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Objective: To perform a retrospective clinical study in order to investigate phenotypic penetrance within a large registry of patients with hypermobile Ehlers-Danlos syndrome (hEDS) to enhance diagnostic and treatment guidelines by understanding associated comorbidities and improving accuracy in diagnosis. Patients and Methods: From May 1, 2021 to July 31, 2023, 2149 clinically diagnosed patients with hEDS completed a self-reported survey focusing on diagnostic and comorbid conditions prevalence. K-means clustering was applied to analyze survey responses, which were then compared across gender groups to identify variations and gain clinical insights. Results: Analysis of clinical manifestations in this cross-sectional cohort revealed insights into multimorbidity patterns across organ systems, identifying 3 distinct patient groups. Differences among these phenotypic clusters provided insights into diversity within the population with hEDS and indicated that Beighton scores are unreliable for multimorbidity phenotyping. Conclusion: Clinical data on the phenotypic presentation and prevalence of comorbidities in patients with hEDS have historically been limited. This study provides comprehensive data sets on phenotypic presentation and comorbidity prevalence in patients with hEDS, highlighting factors often overlooked in diagnosis. The identification of distinct patient groups emphasizes variations in hEDS manifestations beyond current guidelines and emphasizes the necessity of comprehensive multidisciplinary care for those with hEDS.

Abstract Prey must balance resource acquisition with predator avoidance for survival and reproduction. To reduce risk of predation, prey may avoid areas with high predator use, but if they are unable to due to resource acquisition requirements, they may instead change their habitat use or movement speed to mitigate predation risk. Prey risk response may depend on spatially or temporally varying forage availability as well as seasonal variation in prey vulnerability and availability of alternate foods for predators. To quantify how prey respond to spatial and temporal variation in risk of brown bear predation, we examined Roosevelt elk (Cervus canadensis roosevelti) spatiotemporal behavior responses to brown bear (Ursus arctos) habitat use on Afognak and Raspberry islands, Alaska, using Global Positioning System location data during elk parturition (20 May–15 June), summer (16 June–20 September), and autumn (21 September–10 November). During parturition and summer, elk used forest and shrub landcover in areas of higher brown bear probability of use. During parturition, elk used areas with lower forage productivity in areas of higher bear probability of use, and movement speed decreased with higher bear probability of use, especially in shrub landcover. During summer, elk used areas with higher forage productivity in areas of higher brown bear probability of use. During autumn, elk were less likely to use areas with higher bear habitat probability of use across landcover categories and forage productivity. During summer and autumn, elk movement speed increased with higher brown bear probability of use. Elk behavioral response to risk of brown bear predation could increase energy expenditure and decrease their ability to acquire forage, therefore negatively impacting survival and reproduction with spatiotemporal variation in risk response potentially amplifying these impacts.

Objectives Communication barriers, such as channels, comfort, and location, can negatively impact Black prostate cancer survivors’ experiences and health outcomes after treatment. Addressing these barriers promotes a survivor-centric approach that views survivors as active partners in their care. This study explored the communication preferences of Black prostate cancer survivors, focusing on preferred channels, sources, and locations for enhanced quality of life. Design Using grounded theory methodology, we conducted engaged in-depth interviews with 7 Black prostate cancer survivors, centering on their post-treatment experiences. We analyzed participant transcripts to develop codes and themes. Communication accommodation theory (CAT) was applied to examine how survivors adapt their communication styles to navigate barriers and improve their quality of life. CAT helped identify key patterns of survivors’ convergence and divergence in their communication with healthcare providers, crucial for developing survivor-centric communication strategies. Results The analysis revealed the importance of acknowledging cultural and racial perspectives in post-treatment survivorship. Themes extracted from the transcripts included communication barriers, preferences for information channels, and favored locations for sharing information. Survivors expressed a preference for a balance between face-to-face interaction and telehealth, with environments that provide safety and support playing a key role in encouraging vulnerability and open dialogue. Inclusive healthcare practices were seen as essential in empowering Black survivors to engage in meaningful communication without feeling silenced or undervalued, thus fostering a dignified quality of life. Conclusion Tailoring post-treatment communication practices to incorporate cultural sensitivity, inclusive healthcare, and safe spaces is pivotal to supporting Black survivors. These findings provide a pathway to improving survivors’ experiences and empower them to actively shape their survivorship journey. Moreover, they highlight Black men’s need for trustworthy communication with healthcare providers and peers during the post-treatment period, emphasizing the importance of direct, personalized interactions.

BackgroundWearable digital health technologies and mobile apps (personal digital health technologies [DHTs]) hold great promise for transforming health research and care. However, engagement in personal DHT research is poor. ObjectiveThe objective of this paper is to describe how participant engagement techniques and different study designs affect participant adherence, retention, and overall engagement in research involving personal DHTs. MethodsQuantitative and qualitative analysis of engagement factors are reported across 6 unique personal DHT research studies that adopted aspects of a participant-centric design. Study populations included (1) frontline health care workers; (2) a conception, pregnant, and postpartum population; (3) individuals with Crohn disease; (4) individuals with pancreatic cancer; (5) individuals with central nervous system tumors; and (6) families with a Li-Fraumeni syndrome affected member. All included studies involved the use of a study smartphone app that collected both daily and intermittent passive and active tasks, as well as using multiple wearable devices including smartwatches, smart rings, and smart scales. All studies included a variety of participant-centric engagement strategies centered on working with participants as co-designers and regular check-in phone calls to provide support over study participation. Overall retention, probability of staying in the study, and median adherence to study activities are reported. ResultsThe median proportion of participants retained in the study across the 6 studies was 77.2% (IQR 72.6%-88%). The probability of staying in the study stayed above 80% for all studies during the first month of study participation and stayed above 50% for the entire active study period across all studies. Median adherence to study activities varied by study population. Severely ill cancer populations and postpartum mothers showed the lowest adherence to personal DHT research tasks, largely the result of physical, mental, and situational barriers. Except for the cancer and postpartum populations, median adherences for the Oura smart ring, Garmin, and Apple smartwatches were over 80% and 90%, respectively. Median adherence to the scheduled check-in calls was high across all but one cohort (50%, IQR 20%-75%: low-engagement cohort). Median adherence to study-related activities in this low-engagement cohort was lower than in all other included studies. ConclusionsParticipant-centric engagement strategies aid in participant retention and maintain good adherence in some populations. Primary barriers to engagement were participant burden (task fatigue and inconvenience), physical, mental, and situational barriers (unable to complete tasks), and low perceived benefit (lack of understanding of the value of personal DHTs). More population-specific tailoring of personal DHT designs is needed so that these new tools can be perceived as personally valuable to the end user.

