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Aim: Biodiversity hotspots in wide-ranging marine species typically overlap with regions of high productivity, which are often associated with nutrient-rich waters. Here we investigate how element concentrations in feathers vary among highly mobile seabirds in global seabird biodiversity hotspots. Location: Southern Hemisphere. Time period: Contemporary. Major taxa studied: Fifteen species in the order Procellariiformes. Methods: We collected data on the concentration of 15 elements in feathers for 253 seabirds sampled across Australia and New Zealand and compared the “fingerprint” of micronutrient element profiles to feathers of related seabirds from global hotspots using principal component analysis (PCA), cluster analysis and permutational analysis of variance (PERMANOVA). Results: Breast feather concentrations of some elements, including aluminium, iron, cobalt, chromium, manganese, nickel, arsenic and cadmium, were tens-to-hundred-fold higher in smaller (

Using linked birth and death certificates for participants served by a Healthy Start program in South Carolina and community controls, we found that the Healthy Start program contributed to significant improvements in prenatal care, breastfeeding initiation, and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children and significant reductions in inadequate weight gain and large-for-gestational-age births. However, Healthy Start participants were more likely to gain excessive weight during pregnancy, and there were no significant differences in perinatal outcomes. (Am J Public Health. 2023;113(5):509–513. https://doi.org/10.2105/AJPH.2023.307232 )

Substantia nigra (SN) hyperechogenicity, viewed with transcranial ultrasound, is a risk marker for Parkinson's disease. We hypothesized that SN hyperechogenicity in healthy adults aged 50–70 years is associated with reduced short-interval intracortical inhibition in primary motor cortex, and that the reduced intracortical inhibition is associated with neurochemical markers of activity in the pre-supplementary motor area (pre-SMA). Short-interval intracortical inhibition and intracortical facilitation in primary motor cortex was assessed with paired-pulse transcranial magnetic stimulation in 23 healthy adults with normal (n = 14; 61 ± 7 yrs) or abnormally enlarged (hyperechogenic; n = 9; 60 ± 6 yrs) area of SN echogenicity. Thirteen of these participants (7 SN− and 6 SN+) also underwent brain magnetic resonance spectroscopy to investigate pre-SMA neurochemistry. There was no relationship between area of SN echogenicity and short-interval intracortical inhibition in the ipsilateral primary motor cortex. There was a significant positive relationship, however, between area of echogenicity in the right SN and the magnitude of intracortical facilitation in the right (ipsilateral) primary motor cortex (p = .005; multivariate regression), evidenced by the amplitude of the conditioned motor evoked potential (MEP) at the 10–12 ms interstimulus interval. This relationship was not present on the left side. Pre-SMA glutamate did not predict primary motor cortex inhibition or facilitation. The results suggest that SN hyperechogenicity in healthy older adults may be associated with changes in excitability of motor cortical circuitry. The results advance understanding of brain changes in healthy older adults at risk of Parkinson's disease. Refereed/Peer-reviewed

We studied the learnability of English filler-gap dependencies and the “island” constraints on them by assessing the generalizations made by autoregressive (incremental) language models that use deep learning to predict the next word given preceding context. Using factorial tests inspired by experimental psycholinguistics, we found that models acquire not only the basic contingency between fillers and gaps, but also the unboundedness and hierarchical constraints implicated in the dependency. We evaluated a model’s acquisition of island constraints by demonstrating that its expectation for a filler-gap contingency is attenuated within an island environment. Our results provide empirical evidence against the argument from the poverty of the stimulus for this particular structure.

