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The Archean Horne 5 deposit, located in the Rouyn-Noranda district in the southern Abitibi greenstone belt, Canada, contains a total resource of 172.4 t Au (5.6 Moz) from 112.7 Mt of ore grading at 1.53 g/t Au. The deposit is part of the Au-rich Horne volcanogenic massive sulfide (VMS) complex that also includes the past-producing Horne mine (i.e., the Upper and Lower H zones plus small subsidiary lenses) that yielded 325.4 t Au (10.5 Moz Au) from 53.7 Mt of ore grading at 6.06 g/t Au. Combined, the Horne mine and Horne 5 deposit contain ~500 t Au (16 Moz), making them the world’s single largest accumulation of VMS-related Au. The Horne 5 deposit consists of stacked lenses of massive to semimassive sulfides alternating with extensive zones of disseminated and stringer sulfides. The mineralization is hosted within thick accumulations of steeply dipping dacitic to rhyodacitic volcaniclastic units of transitional to calc-alkaline magmatic affinity. Dacitic-rhyodacitic synvolcanic units (lobes, sills, and/or domes) intrude the host succession, which is also crosscut by a series of post-ore mafic and younger intermediate to felsic feldspar ± quartz porphyry dikes. A broad and diffuse halo of distal sericite-chlorite-epidote alteration extends outboard of intensely sericite-altered zones proximal to the sulfide lenses. Gold is interpreted to be synvolcanic on the basis of Au-rich massive sulfide clasts in the volcaniclastic units, the presence of preserved Au-rich primary pyrite, Au zones limited to the sulfide envelope, crosscutting deformed but unaltered and barren dikes, and the absence of typical syndeformation, orogenic-style alteration and mineralization despite overprinting high-strain corridors and faults. Gold is spatially associated with pyrite, sphalerite, and chalcopyrite, and its distribution is largely controlled by the higher porosity and permeability of the volcaniclastic host rocks, which are interpreted to have facilitated hydrothermal fluid circulation in the subseafloor environment. Synvolcanic intrusions and fine-grained tuffs overlying auriferous zones also influenced the distribution of the mineralization by acting as cap rocks to ascending fluids. Evidence suggests that Au enrichment at the Horne 5 deposit is due to efficient transport and precipitation of Au in the subseafloor environment, a favorable geodynamic setting (transitional to calc-alkaline magmatism over thick crust), and possible input of magmatic fluids as suggested by high Te and Cu in the mineralization. Minor and very local remobilization of metals occurred in response to regional deformation and associated greenschist facies metamorphism. The detailed study of the Horne 5 deposit geology and a review of the available information on the Horne mine and recent 3-D modeling indicate that the Horne 5 deposit may have formed higher in the stratigraphy than the Upper and Lower H orebodies of the former Horne mine, which originally formed a single lens. Therefore, the Horne Au-rich VMS complex originally formed as a stacked system in which the Horne 5 deposit was deposited above the Upper and Lower H zones and not in a distal or lateral position as previously proposed, indicating that a robust hydrothermal system was responsible for the formation of the world’s largest Au-rich VMS complex.

The purpose of the present study was to compare and combine the radiographic interpretation accuracy of emergency clinicians and radiographers in clinical practice.A total of 838 radiographic examinations were included for analysis from 1 August to 24 August 2020. The range of examinations reviewed included the appendicular and axial skeleton, chest and abdomen. Both paediatric and adult examinations were reviewed. The emergency clinician's and radiographer's interpretations for each examination were compared to the radiologist's report. This allowed mean sensitivity, specificity and diagnostic accuracy to be calculated.The radiographer's interpretation demonstrated a mean sensitivity, specificity and accuracy of 80%, 98% and 92%, respectively. The emergency clinician's interpretation demonstrated a mean sensitivity, specificity and accuracy of 82%, 95% and 89%, respectively. When the radiographer's and emergency clinician's interpretations were combined, it yielded a mean sensitivity, specificity and accuracy of 90%, 93% and 92%, respectively.This is the first study to directly compare and combine the accuracy of an emergency clinician's radiographic interpretation with a radiographer's interpretation within clinical practice. The present study demonstrated that with the addition of a radiographer's interpretation, an emergency clinician's interpretation can be more accurate than the emergency clinician's interpretation in isolation. This highlights the value of a radiographer's interpretation that can complement an emergency clinician's interpretation when a radiologist's report is unavailable.

