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Summary: Background: Children from racial and ethnic minority groups are at greater risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but it is unclear whether they have increased risk for post-acute sequelae of SARS-CoV-2 (PASC). Our objectives were to assess whether the risk of respiratory and neurologic PASC differs by race/ethnicity and social drivers of health. Methods: We conducted a retrospective cohort study of individuals

Background Children hospitalized with acute decompensated heart failure (ADHF) frequently require intravenous vasoactive (IVV) support drugs and are at risk for adverse cardiovascular (ACV) outcomes. We wished to assess whether serial changes in B‐type natriuretic peptide (BNP) levels are associated with successful weaning off IVV support and/or prespecified ACV outcomes in children hospitalized with ADHF. Methods and Results Children hospitalized with ADHF from 2005 to 2021 at our institution were assessed for serial changes in BNP, weaning off of IVV support, and ACV outcomes. Changes in BNP level were evaluated using linear mixed‐effects modeling. Bonferroni correction was used to adjust for multiple hypothesis testing. In 131 hospitalizations of children with ADHF, the median age was 4.8 years, with 74% receiving IVV support. ACV outcomes occurred in 62 children. IVV support was associated with lower admission left ventricular ejection fraction (26.7% versus 32%, P=0.002), more severe left ventricular dilation (left ventricular internal diastolic dimension Z score 5.9 versus 3.1, P=0.021) moderate or more mitral regurgitation (41.3% versus 20.6%, P=0.038), and qualitative right ventricular systolic dysfunction (in 45.4% versus 11.8%, P

BackgroundElectronic paper (E-paper) screens use electrophoretic ink to provide paper-like low-power displays with advanced networking capabilities that may potentially serve as an alternative to traditional whiteboards and television display screens in hospital settings. E-paper may be leveraged in the emergency department (ED) to facilitate communication. Providing ED patient status updates on E-paper screens could improve patient satisfaction and overall experience and provide more equitable access to their health information. ObjectiveWe aimed to pilot a patient-facing digital whiteboard using E-paper to display relevant orienting and clinical information in real time to ED patients. We also sought to assess patients’ satisfaction after our intervention and understand our patients’ overall perception of the impact of the digital whiteboards on their stay. MethodsWe deployed a 41-inch E-paper digital whiteboard in 4 rooms in an urban, tertiary care, and academic ED and enrolled 110 patients to understand and evaluate their experience. Participants completed a modified Hospital Consumer Assessment of Health Care Provider and Systems satisfaction questionnaire about their ED stay. We compared responses to a matched control group of patients triaged to ED rooms without digital whiteboards. We designed the digital whiteboard based on iterative feedback from various departmental stakeholders. After establishing IT infrastructure to support the project, we enrolled patients on a convenience basis into a control and an intervention (digital whiteboard) group. Enrollees were given a baseline survey to evaluate their comfort with technology and an exit survey to evaluate their opinions of the digital whiteboard and overall ED satisfaction. Statistical analysis was performed to compare baseline characteristics as well as satisfaction. ResultsAfter the successful prototyping and implementation of 4 digital whiteboards, we screened 471 patients for inclusion. We enrolled 110 patients, and 50 patients in each group (control and intervention) completed the study protocol. Age, gender, and racial and ethnic composition were similar between groups. We saw significant increases in satisfaction on postvisit surveys when patients were asked about communication regarding delays (P=.03) and what to do after discharge (P=.02). We found that patients in the intervention group were more likely to recommend the facility to family and friends (P=.04). Additionally, 96% (48/50) stated that they preferred a room with a digital whiteboard, and 70% (35/50) found the intervention “quite a bit” or “extremely” helpful in understanding their ED stay. ConclusionsDigital whiteboards are a feasible and acceptable method of displaying patient-facing data in the ED. Our pilot suggested that E-paper screens coupled with relevant, real-time clinical data and packaged together as a digital whiteboard may positively impact patient satisfaction and the perception of the facility during ED visits. Further study is needed to fully understand the impact on patient satisfaction and experience. Trial RegistrationClinicalTrials.gov NCT04497922; https://clinicaltrials.gov/ct2/show/NCT04497922

Pancreatic ductal adenocarcinoma (PDAC) is one of the most treatment refractory and lethal malignancies. The diversity of endothelial cell (EC) lineages in the tumor microenvironment (TME) impacts the efficacy of antineoplastic therapies, which in turn remodel EC states and distributions. Here, we present a single-cell resolution framework of diverse EC lineages in the PDAC TME in the context of neoadjuvant chemotherapy, radiotherapy, and losartan. We analyzed a custom single-nucleus RNA-seq dataset derived from 37 primary PDAC specimens (18 untreated, 14 neoadjuvant FOLFIRINOX + chemoradiotherapy, 5 neoadjuvant FOLFIRINOX + chemoradiotherapy + losartan). A single-nucleus transcriptome analysis of 15,185 EC profiles revealed two state programs (ribosomal, cycling), four lineage programs (capillary, arterial, venous, lymphatic), and one program that did not overlap significantly with prior signatures but was enriched in pathways involved in vasculogenesis, stem-like state, response to wounding and hypoxia, and endothelial-to-mesenchymal transition (reactive EndMT). A bulk transcriptome analysis of two independent cohorts (n = 269 patients) revealed that the lymphatic and reactive EndMT lineage programs were significantly associated with poor clinical outcomes. While losartan and proton therapy were associated with reduced lymphatic ECs, these therapies also correlated with an increase in reactive EndMT. Thus, the development and inclusion of EndMT-inhibiting drugs (e.g., nintedanib) to a neoadjuvant chemoradiotherapy regimen featuring losartan and/or proton therapy may be most effective in depleting both lymphatic and reactive EndMT populations and potentially improving patient outcomes.

BackgroundDisplay signage is ubiquitous and essential in hospitals to serve several clerical, operational, and clinical functions, including displaying notices, providing directions, and presenting clinical information. These functions improve efficiency and patient engagement, reduce errors, and enhance the continuity of care. Over time, signage has evolved from analog approaches such as whiteboards and handwritten notices to digital displays such as liquid crystal displays, light emitting diodes, and, now, electronic ink displays. Electronic ink displays are paper-like displays that are not backlit and show content by aligning microencapsulated color beads in response to an applied electric current. Power is only required to generate content and not to retain it. These displays are very readable, with low eye strain; minimize the emission of blue light; require minimal power; and can be driven by several data sources, ranging from virtual servers to electronic health record systems. These attributes make adapting electronic ink displays to hospitals an ideal use case. ObjectiveIn this paper, we aimed to outline the use of signage and displays in hospitals with a focus on electronic ink displays. We aimed to assess the advantages and limitations of using these displays in hospitals and outline the various public-facing and patient-facing applications of electronic ink displays. Finally, we aimed to discuss the technological considerations and an implementation framework that must be followed when adopting and deploying electronic ink displays. MethodsThe public-facing applications of electronic ink displays include signage and way-finders, timetables for shared workspaces, and noticeboards and bulletin boards. The clinical display applications may be smaller form factors such as door signs or bedside cards. The larger, ≥40-inch form factors may be used within patient rooms or at clinical command centers as a digital whiteboard to display general information, patient and clinician information, and care plans. In all these applications, such displays could replace analog whiteboards, noticeboards, and even other digital screens. ResultsWe are conducting pilot research projects to delineate best use cases and practices in adopting electronic ink displays in clinical settings. This will entail liaising with key stakeholders, gathering objective logistical and feasibility data, and, ultimately, quantifying and describing the effect on clinical care and patient satisfaction. ConclusionsThere are several use cases in a clinical setting that may lend themselves perfectly to electronic ink display use. The main considerations to be studied in this adoption are network connectivity, content management, privacy and security robustness, and detailed comparison with existing modalities. Electronic ink displays offer a superior opportunity to future-proof existing practices. There is a need for theoretical considerations and real-world testing to determine if the advantages outweigh the limitations of electronic ink displays.