Background:. Goal attainment scaling (GAS) is now widely used as a person-centered measure of outcome from rehabilitation and has demonstrated validity in diverse populations with sensitivity to change. However, as originally described, it is time-consuming for use in busy clinical settings. The “GAS-light” is a simplified version designed for application in routine clinical practice. Although increasingly taken up by clinicians, published evidence of the validity of GAS-light method is currently lacking. Objective:. To evaluate the validity and sensitivity of the GAS-light rating method as a measure of goal attainment in clinical neurorehabilitation practice. To examine its agreement with the standard GAS rating (as originally described by the developers) as the gold standard and to assess its clinical utility and acceptability. Methods design:. A direct, head-to-head comparison of the 2 GAS rating methods in a cohort of adults undergoing upper limb motor rehabilitation programs across a range of rehabilitation settings, including hospital, community outpatient, and spasticity clinic services. Study population: 60 patients (n=54 poststroke) set a total of 136 goals (range 1–4 per patient). In this comparative study, patients acted as their own controls. Measures:. The 2 rating methods were applied independently and in parallel from a single goal-setting discussion. Goal attainment was measured on the original 5-point GAS using a predetermined follow-up guide and the GAS-light with its 6-point verbal rating scale. The evaluation included concurrent validity (intraclass correlation coefficients and agreement between the 2 ratings) and sensitivity to change using the standardized response mean (SRM). Thirteen clinicians and 52 participants completed surveys of clinical utility and patient acceptance, respectively. Results:. Individual absolute agreement of 2-way mixed-effects intraclass correlation between the tools indicated good agreement (ICC(A,1)=0.88, 95% CI: 0.80, 0.93), and small systematic bias (–1.72 (95% CI: −3.04, −0.41). Both tools measured similar levels of change over time (GAS SRM=1.79; GAS-light SRM=1.62). Clinicians perceived GAS-light had stronger clinical utility, being quicker and easier to administer, score, and understand. Patients perceived GAS-light as acceptable, comfortable, worthwhile, and helpful. Conclusions:. GAS-light is reliable and sensitive to change, with better clinical utility than the standard GAS. Either tool may be used to assess goal attainment in clinical upper limb neurorehabilitation.

Introduction: The United States Veterans Health Administration is a leader in the use of telemental health (TMH) to enhance access to mental healthcare amidst a nationwide shortage of mental health professionals. The Tennessee Valley Veterans Affairs (VA) Health System piloted TMH in its emergency department (ED) and urgent care clinic (UCC) in 2019, with full 24/7 availability beginning March 1, 2020. Following implementation, preliminary data demonstrated that veterans ≥65 years old were less likely to receive TMH than younger patients. We sought to examine factors associated with older veterans receiving TMH consultations in acute, unscheduled, outpatient settings to identify limitations in the current process. Methods: This was a retrospective cohort study conducted within the Tennessee Valley VA Health System. We included veterans ≥55 years who received a mental health consultation in the ED or UCC from April 1, 2020–September 30, 2022. Telemental health was administered by a mental health clinician (attending physician, resident physician, nurse practitioner, or physician assistant) via iPad, whereas in-person evaluations were performed in the ED. We examined the influence of patient demographics, visit timing, chief complaint, and psychiatric history on TMH, using multivariable logistic regression. Results: Of the 254 patients included in this analysis, 177 (69.7%) received TMH. Veterans with high-risk chief complaints (suicidal ideation, homicidal ideation, or agitation) were less likely to receive TMH consultation (adjusted odds ratio [AOR]: 0.47, 95% confidence interval [CI] 0.24–0.95). Compared to attending physicians, nurse practitioners and physician assistants were associated with increased TMH use (AOR 4.81, 95% CI 2.04–11.36), whereas consultation by resident physicians was associated with decreased TMH use (AOR 0.04, 95% CI 0.00–0.59). The UCC used TMH for all but one encounter. Patient characteristics including their visit timing, gender, additional medical complaints, comorbidity burden, and number of psychoactive medications did not influence use of TMH. Conclusion: High-risk chief complaints, location, and type of mental health clinician may be key determinants of telemental health use in older adults. This may help expand mental healthcare access to areas with a shortage of mental health professionals and prevent potentially avoidable transfers in low-acuity situations. Further studies and interventions may optimize TMH for older patients to ensure safe, equitable mental health care.

Food waste management is a growing global concern, driven by the imperative to address environmental sustainability, resource conservation, and global hunger. This article aims to provide a theoretical analysis of the historical evolution of food waste management, delving into the definition of the term and its international relevance. Additionally, it critically examines the need for sustainable approaches. The methodology comprises a comprehensive literature review from 2013 to 2023, utilizing keywords related to food waste, sustainability, and the circular economy. The databases used include Science Direct and MDPI. Findings reveal a shift from individual to institutional food waste sources, underscoring the necessity for alternative approaches. Environmental analysis highlights the adverse impacts of conventional practices, while strategies such as food rescue, fermentation, and anaerobic digestion emerge as promising solutions. Understanding consumer behavior is crucial, and smart labels are introduced as potential tools to reduce food waste. The article identifies the challenges and limitations of current food waste management practices, emphasizing the need for sustainable treatments. Sustainable approaches in managing food industry residues, including food rescue, fermentation, and anaerobic digestion, are discussed as alternatives to conventional methods. The article concludes by proposing future research directions, emphasizing the importance of understanding consumer behavior, exploring the potential of smart labels, and addressing gaps in current knowledge to achieve a more sustainable and responsible approach to food consumption and waste management.

Arctic populations are amongst the highest exposed populations to long-range transported contaminants globally, with the main exposure pathway being through the diet. Dietary advice is an important immediate means to address potential exposure and help minimize adverse health effects. The objective of this work is to enable easier access to dietary advice and communication guidance on contaminants with a focus on the Arctic. This manuscript is part of a special issue summarizing the Arctic Monitoring and Assessment Programme’s Assessment 2021: Human Health in the Arctic. The information was derived with internet searches, and by contacting relevant experts directly. Results include risk communication efforts in European Arctic countries, effectiveness evaluation studies for several Arctic countries, experience of social media use, and the advantages and challenges of using social media in risk communication. We found that current risk communication activities in most Arctic countries emphasize the importance of a nutritious diet. Contaminant-related restrictions are mostly based on mercury; a limited amount of dietary advice is based on other contaminants. While more information on effectiveness evaluation was available, specific information, particularly from Arctic countries other than Canada, is still very limited.

Homing is often a critical aspect of an animal's behavioural and spatial ecology. Translocation is considered to be a wildlife management strategy that could reduce human-wildlife confrontation, but this strategy may not be effective if animals attempt to home to their original capture location. Translocation of animals from sites where possible human-wildlife interaction occurs is a widespread but controversial intervention to resolve conflicts. In India, snakes are often the subject of such translocations, but there is a paucity of information on the behaviour of translocated snakes compared to resident snakes. The Indian python (Python molurus), one of the largest carnivores in the Indian subcontinent, is classified as Near Threatened by the IUCN. We conducted a two-year radio-tracking study (December 2018 to December 2020) on the movements of 14 adult Indian pythons in the Moyar River Valley, within the Sathyamangalam and Mudumalai Tiger Reserves. Eleven of the 14 pythons were translocated 0.28–55.7 kms from their capture locations, while 3 pythons were not translocated: 6 were translocated short distances (

Background and Aims: Segmental colitis associated with diverticulosis (SCAD) is an underrecognized disease characterized by chronic segmental inflammation surrounding colonic diverticula. SCAD is recognized as an autonomous entity, although shares similar pathogenic and therapeutic aspects to inflammatory bowel disease and may be considered a complication of diverticulitis. We aimed to characterize the clinical, endoscopic, and radiographic findings of SCAD and its potential overlap with diverticulitis and inflammatory bowel disease. Methods: All patients with suspected diagnosis of SCAD were identified using a bioinformatics search tool from January 1996 to October 2021 at our institution. Relevant demographic, clinical, endoscopic, and radiographic data were abstracted. Disease-related outcomes and radiographic characteristics were determined. Results: Seventy-five patients with SCAD were included (48.0% female) with average age at diagnosis 62.5 years. Thirty-seven (49.3%) had a prior episode of diverticulitis. The most common presenting symptoms were abdominal pain (33.3%) and hematochezia (22.7%). Antibiotics (42.7%) and mesalamine (36.0%) were most used as first-line treatment options. Twenty (26.7%) required surgical intervention. The most common initial endoscopic finding was isolated sigmoid inflammation (86.7%). Fifty-one patients with confirmed SCAD, 72 with diverticulitis, and 12 with Crohn’s disease (CD) had imaging available for review. Penetrating disease was seen in 7 (13.7%) with SCAD compared to 7 (9.7%) and 2 (16.6%) with diverticulitis and CD, respectively (P = .14). Blinded radiologists diagnosed SCAD, CD, or diverticulitis correctly in 43.8%, 8.3%, and 27.1%, respectively. Conclusion: SCAD should be considered when isolated sigmoid colon inflammation is seen on cross-sectional imaging. Penetrating disease is not a specific radiologic feature for either SCAD or diverticulitis. Further prospective studies are needed to correlate imaging characteristics with endoscopic findings to better describe radiographic features in SCAD.