High-intensity Constraint-Induced Aphasia Therapy Plus (CIAT-Plus) and Multi-Modality Aphasia Therapy (M-MAT) are effective interventions for chronic post-stroke aphasia but challenging to provide in clinical practice. Providing these interventions may be more feasible at lower intensities, but comparative evidence is lacking. We therefore explored feasibility, acceptability, and preliminary efficacy of the treatments at a lower intensity. A multisite, single-blinded, randomized Phase II trial was conducted within the Phase III COMPARE trial. Groups of participants with chronic aphasia from the usual care arm of the COMPARE trial were randomized to M-MAT or CIAT-Plus, delivered at the same dose as the COMPARE trial but at lower intensity (6 hours/week × 5 weeks rather than 15 hours/week × 2 weeks). Blinded assessors measured aphasia severity (Western Aphasia Battery-Revised Aphasia Quotient), word retrieval, connected speech, multimodal communication, functional communication, and quality of life immediately post interventions and after 12 weeks. Feasibility and acceptability were explored. Of 70 eligible participants, 77% consented to the trial; 78% of randomized participants completed intervention and 98% of assessment visits were conducted. Fatigue and distress ratings were low with no related withdrawals. Adverse events related to the trial (n = 4) were mild in severity. Statistically significant treatment effects were demonstrated on word retrieval and functional communication and both interventions were equally effective. Low–moderateintensity CIAT-Plus and M-MAT were feasible and acceptable. Both interventions show preliminary efficacy at a low–moderate intensity. These results support a powered trial investigating these interventions at a low–moderate intensity.

Despite its popularity in literature, there are few examples of machine learning (ML) being used for industrial nondestructive evaluation (NDE) applications. A significant barrier is the ‘black box’ nature of most ML algorithms. This paper aims to improve the interpretability and explainability of ML for ultrasonic NDE by presenting a novel dimensionality reduction method: Gaussian feature approximation (GFA). GFA involves fitting a 2D elliptical Gaussian function an ultrasonic image and storing the seven parameters that describe each Gaussian. These seven parameters can then be used as inputs to data analysis methods such as the defect sizing neural network presented in this paper. GFA is applied to ultrasonic defect sizing for inline pipe inspection as an example application. This approach is compared to sizing with the same neural network, and two other dimensionality reduction methods (the parameters of 6 dB drop boxes and principal component analysis), as well as a convolutional neural network applied to raw ultrasonic images. Of the dimensionality reduction methods tested, GFA features produce the closest sizing accuracy to sizing from the raw images, with only a 23% increase in RMSE, despite a 96.5% reduction in the dimensionality of the input data. Implementing ML with GFA is implicitly more interpretable than doing so with principal component analysis or raw images as inputs, and gives significantly more sizing accuracy than 6 dB drop boxes. Shapley additive explanations (SHAP) are used to calculate how each feature contributes to the prediction of an individual defect’s length. Analysis of SHAP values demonstrates that the GFA-based neural network proposed displays many of the same relationships between defect indications and their predicted size as occur in traditional NDE sizing methods.

Background: Sleep and circadian disruption (SCD) is common and severe in the ICU. On the basis of rigorous evidence in non-ICU populations and emerging evidence in ICU populations, SCD is likely to have a profound negative impact on patient outcomes. Thus, it is urgent that we establish research priorities to advance understanding of ICU SCD. Methods: We convened a multidisciplinary group with relevant expertise to participate in an American Thoracic Society Workshop. Workshop objectives included identifying ICU SCD subtopics of interest, key knowledge gaps, and research priorities. Members attended remote sessions from March to November 2021. Recorded presentations were prepared and viewed by members before Workshop sessions. Workshop discussion focused on key gaps and related research priorities. The priorities listed herein were selected on the basis of rank as established by a series of anonymous surveys. Results: We identified the following research priorities: establish an ICU SCD definition, further develop rigorous and feasible ICU SCD measures, test associations between ICU SCD domains and outcomes, promote the inclusion of mechanistic and patient-centered outcomes within large clinical studies, leverage implementation science strategies to maximize intervention fidelity and sustainability, and collaborate among investigators to harmonize methods and promote multisite investigation. Conclusions: ICU SCD is a complex and compelling potential target for improving ICU outcomes. Given the influence on all other research priorities, further development of rigorous, feasible ICU SCD measurement is a key next step in advancing the field.