Stress urinary incontinence and stress-predominant mixed urinary incontinence are prevalent conditions that significantly impair quality of life, particularly among women. Urethral bulking agents have emerged as a non-surgical treatment option for patients who are hesitant to undergo surgical interventions. The aim of this systematic review and meta-analysis is to evaluate the efficacy and safety of various urethral bulking agents, specifically Bulkamid, Macroplastique, and Urolastic, in treating stress urinary incontinence and stress-predominant mixed urinary incontinence. The review encompasses 15 studies, including rando­mized controlled trials and cohort studies, with a total of 1,120 patients. The analysis focuses on cure and improvement rates, complications, and the risk of bias associated with the included studies. The fin­dings indicate that bulking agents demonstrate cure and improvement rates ranging from 70 to 80 %, with a pooled average of 75 %. Subgroup analyses reveal cure rates of 76 % for Bulkamid, 73 % for Urolastic, and 77 % for Macroplastique. Despite significant statistical heterogeneity, particularly for Bulkamid and Urolastic, the results suggest that these agents can serve as effective non-surgical options. The outcomes appear consistent across all continents included in this study, reinforcing their potential as reliable alternative glo­bally. Ho­wever, the review highlights the necessity for well-designed randomized controlled trials to further assess the long-term efficacy and safety of these treatments, ultimately aiming to optimize patient outcomes.

Context: Diabetic nephropathy is the leading cause of end-stage renal disease and also death in the world. Administration of Szeto-Schiller-31 (SS-31) as a potential therapeutic candidate that can decrease the renal function damage progressivity in diabetes needs to be comprehensively analyzed. Aims: To assess the protective effects of SS31 against the progressivity of diabetic nephropathy. Methods: This systematic review follows PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines 2020. Searches of databases (Pubmed, Science Direct, Scopus, ProQuest, and Springer) were done on 17 September 2023 in order to find articles related to the animal diabetic model and SS-31 treatment. Manual searches from medRxiv were also conducted to obtain additional evidence. Renal function, histopathology analysis, reactive oxygen species in vivo, and in vitro analysis were described. Results: There were six in vivo studies, each of which discussed the renal function, histopathology, and reactive oxygen species (ROS), and four in vitro studies that discussed ROS. The available data suggested that SS-31 improves kidney function by lowering urinary albumin excretion, proteinuria, serum creatinine, creatinine clearance, and BUN, supported by histopathological improvements. In addition, SS-31 also has the effect of lowering 8-hydroxy-2-deoxyguanosine (8-OHdG) level, malondialdehyde (MDA) level, and nicotinamide adenine dinucleotide phosphate (NADPH) expression. Conclusions: SS31 had a renoprotective effect that could prevent the worsening of renal function in diabetic mice. In addition, the results of histopathology and ROS analysis also support the positive results of SS-31 treatment. Further studies are required to confirm its findings.

A pandemic in 2020 resulted in economic and social disruption of unprecedented scale. Social distancing — or physical distancing while in public spaces — was required, and social media usage spiked globally as people turned to these online spaces for information and connection. Today’s postsecondary students, in particular, are frequently immersed in social media; it can offer them social supports, such as a greater sense of belonging during times of transition and crisis, but also inherent risks, including cyberbullying and online harassment. Although many studies have examined the social connections or supports for learning that college students without disabilities experience by using social media, few studies have explored these phenomena among college students with disabilities, including neurodevelopmental disabilities such as anxiety disorders (e.g., social anxiety, autism, attention deficit disorder) that make socialization difficult for these young adults. It is important that educational research advances understanding of the socialization experiences of these students with disabilities because students’ sense of belonging and peer support is critical to their engagement and success in K-12 and postsecondary schooling.

Background Very low birthweight (VLBW) infants are at risk for growth failure and poor neurodevelopment. Optimised parenteral nutrition may help promote optimal growth and development, but concerns that provision of enhanced nutrition may contribute to increased early adiposity and later metabolic disease remain.Aim To determine associations between provision of an early enhanced parenteral nutrition protocol or standard parenteral nutrition protocol and growth and body composition for VLBW preterm infants in the neonatal intensive care unit.Subjects This is a secondary analysis of data from a clinical trial aimed at assessing the feasibility and safety of randomising VLBW preterm infants to Standard (n = 45) or Intervention (n = 42) parenteral nutrition groups between August 2017 and June 2019.Methods We evaluated associations between weekly infant growth and body composition measurements from n = 55 infants (Standard = 29, Intervention = 26) that were clinically stable enough to have body composition measurements taken before discharge using mixed effects linear regression models.Result No statistically significant associations between nutrition group and infant growth or body composition measures were observed (p >.05).Conclusion In this pilot trial, enhanced parenteral nutrition in the first week of life was not associated with significant differences in infant growth or body composition during hospitalisation.

Abstract Due to rapid technological advancements, remote patient monitoring (RPM) technology has gained traction in recent years. While the effects of specific RPM interventions are known, few published reviews examine RPM in the context of care transitions from an inpatient hospital setting to a home environment. In this systematic review, we addressed this gap by examining the impacts of RPM interventions on patient safety, adherence, clinical and quality of life outcomes and cost-related outcomes during care transition from inpatient care to a home setting. We searched five academic databases (PubMed, CINAHL, PsycINFO, Embase and SCOPUS), screened 2606 articles, and included 29 studies from 16 countries. These studies examined seven types of RPM interventions (communication tools, computer-based systems, smartphone applications, web portals, augmented clinical devices with monitoring capabilities, wearables and standard clinical tools for intermittent monitoring). RPM interventions demonstrated positive outcomes in patient safety and adherence. RPM interventions also improved patients’ mobility and functional statuses, but the impact on other clinical and quality-of-life measures, such as physical and mental health symptoms, remains inconclusive. In terms of cost-related outcomes, there was a clear downward trend in the risks of hospital admission/readmission, length of stay, number of outpatient visits and non-hospitalisation costs. Future research should explore whether incorporating intervention components with a strong human element alongside the deployment of technology enhances the effectiveness of RPM. The review highlights the need for more economic evaluations and implementation studies that shed light on the facilitators and barriers to adopting RPM interventions in different care settings.