This editorial introduction to the 14.2 open call issue of Journal of Dance & Somatic Practices (JDSP) provides readers with an update on the journal developments and news, followed by an overview of the articles and reviews that make up this issue.

Cannabis vaping involves the vaporization of a cannabis vaping liquid or solid via a vaping accessory such as a vape pen constructed of various metals or other parts. An increasing number of reports advocate for expansion of the testing and regulation of metal contaminants in cannabis vape liquids beyond the metals typically tested such as arsenic, cadmium, mercury, and lead to reflect the possibility of consumers' exposure to other metal contaminants. Metal contaminants may originate not only from the cannabis itself but also from the vape devices in which the cannabis vape liquid is packaged. However, metal analyses of cannabis vape liquids sampled from cannabis vaping devices are challenged by poor precision and reproducibility. Herein, we present data on the metal content of 12 metals in 20 legal and 21 illegal cannabis vape liquids. The lead mass fraction in several illegal samples reached up to 50 μg g

It is important to assess the long-term consequences of the COVID-19 pandemic for gender equality, but we know little about US parents' domestic arrangements beyond the early days of the pandemic or how simultaneous changes in employment, earnings, telework, gender ideologies, and care supports may have altered domestic arrangements. This study assesses changes in parents' domestic labor during the first year of the pandemic using fixedThe online version contains supplementary material available at 10.1007/s11113-022-09735-1.

Mica, especially white mica, is a common detrital mineral in siliciclastic sediments and sedimentary rocks. It is used in provenance studies to constrain the thermal history and exhumation processes in the source region. It thus records valuable complementary provenance information to e.g. U-Pb geochronology of detrital zircon that date magmatic and high-grade metamorphic events in the provenance area.However, in contrast to U-Pb geochronology of detrital zircon, there was a major disadvantage of using mica geochronology in provenance investigations until now: the conventional Argon-Argon (Ar-Ar) or Rubidium-Strontium (Rb-Sr) dating techniques are rather time-consuming due to complex sample preparation. Thus, of major interest for mica-based provenance studies is a recent improvement in in-situ Rb-Sr dating by laser ablation (LA) – inductively coupled plasma (ICP) - mass spectrometer (MS/MS) analyses. This analytical setup uses a reaction cell between two mass spectrometers. Induced gases allow the reaction of targeted masses and thus to chemically separating 87Rb and its daughter isotope 87Sr. This avoids the isobaric overlap during mass-spectrometric analysis. In combination with the novel approach of Rösel and Zack (2022) (GGR 46, 143-168), single-spot Rb-Sr ages can be calculated from individual detrital mica grains. Trace and major elements can be determined contamporaneously from the same laser spots. Consequently, LA-ICP-MS/MS analyses of detrital mica enables collecting of time and cost efficient multi-proxy datasets – a prerequisite for provenance studies.In this contribution, we focus on (1) the analytical routine, (2) data reduction and age calculation strategy and (3) interpretation of in-situ Rb-Sr age and geochemical data from detral mica for provenance investigations. In-situ Rb-Sr LA-ICP-MS/MS dating was tested on detrital white mica from the Late Miocene Loxton Sand Formation, Murray Bain, South Australia. U-Pb dating from detrital zircon extracted from the same formation was performed for comparison.

This paper presents the findings from a detailed study investigating UK undergraduate students’ experience of practical science in their post-16 studies during the COVID-19 pandemic. It also examines the perceived confidence and preparedness of the students in relation to areas of practical science skills at the start of their degree courses. The study employed an exploratory sequential mixed methods design, with the findings from focus groups with students at the end of their post-16 studies used to support the development of a comprehensive quantitative survey for incoming undergraduate students. Survey data were collected in September and October 2021 from 275 students commencing Biological Science/Life Science, Chemistry, Physics and Natural Science degrees at two universities in England.The research is significant for its finding that although almost all students had the opportunity to undertake practical work as part of their post-16 studies during the COVID-19 pandemic, there was significant variation in students’ experiences. The data indicate that students’ self-efficacy in relation to practical science was impacted by the closures of post-16 education establishments, ongoing social distancing and the removal of the assessment criteria for students to have ‘routinely and consistently’ undertaken each of the practical assessment requirements. The research presents important considerations which are relevant for educators supporting students’ transition from post-16 to Higher Education.

