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The triadic comparison of technology options (tricot) approach to participatory varietal selection has been demonstrated to scale out the on‐farm testing of elite candidate crop varieties. In this study, we evaluated elite clones of cassava (Manihot esculenta Crantz) using the tricot approach. We sought to (1) synthesize on‐farm trial data from two cycles evaluating different sets of elite cassava clones; (2) assess the agronomic performance of elite cassava clones considering sociodemographic and climatic factors; and (3) assess the performance of elite cassava clones for both agronomic and food quality traits. The study involved 10 districts in Uganda, two cycles/seasons of evaluation, 20 elite cassava clones, one check variety, and 294 men and 320 women farmers. Our results indicate that the agronomic performance of elite cassava clones was influenced more by geographic than sociodemographic factors. Our analysis identified the number of days with rainfall higher than 20 mm as the most influencing climatic factor over agronomic performance. Further, the study identified superior elite cassava clones UG110164, UGC14170, and UG120193 as promising candidate varieties for release, targeting food products. Overall, our study emphasizes the important contribution of end‐users to crop improvement and provides insights into use of tricot on‐farm testing methodology to evaluate elite cassava clones during cassava variety development in Uganda, which can be used to support decision making for variety release. Core Ideas: We applied the tricot (triadic comparison of technology options) approach to evaluate elite cassava clones on‐farm, exploring how the linked data can be used to advance clones for breeding.We used a rank‐aggregation approach to assess the on‐farm performance of two different sets of elite cassava clones.We assessed the effect of sociodemographic and geographic factors on the on‐farm agronomic performance of elite cassava clones.We assessed the performance of elite cassava clones for beneficial agronomic and food quality traits for consideration in advancement and varietal release. [ABSTRACT FROM AUTHOR]

Field‐scale experiments have shown the Natural Flood Management (NFM) potential of peatland restoration. The likelihoods of effectiveness are yet unknown at scales and storms large enough to impact human lives. Using GMD‐TOPMODEL, we upscale a rare Before‐After‐Control‐Intervention empirical data set to a 25 km2 catchment with >600 properties at flood‐risk, and test storms of up to a 1,000‐year return period (RP). Under these scales/storms, we find that it is not necessary (nor feasible) to delay the outlet flow‐peak to meaningfully attenuate it. Enhancing catchment "kinematic" storage, for example, through restoration, can be sufficient to reduce flow magnitudes without detectable changes to peak‐flow timing. NFM benefit increases exponentially with restoration area size under smaller storms, but linearly under larger storms. At RP ≤ 100 years, longer‐lasting frontal‐type storms are more challenging to defend against via NFM, but at RP > 100 years shorter‐duration convectional‐type events become more challenging. In the order of 1,000–10 years storms: (a) revegetating the bare‐peat areas in 15% of the catchment is 31%–61% likely to reduce peak‐flows by >5%; (b) revegetating & damming the erosion gullies in ∼20% of the catchment is 42%–71% likely to reduce peak‐flows by >5%; (c) Growth of Sphagnum in the dammed gullies of ∼20% and ∼40% of the catchment increase the likelihoods of >5% peak reductions to 65%–86% and 90%–98%, respectively. The numerical evidence of significant NFM benefit due to Sphagnum re‐establishment is an important finding, because it shows that meaningful flood‐risk mitigation in headwater catchments under scales/storms relevant to communities at risk can be delivered alongside other ecosystem benefits of Sphagnum re‐establishment. Key Points: At catchment scale, it is not necessary (nor feasible) to delay the flood‐wave to meaningfully attenuate it at the outletDeferring only a portion of the flood volume to the receding limb can be sufficient for meaningful flood risk mitigation at catchment scaleThrough Sphagnum re‐establishment, significant Natural Flood Management + ecosystem benefits can be delivered at scales/storms relevant to communities at risk [ABSTRACT FROM AUTHOR]

