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Patient work encompasses a challenging set of activities necessary for learning about and managing chronic conditions over time. Many patient-centered health technology interventions focus on supporting types of patient work, such as symptom tracking, medication adherence, and information sharing between patients and providers. However, people may not always follow, or may actively resist, the activities prescribed by their formal patient role. In this paper, we present three case studies about patients with different chronic conditions to critically reflect on the types of patient behavior commonly taken up in health technology design as acts of "noncompliance." Detailing conflicts that emerge when patients are caught between meeting their personal needs and following clinical best practices, we show how everyday life and health system goals are often misaligned in ways that can't be easily reconciled through current design approaches. As a way forward, we argue for alternative ways of understanding the tensions routinely shaping people's healthcare experiences. We introduce the term care frictions as a sensitizing concept useful for helping designers reframe "noncompliant" behaviors as legitimate forms of patient work. Our paper also offers design considerations-both on challenges and generative possibilities-for future CSCW research seeking to support a wider breadth of patient behavior. In this, we call attention to the value of designer and researcher reflexivity in making visible the problematic assumptions in health technology design that can lead to social and emotional patient harms.

Perceptions towards unsustainable supply chain practices in global, mainstream food systems are motivating a shift towards short food supply chains. Short food supply chains are developed to remove the physical and social distances between producer and consumer. Advances in digital technologies offer promise for short food supply chains, including platforms that can enable real-time data flow, create visibility, and support sustainable practices. This research aims to prioritise attractive quality requirements of short food supply chain digital platforms. The methodology consists of a literature review and Kano analysis for requirements prioritisation. The results show that the requirements span across the four Kano categories, attractive quality encompassing the largest number of requirements. The attractive quality requirements identified offer increased levels of satisfaction when present and have limited negative impact when missing. Therefore, they are considered exciting for potential users of a system. The limitations of the research and areas of future work are presented.

Background Falls are a significant source of morbidity, mortality, and health care spending in the elderly. The objective was to identify whether race, insurance status, and median income by zip code were associated with discharge disposition, readmission within 90 days, or mortality within 1 year of ground-level falls in patients aged 60-90. Materials and Methods We conducted a retrospective chart review of 926 patients aged 60-90 treated for ground-level falls. We created a binomial linear regression model to identify predictors of discharge disposition, 90-day readmission, and mortality within 1 year of discharge. Results Length of stay (P < .01), having orthopedic surgery (P < .01), score on Charlson Comorbidity Index (CCI) (P < .01), increasing age (P = .014), female sex (P = .05), and admission to the ICU (P = .05) were associated with discharge to a secondary facility. Readmission within 90 days was only associated with higher scores on the CCI (P < .01). Charlson Comorbidity Index (P < .0001), hospital length of stay (P < .001), and admission to the ICU (P = .015) were associated with increased mortality at 1 year. Discussion Predictors of discharge to another facility included hospital length of stay, having orthopedic surgery, CCI scores, increasing age, female sex, and admission to the ICU. Charlson Comorbidity Index score was the only significant predictor of readmission. Predictors of mortality at 1-year post-fall included CCI score, hospital length of stay, and admission to the ICU. Race, median income by zip code, and insurance provider were not statistically significant.

Depression is a challenging condition that requires individuals to manage their moods and emotions over time. Within CSCW, there has been an interest in understanding how individuals seek and share support on social media and in online communities. However, less attention has been paid to how collaboration as an aspect of self-management of depression unfolds in people's daily lives. In this paper, we explore the collaborative self-management work of 28 individuals managing depression who live in the United States. Data collection included remote semi-structured interviews with an associated cognitive mapping exercise. Our findings describe who participants turn to for day-to-day collaborative support, how collaborative activities are enacted (across both mood-focused and preventative support practices), and where these often technology-mediated interactions occur across text, phone, video, and picture-based channels. We discuss collaborative self-management in the depression support context, including key characteristics: agency, reciprocity, time, and interaction. We also present a four-step model of how the process occurs over time (awareness, planning, interaction, and reflection). We conclude by discussing how technology ecosystems support individuals' collaborative self-management.

