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Introduction: Cluster randomised trials (CRTs) are the gold standard for measuring the community-wide impacts of malaria control tools. CRTs rely on well-defined sample size estimations to detect statistically significant effects of trialled interventions, however these are often predicted poorly by triallists. Here, we review the accuracy of predicted parameters used in sample size calculations for malaria CRTs with epidemiological outcomes., Methods: We searched for published malaria CRTs using four online databases in March 2022. Eligible trials included those with malaria-specific epidemiological outcomes which randomised at least six geographical clusters to study arms. Predicted and observed sample size parameters were extracted by reviewers for each trial. Pair-wise Spearman's correlation coefficients (r s ) were calculated to assess the correlation between predicted and observed control-arm outcome measures and effect sizes (relative percentage reductions) between arms. Among trials which retrospectively calculated an estimate of heterogeneity in cluster outcomes, we recalculated study power according to observed trial estimates., Results: Of the 1889 records identified and screened, 108 articles were eligible and comprised of 71 malaria CRTs. Among 91.5% (65/71) of trials that included sample size calculations, most estimated cluster heterogeneity using the coefficient of variation (k) (80%, 52/65) which were often predicted without using prior data (67.7%, 44/65). Predicted control-arm prevalence moderately correlated with observed control-arm prevalence (r s : 0.44, [95%CI: 0.12,0.68], p-value < 0.05], with 61.2% (19/31) of prevalence estimates overestimated. Among the minority of trials that retrospectively calculated cluster heterogeneity (20%, 13/65), empirical values contrasted with those used in sample size estimations and often compromised study power. Observed effect sizes were often smaller than had been predicted at the sample size stage (72.9%, 51/70) and were typically higher in the first, compared to the second, year of trials. Overall, effect sizes achieved by malaria interventions tested in trials decreased between 1995 and 2021., Conclusions: Study findings reveal sample size parameters in malaria CRTs were often inaccurate and resulted in underpowered studies. Future trials must strive to obtain more representative epidemiological sample size inputs to ensure interventions against malaria are adequately evaluated., Registration: This review is registered with PROSPERO (CRD42022315741)., (© 2024. The Author(s).)

Venom systems are complex traits that have independently emerged multiple times in diverse plant and animal phyla. Within each venomous lineage there typically exists interspecific variation in venom composition where several factors have been proposed as drivers of variation, including phylogeny and diet. Understanding these factors is of broad biological interest and has implications for the development of antivenom therapies and venom-based drug discovery. Because of their high species richness and the presence of several major evolutionary prey shifts, venomous marine cone snails (genus Conus) provide an ideal system to investigate drivers of interspecific venom variation. Here, by analyzing the venom gland expression profiles of ∼3,000 toxin genes from 42 species of cone snail, we elucidate the role of prey-specific selection pressures in shaping venom variation. By analyzing overall venom composition and individual toxin structures, we demonstrate that the shifts from vermivory to piscivory in Conus are complemented by distinct changes in venom composition independent of phylogeny. In vivo injections of venom from piscivorous cone snails in fish further showed a higher potency compared with venom of nonpiscivores demonstrating a selective advantage. Together, our findings provide compelling evidence for the role of prey shifts in directing the venom composition of cone snails and expand our understanding of the mechanisms of venom variation and diversification., (© The Author(s) 2024. Published by Oxford University Press on behalf of Society for Molecular Biology and Evolution.)

In Tanzania, about 600 000 youth between 5 and 24 years old have a disability. Individuals with disabilities face numerous obstacles due to social stigma. The aim of this formative evaluation is to assess how caregivers of children with correctable disabilities (e.g., cleft lip/palate, club foot, and burn scar contractures) in Tanzania perceive their community's acceptance of their child before and after surgical treatment. Semi-structured interviews were conducted with 80 caregivers of children with disabilities treated at Kafika House in Arusha, Tanzania. The constant comparative method identified themes regarding the caregivers' feelings on their child's functional abilities and experiences of stigma in their community. Caregiver perceptions of stigma before and after surgical treatment were categorized and quantified as 'positive', 'neutral' and 'negative'. Thematic analysis of the 80 interviews resulted in five major themes: (1) stigma and acceptance (pre-treatment) and (2) post-treatment; (3) functional abilities (pre-treatment) and (4) post-treatment; and (5) emotional impact (pre- and post-treatment). These themes indicate caregivers and their children experience a range of emotional impacts before and after treatment, more severe stigma before treatment, and overall better social, emotional and functional status after treatment. Frequency analysis of caregiver experiences indicated that stigma experienced by children and their families decreased from 75% before surgical treatment to 2.5% after surgery. Surgical intervention and rehabilitation of physical disabilities mitigated experiences of social stigma for both children and their caregivers. Findings support the need for expanded treatment of correctable disabilities, larger investments in community-based rehabilitation programmes and further interventions to support stigmatized parents and their children., (© 2024 John Wiley & Sons Ltd.)

Background: The need for improved spiritual care education is a national directive, prompting many nursing and medical education programs to respond with spiritual curriculum. This article reports on research that tested an educational intervention to enhance nursing and medical students' understanding of end-of-life communication with families., Method: This mixed-methods study included three reflection questions to ascertain students' attitudes about their own death and dying., Results: Many of the students' responses were spiritual in nature. Findings revealed two important misconceptions about death and one educational strategy that can be used to help students identify potential sources of spiritual discomfort in clinical situations., Conclusion: The findings offer a glimpse into the attitudes and beliefs of nursing and medical students that could influence how they view and deliver spiritual care, contributing to the evidence base for spiritual care education and curriculum. [ J Nurs Educ . 2023;62(11):601-605.] .

Understanding body malodour in a measurable manner is essential for developing personal care products. Body malodour is the result of bodily secretion of a highly complex mixture of volatile organic compounds. Current body malodour measurement methods are manual, time consuming and costly, requiring an expert panel of assessors to assign a malodour score to each human test subject. This article proposes a technology-based solution to automate this task by developing a custom-designed malodour score classification system comprising an electronic nose sensor array, a sensor readout interface and a machine learning hardware fabricated on low-cost flexible substrates. The proposed flexible integrated smart system is to augment the expert panel by acting like a panel assessor but could ultimately replace the panel to reduce the test and measurement costs. We demonstrate that it can classify malodour scores as good as or even better than half of the assessors on the expert panel., (© 2023. The Author(s).)

Background: Spurred by the Coronavirus infectious disease 2019 pandemic, aerosol containment devices (ACDs) were developed to capture infectious respiratory aerosols generated by patients at their source. Prior reviews indicated that such devices had low evidence of effectiveness, but did not address how ACDs should be evaluated, how well they should perform, nor have clearly defined performance standards. Towards developing design criteria for ACDs, two questions were posed: 1) What characteristics have guided the design of ACDs? 2) How have these characteristics been evaluated?, Methods: A scoping review was performed consistent with PRISMA guidelines. Data were extracted with respect to general study information, intended use of the device, device design characteristics and evaluation., Results: Fifty-four articles were included. Evaluation was most commonly performed with respect to device aerosol containment (n = 31, 61%), with only 5 (9%), 3 (6%) and 8 (15%) formally assessing providing experience, patient experience and procedure impact, respectively. Nearly all of the studies that explored provider experience and procedure impact studied intubation. Few studies provided a priori performance criteria for any evaluation metric, or referenced any external guidelines by which to bench mark performance., Conclusion: With respect to aerosol containment, ACDs should reduce exposure among HCP with the device compared with the absence of the device, and provide ≥90% reduction in respirable aerosols, equivalent in performance to N95 filtering facepiece respirators, if the goal is to reduce reliance on personal protective equipment. The ACD should not increase awkward or uncomfortable postures, or adversely impact biomechanics of the procedure itself as this could have implications for procedure outcomes. A variety of standardized instruments exist to assess the experience of patients and healthcare personnel. Integration of ACDs into routine clinical practice requires rigorous studies of aerosol containment and the user experience., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Rachael Jones reports financial support was provided by US Department of Defense. Niles Andrus reports financial support was provided by National Institute for Occupational Safety and Health. Thomas Dominguez reports financial support was provided by US Airforce., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Monitoring the condition (water quality, biodiversity, hydromorphology) of small water bodies presents a challenge for the relevant authorities in terms of time and resources (labour and financial) due to the extensive length of the stream network or the sheer number of small standing water bodies. Citizen science can help address information gaps, but the effort required should not be underestimated if such projects are to generate reliable and sustained data collection. The overall aim of this paper is to propose a framework for operationalisation of citizen science targeting collection of data from small water bodies. We first consider the data gaps and the elements (water chemistry, ecology, hydromorphology) to be addressed, in order to define where citizen science could best make an impact. We review examples of tools and methods that are appropriate for small water bodies, based on experience from a selection of freshwater citizen science projects, and the support that is needed for effective and sustained small water body projects across Europe., Competing Interests: Conflict of interestThe authors have no competing interests to declare that are relevant to the content of this article., (© The Author(s) 2022.)

