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We present Indigenous Presence, a design principle for partnering with Indigenous communities to make computing tools responsive to Indigenous priorities. Indigenous Presence blends participatory design methodologies with radical relationality, a concept from Critical Indigenous Theory, and theories of presence from virtual and mixed-reality (MR) research. Examples come from a six-year partnership with local Micronesian and Dakota communities that aims, in part, to use MR to revitalize and exchange cultural knowledges of canoes, waters, lands, and skies. Five factors for activating Indigenous Presence are identifed: 1) having a community-relevant topic, 2) including Indigenous makers, 3) creating culturally identifiable experiences, 4) centering radical relationality in design, and 5) respecting Indigenous protocols. Potential benefits include higher ethical standards for computing research along with increased trustworthiness and participation in computing.

Integrated production systems have been proposed as alternative to sustainable land use. However, information regarding bacterial community structure and diversity in soils of integrated Crop-Livestock-Forest systems remains unknown. We hypothesize that these integrated production systems, with their ecological intensification, can modulate the soil bacterial communities. However, Yet, it remains unclear whether the modulation of bacterial biodiversity is solely attributable to the complexity of root exudates or if seasonal climatic events also play a contributory role. The objective of this study is to evaluate the impact of monoculture and integrated production systems on bacterial soil communities in the Amazon Biome, Brazil. Three monoculture systems, each with a single crop over time and space (Eucalyptus (E), Crop Soybean (C), Pasture (P)), and three integrated systems with multiple crops over time and space (ECI, PI, ECPI) were evaluated, along with a Native forest serving as a reference area. Soil samples were collected at a depth of 0–10 cm during both the wet and dry seasons. Bacterial composition was determined using Illumina high-throughput sequencing of the 16 S rRNA gene. The sequencing results revealed the highest abundance classified under the phyla Firmicutes, Actinobacteria, and Proteobacteria. The Firmicutes correlated with the Crop in the rainy period and in the dry only ECPI and Forest. For five classes corresponding to the three phyla, the Crop stood out with the greatest fluctuations in their relative abundance compared to other production systems. In cluster analysis by genus during the rainy season, only Forest and ECPI showed no similarity with the other production systems. However, in the dry season, both were grouped with Forest and EPI. Therefore, the bacterial community in integrated systems proved to be sensitive to management practices, even with only two years of use. ECPI demonstrated the greatest similarity in bacterial structure to the Native forest, despite just two years of experimental deployment. Crop exhibited fluctuations in relative abundance in both seasons, indicating an unsustainable production system with changes in soil microbial composition. These findings support our hypothesis that integrated production systems and their ecological intensification, as exemplified by ECPI, can indeed modulate soil bacterial communities.

ABSTRACTUrban agriculture has myriad benefits for those who participate in it, but it’s not guaranteed to be more climate-friendly than conventional agriculture. That said, there are some very specific steps urban farmers can take to slash carbon emissions.

IMPORTANCE: There is limited literature on the exact causes and ways of death in patients with head and neck cancer. To provide optimal care, especially in the palliative phase, more information on this is needed. OBJECTIVE: To provide insights into the causes and ways of death among patients with head and neck cancer. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included a consecutive population of patients who received a diagnosis of primary squamous cell carcinoma of the head and neck between January 2006 and December 2013 who were treated in the Erasmus MC. Patient data were merged with nonpublic microdata from Statistics Netherlands. Follow-up time was specified as the date of diagnosis until death or December 3, 2019, whichever came first. The data were checked and reanalyzed in November 2023. MAIN OUTCOMES AND MEASURES: Causes (eg, head and neck cancer, other cancer) and ways (eg, natural death, suicide) of death. RESULTS: A total of 1291 patients (59.2%; 342 women [26.5%]) died during follow-up (median [IQR] follow-up, 2.7 [1.2-5.6] years). The main cause of death was head and neck cancer (557 [43.1%]), followed by the competing cause of other cancers (344 [26.6%]). In total, 240 patients (18.6%) received palliative sedation and 70 patients (5.4%) euthanasia. Compared with patients with head and neck cancer as the underlying cause of death, lower odds ratios (ORs) were observed for receiving palliative sedation (OR, 0.32 vs 0.07; 95% CI, 0.22-0.46 vs 0.03-0.12) and euthanasia (OR, 0.22 vs 0.01; 95% CI, 0.11-0.41 vs 0-0.107) in patients with other causes of death. Patients with a middle and high income had higher ORs for receiving palliative sedation (OR, 1.46 vs 1.86; 95% CI, 1.05-2.04 vs 1.22-2.85) or euthanasia (OR, 2.25 vs 3.37; 95% CI, 1.18-4.3, 1.6-7.12) compared with low-income patients. Retired patients had lower ORs for receiving palliative sedation or euthanasia compared with employed patients (OR, 0.56 vs 0.44; 95% CI, 0.39-0.8 vs 0.24-0.82). CONCLUSION AND RELEVANCE: The results of this cohort study suggest that more than half of the patients died of competing causes and palliative sedation and euthanasia were more common in patients with head and neck cancer as the underlying cause of death. Patients with a higher socioeconomic status had higher odds of receiving palliative sedation and euthanasia. These insights may support health care professionals in providing patient-centered care, especially for patients in the palliative phase.