Ant diversity in tropical montane rainforests is globally understudied. This is true for Cusuco National Park (CNP), a cloud forest ecosystem in northwestern Honduras that supports geographically isolated and threatened habitats. The current study presents the first comprehensive ant species checklist for CNP, which is also the first ant checklist for Honduras in over a century. Species records from several projects are also combined and presented. Sampling occurred along an elevational range (mainly between 1170 and 2030 m a.s.l.), with methodologies and intensities varying among projects and dates. Overall, 162 ant species belonging to nine subfamilies and 60 genera are reported from the CNP. Five species are recorded for the first time in Honduras (Pheidole natalie Longino, 2019; Strumigenys cf. calamita; Solenopsis invicta Buren, 1972; Solenopsis texana/carolinensis; Pseudomyrmex pallens Mayr, 1870). For the first time, male individuals are reported in Pheidole balatro Longino, 2019. For each species, we provide information on observed habitat preference, elevational range, and sampling technique. Species accumulation curves are provided for each sample technique, representing sampling intensity and community sample coverage. We also provide a key to the ant genera of Honduras to aid future taxonomic efforts in the country. Our research demonstrates that CNP harbours a surprisingly rich diversity of ant species, despite its small area, similar to many other taxa in the park. The information provided here represents baseline information for future work on ants in CNP and other Honduran cloud forests and will help guide research in these otherwise poorly explored yet highly threatened ecosystems.

BackgroundThe co-design of health technology enables patient-centeredness and can help reduce barriers to technology use. ObjectiveThe study objectives were to identify what remote patient monitoring (RPM) technology has been co-designed for inpatients and how effective it is, to identify and describe the co-design approaches used to develop RPM technologies and in which contexts they emerge, and to identify and describe barriers and facilitators of the co-design process. MethodsWe conducted a systematic review of co-designed RPM technologies for inpatients or for the immediate postdischarge period and assessed (1) their effectiveness in improving health outcomes, (2) the co-design approaches used, and (3) barriers and facilitators to the co-design process. Eligible records included those involving stakeholders co-designing RPM technology for use in the inpatient setting or during the immediate postdischarge period. Searches were limited to the English language within the last 10 years. We searched MEDLINE, Embase, CINAHL, PsycInfo, and Science Citation Index (Web of Science) in April 2023. We used the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies and qualitative research. Findings are presented narratively. ResultsWe screened 3334 reports, and 17 projects met the eligibility criteria. Interventions were designed for pre- and postsurgical monitoring (n=6), intensive care monitoring (n=2), posttransplant monitoring (n=3), rehabilitation (n=4), acute inpatients (n=1), and postpartum care (n=1). No projects evaluated the efficacy of their co-designed RPM technology. Three pilot studies reported clinical outcomes; their risk of bias was low to moderate. Pilot evaluations (11/17) also focused on nonclinical outcomes such as usability, usefulness, feasibility, and satisfaction. Common co-design approaches included needs assessment or ideation (16/17), prototyping (15/17), and pilot testing (11/17). The most commonly reported challenge to the co-design process was the generalizability of findings, closely followed by time and resource constraints and participant bias. Stakeholders’ perceived value was the most frequently reported enabler of co-design. Other enablers included continued stakeholder engagement and methodological factors (ie, the use of flexible mixed method approaches and prototyping). ConclusionsCo-design methods can help enhance interventions’ relevance, usability, and adoption. While included studies measured usability, satisfaction, and acceptability—critical factors for successful implementation and uptake—we could not determine the clinical effectiveness of co-designed RPM technologies. A stronger commitment to clinical evaluation is needed. Studies’ use of diverse co-design approaches can foster stakeholder inclusivity, but greater standardization in co-design terminology is needed to improve the quality and consistency of co-design research.

Summary: Background: It is unknown if early COVID-19 monoclonal antibody (mAb) therapy can reduce risk of Long COVID. The mAbs amubarvimab/romlusevimab were previously demonstrated to reduce risk of hospitalization/death by 79%. This study assessed the impact of amubarvimab/romlusevimab on late outcomes, including Long COVID. Methods: Non-hospitalized high-risk adults within 10 days of COVID-19 symptom onset enrolled in a randomized, double-blind, placebo-controlled phase 2/3 trial of amubarvimab/romlusevimab for COVID-19 treatment. Late symptoms, assessed using a participant-completed symptom diary, were a pre-specified exploratory endpoint. The primary outcome for this analysis was the composite of Long COVID by participant self-report (presence of COVID-19 symptoms as recorded in the diary at week 36) or hospitalization or death by week 36. Inverse probability weighting (IPW) was used to address incomplete outcome ascertainment, giving weighted risk ratios (wRR) comparing amubarvimab/romlusevimab to placebo. Findings: Participants received amubarvimab/romlusevimab (n = 390) or placebo (n = 390) between January and July 2021. Median age was 49 years, 52% were female, 18% Black/African American, 49% Hispanic/Latino, and 9% COVID-19-vaccinated at entry. At week 36, 103 (13%) had incomplete outcome ascertainment, and 66 (17%) on amubarvimab/romlusevimab and 92 (24%) on placebo met the primary outcome (wRR = 0.70, 95% confidence interval (CI) 0.53–0.93). The difference was driven by fewer hospitalizations/deaths with amubarvimab/romlusevimab (4%) than placebo (13%). Among 652 participants with available diary responses, 53 (16%) on amubarvimab/romlusevimab and 44 (14%) on placebo reported presence of Long COVID. Interpretation: Amubarvimab/romlusevimab treatment, while highly effective in preventing hospitalizations/deaths, did not reduce risk of Long COVID. Additional interventions are needed to prevent Long COVID. Funding: National Institute of Allergy and Infectious Diseases of the National Institutes of Health. Amubarvimab and romlusevimab supplied by Brii Biosciences.

The fraction of absorbed photosynthetically active radiation (FAPAR) is one of the bio-geophysical Essential Climate Variables assessed through remote sensing observations and distributed globally by space and environmental agencies. Any reliable remote sensing product should be benchmarked against a reference, which is normally determined by means of ground-based measurements. They should generally be aggregated spatially to be compared with remote sensing products at different resolutions. In this work, the effectiveness of various in situ sampling methods proposed to assess FAPAR from flux measurements was evaluated using a three-dimensional radiative transfer framework over eight virtual vegetated landscapes, including dense forests (leaf-on and leaf-off models), open canopies, sparse vegetation, and agricultural fields with a nominal extension of 1 hectare. The reference FAPAR value was determined by summing the absorbed PAR-equivalent photons by either all canopy components, both branches and leaves, or by only the leaves. The incoming and upwelling PAR fluxes were simulated in different illumination conditions and at a high spatial resolution (50 cm). They served to replicate in situ virtual FAPAR measurements, which were carried out using either stationary sensor networks or transects. The focus was on examining the inherent advantages and drawbacks of in situ measurement protocols against GCOS requirements. Consequently, the proficiency of each sampling technique in reflecting the distribution of incident and reflected PAR fluxes—essential for calculating FAPAR—was assessed. This study aims to support activities related to the validation of remote sensing FAPAR products by assessing the potential uncertainty associated with in situ determination of the reference values. Among the sampling schemes considered in our work, the cross shaped sampling schemes showed a particular efficiency in properly representing the pixel scale FAPAR over most of the scenario considered.