(1) Background: Cyanobacteria produce a wide range of secondary metabolites, including tumor-promoting hepatotoxins. We recently reported evidence of an independent association between oral cyanobacteria and hepatocellular carcinoma in a U.S. population. We sought to characterize the nature, sources, and health correlates of cyanotoxin exposure in the U.S. Pacific Island territory of Guam, which has a high incidence of liver cancer. (2) Methods: Seventy-four adult males and females were enrolled in a cross-sectional study to quantify cyanotoxins in saliva, urine, and blood and their correlation with health behaviors, medical history, and environmental exposures. Plant samples were collected from locations throughout the island. Microcystin/nodularin (MC/NOD), cylindrospermopsin (CYN), and anabaenopeptin (AB) were measured in biospecimens and in plant extracts by ELISA. (3) Results: Overall, among study participants MC/NOD were detected in 53.9% of saliva, 7.5% of urine, and 100% of serum.; CYN in 40.0% of saliva, 100.0% of urine, and 70.4% of serum; AB in 30.8% of saliva, 85% of urine, and 92.6% of serum. Salivary MC/NOD levels were significantly higher in individuals using municipal tap water as their primary source of drinking water; both salivary and urinary MC/NOD levels were higher in those not using store-bought/commercial water. Urine MC/NOD levels were highest among individuals consuming fruits and vegetables exclusively from local sources. Urine MC/NOD levels were elevated in individuals with hypertension and hyperlipidemia and salivary MC/NOD in those with recent alcohol consumption. Cyanotoxins were prevalent in plant samples including MC/NOD (46.6%), CYN (35.1%), and AB (51.7%). (4) Conclusions: Our study provides evidence that exposure to cyanobacterial hepatotoxins, including tumor promoters, may be prevalent in Guam and may originate from environmental sources. Population-based epidemiologic studies are needed to investigate the role of cyanotoxins in liver cancer development.

Purpose: This pilot intervention aims to reduce stigma towards children with disabilities living in family-based care., Materials and Methods: Kusamala + is a pre-post evaluation of a pilot community-based intervention in two low-income compounds in Lusaka, Zambia. Door-to-door canvassing and community referrals were used to identify and enroll children with disabilities. Parents/guardians and community members completed surveys regarding stigma and support. Health professionals supervised, trained, and provided ongoing support for 2-3 community caregivers (CCGs). CCG's provided home-based education, referrals, playgroups, and social support for 20-25 families each. Community events were held at health facilities, churches and community spaces to reduce community-level stigma towards children with disabilities., Results: Staff identified 632 children with disabilities. Staff completed over 4500 home visits, 288 children joined playgroups, made 775 referrals, and over 23,000 attended community sensitization events. Longitudinal data was available for 129 families with a child with a disability. Over one year, families and community members reported less perceived rejection by family and peers but less agreement that children with disabilities should be treated the same as other children., Conclusion: Kusamala + was a feasible, acceptable and broad reach with limited program impact. Future work will incorporate lessons learned with a focus on sustainability and scalability.Implications for rehabilitationChildren with disability are often hidden and isolated in low- and middle-income countries (LMIC), particularly in low-resource communities.Stigma towards children with disabilities continues in LMIC and further reduces that child's ability to engage fully in social and civic life.Community- and home-based programming is a feasible and acceptable approach to engaging with community and families with a child with a disability.The identification and referral of additional children with disabilities to physiotherapy and other government services can provide additional strain on already limited resources.Once a pilot program is deemed acceptable and feasible, any further design planning must include considerations for sustainability and scalability.System strengthening is a key component of sustainability and scalability to ensure success in planning, implementation, monitoring and evaluation.

Aseismic afterslip is postseismic fault sliding that may significantly redistribute crustal stresses and drive aftershock sequences. Afterslip is typically modeled through geodetic observations of surface deformation on a case-by-case basis, thus questions of how and why the afterslip moment varies between earthquakes remain largely unaddressed. We compile 148 afterslip studies following 53 M w 6.0-9.1 earthquakes, and formally analyze a subset of 88 well-constrained kinematic models. Afterslip and coseismic moments scale near-linearly, with a median Spearman's rank correlation coefficient (CC) of 0.91 after bootstrapping (95% range: 0.89-0.93). We infer that afterslip area and average slip scale with coseismic moment as M o 2 / 3 and M o 1 / 3 , respectively. The ratio of afterslip to coseismic moment ( M rel ) varies from <1% to >300% (interquartile range: 9%-32%). M rel weakly correlates with M o (CC: -0.21, attributed to a publication bias), rupture aspect ratio (CC: -0.31), and fault slip rate (CC: 0.26, treated as a proxy for fault maturity), indicating that these factors affect afterslip. M rel does not correlate with mainshock dip, rake, or depth. Given the power-law decay of afterslip, we expected studies that started earlier and spanned longer timescales to capture more afterslip, but M rel does not correlate with observation start time or duration. Because M rel estimates for a single earthquake can vary by an order of magnitude, we propose that modeling uncertainty currently presents a challenge for systematic afterslip analysis. Standardizing modeling practices may improve model comparability, and eventually allow for predictive afterslip models that account for mainshock and fault zone factors to be incorporated into aftershock hazard models., (© 2022. The Authors.)

Background: Due to challenges in measuring changes in malaria at low transmission, serology is increasingly being used to complement clinical and parasitological surveillance. Longitudinal studies have shown that serological markers, such as Etramp5.Ag1, can reflect spatio-temporal differences in malaria transmission. However, these markers have yet to be used as endpoints in intervention trials., Methods: Based on data from a 2017 cluster randomised trial conducted in Zambezi Region, Namibia, evaluating the effectiveness of reactive focal mass drug administration (rfMDA) and reactive vector control (RAVC), this study conducted a secondary analysis comparing antibody responses between intervention arms as trial endpoints. Antibody responses were measured on a multiplex immunoassay, using a panel of eight serological markers of Plasmodium falciparum infection - Etramp5.Ag1, GEXP18, HSP40.Ag1, Rh2.2030, EBA175, Pf MSP1 19 , Pf AMA1, and Pf GLURP.R2., Findings: Reductions in sero-prevalence to antigens Etramp.Ag1, Pf MSP1 19 , Rh2.2030, and Pf AMA1 were observed in study arms combining rfMDA and RAVC, but only effects for Etramp5.Ag1 were statistically significant. Etramp5.Ag1 sero-prevalence was significantly lower in all intervention arms. Compared to the reference arms, adjusted prevalence ratio (aPR) for Etramp5.Ag1 was 0.78 (95%CI 0.65 - 0.91, p  = 0.0007) in the rfMDA arms and 0.79 (95%CI 0.67 - 0.92, p  = 0.001) in the RAVC arms. For the combined rfMDA plus RAVC intervention, aPR was 0.59 (95%CI 0.46 - 0.76, p < 0.0001). Significant reductions were also observed based on continuous antibody responses. Sero-prevalence as an endpoint was found to achieve higher study power (99.9% power to detect a 50% reduction in prevalence) compared to quantitative polymerase chain reaction (qPCR) prevalence (72.9% power to detect a 50% reduction in prevalence)., Interpretation: While the observed relative reduction in qPCR prevalence in the study was greater than serology, the use of serological endpoints to evaluate trial outcomes measured effect size with improved precision and study power. Serology has clear application in cluster randomised trials, particularly in settings where measuring clinical incidence or infection is less reliable due to seasonal fluctuations, limitations in health care seeking, or incomplete testing and reporting., Funding: This study was supported by Novartis Foundation (A122666), the Bill & Melinda Gates Foundation (OPP1160129), and the Horchow Family Fund (5,300,375,400)., Competing Interests: MSH declares research grants to her institution from Novartis Foundation, Bill & Melinda Gates Foundation and Horchow Foundation to conduct the cluster randomised trial. IK declares research grants to Wits Health Consortium from the Bill & Melinda Gates Foundation to conduct the cluster randomised trial and to support field visits and attendance at project meetings and scientific conferences related to the trial. DM declares research grants to the University of Namibia from Novartis Foundation and the Bill & Melinda Gates Foundation via a subaward from UCSF. JLS declares receiving salary from the Bill & Melinda Gates Foundation grant that co-funded the study., (© 2022 The Author(s).)