Key Points Question Are results of universal and selective screening for suicide risk implemented in a pediatric emergency department associated with future suicidal behaviors? Findings In this cohort study of 15 003 youths aged 8 to 18 years, positive screens were significantly associated with subsequent suicide-related hospital visits compared with standard emergency department procedures. Screening also more than doubled the detection of suicide risk compared with treatment as usual. Meaning These findings suggest that screening for suicide risk in pediatric emergency departments is an effective approach to identify risk for subsequent suicide-related emergency department visits., This cohort study examines the association between results of universal and selective screening for suicide risk in a pediatric emergency department using the Ask Suicide-Screening Questions (ASQ) instrument and subsequent suicide-related outcomes., Importance According to National Patient Safety Goal 15.01.01, all individuals being treated or evaluated for behavioral health conditions as their primary reason for care in hospitals and behavioral health care organizations accredited by The Joint Commission should be screened for suicide risk using a validated tool. Existing suicide risk screens have minimal or no high-quality evidence of association with future suicide-related outcomes. Objective To test the association between results of the Ask Suicide-Screening Questions (ASQ) instrument in a pediatric emergency department (ED), implemented through selective and universal screening approaches, and subsequent suicide-related outcomes. Design, Setting, and Participants In this retrospective cohort study at an urban pediatric ED in the United States, the ASQ was administered to youths aged 8 to 18 years with behavioral and psychiatric presenting problems from March 18, 2013, to December 31, 2016 (selective condition), and then to youths aged 10 to 18 years with medical presenting problems (in addition to those aged 8-18 years with behavioral and psychiatric presenting problems) from January 1, 2017, to December 31, 2018 (universal condition). Exposure Positive ASQ screen at baseline ED visit. Main Outcomes and Measures The main outcomes were subsequent ED visits with suicide-related presenting problems (ie, ideation or attempts) based on electronic health records and death by suicide identified through state medical examiner records. Association with suicide-related outcomes was calculated over the entire study period using survival analyses and at 3-month follow-up for both conditions using relative risk. Results The complete sample was 15 003 youths (7044 [47.0%] male; 10 209 [68.0%] black; mean [SD] age, 14.5 [3.1] years at baseline). The follow-up for the selective condition was a mean (SD) of 1133.7 (433.3) days; for the universal condition, it was 366.2 (209.2) days. In the selective condition, there were 275 suicide-related ED visits and 3 deaths by suicide. In the universal condition, there were 118 suicide-related ED visits and no deaths during the follow-up period. Adjusting for demographic characteristics and baseline presenting problem, positive ASQ screens were associated with greater risk of suicide-related outcomes among both the universal sample (hazard ratio, 6.8 [95% CI, 4.2-11.1]) and the selective sample (hazard ratio, 4.8 [95% CI, 3.5-6.5]). Conclusions and Relevance Positive results of both selective and universal screening for suicide risk in pediatric EDs appear to be associated with subsequent suicidal behavior. Screening may be a particularly effective way to detect suicide risk among those who did not present with ideation or attempt. Future studies should examine the impact of screening in combination with other policies and procedures aimed at reducing suicide risk.

Wildfire smoke can be transported far from its origin, adversely impacting human health. The height of the atmospheric mixing layer, the near-surface layer of the troposphere in which turbulent convection leads to vertical mixing, is called the mixing height. Mixing height is a critical input in the smoke dispersion and air quality models used by agencies that monitor wildfires and air pollution. These models, coupled with forecaster expertise, are also used to determine if it is safe to execute a prescribed burn. In this paper, we derive mixing heights from two satellite datasets in order to assess mixing height forecasts produced by the National Weather Service (NWS) Fire Weather Program. Namely, we use Cloud-Aerosol Lidar with Orthogonal Polarization (CALIOP) Vertical Feature Masks (VFM) and vertical water vapor profiles from the Moderate Resolution Imaging Spectroradiometer (MODIS). Our comparison indicates that NWS forecasts tend to underestimate CALIOP mixing heights with a median relative error of –13% and a mean relative error of –3.34%. Although MODIS and NWS mixing heights showed some agreement below 3 km, the lower vertical resolution of the MODIS estimates hindered a full comparison. We examine the discrepancies among mixing heights over wildfire smoke plumes determined by these methods and discuss biases and limitations. This work provides insight into potential bias patterns present in current mixing height forecasts and provides directions for future improvements in both NWS mixing height forecasts and satellite-based measurements of mixing height.

