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OBJECTIVE The study objective was to create a novel milestones evaluation form for neurosurgery sub-interns and assess its potential as a quantitative and standardized performance assessment to compare potential residency applicants. In this pilot study, the authors aimed to determine the form’s interrater reliability, relationship to percentile assignments in the neurosurgery standardized letter of recommendation (SLOR), ability to quantitatively differentiate tiers of students, and ease of use. METHODS Medical student milestones were either adapted from the resident Neurological Surgery Milestones or created de novo to evaluate a student’s medical knowledge, procedural aptitude, professionalism, interpersonal and communication skills, and evidence-based practice and improvement. Four milestone levels were defined, corresponding to estimated 3rd-year medical student through 2nd-year resident levels. Faculty and resident evaluations as well as student self-evaluations were completed for 35 sub-interns across 8 programs. A cumulative milestone score (CMS) was computed for each student. Student CMSs were compared both within and between programs. Interrater reliability was determined with Kendall’s coefficient of concordance (Kendall’s W). Student CMSs were compared against their percentile assignments in the SLOR using analysis of variance with post hoc testing. CMS-derived percentile rankings were assigned to quantitatively distinguish tiers of students. Students and faculty were surveyed on the form’s usefulness. RESULTS The average faculty rating overall was 3.20, similar to the estimated competency level of an intern. Student and faculty ratings were similar, whereas resident ratings were lower (p < 0.001). Students were rated most highly in coachability and feedback (3.49 and 3.67, respectively) and lowest in bedside procedural aptitude (2.90 and 2.85, respectively) in both faculty and self-evaluations. The median CMS was 26.5 (IQR 21.75–29.75, range 14–32) with only 2 students (5.7%) achieving the highest rating of 32. Programs that evaluated the most students differentiated the highest-performing students from the lowest by at least 13 points. A program with 3 faculty raters demonstrated scoring agreement across 5 students (p = 0.024). The CMS differed significantly between SLOR percentile assignments, despite 25% of students being assigned to the top fifth percentile. CMS-driven percentile assignment significantly differentiated the bottom, middle, and top third of students (p < 0.001). Faculty and students strongly endorsed the milestones form. CONCLUSIONS The medical student milestones form was well received and differentiated neurosurgery sub-interns both within and across programs. This form has potential as a replacement for numerical Step 1 scoring as a standardized, quantitative performance assessment for neurosurgery residency applicants.

As in other disciplines, the Atlantic slave-trade and New World slavery have assumed an increasingly contentious role in accounting history. In her Accounting for Slavery, Rosenthal has recently located many current business practices in the nexus between accounting, capitalism and slavery. Other accounting historians have explored slave-trading ventures from Africa, the role of accounting and slavery in New World colonisation, and in accounting and managerial practices in the slave-estates of the Americas. Absent from the extant literature are studies that explore the nexus between accounting, capitalism and slavery from a multi-continental perspective that considers Atlantic slavery as an integrated whole. This study, by drawing on the Trans-Atlantic Slave-trade Database, seeks to fill this gap, examining the correlations between Atlantic slavery and African demographic and social regression, European prosperity and New World accounting and managerial practices. In doing so, it argues that accounting played a fundamentally different role in the slave economy to that which it undertook in emerging systems of industrial capitalism.

