Search

Abstract: Fine‐scale microclimate variation due to complex topography can shape both current vegetation distributional patterns and how vegetation responds to changing climate. Topographic heterogeneity in mountains is hypothesized to mediate responses to regional climate change at the scale of metres. For alpine vegetation especially, the interplay between changing temperatures and topographically mediated variation in snow accumulation will determine the overall impact of climate change on vegetation dynamics. We combined 30 years of co‐located measurements of temperature, snow and alpine plant community composition in Colorado, USA, to investigate vegetation community trajectories across a snow depth gradient. Our analysis of long‐term trends in plant community composition revealed notable directional change in the alpine vegetation with warming temperatures. Furthermore, community trajectories are divergent across the snow depth gradient, with exposed parts of the landscape that experience little snow accumulation shifting towards stress‐tolerant, cold‐ and drought‐adapted communities, while snowier areas shifted towards more warm‐adapted communities. Synthesis: Our findings demonstrate that fine‐scale topography can mediate both the magnitude and direction of vegetation responses to climate change. We documented notable shifts in plant community composition over a 30‐year period even though alpine vegetation is known for slow dynamics that often lag behind environmental change. These results suggest that the processes driving alpine plant population and community dynamics at this site are strong and highly heterogeneous across the complex topography that is characteristic of high‐elevation mountain systems.

Abstract: A central goal at the interface of ecology and conservation is understanding how the relationship between biodiversity and ecosystem function (B–EF) will shift with changing climate. Despite recent theoretical advances, studies which examine temporal variation in the functional traits and mechanisms (mass ratio effects and niche complementarity effects) that underpin the B–EF relationship are lacking. Here, we use 13 years of data on plant species composition, plant traits, local‐scale abiotic variables, above‐ground net primary productivity (ANPP), and climate from the alpine tundra of Colorado (USA) to investigate temporal dynamics in the B–EF relationship. To assess how changing climatic conditions may alter the B–EF relationship, we built structural equation models (SEMs) for 11 traits across 13 years and evaluated the power of different trait SEMs to predict ANPP, as well as the relative contributions of mass ratio effects (community‐weighted mean trait values; CWM), niche complementarity effects (functional dispersion; FDis) and local abiotic variables. Additionally, we coupled linear mixed effects models with Multimodel inference methods to assess how inclusion of trait–climate interactions might improve our ability to predict ANPP through time. In every year, at least one SEM exhibited good fit, explaining between 19.6% and 57.2% of the variation in ANPP. However, the identity of the trait which best explained ANPP changed depending on winter precipitation, with leaf area, plant height and foliar nitrogen isotope content (δ15N) SEMs performing best in high, middle and low precipitation years, respectively. Regardless of trait identity, CWMs exerted a stronger influence on ANPP than FDis and total biotic effects were always greater than total abiotic effects. Multimodel inference reinforced the results of SEM analysis, with the inclusion of climate–trait interactions marginally improving our ability to predict ANPP through time. Synthesis. Our results suggest that temporal variation in climatic conditions influences which traits, mechanisms and abiotic variables were most responsible for driving the B–EF relationship. Importantly, our findings suggest that future research should consider temporal variability in the B–EF relationship, particularly how the predictive power of individual functional traits and abiotic variables may fluctuate as conditions shift due to climate change.

Background: The practice of mercy killing, also known as euthnasia or assisted suicide, is a contentious and morally complex issue in healthcare. Understanding the ethical dilemmas related to mercy killing within specific religious communities, such as Maranao Muslims, can provide valuable insights into the intersection of faith, culture, and healthcare decision-making. This study aimed to explore the practice of mercy killing among Muslim Maranao nurses in the critical care setting. Methods: A qualitative research design based on descriptive phenomenology and criterion sampling was used to select 10 Muslim Maranao nurses with at least five years of working experience in intensive care units (ICUs) in the southern Philippines. In-depth semi-structured face-to-face interviews were conducted with the participants and Colizzi’s thematic analysis was employed to analyze the obtained data. Results: Thematic analysis revealed three main themes with three corresponding subthemes: Religious beliefs (Islamic teachings, religious duties and moral responsibility), cultural norms (community values, stigma and taboo, sense of identity), and professional ethics (duty to the patient, team collaboration and ethical considerations). Conclusion: The perspectives of Muslim Maranao nurses on mercy killing are strongly influenced by their religious beliefs, cultural norms and professional ethics. Islamic teachings guide their rejection of mercy killing, emphasizing compassionate care and respect for the natural course of life. Family and community values, fear of social judgment and the preservation of cultural identity shape their perspectives. Professional ethics highlight their commitment to patient well-being, autonomy, and collaborative decision-making. Culturally sensitive and ethically sound healthcare practices are essential, and ongoing dialogue, education and policy development are needed to address the complexities surrounding mercy killing within specific cultural and religious contexts.