A retrospective analysis of 55 patients undergoing an exercise-based cardiac rehabilitation (CR) with a wearable cardioverter defibrillator (WCD) was performed. Completing CR with a WCD seems to be feasible, does not lead to severe WCD-related adverse events and may contribute positively to functional capacity and restitution of cardiac function.

The transplantation of organ(s) across species may alleviate the shortage of available donor kidneys for an ever-growing number of patients on transplant waiting lists. However, this potential remains limited by uncharacterized physiologic and immune effects of xenotransplants in recipients, which Pan et al.1investigated in the current study.

In a sixty-eight-bed level-IV NICU, an increased incidence of hospital-acquired pressure injuries (HAPIs) from noninvasive ventilation (NIV) devices was identified. The aim of this quality improvement project was to decrease HAPIs from NIV by 10%. A literature review and the Plan–Do–Study–Act were implemented. The intervention included a customized silicone foam dressing under NIV, an NIV skincare bundle, and multidisciplinary support. Hospital-acquired pressure injury rates were tracked over 3 years postinterventions. The incidence of HAPIs declined by 20% from 0.2 per 1,000 patient days to 0.05 per 1,000 patient days. Relative risk was 4.6 times greater prior to intervention (p= .04). Continuous positive airway pressure (CPAP) failure was not noted and measured by the percentage of patients on ventilators pre- and postintervention. Customized silicone foam dressings under NIV, NIV skincare bundle, and multidisciplinary team support may decrease HAPIs in neonates without CPAP failure.

Background: Patients with ankylosing spondylitis (AS) experience abnormal spinopelvic motion due to chronic inflammation of the axial skeleton, predisposing them to impingement and dislocation. The purpose of this study was to evaluate total hip arthroplasty (THA) dislocation rates in AS patients and evaluate the effects of age and gender on dislocation risk.Methods: Patients who underwent primary THA from 2005 to 2014 were identified using the PearlDiver database. AS patients were compared to age- and gender-matched controls without AS. Patients with a history of spine pathology or spine surgery were excluded. Univariate analyses were performed based on age and sex to evaluate dislocation rates at 90 days, 6 months, 1 year, and 5 years postoperatively.Results: A total of 2792 THA patients (59.6% male) with AS were identified and compared to an age- and gender-matched control group of 5582 THA patients (59.5% male) without AS or known spine pathology. At final follow-up, there were 96 dislocations (3.4%) in the AS group and 138 (2.5%) dislocations in the control group (OR 1.40; 95% CI, 1.08–1.83; p= 0.0118). AS patients ⩾70 years old had higher dislocation rates at all time points (OR range, 1.75–2.09; p< 0.05) compared to controls. At 5-year follow-up, dislocation-free survivorship was 95.7% (95% CI, 94.5–96.9%) for AS patients ⩾70 years old compared to 97.3% (95% CI, 96.6–98.0%) for patients ⩾70 years old without AS.Conclusions: Older AS patients have higher dislocation rates following THA. This effect is likely related to decreased spinopelvic motion in the sagittal plane, predisposing patients to impinge and dislocate.

The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy.

Types are designated for the names of three species of Byttnerioideae (Malvaceae) described by Linnaeus. These include lectotypes for the names Hermannia triphyllaand Melochia supina(= M. corchorifolia), and a neotype for the name Theobroma augustum(≡ Abroma augustum). Two of the type designations are illustrations and one is a specimen. The identity of H. triphyllahas long been uncertain but the lectotype designated here fixes the name as a species of papilionoid legume, which reflects current usage, and a new combination in Lotononis(Fabaceae) is proposed.

Deterioration of seed during dry storage is a major problem for genebanks and seed companies. Germination tests are the gold standard to monitor seed viability; however, these prove to be insensitive during the early stage of storage when viability changes are subtle. Recent findings demonstrate that decline in RNA integrity may be an early indicator of seed longevity during dry storage. The goal of this study was to determine the sensitivity of RNA integrity, measured as RNA integrity number (RIN), regarding how soon changes can be detected and how many seeds are required. We compared the statistical power of germination and RIN assays using a well‐characterized collection of ‘Williams 82’ soybean seeds, with cohorts harvested between 1989 and 2019 and stored at 5 °C. Germination was monitored in 1‐ to 3‐yr intervals since 1989, and RIN was monitored in 1‐ to 2‐yr intervals since 2016 providing an extensive dataset to conduct statistical power analyses. Decline in RIN can be detected in soybean seeds within 10 yr with a RNA monitor test that consumes approximately 30 seeds. In contrast, a germination test detects deterioration in 16 yr using approximately 50 seeds, and by this time, the seed lot is near the limit of longevity and has entered the phase of rapid mortality. Work from this study indicates that early detection of aging using RIN decline can be used to predict the longevity threshold to optimize viability monitoring and regeneration times, preventing loss of valuable samples by overtesting or missing the longevity threshold. We calculate the statistical power of RNA integrity assays (RIN) for monitoring seed aging during storage.RIN detects changes in stored seeds earlier and with fewer seeds compared with traditional germination assays.Monitoring RIN presents a method to predict seed longevity with increased efficiency in seed storage operations.