Mosquitoes utilize a plethora of digestive enzymes to meet the challenge of both requisite blood and sugar meals that enable them to survive and reproduce. Sugar meals, typically derived from plant sources, are critical to maintain energy in both male and female mosquitoes, whereas blood meals are taken only by females to complete oogenesis. Enzymes involved in sugar digestion have been the subject of study for decades but have been limited to a relatively narrow range of mosquito species. The southern house mosquito,Culex quinquefasciatus, is of public health importance and seldom considered in these types of studies outside of topics related toBacillus sphaericus, a biocontrol agent that requires interaction with a specific gut-associated α-glucosidase. Here we sought to describe the nature of α-glucosidases and the unexplored β-glucosidases that may aidCx. quinquefasciatuslarvae in acquiring nutrients from cellulosic sources in their aquatic environments. Consistent with our hypothesis, we found both α- and β-glucosidase activity in larvae. Interestingly, β-glucosidase activity all but disappeared at the pupal stage and remained low in adults, while α-glucosidase activity remained in the pupal stage and then exceeded larval activity by approximately 1.5-fold. Expression of the putative α- and β-glucosidase genes chosen did not generally follow the trends seen in enzyme activities. When the α-glucosidase inhibitor acarbose was administered to adults, mortality was seen especially in males but also in females after two days of exposure and key energetic storage molecules, glycogen and lipids, were significantly lower than controls. In contrast, administering the β-glucosidase inhibitor conduritol β-epoxide to larvae did not produce mortality even at the highest soluble concentration. Here we provide insights into the importance of α- and β-glucosidases on the survival ofCx. quinquefasciatusin their three mobile life stages.

The survival of an organism is dependent on their ability to respond to cues in the environment. Such cues can attain control over behavior as a function of the value ascribed to them. Some individuals have an inherent tendency to attribute reward-paired cues with incentive motivational value, or incentive salience. For these individuals, termed sign-trackers, a discrete cue that precedes reward delivery becomes attractive and desirable in its own right. Prior work suggests that the behavior of sign-trackers is dopamine-dependent, and cue-elicited dopamine in the nucleus accumbens is believed to encode the incentive value of reward cues. Here we exploited the temporal resolution of optogenetics to determine whether selective inhibition of ventral tegmental area (VTA) dopamine neurons during cue presentation attenuates the propensity to sign-track. Using male tyrosine hydroxylase (TH)-Cre Long Evans rats it was found that, under baseline conditions, ∼84% of TH-Cre rats tend to sign-track. Laser-induced inhibition of VTA dopamine neurons during cue presentation prevented the development of sign-tracking behavior, without affecting goal-tracking behavior. When laser inhibition was terminated, these same rats developed a sign-tracking response. Video analysis using DeepLabCut revealed that, relative to rats that received laser inhibition, rats in the control group spent more time near the location of the reward cue even when it was not present and were more likely to orient towards and approach the cue during its presentation. These findings demonstrate that cue-elicited dopamine release is critical for the attribution of incentive salience to reward cues.Significance StatementActivity of dopamine neurons in the ventral tegmental area (VTA) during cue presentation is necessary for the development of a sign-tracking, but not a goal-tracking, conditioned response in a Pavlovian task. We capitalized on the temporal precision of optogenetics to pair cue presentation with inhibition of VTA dopamine neurons. A detailed behavioral analysis with DeepLabCut revealed that cue-directed behaviors do not emerge without VTA dopamine. Importantly, however, when optogenetic inhibition is lifted, cue-directed behaviors increase, and a sign-tracking response develops. These findings confirm the necessity of VTA dopamine during cue presentation to encode the incentive value of reward cues.

With widespread resistance to a limited number of insecticides available for medical and veterinary pests, new insecticides and insecticide synergists are desperately needed in this market space. We assessed the topical toxicity of carvone, menthone, and fenchone compared to permethrin and methomyl against the yellow fever mosquito, Aedes aegypti, and the house fly, Musca domestica. We also evaluated the synergistic potential of the monoterpenoids with permethrin and methomyl. Additionally, we assessed the acetylcholinesterase inhibitory potential of each monoterpenoid compared to methomyl. While all three monoterpenoids performed relatively poorly as topical insecticides (LD50 > 4000 ng/mg on M. domestica; > 6000 ng/mg on Ae. aegypti), they synergized both permethrin and methomyl as well as or better than piperonyl butoxide (PBO). Carvone and menthone yielded synergistic co-toxicity factors (23 and 29, respectively), which were each higher than PBO at 24 h. Acetylcholinesterase inhibition did not appear to explain the toxic or synergistic effects of the three monoterpenoids with IC50 values greater than 1 mM for all, compared to the 2.5 and 1.7 µM for methomyl on Aedes aegypti and Musca domestica, respectively. This study provides valuable monoterpenoid toxicity and synergism data on two pestiferous insects and highlights potential for these chemistries in future pest control formulations.