Diadema antillarum es considerada como el principal invertebrado herbívoro de los arrecifes de coral del Caribe. Debido a la significación que representa esta especie, en esta investigación se evaluaron indicadores poblacionales de la misma en las crestas arrecifales de playa Baracoa y Rincón de Guanabo, costa noroccidental de Cuba. Los muestreos se realizaron en enero-marzo de 2021. Se estimó la densidad media, diámetro medio de la testa, porcentaje de juveniles y adultos, de agregaciones y albinismo de D. antillarum para cada cresta. Las variables fueron evaluadas utilizando un transecto de banda de 10 m de largo por 1 m de ancho. La densidad media de D. antillarum en playa Baracoa (19.28 ± 14.40 ind./10 m2) fue superior al valor reportado en Rincón de Guanabo (0.78 ± 0.43 ind./10 m2) y en algunos arrecifes del Caribe. En playa Baracoa el porcentaje de individuos adultos representa el 95.25 % del total. El diámetro medio de D. antillarum en playa Baracoa (5.53 ± 1.76 cm) y Rincón de Guanabo (3.05 ± 1.56 cm) resultó ser inferior al reportado en algunos arrecifes del Caribe. En playa Baracoa se encontraron 148 agregaciones y 40 individuos albinos. El número bajo de individuos en el Rincón de Guanabo (47) ha generado varias hipótesis que necesitaran ser corroboradas en el futuro. No se encontró evidencia de la pandemia que sufre D. antillarum en el Caribe, lo cual se considera un indicador positivo. Se recomienda evaluar el manejo (restauración) de la especie en la cresta del Rincón de Guanabo.

Abstract Background The co-design of health care enables patient-centredness by partnering patients, clinicians and other stakeholders together to create services. Methods We conducted a systematic review of co-designed health interventions for people living with multimorbidity and assessed (a) their effectiveness in improving health outcomes, (b) the co-design approaches used and (c) barriers and facilitators to the co-design process with people living with multimorbidity. We searched MEDLINE, EMBASE, CINAHL, Scopus and PsycINFO between 2000 and March 2022. Included experimental studies were quality assessed using the Cochrane risk of bias tool (ROB-2 and ROBINS-I). Results We screened 14,376 reports, with 13 reports meeting the eligibility criteria. Two reported health and well-being outcomes: one randomised clinical trial (n = 134) and one controlled cohort (n = 1933). Outcome measures included quality of life, self-efficacy, well-being, anxiety, depression, functional status, healthcare utilisation and mortality. Outcomes favouring the co-design interventions compared to control were minimal, with only 4 of 17 outcomes considered beneficial. Co-design approaches included needs assessment/ideation (12 of 13), prototype (11 of 13), pilot testing (5 of 13) (i.e. focus on usability) and health and well-being evaluations (2 of 13). Common challenges to the co-design process include poor stakeholder interest, passive participation, power imbalances and a lack of representativeness in the design group. Enablers include flexibility in approach, smaller group work, advocating for stakeholders’ views and commitment to the process or decisions made. Conclusions In this systematic review of co-design health interventions, we found that few projects assessed health and well-being outcomes, and the observed health and well-being benefits were minimal. The intensity and variability in the co-design approaches were substantial, and challenges were evident. Co-design aided the design of novel services and interventions for those with multimorbidity, improving their relevance, usability and acceptability. However, the clinical benefits of co-designed interventions for those with multimorbidity are unclear.

Abstract Background Conventional quantitative or qualitative methodologies may not encompass the wide array of experiences of individuals living with Chronic Obstructive Pulmonary Disease (COPD). We used a novel approach – photovoice—to understand the impact of COPD on activities of daily living (ADLs) in a multicultural Asian country. Methods We recruited a purposive sample of eight patients from the outpatient clinics of the National University Health System, Singapore, between December 2020 and August 2021. We adopted a photovoice approach for data collection; participants were invited to take photos of how ADLs were impacted by COPD and attend a follow-up interview. An Interpretative Phenomenological Analysis method was used to analyze the data. Data saturation was reached by the seventh patient. Results COPD and the resulting breathlessness had a profound and diverse impact on our participants’ lives. Living with COPD required substantial changes to how everyday tasks are performed, and participants learnt new strategies to deal with such tasks. A mixture of active and passive coping styles was evident. Feelings of frustration, anxiety and a sense of isolation were also reported. Contextual factors impacting ADLs included challenging climatic conditions and the local popularity of traditional or alternative medicine. Conclusion The photovoice technique improved our understanding of the lived experiences of COPD patients and can benefit those who struggle to articulate their views by offering a different way to communicate beyond conventional interviewing.

Abstract Background Longitudinal work on the impact of COVID-19 on population mental health and resilience beyond the first year of the pandemic is lacking. We aimed to understand how mental health and resilience evolved during the pandemic (2020) and two years later (2022) in a multi-ethnic Singaporean population. In addition, we assessed what characteristics were associated with mental health and resilience scores. Methods We surveyed and analysed two balanced panel samples up to four times between 30th April 2020 and 11th July 2022. One panel assessed psychological distress (Kessler-10) and well-being (short Warwick Edinburgh Mental Well-being scale) n = 313, and one panel assessed resilience (10-item Connor-Davidson Resilience Scale©) n = 583. A linear panel regression model with random effects assessed the temporal patterns for psychological distress, well-being, and resilience. Results Mean psychological distress scores (Kessler-10) were relatively stable over time and were not statistically significantly worse than baseline at any follow-up. Well-being scores improved over time and were significantly better than baseline by the third survey (22nd Jul-18th Aug 2020) (0.54 p = 0.007, Cohen’s d 0.12). Scores had worsened by the last survey (27th June-11th July 2022) but were not significantly different from baseline 0.20 p = 0.30. Resilience scores declined over time. Scores at both follow-ups (14th Aug- 4th Sep 2020 and 27th June-11th July 2022) were statistically significantly lower than baseline: -1.69 p

Exploring the results of the COVID-19 response in New Zealand (Aotearoa) is warranted so that insights can inform future pandemic planning. We compared the COVID-19 response in New Zealand to that for the more severe 1918–19 influenza pandemic. Both pandemics were caused by respiratory viruses, but the 1918–19 pandemic was short, intense, and yielded a higher mortality rate. The government and societal responses to COVID-19 were vastly superior; responses had a clear strategic direction and included a highly effective elimination strategy, border restrictions, minimal community spread for 20 months, successful vaccination rollout, and strong central government support. Both pandemics involved a whole-of-government response, community mobilization, and use of public health and social measures. Nevertheless, lessons from 1918–19 on the necessity of action to prevent inequities among different social groups were not fully learned, as demonstrated by the COVID-19 response and its ongoing unequal health outcomes in New Zealand.