BackgroundWearable physiological monitoring devices are promising tools for remote monitoring and early detection of potential health changes of interest. The widespread adoption of such an approach across communities and over long periods of time will require an automated data platform for collecting, processing, and analyzing relevant health information. ObjectiveIn this study, we explore prospective monitoring of individual health through an automated data collection, metrics extraction, and health anomaly analysis pipeline in free-living conditions over a continuous monitoring period of several months with a focus on viral respiratory infections, such as influenza or COVID-19. MethodsA total of 59 participants provided smartwatch data and health symptom and illness reports daily over an 8-month window. Physiological and activity data from photoplethysmography sensors, including high-resolution interbeat interval (IBI) and step counts, were uploaded directly from Garmin Fenix 6 smartwatches and processed automatically in the cloud using a stand-alone, open-source analytical engine. Health risk scores were computed based on a deviation in heart rate and heart rate variability metrics from each individual’s activity-matched baseline values, and scores exceeding a predefined threshold were checked for corresponding symptoms or illness reports. Conversely, reports of viral respiratory illnesses in health survey responses were also checked for corresponding changes in health risk scores to qualitatively assess the risk score as an indicator of acute respiratory health anomalies. ResultsThe median average percentage of sensor data provided per day indicating smartwatch wear compliance was 70%, and survey responses indicating health reporting compliance was 46%. A total of 29 elevated health risk scores were detected, of which 12 (41%) had concurrent survey data and indicated a health symptom or illness. A total of 21 influenza or COVID-19 illnesses were reported by study participants; 9 (43%) of these reports had concurrent smartwatch data, of which 6 (67%) had an increase in health risk score. ConclusionsWe demonstrate a protocol for data collection, extraction of heart rate and heart rate variability metrics, and prospective analysis that is compatible with near real-time health assessment using wearable sensors for continuous monitoring. The modular platform for data collection and analysis allows for a choice of different wearable sensors and algorithms. Here, we demonstrate its implementation in the collection of high-fidelity IBI data from Garmin Fenix 6 smartwatches worn by individuals in free-living conditions, and the prospective, near real-time analysis of the data, culminating in the calculation of health risk scores. To our knowledge, this study demonstrates for the first time the feasibility of measuring high-resolution heart IBI and step count using smartwatches in near real time for respiratory illness detection over a long-term monitoring period in free-living conditions.

Healthy dietary practices are highly influenced by social norms, the widely-held expectations about the behaviors that are appropriate or typical within a given group. However, many nutrition programs designed to reduce women’s undernutrition in low- and middle-income countries do not address the influence of social and gender norms in their interventions, and therefore, there is limited information about how norms-responsive interventions have been designed and implemented. The objective of this scoping review was to identify and describe social and behavioral change interventions designed to improve women’s dietary practices and nutritional intake that integrate the influence of social and gender norms. We systematically searched 4 databases (Scopus, Web of Science, PubMed, and CINAHL) for peer-reviewed articles describing design, implementation, and/or assessment of nutrition interventions in low- or middle-income countries. Results are reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Our review identified 27 articles from 25 projects or research studies that addressed social or gender norms related to women’s dietary practices. The majority focused on the pregnancy and lactation periods, and a few aimed to reach all women of reproductive age. Interventions most often endeavored to shift norms through multiple activities, channels, and platforms, aiming to reach not only the primary participants but also influencers and reference groups. Intervention approaches ranged from home visits and support groups to engage influential family members to community-level outreach with opinion leaders such as religious leaders, health care workers, and peer change agents. Most interventions were delivered through the health sector or were community-based, with some nutrition-sensitive agriculture interventions. There is increasing, although still limited, integration of social and gender norms perspectives in the design, implementation, and assessment of interventions to improve women’s diets. This comprehensive review summarizes influential norms and intervention approaches, an important step toward enhancing the effectiveness of social and behavioral change interventions by addressing nutrition-relevant norms.This study was registered at Open Science Framework as JSBF7.