Phaeochromocytoma and paraganglioma are highly heritable tumours; half of those associated with a germline mutation are caused by mutations in genes for Krebs’s cycle enzymes, including succinate dehydrogenase (SDH). Inheritance of SDH alleles is assumed to be Mendelian (probability of 50% from each parent). The departure from transmission of parental alleles in a ratio of 1:1 is termed transmission ratio distortion (TRD). We sought to assess whether TRD occurs in the transmission of SDHB pathogenic variants (PVs). This study was conducted with 41 families of a discovery cohort from Royal North Shore Hospital, Australia, and 41 families from a validation cohort from St. Bartholomew’s Hospital, United Kingdom (UK). Inclusion criteria were a clinically diagnosed SDHB PV and a pedigree available for at least two generations. TRD was assessed in 575 participants with the exact binomial test. The transmission ratio for SDHB PV was 0.59 (P = 0.005) in the discovery cohort, 0.67 (P < 0.001) in the validation cohort, and 0.63 (P < 0.001) in the combined cohort. No parent-of-origin effect was observed. TRD remained significant after adjusting for potential confounders: 0.67 (P < 0.001) excluding families with incomplete family size data; 0.58 (P < 0.001) when probands were excluded. TRD was also evident for SDHD PVs in a cohort of 81 patients from 13 families from the UK. The reason for TRD of SDHB and SDHD PVs is unknown, but we hypothesize a survival advantage selected during early embryogenesis. The existence of TRD for SDHB and SDHD has implications for reproductive counselling, and further research into the heterozygote state.

Medication errors are more prevalent in settings with acutely ill patients and heavy workloads, such as in an emergency department (ED). A pragmatic, controlled study compared partnered pharmacist medication charting (PPMC) (pharmacist-documented best-possible medication history [BPMH] followed by clinical discussion between a pharmacist and medical officer to co-develop a treatment plan and chart medications) with early BPMH (pharmacist-documented BPMH followed by medical officer-led traditional medication charting) and usual care (traditional medication charting approach without a pharmacist-collected BPMH in ED). Medication discrepancies were undocumented differences between medication charts and medication reconciliation. An expert panel assessed the discrepancies’ clinical significance, with ‘unintentional’ discrepancies deemed ‘errors’. Fewer patients in the PPMC group had at least one error (3.5%; 95% confidence interval [CI]: 1.1% to 5.8%) than in the early BPMH (49.4%; 95% CI: 42.5% to 56.3%) and usual care group (61.4%; 95% CI: 56.3% to 66.7%). The number of patients who need to be treated with PPMC to prevent at least one high/extreme error was 4.6 (95% CI: 3.4 to 6.9) and 4.0 (95% CI: 3.1 to 5.3) compared to the early BPMH and usual care group, respectively. PPMC within ED, incorporating interdisciplinary discussion, reduced clinically significant errors compared to early BPMH or usual care.

Mitosis is an essential process in which the duplicated genome is segregated equally into two daughter cells. CTCF has been reported to be present in mitosis but its importance for mitotic fidelity remains to be determined. To evaluate the importance of CTCF in mitosis, we tracked mitotic behaviors in wild type and two different CTCF CRISPR-based genetic knockdowns. We find that knockdown of CTCF results in prolonged mitoses and failed anaphase segregation via time lapse imaging of SiR-DNA. CTCF knockdown did not alter cell cycling or the mitotic checkpoint, which was activated upon nocodazole treatment. Immunofluorescence imaging of the mitotic spindle in CTCF knockdowns revealed disorganization via tri/tetrapolar spindles and chromosomes behind the spindle pole. Imaging of interphase nuclei showed that nuclear size increased drastically, consistent with failure to divide the duplicated genome in anaphase. Population measurements of nuclear shape in CTCF knockdowns do not display decreased circularity or increased nuclear blebbing relative to wild type. However, failed mitoses do display abnormal nuclear morphologies relative to successful mitoses, suggesting population images do not capture individual behaviors. Thus, CTCF is important for both proper metaphase organization and anaphase segregation which impacts the size and shape of the interphase nucleus.

Most parasitoid wasps parasitize herbivorous insects, so nectar from flowers is readily available. However, parasitoid wasps are also an important component of the rich invertebrate communities at livestock facilities in large accumulations of manure, where flowers are largely absent. Little is known about adult parasitoid diet and nutrition in these communities. The present study examined this in Spalangia cameroni Perkins, a pupal parasitoid of filth flies. Like many parasitoid wasps, S. cameroni feed on host fluids, and in the laboratory readily feed on honey or a sucrose solution, which increases their longevity. Here adult longevity in the presence of six potential food sources, bovine manure, sorghum silage, bovine milk, buckwheat inflorescence (Polygonaceae), sweet alyssum inflorescence (Brassicaceae), or dandelion inflorescence (Asteraceae), was compared to that with water or honey. Only parasitoids given buckwheat lived as long as parasitoids given honey, and parasitoids given honey or buckwheat lived longer than parasitoids given water. Parasitoids readily ate buckwheat nectar, avoiding pollen grains. Diet affected the amount of free sugars, glycogen, and lipids in complex ways. Compared to parasitoids that were given just water, parasitoids with access to honey or sucrose had higher sugar and glycogen levels, but not detectably higher lipid levels. Access to buckwheat had no detectable effect on a parasitoid’s free sugar, glycogen, or lipid levels; however, then after 4 d with just water, sugar levels were lower and glycogen levels were higher compared to parasitoids that had been given access to only water the entire time.