The study investigated parenting styles, emotional support and moral behaviour among secondary school adolescents in Obio-Akpor Local Government Area of Rivers state. A sample of 800 students from a population of 15,337 junior secondary school students was used for the study. Simple random and proportionate stratified sampling techniques were used to compose the sample. Six research questions were answered while six corresponding null hypotheses were tested at 0.05 level of significance. Three instruments were used for the study. They are the Moral Behaviour Questionnaire (MBQ), the Parenting Styles Survey (PSS), and the Parental Emotional Support Questionnaire (PESQ). The instruments were validated by the researcher’s supervisor and three experts in Psychological Measurement and Evaluation. The reliabilities of the instruments were tested using Cronbach alpha reliability method of internal consistency. Reliability coefficient of the items in the authoritative parenting style at 0.66; authoritarian parenting style at 0.61; permissive parenting style at 0.73; uninvolved parenting style at 0.74; parental emotional support at 0.77; and the moral behaviour at 0.65 were high enough to guarantee their use for the study. Research questions 1 to 5 were answered using simple regression while their corresponding null hypotheses were tested using t-test associated with regression. Research question 6 was answered using multiple regression while its corresponding null hypothesis was tested with Analysis of Variance (ANOVA). The results of the study are that parenting styles and parental emotional support predict moral behaviours of students. Based on the findings, some recommendations were made, one of which is that parents, especially mothers should be more intentional in spending time and getting involved with their children so as t enhance the development of their children’s moral behaviour. This study has established empirically that the parenting styles predict moral behaviour.

Context The growing demand for global food security has resulted in rising fishing intensity, sometimes leading to overexploitation of fish resources, including tuna. Increasingly, fishers are using anchored fish aggregating devices (aFADs) to improve efficiencies and reduce costs. Aims To identify locations and use patterns of FADs and characterise aFAD usage in Indonesia and beyond. Methods We identified general patterns of aFAD usage by tuna purse-seine, pole and line, hand-line and troll-line vessels operating in Indonesian waters through reviewing relevant literature and focal-group discussions. Key results aFADs usage can be characterised by gear type and fishing strategy; vessel behaviour; equipment and spare parts for aFADs installation; association with light; trip duration, catch per unit effort (CPUE), ratio of live bait to catch, fuel consumption; existence of aFAD floats on board vessels and by-catch composition. Conclusions aFAD usage has been widely adopted by both industrial and small-scale tuna fishers to efficiency. However, this efficiency comes at the cost of significant increases in catches of juveniles and non-target species, which raises sustainability concerns for Indonesian officials. Implications Ultimately, quantifying the numbers, types and locations of aFADs is key to fisheries management to avoid overfishing, overcrowding and limit by-catch and fishing-associated waste.

Purpose The purpose of this study is to use text-mining methods to examine the dominant sources of online information and content about continuous glucose monitors (CGMs). Because the internet is the most popular source for health information, it is important to understand what is being said about CGMs in online sources of information. Methods A text miner, algorithmic-driven statistical program was used to identify the main sources of online information and topics on CGMs. Content was limited to English and was posted from August 1, 2020, to August 4, 2022. Using Brandwatch software, 17 940 messages were identified. After cleaning, there were 10 677 messages in final analyses conducted using SAS Text Miner V.12.1 software. Results The analysis identified 20 topics that formed 7 themes. Results show that most online information comes from news sources and focuses on the general benefits of CGM use. Beneficial aspects ranged from improvements in self-management behaviors, cost, and glucose levels. None of the themes mentioned changes to practice, research, or policies related to CGM. Conclusions To improve diffusion of information and innovations going forward, novel ways of information sharing should be explored, such as diabetes specialist, provider, and researcher engagement in social media and digital storytelling.

Raman cross sections and spectra were measured for five synthetic opioid fentanyl analogs: fentanyl citrate, sufentanil citrate, alfentanil HCl, carfentanil oxalate, and remifentanil HCl. The measurements were performed with excitation wavelengths in the visible (532 nm) and near infrared (785 nm). In addition, density functional theory (DFT) calculations were employed to generate simulated spectra of the compounds and aid in identification of the observed spectral modes. These cross-section measurements and calculations were also used to assess results from a series of measurements of fentanyls cut with other powdered materials. These measurements are valuable for assessment of field-deployable Raman chemical sensors for detection of fentanyl and fentanyl analogs, including when mixed with other materials.