This exploratory study evaluated the impact of a Spanish second language (L2) domestic immersion (DI) program that was developed expediently at a large university in the United States in response to widespread study abroad (SA) program closures due to COVID-19. Spanish language learners (n = 14) participated in an intensive, six-week summer immersion program for a total of 96 contact hours over the duration of the program. L2 development was evaluated via a conceptual replication of Issa et al. (2020), which recently provided compelling evidence of the benefits of short-term SA programs. L2 gains were measured using an acceptability judgment task, a lexical decision task, and an elicited imitation task. Results showed that DI learners had significant L2 gains in some of the same areas as the SA students, including subject-verb agreement and scores on the elicited imitation task. Implications for creating and maintaining DI programs in the current educational landscape are discussed. Abstract in Spanish Este estudio exploratorio evaluó el impacto de un programa doméstico de inmersión (DI) de español como segunda lengua (L2) que se desarrolló en una universidad estadounidense en respuesta al cierre generalizado de estudios en el extranjero debido a la COVID-19. Catorce estudiantes de español participaron en un programa de inmersión intensivo durante el verano con un total de 96 horas de contacto a lo largo de las seis semanas de duración del programa. El desarrollo de la segunda lengua se evaluó a través de una réplica conceptual de Issa et al. (2020), el cual recientemente había aportado datos convincentes sobre los beneficios de programas de estudio en el extranjero de corta duración. La adquisición de la segunda lengua se midió usando una tarea de juicio gramatical, una tarea de decisión léxica y una tarea de imitación suscitada. Los resultados mostraron que los estudiantes del programa doméstico de inmersión desarrollaron sus competencias lingüísticas de forma significativa en algunas de las mismas áreas que los estudiantes que participaron en programas en el extranjero, incluyendo la concordancia entre sujeto y verbo, así como la puntuación en la tarea de imitación suscitada. Se discuten también algunas implicaciones sobre la creación y el mantenimiento de programas domésticos de inmersión en el actual panorama educativo.

The goals of this study were to determine whether mice would adapt to a low-calorie flavored water gel as their sole source of hydration and whether the addition of acetaminophen, tramadol, meloxicam, or buprenorphine to the gel would affect their intake. Water and gel intakes were measured during a 4-phase study, each of which lasted 1 wk: phase 1, standard water bottle only; phase 2, standard water bottle and a separate tube containing water gel; phase 3, water gel only; and phase 4, water gel containing an analgesic drug. Water consumption, corrected for body mass, was not different between male and female mice when water was available (phases 1 and 2). However, the total consumption of water and water gel was higher for females than males during phase 2, and female mice consumed more gel than males during phase 3. When male and female data were combined, total corrected water intake was not different among the first 3 phases of the study. Gel intake did not change significantly after the addition of acetaminophen, meloxicam, buprenorphine or tramadol as compared with untreated water gel. These data suggest that drugs presented in the low-calorie flavored water gel may be a viable alternative to injection or gavage for the administration of analgesic drugs.

Actinobacillus pleuropneumoniae is the cause of porcine pleuropneumonia, a severe respiratory tract infection that is responsible for major economic losses to the swine industry. Many host-adapted bacterial pathogens encode systems known as phasevarions (phase-variable regulons). Phasevarions result from variable expression of cytoplasmic DNA methyltransferases. Variable expression results in genome-wide methylation differences within a bacterial population, leading to altered expression of multiple genes via epigenetic mechanisms. Our examination of a diverse population of A. pleuropneumoniae strains determined that Type I and Type III DNA methyltransferases with the hallmarks of phase variation were present in this species. We demonstrate that phase variation is occurring in these methyltransferases, and show associations between particular Type III methyltransferase alleles and serovar. Using Pacific BioSciences Single-Molecule, Real-Time (SMRT) sequencing and Oxford Nanopore sequencing, we demonstrate the presence of the first ever characterised phase-variable, cytosine-specific Type III DNA methyltransferase. Phase variation of distinct Type III DNA methyltransferase in A. pleuropneumoniae results in the regulation of distinct phasevarions, and in multiple phenotypic differences relevant to pathobiology. Our characterisation of these newly described phasevarions in A. pleuropneumoniae will aid in the selection of stably expressed antigens, and direct and inform development of a rationally designed subunit vaccine against this major veterinary pathogen.