BACKGROUND/AIMS: Maintenance of whole-body ascorbate levels and distribution is mediated via sodium-dependent vitamin C transporters (SVCTs). The kidney is one of a few organs that express both SVCT1 and SVCT2. Recent evidence suggests that accumulation of ascorbate may be different in tumour compared to normal tissue, but data on SVCT levels in tumours is sparse. METHODS: The role of the two SVCT isoforms in ascorbate uptake in renal cell carcinoma (RCC) was investigated in vitro and in clinical samples. In three human RCC cell lines, we investigated SVCT protein levels and cellular location in response to ascorbate supplementation and withdrawal. In clinical RCC samples (n=114), SVCT patterns of staining and protein levels were analysed and compared to ascorbate levels. RESULTS: In cell culture, transporter levels and cellular location were not modified by ascorbate availability at any time up to 8h, although basal SVCT2 levels governed maximal ascorbate accumulation. In clinical samples, SVCT1 protein levels in papillary RCC (pRCC) were similar to matched normal renal cortex, but were increased in clear-cell RCC (ccRCC). Native SVCT2 (72 kDa) was significantly decreased in both pRCC and ccRCC tissues compared to cortex (p

BACKGROUND: Trends in the prevalence of hepatitis C virus (HCV) infection among women delivering live births may differ in rural vs. urban areas of the United States, but estimation of trends based on observed counts may lead to unstable estimates in rural counties due to small numbers. OBJECTIVES: The objective of the study was to use small area estimation methods to provide updated county-level prevalence estimates and, for the first time, trends in maternal HCV infection among live births by county-level rurality. METHODS: Cross-sectional natality data from 2016 to 2020 were used to estimate maternal hepatitis C prevalence using hierarchical Bayesian models with spatiotemporal random effects to produce annual county-level estimates of maternal HCV infection and trends over time. Models included a 6-Ievel rural–urban county classification, year, maternal characteristics and county-specific covariates. Data were analysed in 2022. RESULTS: There were 90,764/18,905,314 live births (4.8 per 1000) with HCV infection reported on the birth certificate. Hepatitis C prevalence was higher among rural counties as compared to urban counties. Rural counties had the largest annual increases in maternal hepatitis C prevalence (per 1000 births) from 2016 to 2020 (micropolitan: 0.39; noncore: 0.40), with smaller increases among less densely populated urban counties (medium metro: 0.28; small metro: 0.28) and urban counties (large central metro:0.11; large fringe metro: 0.14). CONCLUSIONS: The prevalence of maternal HCV infection was the highest in rural counties, and rural counties saw the greatest average prevalence increase during 2016–2020. County-level data can help in monitoring rural–urban trends in maternal HCV infection to reduce geographic disparities.

Given the widespread prevalence of sleep disorders and their impacts on health, it is critical that researchers continue to identify and evaluate novel avenues of treatment. Recently the melanin-concentrating hormone (MCH) system has attracted commercial and scientific interest as a potential target of pharmacotherapy for sleep disorders. This interest emerges from basic scientific research demonstrating a role for MCH in regulating sleep, and particularly REM sleep. In addition to this role in sleep regulation, the MCH system and the MCH receptor 1 (MCHR1) have been implicated in a wide variety of other physiological functions and behaviors, including feeding/metabolism, reward, anxiety, depression, and learning. The basic research literature on sleep and the MCH system, and the history of MCH drug development, provide cause for both skepticism and cautious optimism about the prospects of MCH-targeting drugs in sleep disorders. Extensive efforts have focused on developing MCHR1 antagonists for use in obesity, however, few of these drugs have advanced to clinical trials, and none have gained regulatory approval. Additional basic research will be needed to fully characterize the MCH system’s role in sleep regulation, for example, to fully differentiate between MCH-neuron and peptide/receptor-mediated functions. Additionally, a number of issues relating to drug design will continue to pose a practical challenge for novel pharmacotherapies targeting the MCH system.

Filth flies associated with animal production transmit pathogens to humans and animals, propagate antimicrobial resistance in microbial communities and provoke nuisance litigation. Although dispersal of flies from facilities is often responsible for these negative effects, filth fly research on swine facilities has been limited to within the barns. Filth fly adaptations in space and time, as well as influences of abiotic and biotic factors impact distribution and abundance of animal-associated filth flies on swine production facilities. In this study, fly surveillance was conducted around four swine facilities in Bladen County, North Carolina, U.S.A. from January 2019 to October 2019. Traps were replaced weekly and animal-associated filth flies were identified. Flies were grouped for comparison based on biology and differences in pest management strategies. There were distinct differences in abundance and spatial distribution of different filth fly groups on the swine facilities, which are likely linked to environmental factors like spatial relation to crop production and species phenology. The impact of the observed temporal and spatial distribution and abundance is discussed in the context of filth fly management.