Globally, 15,521 animal species are listed as threatened by the International Union for the Conservation of Nature, and of these less than 3% have genomic resources that can inform conservation management. To combat this, global genome initiatives are developing genomic resources, yet production of a reference genome alone does not conserve a species. The reference genome allows us to develop a suite of tools to understand both genome-wide and functional diversity within and between species. Conservation practitioners can use these tools to inform their decision-making. But, at present there is an implementation gap between the release of genome information and the use of genomic data in applied conservation by conservation practitioners. In May 2020, we launched the Threatened Species Initiative and brought a consortium of genome biologists, population biologists, bioinformaticians, population geneticists, and ecologists together with conservation agencies across Australia, including government, zoos, and nongovernment organizations. Our objective is to create a foundation of genomic data to advance our understanding of key Australian threatened species, and ultimately empower conservation practitioners to access and apply genomic data to their decision-making processes through a web-based portal. Currently, we are developing genomic resources for 61 threatened species from a range of taxa, across Australia, with more than 130 collaborators from government, academia, and conservation organizations. Developed in direct consultation with government threatened-species managers and other conservation practitioners, herein we present our framework for meeting their needs and our systematic approach to integrating genomics into threatened species recovery., Competing Interests: Competing interest statement: All authors are members of the Threatened Species Initiative Steering Committee., (Copyright © 2022 the Author(s). Published by PNAS.)

Introduction: Missed appointments are a problem for health care systems, causing lost revenue and concern for poor health outcomes. This is particularly true at Community Health Centers (CHCs), where clients may already face substantial barriers to optimal care and outcomes. Identified solutions to this problem are limited, and often focus on reminder calls and messages to clients. Methods: This project utilized a unique academic/CHC collaboration to investigate and initiate solutions to their high missed appointment rates. Client phone calls to determine clinic specific needs, monthly team meetings to brainstorm and choose initiatives, engaging stake holders, and phased implementation were the tools used to address the high missed appointment rates within the limitations of the clinic resources available. Results: Within one quarter, missed appointment rates at the clinic dropped by 6%-17% for different appointment types. Conclusion: While the project was interrupted due to the pandemic, early outcomes were promising and the model may be helpful to other CHCs with similar concerns.

Radar (SAR) satellites systematically acquire imagery that can be used for volcano monitoring, characterising magmatic systems and potentially forecasting eruptions on a global scale. However, exploiting the large dataset is limited by the need for manual inspection, meaning timely dissemination of information is challenging. Here we automatically process ~ 600,000 images of > 1000 volcanoes acquired by the Sentinel-1 satellite in a 5-year period (2015-2020) and use the dataset to demonstrate the applicability and limitations of machine learning for detecting deformation signals. Of the 16 volcanoes flagged most often, 5 experienced eruptions, 6 showed slow deformation, 2 had non-volcanic deformation and 3 had atmospheric artefacts. The detection threshold for the whole dataset is 5.9 cm, equivalent to a rate of 1.2 cm/year over the 5-year study period. We then use the large testing dataset to explore the effects of atmospheric conditions, land cover and signal characteristics on detectability and find that the performance of the machine learning algorithm is primarily limited by the quality of the available data, with poor coherence and slow signals being particularly challenging. The expanding dataset of systematically acquired, processed and flagged images will enable the quantitative analysis of volcanic monitoring signals on an unprecedented scale, but tailored processing will be needed for routine monitoring applications., Supplementary Information: The online version contains supplementary material available at 10.1007/s00445-022-01608-x., (© The Author(s) 2022.)

Over the past two decades, multidisciplinary studies have unearthed a rich history of volcanic activity and unrest in the densely-populated East African Rift System, providing new insights into the influence of rift dynamics on magmatism, the characteristics of the volcanic plumbing systems and the foundation for hazard assessments. The raised awareness of volcanic hazards is driving a shift from crisis response to reducing disaster risks, but a lack of institutional and human capacity in sub-Saharan Africa means baseline data are sparse and mitigating geohazards remains challenging., (© 2021. The Author(s).)

Background: Public stigma, or negative community-held beliefs, about children with disabilities (CWDs) often leads to negative outcomes for CWD and their families. This study considers the effectiveness of four community-level interventions to reduce public stigma in two Lusaka, Zambia communities., Methods: This feasibility study describes four community-based interventions to provide education to consider whether perceptions of attitudes and stigma towards CWD changed after implementing four educational interventions., Results: Results revealed that these interventions were achievable. Preliminary multiple regression analyses indicated a significant impact of attending an event on the attitude scale, while no effect on the stigma scale. Presence at multiple anti-stigma events exhibited no effect for the stigma scale, while the attitude scale showed significance., Discussion: This study builds on the limited research available in low-income countries to reduce public stigma towards CWD, with the hope of enhance quality of life for CWD and their families., (© 2021 John Wiley & Sons Ltd.)

Persistent global health inequities and workforce shortage require innovative strategies to prepare professionals for teamwork in a global context. Over two years, students (n = 33) from education, nursing, occupational therapy, public health, and physical therapy participated in a course in Zambia that emphasized interprofessional collaborative practice (IPP), cultural fluency, and understanding ecological approaches to health. Faculty measured the learning outcomes of the course using the Interprofessional Education Collaborative (IPEC) Competency Self-Assessment Tool (pre and posttest), and a focus group to gain a deeper understanding of the student experience and course effectiveness. The Beliefs, Events and Values Inventory (BEVI) was used post trip to determine feasibility of distribution and response of the tool via e-mail. These preliminary results suggested that students developed skills and knowledge related to IPP, cultural fluency, and ecological approaches to health. Specifically, students acknowledged growth in their ability to communicate more effectively with other health professions, and ability to evaluate personal assumptions and biases toward health, healthcare, and cultural practices. The method of developing this course could be a model for other institutions wanting to grow IPP experiences for their students.

Objective: To describe the outcome and associated complications with the use of peripherally inser ted central venous catheters in neonates, and to identify risk factors associated with the presence of major complications., Subjects and Method: Analytical study of the follow-up of catheters placed in 541 neonates hospitalized in a neonatal intensive care unit. Outcome and complications were descri bed. To assess risk factors associated with major complications, multivariate logistic regression analy sis was used., Results: 655 catheters were placed in 541 infants with birth-weight ranging from 420g to 4.575g. The mean duration was 11.6 ± 8.5 days. 29 patients (4.4%) presented major complications, and associated bloodstream infection was the most frequent (n = 17), determining an infection rate of 2.25 %o catheter days. Infections were more frequent among catheters lasting > 14 days: 9/179 (5%) vs 8/476 (1.7%) of those lasting ≤ 14 days (p < 0.05). Other complications included: pleural effusion due to extravasation (n = 6) and atrial thrombosis (n = 3). Multivariate analysis showed that the presence of major complications was associated with a gestational age < 28 weeks: OR 5.9 (95% CI 1.2 to 40), and upper extremities use: OR 3.2 (95% CI 1.1-7.0). Infections were associated with a greater number of punctures during placement: OR 2.1 (95% CI 1.2-4.8) for each puncture and ges tational age < 28 weeks: OR 7.9 (95% CI: 1.4-73)., Conclusion: The use of catheters was long-lasting and with a low rate of major complications, which were more common in extremely preterm infants. Infections were associated with an increased number of punctures and duration > 14 days. Other complications were more frequent when upper extremities insertion was used.