A significant proportion of Southern Ocean seafloor biodiversity is thought to be associated with fragile, slow growing, long-lived, and habitat-forming taxa. Minimizing adverse impact to these so-called vulnerable marine ecosystems (VMEs) is a conservation priority that is often managed by relying on fisheries bycatch data, combined with threshold-based conservation rules in which all “indicator” taxa are considered equal. However, VME indicator taxa have different vulnerabilities to fishing disturbance and more consideration needs to be given to how these taxa may combine to form components of ecosystems with high conservation value. Here, we propose a multi-criteria approach to VME identification that explicitly considers multiple taxa identified from imagery as VME indicator morpho-taxa. Each VME indicator morpho-taxon is weighted differently, based on its vulnerability to fishing. Using the “Antarctic Seafloor Annotated Imagery Database”, where 53 VME indicator morpho-taxa were manually annotated generating >40000 annotations, we computed an index of cumulative abundance and overall richness and assigned it to spatial grid cells. Our analysis quantifies the assemblage-level vulnerability to fishing, and allows assemblages to be characterized, e.g. as highly diverse or highly abundant. The implementation of this quantitative method is intended to enhance VME identification and contextualize the bycatch events.

Anadromous river herring (alewife and blueback herring) persist at historically low abundances and are caught as bycatch in commercial fisheries, potentially preventing recovery despite conservation efforts. We used newly established single-nucleotide polymorphism genetic baselines for alewife and blueback herring to define fine-scale reporting groups for each species. We then determined the occurrence of fish from these reporting groups in bycatch samples from a Northwest Atlantic fishery over four years. Within sampled bycatch events, the highest proportions of alewife were from the Block Island (34%) and Long Island Sound (22%) reporting groups, while for blueback herring the highest proportions were from the Mid-Atlantic (47%) and Northern New England (24%) reporting groups. We then quantified stock-specific mortality in a focal geographic area (∼3500 km2, including Block Island Sound) of high bycatch incidence and sampling effort, where the most accurate estimates of mortality could be made. During this period, we estimate that bycatch took about 4.6 million alewife and 1.2 million blueback herring, highlighting the need to reduce bycatch mortality for the most depleted river herring stocks.

Archaeological glasses with prolonged exposure to biogeochemical processes in the environment can be used to understand glass alteration, which is important for the safe disposal of vitrified nuclear waste. Samples of mafic and felsic glasses with different chemistries, formed from melting amphibolitic and granitoid rocks, were obtained from Broborg, a Swedish Iron Age hillfort. Glasses were excavated from the top of the hillfort wall and from the wall interior. A detailed microscopic, spectroscopic, and diffraction study of surficial textures and chemistries were conducted on these glasses. Felsic glass chemistry was uniform, with a smooth surface showing limited chemical alteration (

PurposeIntegrated service models aim to simplify access, enable effective delivery, remove duplication and provide a holistic and person-centred approach. This project explored the development of integrated well-being services in two local authorities in North-East England. The purpose of this paper is to address this issue.Design/methodology/approachUnderpinned by public health and co-production approaches, the project utilised a mixed-methods approach. Data were collected via online surveys (n = 95), virtual interviews with members of the local population (n = 8) and practitioners and commissioners (n = 8) to explore needs for a new service. Thematic analysis was used to identify key themes and issues.FindingsSeveral benefits of an integrated service were highlighted by both staff and service users, with a central anticipated benefit being the provision of holistic care. Improvement in information sharing was also seen to increase the efficiency of services and communication barriers between services. Beneficial aspects and barriers related to the COVID-19 pandemic on current service provision were reported that have informed our future recommendations.Originality/valueThe authors’ findings provide a much deeper insight into function, care, social inclusion and ongoing support needs, from both the perspectives of staff and service users. Service users and staff saw value in an integrated model for themselves, as well as the wider community. The authors’ findings indicate that the integrated service model is a promising one for the development of services within local authorities.