Introduction: Integrated care programs that prioritize comprehensive service delivery for behavioural health and medical conditions have the potential to improve patient outcomes. Few programs, however, use data-driven methods to guide program evaluation and implementation, limiting their effectiveness, as well as the scope of findings in the research literature. Purpose: To address these gaps, we describe an innovative and rigorous evaluative research framework: the Rutgers Integrated Care Evaluation (RICE) Research Framework, designed to be tailorable across conditions and care settings. Method: The RICE Research Framework is guided by two core concepts: (1) an approach built on engaging as equal partners and (2) data source triangulation. For the former, the approach relies on multiple teams (Project, Clinical Site, Evaluation, and Consumer) working in collaboration. While teams have specific roles, all teams engage frequently as equal partners to facilitate performance and advance research deliverables. For the latter, we provide a template with recommended primary and secondary data sources with areas of focus, applicable methods, and samples. These sources, when used in combination, can guide implementation, advance replicability, develop/refine health care programs, and foster dissemination of scientific findings. Conclusions: We recommend clinicians and scientists implement the RICE Research Framework to enhance their integrated care programs.

Current state-of-the-art superconducting microwave qubits are cooled to extremely low temperatures to avoid sources of decoherence. Higher qubit operating temperatures would significantly increase the cooling power available, which is desirable for scaling up the number of qubits in quantum computing architectures and integrating qubits in experiments requiring increased heat dissipation. To operate superconducting qubits at higher temperatures, it is necessary to address both quasiparticle decoherence (which becomes significant for aluminum junctions above 160 mK) and dephasing from thermal microwave photons (which are problematic above 50 mK). Using low-loss niobium-trilayer junctions, which have reduced sensitivity to quasiparticles due to the higher superconducting transition temperature of niobium, we fabricate transmons with higher frequencies than previously studied, up to 24 GHz. We measure decoherence and dephasing times of about 1μs, corresponding to average qubit quality factors of approximately 10^{5}, and find that decoherence is unaffected by quasiparticles up to 1K. Without relaxation from quasiparticles, we are able to explore dephasing from purely thermal sources, finding that our qubits can operate up to approximately 250mK while maintaining similar performance. The thermal resilience of these qubits creates new options for scaling up quantum processors, enables hybrid quantum experiments with high heat-dissipation budgets, and introduces a material platform for even-higher-frequency qubits.

Abstract High-throughput proteomic analysis of archaeological skeletal remains provides information about past fauna community compositions and species dispersals in time and space. Archaeological skeletal remains are a finite resource, however, and therefore it becomes relevant to optimize methods of skeletal proteome extraction. Ancient proteins in bone specimens can be highly degraded and consequently, extraction methods for well-preserved or modern bone might be unsuitable for the processing of highly degraded skeletal proteomes. In this study, we compared six proteomic extraction methods on Late Pleistocene remains with variable levels of proteome preservation. We tested the accuracy of species identification, protein sequence coverage, deamidation, and the number of post-translational modifications per method. We find striking differences in obtained proteome complexity and sequence coverage, highlighting that simple acid-insoluble proteome extraction methods perform better in highly degraded contexts. For well-preserved specimens, the approach using EDTA demineralization and protease-mix proteolysis yielded a higher number of identified peptides. The protocols presented here allowed protein extraction from ancient bone with a minimum number of working steps and equipment and yielded protein extracts within three working days. We expect further development along this route to benefit large-scale screening applications of relevance to archaeological and human evolution research.

Background: A certified hyperbaric and wound care specialist in the South-west US evaluated three patients who presented with refractory wounds containing substantial necrotic tissue. Aims and Objectives: The primary aim/objective of this study was for the investigator to ascertain if the wound gel, in combination with dietary changes and standard hyperbaric oxygen treatment (HBOT) when placed on refractory wounds evidentiary with necrotic tissue, would result in favorable wound healing outcomes. This study’s secondary aim/objective was to determine if this treatment approach could result in avoiding costly and deleterious, life-changing amputations, and/or surgical reconstructions. Materials and Methods: The physician investigator conducted this qualitative method case study during her regular professional medical practice. She selected study subjects based on the exigency of patients’ needs. The three subjects selected met three inclusion criteria. The first inclusion criterion was that the patient had at least one serious refractory wound, which wound did not respond to any previous treatment regimens at any treatment center. The second inclusion criterion was that significant necrotic tissue was evidentiary in the wound(s). The third inclusion criterion was that each patient was facing traumatic surgical intervention – either amputation or excision with reconstruction. The investigator measured wound diameters and tracked the time to wound closure and wound healing. In addition, the investigator noted patient comments during the wound healing. Results: In two cases, patients were scheduled for umbilical reconstruction; in the third, the patient was scheduled for a frontal foot amputation. In 10 weeks, the three patients experienced complete wound healing or substantial wound resolution. Case #2 patient initially only received HBOT at a different wound center and was emergently admitted to the hospital after 2 weeks of HBOT (no dietary alteration or specialized wound gel application). The patient underwent wide excisional debridement with general surgery but received the trifurcated treatment regimen after discharge, resulting in wound healing within 10 weeks. Conclusion: These results warrant further study with more subjects to determine the replicability of findings. If the results are generalizable to this population of patients suffering from advanced refractory wounds and facing limb amputations, the health and quality-of-life benefits for these patients and the prospective cost savings on the U.S. health system could be incalculable.