To compare efficacy outcomes for all approved and investigational first-line (1L) treatment regimens for locally advanced or metastatic urothelial carcinoma (la/mUC) with standard of care (SOC), a network meta-analysis (NMA) was conducted. A systematic literature review (SLR) identified phase 2 and 3 randomized trials investigating 1L treatment regimens in la/mUC published January 2001–September 2021. Three networks were formed based on cisplatin (cis) eligibility: cis-eligible/mixed (cis-eligible patients and mixed populations of cis-eligible/ineligible patients), cis-ineligible (strict; exclusively cis-ineligible patients), and cis-ineligible (wide; including studies with investigator’s choice of carbo). Analyses examined comparative efficacy by hazard ratio (HR) for overall survival (OS), and progression-free survival (PFS), and odds ratio (OR) for overall response rate (ORR), with 1L regimens vs. SOC. SOC was gemcitabine + cis (GemCis) or carboplatin (GemCarbo), cis-eligible/mixed network, and GemCarbo cis-ineligible networks. Of 1906 SLR identified citations, 55 trials were selected for data extraction. The NMA comprised 11, 6, and 8 studies in the cis-eligible/mixed, cis-ineligible (strict), cis-ineligible (wide) networks, respectively. In a meta-analysis of SOC control arms, median (95% CI) overall survival (OS) in months varied by network: 13.19 (12.43, 13.95) cis-eligible/mixed, 11.96 (10.43, 13.48) cis-ineligible (wide), and 9.74 (6.71, 12.76) cis-ineligible (strict). Most differences in OS, PFS, and ORR with treatment regimens across treatment networks were not statistically significant compared with SOC. Outcomes with current 1L regimens remain poor, and few significant improvements over SOC have been made, despite inclusion of recent clinical trial data, highlighting an unmet need in the la/mUC patient population.

This lively autobiography details Marion Nestle’s life-long engagement with food, particularly the tumultuous politics that inevitably accompany this central aspect of human life. As the founder of the interdiscipline of food studies, she describes her early life in academia, her work with the federal government and her appointment as a professor at New York University (NYU). Food studies scholars and practitioners will be fascinated by her insider stories of creating the field – from acquiring financial backing and finding qualified faculty to attracting students and bringing food influencers onside. To paraphrase Wendell Barry, eating is a political act, and no-one brings that to life more acutely than Marion Nestle.

Summary: Background: With the emergence of SARS-CoV-2 variants resistant to monoclonal antibody therapies and limited global access to therapeutics, the evaluation of novel therapeutics to prevent progression to severe COVID-19 remains a critical need. Methods: Safety, clinical and antiviral efficacy of inhaled interferon-β1a (SNG001) were evaluated in a phase II randomized controlled trial on the ACTIV-2/A5401 platform (ClinicalTrials.gov NCT04518410). Adult outpatients with confirmed SARS-CoV-2 infection within 10 days of symptom onset were randomized and initiated either orally inhaled nebulized SNG001 given once daily for 14 days (n = 110) or blinded pooled placebo (n = 110) between February 10 and August 18, 2021. Findings: The proportion of participants reporting premature treatment discontinuation was 9% among SNG001 and 13% among placebo participants. There were no differences between participants who received SNG001 or placebo in the primary outcomes of treatment emergent Grade 3 or higher adverse events (3.6% and 8.2%, respectively), time to symptom improvement (median 13 and 9 days, respectively), or proportion with unquantifiable nasopharyngeal SARS-CoV-2 RNA at days 3 (28% [26/93] vs. 39% [37/94], respectively), 7 (65% [60/93] vs. 66% [62/94]) and 14 (91% [86/95] vs. 91% [83/81]). There were fewer hospitalizations with SNG001 (n = 1; 1%) compared with placebo (n = 7; 6%), representing an 86% relative risk reduction (p = 0.07). There were no deaths in either arm. Interpretation: In this trial, SNG001 was safe and associated with a non-statistically significant decrease in hospitalization for COVID-19 pneumonia. Funding: The ACTIV-2 platform study is funded by the NIH. Research reported in this publication was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number UM1 AI068634, UM1 AI068636 and UM1 AI106701. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

We present a genome assembly from an individual male Sphaerophoria taeniata (a hoverfly; Arthropoda; Insecta; Diptera; Syrphidae). The genome sequence is 609.3 megabases in span. Most of the assembly is scaffolded into 5 chromosomal pseudomolecules, including the X and Y sex chromosomes. The mitochondrial genome has also been assembled and is 16.42 kilobases in length. Gene annotation of this assembly on Ensembl identified 24,213 protein coding genes.

Abstract Background Job loss after a cancer diagnosis can lead to long-term financial toxicity and its attendant adverse clinical consequences, including decreased treatment adherence. Among women undergoing (neo)adjuvant chemotherapy for breast cancer, access to work accommodations (e.g., sick leave) is associated with higher job retention after treatment completion. However, low-income and/or minority women are less likely to have access to work accommodations and, therefore, are at higher risk of job loss. Given the time and transportation barriers that low-income working patients commonly face, it is crucial to develop an intervention that is convenient and easy to use. Methods We designed an intervention to promote job retention during and after (neo)adjuvant chemotherapy for breast cancer by improving access to relevant accommodations. Talking to Employers And Medical staff about Work (TEAMWork) is an English/Spanish mobile application (app) that provides (1) suggestions for work accommodations tailored to specific job demands, (2) coaching/strategies for negotiating with an employer, (3) advice for symptom self-management, and (4) tools to improve communication with the medical oncology team. This study is a randomized controlled trial to evaluate the app as a job-retention tool compared to a control condition that provides the app content in an informational paper booklet. The primary outcome of the study is work status after treatment completion. Secondary outcomes include work status 1 and 2 years later, participant self-efficacy to ask an employer for accommodations, receipt of workplace accommodations during and following adjuvant therapy, patient self-efficacy to communicate with the oncology provider, self-reported symptom burden during and following adjuvant therapy, and cancer treatment adherence. Discussion This study will assess the use of mobile technology to improve vulnerable breast cancer patients’ ability to communicate with their employers and oncology providers, work during treatment and retain their jobs in the long term, thereby diminishing the potential consequences of job loss, including decreased treatment adherence, debt, and bankruptcy. Trial registration ClincalTrials.gov NCT03572374 . Registered on 08 June 2018.

We present a genome assembly from an individual female Ophonus ardosiacus (a ground beetle; Arthropoda; Insecta; Coleoptera; Carabidae). The genome sequence is 911.9 megabases in span. Most of the assembly is scaffolded into 19 chromosomal pseudomolecules, including the X sex chromosome. The mitochondrial genome has also been assembled and is 16.61 kilobases in length. Gene annotation of this assembly on Ensembl identified 40,995 protein coding genes.

We present a genome assembly from an individual male Agrypnus murinus (a click beetle; Arthropoda; Insecta; Coleoptera; Elateridae). The genome sequence is 1,578.5 megabases in span. Most of the assembly is scaffolded into 9 chromosomal pseudomolecules, including the X sex chromosome. The mitochondrial genome has also been assembled and is 18.23 kilobases in length. Gene annotation of this assembly on Ensembl identified 42,204 protein coding genes.