Suicide rates and frequency of pediatric emergency department (ED) visits for suicidal thoughts and behaviors have increased among Black preadolescents in the United States in recent years. This study examined whether characteristics of ED visits and treatment management of preadolescents with suicidal thoughts and behaviors differed by race.An electronic medical record query identified patients ages 8-12 (N=504) who visited a pediatric ED with a psychiatric-related chief complaint in 2019. The authors examined suicidal thoughts and behaviors that were reported with the Ask Suicide-Screening Questions tool, ED clinical impression, and ED disposition overall and by race.Compared with other racial groups, Black preadolescents were less likely to report suicidal thoughts, despite equivalent lifetime histories of suicide attempts, and were more likely to be brought to the ED by police and discharged (instead of being admitted to inpatient psychiatric care).Research to better understand racial disparities in suicide risk among preadolescents can inform prevention efforts.

Psychology, and the United States more broadly, finds itself at yet another reckoning point with White supremacy and anti-Black racism. The

There is much agreement within counseling psychology on the importance of social justice, yet social justice education and training remain limited in counseling psychology programs (Beerman et al., 2012; Pieterse et al., 2009; Singh et al., 2010). Critical components to social justice education and training include an emphasis on systems theories that could inform interventions (i.e. advocacy and activism) at the exosystem and mesosystem levels as well as learning about the breadth of activism and advocacy skills. Assessment, diagnosis, and conceptualization are considered core functional competencies in professional psychology (Fouad, 2009), yet these processes are often only taught at the individual level. If the goal of advocacy and activism are to foster systems change, considered a functional competency in counseling psychology (CCPTP, 2012), then it is crucial to provide systems-level theories and skills in counseling psychology education and training. We describe how we have attended to the provision of systems-level education and training in our respective programs. We will provide recommendations about the inclusion of systems-level theories, classroom formats, assignments, and mentorship designed to foster trainees’ development of a systems-level theoretical orientation, as well as skills to engage in social justice research, leadership, and both micro- and macro-level advocacy interventions.

This study implemented a 16-week Tai Ji Quan: Moving for Better Balance® intervention for older adults in churches in hard-to-reach, medically underserved, rural communities, and evaluated the process using the RE-AIM Framework. Community-dwelling adults, aged 55 years, or older, were eligible. Data (N = 237) were collected at baseline, 16 weeks, and 32 weeks on falls efficacy, depression, physical/mental health-related quality of life, aerobic activity, gait speed, mobility, balance, and leg strength. Generalized/linear mixed models determined if outcomes improved. Eighteen churches sponsored 16 classes. Church adoption was 94%, instructor adoption was 86%, reach was 90%, and fidelity was good/fair. All outcomes improved except physical health-related quality of life and gait speed. Thirty-six percent of participants, 28% of churches, and 37% of instructors continued Tai Ji Quan: Moving for Better Balance at 32 weeks. Compared with two prior RE-AIM evaluations, adoption and reach rates, improvements in outcomes, and satisfaction were comparable; attendance, program completion, and continuation rates were lower.

Physical activity policy can play a crucial role in ensuring that individuals, communities, and societies can obtain the wide range of health benefits associated with regular physical activity participation. Policies such as Title IX, the Americans With Disabilities Act, and state physical education laws have all increased opportunities for millions of Americans to participate in physical activity. With that said, how policies are developed and implemented vary considerably. The purpose of this manuscript is to contrast an academic conceptual framework with a pragmatic approach for policy implementation. In an ideal world, polices would be developed from foundational knowledge, scaled up to community-level interventions, and implemented in a sequential fashion. However, policy implementation is a disorderly process that requires a practical methodology. The National Physical Activity Plan encompasses strategies and tactics across 10 key societal sectors—and highlights the disorderly process of policy implementation across the various sectors.