Background: Atlanto-axial (AA) subluxation can be a complex syndrome in dogs. Accurate identification and assessment of this condition is key to providing treatment and resolution. Aim: The purpose of this retrospective study was to describe the magnetic resonance imaging (MRI) characteristics of AA subluxation and associated neurologic deficits. Methods: A multicenter review of dogs with a diagnosis of AA subluxation was conducted, evaluating signalment, neurologic grade, duration of signs, and MRI characteristics. MRI characteristics included degree of spinal cord compression and joint subluxation, integrity of odontoid ligaments, presence of a dens, spinal cord signal intensity, and presence of syringohydromyelia, hydrocephalus, and Chiari-like malformation. A control population with normal AA joints was also evaluated. MR images of 42 dogs with AA subluxation were compared to 26 age and breed-matched control dogs. Results: Affected dogs had a median age of 27 months and median weight of 2.7 kg, and the most commonly affected breed was Yorkshire terrier (47.5%). Spinal cord signal hyperintensity, increased AA joint size, and cross-sectional cord compression at the level of the dens and mid-body C2 were associated with AA subluxation. No associations were found between cord compression, appearance of the dens, or cord signal intensity and neurologic grade. Affected dogs did not have a higher incidence of Chiari-like malformation, syringohydromyelia, or hydrocephalus than control dogs, and their neurologic grade was not associated with MRI findings. Lack of a dens and/or odontoid ligaments was associated with larger subluxations. Conclusion: Dogs with clinical signs of AA subluxation were significantly more likely to have intramedullary hyperintensity at the level of compression (p=0.0004), an increased AA joint cavity size (p=0.0005), and increased spinal cord compression at the level of dens and mid-body C2 (p=1.4mm and a subluxation distance >2.5mm as cutoffs for MRI diagnosis of AA subluxation in dogs. No differences were noted between dogs with AA subluxation and control dogs regarding syringohydromyelia, hydrocephalus, and Chiari-like malformation. [Open Vet J 2023; 13(9.000): 1091-1098]

Abstract Sampling restrictions have hindered the comprehensive study of invasive non-enhancing (NE) high-grade glioma (HGG) cell populations driving tumor progression. Here, we present an integrated multi-omic analysis of spatially matched molecular and multi-parametric magnetic resonance imaging (MRI) profiling across 313 multi-regional tumor biopsies, including 111 from the NE, across 68 HGG patients. Whole exome and RNA sequencing uncover unique genomic alterations to unresectable invasive NE tumor, including subclonal events, which inform genomic models predictive of geographic evolution. Infiltrative NE tumor is alternatively enriched with tumor cells exhibiting neuronal or glycolytic/plurimetabolic cellular states, two principal transcriptomic pathway-based glioma subtypes, which respectively demonstrate abundant private mutations or enrichment in immune cell signatures. These NE phenotypes are non-invasively identified through normalized K2 imaging signatures, which discern cell size heterogeneity on dynamic susceptibility contrast (DSC)-MRI. NE tumor populations predicted to display increased cellular proliferation by mean diffusivity (MD) MRI metrics are uniquely associated with EGFR amplification and CDKN2A homozygous deletion. The biophysical mapping of infiltrative HGG potentially enables the clinical recognition of tumor subpopulations with aggressive molecular signatures driving tumor progression, thereby informing precision medicine targeting.

Organizational obliviousness is a theoretical framework that acknowledges how socially constructed stereotypes of marginalized groups become embedded individually, culturally, and institutionally within organizations. Prior work on organizational obliviousness has focused on exploring gender within organizational contexts. This work builds on previous scholarship on organizational obliviousness in the public sector and discussions of race in public organizations. It also builds on applying the organizational obliviousness framework in order to understand how racialized and intersectional forms of oppression manifest within public organizations. Specifically, we use the organizational obliviousness framework to explore how grooming and appearance policies that seem neutral on the surface can be exclusionary and grounded in racial stereotypes.

Background: Medication prescribing is essential for the treatment, curing, maintenance, and/or prevention of an illness and disease, however, medication errors remain common. Common errors including prescribing and administration, pose significant risk to patients. Electronic prescribing (e-prescribing) is one intervention used to enhance the safety and quality of prescribing by decreasing medication errors and reducing harm. E-prescribing in community-based settings has not been extensively examined. Objective: To map and characterize the current evidence on e-prescribing and medication safety in community pharmacy settings. Methods: We conducted a rapid scoping review of quantitative, qualitative, and mixed methods studies reporting on e-prescribing and medication safety. MEDLINE All (OVID), Embase (Elsevier), CINAHL Full Text (EBSCOHost), and Scopus (Elsevier) databases were searched December 2022 using keywords and MeSH terms related to e-prescribing, medication safety, efficiency, and uptake. Articles were imported to Covidence and screened by two reviewers. Data were extracted by a single reviewer and verified by a second reviewer using a standardized data extraction form. Findings are reported in accordance with JBI Manual for Evidence Synthesis following thematic analysis to narratively describe results. Results: Thirty-five studies were included in this review. Most studies were quantitative (n = 22), non-experimental study designs (n = 16) and were conducted in the United States (n = 18). Half of included studies reported physicians as the prescriber (n = 18), while the remaining reported a mix of nurse practitioners, pharmacists, and physician assistants (n = 6). Studies reported on types of errors, including prescription errors (n = 20), medication safety errors (n = 9), dispensing errors (n = 2), and administration errors (n = 1). Few studies examined patient health outcomes, such as adverse drug events (n = 5). Conclusions: Findings indicate that most research is descriptive in nature and focused primarily on rates of prescription errors. Further research, such as experimental, implementation, and evaluation mixed-methods research, is needed to investigate the effects of e-prescribing on reducing error rates and improving patient and health system outcomes.

IntroductionResearch over the last couple of decades has demonstrated a relationship between psychophysiological measures, specifically cardiac functions, and cognitive performance. Regulation of the cardiac system under parasympathetic control is commonly referred to as cardiac vagal tone and is associated with the regulation of cognitive and socioemotional states. The goal of the current study was to capture the dynamic relationship between cardiac vagal tone and performance in a vigilance task.Method/ResultsWe implemented a longitudinal growth curve modeling approach which unveiled a relationship between cardiac vagal tone and vigilance that was non-monotonic and dependent upon each person.DiscussionThe findings suggest that cardiac vagal tone may be a process-based physiological measure that further explains how the vigilance decrement manifests over time and differs across individuals. This contributes to our understanding of vigilance by modeling individual differences in cardiac vagal tone changes that occur over the course of the vigilance task.

Abstract Background How often a child naps, during infancy, is believed to reflect both intrinsic factors, that is, the need of an immature brain to consolidate information soon after it is acquired, and environmental factors. Difficulty accounting for important environmental factors that interfere with a child's sleep needs (e.g., attending daycare) has clouded our ability to understand the role of intrinsic drivers of napping frequency. Methods Here we investigate sleep patterns in association with two measures of cognitive ability, vocabulary size, measured with the Oxford‐Communicative Development Inventory (N = 298) and cognitive executive functions (EF), measured with the Early EF Questionnaire (N = 463), in a cohort of 8–38‐month‐olds. Importantly, because of the social distancing measures imposed during the Covid‐19 Spring 2020 lockdown, in the UK, measures of sleep were taken when children did not access daycare settings. Results We find that children with more frequent but shorter naps than expected for their age had lower concurrent receptive vocabularies, lower cognitive EF and a slower increase in expressive vocabulary from spring to winter 2020, when age, sex, and SES were accounted for. The negative association between vocabulary and frequency of naps became stronger with age. Conclusions These findings suggest that the structure of daytime sleep is an indicator of cognitive development and highlight the importance of considering environmental perturbations and age when investigating developmental correlates of sleep.

Abstract Procedures used to elicit both behavioral and neurophysiological data to address a particular cognitive question can impact the nature of the data collected. We used functional near-infrared spectroscopy (fNIRS) to assess performance of a modified finger tapping task in which participants performed synchronized or syncopated tapping relative to a metronomic tone. Both versions of the tapping task included a pacing phase (tapping with the tone) followed by a continuation phase (tapping without the tone). Both behavioral and brain-based findings revealed two distinct timing mechanisms underlying the two forms of tapping. Here we investigate the impact of an additional—and extremely subtle—manipulation of the study’s experimental design. We measured responses in 23 healthy adults as they performed the two versions of the finger-tapping tasks either blocked by tapping type or alternating from one to the other type during the course of the experiment. As in our previous study, behavioral tapping indices and cortical hemodynamics were monitored, allowing us to compare results across the two study designs. Consistent with previous findings, results reflected distinct, context-dependent parameters of the tapping. Moreover, our results demonstrated a significant impact of study design on rhythmic entrainment in the presence/absence of auditory stimuli. Tapping accuracy and hemodynamic responsivity collectively indicate that the block design context is preferable for studying action-based timing behavior.