Renal interstitial fibrosis is a common pathological feature of chronic kidney disease that may involve changes of metabolism in kidney cells. In the present study, we first showed that blockade of glycolysis with either dichloroacetate (DCA) or shikonin to target different glycolytic enzymes reduced renal fibrosis in a mouse model of unilateral ureteral obstruction (UUO). Both inhibitors evidently suppressed the induction of fibronectin and collagen type I in obstructed kidneys, with DCA also showing inhibitory effects on collagen type IV and α-smooth muscle actin (α-SMA). Histological examination also confirmed less collagen deposition in DCA-treated kidneys. Both DCA and shikonin significantly inhibited renal tubular apoptosis but not interstitial apoptosis in UUO. Macrophage infiltration after UUO injury was also suppressed. Shikonin, but not DCA, caused obvious animal weight loss during UUO. To determine whether shikonin and DCA worked on tubular cells and/or fibroblasts, we tested their effects on cultured renal proximal tubular BUMPT cells and renal NRK-49F fibroblasts during hypoxia or transforming growth factor-β1 treatment. Although both inhibitors reduced fibronectin and α-SMA production in NRK-49F cells during hypoxia or transforming growth factor-β1 treatment, they did not suppress fibronectin and α-SMA expression in BUMPT cells. Altogether, these results demonstrate the inhibitory effect of glycolysis inhibitors on renal interstitial fibrosis. In this regard, DCA is more potent for fibrosis inhibition and less toxic to animals than shikonin. [ABSTRACT FROM AUTHOR]

Abstract Background Patients with chronic diseases have seen unprecedented changes to healthcare practices since the emergence of COVID-19. Traditional ‘on-site’ clinics have had to innovate to continue services. Whether these changes are acceptable to patients and are effective for care continuation are largely unreported. Methods We evaluated the effectiveness of care provision at a re-structured chronic care clinic and elicited the patient experiences of care and self-management. We conducted a convergent, parallel, mixed-methods study. Adult patients attending a chronic care clinic were included. We extracted data from 4,849 clinic visits before and during the COVID-19 pandemic, including operational metrics and attendee profile. We also conducted fifteen interviews with patients from the same clinic using a semi-structured interview guide. Results Re-structuring the chronic clinic, including the introduction of teleconsultations, home-delivery of prescriptions and use of community-based phlebotomy services, served to maintain continuity of care while adhering to COVID-19 containment measures. Qualitatively, five themes emerged. Patients were able to adjust to healthcare practice changes and adapt their own lifestyles, although poor self-management practices were adopted. While most were apprehensive about attending the clinic, they valued ongoing care access and were reassured by the on-site containment measures. Conclusions Continuation of routine services is desired by patients and can be achieved through the adoption of containment measures, by greater collaboration with community partners, and the use of technology. Patients adapted to service changes, but poor self-management was evident. To prevent chronic disease relapse, services must strive to innovate rather than suspend services during pandemics.

Highlights: 1. Carrots (Daucus carota L.) can reduce the side effects of non-steroidal anti-inflammatory drugs (NSAIDs) due to its gastroprotective components. 2. Histopathological studies of the gastric inflammation signs showed that carrots can prevent NSAID-induced peptic ulcers. Abstract Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) consumption contributes significantly to gastrointestinal morbidity, including peptic ulcers. NSAIDs cause gastric mucosal damage by inhibiting PGE2 and PGI2 secretion, increasing HCl secretion, and also causing local irritation and neutrophil adhesion. Flavonoids and chlorogenic acid are gastroprotective agents found in carrots (Daucus carota L.). Therefore, this study aimed to validate the effect of carrots on gastric histopathology of piroxicam-induced mice. Methods: This was an experimental study using a post-test-only control group design. 35 mice were divided into 5 groups and were allowed to adapt for 1 week. The negative control group received 0.25 mL aqua dest, while the positive control group received 0.104 mg famotidine. Group A, B, and C received carrot extract with each dosage was 200 mg/kgBW, 300 mg/kgBW, and 400 mg/kgBW. The mice were induced 2 hours later with 0.052 mg piroxicam. The treatments lasted 14 days. Each stomach was taken and examined on the 15th day. Afterward, histopathological preparations were made. Results: The results of the histopathological signs of inflammation using the Kruskal-Wallis method showed p = 0.000, indicating that there was an effect of the carrot extract in preventing the inflammation on the gastric histopathology (p < 0.05). Conclusion: In conclusion, this study confirmed that carrot extract is more effective in avoiding peptic ulcers due to NSAID consumption.

Abstract Bromodomain-containing protein 9 (BRD9), an essential component of the SWI/SNF chromatin remodeling complex termed ncBAF, has been established as a therapeutic target in a subset of sarcomas and leukemias. Here, we used novel small molecule inhibitors and degraders along with RNA interference to assess the dependency on BRD9 in the context of diverse hematological malignancies, including acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and multiple myeloma (MM) model systems. Following depletion of BRD9 protein, AML cells undergo terminal differentiation, whereas apoptosis was more prominent in ALL and MM. RNA-seq analysis of acute leukemia and MM cells revealed both unique and common signaling pathways affected by BRD9 degradation, with common pathways including those associated with regulation of inflammation, cell adhesion, DNA repair and cell cycle progression. Degradation of BRD9 potentiated the effects of several chemotherapeutic agents and targeted therapies against AML, ALL, and MM. Our findings support further development of therapeutic targeting of BRD9, alone or combined with other agents, as a novel strategy for acute leukemias and MM.

Abstract Members of the highly polymorphic Plasmodium falciparum erythrocyte membrane protein 1 (PfEMP1) family expressed on the surface of infected erythrocytes (IEs) are important virulence factors, which mediate vascular adhesion of IEs via endothelial host receptors and are targets of naturally acquired immunity. The PfEMP1 family can be divided into clinically relevant subgroups, of which some bind intercellular adhesion molecule 1 (ICAM-1). While the acquisition of IgG specific for ICAM-1-binding DBLβ domains is known to differ between PfEMP1 groups, its ability to induce antibody-dependent cellular phagocytosis (ADCP) is unclear. We therefore measured plasma levels of DBLβ-specific IgG, the ability of such IgG to inhibit PfEMP1-binding to ICAM-1, and its ability to opsonize IEs for ADCP, using plasma from Beninese children with severe (SM) or uncomplicated malaria (UM). IgG specific for DBLβ from group A and B ICAM-1-binding PfEMP1 were dominated by IgG1 and IgG3, and were similar in SM and UM. However, levels of plasma IgG inhibiting ICAM-1-binding of group A DBLβ of PFD1235w was significantly higher in children with UM than SM, and acute UM plasma induced a higher ADCP response than acute SM plasma.

Myotonic dystrophy (MD) is a progressive multisystem genetic disorder that is characterized by progressive muscle weakness and wasting. MD1 (also known as Steinert disease) is associated with various clinical entities such as skeletal muscle weakness, myotonia, cardiac abnormalities, respiratory dysfunction, gastrointestinal involvement, and cognitive impairment. In this case report, we present a 32-year-old woman with MD1 who presented with a sigmoid volvulus, which was treated with endoscopic decompression.