Increasing the precision of nitrogen (N) fertiliser management in cropping systems is integral to increasing the environmental and economic sustainability of cropping. In a simulation study, we found that natural variability in year-to-year climate had a major effect on optimum N fertiliser rates for sugarcane in the Tully region of north-eastern Australia, where N discharges pose high risks to Great Barrier Reef ecosystems. There were interactions between climate and other factors affecting crop growth that made optimum N rates field-specific. The regional average optimum N fertiliser rate was substantially lower than current industry guidelines. Likewise, simulated N losses to the environment at optimum N fertiliser rates were substantially lower than the simulated losses at current industry fertiliser guidelines. Dissolved N discharged from rivers is related to fertiliser applications. If the reductions in N applications identified in the study occurred in the Tully region, the reduction in dissolved N discharges from rivers in the region would almost meet current water quality improvement targets. Whilst there were many assumptions made in this exploratory study, and there are many steps between the study and a practically implemented dynamic N fertiliser recommendation system, the potential environmental benefits justify field validation and further development of the concepts identified in the study., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Nearly 50 years ago, Intel created the world's first commercially produced microprocessor-the 4004 (ref. 1 ), a modest 4-bit CPU (central processing unit) with 2,300 transistors fabricated using 10 μm process technology in silicon and capable only of simple arithmetic calculations. Since this ground-breaking achievement, there has been continuous technological development with increasing sophistication to the stage where state-of-the-art silicon 64-bit microprocessors now have 30 billion transistors (for example, the AWS Graviton2 (ref. 2 ) microprocessor, fabricated using 7 nm process technology). The microprocessor is now so embedded within our culture that it has become a meta-invention-that is, it is a tool that allows other inventions to be realized, most recently enabling the big data analysis needed for a COVID-19 vaccine to be developed in record time. Here we report a 32-bit Arm (a reduced instruction set computing (RISC) architecture) microprocessor developed with metal-oxide thin-film transistor technology on a flexible substrate (which we call the PlasticARM). Separate from the mainstream semiconductor industry, flexible electronics operate within a domain that seamlessly integrates with everyday objects through a combination of ultrathin form factor, conformability, extreme low cost and potential for mass-scale production. PlasticARM pioneers the embedding of billions of low-cost, ultrathin microprocessors into everyday objects., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Increasing insecticide costs and constrained malaria budgets could make universal vector control strategies, such as indoor residual spraying (IRS), unsustainable in low-transmission settings. We investigated the effectiveness and cost-effectiveness of a reactive, targeted IRS strategy., Methods: This cluster-randomised, open-label, non-inferiority trial compared reactive, targeted IRS with standard IRS practice in northeastern South Africa over two malaria seasons (2015-17). In standard IRS clusters, programme managers conducted annual mass spray campaigns prioritising areas using historical data, expert opinion, and other factors. In targeted IRS clusters, only houses of index cases (identified through passive surveillance) and their immediate neighbours were sprayed. The non-inferiority margin was 1 case per 1000 person-years. Health service costs of real-world implementation were modelled from primary and secondary data. Incremental costs per disability-adjusted life-year (DALY) were estimated and deterministic and probabilistic sensitivity analyses conducted. This study is registered with ClinicalTrials.gov, NCT02556242., Findings: Malaria incidence was 0·95 per 1000 person-years (95% CI 0·58 to 1·32) in the standard IRS group and 1·05 per 1000 person-years (0·72 to 1·38) in the targeted IRS group, corresponding to a rate difference of 0·10 per 1000 person-years (-0·38 to 0·59), demonstrating non-inferiority for targeted IRS (p<0·0001). Per additional DALY incurred, targeted IRS saved US$7845 (2902 to 64 907), giving a 94-98% probability that switching to targeted IRS would be cost-effective relative to plausible cost-effectiveness thresholds for South Africa ($2637 to $3557 per DALY averted). Depending on the threshold used, targeted IRS would remain cost-effective at incidences of less than 2·0-2·7 per 1000 person-years. Findings were robust to plausible variation in other parameters., Interpretation: Targeted IRS was non-inferior, safe, less costly, and cost-effective compared with standard IRS in this very-low-transmission setting. Saved resources could be reallocated to other malaria control and elimination activities., Funding: Joint Global Health Trials., (Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objective: This study investigates if higher utilization of physical therapist assistants adversely affects patient outcomes in the acute rehabilitation setting for patients following a cerebrovascular accident (CVA)., Methods: Participants were admitted to 1 of 5 inpatient rehabilitation facilities following a CVA from 2008 to 2010. High physical therapist assistant use was defined as ≥20% of the physical therapist visits being provided by the physical therapist assistant for an episode of care. Multivariable regression techniques examined differences in functional outcome, discharge location, and length of stay between high and low physical therapist assistant use groups. Propensity scoring methods supplemented findings of the regression analyses., Results: Of the 1561 participants, 496 (32%) had high physical therapist assistant involvement. Baseline participant characteristics such as age, sex, baseline motor function, and comorbidities did not differ between high and low physical therapist assistant use groups. After adjusting for patient characteristics, rehabilitation facility, and year, higher physical therapist assistant use did not adversely affect functional outcome or length of stay. Fewer conclusions can be drawn regarding discharge location, although there was no significant difference in discharge location between groups with high and low physical therapist assistant utilization. Propensity scoring methods supported the findings of the regression analyses., Conclusions: Higher physical therapist assistant involvement in the rehabilitation of patients following CVA did not adversely affect functional outcome, increase length of stay, or reduce the likelihood of discharge to home from an inpatient rehabilitation facility., Impact: The results demonstrate the value of the physical therapist assistant in the provision of physical therapy for patients with stroke in the inpatient rehabilitation setting. Higher involvement of the physical therapist assistant may provide cost savings while maintaining patient outcomes for this setting and population., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Diffuse pollution of surface waters by herbicides remains a problem despite 25 years of research into mitigation approaches. This study adopts the grassweed herbicide propyzamide as a focus to compare the efficacy of technical, field-scale, interventions with systems-based cropping solutions in a 900 ha headwater catchment on heavy clay soils. Catchment monitoring was combined with modelling of land management options using SWAT, and semi-structured discussions with farmers. Vegetated buffers are the main mitigation in the catchment at present, and these are estimated to be halving propyzamide concentrations in the headwater stream. Increasing vegetated buffers to 20 m width around all water courses would be the most effective technical intervention. Collaboration between farmers to ensure differentiated application timings would be ineffective without precise forecasting to avoid application soon before storm events. Downstream pesticide limits could only be met by restricting the area of land treated with propyzamide, requiring a switch away from oilseed rape cultivation. This restriction was not acceptable to farmers who noted the lack of enablers for coordination between landowners and the need for pesticide targets that are specific to headwater catchments., Competing Interests: Declaration of competing interest The authors confirm that they have no competing interests., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background . Disrupted sleep is common after traumatic brain injury (TBI) particularly in the inpatient rehabilitation setting where it may affect participation in therapy and outcomes. Treatment of sleep disruption in this setting is varied and largely unexamined. Objective . To study the feasibility of instituting a sleep hygiene intervention on a rehabilitation unit. Methods . Twenty-two individuals admitted to a brain injury unit were enrolled and allocated, using minimization, to either a sleep hygiene protocol (SHP) or standard of care (SOC). All participants wore actigraphs, underwent serial cognitive testing, and had light monitors placed in their hospital rooms for 4 weeks. Additionally, participants in the SHP received 30 minutes of blue-light therapy each morning, had restricted caffeine intake after noon, and were limited to 30-minute naps during the day. SHP participants had their lights out time set according to preinjury sleep time preference. Both groups were treated with the same restricted formulary of centrally acting medications. Results . Of 258 patients screened, 27 met all study inclusion criteria of whom 22 were enrolled. Nine participants in each group who had at least 21 days of treatment were retained for analysis. The protocol was rated favorably by participants, families, and staff. Actigraph sleep metrics improved in both groups during the 4-week intervention; however, only in the SHP was the change significant. Conclusions . Sleep hygiene is a feasible, nonpharmacologic intervention to treat disrupted sleep in a TBI inpatient rehabilitation setting. A larger study is warranted to examine treatment efficacy. ClinicalTrials.gov Identifier: NCT02838082.