Newborn screening (NBS) for sickle cell disease (SCD) has significantly improved childhood survival but there are still gaps resulting in delayed care for affected infants. As a state-run program, there are no national quality assurance programs to ensure each state achieves consistent, reliable outcomes. We performed this qualitative study of NBS follow-up practices to better evaluate and understand the multi-level, state-specific processes of how each state’s public health department delivers the NBS results to families, how/if they ensure affected infants are seen quickly by sickle cell specialists, and to determine the close-out processes used in each state. This project used semi-structured interviews conducted with 29 participants across eight states to explore these NBS follow-up processes in each state. Participants included SCD providers, NBS coordinators, or personnel associated with state health departments and community-based SCD organizations (CBO). Our results show significant state-dependent variations in the NBS processes of information delivery and patient management. Specifically, programs differed in how they communicated results to affected families and which other organizations were informed of the diagnosis. There was also state-based (and intrastate) variation in who should assume responsibility for ensuring that infants receive confirmatory testing and are promptly started on penicillin prophylaxis. Case closure was also highly variable and poorly validated. Our results also yielded identifiable challenges and facilitators to NBS which were highly variable by state but potentially addressable in the future. This information suggests opportunities for systematic improvement in NBS follow-up processes.

Background To assess the impact of coronavirus disease 2019 (COVID-19) pandemic on non-small cell lung cancer (NSCLC) screening, staging, and management in a single health care system.

ObjectiveBlack individuals living with psychosis are at risk for stigma and marginalization due to systematic discrimination and barriers to receiving treatment. Social contact-based interventions have the potential to reduce stigma; however, interventions with elements specific to the experiences of Black youth are limited. Therefore, we aimed to gather input from Black youth living with psychosis to develop a social contact-based, brief video intervention to reduce public stigma toward Black youth with psychosis.MethodsTwo 90-min focus groups were conducted with seven young Black individuals ages 18–30 with First Episode Psychosis from OnTrackNY. Participants were asked about their experiences of stigma and racial discrimination, and their perspectives on a video intervention. Focus group transcripts were analyzed using thematic content analysis.ResultsThemes that emerged included: the salience of stigma and racial experiences for some participants and not others; the linking of religiosity and symptoms in Black communities; the importance of taking responsibility for recovery as a coping strategy to counteract stigma; and mixed views on creating a video intervention specific to Black youth.ConclusionMeaningful and empowering involvement of individuals with lived experience of psychosis is essential to create stigma reducing interventions. Input from Black youth living with psychosis assisted in developing a culturally tailored brief video-based intervention to reduce public stigma toward Black youth with psychosis that included information about the protagonist’s experience of race and mental illness, specifically family, religious, and community-based experiences.

IntroductionCannabis is one of the most commonly used substances during pregnancy and has the potential to negatively impact parent-infant relationships. The prefrontal cortex (PFC) response to infant cues during pregnancy has been associated with subsequent positive parenting behaviors. However, PFC activation is altered in individuals who use cannabis. As the potency of cannabis has changed over the years, little is known about the specific role of cannabis use on gestational parent brain responses to infant cues.Materials and methodsUsing functional Near-Infrared Spectroscopy (fNIRS) in the second trimester of pregnancy, we measured hemodynamic responses to an infant cry task and an infant faces task among individuals who were using cannabis (N = 14) and compared them with those who were not using cannabis (N = 45). For the infant cry task, pregnant individuals listened to cry sounds and matched white noise. For the infant faces task, they viewed happy, sad, and neutral faces.ResultsThere was no significant difference between the two groups after adjusting for multiple comparisons. Without adjusting for multiple comparisons, we found preliminary evidence for the differences in the dorsomedial PFC associated with heightened response to infant cry among individuals who use cannabis. The groups were also different in the dorsolateral PFC associated with decreased response to infant sad faces among individuals who use cannabis.DiscussionOur preliminary data suggests that cannabis use during pregnancy was associated with brain activation in the regions involved in the emotional regulation and information processes. However, the results did not survive after adjustment for multiple comparisons, thus future research with larger sample sizes is needed to confirm potential differences in brain function among cannabis-using pregnant individuals.

The field of public administration writes and theorizes a good deal about institutional and structural racism, but as an applied field, we don’t address some of the potential intervention strategies for dismantling racist structures and institutions. This article examines some of the prospective strategies in areas such as reparations, criminal justice, health care, and housing which have been implemented seeking to upend institutional and structural racism in this nation. Policies or programs, unless implemented, create a revolving-door syndrome. However, even when policies are developed and implemented, their efficacy is not always guaranteed, as will be seen. This article discusses how public administration can move away from the “ready, aim, study more” conundrum, and offers suggestions for moving forward to the next frontier.

Given the wide usage of Roundup, a common herbicide, the impacts of its presence in ecological communities are of great interest. Many studies have investigated the effects of glyphosate, the active ingredient in Roundup, on different factions of an ecosystem including on animals, plants, microorganisms, and nutrients. The current study expanded upon these works using Roundup instead of glyphosate to provide a realistic application in which to observe the development of microbial assemblages and nutrient composition in two different habitats. Winogradsky columns were prepared using benthic material from a ditch and a pond. Varying concentrations of Roundup were introduced to the columns at the beginning of the study and microbial growth and nutrient compositions from each column were measured weekly. The results indicate that the presence of Roundup has varying effects on microorganisms and nutrients. While photosynthetic microbes were negatively impacted, a shift in the microbial composition to heterotrophic microbes indicates that these microorganisms were able to utilize some ingredients in Roundup as a nutrient source. Additionally, the temporal analysis of nutrient compositions indicated that microbes metabolize glyphosate starting with the phosphate moiety even when the other compounds in Roundup are present. While these trends were observed in both benthic habitats, the composition of the ecological community can affect its ability to utilize the ingredients in Roundup as a nutrient source.

Individuals with Autism Spectrum Disorder (ASD) often exhibit atypical social behaviors that some may perceive as odd or discomforting. Given that ASD is largely invisible, it may be difficult to understand why a person is displaying these atypical behaviors, leading to less favorable attitudes. The current study aimed to examine if having an explanation for an individual exhibiting behaviors associated with ASD could improve perceptions of warmth and competence, as well as the amount of empathy felt towards the individual. Participants (n = 82) were presented with a scenario involving two people, one of whom exhibited behaviors consistent with ASD. ASD diagnosis information was manipulated, such that half of the participants were told that the target was diagnosed with ASD, and the other half were given no diagnostic information. Afterwards, participants rated the target. Results indicated that having an explanation for the ASD-related behaviors led to higher ratings of warmth and competence and greater feelings of empathy. Furthermore, empathy mediated the relationship between having the diagnostic information and target ratings. Thus, having an explanation for someone’s behavior may lead to greater feelings of empathy and improve perceptions and understanding. This has important implications for improving education and awareness about behaviors associated with ASD as well as for making the decision of whether or not to disclose one’s diagnosis.