Supplemental Materials and Methods

The incidence of esophageal adenocarcinoma is rising, survival remains poor, and new tools to improve early diagnosis and precise treatment are needed. Cancer phospholipidomes quantified with mass spectrometry imaging (MSI) can support objective diagnosis in minutes using a routine frozen tissue section. However, whether MSI can objectively identify primary esophageal adenocarcinoma is currently unknown and represents a significant challenge, as this microenvironment is complex with phenotypically similar tissue-types. Here, we used desorption electrospray ionization-MSI (DESI-MSI) and bespoke chemometrics to assess the phospholipidomes of esophageal adenocarcinoma and relevant control tissues. Multivariate models derived from phospholipid profiles of 117 patients were highly discriminant for esophageal adenocarcinoma both in discovery (AUC = 0.97) and validation cohorts (AUC = 1). Among many other changes, esophageal adenocarcinoma samples were markedly enriched for polyunsaturated phosphatidylglycerols with longer acyl chains, with stepwise enrichment in premalignant tissues. Expression of fatty acid and glycerophospholipid synthesis genes was significantly upregulated, and characteristics of fatty acid acyls matched glycerophospholipid acyls. Mechanistically, silencing the carbon switch ACLY in esophageal adenocarcinoma cells shortened glycerophospholipid chains, linking de novo lipogenesis to the phospholipidome. Thus, DESI-MSI can objectively identify invasive esophageal adenocarcinoma from a number of premalignant tissues and unveils mechanisms of phospholipidomic reprogramming.Significance:These results call for accelerated diagnosis studies using DESI-MSI in the upper gastrointestinal endoscopy suite, as well as functional studies to determine how polyunsaturated phosphatidylglycerols contribute to esophageal carcinogenesis.

The Supplementary information file contains: (i) Supplementary Methods, concerning PCR primers, antibodies and explanation of the chemometric approach. (ii) Supplementary Figures 1-4, which provide extended data for the multivariable models of Figure 2 and 3, MS/MS analyses, and further gene expression data supporting Figure 5. (iii) Supplementary Tables 1-4, which provide demographics of the cohorts and univariate lipid analyses from Cohort 1 and 2.

The clinically aggressive alveolar rhabdomyosarcoma (RMS) subtype is characterized by expression of the oncogenic fusion protein PAX3-FOXO1, which is critical for tumorigenesis and cell survival. Here, we studied the mechanism of cell death induced by loss of PAX3-FOXO1 expression and identified a novel pharmacologic combination therapy that interferes with PAX3-FOXO1 biology at different levels. Depletion of PAX3-FOXO1 in fusion-positive (FP)-RMS cells induced intrinsic apoptosis in a NOXA-dependent manner. This was pharmacologically mimicked by the BH3 mimetic navitoclax, identified as top compound in a screen from 208 targeted compounds. In a parallel approach, and to identify drugs that alter the stability of PAX3-FOXO1 protein, the same drug library was screened and fusion protein levels were directly measured as a read-out. This revealed that inhibition of Aurora kinase A most efficiently negatively affected PAX3-FOXO1 protein levels. Interestingly, this occurred through a novel specific phosphorylation event in and binding to the fusion protein. Aurora kinase A inhibition also destabilized MYCN, which is both a functionally important oncogene and transcriptional target of PAX3-FOXO1. Combined treatment with an Aurora kinase A inhibitor and navitoclax in FP-RMS cell lines and patient-derived xenografts synergistically induced cell death and significantly slowed tumor growth. These studies identify a novel functional interaction of Aurora kinase A with both PAX3-FOXO1 and its effector MYCN, and reveal new opportunities for targeted combination treatment of FP-RMS.Significance:These findings show that Aurora kinase A and Bcl-2 family proteins are potential targets for FP-RMS.