IntroductionThe heightened risk of COVID-19 infection and mortality in prisons is well documented, but COVID-19's impact on all-cause mortality in incarcerated populations has not yet been studied. This study analyzed mortality records from the Florida State Department of Corrections prison system population to evaluate the impact COVID-19 had on all-cause mortality and compare mortality rates and life expectancy with that of the overall state of Florida population.MethodsPopulation age and sex data for Florida State Department of Corrections were ascertained from the Florida State Department of Corrections Offender Based Information System. Death data by age, sex, and cause of death were acquired from medical records and Florida State Department of Corrections offender reports. The state of Florida demographic and death data were collected from the Census Bureau, Florida Department of Health, and Centers for Disease Control and Prevention. Age- and sex-standardized life table measures were calculated, and COVID-19 contributions to changes in life expectancy were assessed using Arriaga's decomposition.ResultsThe standardized mortality rate in the Florida State Department of Corrections population increased by 45% between 2019 and 2020, causing an overall 4.0-year decline in life expectancy. Over the same period, the state of Florida population's standardized mortality increased by 19%, resulting in an overall 2.7-year decline. Within the Florida State Department of Corrections population, life expectancy decline could be attributed exclusively to COVID-19 mortality.ConclusionsThe state of Florida prison population saw a substantial increase in mortality driven solely by COVID-19 mortality, leading to an overall 4-year decline in life expectancy. Given the findings and continued threat of COVID-19 outbreaks, Florida State Department of Corrections and other prison systems should strive to increase vaccination uptake, decrease prison populations, and commit to COVID-19 data transparency.

Purpose: The purpose of this study was to investigate e-learning fatigue; the cognitive, educational, and emotional impacts on university students; and attitudes toward different course delivery modes after more than a year of COVID-19--mandated distance education in the United States. Method: A survey consisting of 25 Likert items was conducted with a total of 50 graduate and undergraduate students, mostly women between the ages of 18 and 45 years, majoring in communication sciences and disorders (CSD) at a Historically Black College/University (HBCU). Results: Younger, undergraduate, and Black/African American students reported being most unfavorably impacted by the e-learning requirements of COVID-19. Students without a prior history of online and hybrid learning also reported unfavorable effects, but not as consistently. Participants reporting higher levels of e-learning fatigue noted the greatest difficulties across all major areas of the study: learning, mental health, and attitudes toward e-learning. Higher e-learning fatigue was correlated with a higher negative impact on perceptions of future clinical effectiveness. Conclusions: Results show e-learning fatigue and the educational and emotional challenges of mandated e-learning during COVID-19 disproportionately affected certain groups of students, and they reported unfavorable views of e-learning and future clinical ability. This is the first study to examine how CSD students were affected by required distance learning during the pandemic. Future investigations may examine the long-term effects of the pandemic on students and their clinical skills, groups most susceptible to the negative impacts of e-learning, and ways to mitigate these effects to improve students' educational experiences and emotional well-being.

Introduction: Older adults comprise a large portion of back pain (BP) sufferers but are under-represented in the literature. Patients over age 65 present with different clinical characteristics and psychosocial needs than younger patients. Therefore, recommended patient-centered outcomes for BP may not be relevant to older patients. Research question: What treatment outcomes are most important to adults over 65 years of age? Materials and methods: We queried older adults seeking treatment for BP using qualitative methods. Participants were asked about their goals and expectations of treatment in an audio-taped interview. Audiotapes were transcribed, coded and analyzed by the investigators. Using thematic analysis, main themes and constructs were extracted and interpreted by the investigators. From there we were able to generate hypotheses about what older patients want from spine treatment. Results: For all participants, age played a role in their treatment goals as a moderator or motivator. They were most concerned with returning to usual activities and preventing further physical limitations to maintain independence. Goals that reflect important outcomes such as increasing walking tolerance and improving balance were of particular importance. Confidence in the provider acted as a facilitator of goals. Discussion and conclusion: Unlike their younger cohorts, they did not emphasize work-related outcomes and pain relief. These findings can be tested in future quantitative studies and will help to develop protocols for outcomes assessment in older adults. This study is a first step towards understanding and improving the quality of care for older patients with back pain.

Abstract Objective: Caregivers require tangible (e.g. food and financial) and intangible resources to provide care to ensure child health, nutrition and development. Intangible resources include beliefs and knowledge, education, self-efficacy, perceived physical health, mental health, healthy stress levels, social support, empowerment, equitable gender attitudes, safety and security and time sufficiency. These intangible caregiver resources are included as intermediate outcomes in nutrition conceptual frameworks yet are rarely measured as part of maternal and child nutrition research or evaluations. To facilitate their measurement, this scoping review focused on understudied caregiver resources that have been measured during the complementary feeding period in low- and lower-middle-income countries. Design: We screened 9,232 abstracts, reviewed 277 full-text articles and included 163 articles that measured caregiver resources related to complementary feeding or the nutritional status of children 6 months to 2 years of age. Results: We identified measures of each caregiver resource, though the number of measures and quality of descriptions varied widely. Most articles (77 %) measured only one caregiver resource, mental health (n 83) and social support (n 54) most frequently. Psychometric properties were often reported for mental health measures, but less commonly for other constructs. Few studies reported adapting measures for specific contexts. Existing measures for mental health, equitable gender attitudes, safety and security and time sufficiency were commonly used; other constructs lacked standardised measures. Conclusions: Measurement of caregiver resources during the complementary feeding period is limited. Measuring caregiver resources is essential for prioritising caregivers and understanding how resources influence child care, feeding and nutrition.