Total body irradiation (TBI) is a complex treatment technique, which has been slow to transition to a three-dimensional (3D) planning approach. There is limited literature available providing a detailed description on methods to plan TBI on a 3D planning system. 3D planning using the modulated arc TBI (MATBI) technique is a complex process involving a significant number of quality assurance processes and scripts, due to more than 40 treatment beams and two patient positions. This article will focus on the workflow and technical planning aspects of our institution's MATBI technique and identify reasons for modifications made to the developing institution's original MATBI approach. Included is a description of specific simulation equipment, detailed explanation of the four-stage computing process including the role of scripting to standardise and streamline what is otherwise a complex number of steps. The information provided is specific to one centre's approach but shows the fundamental planning process and demonstrates a streamlined method, which can be adapted to other planning systems. Overall, the ability to accurately represent the TBI technique in 3D on a planning system will be shown., (© 2019 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.)

Competing Interests: Competing interests: None declared.

Thermal and mechanical models of magma reservoir growth need to be reconciled with deformation patterns and structural relationships observed at active magma systems. Geophysical observations provide a series of short time-scale snap-shots (10 0 -10 2 years) of the long-term growth of magmatic bodies (10 3 -10 6 years). In this paper, we first review evidence for the growth of magmatic systems along structural features and the associated deformation patterns. We then define three distinct growth stages, (1) aligned melt pockets, (2) coalesced reservoirs, (3) highly evolved systems, which can be distinguished using short-term surface observations. We use two-dimensional thermal models to provide first-order constraints on the time scales and conditions associated with coalescence of individual magma bodies into large-scale reservoirs. We find that closely spaced intrusions (less than 1 km apart) can develop combined viscoelastic shells over time scales of 10s kyr and form laterally extensive mush systems over time scales of 10-100 kyr. The highest temperatures and melt fractions occur during a period of thermal relaxation after melt injection has ceased, suggesting that caldera-forming eruptions may preferentially occur long after the main intrusive activity. The coalescence of eruptible melt-rich chambers only occurs for the highest melt supply rates and deepest systems. Thus, these models indicate that, in most cases, conductive heat transfer alone is not sufficient for a full coalescence of magma chambers and that other processes involving mechanical ruptures and mush mobilization are necessary; individual melt lenses can remain isolated for long periods within growing mush systems, and will only mix during eruption or other catastrophic events. The long-term history of the magmatic system is therefore critical in determining rheological structure and hence short-term behaviour. This framework for the development of magmatic systems in the continental crust provides a mechanical basis for the interpretation of unrest at the world's largest volcanoes. This article is part of the Theo Murphy meeting issue 'Magma reservoir architecture and dynamics'.

Forecasting explosive eruptions relies on using monitoring data to interpret the patterns and timescales of magma transport and mixing. In September 2017, a distal seismic swarm triggered the evacuation of around 140,000 people from Agung volcano, Bali. From satellite imagery and 3D numerical models, we show that seismicity was associated with a deep, sub-vertical magma intrusion between Agung and its neighbour Batur. This, combined with observations of the 1963 eruption which caused more than thousand fatalities, suggests a vertically and laterally interconnected system experiencing recurring magma mixing. The geometry of the 2017 dyke is consistent with transport from a deep mafic source to a shallow andesitic reservoir controlled by stresses induced by the topographic load, but not the regional tectonics. The ongoing interactions between Agung and Batur have important implications for interpretation of distal seismicity, the links between closely spaced arc volcanoes, and the potential for cascading hazards.

Objective : Disrupted sleep is common during acute recovery from traumatic brain injury (TBI) and has been linked to daytime agitation. This study investigated the relationship among nighttime sleep efficiency (SE), total sleep time (TST), wakefulness after sleep onset (WASO), and number of wake bouts (NWB) as measured by actigraphy to observer ratings of agitation for patients with TBI who were undergoing inpatient rehabilitation. Methods : This is a retrospective, observational study of a convenience sample of 65 individuals admitted to TBI inpatient rehabilitation who were monitored with actigraphy and the Agitated Behaviour Scale (ABS) for the first 72 h. Each patient's average SE, TST, WASO, and NWB for the 72-h period was calculated using actigraphy for the rest interval from 2100 to 0700. Daily ABS scores were obtained for each day following the nighttime sleep period. Results : Patients were not significantly different on age, gender, etiology of injury, days post-injury, rehabilitation length of stay, or severity of injury as measured by length of posttraumatic amnesia (PTA). SE and TST were significantly lower for patients with agitation than for patients without agitation. Conclusions : This study suggests a relationship between disrupted sleep and agitation for patients with TBI who are undergoing inpatient rehabilitation.

Three related new alkylphenols, termed anaephenes A-C (1-3), containing different side chains, were isolated from an undescribed filamentous cyanobacterium (VPG 16-59) collected in Guam. Our 16S rDNA sequencing efforts indicated that VPG 16-59 is a member of the marine genus Hormoscilla (Oscillatoriales). The structures of anaephenes A-C (1-3) were elucidated by spectroscopic methods, and compounds assayed for growth inhibitory activity against prokaryotic and eukaryotic cell lines. Anaephene B (2), possessing a terminal alkyne, displayed moderate activity against Bacillus cereus and Staphylococcus aureus with MIC values of 6.1 μg/mL. While 1 and 3 showed no pronounced activity in these assays, their structural features highlight the unusual biosynthetic capacity of this cyanobacterium and warrant further study.

Small, 1st and 2nd-order, headwater streams and ponds play essential roles in providing natural flood control, trapping sediments and contaminants, retaining nutrients, and maintaining biological diversity, which extend into downstream reaches, lakes and estuaries. However, the large geographic extent and high connectivity of these small water bodies with the surrounding terrestrial ecosystem makes them particularly vulnerable to growing land-use pressures and environmental change. The greatest pressure on the physical processes in these waters has been their extension and modification for agricultural and forestry drainage, resulting in highly modified discharge and temperature regimes that have implications for flood and drought control further downstream. The extensive length of the small stream network exposes rivers to a wide range of inputs, including nutrients, pesticides, heavy metals, sediment and emerging contaminants. Small water bodies have also been affected by invasions of non-native species, which along with the physical and chemical pressures, have affected most groups of organisms with consequent implications for the wider biodiversity within the catchment. Reducing the impacts and restoring the natural ecosystem function of these water bodies requires a three-tiered approach based on: restoration of channel hydromorphological dynamics; restoration and management of the riparian zone; and management of activities in the wider catchment that have both point-source and diffuse impacts. Such activities are expensive and so emphasis must be placed on integrated programmes that provide multiple benefits. Practical options need to be promoted through legislative regulation, financial incentives, markets for resource services and voluntary codes and actions., (Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.)

Introduction: To implement the modulated arc total body irradiation (MATBI) technique within the existing infrastructure of a radiation oncology department. The technique needed to treat paediatric patients of all ages, some of whom would require general anaesthesia (GA)., Methods: The MATBI technique required minor modifications to be incorporated within existing departmental infrastructure. Ancillary equipment essential to the technique were identified and in some cases custom designed to meet health and safety criteria. GA equipment was also considered. To evaluate the effectiveness of the implemented technique, an audit of the cases clinically treated was conducted., Results: A motorised treatment couch was designed to allow the patient to be positioned in stabilisation equipment at a height, then lowered to the floor to accommodate source-to-skin-distances from 180 cm to 198 cm to treat the fixed 40 cm × 40 cm field size. Treatment couch design also facilitated positioning of the bespoke two-part spoiler. While organ at risk dose is limited using a beam weight optimisation technique, the dose is further reduced using compensators placed close to the patient's skin on a 3D printed custom-made support bridge. A digital radiography system is used to verify compensator position. Fifteen patients have been treated to date for various diseases using a variety of dose fractionations ranging from 2 Gy in a single fraction to 12 Gy in 6 fractions. Five patients have required GA due to age or behavioural issues., Conclusion: The modified MATBI technique and the equipment required for treatment delivery has been found to be well tolerated by all patients., (© 2018 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.)