Supplemental video 4 from NCI Imaging Data Commons

The National Cancer Institute (NCI) Cancer Research Data Commons (CRDC) aims to establish a national cloud-based data science infrastructure. Imaging Data Commons (IDC) is a new component of CRDC supported by the Cancer Moonshot. The goal of IDC is to enable a broad spectrum of cancer researchers, with and without imaging expertise, to easily access and explore the value of deidentified imaging data and to support integrated analyses with nonimaging data. We achieve this goal by colocating versatile imaging collections with cloud-based computing resources and data exploration, visualization, and analysis tools. The IDC pilot was released in October 2020 and is being continuously populated with radiology and histopathology collections. IDC provides access to curated imaging collections, accompanied by documentation, a user forum, and a growing number of analysis use cases that aim to demonstrate the value of a data commons framework applied to cancer imaging research.Significance:This study introduces NCI Imaging Data Commons, a new repository of the NCI Cancer Research Data Commons, which will support cancer imaging research on the cloud.

Supplemental video 2 from NCI Imaging Data Commons

Supplemental video 3 from NCI Imaging Data Commons

Supplemental video 1 from NCI Imaging Data Commons

In this article, we present the first detailed simulation of the antineutrino emissions from an Advanced Gas-cooled Reactor (AGR) core, benchmarked with input data from the UK Hartlepool reactors. An accurate description of the evolution of the antineutrino spectrum of reactor cores is needed to assess the performance of antineutrino-based monitoring concepts for nonproliferation, including estimations of the sensitivity of the antineutrino rate and spectrum to fuel content and reactor thermal power. The antineutrino spectral variation we present, while specific to AGRs, helps provide insight into the likely behavior of other reactor designs that use a similar batch refueling approach, such as those used in RBMK, CANDU and other reactors., 8 Pages, 8 figures

Here we offer open access to the Familydemic Cross Country and Gender Dataset (FCCGD), which offers cross country and gender comparative data on work and family outcomes among parents of dependent children, before and during the Covid-19 pandemic. It covers six countries from two different continents representing diverse welfare regimes as well as policy reactions to the pandemic outbreak. The FCCGD was created using the first wave of a comparative, web-based international survey (Familydemic) carried out between June and September 2021, on representative samples of parents (aged 20-59) living with at least one child under 12 in Canada, Germany, Italy, Poland, Sweden and the US. While individual datasets are not available due to country-level restriction policies, the presented database allows for cross-country comparison of a wide range of employment outcomes and work arrangements, the division of diverse tasks of unpaid labour (housework and childcare) in couples, experiences with childcare and school closures due to pandemic and subjective assessments of changes to work-life balance, career prospects and the financial situation of families. The detailed description of how the dataset was created can be found in Data Descriptor published in Scientific Data (Springer Nature): https://rdcu.be/c2GwL IMPORTANT: Before accessing the data please DOWNLOAD IT as the built-in OSF browser distorts the tables.

Supplemental material, sj-docx-1-smh-10.1177_21568693231169521 for Managing a Household during a Pandemic: Cognitive Labor and Parents’ Psychological Well-being by Richard J. Petts and Daniel L. Carlson in Society and Mental Health

The microscopic composition of thirteen samples of epidote related to porphyry Cu mineralization was mapped using laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) at the Geological Survey of Canada. The objective of this research is to improve the indicator mineral method of mineral exploration in glaciated terrains by utilizing the trace element composition of epidote. Six bedrock samples from porphyry Cu deposits of south-central British Columbia (Gibraltar, Mount Polley and Woodjam), three bedrock samples from the Nicola Group located close (