The highly mutated BA.2.86, with over 30 spike protein mutations in comparison to Omicron BA.2 and XBB.1.5 variants, has raised concerns about its potential to evade COVID-19 vaccination or prior SARS-CoV-2 infection-elicited immunity. In this study, we employ a live SARS-CoV-2 neutralization assay to compare the neutralization evasion ability of BA.2.86 with other emerged SARS-CoV-2 subvariants, including BA.2-derived CH.1.1, Delta-Omicron recombinant XBC.1.6, and XBB descendants XBB.1.5, XBB.1.16, XBB.2.3, EG.5.1 and FL.1.5.1. Our results show that BA.2.86 is less neutralization evasive than XBB sublineages. XBB descendants XBB.1.16, EG.5.1, and FL.1.5.1 continue to significantly evade neutralization induced by the parental COVID-19 mRNA vaccine and a BA.5 Bivalent booster. Notably, when compared to XBB.1.5, the more recent XBB descendants, particularly EG.5.1, display increased resistance to neutralization. Among all the tested variants, CH.1.1 exhibits the greatest neutralization evasion. In contrast, XBC.1.6 shows a slight reduction but remains comparably sensitive to neutralization when compared to BA.5. Furthermore, a recent XBB.1.5-breakthrough infection significantly enhances the breadth and potency of cross-neutralization. These findings reinforce the expectation that the upcoming XBB.1.5 mRNA vaccine would likely boost the neutralization of currently circulating variants, while also underscoring the critical importance of ongoing surveillance to monitor the evolution and immune evasion potential of SARS-CoV-2 variants.

Background Effective social and behavior change strategies for exclusive breastfeeding (EBF) rely on understanding how families interpret infant behavior and provide care. Little research thoroughly explores household use of non-prescribed medicine for infants under 6 months in rural Tanzania, which can interrupt EBF and may have other harmful unintended effects. Aim To explore parents’ use of non-prescribed medicine in response to infants’ colic-like symptoms during the EBF period. Methods We conducted thematic analysis of a series of qualitative, semi-structured interviews with 36 mothers and 30 fathers of infants 0-6 months in Lake Zone, Tanzania. Here, we focus on emergent themes related to concerns about colic-like symptoms and global implications for public health practitioners. Results Parents reported concerns about excessive crying and perceived infant abdominal pain, attributed to a potentially serious disease state locally known as mchango. Most parents gave non-prescribed medicines (e.g. gripe water, oral traditional medicine, and/or other commercial medicines) to treat or prevent mchango and associated symptoms, often including infant crying. After receiving supportive counselling on soothing techniques, most were willing to avoid giving non-prescribed medicines. Some reported continued challenges attributed to mchango symptoms, namely inconsolable crying. Conclusion While symptoms of mchango reported in this study overlapped with colic symptoms, literature in Tanzania suggests, in some cases, mchango is perceived to have spiritual origins and potentially be dangerous if left untreated. Empathetic counseling can offer parents knowledge and skills to manage colic-like symptoms without using non-prescribed medicines. Health workers need clear messages and training on risks of non-prescribed medicines and Tanzanian legislation banning its promotion and distribution.

Abstract This study explores common factors associated with not meeting minimum dietary diversity (MDD) among 27,072 children aged 6–23 months in Eastern and Southern Africa using data from nine Demographic and Health Surveys from 2013 to 2016. MDD was defined as consumption of more than or equals to five of eight food groups including breast milk in the past 24 h. Equity gaps were calculated as the difference in MDD prevalence between the top and bottom wealth quintiles. Logistic regression was conducted to identify common factors for not meeting MDD at the household, maternal and child levels across two or more countries to inform regional policies to improve children's diets. Kenya had the highest MDD wealth equity gap (40.4 pts), and South Africa had the smallest (14.4 pts). Equity gaps for flesh foods or eggs (up to 39.8 pp) were larger than for grain or legumes (up to 20 pp). Common risk factors for not reaching MDD included younger child age (6–11 months) (n = 9 countries), no formal maternal occupation (n = 6), not receiving vitamin‐A supplementation (n = 3), younger maternal age (n = 3), lower maternal education (n = 3), no media (n = 3) or newspaper (n = 3) exposure, lower household wealth quintile (n = 3), use of nonefficient cooking fuel (n = 2), longer time to get to the water source (n = 2), not listening to the radio (n = 2) and higher birth order (n = 2). Priorities for improving MDD in the region include introducing diverse foods at a young age from 6 months with early nutrition counselling, promoting higher maternal education, increasing food purchasing power and ensuring the support of younger mothers.