Abstract Protected areas that restrict human activities can enhance wildlife habitat quality. Efficacy of protected areas can be improved with increased protection from illegal activities and presence of buffer protected areas that surround a core protected area. Habitat value of protected areas also can be affected by seasonal variation in anthropogenic pressures. We examined seasonal space use by African lions (Panthera leo) within a core protected area, Serengeti National Park, Tanzania, and surrounding buffer protected areas with varying protection strengths. We used lion locations in logistic regression models during wet and dry seasons to estimate probability of use in relation to protection strength, distance to protected area edge, human and livestock density, distance to roads and rivers, and land cover. Lions used strongly protected buffer areas over the core protected area and unprotected areas, and moved away from protected area boundaries toward the core protected area when buffer protected areas had less protection. Lions avoided high livestock density in the wet season and high human density in the dry season. Increased strength of protection can decrease edge effects on buffer areas and help maintain habitat quality of core protected areas for lions and other wildlife species.

BackgroundHuman papillomavirus (HPV) is a common sexually transmitted infection, causing multiple cancers, including cervical, penile, and anal. Infection and subsequent health risks caused by HPV can be diminished by HPV vaccination. Unfortunately, vaccination rates among Hmong Americans are substantially lower than those among other racial and ethnic groups, despite having higher cervical cancer rates than non-Hispanic White women. Such disparities and sparse literature highlight the need for innovative and culturally appropriate educational interventions to improve HPV vaccine rates in Hmong Americans. ObjectiveWe aimed to develop and evaluate the effectiveness and usability of an innovative web-based eHealth educational website, the Hmong Promoting Vaccines website (HmongHPV website), for Hmong-American parents and adolescents to improve their knowledge, self-efficacy, and decision-making capacities to obtain HPV vaccinations. MethodsThrough social cognitive theory and community-based participatory action research process, we created a theory-driven and culturally and linguistically appropriate website for Hmong parents and adolescents. We conducted a pre-post intervention pilot study to assess the website’s effectiveness and usability. Overall, 30 Hmong-American parent and adolescent dyads responded to questions about HPV and HPV vaccine knowledge, self-efficacy, and decision-making at preintervention, 1 week after intervention, and at the 5-week follow-up. Participants responded to survey questions about website content and processes at 1 and 5 weeks, and a subset of 20 dyad participants participated in telephone interviews 6 weeks later. We used paired t tests (2-tailed) to measure the change in knowledge, self-efficacy, and decision-making processes, and used template analysis to identify a priori themes for website usability. ResultsParticipants’ HPV and HPV vaccine knowledge improved significantly from pre- to postintervention stage and follow-up. Knowledge scores increased from preintervention to 1 week after intervention for both parents (HPV knowledge, P=.01; vaccine knowledge, P=.01) and children (HPV knowledge, P=.01; vaccine knowledge, P

Perioperative handoffs are high-risk events for miscommunications and poor care coordination, which cause patient harm. Extensive research and several interventions have sought to overcome the challenges to perioperative handoff quality and safety, but few efforts have focused on teamwork training. Evidence shows that team training decreases surgical morbidity and mortality, and there remains a significant opportunity to implement teamwork training in the perioperative environment. Current perioperative handoff interventions face significant difficulty with adherence which raises concerns about the sustainability of their impact. In this perspective article, we explain why teamwork is critical to safe and reliable perioperative handoffs and discuss implementation challenges to the five core components of teamwork training programs in the perioperative environment. We outline evidence-based best practices imperative for training success and acknowledge the obstacles to implementing those best practices. Explicitly identifying and discussing these obstacles is critical to designing and implementing teamwork training programs fit for the perioperative environment. Teamwork training will equip providers with the foundational teamwork competencies needed to effectively participate in handoffs and utilize handoff interventions. This will improve team effectiveness, adherence to current perioperative handoff interventions, and ultimately, patient safety.

Obesity is an important health concern in horses, along with humans and companion animals. Adipose tissue is an inflammatory organ that alters the insulin-signaling cascade, ultimately causing insulin dysregulation and impaired glucose metabolism. These disruptions can increase the risk of metabolic disease and laminitis in horses and may also impact energy metabolism during exercise. A single bout of exercise, along with chronic exercise conditioning, increases insulin sensitivity and glucose disposal via both contraction- and insulin-mediated glucose uptake pathways. Regular exercise also increases calorie expenditure, which can facilitate weight (as body fat) loss. This paper explores the metabolic pathways affected by adiposity, as well as discusses the impact of exercise on insulin metabolism in horses.

Summary: During bloodstream infections, neutrophils home to the liver as part of an intravascular immune response to eradicate blood-borne pathogens, but the mechanisms regulating this crucial response are unknown. Using in vivo imaging of neutrophil trafficking in germ-free and gnotobiotic mice, we demonstrate that the intestinal microbiota guides neutrophil homing to the liver in response to infection mediated by the microbial metabolite D-lactate. Commensal-derived D-lactate augments neutrophil adhesion in the liver independent of granulopoiesis in bone marrow or neutrophil maturation and activation in blood. Instead, gut-to-liver D-lactate signaling primes liver endothelial cells to upregulate adhesion molecule expression in response to infection and promote neutrophil adherence. Targeted correction of microbiota D-lactate production in a model of antibiotic-induced dysbiosis restores neutrophil homing to the liver and reduces bacteremia in a model of Staphylococcus aureus infection. These findings reveal long-distance traffic control of neutrophil recruitment to the liver by microbiota-endothelium crosstalk.

Objectives One-fifth of total knee arthroplasty (TKA) recipients experience a suboptimal outcome. Incorporation of patients’ preferences in TKA assessment may improve outcomes. We determined the discriminant ability of preoperative measures of TKA need, readiness/willingness and expectations for a good TKA outcome.Methods In patients with knee osteoarthritis (OA) undergoing primary TKA, we preoperatively assessed TKA need (Western Ontario-McMaster Universities OA Index (WOMAC) Pain Score and Knee injury and Osteoarthritis Outcome Score (KOOS) function, arthritis coping), health status, readiness (Patient Acceptable Symptom State, depressive symptoms), willingness (definitely yes—yes/no) and expectations (outcomes deemed ‘very important’). A good outcome was defined as symptom improvement (met Outcome Measures in Rheumatology and Osteoarthritis Research Society International (OMERACT–OARSI) responder criteria) and satisfaction with results 1 year post TKA. Using logistic regression, we assessed independent outcome predictors, model discrimination (area under the receiver operating characteristic curve, AUC) and the predicted probability of a good outcome for different need, readiness/willingness and expectations scenarios.Results Of 1,053 TKA recipients (mean age 66.9 years (SD 8.8); 58.6% women), 78.1% achieved a good outcome. With TKA need alone (WOMAC pain subscale, KOOS physical function short-form), model discrimination was good (AUC 0.67, 95% CI 0.63 to 0.71). Inclusion of readiness/willingness, depressive symptoms and expectations regarding kneeling, stair climbing, well-being and performing recreational activities improved discrimination (p=0.01; optimism corrected AUC 0.70, 0.66–0.74). The predicted probability of a good outcome ranged from 44.4% (33.9–55.5) to 92.4% (88.4–95.1) depending on level of TKA need, readiness/willingness, depressive symptoms and surgical expectations.Conclusions Although external validation is required, our findings suggest that incorporation of patients’ TKA readiness, willingness and expectations in TKA decision-making may improve the proportion of recipients that experience a good outcome.