Health communication has relevance for virtually every aspect of health and well-being, including disease prevention. This review explored the effectiveness of communications in enhancing the adoption of or adherence to behavioural interventions (non-pharmaceutical interventions (NPIs)) related to COVID-19. The review takes the UK as a case study and focuses on self-reported behaviours (e.g. social distancing). It also reviews the psychosocial determinants of adherence. Searches were conducted using PubMed; Scopus; CINAL; ASSIA and iCite databases. Eleven thousand five hundred records were identified and 13 were included in the final sample. Included studies suggest that NPI adoption or adherence was generally high, and communication had significant impacts, with key themes including clarity and consistency, trust and control. Based on the evidence in this review, features of effective communication in the content of NPI adoption or adherence are (i) information should be conveyed clearly and conflicting (mixed) messages should be avoided; (ii) information should be conveyed by trusted sources (e.g. health authorities) and (iii) communication should strike a balance between being authoritative but avoiding language seen as controlling (e.g. ‘you must’). Future research should prioritize quantitative, experimental and longitudinal study designs, that focus specifically on communication as an intervention, and which measure behaviour.This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the Covid-19 pandemic: the evidence'.

Supplemental material, sj-docx-1-smh-10.1177_21568693231169521 for Managing a Household during a Pandemic: Cognitive Labor and Parents’ Psychological Well-being by Richard J. Petts and Daniel L. Carlson in Society and Mental Health

Leading international scholars present analysis and case studies from different cultural settings, East and West, exploring aesthetic interest and experience in our daily lives at home, in workplaces, using everyday things, in our built and natural environments, and in our relationships and communities. A wide range of views and examples of everyday aesthetics are presented from western philosophical paradigms, from Confucian and Daoist aesthetics, and from the Japanese tradition. All indicate universal features of human aesthetic lives together with their cultural variations. Comparative Everyday Aesthetics is a significant contribution to a key trend in international aesthetics for thinking beyond narrow art-centered conceptions of the aesthetic. It generates global discussions about good, aesthetic, everyday living in all its various aspects. It also promotes aesthetic education for personal, social, and environmental development and presents opportunities for global collaborative projects in philosophical aesthetics.

Skill stories from the Zhuangzi – the cook’s, the woodcarver’s, and the wheelwright’s, among others – are stories of craftsmanship, describing displays of skill and awe-inspiring outcomes. Also, the stories are usually understood to show that the skilled worker acts instinctively and achieves success without knowing why. This chapter examines descriptions of skill stories from the Zhuangzi in a western, as well as Chinese, philosophical aesthetic light. That is, in terms of aesthetic concepts like ‘fit’ and ‘harmony’ that occur in the skill stories. Skill stories from the Zhuangzi and arts and crafts tend to a global idea of developmental aesthetics: an everyday philosophical aesthetics that embraces both individual cultivation and social progress while maintaining different cultural traditions of beauty and creative making.

Contains fulltext : 291463.pdf (Publisher’s version ) (Open Access) 26 februari 2023

INTRODUCTION Despite increased prevalence and identification of pediatric behavioral health concerns, families face many barriers when attempting to access behavioral health services. System navigators, or individuals experienced in navigating the health system, help to engage families in services by helping individuals overcome barriers for accessing care. However, limited research to date has systematically reviewed the implementation and effectiveness of navigation models in pediatric populations. METHOD We systematically reviewed published studies examining navigation models for pediatric populations (up to age 18) referred to behavioral health services. We searched PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO for studies that evaluated a navigation model and included service use outcomes. We aggregated data pertaining to characteristics of the study and navigation model, service use outcomes, and implementation outcomes. RESULTS Eight studies met inclusion criteria. Families who participated in navigation services were more likely to complete diagnostic assessments and received an increased dosage (e.g., time spent, services completed) of behavioral health treatments. There was notable variability across studies in terms of processes involved in the navigation models. DISCUSSION Findings indicate that system navigation is a promising method for improving service use for pediatric populations referred to behavioral health services. Future research may continue to examine the effectiveness and implementation of the model, to best understand its benefits and what processes may contribute to improved service outcomes. Public Significance Statement: This paper reviews the effectiveness of system navigator models, which are designed to engage children and families in behavioral health services. The interventions reviewed are associated with increased behavioral health service use in children and show promise as a method of overcoming barriers to accessing behavioral health care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Humankind has lived with the danger of endemic, epidemic and pandemic disease for thousands of years. The effects of these outbreaks have often devastated human populations. Sixteen pandemic events causing an estimated 147 million deaths have occurred since the eighth century, The Black Death and the influenza pandemic of 1918-1920 probably having the greatest impact. Animal populations, both wild and domestic, have similarly suffered devastating outbreaks of disease which, on occasions, have translated into serious effects on human health. The deliberate or accidental introduction of animals into virgin areas has given rise to unforeseen disease events occasionally leading to extinction. Similarly, human intent or negligence and the vagaries of nature itself has resulted in ill health and loss of life. This paper describes the history of pandemics, epidemics and disasters, and the attempts to bring them under control.

