Walters [...]