Purpose: Thoracic aortic aneurysm/aortic dissection (TAAD) is a disorder with highly variable age of onset and phenotype. We sought to determine the prevalence of pathogenic variants in TAAD-associated genes in a mixed cohort of sporadic and familial TAAD patients and identify relevant genotype-phenotype relationships., Methods: We used a targeted polymerase chain reaction and next-generation sequencing-based panel for genetic analysis of 15 TAAD-associated genes in 1,025 unrelated TAAD cases., Results: We identified 49 pathogenic or likely pathogenic (P/LP) variants in 47 cases (4.9% of those successfully sequenced). Almost half of the variants were in nonsyndromic cases with no known family history of aortic disease. Twenty-five variants were within FBN1 and two patients were found to harbor two P/LP variants. Presence of a related syndrome, younger age at presentation, family history of aortic disease, and involvement of the ascending aorta increased the risk of carrying a P/LP variant., Conclusion: Given the poor prognosis of TAAD that is undiagnosed prior to acute rupture or dissection, genetic analysis of both familial and sporadic cases of TAAD will lead to new diagnoses, more informed management, and possibly reduced mortality through earlier, preclinical diagnosis in genetically determined cases and their family members.

Objective: To evaluate the impact of Teach-Back on communication quality in a national telephone-based telehealth service, for callers varying in health literacy., Design: Cross-sectional stepped wedge cluster randomised trial with continuous recruitment, short (fixed) exposure and blinded outcome assessors. Nurses were stratified by hours worked and randomised into training groups using a computer generated sequence., Setting: An Australian national pregnancy and parenting telephone helpline., Intervention: Complex intervention involving a single 2-hour group Teach-Back training session, combined with ongoing nurse self-reflection on their communication following each call and each shift., Participants: Participants were 637 callers to the telephone helpline aged 18-75 (87% female), of whom 127 (13%) had inadequate health literacy (measured with the Single Item Literacy Screener); and 15 maternal and child health nurses with 15 years' experience on average., Measures: Primary outcome was a modified subscale of the Health Literacy Questionnaire, 'having sufficient information to manage health'. Secondary caller outcomes included caller confidence, perceived actionability of information and nurse effort to listen and understand. Nurse outcomes were perceptions of their communication effectiveness., Results: Over a 7 week period, 376 surveyed callers received usual care and 261 Teach-Back. Ratings on the primary outcome increased over time (OR 1.17, CI 1.01 to 1.32, p = 0.03) but no independent Teach-Back effect was observed. A consistent pattern suggests that, compared with usual care, Teach-Back helps callers with inadequate health literacy feel listened to (OR 2.3, CI 0.98 to 5.42, p = 0.06), confident to act (OR 2.44, CI 1.00 to 5.98, p = 0.06), and know what steps to take (OR 2.68, CI 1.00 to 7.17, p = 0.06). Nurse perceptions of both their own communication effectiveness (OR = 2.31; CI 1.38 to 3.86, p<0.0001), and caller understanding (OR = 2.56; CI 1.52 to 4.30, p<0.001) both increased with Teach-Back. No harms were reported., Conclusions: Teach-Back appears to benefit telephone health service users with inadequate health literacy, but the extent of this is unclear due to smaller numbers of lower literacy participants. Improving caller ratings over time are likely due to increasing nurse communication competence., Competing Interests: The authors have read the journal's policy and the authors of this manuscript have the following competing interests: SM was funded by a grant from Healthdirect Australia, during the conduct of the study; JB was employed by Healthdirect Australia, during the conduct of the study. All other authors have declared that no competing interests exist. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Use of chemical agricultural inputs such as nitrogen fertilisers (N) in agricultural production can cause diffuse source pollution thereby degrading the health of coastal and marine ecosystems in coastal river catchments. Previous reviewed economic assessments of N management in agricultural production seldom consider broader environmental impacts and uncertain climatic and economic conditions. This paper presents an economic risk framework for assessing economic and environmental trade-offs of N management strategies taking into account variable climatic and economic conditions. The framework is underpinned by a modelling platform that integrates Agricultural Production System sIMulation modelling (APSIM), probability theory, Monte Carlo simulation, and financial risk analysis techniques. We applied the framework to a case study in Tully, a coastal catchment in north-eastern Australia with a well-documented N pollution problem. Our results show that switching from managing N to maximise private net returns to maximising social net returns could reduce expected private net returns by $99 ha -1 , but yield additional environmental benefits equal to $191 ha -1 . Further, switching from managing N to maximise private returns in years with the highest profit potential (hereafter, good years) to maximising mean social net returns could reduce expected private profits in good years by $277 ha -1 , but yield additional environmental benefits equal to $287 ha -1 . We contend that it is essential to incorporate farmer risk behaviour and environmental impacts in analyses that inform policies aimed at enhancing adoption of management activities for mitigating deterioration of the health of coastal and marine ecosystems due to diffuse source pollution from agricultural production., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

There is growing recognition of the essential services provided to humanity by functionally intact ecosystems. Freshwater ecosystems are found throughout agricultural and urban landscapes and provide a wide range of ecosystem services, but globally they are also amongst the most vulnerable. In particular, ponds (lentic waters typically less than 2 ha), provide natural flood management, sequester carbon and hold significant cultural value. However, to inform their management it is important to understand (1) how functional diversity varies in response to disturbance and (2) the link between biodiversity conservation and ecosystem function. In this study, a meta-analysis of seven separate pond studies from across England and Wales was carried out to explore the effect of urban and agricultural land-use gradients, shading, emergent vegetation, surface area and pH upon groups of functionally similar members of the macroinvertebrate fauna. Functional effect groups were first identified by carrying out a hierarchical cluster analysis using body size, voltinism and feeding habits (18 categories) that are closely related to biogeochemical processes (e.g. nutrient and carbon recycling). Secondly, the influence of the gradients upon effect group membership (functional redundancy-FR) and the breadth of traits available to aid ecosystem recovery (response diversity) was assessed using species counts and functional dispersion (FDis) using 12 response traits. The effect of land-use gradients was unpredictable, whilst there was a negative response in both FR and FDis to shading and positive responses to increases in emergent vegetation cover and surface area. An inconsistent association between FDis and FR suggested that arguments for taxonomic biodiversity conservation to augment ecosystem functioning are too simplistic. Thus, a deeper understanding of the response of functional diversity to disturbance could have greater impact with decision-makers who may relate better to the loss of ecosystem function in response to environmental degradation than species loss alone., (© 2018 John Wiley & Sons Ltd.)

Background: Telehealth professionals require advanced communication skills, in part to compensate for lack of visual cues. Teach-Back is a best practice communication technique that has been recommended but not previously evaluated for consumer telehealth. We aimed to implement Teach-Back at a national maternal and child health telephone helpline. We describe the intervention and report telenurse experiences learning to use Teach-Back., Methods: We identified barriers (time, knowledge, skills, beliefs) and enablers (self-reflection) to using Teach-Back, and developed a novel training program to address these, guided by the Theoretical Domains Framework. We engaged maternal and child health telenurses to participate in a "communication skills" study. The intervention had two key components: guided self-reflection and a Teach-Back skills workshop. For the duration of the 7-week study nurses completed brief online surveys following each call, reflecting on both the effectiveness of their communication and perceived caller understanding. At the end of each shift they reflected on what worked well. Teach-Back knowledge, skills, and beliefs were addressed in a 2-h workshop using videos, discussion, and role play. We explored nurses' experiences of the intervention in focus groups and interviews; and analysed transcripts and comments from the self-reflection surveys using the Framework method. This study forms part of a larger evaluation conducted in 2016., Results: In total 16 nurses participated: 15 were trained in Teach-Back, and 13 participated in focus groups or interviews. All engaged with both self-reflection and Teach-Back, although to differing extents. Those who reported acquiring Teach-Back skills easily limited themselves to one or two Teach-Back phrases. Nurses reported that actively self-reflecting (including on what they did well) was useful both for developing Teach-Back skills and analysing effectiveness of the techniques. Most wanted more opportunity to learn how their colleagues manage Teach-Back in different situations, and more visual reminders to use Teach-Back., Conclusions: Our theory-informed intervention successfully enabled nurses to use Teach-Back. Guided self-reflection is a low-resource method aligned with nurse professional identity that can facilitate Teach-Back skills learning, and could also be applied to other advanced communication skills for telehealth. Listening to multiple workplace-specific examples of Teach-Back is recommended for future training., Trial Registration: ACTRN12616000623493 Registered 15 May 2016. Retrospectively registered.