Technical complexity associated with biodegradation testing, particularly for substances of unknown or variable composition, complex reaction products, or biological materials (UVCB), necessitates the advancement of non‐testing methods such as quantitative structure–property relationships (QSPRs). Models for describing the biodegradation of petroleum hydrocarbons (HCs) have been previously developed. A critical limitation of available models is their inability to capture the variability in biodegradation rates associated with variable test systems and environmental conditions. Recently, the Hydrocarbon Biodegradation System Integrated Model (HC‐BioSIM) was developed to characterize the biodegradation of HCs in aquatic systems with the inclusion of key test system variables. The present study further expands the HC‐BioSIM methodology to soil and sediment systems using a database of 2195 half‐life (i.e., degradation time [DT]50) entries for HCs in soil and sediment. Relevance and reliability criteria were defined based on similarity to standard testing guidelines for biodegradation testing and applied to all entries in the database. The HC‐BioSIM soil and sediment models significantly outperformed the existing biodegradation HC half‐life (BioHCWin) and virtual evaluation of chemical properties and toxicities (VEGA) quantitative Mario Negri Institute for Pharmacological Research (IRFMN) models in soil and sediment. Average errors in predicted DT50s were reduced by up to 6.3‐ and 8.7‐fold for soil and sediment, respectively. No significant bias as a function of HC class, carbon number, or test system parameters was observed. Model diagnostics demonstrated low variability in performance and high consistency of parameter usage/importance and rule structure, supporting the generalizability and stability of the models for application to external data sets. The HC‐BioSIM provides improved accuracy of Persistence categorization, with correct classification rates of 83.9%, and 90.6% for soil and sediment, respectively, demonstrating a significant improvement over the existing BioHCWin (70.7% and 58.6%) and VEGA (59.5% and 18.5%) models. Environ Toxicol Chem 2024;43:1352–1363. © 2024 Concawe. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC. [ABSTRACT FROM AUTHOR]

Introduction: Gamma‐hydroxybutyrate (GHB) use is associated with high risk of accidental overdose. This study examined the pre‐hospital circumstances, demographic characteristics and clinical outcomes of analytically confirmed GHB emergency department (ED) presentations in Western Australia (WA). Methods: This case series was conducted across three WA EDs involved in the Emerging Drugs Network of Australia, from April 2020 to July 2022. Patient demographics, pre‐hospital drug exposure circumstances and ED presentation and outcome characteristics were collected from ambulance and hospital medical records of GHB‐confirmed cases. Results: GHB was detected in 45 ED presentations. The median age was 34 years and 53.3% (n = 24) were female. Most patients arrived at the ED by ambulance (n = 37, 85.7%) and required immediate emergency care (Australasian Triage Score 1 or 2 = 97.8%). One‐third of patients were admitted to intensive care (n = 14, 31.1%). Methylamphetamine was co‐detected in 37 (82.2%) GHB‐confirmed cases. Reduced conscious state was indicated by first recorded Glasgow Coma Scale of ≤8 (n = 29, 64.4%) and observations of patients becoming, or being found, 'unresponsive' and 'unconscious' in various pre‐hospital settings (n = 28, 62.2%). 'Agitated' and/or 'erratic' mental state and behavioural observations were recorded in 20 (44.4%) cases. Discussion and Conclusions: Analytically verified data from ED presentations with acute toxicity provides an objective information source on drug use trends and emerging public health threats. In our study, patients presenting to WA EDs with GHB intoxication were acutely unwell, often requiring intensive care treatment. The unexpectedly high proportion of female GHB intoxications and methylamphetamine co‐ingestion warrants further exploration. [ABSTRACT FROM AUTHOR]

In pursuit of a suitable scaffold material for cardiac valve tissue engineering applications, an acellular, electrospun, biodegradable polyester carbonate urethane urea (PECUU) scaffold was evaluated as a pulmonary valve leaflet replacement in vivo. In sheep (n = 8), a single pulmonary valve leaflet was replaced with a PECUU leaflet and followed for 1, 6, and 12 weeks. Implanted leaflet function was assessed in vivo by echocardiography. Explanted samples were studied for gross pathology, microscopic changes in the extracellular matrix, host cellular re‐population, and immune responses, and for biomechanical properties. PECUU leaflets showed normal leaflet motion at implant, but decreased leaflet motion and dimensions at 6 weeks. The leaflets accumulated α‐SMA and CD45 positive cells, with surfaces covered with endothelial cells (CD31+). New collagen formation occurred (Picrosirius Red). Accumulated tissue thickness correlated with the decrease in leaflet motion. The PECUU scaffolds had histologic evidence of scaffold degradation and an accumulation of pro‐inflammatory/M1 and anti‐inflammatory/M2 macrophages over time in vivo. The extent of inflammatory cell accumulation correlated with tissue formation and polymer degradation but was also associated with leaflet thickening and decreased leaflet motion. Future studies should explore pre‐implant seeding of polymer scaffolds, more advanced polymer fabrication methods able to more closely approximate native tissue structure and function, and other techniques to control and balance the degradation of biomaterials and new tissue formation by modulation of the host immune response. [ABSTRACT FROM AUTHOR]