While the social economy can achieve many positive outcomes, one recent benefit is that it can be a route to Indigenous food sovereignty—a restorative framework for feeding communities and engaging in decolonization. This article examines how some Indigenous groups in Canada use the social economy to build food sovereignty, beginning with an overview of cultural relationships with food, its place in an Indigenous worldview, and the effect of colonization on Indigenous foodways. After introducing food sovereignty, and in particular Indigenous food sovereignty, it focuses on how some Indigenous communities are using the social economy to build food sovereignty, using the example of the Northern Manitoba Food, Culture, and Community Collaborative. The article concludes with a discussion of the importance of community and food sovereignty, not only for Indigenous Peoples but also for the social economy itself.

Abstract Thin film-based optical sensors have been attracting increasing interest for use in developing technologies such as biometrics. Multilayered dielectric thin films with different refractive indices have been utilized to modulate the optical properties in specific wavelength bands for spectral selectivity of Thin Film Narrow Bandpass Filters (TFNBFs). Progress in TFNBF design has been made with the incorporation of metallic thin films. Narrower bandwidths with higher transmittance have been achieved in specific spectral bands. In this work, Ti/TiO2/SiO2 based multilayer thin films were prepared using pulsed-DC reactive sputtering. Computer simulations using the Essential Macleod Program allowed the optimal number of layers and thickness of the multilayer thin films to be determined to efficiently tailor the optical path transmitting specific wavelength bands. The addition of Ti metal layers within dielectric (TiO2/SiO2) multilayer thin films significantly changes the cutoff frequency of transmittance at specific wavelengths. Representative 26 multilayer films consisting of Ti, TiO2, and SiO2 show lower transmittance of 10.29% at 400 nm and 10.48% at 680 nm. High transmittance of 80.42% at 485 nm was observed, which is expected to improve the spectral selectivity of the TFNBF. This work provides a contribution to future simulation based design strategy based on experimental thin film engineering for potential industrial development opportunities such as optical biometrics.

Abstract To avoid collisions, pedestrians depend on their ability to perceive and interpret the visual motion of other road users. Eye movements influence motion perception, yet pedestrians’ gaze behavior has been little investigated. In the present study, we ask whether observers sample visual information differently when making two types of judgements based on the same virtual road-crossing scenario and to which extent spontaneous gaze behavior affects those judgements. Participants performed in succession a speed and a time-to-arrival two-interval discrimination task on the same simple traffic scenario—a car approaching at a constant speed (varying from 10 to 90 km/h) on a single-lane road. On average, observers were able to discriminate vehicle speeds of around 18 km/h and times-to-arrival of 0.7 s. In both tasks, observers placed their gaze closely towards the center of the vehicle’s front plane while pursuing the vehicle. Other areas of the visual scene were sampled infrequently. No differences were found in the average gaze behavior between the two tasks and a pattern classifier (Support Vector Machine), trained on trial-level gaze patterns, failed to reliably classify the task from the spontaneous eye movements it elicited. Saccadic gaze behavior could predict time-to-arrival discrimination performance, demonstrating the relevance of gaze behavior for perceptual sensitivity in road-crossing.

Introduction: Healthcare integration has become prevalent as health systems manage a growing population of older adults with multi-morbid conditions. The integrated general hospital (IGH) is the latest example of how services can be remodelled to achieve greater care integration. Methods: We conducted a mixed-method evaluation to identify factors impacting the implementation and effectiveness of the IGH model. Data were collected through in-depth interviews (n = 15) and focus group discussions (n = 8 groups) with hospital staff, and a staff survey (n = 226). Results: Staff perceived improvements in clinical practice and better clinical outcomes for patients. The care model empowered nursing and allied health staff through a more collegial team structure. However, staff reported an unequal workload distribution; a third reported burnout; and some observed inconsistencies between leaders’ aspirations for IGH and what was happening on the ground. For IGH to sustain, staff’s education on the IGH model needs to be improved. Further examination of work processes is recommended to boost staff morale and prevent burnout. Conclusion: Overall, IGH provided better integrated, team-based care. The model challenged traditional team structures and empowered staff to expand their roles and responsibilities. Policymakers could consider the IGH model a successful approach for integrating services across the care continuum.

Abstract Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of cardiometabolic diseases in overweight individuals. While liver biopsy is the current gold standard to diagnose NAFLD and magnetic resonance imaging (MRI) is a non-invasive alternative still under clinical trials, the former is invasive and the latter costly. We demonstrate electrical impedance tomography (EIT) as a portable method for detecting fatty infiltrate. We enrolled 19 overweight subjects to undergo liver MRI scans, followed by EIT measurements. The MRI images provided the a priori knowledge of the liver boundary conditions for EIT reconstruction, and the multi-echo MRI data quantified liver proton-density fat fraction (PDFF%) to validate fat infiltrate. Using the EIT electrode belts, we circumferentially injected pairwise current to the upper abdomen, followed by acquiring the resulting surface-voltage to reconstruct the liver conductivity. Pearson’s correlation analyses compared EIT conductivity or MRI PDFF with body mass index, age, waist circumference, height, and weight variables. We reveal that the correlation between liver EIT conductivity or MRI PDFF with demographics is statistically insignificant, whereas liver EIT conductivity is inversely correlated with MRI PDFF (R = −0.69, p = 0.003, n = 16). As a pilot study, EIT conductivity provides a portable method for operator-independent and cost-effective detection of hepatic steatosis.

This article introduces a Special Issue on anti-trafficking education. The past decade has seen a dramatic increase in the sites for anti-trafficking education and the range of educators who shape how the public and institutions understand and respond to human trafficking. Thus, there is a need to analyse the formalised and informalised practices that facilitate teaching and learning about trafficking. We argue that anti-trafficking education can perpetuate misinformation and myths about trafficking as well as legitimise carceral systems that lead to dehumanisation and violence. At the same time, critical approaches to teaching trafficking can encourage and inform endeavours to create structural change, social justice, and individual empowerment. We conclude that if the expansion of anti-trafficking education is divorced from longstanding movements for equity, then it runs the risk of teaching about trafficking while upholding practices and systems of oppression, exclusion, and expropriation, as well as diverting attention and resources from global work toward social and structural change.

Abstract Cancer patients undergo detrimental toxicities and ineffective treatments especially in the relapsed setting, due to failed treatment attempts. The development of a tool that predicts the clinical response of individual patients to therapy is greatly desired. We have developed a novel patient-derived 3D tissue engineered bone marrow (3DTEBM) technology that closely recapitulate the pathophysiological conditions in the bone marrow and allows ex vivo proliferation of tumor cells of hematologic malignancies. In this study, we used the 3DTEBM to predict the clinical response of individual multiple myeloma (MM) patients to different therapeutic regimens. We found that while no correlation was observed between in vitro efficacy in classic 2D culture systems of drugs used for MM with their clinical efficacious concentration, the efficacious concentration in the 3DTEBM were directly correlated. Furthermore, the 3DTEBM model retrospectively predicted the clinical response to different treatment regimens in 89% of the MM patient cohort. These results demonstrated that the 3DTEBM is a feasible platform which can predict MM clinical responses with high accuracy and within a clinically actionable time frame. Utilization of this technology to predict drug efficacy and the likelihood of treatment failure could significantly improve patient care and treatment in many ways, particularly in the relapsed and refractory setting. Future studies are needed to validate the 3DTEBM model as a tool for predicting clinical efficacy.