Complex lymphatic anomalies (CLAs) are a set of rare diseases with unique osteopathic profiles. Recent efforts have identified how lymphatic-specific somatic activating mutations can induce abnormal lymphatic formations that are capable of invading bone and inducing bone resorption. The abnormal bone resorption in CLA patients has been linked to overactive osteoclasts in areas with lymphatic invasions. Despite these findings, the mechanism associated with progressive bone loss in CLAs remains to be elucidated. In order to determine the role of osteoblasts in CLAs, we sought to assess osteoblast differentiation and bone formation when exposed to the lymphatic endothelial cell secretome. When treated with lymphatic endothelial cell conditioned medium (L-CM), osteoblasts exhibited a significant decrease in proliferation, differentiation, and function. Additionally, L-CM treatment also inhibited bone formation through a neonatal calvaria explant culture. These findings are the first to reveal how osteoblasts may be actively suppressed during bone lymphatic invasion in CLAs.

Background: Health-related quality of life (HRQOL), a patient-sensitive outcome globally, has become the clinician’s primary goal of care. Evidence suggests that diabetes mellitus (DM) and its treatment/care impair patients’ HRQOL, which varies depending on patient population/factors. Diabetics’ HRQOL in South-South Nigeria is largely unknown. Objectives: This study assessed and compared the HRQOL of patients with type 2 diabetes attending the outpatient diabetic clinic at a tertiary hospital in Port-Harcourt, Rivers State, South-South Nigeria with age-/gender-matched nondiabetics living within the same environment. Materials and Methods: This descriptive cross-sectional comparative study recruited 200 respondents, respectively those with type 2 diabetes (cases) and nondiabetics (controls). Data were collected by using the World Health Organization Quality of Life–BREF (WHOQOL-BREF) questionnaire and analyzed by using descriptive and inferential statistics at P≤ 0.05 level of significance. Results: The two groups (200 each) had no significant differences (P = 0.35 - P = 0.98) in terms of their demographic variables. The diabetic group mean scores were significantly (P = 0.00) lower than that of the non-diabetics in terms of WHOQOL-BREF overall, health satisfaction, physical, psychological, and social domains. Diabetics with tertiary education (58%) had a significantly higher mean score (P = 0.012) in terms of overall WHOQOL-BREF than those with secondary and primary education (42%). Ninety-two patients (46%) with diabetes had comorbidities that increased significantly with age (P = 0.00) and expressed less satisfaction with their health (P = 0.04). Conclusion: Patients with diabetes had lower HRQOL scores than non-diabetics, implying the negative impact of diabetes and its treatment/care on their life. Diabetics’ HRQOL should be routinely evaluated and enhanced by empowering diabetic self-care activities that aid diabetes control and retard complications.

A reliable and efficient serological test is crucial for monitoring neutralizing antibodies against SARS-CoV-2 and its variants of concern (VOCs). Here, we present an integrated research–clinical platform for a live SARS-CoV-2 neutralization assay, utilizing highly attenuated SARS-CoV-2 (Δ3678_WA1-spike). This strain contains mutations in viral transcription regulation sequences and deletion in the open-reading-frames 3, 6, 7, and 8, allowing for safe handling in biosafety level 2 (BSL-2) laboratories. Building on this backbone, we constructed a genetically stable reporter virus (mGFP Δ3678_WA1-spike) by incorporating a modified green fluorescent protein sequence (mGFP). We also constructed mGFP Δ3678_BA.5-spike and mGFP Δ3678_XBB.1.5-spike by substituting the WA1 spike with variants BA.5 and XBB.1.5 spike, respectively. All three viruses exhibit robust fluorescent signals in infected cells and neutralization titers in an optimized fluorescence reduction neutralization assay that highly correlates with a conventional plaque reduction assay. Furthermore, we established that a streamlined robot-aided Bench-to-Clinics COVID-19 Neutralization Test workflow demonstrated remarkably sensitive, specific, reproducible, and accurate characteristics, allowing the assessment of neutralization titers against SARS-CoV-2 variants within 24 h after sample receiving. Overall, our innovative approach provides a valuable avenue for large-scale testing of clinical samples against SARS-CoV-2 and VOCs at BSL-2, supporting pandemic preparedness and response strategies.

Plasmodium falciparum, the causative agent of malaria, remains a global health threat as parasites continue to develop resistance to antimalarial drugs used throughout the world. Accordingly, drugs with novel modes of action are desperately required to combat malaria. P. falciparum parasites infect human red blood cells where they digest the host’s main protein constituent, hemoglobin. Leucine aminopeptidase PfA-M17 is one of several aminopeptidases that have been implicated in the last step of this digestive pathway. Here, we use both reverse genetics and a compound specifically designed to inhibit the activity of PfA-M17 to show that PfA-M17 is essential for P. falciparum survival as it provides parasites with free amino acids for growth, many of which are highly likely to originate from hemoglobin. We further show that loss of PfA-M17 results in parasites exhibiting multiple digestive vacuoles at the trophozoite stage. In contrast to other hemoglobin-degrading proteases that have overlapping redundant functions, we validate PfA-M17 as a potential novel drug target.