Dendrophthora kuijtiana(Santalaceae), a new species of mistletoe endemic to the páramos and subpáramos of the Venezuelan Andes, is described and illustrated. We discuss aspects of its ecology, and taxonomic affinities with Dendrophthora davidsei. In addition, we report a new record (D. paucifolia) and two updates (D. karuaianay D. warmingii) to Dendrophthorain Venezuela and present a dichotomous key to identify the species of Dendrophthorareported for the Guaramacal National Park.

IMPORTANCE: Patients who experience less decisional conflict (DC) are more engaged in treatment and less prone to decisional regret, nervousness, and fretting. OBJECTIVES: To assess DC among patients with head and neck squamous cell carcinoma (HNSCC) after the treatment decision consultation and the association between DC and quality of life as well as the degree of control patients experience in the decision-making process using the control preference scale and the association with DC. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study with 2 separate cohorts was conducted at a tertiary cancer center and included patients who were eligible for curative treatment of a primary squamous cell carcinoma between January 2014 and August 2018. The 2 cohorts comprised 102 patients with small laryngeal squamous cell carcinoma (SLSCC) and 161 patients with other HNSCC. MAIN OUTCOMES AND MEASURES: Decisional Conflict Scale (DCS) score, which was scored within 2 weeks after the treatment decision consultation. Other measures included patient characteristics, tumor characteristics, and Control Preference Scale , EuroQol-5D, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, Hospital Anxiety and Depression Scale (HADS), Eating Assessment Tool, and Voice Handicap Index (VHI) scores. RESULTS: Of 263 patients, 50 (19%) were women; the mean (SD) age was 66.1 (11.4) years in the SLSCC group and 64.9 (9.8) years in the other HNSCC group. In the SLSCC group, 51 patients (50%) experienced clinically significant DC (total score ≥25) compared with 74 patients (46%) in the other HNSCC group. In the SLSCC group, there was a large difference in the median EuroQol-5D, Global Health status, HADS anxiety, HADS depression, and VHI scores between the patients with a total DCS score of less than 25 and total DCS score of 25 or greater, whereas in the other HNSCC group, this only applied to the VHI. Forty-four patients (43.1%) in the SLSCC group felt their treatment choice was a shared decision, and 39 (38.2%) made the decision themselves. In the other HNSCC group, 62 (38.5%) felt that the physician decided, and 56 (34.8%) felt it was a shared decision. In both groups there was a weak association between control preference scale scores and DC. CONCLUSIONS AND RELEVANCE: The results of this cohort study found that almost half of patients (48%) experienced clinically significant DC. Several quality-of-life measures associated with clinically significant DC were identified. These results suggest that there is room for improvement in aiming to reduce decision delay and decision-related distress.

Types are designated for five species of Grewioideae (Malvaceae) described by Linnaeus. These include three lectotypes and one neotype of names of Corchorusspecies and one lectotype of the name of a Triumfettaspecies. Three of the lectotypes are illustrations and one is a specimen in Linnaeus's herbarium. In addition, an epitype for T. lappulais designated to facilitate the interpretation of the lectotype specimen, which lacks flowers that are diagnostic for the unambiguous application of the name.

BackgroundNeurodegeneration in multiple sclerosis (MS) affects the visual system but dynamics and pathomechanisms over several years especially in primary progressive MS (PPMS) are not fully understood.MethodsWe assessed longitudinal changes in visual function, retinal neurodegeneration using optical coherence tomography, MRI and serum NfL (sNfL) levels in a prospective PPMS cohort and matched healthy controls. We investigated the changes over time, correlations between outcomes and with loss of visual function.ResultsWe followed 81 patients with PPMS (mean disease duration 5.9 years) over 2.7 years on average. Retinal nerve fibre layer thickness (RNFL) was reduced in comparison with controls (90.1 vs 97.8 µm; p<0.001). Visual function quantified by the area under the log contrast sensitivity function (AULCSF) remained stable over a continuous loss of RNFL (0.46 µm/year, 95% CI 0.10 to 0.82; p=0.015) up until a mean turning point of 91 µm from which the AULCSF deteriorated. Intereye RNFL asymmetry above 6 µm, suggestive of subclinical optic neuritis, occurred in 15 patients and was related to lower AULCSF but occurred also in 5 out of 44 controls. Patients with an AULCSF progression had a faster increase in Expanded Disability Status Scale (beta=0.17/year, p=0.043). sNfL levels were elevated in patients (12.2 pg/mL vs 8.0 pg/mL, p<0.001), but remained stable during follow-up (beta=–0.14 pg/mL/year, p=0.291) and were not associated with other outcomes.ConclusionWhereas neurodegeneration in the anterior visual system is already present at onset, visual function is not impaired until a certain turning point. sNfL is not correlated with structural or functional impairment in the visual system.