Understanding how a subset of expressed genes dictates cellular phenotype is a considerable challenge owing to the large numbers of molecules involved, their combinatorics and the plethora of cellular behaviours that they determine1,2. Here we reduced this complexity by focusing on cellular organization—a key readout and driver of cell behaviour3,4—at the level of major cellular structures that represent distinct organelles and functional machines, and generated the WTC-11 hiPSC Single-Cell Image Dataset v1, which contains more than 200,000 live cells in 3D, spanning 25 key cellular structures. The scale and quality of this dataset permitted the creation of a generalizable analysis framework to convert raw image data of cells and their structures into dimensionally reduced, quantitative measurements that can be interpreted by humans, and to facilitate data exploration. This framework embraces the vast cell-to-cell variability that is observed within a normal population, facilitates the integration of cell-by-cell structural data and allows quantitative analyses of distinct, separable aspects of organization within and across different cell populations. We found that the integrated intracellular organization of interphase cells was robust to the wide range of variation in cell shape in the population; that the average locations of some structures became polarized in cells at the edges of colonies while maintaining the ‘wiring’ of their interactions with other structures; and that, by contrast, changes in the location of structures during early mitotic reorganization were accompanied by changes in their wiring.

A Ni–Fe based perovskite oxide catalyzes the oxygen evolution reaction (OER), coupled with changes in local composition and structure identified by virtue of an epitaxial thin film geometry.

BACKGROUND AND AIMS: Germline CDH1 variants resulting in E-cadherin loss of function result in an increased risk of diffuse type gastric cancer and lobular type breast cancer. However, the risk of developing other epithelial neoplasms, specifically colorectal cancer, is unknown. METHODS: Patients enrolled in a prospective natural history study of hereditary gastric cancer who underwent at least one colonoscopy were evaluated. RESULTS: Out of 300 patients with CDH1 pathogenic or likely pathogenic variants, 85 underwent colonoscopy. More than half of patients (56%, 48/85) had at least one colorectal polyp. Most of those patients (83%, 40/48) had at least one precancerous polyp (adenoma or sessile serrated lesion). More than half (56%) of patients younger than age 45 had a colorectal polyp. Of those with polyps, the most frequent CDH1 variant type was canonical splice site (27%, 13/48) followed by nonsense (21%, 10/48). There was no association between CDH1 variant type and increased likelihood of colorectal polyps. CONCLUSIONS: In summary, a majority of CDH1 variant carriers who underwent colonoscopy had colorectal polyps detected, and most subjects were less than 45 years old. This study of colorectal cancer risk based on the prevalence of colorectal polyps in the CDH1 population requires further investigation to appropriately counsel patients on colorectal cancer screening. Clinical trial registry website: https://clinicaltrials.gov/. Clinical trial number: NCT03030404

The widespread demise of coral reefs due to climate change is now a certainty, and investing in restoration without facing this stark reality risks failure. The 50 Reefs Initiative, the dominant adaptation model for coral reefs is examined, and a new coral-focused paradigm is proposed, based on helping coral reefs adapt to rising temperature, to ensure that as many coral species as possible survive locally over time. With pilot sites established in six Pacific Island nations, genebank nurseries of bleaching resistant corals are secured in cooler waters, to help prevent their demise as heat stress increases. Unbleached corals selected during bleaching events are included. From these nurseries corals are harvested to create nucleation patches of genetically diverse pre-adapted corals, which become reproductively, ecologically and biologically viable at reef scale, spreading out over time. This “Reefs of Hope” paradigm, modelled on tropical forest restoration, creates dense coral patches, using larger transplants or multiple small fragments elevated on structures, forming fish habitat immediately. The fish help increase coral and substratum health, which presumably will enhance natural larval-based recovery processes. We also hypothesize that incoming coral recruits, attracted to the patch, are inoculated by heat adapted algal symbionts, facilitating adaptation of the wider reef. With global emissions out of control, the most we can hope for is to buy precious time for coral reefs by saving coral species and coral diversity that will not likely survive unassisted.