Introduction Musculoskeletal injuries (MSIs) pose a significant problem for active duty service members (ADSMs). MSIs may compromise readiness and are one of the main reasons for separation from the Navy and long-term disability. Implementation of optimal treatment strategies rests on understanding the characteristics of MSI complaints in a given population. This study reports on the frequency and nature of MSI complaints of ADSMs seeking care at a military treatment facility (MTF). Materials and Methods As part of a larger quasi-experimental study, data on MSIs from ADSMs reporting to an MTF were collected. Subjects completed a baseline questionnaire during an initial evaluation, including the self-reported MSIs for which participants were seeking care, time since onset, and other MSI comorbidities. Results Of the 289 respondents, 118 (41%) were female and 172 (59%) were male. The mean age was 33 years (SD = 8). The most frequently reported injury was low-back pain (n  = 79, 27%), followed by knee pain (n  = 60, 21%) and shoulder pain (n  = 55, 19%). Thirty-four (12%) respondents reported injuries to the ankle or foot. The remaining respondents (21%) reported injuries to the neck, mid-back, arm or hand, hip, or other. Sixty-five (22%) reported an acute/subacute injury of less than 3 months, whereas 224 (78%) reported chronic injury >3 months. Furthermore, MSI comorbidities were reported by 233 (80%) of respondents with 128 of those reporting more than one. Conclusions Back and knee injuries were most prevalent in ADSMs reporting an MSI at a Navy shore-based MTF. Shoulder injuries were also common. Of interest, 80% of ADSMs reported at least one MSI comorbidity and 80% reported chronic injury in this study. These rates are higher than those found in a previous study of ADSMs deployed on a carrier. This is notable because chronicity and multiple MSIs are obstacles to readiness. Our findings suggest that ADSMs reporting to shore-based facilities may be at higher risk for disability than their deployed counterparts. This information is important to the development of targeted care to improve readiness in this population. [ABSTRACT FROM AUTHOR]

Introduction Musculoskeletal injuries (MSIs) are a leading cause of separation from the U.S. Navy. Data have shown that several psychological responses to MSI are associated with treatment outcomes. Yellow flags are maladaptive psychological responses to injury and predict delayed recovery, whereas pink flags indicate resilience after MSI and are associated with good treatment outcomes. Identifying these factors in patients with MSI would permit early targeted care to address factors that may delay their readiness for deployment and enhance factors that support recovery. Materials and Methods Active duty service members with MSI who reported to physical therapy outpatient services at a naval hospital were recruited for the study. Yellow flags were assessed at baseline as part of a larger study. Participants completed the Fear Avoidance Beliefs Questionnaire (with two subscales, physical activity and work), the Pain Catastrophizing Scale, and the Hospital Anxiety and Depression Scale. Clinically relevant cut-off scores were used to indicate risk factors of delayed recovery. Pink flags were assessed with the Pain Self-Efficacy Questionnaire and a measure of positive outcome expectations for recovery. Results Two hundred and ninety participants responded to some or all of the questionnaires. Of these, 82% exceeded the cut-off scores on the physical activity subscale of the Fear Avoidance Beliefs Questionnaire, and 39% did so on the work subscale. Pain catastrophizing exceeded the cut-off in only 4.9% of the sample. Forty-three percent of these exceeded the cut-off for the anxiety subscale of the Hospital Anxiety and Depression Scale; 27% exceeded the cut-off on the depression subscale of the Hospital Anxiety and Depression Scale. Additionally, 54% endorsed scores greater than 40 on the Pain Self-Efficacy Questionnaire, and 53% endorsed a high score on the positive outcome expectations. Conclusions A substantial portion of the sample endorsed elevated scores on one or more indicators of delayed recovery from MSI. Most participants showed a fear of physical activity, and approximately half reported pain-related distress (anxiety and depression). In addition, feelings of self-efficacy and positive outcome expectations of treatment were endorsed by only about half of the participants, indicating that the remaining half did not report adaptive responses to MSI. Early identification of these risk factors will allow for targeted treatment approaches that incorporate these yellow flags into treatment and support a psychologically informed approach to physical therapy. This approach is likely to reduce delayed recovery and improve deployment readiness. [ABSTRACT FROM AUTHOR]

Background: The practice of mercy killing, also known as euthnasia or assisted suicide, is a contentious and morally complex issue in healthcare. Understanding the ethical dilemmas related to mercy killing within specific religious communities, such as Maranao Muslims, can provide valuable insights into the intersection of faith, culture, and healthcare decision-making.... [ABSTRACT FROM AUTHOR]

DNA methylation profiles from 26 bat species accurately predicts chronological age, while longevity-related methylation patterns across the genome suggest that bat longevity results from augmented immune response and cancer suppression.