Trastuzumab has demonstrated clinical efficacy in the treatment of HER2‐positive serous endometrial cancer (EC), which led to its incorporation into standard‐of‐care management of this aggressive disease. Acquired resistance remains an important challenge, however, and its underlying mechanisms in EC are unknown. To define the molecular changes that occur in response to anti‐HER2 therapy in EC, targeted next‐generation sequencing (NGS), HER2 immunohistochemistry (IHC), and fluorescence in situ hybridization (FISH) were performed on pre‐ and post‐treatment tumour samples from 14 patients with EC treated with trastuzumab or trastuzumab emtansine. Recurrent tumours after anti‐HER2 therapy acquired additional genetic alterations compared with matched pre‐treatment ECs and frequently showed decreased HER2 protein expression by IHC (7/14, 50%). Complete/near‐complete absence of HER2 protein expression (score 0/1+) observed post‐treatment (4/14, 29%) was associated with retained HER2 gene amplification (n = 3) or copy number neutral status (n = 1). Whole‐exome sequencing performed on primary and recurrent tumours from the latter case, which exhibited genetic heterogeneity of HER2 amplification in the primary tumour, revealed selection of an early HER2‐non‐amplified clone following therapy. Our findings demonstrate that loss of target expression, by selection of HER2‐non‐amplified clones or, more commonly, by downregulation of expression, may constitute a mechanism of resistance to anti‐HER2 therapy in HER2‐positive EC. © 2023 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: In 2014, the Hazelwood coalmine fire shrouded the regional Australian town of Morwell in smoke and ash for 6 weeks. One of the fire's by‐products, PM2.5, is associated with an increased risk of COVID‐19 and severe disease. However, it is unclear whether the effect persisted for years after exposure. In this study, we surveyed a cohort established prior to the pandemic to determine whether PM2.5 from the coalmine fire increased long‐term vulnerability to COVID‐19 and severe disease. Methods: From August to December 2022, 612 members of the Hazelwood Health Study's adult cohort, established in 2016/17, participated in a follow‐up survey that included standardized items to capture COVID‐19 cases, as well as questions about hospitalization and vaccinations. Associations were evaluated in crude and adjusted logistic regression models. Results: A total of 268 (44%) participants self‐reported or met symptom criteria for having had COVID‐19 at least once. All models found a positive association, with odds of COVID‐19 increasing by between 4% and 30% for a 10 μg/m3 increase in coalmine fire‐related PM2.5 exposure. However, the association was significant in only 2 of the 18 models. There were insufficient hospitalizations to examine severity (n = 7; 1%). Conclusion: The findings are inconclusive on the effect of coalmine fire‐related PM2.5 exposure on long‐term vulnerability to COVID‐19. Given the positive association that was robust to modelling variations as well as evidence for a causal mechanism, it would be prudent to treat PM2.5 from fire events as a long‐term risk factor until more evidence accumulates. Surveying a cohort established before the pandemic, we investigated long‐term COVID‐19 vulnerability due to coalmine fire smoke exposure. There was a positive but generally non‐significant association between PM2.5 and COVID‐19. It would therefore be prudent to treat extreme but discrete coalmine fire smoke as a long‐term COVID‐19 risk factor. See relatededitorial [ABSTRACT FROM AUTHOR]

This article discusses granulomatous mastitis (GM), a condition primarily affecting premenopausal women. It explores the use of systemic immunosuppression as a treatment for refractory GM and finds that drugs like methotrexate, hydroxychloroquine, and mycophenolate can induce remission and improve symptoms. However, the evidence for these treatments is limited, and more research is needed. The study emphasizes the importance of considering individual patient circumstances when deciding on treatment options. [Extracted from the article]

We examine the determinants of the levels of forward contracting preferred by generators and buyers of electricity. Increased forward contracting systematically reduces the variance of a generator's profit, so a generator prefers higher levels of forward contracting as market uncertainty or its aversion to risk increases. In contrast, increased forward contracting can either increase or reduce the variance of a buyer's profit. Consequently, a buyer can prefer either reduced or increased levels of forward contracting as market uncertainty or its aversion to risk increases. [ABSTRACT FROM AUTHOR]

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This paper highlights how immersive educational experiences can help students understand the United Nations' Sustainable Development Goals (SDGs) and their relation to leadership. The paper provides an example of how a carefully designed faculty‐led program using original research can cultivate cross‐cultural competencies and build student knowledge and skills to support sustainability. Educators can use this paper as a guide to other immersive experiences to address the SDGs while developing student leadership capacity. [ABSTRACT FROM AUTHOR]