To evaluate the effectiveness and health costs of a new primary care service delivery model (the Optimising Primary Care Management of Knee Osteoarthritis [PARTNER] model) to improve health outcomes for patients with knee osteoarthritis (OA) compared to usual care.This study was a 2-arm, cluster, superiority, randomized controlled trial with randomization at the general practice level, undertaken in Victoria and New South Wales, Australia. We aimed to recruit 44 practices and 572 patients age ≥45 years with knee pain for3 months. Professional development opportunities on best practice OA care were provided to intervention group general practitioners (GPs). All recruited patients had an initial GP visit to confirm knee OA diagnosis. Control patients continued usual GP care, and intervention patients were referred to a centralized care support team (CST) for 12-months. Via telehealth, the CST provided OA education and an agreed OA action plan focused on muscle strengthening, physical activity, and weight management. Primary outcomes were patient self-reported change in knee pain (Numerical Rating Scale [range 0-10; higher score = worse]) and physical function (Knee Injury and Osteoarthritis Outcome Score activities of daily living subscale [range 0-100; higher score = better] at 12 months. Health care cost outcomes included costs of medical visits and prescription medications over the 12-month period.Recruitment targets were not reached. A total of 38 practices and 217 patients were recruited. The intervention improved pain by 0.8 of 10 points (95% confidence interval [95% CI] 0.2, 1.4) and function by 6.5 of 100 points (95% CI 2.3, 10.7), more than usual care at 12 months. Total costs of medical visits and prescriptions were $3,940 (Australian) for the intervention group versus $4,161 for usual care. This difference was not statistically significant.The PARTNER model improved knee pain and function more than usual GP care. The magnitude of improvement is unlikely to be clinically meaningful for pain but is uncertain for function.

Lumpy skin disease, a mechanically transmitted poxvirus, causes severe disease in naïve populations of cattle and buffalo. It is characterised by development of multifocal cutaneous nodules and systemic illness with significant impacts on animal health, productivity, welfare and trade. Lumpy skin disease entered South-East Asia via Myanmar (November 2020) and later Thailand (March 2021), and has spread rapidly through the region reaching Indonesia in February 2022. This article provides a brief overview of current literature and its application to the Australian context including possible routes of entry, early detection and knowledge gaps that need to be addressed to improve preparedness and response capability.

Introduction: Pasifika young people of Aotearoa New Zealand are known to experience higher rates of mental health and addiction conditions (especially anxiety and depression), compared with young non-Māori/non-Pasifika (NMNP). However, there is little information about how well these issues are identified by mental health services. Aim: We compared rates of diagnosis of common mental health and substance use-related conditions between Pasifika and NMNP young people (aged 10-24 years) and examined how these diagnoses varied with deprivation. Method: This national, cross-sectional study was undertaken using 2017/18 fiscal year data from a national database known as the Integrated Data Infrastructure. Specialist mental health service use, hospitalisations and pharmaceutical dispensing for any mental health condition, emotional condition (depression and/or anxiety), substance use-related conditions, and self-harm were examined. Results: A total of 982,305 young people (12.4%, Pasifika and 63.9%, NMNP) were identified. Compared with NMNP, Pasifika young people were significantly less likely to be diagnosed by specialist mental health services with any mental health condition (adjusted Risk Ratio (aRR) = 0.77, 95% CI = 0.75 to 0.78); any emotional condition (aRR= 0.44, 95% Confidence Interval (CI) = 0.43 to 0.45); or to be hospitalised for self-harm (aRR = 0.88, 95% CI = 0.82 to 0.94). However, they were significantly more likely than NMNP to be diagnosed with substance use-related conditions (aRR = 1.68, 95% CI = 1.63 to 1.74). Although the overall rate of mental health issues remained relatively stable across deprivation levels, emotional conditions were much less frequently diagnosed in those with greater deprivation. Discussion: Discrepancies between expected and identified rates of diagnoses of common mental health and substance use-related conditions might indicate different patterns of service access by Pasifika young people, or they may reflect the bias of an inequitable and less than culturally appropriate health system.