Sarah Wali,1 Charlotte Porter-Hope,2 Tejal N Amin,1 Tariq Miskry1 1Department of Obstetrics and Gynaecology, St Mary’s Hospital, Paddington, London, W2 1NY, UK; 2Imperial College Medical School, London, UKCorrespondence: Sarah Wali Email Sarah.wali@doctors.org.ukBackground: Although the most common uterine tumour is leiomyoma, the differential diagnoses also include the rarer adenomyoma and leiomyosarcoma. A lack of clear reliable clinical and radiological features makes the triage of uterine masses to the appropriate surgical procedure difficult. In the case of suspicious appearance of a presumed leiomyoma, an open surgical approach is recommended and morcellation is avoided.Case: We present a case of a woman undergoing an elective laparoscopic myomectomy for a fibroid that appeared benign on ultrasound but had suspicious features intraoperatively. The operation was converted to a laparotomy to avoid the risk of morcellation-related seeding in the event that the histology was malignant. The histology was subsequently a benign exophytic adenomyoma.Conclusion: The assessment of the nature of fibroids can be difficult both pre- and intraoperatively, and the need for difficult decision making to convert to open surgery during a laparoscopic myomectomy but with subsequent benign histology should be part of patient counselling.Keywords: adenomyoma, communication, differential diagnosis, converting to laparotomy, morcellation risks, histology

Exotic species dominate many communities; however the functional significance of species' biogeographic origin remains highly contentious. This debate is fuelled in part by the lack of globally replicated, systematic data assessing the relationship between species provenance, function and response to perturbations. We examined the abundance of native and exotic plant species at 64 grasslands in 13 countries, and at a subset of the sites we experimentally tested native and exotic species responses to two fundamental drivers of invasion, mineral nutrient supplies and vertebrate herbivory. Exotic species are six times more likely to dominate communities than native species. Furthermore, while experimental nutrient addition increases the cover and richness of exotic species, nutrients decrease native diversity and cover. Native and exotic species also differ in their response to vertebrate consumer exclusion. These results suggest that species origin has functional significance, and that eutrophication will lead to increased exotic dominance in grasslands.

Abstract Antenatal care (ANC) provides a platform to counsel pregnant women on maternal nutrition and to prepare the mother to breastfeed. Recent reviews suggest that gaps in the coverage and quality of counselling during pregnancy may partly explain why services do not consistently translate to improved behavioural outcomes in South Asia. This scoping literature review collates evidence on the coverage and quality of counselling on maternal nutrition and infant feeding during ANC in five South Asian countries and the effectiveness of approaches to improve the quality of counselling. Coverage data were extracted from the most recent national surveys, and a scoping review of peer‐reviewed and grey literature (1990–2019) was conducted. Only Afghanistan and Pakistan have survey data on the coverage of counselling on both maternal nutrition and breastfeeding, nine studies described the quality of counselling and three studies assessed the effectiveness of interventions to improve the quality of services. This limited body of evidence suggests that inequalities in access to services, gaps in capacity building opportunities for frontline workers and the short duration and frequency of counselling contracts constrain quality, while the format, duration, frequency and content of health worker training, together with supportive supervision, are probable approaches to improve quality. Greater attention is needed to integrate indicators into monitoring and supervision mechanisms, periodic surveys and programme evaluations to assess the status of and track progress in improving quality and to build accountability for quality counselling, while research is needed to understand how best to assess and strengthen quality in specific settings.

Tuberculosis (TB) is often difficult to diagnose in immunocompromised patients and occurs 20 to 74 times more frequently in recipients of solid organ transplants than in the general population. We present the case of a 40-year-old female immigrant from Mexico previously treated for latent TB who underwent a simultaneous pancreas and kidney transplant. She experienced 3 episodes of rejection and then presented with 4 months of nonspecific abdominal pain. She was ultimately diagnosed with disseminated TB presenting with intestinal perforation and pulmonary involvement. This case illustrates the need for clinicians to maintain a high index of suspicion for TB in transplant recipients, especially those previously treated for TB or rejection.