Background: As awareness of disrupted sleep in patients with traumatic brain injury (TBI) increases so does interest in finding objective measures of sleep. As a result, many clinicians are turning to actigraphs to monitor sleep in patients with altered consciousness. Actigraphs are accelerometers which have been used in sleep research for over four decades., Objective: The purpose of the present study was to determine the best method for scoring actigraphs in a TBI population and to describe the benefits and pitfalls of using actigraphs with patients on a brain injury rehabilitation unit., Methods: A retrospective chart review of 43 patients compared three different ways of scoring night time rest periods: autoscoring, manual scoring, and set interval scoring for the sleep parameters of sleep efficiency, wakefulness after sleep onset, and total sleep time. Nursing compliance with using the event marker on the device to set rest period was also analyzed., Results: The autoscoring method of determining the rest interval showed an inflation of sleep efficiency. For each sleep parameter compared, the strongest correlations were observed between the manual and set interval scoring methods. Compliance using event markers to set rest interval was low (16.7%)., Conclusions: Set interval scoring is the most efficient method to determine the rest interval in TBI patients. The use of event markers was an unreliable method to determine rest period.

This paper presents rich new families of relative orbits for spacecraft formation flight generated through the application of continuous thrust with only minimal intervention into the dynamics of the problem. Such simplicity facilitates implementation for small, low-cost spacecraft with only position state feedback, and yet permits interesting and novel relative orbits in both two- and three-body systems with potential future applications in space-based interferometry, hyperspectral sensing, and on-orbit inspection. Position feedback is used to modify the natural frequencies of the linearised relative dynamics through direct manipulation of the system eigenvalues, producing new families of stable relative orbits. Specifically, in the Hill-Clohessy-Wiltshire frame, simple adaptations of the linearised dynamics are used to produce a circular relative orbit, frequency-modulated out-of-plane motion, and a novel doubly periodic cylindrical relative trajectory for the purposes of on-orbit inspection. Within the circular restricted three-body problem, a similar minimal approach with position feedback is used to generate new families of stable, frequency-modulated relative orbits in the vicinity of a Lagrange point, culminating in the derivation of the gain requirements for synchronisation of the in-plane and out-of-plane frequencies to yield a singly periodic tilted elliptical relative orbit with potential use as a Lunar far-side communications relay. The Δ v requirements for the cylindrical relative orbit and singly periodic Lagrange point orbit are analysed, and it is shown that these requirements are modest and feasible for existing low-thrust propulsion technology., (© The Author(s) 2018.)

Background: Asking patients to "Teach-Back" information during a health care consultation is widely recommended, yet little is known about patient and provider experiences using this method. Teach-Back has not previously been evaluated in a consumer telephone health service, a situation in which low health literacy can be especially difficult to identify., Objective: This study sought to explore telenurse experiences using Teach-Back at a maternal and child health helpline, supplemented with caller experiences., Method: After training maternal and child health nurses to use Teach-Back ( n = 15), we interviewed nurses and callers to the helpline service. We used semi-structured guides to conduct focus groups and telephone interviews and analyzed transcripts of nurse and caller data using the Framework method. This qualitative study forms part of a randomized controlled trial of Teach-Back involving 637 callers., Key Results: Nurses ( n = 13) reported Teach-Back was helpful to invite questions from callers, summarize information, review action plans, and close calls. Some found it helpful to empower and calm (anxious) callers. Nurses reported they did not always use Teach-Back, either because it was not appropriate or they felt uncomfortable with phrasing. Comfort with using Teach-Back tended to improve with practice. Perceived effect on call duration was mixed. We report sample Teach-Back strategies used by nurses, including the lead-in phrase "just before you go…," which was considered helpful for initiating Teach-Back at close of a call. Caller reports of Teach-Back were limited ( n = 8) but mostly positive., Conclusions: Teach-Back is a simple communication technique that can be used in a consumer telehealth service to confirm caller understanding and actions to take, and in some cases it may also reduce caller anxiety. Further research on caller experiences and objective impact on call duration is needed. [ Health Literacy Research and Practice . 2017;1(4):e173-e181.] ., Plain Language Summary: Low health literacy can be difficult to identify, especially over the telephone. Asking callers to summarize important information and agreed actions (known as Teach-Back) could help telehealth providers confirm understanding. We interviewed nurses operating a maternal and child health helpline and callers about their experiences with Teach-Back. Findings support Teach-Back for telehealth and suggest Teach-Back can also reduce caller anxiety.

Urbanization is a global process contributing to the loss and fragmentation of natural habitats. Many studies have focused on the biological response of terrestrial taxa and habitats to urbanization. However, little is known regarding the consequences of urbanization on freshwater habitats, especially small lentic systems. In this study, we examined aquatic macro-invertebrate diversity (family and species level) and variation in community composition between 240 urban and 782 nonurban ponds distributed across the United Kingdom. Contrary to predictions, urban ponds supported similar numbers of invertebrate species and families compared to nonurban ponds. Similar gamma diversity was found between the two groups at both family and species taxonomic levels. The biological communities of urban ponds were markedly different to those of nonurban ponds, and the variability in urban pond community composition was greater than that in nonurban ponds, contrary to previous work showing homogenization of communities in urban areas. Positive spatial autocorrelation was recorded for urban and nonurban ponds at 0-50 km (distance between pond study sites) and negative spatial autocorrelation was observed at 100-150 km and was stronger in urban ponds in both cases. Ponds do not follow the same ecological patterns as terrestrial and lotic habitats (reduced taxonomic richness) in urban environments; in contrast, they support high taxonomic richness and contribute significantly to regional faunal diversity. Individual cities are complex structural mosaics which evolve over long periods of time and are managed in diverse ways. This facilitates the development of a wide range of environmental conditions and habitat niches in urban ponds which can promote greater heterogeneity between pond communities at larger scales. Ponds provide an opportunity for managers and environmental regulators to conserve and enhance freshwater biodiversity in urbanized landscapes whilst also facilitating key ecosystem services including storm water storage and water treatment., (© 2016 John Wiley & Sons Ltd.)