This study aimed to sequence, assemble, and annotate three plasmids (two IncN and one IncI1) carrying the blaCTX-M-1gene and assess their transferability rates between homologous and heterologous serovars and/or species of bacteria.

African American (AA) kidney transplant recipients (KTRs) have poor outcomes, which may in-part be due to tacrolimus (TAC) sub-optimal immunosuppression. We previously determined the common genetic regulators of TAC pharmacokinetics in AAs which were CYP3A5 *3, *6, and *7. To identify low-frequency variants that impact TAC pharmacokinetics, we used extreme phenotype sampling and compared individuals with extreme high (n= 58) and low (n= 60) TAC troughs (N= 515 AA KTRs). Targeted next generation sequencing was conducted in these two groups. Median TAC troughs in the high group were 7.7 ng/ml compared with 6.3 ng/ml in the low group, despite lower daily doses of 5 versus 12 mg, respectively. Of 34,542 identified variants across 99 genes, 1406 variants were suggestively associated with TAC troughs in univariate models (p-value < 0.05), however none were significant after multiple testing correction. We suggest future studies investigate additional sources of TAC pharmacokinetic variability such as drug-drug-gene interactions and pharmacomicrobiome.

A 10-y-old, castrated male Boxer dog that was born and had lived in Missouri without any travel history to other states, except for a few trips to Kansas, was presented with a distended abdomen and declined health. Ultrasonographic examination revealed a large hepatic mass, and the dog was euthanized. A postmortem examination revealed that the left liver lobes were largely replaced by a white-to-tan multilobular mass with a cobblestone surface. The lesion also involved the diaphragm. Histologically, hepatic architecture was effaced by large areas of necrosis with numerous, ≤0.2-cm, cystic structures that stained positively with periodic acid–Schiff stain and contained calcareous corpuscles. Gross and microscopic hepatic lesions were compatible with alveolar echinococcosis (AE) caused by Echinococcus multilocularis. PCR examination confirmed E. multilocularis, and results from genotyping were consistent with the E4 haplotype. To our knowledge, this is only the second canine AE case and the third pet dog that has been confirmed to be infected by E. multilocularisin the contiguous United States. E. multilocularisis a serious health risk for both pet dogs and humans.

Types are designated for the names of two species of Helicteres(Malvaceae: Helicteroideae) described by Linnaeus. A lectotype is designated for H. angustifoliaand a neotype for H. pentandra.

Double‐crested cormorants (Phalacrocorax auritus) recovered from a demographic bottleneck so well that they are now considered a nuisance species at breeding and wintering grounds across the United States and Canada. Management of this species could be improved by refining genetic population boundaries and assigning individuals to their natal population. Further, recent radio‐telemetry data suggest the existence of Interior and Atlantic migratory flyways, which could reduce gene flow and result in substantial genetic isolation. In this study, we used 1,784 individuals collected across the eastern United States, a large panel of microsatellite markers developed for this species, and individuals banded as chicks and recaptured as adults to explore the effects of migratory flyways on population structure, quantify the genetic effects of demographic bottlenecks, and determine whether individuals could be assigned to their natal population based on genotype. We found evidence for genetic population division only along migratory flyways, no evidence of genetic bottlenecks, and mixed effectiveness of assignment tests. Our population structure findings suggest that gene flow is high across large scales; for example, individuals from New York, Minnesota, and Alabama are all in panmixia. We also found that traditional subspecies ranges may not be valid because >1 subspecies was present in single genetic populations. The lack of evidence for genetic bottlenecks also likely underscores the vagility of this species, suggesting that even during demographic bottlenecks, populations were not isolated from allelic exchange. Finally, the failure of assignment tests to consistently perform is likely due in part to imperfect a priorisampling of Atlantic and Interior chicks and the high vagility of adults. We conclude that the demographic bottleneck is not likely to have reduced genetic diversity, and that assignment tests remain unreliable for this species. We recommend double‐crested cormorants be managed by flyway. Further development of genomic resources in this species could improve population subdivision resolution, improve assignment tests, and reveal further information on demographic histories. © 2020 The Wildlife Society. Population genetic analyses of double‐crested cormorants in eastern North America suggest that there are 2 populations that coincide with the Mississippi River and Atlantic Coast migratory flyways and cut across traditional subspecies designations, which may affect management. Despite experiencing a severe demographic bottleneck in the twentieth century, these populations exhibit high genetic diversity, relatively high allelic exchange, and no evidence of recent genetic bottlenecks.