A 46-year-old man presented with worsening vision in the context of long-standing optic disc changes, bilateral sensorineural hearing loss, chronic aseptic meningitis, rash, arthralgia and raised inflammatory markers. The differential diagnoses of neoplasia, infection and inflammation are discussed. We highlight a condition that can present to adult neurologists, with successful diagnosis leading to targeted treatments that transform patient outcomes. This case was presented at the Association of British Neurologists Annual Meeting 2020 as a Clinicopathological Conference (CPC).

KEY POINTS We investigated the influence of arterial PCO2 (PaCO2 ) with and without experimentally altered pH on cerebral blood flow (CBF) regulation at sea level and with acclimatization to 5050 m. At sea level and high altitude, we assessed stepwise alterations in PaCO2 following metabolic acidosis (via 2 days of oral acetazolamide; ACZ) with and without acute restoration of pH (via intravenous sodium bicarbonate; ACZ+HCO3- ). Total resting CBF was unchanged between trials at each altitude even though arterial pH and [HCO3- ] (i.e. buffering capacity) were effectively altered. The cerebrovascular responses to changes in arterial [H+ ]/pH were consistent with the altered relationship between PaCO2 and [H+ ]/pH following ACZ at high altitude (i.e. leftward x-intercept shifts). Absolute cerebral blood velocity (CBV) and the sensitivity of CBV to PaCO2 was unchanged between trials at high altitude, indicating that CBF is acutely regulated by PaCO2 rather than arterial pH. ABSTRACT Alterations in acid-base balance with progressive acclimatization to high altitude have been well-established. However, how respiratory alkalosis and the resultant metabolic compensation interact to regulate cerebral blood flow (CBF) is uncertain. We addressed this via three separate experimental trials at sea level and following partial acclimatization (14 to 20 days) at 5050 m; involving: (1) resting acid-base balance (control); (2) following metabolic acidosis via 2 days of oral acetazolamide at 250 mg every 8 h (ACZ; pH: Δ -0.07 ± 0.04 and base excess: Δ -5.7 ± 1.9 mEq⋅l-1 , trial effects: P < 0.001 and P < 0.001, respectively); and (3) after acute normalization of arterial acidosis via intravenous sodium bicarbonate (ACZ + HCO3- ; pH: Δ -0.01 ± 0.04 and base excess: Δ -1.5 ± 2.1 mEq⋅l-1 , trial effects: P = 1.000 and P = 0.052, respectively). Within each trial, we utilized transcranial Doppler ultrasound to assess the cerebral blood velocity (CBV) response to stepwise alterations in arterial PCO2 (PaCO2 ), i.e. cerebrovascular CO2 reactivity. Resting CBF (via Duplex ultrasound) was unaltered between trials within each altitude, indicating that respiratory compensation (i.e. Δ -3.4 ± 2.3 mmHg PaCO2 , trial effect: P < 0.001) was sufficient to offset any elevations in CBF induced via the ACZ-mediated metabolic acidosis. Between trials at high altitude, we observed consistent leftward shifts in both the PaCO2 -pH and CBV-pH responses across the CO2 reactivity tests with experimentally reduced arterial pH via ACZ. When indexed against PaCO2 - rather than pH - the absolute CBV and sensitivity of CBV-PaCO2 was unchanged between trials at high altitude. Taken together, following acclimatization, CO2 -mediated changes in cerebrovascular tone rather than arterial [H+ ]/pH is integral to CBF regulation at high altitude.

Genetic eye diseases, representing a wide spectrum of simple and complex conditions, are one of the leading causes of visual loss in children and working adults, and progress in the field has led to changes in disease investigation, diagnosis, and management. The past 15 years have seen the emergence of novel therapies for these previously untreatable conditions to the extent that we now have a licensed therapy for one form of genetic eye disease and many more in clinical trial. This is a systematic review of published and ongoing clinical trials of gene therapies for monogenic eye diseases. Databases of clinical trials and the published literature were searched for interventional studies of gene therapies for eye diseases. Standard methodological procedures were used to assess the relevance of search results. A total of 59 registered clinical trials are referenced, showing the significant level of interest in the potential for translation of these therapies from bench to bedside. The breadth of therapy design is encouraging, providing multiple possible therapeutic mechanisms. Some fundamental questions regarding gene therapy for genetic eye diseases remain, such as optimal dosing, the relative benefits of adeno-associated virus (AAV)-packaging and the potential for a significant inflammatory response to the therapy itself. As a result, despite the promise of the eye as a target, it has proven difficult to deliver clinically effective gene therapies to the eye. Despite setbacks, the licensing of Luxturna (voretigene neparvovec, Novartis) for the treatment of RPE65-mediated Leber congenital amaurosis (LCA) is a major advance in efforts to treat these rare, but devastating, causes of visual loss.