This study investigated patterns of nutrient pollution in waterbody types across Greater London. Nitrate and phosphate data were collected by both citizen scientists and professional ecologists and their results were compared. The professional survey comprised 495 randomly selected pond, lake, river, stream and ditch sites. Citizen science survey sites were self-selected and comprised 76 ponds, lakes, rivers and streams. At each site, nutrient concentrations were assessed using field chemistry kits to measure nitrate-N and phosphate-P. The professional and the citizen science datasets both showed that standing waterbodies had significantly lower average nutrient concentrations than running waters. In the professional datasets 46% of ponds and lakes had nutrient levels below the threshold at which biological impairment is likely, whereas only 3% of running waters were unimpaired by nutrients. The citizen science dataset showed the same broad pattern, but there was a trend towards selection of higher quality waterbodies with 77% standing waters and 14% of rivers and streams unimpaired. Waterbody nutrient levels in the professional dataset were broadly correlated with landuse intensity. Rivers and streams had a significantly higher proportion of urban and suburban land cover than other waterbody types. Ponds had higher percentage of semi-natural vegetation within their much smaller catchments. Relationships with land cover and water quality were less apparent in the citizen-collected dataset probably because the areas visited by citizens were less representative of the landscape as whole. The results suggest that standing waterbodies, especially ponds, may represent an important clean water resource within urban areas. Small waterbodies, including ponds, small lakes<50ha and ditches, are rarely part of the statutory water quality monitoring programmes and are frequently overlooked. Citizen scientist data have the potential to partly fill this gap if they are co-ordinated to reduce bias in the type and location of the waterbodies selected., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: It is widely acknowledged that modifications to existing control interventions are required if South Africa is to achieve malaria elimination. Targeting indoor residual spraying (IRS) to areas where cases have been detected is one strategy currently under investigation in northeastern South Africa. This seroprevalence baseline study, nested within a targeted IRS trial, was undertaken to provide insights into malaria transmission dynamics in South Africa and evaluate whether sero-epidemiological practices have the potential to be routinely incorporated into elimination programmes., Methods: Filter-paper blood spots, demographic and household survey data were collected from 2710 randomly selected households in 56 study wards located in the municipalities of Ba-Phalaborwa and Bushbuckridge. Blood spots were assayed for Plasmodium falciparum apical membrane antigen-1 and merozoite surface protein-1 19 blood-stage antigens using an enzyme linked immunosorbent assay. Seroprevalence data were analysed using a reverse catalytic model to determine malaria seroconversion rates (SCR). Geospatial cluster analysis was used to investigate transmission heterogeneity while random effects logistic regression identified risk factors associated with malaria exposure., Results: The overall SCR across the entire study site was 0.012 (95% CI 0.008-0.017) per year. Contrasting SCRs, corresponding to distinct geographical regions across the study site, ranging from <0.001 (95% CI <0.001-0.005) to 0.022 (95% CI 0.008-0.062) per annum revealed prominent transmission heterogeneity. Geospatial cluster analysis of household seroprevalence and age-adjusted antibody responses detected statistically significant (p < 0.05) spatial clusters of P. falciparum exposure. Formal secondary education was associated with lower malaria exposure in the sampled population (AOR 0.72, 95% CI 0.56-0.95, p = 0.018)., Conclusions: Although overall transmission intensity and exposure to malaria was low across both study sites, malaria transmission intensity was highly heterogeneous and associated with low socio-economic status in the region. Findings suggest focal targeting of interventions has the potential to be an appropriate strategy to deploy in South Africa. Furthermore, routinely incorporating sero-epidemiological practices into elimination programmes may prove useful in monitoring malaria transmission intensity in South Africa, and other countries striving for malaria elimination.

Observations of volcanoes from space are a critical component of volcano monitoring, but we lack quantitative integrated models to interpret them. The atmospheric sulfur yields of eruptions are variable and not well correlated with eruption magnitude and for many eruptions the volume of erupted material is much greater than the subsurface volume change inferred from ground displacements. Up to now, these observations have been treated independently, but they are fundamentally linked. If magmas are vapour-saturated before eruption, bubbles cause the magma to become more compressible, resulting in muted ground displacements. The bubbles contain the sulfur-bearing vapour injected into the atmosphere during eruptions. Here we present a model that allows the inferred volume change of the reservoir and the sulfur mass loading to be predicted as a function of reservoir depth and the magma's oxidation state and volatile content, which is consistent with the array of natural data.

Purpose: Ehlers-Danlos syndrome (EDS) comprises a group of overlapping hereditary disorders of connective tissue with significant morbidity and mortality, including major vascular complications. We sought to identify the diagnostic utility of a next-generation sequencing (NGS) panel in a mixed EDS cohort., Methods: We developed and applied PCR-based NGS assays for targeted, unbiased sequencing of 12 collagen and aortopathy genes to a cohort of 177 unrelated EDS patients. Variants were scored blind to previous genetic testing and then compared with results of previous Sanger sequencing., Results: Twenty-eight pathogenic variants in COL5A1/2, COL3A1, FBN1, and COL1A1 and four likely pathogenic variants in COL1A1, TGFBR1/2, and SMAD3 were identified by the NGS assays. These included all previously detected single-nucleotide and other short pathogenic variants in these genes, and seven newly detected pathogenic or likely pathogenic variants leading to clinically significant diagnostic revisions. Twenty-two variants of uncertain significance were identified, seven of which were in aortopathy genes and required clinical follow-up., Conclusion: Unbiased NGS-based sequencing made new molecular diagnoses outside the expected EDS genotype-phenotype relationship and identified previously undetected clinically actionable variants in aortopathy susceptibility genes. These data may be of value in guiding future clinical pathways for genetic diagnosis in EDS.Genet Med 18 11, 1119-1127.

Synthetic polymer microarray technology holds remarkable promise to rapidly identify suitable biomaterials for stem cell and tissue engineering applications. However, most of previous microarrayed synthetic polymers do not possess biological ligands (e.g., peptides) to directly engage cell surface receptors. Here, we report the development of peptide-functionalized hydrogel microarrays based on light-assisted copolymerization of poly(ethylene glycol) diacrylates (PEGDA) and methacrylated-peptides. Using solid-phase peptide/organic synthesis, we developed an efficient route to synthesize methacrylated-peptides. In parallel, we identified PEG hydrogels that effectively inhibit non-specific cell adhesion by using PEGDA-700 (M. W.=700) as a monomer. The combined use of these chemistries enables the development of a powerful platform to prepare peptide-functionalized PEG hydrogel microarrays. Additionally, we identified a linker composed of 4 glycines to ensure sufficient exposure of the peptide moieties from hydrogel surfaces. Further, we used this system to directly compare cell adhesion abilities of several related RGD peptides: RGD, RGDS, RGDSG and RGDSP. Finally, we combined the peptide-functionalized hydrogel technology with bioinformatics to construct a library composed of 12 different RGD peptides, including 6 unexplored RGD peptides, to develop culture substrates for hiPSC-derived cardiomyocytes (hiPSC-CMs), a cell type known for poor adhesion to synthetic substrates. 2 out of 6 unexplored RGD peptides showed substantial activities to support hiPSC-CMs. Among them, PMQKMRGDVFSP from laminin β4 subunit was found to support the highest adhesion and sarcomere formation of hiPSC-CMs. With bioinformatics, the peptide-functionalized hydrogel microarrays accelerate the discovery of novel biological ligands to develop biomaterials for stem cell and tissue engineering applications., Statement of Significance: In this manuscript, we described the development of a robust approach to prepare peptide-functionalized synthetic hydrogel microarrays. Combined with bioinformatics, this technology enables us to rapidly identify novel biological ligands for the development of the next generation of functional biomaterials for stem cell and tissue engineering applications., (Copyright © 2016 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.)

A specialized insulin was recently found in the venom of a fish-hunting cone snail, Conus geographus Here we show that many worm-hunting and snail-hunting cones also express venom insulins, and that this novel gene family has diversified explosively. Cone snails express a highly conserved insulin in their nerve ring; presumably this conventional signaling insulin is finely tuned to the Conus insulin receptor, which also evolves very slowly. By contrast, the venom insulins diverge rapidly, apparently in response to biotic interactions with prey and also possibly the cones' own predators and competitors. Thus, the inwardly directed signaling insulins appear to experience predominantly purifying sele\ction to target an internal receptor that seldom changes, while the outwardly directed venom insulins frequently experience directional selection to target heterospecific insulin receptors in a changing mix of prey, predators and competitors. Prey insulin receptors may often be constrained in ways that prevent their evolutionary escape from targeted venom insulins, if amino-acid substitutions that result in escape also degrade the receptor's signaling functions., (© The Author 2016. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution.)

The Ethiopian Rift Valley hosts the longest record of human co-existence with volcanoes on Earth, however, current understanding of the magnitude and timing of large explosive eruptions in this region is poor. Detailed records of volcanism are essential for interpreting the palaeoenvironments occupied by our hominin ancestors; and also for evaluating the volcanic hazards posed to the 10 million people currently living within this active rift zone. Here we use new geochronological evidence to suggest that a 200 km-long segment of rift experienced a major pulse of explosive volcanic activity between 320 and 170 ka. During this period, at least four distinct volcanic centres underwent large-volume (>10 km 3 ) caldera-forming eruptions, and eruptive fluxes were elevated five times above the average eruption rate for the past 700 ka. We propose that such pulses of episodic silicic volcanism would have drastically remodelled landscapes and ecosystems occupied by early hominin populations.