Supplemental Digital Content is available in the text.Many medical schools are instituting gender equity initiatives to address long-standing inequities (e.g., salary, leadership positions, resource distribution) between women and men in academic medicine. However, few theory-driven models exist with built-in metrics to assess the impact of gender equity initiatives. The authors describe the theory- and metric-driven process used to create the Center for Women in Medicine and Science (CWIMS) at the University of Minnesota (UMN) Medical School. An innovative theory-driven approach using community-based participatory research (CBPR) was used to create and organize CWIMS. CBPR acknowledges community members (e.g., faculty members, staff), academic organizational representatives (e.g., department heads, center directors), and administrative leaders (e.g., deans) as equal contributors in carrying out all aspects of gender equity work. CBPR values collaborative approaches that empower faculty, promote co-learning and co-creation of initiatives among all university partners, and build upon already existing community strengths and resources. Four CWIMS action groups were created using CBPR principles. The action groups are retention and recruitment; mentoring; salary, resource, and leadership equity; and strategic communications and collaborations. Faculty members across all medical school departments joined these 4 action groups to co-create and carry out all CWIMS gender equity initiatives. The process of developing the CWIMS center and action groups, the CBPR theoretical model guiding the approach, the initiatives developed by the action groups and metrics created, and the outcomes achieved to date are described. In addition, 4 lessons learned from the development of the CWIMS—use of theoretically driven and evidence-based models is key to building a sustainable organization; bottom-up and top-down engagement of partners is crucial for sustainability; passion and innovation are critical for long-term momentum; and not all faculty members and leaders will be enthusiastic about gender equity issues—are shared for the benefit of other medical schools wanting to develop similar centers.

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Avian predation in catfish aquaculture has been a persistent issue throughout the history of the industry, and as production has expanded predation from piscivorous birds has intensified. Catfish ponds in the Mississippi River delta (in the Mississippi migratory flyway) provide a constant and readily accessible supply of forage for birds. Intensive foraging by fish‐eating birds has led to a specific regulatory policy and numerous on‐farm and regional management efforts. However, in 2016, legal challenges lead to recision of some federal policies and uncertainty as to allowable management, resulting in limitations on bird depredation. Estimating the extent of fish losses to avian predators is difficult, as loss estimates from farms are often confounded with disease‐ and management‐related mortalities. This study details the reported losses to birds that were observed in commercial‐scale catfish ponds at the Thad Cochran National Warmwater Aquaculture Center, Stoneville, Mississippi, during periods of limited bird management. The observed fish losses attributed to birds ranged from 33% to 95% loss in survival and potential yield losses of 4,396 to 8,889 lb/acre, increasing production costs and decreasing net returns. Net economic losses when accounting for negative net returns and lost profits ranged from US$3,518 to $4,060/acre. Losses of this magnitude on commercial fish farms are economically detrimental, especially because catfish farms lack the compensatory economic relief programs that are available in other agriculture sectors. Roost dispersal activities that are organized by federal agencies and avoiding delays in issuing bird depredation permits are vital for mitigating this persistent and growing regulatory problem in the U.S. catfish industry.

Epitope-specific enzymes are powerful tools for site-specific protein modification but generally require genetic manipulation of the target protein. Here, we describe the laboratory evolution of the bacterial transpeptidase sortase A to recognize the LMVGG sequence in endogenous amyloid-β (Aβ) protein. Using a yeast display selection for covalent bond formation, we evolved a sortase variant that prefers LMVGG substrates from a starting enzyme that prefers LPESG substrates, resulting in a >1,400-fold change in substrate preference. We used this evolved sortase to label endogenous Aβ in human cerebrospinal fluid, enabling the detection of Aβ with sensitivities rivaling those of commercial assays. The evolved sortase can conjugate a hydrophilic peptide to Aβ42, greatly impeding the ability of the resulting protein to aggregate into higher-order structures. These results demonstrate laboratory evolution of epitope-specific enzymes toward endogenous targets as a strategy for site-specific protein modification without target gene manipulation and enable potential future applications of sortase-mediated labeling of Aβ peptides.

Molecular phylogenetic analyses of Malvaceae subfamily Dombeyoideae based on a 6‐marker dataset sampling all 21 currently accepted genera (including extinct Astyria) yielded improved resolution and evidence for multiple generic circumscription problems. The taxonomy of the subfamily is adjusted with the synonymization of 10 genera (eight in current use) and the description of one new one, for a revised Dombeyoideae comprised of 14 genera and supported by morphological, anatomical, and/or palynological evidence. Eriolaenais expanded from a narrow Indo‐Asian group to include the Malagasy endemic genera Helmiopsisand Helmiopsiella, and a recently described species from continental Africa. A conspectus is presented of the new broadly circumscribed Eriolaenawith 27 species (28 taxa, including 3 new Malagasy species and 16 new combinations) and defined by a unique winged‐seed morphology. A new monotypic Malagasy genus (Hafotra), resolved as sister to Eriolaena, is described. A conspectus is presented of a broadly circumscribed Mascarene‐Malagasy Ruizia(+ Astyriaand Trochetia, with 13 new combinations). Two other genera are expanded and recircumscribed: Melhania(+ Trochetiopsisand Paramelhania, with one new name and two new combinations) and Corchoropsis(+ Paradombeya, with two new combinations). Additionally, two genera are typified, and 21 names are lectotypified.