The purpose of this study was to examine patient and provider experiences of integrated behavioral health care at a Federally Qualified Health Center (FQHC). Using a mixed methodology design, both patients (n = 186) and providers (n = 17) completed a survey regarding satisfaction with care and the extent of integration at the clinic, as well as attended a focus group or interview (n = 11 patients; n = 12 providers) regarding their satisfaction and experiences. Both patients and providers found integration to be acceptable and satisfactory and the integration of services among different health care providers occurred fairly regularly. Themes from the provider and patient interviews/focus groups highlighted both positive aspects of the integration and specific challenges within the clinic. This more nuanced perspective of integration both replicates and extends upon previous research regarding satisfaction with integrated care and emphasizes the complexities and challenges of integration within community health clinics.

Promising community-level approaches to addressing interpersonal violence have increased in popularity over the last few decades. However, the shift towards community-based research has not necessarily extended to all graduate program pedagogies, especially given the range of disciplines from which researchers of interpersonal violence hail. Coupled with the fact that many new doctorates relocate to unfamiliar communities to secure their tenure-track positions, junior faculty may find the task of forming and maintaining rewarding community partnerships to be daunting at best. This article focuses on the process of embarking on community-based research as a new faculty member within a new community. In this article, three tenure-track assistant professors of a psychology department within an urban, Midwestern-based university reflected on their own experiences establishing community-based research collaborations after relocating for their positions. Personal narratives focused on experienced challenges and successes related to building mutually beneficial relationships with community organizations of relevance to addressing interpersonal violence (e.g., victim response services, healthcare providers, school systems) were written. Individual narratives were then compiled and six overarching themes (i.e., establishing initial connections, messaging and marketing one’s research to gain buy-in, overcoming misperceptions and distrust, maintaining relationships as an external partner, conducting research with community organizations, balancing community-based research and academic demands) related to challenges and multiple associated strategies and lessons learned were identified. Implications of this article for researchers of interpersonal violence who are building careers in a new community are discussed. Some of these implications include the need for increased mentorship, trainings and resources that are specifically targeted to junior faculty’s unique needs, and changes to departmental and college level infrastructures that better support and reward community-based research.

This paper examines the relationship between gender ideology and attitudes toward parental leave. We use data from two original survey experiments with a total analytic sample of 3332 respondents. Using an experimental design where participants evaluate a new parent’s decision about taking parental leave in light of the employer’s leave policies, and answer attitudinal questions about leave and gender ideology, we assess the associations between gender ideology and (a) desired weeks of parental leave for mothers and fathers, as well as (b) perceptions of whether the new parent described in the experiment took too little or too much leave. We find that participants think fathers should receive 10.5 weeks of paid paternity leave, whereas mothers should receive 16 weeks of paid maternity leave. In general, those with egalitarian gender ideals support longer paternity leave and more equal periods of leave for mothers and fathers—and are more likely to think that men workers take too little leave. However, those who support mothers as financial providers are more likely to think that women workers take too much leave, demonstrating the complexities between dimensions of gender ideology, the gender of the parent taking leave, and views of parental leave.

Rising domestic burdens for mothers fueled concerns that the COVID-19 pandemic exacerbated gender inequalities in well-being. Yet, survey research has not considered whether and how cognitive labor—planning, organizing, and monitoring family needs—contributed to gendered health disparities during the pandemic. Using data from the Study on U.S. Parents’ Divisions of Labor during COVID-19 (SPDLC) and a stress process perspective, we examine the association between cognitive labor and parents’ psychological well-being, and whether this association (1) differs between mothers and fathers and (2) is moderated by employment status and telecommuting. Mothers performed more cognitive labor during the pandemic than fathers, and cognitive labor was negatively associated with mothers’ psychological well-being—particularly for mothers who never or exclusively telecommuted. Mothers’ psychological well-being was higher when fathers did more cognitive labor, especially among mothers who worked outside the home. Overall, cognitive labor appears to be another stressor that contributed to increased gender inequality.