Background: Radiation necrosis (RN) is a clinically relevant complication of stereotactic radiosurgery (SRS) for intracranial metastasis (ICM) treatments. Radiation necrosis development is variable following SRS. It remains unclear if risk factors for and clinical outcomes following RN may be different for melanoma patients. We reviewed patients with ICM from metastatic melanoma to understand the potential impact of RN in this patient population. Methods: Patients who received SRS for ICM from melanoma at Mayo Clinic Arizona between 2013 and 2018 were retrospectively reviewed. Data collected included demographics, tumor characteristics, radiation parameters, prior surgical and systemic treatments, and patient outcomes. Radiation necrosis was diagnosed by clinical evaluation including brain magnetic resonance imaging (MRI) and, in some cases, tissue evaluation. Results: Radiation necrosis was diagnosed in 7 (27%) of 26 patients at 1.6 to 38 months following initial SRS. Almost 92% of all patients received systemic therapy and 35% had surgical resection prior to SRS. Patients with RN trended toward having larger ICM and a prior history of surgical resection, although statistical significance was not reached. Among patients with resection, those who developed RN had a longer period between surgery and SRS start (mean 44 vs 33 days). Clinical improvement following treatment for RN was noted in 2 (29%) patients. Conclusions: Radiation necrosis is relatively common following SRS for treatment of ICM from metastatic melanoma and clinical outcomes are poor. Further studies aimed at mitigating RN development and identifying novel approaches for treatment are warranted.

Interprofessional healthcare team function is critical to the effective delivery of patient care. Team members must possess teamwork competencies, as team function impacts patient, staff, team, and healthcare organizational outcomes. There is evidence that team training is beneficial; however, consensus on the optimal training content, methods, and evaluation is lacking. This manuscript will focus on training content. Team science and training research indicates that an effective team training program must be founded upon teamwork competencies. The Team FIRST framework asserts there are 10 teamwork competencies essential for healthcare providers: recognizing criticality of teamwork, creating a psychologically safe environment, structured communication, closed-loop communication, asking clarifying questions, sharing unique information, optimizing team mental models, mutual trust, mutual performance monitoring, and reflection/debriefing. The Team FIRST framework was conceptualized to instill these evidence-based teamwork competencies in healthcare professionals to improve interprofessional collaboration. This framework is founded in validated team science research and serves future efforts to develop and pilot educational strategies that educate healthcare workers on these competencies.

Abstract Background Family planning (FP) is an important element of sexual and reproductive health and rights, but socio-cultural barriers and unbalanced gender relations often limit women’s decision-making about contraceptive use. Covert contraceptive use (CCU) exemplifies the limits on women’s decision-making and represents a way in which some women overcome constraints to achieve their reproductive goals. This study explores the decision-making process through which women choose to use contraceptives covertly. Methods A qualitative synthesis was conducted using data from women, health providers, community members, health administrators, and intervention implementers (n = 400) to explore the decision-making process through which women choose to use contraceptives covertly. Interviews and focus group discussions were conducted at two time points as part of an evaluation of interventions integrating FP and childhood immunisation services at sites in Benin, Kenya, Malawi and Uganda. The sexual and reproductive health empowerment framework by Karp et al. (2020) was adapted and used to guide the analysis. Results Women recognised that although they suffered the negative consequences of frequent pregnancies and of raising large families, they lacked overt decision-making power over their fertility. Women were confident to engage in CCU because they believed their husbands did not understand these consequences nor acknowledged their suffering, which justified not informing them. CCU was a difficult choice however, women felt comfortable voicing their reproductive preferences in settings where health providers were supportive. Conclusions Women chose to use contraceptives covertly when they questioned the unfairness of their situation and recognised their own power to act in accordance with their reproductive preferences. This represented an important shift in a woman’s perception of who is entitled to make decisions about contraceptive use. Importantly, health providers can play a key role in supporting women’s autonomous decision making about contraceptive use and should be careful not to undermine women’s confidence.

Abstract Background Postpartum women represent a considerable share of the global unmet need for modern contraceptives. Evidence suggests that the integration of family planning (FP) with childhood immunisation services could help reduce this unmet need by providing repeat opportunities for timely contact with FP services. However, little is known about the clients’ experiences of FP services that are integrated with childhood immunisations, despite being crucial to contraceptive uptake and repeat service utilisation. Methods The responsiveness of FP services that were integrated with childhood immunisations in Malawi was assessed using cross-sectional convergent mixed methods. Exit interviews with clients (n=146) and audits (n=15) were conducted in routine outreach clinics. Responsiveness scores across eight domains were determined according to the proportion of clients who rated each domain positively. Text summary analyses of qualitative data from cognitive interviewing probes were also conducted to explain responsiveness scores. Additionally, Spearman rank correlation and Pearson’s chi-squared test were used to identify correlations between domain ratings and to examine associations between domain ratings and client, service and clinic characteristics. Results Responsiveness scores varied across domains: dignity (97.9%); service continuity (90.9%); communication (88.7%); ease of access (77.2%); counselling (66.4%); confidentiality (62.0%); environment (53.9%) and choice of provider (28.4%). Despite some low performing domains, 98.6% of clients said they would recommend the clinic to a friend or family member interested in FP. The choice of provider, communication, confidentiality and counselling ratings were positively associated with clients’ exclusive use of one clinic for FP services. Also, the organisation of services in the clinics and the providers’ individual behaviours were found to be critical to service responsiveness. Conclusions This study establishes that in routine outreach clinics, FP services can be responsive when integrated with childhood immunisations, particularly in terms of the dignity and service continuity afforded to clients, though less so in terms of the choice of provider, environment, and confidentiality experienced. Additionally, it demonstrates the value of combining cognitive interviewing techniques with Likert questions to assess service responsiveness.

For decades, there has been a well-coordinated effort to unmake public education in Canada and around the globe. Neoliberal reformers have undermined public education through increased privatization, marketization, and managerialism. Government austerity measures have shaped policy that falsely necessitates, validates, and legitimizes the privatization of public education. All of these forces that fuel the neoliberal reform movement diminish the collective aims, benefits, and responsibility of/for public education. Instead, the movement encourages systems that ration education. The moves to emulate business models in education systems exacerbate inequities and run counter to the purpose of public education. Indeed, attempts to marketize, commodify, privatize, and dismantle public education are well-organized and coordinated. Yet, in Canada, provincial and territorial fragmentation has veiled the well-organized rhetoric and tactics of neoliberal education reforms. As a result, community and political responses have often been confined within borders. The reformers have been centrally organized, but the resistance has not. Recognizing that provincial and territorial borders can act as barriers to collective advocacy, this special issue is intended to share activities, research, and writing from across Canada about the tactics and impacts of privatization, to recognize the efforts being made to organize a collective response to privatization efforts, and to encourage national conversations beyond borders.

Abstract Older children with online schooling requirements, unsurprisingly, were reported to have increased screen time during the first COVID-19 lockdown in many countries. Here, we ask whether younger children with no similar online schooling requirements also had increased screen time during lockdown. We examined children’s screen time during the first COVID-19 lockdown in a large cohort (n = 2209) of 8-to-36-month-olds sampled from 15 labs across 12 countries. Caregivers reported that toddlers with no online schooling requirements were exposed to more screen time during lockdown than before lockdown. While this was exacerbated for countries with longer lockdowns, there was no evidence that the increase in screen time during lockdown was associated with socio-demographic variables, such as child age and socio-economic status (SES). However, screen time during lockdown was negatively associated with SES and positively associated with child age, caregiver screen time, and attitudes towards children’s screen time. The results highlight the impact of the COVID-19 lockdown on young children’s screen time.