Biological systems assemble living materials that are autonomously patterned, can self-repair and can sense and respond to their environment. The field of engineered living materials aims to create novel materials with properties similar to those of natural biomaterials using genetically engineered organisms. Here, we describe an approach to fabricating functional bacterial cellulose-based living materials using a stable co-culture of Saccharomyces cerevisiaeyeast and bacterial cellulose-producing Komagataeibacter rhaeticusbacteria. Yeast strains can be engineered to secrete enzymes into bacterial cellulose, generating autonomously grown catalytic materials and enabling DNA-encoded modification of bacterial cellulose bulk properties. Alternatively, engineered yeast can be incorporated within the growing cellulose matrix, creating living materials that can sense and respond to chemical and optical stimuli. This symbiotic culture of bacteria and yeast is a flexible platform for the production of bacterial cellulose-based engineered living materials with potential applications in biosensing and biocatalysis.

With the morbidity and mortality associated with the COVID‐19 pandemic that we are witnessing this year, the risks posed by emerging viral diseases to global health are all too obvious. This pandemic highlights the importance of antiviral drug discovery, which targets emerging viral pathogens, as well as existing pathogenic viruses that undergo continuous evolution. Drug discovery and development is a long and resource intensive process; however, the use of biomarkers can accelerate clinical development of antivirals by providing information regarding diagnosis of specific viral infections, status of infection, potential safety parameters, and antiviral responses. In clinical practice, many of the biomarkers initially utilized to support clinical development are also used for patient care. While viral load is a standard and essential biomarker used to detect the desired viral suppression induced by an antiviral agent, it has become apparent that additional biomarkers, whether related to the virus, the host or as a consequence of the drug's mechanistic effects, are also important for monitoring clinical outcomes associated with an antiviral therapy. This review summarizes the biomarkers used in the clinical development (as well as in clinical practice, where appropriate) of antiviral therapies for hepatitis C virus, hepatitis B virus, human immunodeficiency virus, and severe acute respiratory syndrome coronavirus 2.

Introduction: Clostridioides (Clostridium)difficileinfection, the leading cause of healthcare-associated diarrhea, represents a significant burden on global healthcare systems. Despite being a global issue, information on C. difficilefrom a global perspective is lacking. The aim of this study is to model the global phylogeography of clinical C. difficile. Methods: Using samples collected from the MODIFY I and II studies (NCT01241552, NCT01513239), we performed whole-genome sequencing of 1501 clinical isolates including 37 novel sequence types (STs), representing the largest worldwide collection to date. Results: Our data showed ribotypes, multi-locus sequence typing clades, and whole-genome phylogeny were in good accordance. The clinical C. difficilegenome was found to be more conserved than previously reported (61% core genes), and modest recombination rates of 1.4–5.0 were observed across clades. We observed a significant continent distribution preference among five C. difficileclades (Benjamini-Hochberg corrected Fisher’s exact test P&lt; 0.01); moreover, weak association between geographic and genetic distance among ribotypes suggested sources beyond healthcare-related transmission. Markedly different trends of antibiotic susceptibility among lineages and regions were identified, and three novel mutations (in pyridoxamine 5′-phosphate oxidase family protein: Tyr130Ser, Tyr130Cys, and a promoter SNP) associated with metronidazole-reduced susceptibility were discovered on a nim-related gene and its promotor by genome-wide association study. Toxin gene polymorphisms were shown to vary within and between prevalent ribotypes, and novel severe mutations were found on the tcdC toxin regulator protein. Conclusion: Our systematic characterization of a global set of clinical trial C. difficileisolates from infected individuals demonstrated the complexity of the genetic makeup of this pathogenic organism. The geographic variability of clades, variability in toxin genes, and mutations associated with antibiotic susceptibility indicate a highly complex interaction of C. difficilebetween host and environment. This dataset will provide a useful resource for validation of findings and future research of C. difficile.

Double‐crested cormorants (Phalacrocorax auritus) and great egrets (Ardea alba) have an extensive history of human‐wildlife conflict with the aquaculture industry of western Mississippi, USA, due to their depredation of cultured catfish (Ictalurusspp.). Although aquaculture is abundant, western Mississippi also contains naturally occurring water bodies that offer alternative forage opportunities to these species. How cormorants or egrets distribute themselves among these 2 foraging options is unknown, but it has been generally assumed each species uses aquaculture disproportionately more because of the high density of available prey. To test this assumption, we surveyed these species on aquaculture and naturally occurring water bodies using aerial surveys from October through April of 2015–2016, 2016–2017, and 2017–2018. We modeled the proportion of each species on aquaculture as a function of year, date, and weather‐related variables using quasi‐binomial generalized linear models. Egrets used aquaculture consistently more than what was proportionally available to them and use was not influenced by any of the variables we measured. Proportional use of aquaculture by cormorants was lowest during October through January but steadily increased through April, indicating a distribution shift toward aquaculture in the months immediately prior to their migration. The highest proportional use of aquaculture by cormorants occurred in 2016, a year when lethal control measures were not allowed against cormorants. Conversely, the least proportion of cormorants on aquaculture was in 2015 when cormorants could be lethally controlled under authority of an Aquaculture Depredation Order. This trend highlights the potential influence of changes in mortality risk, caused by changes in policy regarding lethal take of cormorants, on cormorant distribution between foraging options. © 2020 The Wildlife Society. We found greater proportions of double‐crested cormorants on aquaculture ponds relative to natural water bodies seasonally during spring, under wetter conditions, and in years when lethal management was limited, suggesting mortality risk altered cormorant distribution and reduced depredation. Great egret use of aquaculture was consistently more than proportionally available and was not influenced by other measured environmental factors.