Affirmative action is any policy or program that provides special consideration to historically excluded groups, like racial minorities. Affirmative action in higher education is largely understood...

Despite the high prevalence of behavioral health concerns presenting in pediatric primary care and the growing support for integrating behavioral health services into this setting, a majority of primary care providers do not have access to on-site behavioral health specialists. Fortunately, primary care providers can implement some services typically provided by behavioral health clinicians. This article outlines screening, brief intervention, and referral guidelines for prominent behavioral health problems seen in primary care. The evidence-based approaches have the potential to supplement typical management of behavioral health problems in primary care and provide a foundation for future integrated behavioral health practice.

Prior studies that show no association between fathers’ work flexibility and their domestic contributions suffer from measurement limitations and/or the lack of nationally representative data. Using data on fathers in different-sex partnerships (n = 1,956) from the 2017–2018 American Time Use Survey Leave Module, we examine three indicators (use, frequency of use and reason for use) of working from home—a work–family benefit is known as flexplace—and consider whether partners’ employment status moderates the association between flexplace and fathers’ time in domestic labor. Fathers who use flexplace benefits report more routine childcare, regardless of the reason for flexplace use or their partners’ employment status. The association between flexplace use and fathers’ housework time is conditional on their partners’ employment status and fathers’ rationale for working from home.

BackgroundWolman disease is a rare, lysosomal storage disorder in which biallelic variants in theLIPAgene result in reduced or complete lack of lysosomal acid lipase. The accumulation of the substrates; cholesterol esters and triglycerides, significantly impacts cellular function. Untreated patients die within the first 12 months of life. Clinically, patients present severely malnourished, with diarrhoea and hepatosplenomegaly, many have an inflammatory phenotype, including with hemophagocytic lymphohistiocytosis (HLH). Hematopoietic stem cell transplant (HCT) had been historically the only treatment available but has a high procedure-related mortality because of disease progression and disease-associated morbidities. More recently, enzyme replacement therapy (ERT) with dietary substrate reduction (DSR) has significantly improved patient survival. However, ERT is life long, expensive and its utility is limited by anti-drug antibodies (ADA) and the need for central venous access.ResultsWe describe five Wolman disease patients diagnosed in infancy that were treated at Royal Manchester Children's Hospital receiving ERT with DSR then HCT—multimodal therapy. In 3/5 an initial response to ERT was attenuated by ADA with associated clinical and laboratory features of deterioration. 1/5 developed anaphylaxis to ERT and the other patient died post HCT with ongoing HLH. All patients received allogeneic HCT. 4/5 patients are alive, and both disease phenotype and laboratory parameters are improved compared to when they were on ERT alone. The gastrointestinal symptoms are particularly improved after HCT, with reduced diarrhoea and vomiting. This allows gradual structured normalisation of diet with improved tolerance of dietary fat. Histologically there are reduced cholesterol clefts, fewer foamy macrophages and an improved villous structure. Disease biomarkers also show improvement with ERT, immunotherapy and HCT. Three patients have mixed chimerism after HCT, indicating a likely engraftment-defect in this condition.ConclusionWe describe combined ERT, DSR and HCT, multimodal treatment for Wolman disease. ERT and DSR stabilises the sick infant and reduces the formerly described prohibitively high, transplant-associated mortality in this condition. HCT abrogates the problems of ERT, namely attenuating ADA, the need for continuing venous access, and continuing high cost drug treatment. HCT also brings improved efficacy, particularly evident in improved gastrointestinal function and histology. Multimodal therapy should be considered a new paradigm of treatment for Wolman disease patients where there is an attenuated response to ERT, and for all patients where there is a well-matched transplant donor, in order to improve long term gut function, tolerance of a normal diet and quality of life.