Citrus bioflavonoids are polyphenolic plant-derived pigments found in high levels in oranges, lemons, grapefruits and other citrus fruits. The three most abundant types of citrus bioflavonoids are hesperidin, naringenin and eriocitrin. Citrus bioflavonoids have long been known to possess powerful free radical-scavenging properties and cardioprotective effects. The study involved the analysis of 10 commercially available citrus bioflavonoid supplements from three different countries: Australia, the United States and Canada. The supplements were tested for their citrus bioflavonoid content which varied from 0.8 to 33.3% w/w. The daily bioflavonoid dose varied from 19 mg to 560 mg. Hesperidin was the major citrus bioflavonoid in nine out of ten supplements. One supplement was found to contain less than 10% of the quantity of rutin claimed to have been added. The DPP-4 inhibitory potential, compared through an estimation of rutin equivalence, ranged from 1.9 mg to 400 mg per day. This data highlights the variability between the supplements in their potential to inhibit DPP-4 for subsequent health benefits.

As U.S. healthcare organizations transition to value-based healthcare, they are increasingly focusing on supporting patients who have difficulties managing chronic care, including mental health, through the growing role of care managers (CMs). CMs communicate with patients, provide access to resources, and coach them toward healthy behaviors. CMs also coordinate patient-related issues internally with healthcare practitioners and externally with community organizations and insurance providers. While there have been many interaction design studies regarding the work of clinical and non-clinical healthcare providers and how best to design support systems for them, we know little about the work of CMs. In this study, we examine the role of CMs, particularly focusing on their work to support patient mental health, through interviews with 11 CMs who are part of a large Midwestern U.S. health system. Workflow observations were conducted to supplement the interview data. We describe the role of CMs and identify challenges that they face in supporting patient mental health. A key challenge is a high degree of role ambiguity in this professional role. We discuss sociotechnical implications to better support care delivery processes and technologies for the delivery of mental health services by CMs.

Short food supply chains emerged from initiatives for reducing distances and intermediaries in food supply chains, substantiated in part by a shift in consumer’s perceptions on sustainability of global systems. Short food supply chains attract consumers due to the reduced distance to the origin of food. Informational platforms can help these types of supply chains achieve desirable network effect and add value for relevant stakeholders. This paper explores prioritisation of requirements for informational short food supply chains. It uses seventeen requirements selected by a panel of experts. Prioritisation is accomplished through a Fuzzy MoSCoW method. Results suggest that track and trace, real-time operations and supply chain related data exchange, and real-time supplier data exchange are must have/top ranked functional requirements for informational short food supply chains. Real-time sustainability related data exchange is categorised as should have and is likely to rank higher as short food supply chains increasingly embrace sustainability.

Global supply chains shift to meet exceeding expectations in supply chains lead to the need for digital technologies in supply chain management. Industry 4.0 has emerged in sustainable supply chain systems, blockchain is prominent, with the potential of immutable transparent data. Blockchains present potential to disrupt supply chains through digital transformation by enabling provenance, visibility, relationships, collaboration, lower costs, and enabling real-time trusted data. Scholars are increasingly investigating blockchain adoption, with an emphasis on technology acceptance modelling. Current research is valuable to understand potentials of blockchain technology in supply chains however, there is limited work on the building blocks for blockchain adoption in digital transformation of supply chains. This study aims to investigate through a systematic literature review and case studies, the building blocks for blockchain adoption in digital transformation of sustainable supply chains. Blockchain adoption in supply chain management is receiving increasing attention, along with highlights of critical factors. This paper offers a building block model that is in three main phases; pre-adoption, adoption, and the post adoption. The model indicates that adoption context, blockchain technology platform offerings, strategic responses, and adoption readiness are some key building blocks, particularly at the pre-adoption phase. Trust and supply chain network, firm resources, and blockchain costs are all considered critical in the considerations of the building blocks. In addition, aligning supply chain objectives with blockchain systems is critical and so is blockchain compatibility. Law and governance are amongst the two prominent challenges in blockchain adoption and should be considered as part of the building blocks for blockchain adoption.

Current technologies designed for mental health support often have low adoption rates and may not fit people's routines. However, recent literature demonstrates that individuals managing mental illness often incorporate a variety of technologies into their self-management routines, including texting, music, wearables, online communities, games, and social media. Therefore, adopting a perspective focused on understanding the technology ecosystem of mental health management may be a better approach than focusing on singular platforms and applications. In this CHI workshop, we will examine a constellation of digital and non-digital mental health support resources. We will discuss the needs and practices of individuals managing mental illness, how these needs relate to future ecosystems of technologies and services, and the potentials and repercussions of current technologies. By convening a group of interdisciplinary researchers and practitioners, we will collectively address these topics to create resources attentive to individuals' lived experiences with mental illness, goals with respect to management and recovery, and interactions with existing forms of resources, care, and technology.