Background: Individuals with end‐stage knee osteoarthritis (OA) walk at a lower intensity (ie, slower step cadence) contributing to worse physical function. Previous literature reports daily step counts and sedentary time, with little information regarding stepping bouts or cadence. Determining relationships between daily higher stepping cadence duration and clinical outcomes can move the field toward optimal daily stepping prescription. Objective: To quantify daily physical activity patterns of individuals with end‐stage knee OA and determine the contribution of high stepping cadence to explain functional capacity variability. Design: Cross‐sectional analysis. Setting: Veterans Administration medical center. Participants: U.S. military veterans (n = 104; age: 67.1 years [7.2]; mean [SD]; male [89.3%]) with end‐stage knee OA were enrolled. Intervention: Not applicable. Main outcome measure: Functional capacity (6‐Minute Walk Test [6MWT]). Physical activity (activPAL wearable sensor; cadence and time sitting, standing, and stepping), pain (Western Ontario and McMaster Universities Osteoarthritis Index‐pain subscale) sociodemographic variables, and comorbidities (body mass index and Functional Comorbidity Index) are the main explanatory variables. Results: Participants' wake time was mainly sitting (11.0 h/day) in ≥60‐minute bouts (29.7% ± 12.7 of sitting time). Standing (3.4 hours/day) and stepping (1.4 h/day) primarily occurred in 0–5 minute bouts (standing: 87.7% ± 14.4 of standing time, stepping: 98.7% ± 12.7 of stepping time) and stepping cadence was predominantly incidental (1–19 spm; 52.9% ± 9.6 of total stepping time). Backward elimination model results indicated shorter medium‐to‐brisk cadence bout duration, older age, and higher pain significantly explained shorter 6MWT distance (AdjR2=0.24, p <.01). Conclusions: Individuals with knee OA spend most of their waking hours sitting, while standing and stepping occurs in short bouts at very low stepping cadence. Decreased time in high stepping cadence is associated with lower functional capacity. Future studies should explore if increasing the daily time spent in higher step cadence can improve functional capacity in this population. [ABSTRACT FROM AUTHOR]

Turtle nesting habitat can be created as a restoration strategy to increase habitat availability or provide suitable habitat away from threats. Traditional nest habitat restoration consists of creating nesting mounds using a mix of sand and gravel. However, nesting mounds do not resemble natural turtle nesting habitat in a rock barren landscape where turtles nest in crevices and cracks in the bedrock. Therefore, our objective was to design and evaluate the success of a landscape‐appropriate design for turtle nesting habitat in a rock barren landscape. To evaluate success of the nest habitat design, we assessed the (1) survival of transplanted moss and lichen cover on created nest sites, (2) ecohydrological and physical conditions at created and natural sites, and (3) turtle egg hatching success at created and natural sites using a split‐clutch experiment. We found no difference in productivity between lichen transplants and natural sites, indicating that intact lichen transplants were successful. Moss transplant success was more variable due to moisture stress because transplants were conducted during dry conditions. In general, created nest habitat tended to have a more stable thermal and moisture regime compared to natural sites. When accounting for maternal effects, the odds of an egg hatching successfully was 6.6 times higher in a created site than a natural site. Overall, the success of our nest habitat design in the first few years suggests that this landscape‐appropriate design will be a useful restoration strategy for increasing turtle nesting habitat in rock barren landscapes. [ABSTRACT FROM AUTHOR]

People with lower-limb loss participate in less physical activity than able-bodied individuals, which increases the mortality risk and incidence of metabolic syndromes. This study evaluated the effect of lower-limb prosthesis osseointegration on physical activity, including daily steps and stepping cadence. Free-living walking activity was assessed from 14 patients scheduled to undergo prosthesis osseointegration at two time points (within 2 weeks prior to osseointegration surgery and 12-months following). Daily step count, stepping time, number of walking bouts, average step cadence per bout, maximum step cadence per bout, and time spent in bands of step cadence were compared before and after osseointegration. Twelve months after prosthesis osseointegration, participants increased daily steps, daily stepping time, average step cadence, and maximum cadence per walking bout compared to pre-osseointegration. Participants engaged in more daily steps, higher stepping cadence, and longer bouts at higher cadence one year following osseointegration compared to when using a socket prosthesis. As a novel intervention that is becoming more common, it is important to understand walking activity outcomes as these are critical for long-term health. People with lower-limb loss participate in less physical activity than able-bodied individuals, which increases the mortality risk and incidence of metabolic syndromes. Daily step count, walking bouts, and step cadence during free-living walking activity are promising measures to capture physical functional performance in patients with lower-limb amputation. This study shows that patients with osseointegrated prostheses increase their stepping activity, including daily steps, number of bouts, and stepping cadence compared to when using a socket prosthesis, which has positive implications on overall patient health. As a novel intervention that is becoming more common, it is important for clinicians, patients, and researchers to understand expectations for walking activity outcomes as a critical factor in long-term patient health after prosthesis osseointegration. [ABSTRACT FROM AUTHOR]