ABSTRACTIntroductionTriple negative breast cancer (TNBC) was once thought to be an insurmountable disease marked by a lack of targeted treatments. However, we are now witnessing the dawn of targeted therapies for TNBC in which progress has stemmed from an improved understanding of the components that make TNBC unique. The identification of biomarkers, such as BRCA1/2, PIK3CA and RSK2, have advanced the field remarkably and there is considerable interest in finding novel therapeutics for TNBC that offer durable clinical benefit with fewer adverse events.Areas coveredWe discuss phase I/II trials of new and emerging targeted therapies for TNBC, according to ClinicalTrials.gov up to June 2020. Although the emphasis is on ongoing and completed early phase trials, we also highlight pivotal studies that have led to the approval of new targeted classes of drugs for TNBC, with a focus on outcomes and common adverse events of each class of therapy.Expert opinionThe way forward for TNBC treatment is through precision medicine. The use of novel agents matched with biomarkers to identify patients with the best chance of sustainable response offers new hope. We now have great potential for improving the outcomes for patients with TNBC.

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Purpose: As Baby Boomers continue to retire, organizations should have plans in place that successfully execute this transition. Some industries, such as accounting, are unique in that there is specialized knowledge required by employees, including education and work experience. This study examines what accounting organizations are doing to manage this transition. The research question posed is as follows: How are organizations in the accounting industry addressing anticipated retirements?. Design/methodology/approach: This is a qualitative study that is interpretive. In order to answer the research question, six managers who are involved in the hiring process at accounting organizations of varying sizes were interviewed. Semi-structured interviews were conducted and coded using the software program, Dedoose, in order to develop themes that addressed the research question. Findings: By conducting semi-structured interviews that focused on efforts related to this issue, it was found that accounting organizations are focusing on three aspects related to the research question: Accounting firms are focusing on (1) culture, (2) knowledge and (3) transition as they lead their organizations through this time. Practical implications: This research project provides insight into how some accounting organizations are managing issues related to increasing retirements. By knowing how other organizations are handling these issues, accounting organizations can use this knowledge to prepare, themselves, for anticipated retirements. This knowledge is also valuable in other fields that provide professional services (e.g., medical and legal). Originality/value: This topic has not been fully explored in the accounting industry. The findings of this study are useful to accounting firms, world-wide, as well as to organizations in other professional services fields, world-wide. This research could be further explored in other professional services organizations, such as the health and legal fields.

The use of moderate sedation in children for the performance of a variety of diagnostic imaging tests and therapeutic interventions outside of the operating room, not directly supervised by an anesthesiologist, has been successful and well-documented in recent years. However, to date, all published reports describe only physicians as the primary provider performing the moderate sedation. In this article, we discuss our development of a nurse practitioner (NP)-led pediatric sedation program and a 7-year review of practice. We discuss the development of our NP-led team including key elements such as necessary personnel, process components, and guidelines for pharmacologic agents. We also present our practice outcomes, demonstrating an annual increase in patient volumes, a procedure success rate of 99.5%, and the occurrence of no major adverse events. NPs are an effective, safe alternative to physicians as the primary provider for this specialty service.

Bezlotoxumab is a fully human monoclonal antibody that binds and neutralizes Clostridium difficiletoxin B. This analysis investigated the potential of bezlotoxumab to induce immunogenicity in healthy phase 1 trial participants and in phase 2/3 trial participants receiving oral antibacterial therapy for primary or recurrent C difficileinfection. Immunogenicity to bezlotoxumab was evaluated following a single intravenous dose (≤20 mg/kg) or 2 consecutive doses (10 mg/kg) given 84 days apart in healthy participants across 3 phase 1 trials (Protocol MK‐3415A‐004, N = 30; Protocol CA‐GCDX‐05‐01, N = 54; Protocol MK‐3415A‐006, N = 12) and following a single 10 mg/kg dose in 1 phase 2 trial (Protocol CA‐GCDX‐06‐02, ClinicalTrials.gov identifier: NCT00350298; N = 97) and 2 phase 3 trials (Protocols MK‐3415A‐001 and MK‐3415A‐002, ClinicalTrials.gov identifiers: NCT01241552 and NCT01513239; N = 1414). No treatment‐emergent antidrug antibodies were observed following single or repeated dosing of bezlotoxumab. No phase 1 participants and only 1 phase 2 participant tested positive before bezlotoxumab exposure (non–treatment‐emergent positive). Nine participants tested non–treatment‐emergent positive in phase 3 trials, 1 of whom was neutralizing antibody–positive. Overall, the immunogenicity potential of bezlotoxumab is considered to be low.