Objective: Evaluate 2‐year outcomes after lidocaine/epinephrine iontophoresis and tympanostomy using an automated tube delivery system for pediatric tube placement in‐office. Study Design: Prospective, single‐arm. Setting: Eighteen otolaryngology practices. Methods: Children age 6 months to 12 years indicated for tympanostomy were enrolled between October 2017 and February 2019. Local anesthesia of the tympanic membrane was achieved via lidocaine/epinephrine iontophoresis and tympanostomy was completed using an automated tube delivery system (the Tula® System). An additional Lead‐In cohort of patients underwent tube placement in the operating room (OR) under general anesthesia using only the tube delivery system. Patients were followed for 2 years or until tube extrusion, whichever occurred first. Otoscopy and tympanometry were performed at 3 weeks, and 6, 12, 18, and 24 months. Tube retention, patency, and safety were evaluated. Results: Tubes were placed in‐office for 269 patients (449 ears) and in the OR for 68 patients (131 ears) (mean age, 4.5 years). The median and mean times to tube extrusion for the combined OR and In‐Office cohorts were 15.82 (95% confidence interval [CI]: 15.41‐19.05) and 16.79 (95% CI: 16.16‐17.42) months, respectively. Sequelae included ongoing perforation for 1.9% of ears (11/580) and medial tube displacement for 0.2% (1/580) observed at 18 months. Over a mean follow‐up of 14.3 months, 30.3% (176/580) of ears had otorrhea and 14.3% (83/580) had occluded tubes. Conclusion: In‐office pediatric tympanostomy using lidocaine/epinephrine iontophoresis and automated tube delivery results in tube retention within the ranges described for similar grommet‐type tubes and complication rates consistent with traditional tube placement in the OR. [ABSTRACT FROM AUTHOR]

Preference signaling has been implemented in the residency application process in response to the challenges posed by the COVID-19 pandemic. This system allows students to send a set number of signals to programs of interest, without ranking them. The goal is to provide a fair and credible way for students to receive special attention from their preferred programs. Preference signaling has been adopted by various medical specialties and has shown positive outcomes, including improving the likelihood of receiving interview offers and combating interview hoarding. However, there is a need for clear communication and transparency regarding how programs value signals, as well as consistent compliance with signaling guidelines. Future research should focus on optimizing preference signaling and clarifying the utility of non-signal applications. The collaboration between organizations has benefited not only Otolaryngology but also residency programs across medicine and the thousands of medical students who apply each year. [Extracted from the article]

The Collaborative Computational Project No. 4 (CCP4) is a UK‐led international collective with a mission to develop, test, distribute and promote software for macromolecular crystallography. The CCP4 suite is a multiplatform collection of programs brought together by familiar execution routines, a set of common libraries and graphical interfaces. The CCP4 suite has experienced several considerable changes since its last reference article, involving new infrastructure, original programs and graphical interfaces. This article, which is intended as a general literature citation for the use of the CCP4 software suite in structure determination, will guide the reader through such transformations, offering a general overview of the new features and outlining future developments. As such, it aims to highlight the individual programs that comprise the suite and to provide the latest references to them for perusal by crystallographers around the world. [ABSTRACT FROM AUTHOR]

Historical data on co‐occurring taxa are extremely rare. As such, the extent to which distinct co‐occurring taxa experience similar long‐term patterns in species richness and compositional change (e.g., when exposed to a changing environment) is not clear. Using data from a diverse ecological community surveyed in the 1930s and resurveyed in the 2010s, we investigated whether local plant and insect assemblages displayed cross‐taxon congruence—that is, spatiotemporal correlation in species richness and compositional change—across six co‐occurring taxa: vascular plants, non‐vascular plants, grasshoppers and crickets (Orthoptera), ants (Hymenoptera: Formicinae), hoverflies (Diptera: Syrphidae), and dragonflies and damselflies (Odonata). All taxa exhibited high levels of turnover across the ca. 80‐year time period. Despite minimal observed changes at the level of the whole study system, species richness displayed widespread cross‐taxon congruence (i.e., correlated temporal change) across local assemblages within the study system. Hierarchical logistic regression models suggest a role for shared responses to environmental change underlying cross‐taxon correlations and highlight stronger correlations between vascular plants and their direct consumers, suggesting a possible role for biotic interactions between these groups. These results provide an illustration of cross‐taxon congruence in biodiversity change using data unique in its combination of temporal and taxonomic scope, and highlight the potential for cascading and comparable effects of environmental change (abiotic and biotic) on co‐occurring plant and insect communities. However, analyses of historical resurveys based on currently available data come with inherent uncertainties. As such, this study highlights a need for well‐designed experiments, and monitoring programs incorporating co‐occurring taxa, to determine the underlying mechanisms and prevalence of congruent biodiversity change as anthropogenic environmental change accelerates apace. [ABSTRACT FROM AUTHOR]