Many coastal forage fish species spend most of their life history using the water column, but some species such as Pacific Sand Lance (Ammodytes personatus) and Surf Smelt (Hypomesus pretiosus) have a requirement for intertidal sediments for spawning and or burying. Detection of suitable but typically uncommon intertidal habitats for spawning has historically relied on extensive visual surveys for eggs from large sand samples. In the present study, we developed and validated two new non-destructive qPCR-based tools for detecting Sand Lance and Surf Smelt eDNA from small sand samples. A total of 279 composite transect sand samples were collected from 101 beaches and were tested for eDNA sample integrity using the IntegritE-DNATM test. Initial testing showed that all but 42 of 46 samples passed after an inhibitor clean-up step. Of the 101 beaches sampled 275 times, there were 111 detections of Sand Lance on 52 beaches, and there were 13 detections of Surf Smelt on 10 beaches. One hundred and eighty-one samples were paired with visual egg counts and 76 (42%) of these tested positive for Sand Lance while 9 of 132 (7%) samples tested positive for Surf Smelt. For the 27 paired samples with two or more Sand Lance eggs visually detected there was a significant positive correlation (r = 0.694, p = 0.0001) with eDNA copies per liter suggesting that a larger Sand Lance presence is easily and reliably detected using eDNA. The methods and approaches described herein will serve as a foundation for broad application of eDNA approaches for forage fish species that utilize intertidal benthic habitats.

Abstract Evidence is mounting that climate‐driven shifts in environmental conditions can elicit organismal evolution, yet there are sparingly few long‐term records that document the tempo and progression of responses, particularly for plants capable of transforming ecosystems. In this study, we “resurrected” cohorts of a foundational coastal marsh sedge (Schoenoplectus americanus) from a time‐stratified seed bank to reconstruct a century‐long record of heritable variation in response to salinity exposure. Common‐garden experiments revealed that S. americanus exhibits heritable variation in phenotypic traits and biomass‐based measures of salinity tolerance. We found that responses to salinity exposure differed among the revived cohorts, with plants from the early 20th century exhibiting greater salinity tolerance than those from the mid to late 20th century. Fluctuations in salinity tolerance could reflect stochastic variation but a congruent record of genotypic variation points to the alternative possibility that the loss and gain in functionality are driven by selection, with comparisons to historical rainfall and paleosalinity records suggesting that selective pressures vary according to shifting estuarine conditions. Because salinity tolerance in S. americanus is tightly coupled to primary productivity and other vital ecosystem attributes, these findings indicate that organismal evolution merits further consideration as a factor shaping coastal marsh responses to climate change.

Functional beverages from lemongrass (Cymbopogon citratus), white ginger (Zingiber officinale Roscoe) and black tea (Camelia sinensis) were developed based on their α-glucosidase inhibitory (AGI) activities and sensory acceptance. The AGI was evaluated using in vitro enzymatic assay, while sensory acceptance was tested using affective sensory tests. The evaluation of their aqueous extracts showed that dried lemongrass and ginger possessed higher extraction yield (3.4 %, 2.7 %, respectively), though not necessarily accompanied with a better AGI activity (IC50 24.50 mg/mL, IC50 16.61 mg/mL) than the fresh lemongrass and ginger (2.1 %, 1.8 %, IC50 17.93 mg/ml, IC50 47.00 mg/mL, respectively). Meanwhile, the evaluation of the combined extract showed additive and synergistic effects. The extract combination formula was selected based on the sensory acceptance, resulting in the beverages containing 4.29 mg/mL of lemongrass, 0.71 mg/mL of ginger, and 1.05 mg/mL of black tea with a total phenolic content of 636.45 mg/L Gallic Acid Equivalent (GAE). The selected formula showed the stability of AGI activity andthe pH value at 4 °C were in accordance with the growth of microbial count that was lower than those stored at 25 °C in a 50-day period. Changes in color and oBrix value were not significantly observed in the samples stored at 25 °C and 4 °C. Lime juice was selected as the additional flavoring agent, which could increase both the palatability and AGI activity of the beverages.

Purpose — To determine the effect of customer service quality on customer decision to use bank plan savings of Bank Mandiri Cirebon Siliwangi branch. Research method — This study used a quantitative approach with a simple linear regression analysis technique. The research data is processed by statistical software. Samples in this study were 91 respondents with probability sampling using a simple random sample technique. Result — The findings indicated that customer service quality has a significant influence to customer decision in using bank plan savings of Bank Mandiri Cirebon Siliwangi Branch. In addition, this study also discovered that customer service quality has a contribution of 27.8% to the customer's decision to use the bank product, while the remaining 72.7% is influenced by other factors which is not examined by the author.

Historical climate adaptation can give insight into the potential for adaptation to contemporary changing climates. Here Bennett et al. investigate thermal tolerance evolution across much of the tree of life and find different effects of ancestral climate on the subsequent evolution of ectotherms vs. endotherms.

The tumour microenvironment (TME) has a major role in chemoresistance in multiple myeloma. The authors show that a nanoparticle targeted to TME and loaded with bortezomib (BTZ) and Y27632 is more effective than free drugs, non-targeted and single-agent controls and reduces BTZ-related side effects.

Objective: The purpose of this study was to explore, describe and illuminate nursing students’ best encounters of caring in the clinical learning environment. Caring for nursing students was emphasized and recommendations provided to enhance caring for nursing students within their clinical learning environment. Methods: Qualitative data was collected by the researcher using semi-structured individual interviews and an Appreciative Inquiry (AI) methodology. Ten second year nursing students undertaking the bridging course leading to registration as general nurses in terms of Regulation 683 of the South African Nursing Council (SANC) were purposively sampled from 3 private hospitals within the Western Cape. Data was analysed using Giorgi’s method. Results: The main theme included the best and ‘least best’ caring practices embedded in the centrality of the heart. The subthemes comprised of the nursing students’ experiences of caring literacy and caring illiteracy. The second theme included the creation of best caring practices within a conducive clinical learning environment. Within this theme, the subthemes comprised of the caring attributes required in reflecting best caring practices, as well the creation of a clinical learning environment to optimise caring. Conclusions: The significance and necessity of caring for the nursing student were clearly illustrated and confirmed by participants. Caring was equated to the heart as the core to the nursing students’ being. Recommendations for nursing education, management, practice and research were therefore specifically formulated to enhance caring towards nursing students.

In this themed section, we argue that beyond health-related dietary goals for society, food guidance must also reflect the expanding public awareness and uncertainty about the complexities and vulnerabilities of the current food system. Increasingly influential issues include environmental change, agriculture-related pollution, food worker injustice, animal welfare, persistent household food insecurity, food waste, and fish stock depletion. No form of food guidance can address all these complex phenomena, but many people want to be informed and empowered to make change. Accordingly, academic and citizen groups have been devising an assortment of directives, recommendations, principles, and charters to promote alternative food environments and food behaviours that cumulatively support sustainable food systems. These on-going debates and efforts can collectively be termed critical food guidance.