Raptor nests on human‐built structures represent a significant source of conflict, as they can result in bird mortality, fires, or power outages due to falling nest materials or animals connecting with energized conductors. Power companies typically try to mitigate these conflicts to avoid service disruptions. Performing mitigation measures across all potentially problematic power infrastructure is generally not a practical solution given logistical, time, or budgetary constraints. Therefore, there is a need for quantitative, landscape‐scale tools to identify conflict risk and prioritize mitigation. We examined the influence of habitat and transmission infrastructure distribution on the potential risk of osprey (Pandion haliaetus) nesting‐infrastructure conflict in the Tennessee Valley Authority (TVA) power service area within Tennessee, Alabama, Georgia, Kentucky, Mississippi, North Carolina, and Virginia, USA, using osprey nesting and conflict records from 1990–2020. We modeled risk using a 3‐stage approach, which intersected a nesting habitat suitability model and density of infrastructure to evaluate the potential risk of conflict. Habitat suitability was greater on or near open water and closer to developed areas. Transmission line density was low (0.14 ± 0.29 lines/km2) and heterogenous across the service area with more lines within urban centers and near power facilities. Integrating habitat suitability and transmission infrastructure information revealed that very low and low‐risk areas comprised 99% of the service area. Less than 1% comprised 1,113.7 km2of moderate and 82.2 km2of high or very high risk, mostly concentrated along major rivers and lakes, and around urban centers. Risk was more prevalent in the northeastern portion of the service area. This work presents a top‐down approach to mitigating osprey–power infrastructure conflict, which allows for the prioritization of mitigation actions and can facilitate long‐term coexistence with this protected species. We present a top‐down approach to mitigating osprey‐transmission infrastructure conflict, allowing for information about potential conflict risk across a given power service area to help inform the prioritization of mitigation actions and facilitate long‐term coexistence with this protected species.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2007.05.018 Byline: Anouk E. Muller (a), Joost DeJongh (c), Paul M. Oostvogel (b), Rob A. Voskuyl (d), P. Joep Dorr (b), Meindert Danhof (d), Johan W. Mouton (e) Keywords: clearance; interindividual variability; pregnancy; preterm premature rupture of the membranes; volume of distribution Abstract: This study was undertaken to study the pharmacokinetics of intravenously administered amoxicillin in pregnant women with preterm premature rupture of the membranes (PPROM). Author Affiliation: (a) Department of Obstetrics and Gynecology, Medical Centre Haaglanden, Lijnbaan, the Hague (b) Department of Clinical Microbiology, Medical Centre Haaglanden, Lijnbaan, the Hague (c) LAP&P Consultants BV, Leiden, the Netherlands (d) Division of Pharmacology, Leiden/Amsterdam Center for Drug Research, Leiden University, Leiden, the Netherlands (e) Department of Clinical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands. Article History: Received 2 January 2007; Revised 21 February 2007; Accepted 11 May 2007 Article Note: (footnote) Reprints not available from the authors. Supported by a grant from the Stichting Nuts Ohra (SNO-T-06-31). Cite this article as: Muller AE, DeJongh J, Oostvogel PM, et al. Amoxicillin pharmacokinetics in pregnant women with preterm premature rupture of the membranes. Am J Obstet Gynecol 2008;198:108.e1-108.e6.

Tacrolimus trough and dose requirements vary dramatically between individuals of European and African American ancestry. These differences are less well described in other populations. We conducted an observational, prospective, multicenter study from which 2595 kidney transplant recipients of European, African, Native American, and Asian ancestry were studied for tacrolimus trough, doses, and genetic determinants of metabolism. We studied the well-known variants and conducted a CYP3A4/5 gene-wide analysis to identify new variants. Daily doses, and dose-normalized troughs were significantly different between the four groups (P< .001). CYP3A5*3(rs776746) was associated with higher dose-normalized tacrolimus troughs in all groups but occurred at different allele frequencies and had differing effect sizes. The CYP3A5*6(rs10264272) and *7(rs413003343) variants were only present in African Americans. CYP3A4*22(rs35599367) was not found in any of the Asian ancestry samples. We identified seven suggestive variants in the CYP3A4/5 genes associated with dose-normalized troughs in Native Americans (P= 1.1 × 10−5-8.8 × 10−6) and one suggestive variant in Asian Americans (P= 5.6 × 10−6). Tacrolimus daily doses and dose-normalized troughs vary significantly among different ancestry groups. We identified potential new variants important in Asians and Native Americans. Studies with larger populations should be conducted to assess the importance of the identified suggestive variants.