Undergraduate research is increasingly prevalent in many fields of study, but it is not yet widespread in mathematics education. We argue that expanding undergraduate research opportunities in mathematics education would be beneficial to the field. Such opportunities can be impactful as either extracurricular or course-embedded experiences. To help readers envision directions for undergraduate research experiences in mathematics education with prospective teachers, we describe a model built on a design-based research paradigm. The model engages pairs of prospective teachers in working with faculty mentors to design instructional sequences and test the extent to which they support children’s learning. Undergraduates learn about the nature of systematic mathematics education research and how careful analyses of classroom data can guide practice. Mentors gain opportunities to pursue their personal research interests while guiding undergraduate pairs. We explain how implementing the core cycle of the model, whether on a small or large scale, can help teachers make instructional decisions that are based on rich, qualitative classroom data.

Objectives Prefabrication and storage of antibiotic beads may decrease surgical time and allow for use in other settings. This study investigated the effects of sterilization technique and storage time on the bioactivity of antibiotic polymethyl methacrylate (PMMA) beads. Methods Uniform beads of PMMA containing 1 g each of tobramycin and vancomycin were sterilized using autoclave, ethylene oxide (ETO), or ultraviolet (UV) light. Beads were made in a sterile fashion as a control. Disks containing eluted antibiotics from each of the 4 groups were placed onto agar plates inoculated with Staphylococcus aureus. Zones of inhibition, a measure of bioactivity for antibiotic eluted, were determined for the experimental groups and control. Repeat testing was performed for beads stored for 1 week, 1, 3, and 6 months. Results Beads sterilized using autoclave, ETO, and UV light showed similar ZOIs after 24 hours of and 1 week of elution compared with the control group. Beads stored for up to 6 months demonstrated similar bioactivity to beads made sterile and tested immediately. Conclusion PMMA beads containing vancomycin and tobramycin made in a sterile fashion and stored for up to 6 months have the same efficacy as the current standard of beads made sterile and used immediately. The elution and bioactivity of vancomycin-tobramycin antibiotic beads are not negatively impacted by the sterilization methods of autoclaving, ETO gas, or UV light. Furthermore, nonsterile beads can be sterilized and stored up to 6 months with an expected efficacy comparable with beads made in a standard sterile fashion.

BackgroundThe first pass effect has been shown to improve clinical outcomes in patients with middle cerebral artery (MCA) M1 occlusions.ObjectiveTo determine the rates of first pass effect in MCA M1 occlusions and determine if proximal or distal location of occlusion modified clinical outcomes.MethodsPatients with recanalized MCA M1 occlusions who underwent endovascular thrombectomy (EVT) were reviewed to determine the effect of first pass effect (FPE) and location of occlusion on clinical outcomes. MCA occlusions were classified as proximal if they included the first two thirds of the MCA and involved the lenticulostriate vessels, or distal if they did not.ResultsWe included 261 patients of which 27% achieved FPE. Of the cohort, there were 91 (35%) proximal MCA occlusions and 170 (65%) distal MCA occlusions. Baseline demographics and treatment time metrics were comparable across both groups. There was a trend toward good clinical outcome in patients with or without a FPE (60 vs. 46%; p = 0.06), however a higher rate of excellent clinical outcome was noted in patients with FPE (46 vs. 30%; p = 0.02). When compared by location, patients with distal MCA occlusions had a higher rate of excellent clinical outcome (40 vs. 25%; p = 0.02). Multivariable analysis showed that distal MCA occlusion was the strongest predictor of an excellent clinical outcome and first pass effect.ConclusionPatients with MCA M1 occlusions with FPE have a higher rate of excellent clinical outcomes compared to those who did not. Location of MCA occlusion appears to modify rates of first pass effect and excellent clinical outcomes.

Culex pipiens complex is an important vector of epizootic and zoonotic pathogens, including West Nile virus. Chicago, Illinois and its suburbs have suffered high incidence of human West Nile virus infections in the past. This makes abatement programs in and around the Chicago area an essential service. The control of Cx. pipiens is often complicated by rapidly evolving resistance to pyrethroids, which are the most widely used chemical class in US mosquito abatement programs. The present study assessed Sumithrin® resistance in Cx. pipiens collected from five locations around Cook County, Illinois, neighboring the city limits of Chicago. According to CDC guidelines, samples from all five locations demonstrated some resistance to Sumithrin®. When assessed with Anvil®, a formulated product made of Sumithrin® synergized with piperonyl butoxide, susceptibility was rescued in mosquitoes from three out of the five locations, suggesting involvement of mixed-function oxidases and/or carboxylesterases in Sumithrin® resistance at these locations. Not all locations had susceptibility rescued by Anvil®, but these locations had relatively low knockdown resistance allele frequencies, suggesting that mechanisms other than knockdown resistance may be involved. Enzyme activities did not reveal any marked trends that could be related back to mortality in the bottle bioassays, which highlights the need for multiple types of assays to infer enzymatic involvement in resistance. Future directions in pyrethroid resistance management in Chicago area Cx. pipiens are discussed.