Abstract Humans interact with other humans at a variety of timescales and in a variety of social contexts. We exhibit patterns of coordination that may differ depending on whether we are genuinely interacting as part of a coordinated group of individuals vs merely co-existing within the same physical space. Moreover, the local coordination dynamics of an interacting pair of individuals in an otherwise non-interacting group may spread, propagating change in the global coordination dynamics and interaction of an entire crowd. Dynamical systems analyses, such as Recurrence Quantification Analysis (RQA), can shed light on some of the underlying coordination dynamics of multi-agent human interaction. We used RQA to examine the coordination dynamics of a performance of “Welcome to the Imagination World”, composed for wind orchestra. This performance enacts a real-life simulation of the transition from uncoordinated, non-interacting individuals to a coordinated, interacting multi-agent group. Unlike previous studies of social interaction in musical performance which rely on different aspects of video and/or acoustic data recorded from each individual, this project analyzes group-level coordination patterns solely from the group-level acoustic data of an audio recording of the performance. Recurrence and stability measures extracted from the audio recording increased when musicians coordinated as an interacting group. Variability in these measures also increased, indicating that the interacting ensemble of musicians were able to explore a greater variety of behavior than when they performed as non-interacting individuals. As an orchestrated (non-emergent) example of coordination, we believe these analyses provide an indication of approximate expected distributions for recurrence patterns that may be measurable before and after truly emergent coordination.

Functional Near-Infrared Spectroscopy (fNIRS) is an innovative and promising neuroimaging modality for studying brain activity in real-world environments. While fNIRS has seen rapid advancements in hardware, software, and research applications since its emergence nearly 30 years ago, limitations still exist regarding all three areas, where existing practices contribute to greater bias within the neuroscience research community. We spotlight fNIRS through the lens of different end-application users, including the unique perspective of a fNIRS manufacturer, and report the challenges of using this technology across several research disciplines and populations. Through the review of different research domains where fNIRS is utilized, we identify and address the presence of bias, specifically due to the restraints of current fNIRS technology, limited diversity among sample populations, and the societal prejudice that infiltrates today's research. Finally, we provide resources for minimizing bias in neuroscience research and an application agenda for the future use of fNIRS that is equitable, diverse, and inclusive.

Neuroretinitis is a condition typically characterized by unilateral optic neuropathy and is most commonly a sequelae of cat scratch disease (CSD) due to infection with Bartonella henselae . Ophthalmologic examination will reveal a swollen optic nerve and may eventually reveal a canonical macular star; optical coherence tomography (OCT) will reveal flattening of the fovea, a thickened neurosensory retina, and subretinal fluid accumulation. Although CSD rarely presents with isolated neuorretinitis, it should be considered in patients presenting with unilateral visual changes. The differential diagnosis for neuroretinitis includes optic neuritis, inflammatory optic neuropathies (sarcoid, para-infectious, autoimmune), compressive, toxic, and more. We describe a pediatric patient presenting with visual changes that were initially concerning for optic neuritis and the diagnostic workup that ultimately led to a diagnosis of CSD neuroretinitis.

There is growing recognition among global health practitioners of the importance of rights-based family planning (FP) programming that addresses inequities. Despite Kenya achieving its national FP target, inequities in access and use of modern FP remain, especially amongst marginalised nomadic and semi-nomadic pastoralist communities. Few studies explore norms affecting FP practices amongst nomadic and semi-nomadic pastoralists and how these can influence social and behaviour change (SBC) interventions. We carried out 48 in-depth interviews and 16 focus group discussions with women and men from pastoralist communities in North Eastern Kenya in November 2018. Data were analysed thematically. Results from focus groups and interviews confirmed themes, while allowing differences between the qualitative approaches to emerge. We found that large family size was a descriptive and injunctive norm in both nomadic and semi-nomadic communities. The desire for around 10 children was sustained by religious beliefs and pastoralist ways of living. Despite a desire for large families, maintaining child spacing was encouraged and practised through breastfeeding and sexual abstinence. Most participants viewed modern FP negatively and as something used by “others”. However, it was acceptable in order to prevent severe negative health outcomes. Future FP research to inform interventions should continue to consider community fertility preferences and the rationale for these, including norms, religion and power dynamics. Targeted qualitative social norms research could inform multi-component SBC interventions in this context.

Evidence suggests that integrating family planning (FP) services with childhood immunisations can increase postpartum contraceptive use by providing timely contact with FP services during the year following childbirth. However, little is known about clients' experiences of FP services within this context. Systems thinking was applied to examine the responsiveness of FP services that were integrated with childhood immunisations in routine outreach clinics across two districts of Malawi. A causal loop analysis of qualitative data captured through 1) structured exit interviews with clients (n=146) and 2) semi-structured interviews with clients (n=23) and their FP providers (n=10) was carried out to explain the system dynamics influencing the responsiveness of integrated FP services. Through this analysis, six feedback loops were identified as having a balancing effect on service responsiveness. Importantly, the clinic's client load was found to drive the responsiveness experienced by clients in the studied context. Overall, the results suggest that efforts to enhance the responsiveness of integrated FP services in outreach clinics should focus on 1) enhancing the providers' ability to alter the client flow in response to fluctuations in the clinic's client load, and 2) ensuring that an appropriate buffer of FP supplies is available in clinics to enable clients to consistently receive their preferred contraceptive irrespective of surges in demand. This study represents the first attempt at modelling the responsiveness of integrated FP services and its findings can be used to inform the design and delivery of FP services that are integrated with childhood immunisations in different settings.

Abstract Purpose/Objective The primary objective is to examine patient self‐assessment of breast pain and cosmesis between three‐dimensional (3D‐CRT) versus intensity‐modulated radiotherapy (IMRT). The secondary objective is to evaluate any relationship of treatment planning conformality of both cohorts to patient‐assessed pain. Assessments were performed at interim 12, 24, 36, and 48 months with a final 5‐year assessment. Materials/Methods In total, 656 patients (3D‐CRT n = 328; IMRT n = 328) were randomly assigned to either IMRT or 3D‐CRT accelerated partial breast radiotherapy to 38.5 Gy in 10 BID 3.85 Gy fractions. Results Median follow‐up was 3 years. Multivariate analysis showed that pain severity significantly decreased from baseline to the 12‐month follow‐up visit (

Abstract Prehistoric stone tools are an important source of evidence for the study of human behavioural and cognitive evolution. Archaeologists use insights from the experimental replication of lithics to understand phenomena such as the behaviours and cognitive capacities required to manufacture them. However, such experiments can require large amounts of time and raw materials, and achieving sufficient control of key variables can be difficult. A computer program able to accurately simulate stone tool production would make lithic experimentation faster, more accessible, reproducible, less biased, and may lead to reliable insights into the factors that structure the archaeological record. We present here a proof of concept for a machine learning-based virtual knapping framework capable of quickly and accurately predicting flake removals from 3D cores using a conditional adversarial neural network (CGAN). We programmatically generated a testing dataset of standardised 3D cores with flakes knapped from them. After training, the CGAN accurately predicted the length, volume, width, and shape of these flake removals using the intact core surface information alone. This demonstrates the feasibility of machine learning for investigating lithic production virtually. With a larger training sample and validation against archaeological data, virtual knapping could enable fast, cheap, and highly-reproducible virtual lithic experimentation.