Liver transplant (LT) is a lifesaving treatment for patients with end stage liver disease. Historically, institutions across the United States have deemed active marijuana use as an exclusion criterion for listing. This study aims to investigate LT outcomes in patients with history of marijuana use prior to LT.We performed a retrospective review of 111 patients who tested positive for marijuana on urine drug screen during initial LT evaluation between February 2016 and January 2021. 100 non-marijuana users who underwent LT were cross matched for control. Patient demographics, substance use history, and transplant decisions were recorded. Post-LT variables were also collected up to 1 year post surgery including postoperative infections, issues with non-compliance, and continued substance use. Chi-square analysis was used to assess the association between pre-transplant marijuana use and post-transplant complications. Logistics regression was implemented to measure associations amongst the entire cohort.From 111 marijuana users, 32 (29%) received a transplant. There was no statistical difference in post-LT outcomes between marijuana and non-marijuana users, including incidence of cardiac, respiratory, renal, psychiatric, or neurological complications, as well as readmission rates post-surgery. There were no statistically significant associations between marijuana use with post-transplant bacterial or fungal infections, medication non-compliance, or continued substance use (all p0.05). Marijuana use was associated with pre-LT tobacco use (p = 0.020).Our data indicates that marijuana is not associated with increased risk of postoperative noncompliance, other organ complications, infections, or death. As a single factor, marijuana may not need to be a contraindication for LT.

Dissemination and implementation (D&I) studies of dietary interventions for African Americans are limited. Restaurants may be an innovative setting to deliver dietary interventions. Purpose: Assess weight loss, self-efficacy for healthy eating, diet quality, and quality of life in African Americans in two groups: virtual synchronous and virtual asynchronous. Guided by RE-AIM, the Nutritious Eating with Soul @ Rare Variety Café Feasibility study included nutrition education, accountability partners for support, and cooking demonstrations led by a community health worker and was delivered across two cohorts in a non-randomized design. The intervention was conducted over 12 consecutive weekly classes. Due to the COVID-19 pandemic, intervention delivery was online. African Americans between 18–65 years old with overweight/obesity, not currently following a plant-based diet or taking medications to control diabetes, and living in a southeastern city were recruited. Participants completed in-person weight assessments and online surveys at baseline and post-intervention. Linear mixed models analyzed changes in outcomes and differences in 3-month outcomes between groups. All models controlled for age and sex. Regarding Reach, 199 participants expressed interest, and 60 enrolled. Among the full sample, participants decreased body weight −2.6 ± 0.5 kg (p < .0001) and increased self-efficacy 1.6 ± 0.7 points (p = .03). No differences in 3-month outcomes between groups were observed. This D&I feasibility study successfully recruited participants during the COVID-19 pandemic and produced significant results. The successful online intervention delivery compared to in-person suggests the potential for greater D&I in vegan soul food restaurants. As restrictions are loosened, future studies will test in-person delivery.

The implementation of evidence-based public health programs into practice is critical for improving health, but trainings for organizational change agents are often not scalable. To describe the process of converting a training that targets faith-based organizational capacity development from an in-person to an online format. We engaged in an iterative process to convert the training delivery mode from in-person to online that included assessing stakeholder support, consulting the literature on best practices, seeking a design team, consolidating content, designing engaging lessons, and building an online site. Feedback from end-users and other audiences was incorporated throughout. Pilot participants with characteristics like intended training users were then recruited via community and faith-based partner networks. They rated their agreement with statements about the effectiveness as well as design and functionality of each lesson and the overall training (1 = strongly disagree, 5 = strongly agree) and participated in a structured follow-up interview. Nine pilot participants (representing 9 churches in 7 states; 6 African American, 5 with health ministries) rated the online lessons favorably (all ratings ≥ 4.5). Most (90.4%) perceived the lesson duration to be “just right” and spent 52.5 ± 9.9 minutes/lesson. Participants evaluated the overall training positively (all ratings ≥ 4.7). Lesson content, resources, multimedia, and program ideas were most-liked aspects of lessons, while content, staff responsiveness, discussion board, and pace were most-liked aspects of the overall training in open-ended and interview responses. This paper shares a replicable process for converting training modalities from in-person to online with the goal of increased scalability.