As resistance to the limited number of insecticides available for medical and veterinary pests becomes more widespread, there is an urgent need for new insecticides and synergists on the market. To address this need, we conducted a study to assess the toxicity of three monoterpenoids—carvone, menthone, and fenchone—in comparison to permethrin and methomyl against adults of two common pests: the yellow fever mosquito (Aedes aegypti) and the house fly (Musca domestica). We also examined the potential for these monoterpenoids to enhance the effectiveness of permethrin and methomyl when used together. Finally, we evaluated the ability of each monoterpenoid to inhibit acetylcholinesterase, comparing them to methomyl. While all three monoterpenoids performed relatively poorly as topical insecticides (LD50 > 4000 ng/mg on M. domestica; >6000 ng/mg on Ae. aegypti), they synergized both permethrin and methomyl as well as or better than piperonyl butoxide (PBO). Carvone and menthone yielded synergistic co-toxicity factors (23 and 29, respectively), which were each higher than PBO at 24 h. Currently, the mechanism of action is unknown. During preliminary testing, symptoms of acetylcholinesterase inhibition were identified, prompting further testing. Acetylcholinesterase inhibition did not appear to explain the toxic or synergistic effects of the three monoterpenoids, with IC50 values greater than 1 mM for all, compared to the 2.5 and 1.7 µM for methomyl on Aedes aegypti and Musca domestica, respectively. This study provides valuable monoterpenoid toxicity and synergism data on two pestiferous insects and highlights the potential for these chemistries in future pest control formulations.

CC-90002 is an anti-CD47 antibody that inhibits CD47-SIRPα interaction and enables macrophage-mediated killing of tumor cells in hematological cancer cell lines. In this first clinical, phase 1, dose-escalation and -expansion study (CC-90002-AML-001; NCT02641002), we evaluated CC-90002 in patients with relapsed/refractory acute myeloid leukemia (AML) or high-risk myelodysplastic syndrome (MDS). CC-90002 was administered in escalating doses of 0.1–4.0 mg/kg, using a modified 3+3 design. Primary endpoints included dose-limiting toxicities (DLTs), non-tolerated dose (NTD), maximum tolerated dose (MTD), and recommended phase 2 dose. Secondary endpoints included preliminary efficacy, pharmacokinetics, and presence/frequency of anti-drug antibodies (ADAs). Between March 2016 and July 2018, 28 patients were enrolled (24 with AML and 4 with MDS) at 6 sites across the United States. As of July 18, 2018, all patients had discontinued, mainly due to death or progressive disease. The most common treatment-emergent adverse events were diarrhea (46.4%), thrombocytopenia (39.3%), febrile neutropenia (35.7%), and aspartate aminotransferase increase (35.7%). Four patients experienced DLTs (1 patient had grade 4 disseminated intravascular coagulation and grade 5 cerebral hemorrhage, 1 had grade 3 purpura, 1 had grade 4 congestive cardiac failure and grade 5 acute respiratory failure, and another had grade 5 sepsis). The NTD and MTD were not reached. No objective responses occurred. CC-90002 serum exposure was dose-dependent. ADAs were present across all doses, and the proportion of ADA-positive patients in cycle 1 increased over time. Despite no unexpected safety findings, the CC-90002-AML-001 study was discontinued in dose escalation for lack of monotherapy activity and evidence of ADAs. However, as other anti-CD47 agents in clinical trials are showing promising early results for AML and MDS, understanding preclinical and clinical differences between individual agents in this class will be of high importance.

Filth fly pests have a substantial impact on livestock production; annual losses from filth flies were estimated at over US$1.5 billion in 1981. Knowing filth fly management and animal production have changed significantly over the past 40 yr, our objective is to lay the foundation for the development of a transdisciplinary integrated pest management (IPM) approach that considers the economics of controlling flies in animal production, with most of the examples provided towards beef cattle production systems. By performing an in-depth literature review, it is our goal to highlight losses and expenditures associated with the damages caused by these flies, discuss current management strategies for the system, and propose industry needs in terms of research gaps and producer education to enhance sustainable livestock production. Immediate industry needs include: (1) developing dynamic economic thresholds incorporating animal welfare, economics, impacts of chemical use, and climate-related responses; (2) improving monitoring methods to improve surveillance efforts for flies as a system and how all types collectively shape the system; and (3) updating economic loss assessments to account for losses due to animal defensive behaviors, reduced feed efficiency, and unplanned expenditures. While we focus on the beef cattle system in the United States, this paper is meant to provide an argument for research in worldwide livestock production (e.g., dairy, poultry, swine, and small ruminant).