Introduction: Autism is a lifelong neurodevelopmental condition that is estimated to impact 1 in 44 children. In Aotearoa New Zealand, the rate of autism among Pasifika children and young people (38.6 per 10,000 people) is substantively lower than other ethnic groups (67.5 for European and 47.2 for Māori); however, the complexities associated with Autism diagnosis in Pasifika is unknown. Aim: We compared rates of Autism and co-occurring diagnoses of conditions as a proxy for Autism case complexity between Pasifika and NMNP young people (aged 0-24 years) in Aotearoa New Zealand. Methods: This national, cross-sectional study was undertaken using data from a national database; the Integrated Data Infrastructure (IDI). Three separate indicators were created to reflect different types of complexity for someone with autism: Asperger’s syndrome (identifies those with lower complexity with fewer demands on support services); intellectual disability (higher needs/greater complexity); ORS funding (higher needs/greater complexity). Findings: In this present study, Pasifika in Aotearoa New Zealand had much lower autism identification rates in comparison to Non-Māori Non-Pasifika (NMNP) (53.3 per 10,000 vs 83 per 10,000). After adjusting for socioeconomic differences, Pasifika had significantly lower odds (Odds Ratio (OR) = 0.47) of having an Asperger’s syndrome diagnosis. However, Pasifika had significantly higher odds of having an intellectual disability (OR = 2.23) and being Ongoing Resources Scheme funded (OR = 2.18). Conclusions: Using this method within the IDI, Pasifika children in Aotearoa continue to have lower rates of Autism diagnosis; however, they are more likely to have a higher complexity of autism diagnosis.

Introduction: Since early 2020 the whole world has been challenged by the SARS-CoV-2 virus (COVID-19), its successive variants and the associated pandemic caused. We have previously shown that for people living with type 2 diabetes (T2DM), the risk of being admitted to hospital or dying following a COVID-19 infection progressively decreased through the first months of 2021. In this subsequent analysis we have examined how the UK COVID-19 vaccination programme impacted differentially on COVID-19 outcomes in people with T1DM or T2DM compared to appropriate controls. Methods: T1DM and T2DM affected individuals were compared with their matched controls on 3:1 ratio basis. A 28-day hospital admission or mortality was used as the binary outcome variable with diabetes status and vaccination for COVID-19 as the main exposure variables. Results: A higher proportion of T1DM individuals vs their controls was found to be vaccinated at the point of their first recorded positive COVID-19 test when compared to T2DM individuals vs their controls. Regarding the 28-day hospital admission rate, there was a greater and increasing protective effect of subsequent vaccination dosage (one, two or three) in mitigating the effects of COVID-19 infection versus no vaccination in T1DM than in T2DM individuals when compared with matched controls. Similar effects were observed in T2DM for death. Across both diabetes and non-diabetes individuals, those at greater socio-economic disadvantage were more likely to test positive for COVID-19 in the early phase of the pandemic. For T2DM individuals socio-economic disadvantage was associated with a greater likelihood of hospital admission and death, independent of vaccination status. Age and male sex were also independently associated with 28-day hospital admission in T2DM and to 28-day mortality, independent of vaccination status. African ethnicity was also an additional factor for hospital admission in people with T2DM. Conclusion: A beneficial effect of COVID-19 vaccination was seen in mitigating the harmful effects of COVID-19 infection; this was manifest in reduced hospital admission rate in T1DM individuals with a lesser effect in T2DM when compared with matched controls, regarding both hospital admission and mortality. Socio-economic disadvantage influenced likelihood of COVID-19 confirmed infection and the likelihood of hospital admission/death independent of the number of vaccinations given in T2DM.

A six-month-old female intact domestic shorthair cat was presented for evaluation of a loud heart murmur. Transthoracic echocardiography revealed dilation of the left ventricle secondary to an abnormal vessel shunting blood into the left ventricular outflow tract at a high velocity during diastole. Multidetector computed tomography angiography revealed a coronary cameral fistula that originated at the right coronary artery, encircled the heart, and then terminated into the left ventricular outflow tract. This case report documents the first known case of a coronary cameral fistula in a cat. Multimodal imaging was an essential aspect to diagnosing the congenital lesion in this case.