Spallation targets for neutron production with high energy protons are made of high density and high atomic number materials in order to maximise the yield of neutrons for all the instruments around. Operating a proton beam onto a spallation target produces residual radioactive nuclei either as direct product of the spallation process and as secondary low energy neutron absorption. A reliable estimation of the overall activation and decay heat, as a function of the cooling time and irradiation profile history, is fundamental for a valuable design of the radiation shielding and cooling system during the operation phase as well for envisaging the optimal storage solution at the end of life of the target. This work presents the comparison between the FLUKA predictions of the decay heat in the ISIS TS1 target operated between 2014 and 2019 and the decay heat estimations derived from the measurement of the temperature in each plate at different cooling times. The agreement between the FLUKA predictions and the experimentally assessed values shows and quantifies the goodness of the FLUKA model in predicting measurable physical quantities relevant for the engineering thermal design of the target/reflector and moderator (TRAM) assembly. In addition, it also provides an indirect evidence of the accuracy of the simulated spallation physics and neutron transport throughout the TRAM assembly. Finally this work attempts to highlight and propose a general empirical procedure that could be eventually applied and used to proficiently measure the decay heat at whatever cooling time in targets with similar ISIS design.

PURPOSE Nonresponse and relapse after CD19-chimeric antigen receptor (CAR) T-cell therapy continue to challenge survival outcomes. Phase II landmark data from the ELIANA trial demonstrated nonresponse and relapse rates of 14.5% and 28%, respectively, whereas use in the real-world setting showed nonresponse and relapse rates of 15% and 37%. Outcome analyses describing fate after post-CAR nonresponse and relapse remain limited. Here, we aim to establish survival outcomes after nonresponse and both CD19+ and CD19– relapses and explore treatment variables associated with inferior survival. METHODS We conducted a retrospective multi-institutional study of 80 children and young adults with B-cell acute lymphoblastic leukemia experiencing nonresponse (n = 23) or relapse (n = 57) after tisagenlecleucel. We analyze associations between baseline characteristics and these outcomes and establish survival rates and salvage approaches. RESULTS The overall survival (OS) at 12 months was 19% across nonresponders (n = 23; 95% CI, 7 to 50). Ninety-five percent of patients with nonresponse had high preinfusion disease burden. Among 156 morphologic responders, the cumulative incidence of relapse was 37% (95% CI, 30 to 47) at 12 months (CD19+; 21% [15 to 29], CD19–; 16% [11 to 24], median follow-up; 380 days). Across 57 patients experiencing relapse, the OS was 52% (95% CI, 38 to 71) at 12 months after time of relapse. Notably, CD19– relapse was associated with significantly decreased OS as compared with patients who relapsed with conserved CD19 expression (CD19– 12-month OS; 30% [14 to 66], CD19+ 12-month OS; 68% [49 to 92], P = .0068). Inotuzumab, CAR reinfusion, and chemotherapy were used as postrelapse salvage therapy with greatest frequency, yet high variability in treatment sequencing and responses limits efficacy analysis across salvage approaches. CONCLUSION We describe poor survival across patients experiencing nonresponse to tisagenlecleucel. In the post-tisagenlecleucel relapse setting, patients can be salvaged; however, CD19– relapse is distinctly associated with decreased survival outcomes.

The braiding of Indigenous knowledge systems and Western-based sciences offers insights into ecology and has emerged as a way to help address complex environmental issues. We reviewed the publicly available ecological research involving the braiding of Indigenous knowledge systems and Western-based sciences to support collaborative work in the Alberta oil sands region of Canada. We conducted a systematic review, coding for 78 questions in six categories: (1) literature search and bibliographic information; (2) research themes; (3) study setting and design; (4) knowledge systems; (5) power relationships, colonization, and ethical considerations in research; and (6) benefits and challenges of braiding. We identified six articles that braided knowledge, with those articles focusing on environmental management and monitoring for impacts of industrial activity in northern Alberta. Researchers used a broad range of approaches to gather Indigenous knowledge and scientific data and identified multiple challenges (e.g., asymmetries of power, resource availability, and funding) to research. Our findings show that more support is needed to foster, promote, and disseminate interdisciplinary collaborative work involving braiding. Additional support is also required to address Indigenous community research needs related to the assessment of environmental impact and reclamation, as well as the understanding of ecological threats across the region.