The 2014 Hazelwood coal mine fire in the Latrobe Valley, Australia, distributed toxic smoke into surrounding communities over 45 days. This study investigated risk and protective factors associated with four trajectories of posttraumatic distress (resilient, recovery, delayed‐onset, chronic) among exposed adults. Participants (N = 709) completed surveys in 2016–2017 and 2019–2020 assessing mine fire–related particulate matter (PM2.5) exposure; sociodemographic, physical, and mental health variables; and exposure to other traumatic and recent stressful events. Mine fire–related posttraumatic distress was measured using the IES‐R; trajectories were determined according to established clinical significance thresholds. Relative risk ratios (RRRs) were generated from multivariate multinomial regressions. The resilient trajectory was most common (77.0%). The chronic trajectory (8.5%) was associated with loneliness, RRR = 2.59, 95% CI [1.30, 5.16], and physical health diagnoses, RRR = 2.31, 95% CI [1.32, 4.02]. The delayed‐onset trajectory (9.1%) was associated with multiple recent stressful events, RRR = 2.51, 95% CI [1.37, 4.59]; mental health diagnoses, RRR = 2.30, 95% CI [1.25, 4.24]; loneliness, RRR = 2.05, 95% CI [1.09, 3.88]; and male gender, RRR = 2.01, 95% CI [1.18, 3.44]. Socioeconomic advantage protected against chronic, RRR = 0.68, 95% CI [0.53, 0.86], and delayed‐onset trajectory membership, RRR = 0.68, 95% CI [0.50, 0.94]; social support protected against chronic trajectory membership, RRR = 0.67, 95% CI [0.49, 0.92]. PM2.5 exposure did not determine trajectory. These findings enhance understanding of longer‐term posttraumatic responses to large‐scale smoke events and can inform mental health initiatives within at‐risk communities. [ABSTRACT FROM AUTHOR]

Objectives: In Australia, temporary agency workers are a relatively small but enduring component of the residential aged care workforce. However, evidence from other countries suggests reliance on agency workers has a detrimental effect on the quality of care (QoC). We examined whether QoC outcomes differ for Australian residential aged care facilities (RACFs) based on their reliance on agency care staff. Methods: A retrospective observational study was conducted using de‐identified datasets obtained under the legal authority of the Royal Commission into Aged Care Quality and Safety. Regression analysis was conducted using data comprising 6221 RACF‐year observations, across 5 years (2015–2019), from 1709 unique RACFs in Australia. Results: After controlling for other determinants of QoC, RACFs with a greater reliance on agency care staff have poorer QoC outcomes, with significantly higher rates of complaints, missing persons, reportable assaults, hospitalisations, and accreditation flags. Conclusions: Consistent with international evidence, we found that the QoC of Australian RACFs is sensitive to the reliance on agency staff in delivering direct care to residents. These findings illustrate the importance of workers' employment conditions, alongside other workforce characteristics, in driving the quality of residential aged care. [ABSTRACT FROM AUTHOR]

Issues regarding scientific explanation have been of interest to philosophers from Pre‐Socratic times. The notion of scientific explanation is of interest not only to philosophers, but also to science educators as is clearly evident in the emphasis given to K‐12 students' construction of explanations in current national science education reform efforts. Nonetheless, there is a dearth of research on conceptualizing explanation in science education. Using a philosophically guided framework—the Nature of Scientific Explanation (NOSE) framework—the study aims to elucidate and compare college freshmen science students', secondary science teachers', and practicing scientists' scientific explanations and their views of scientific explanations. In particular, this study aims to: (1) analyze students', teachers', and scientists' scientific explanations; (2) explore the nuances about how freshman students, science teachers, and practicing scientists construct explanations; and (3) elucidate the criteria that participants use in analyzing scientific explanations. In two separate interviews, participants first constructed explanations of everyday scientific phenomena and then provided feedback on the explanations constructed by other participants. Major findings showed that, when analyzed using NOSE framework, participant scientists did significantly "better" than teachers and students. Our analysis revealed that scientists, teachers, and students share a lot of similarities in how they construct their explanations in science. However, they differ in some key dimensions. The present study highlighted the need articulated by many researchers in science education to understand additional aspects specific to scientific explanation. The present findings provide an initial analytical framework for examining students' and science teachers' scientific explanations. [ABSTRACT FROM AUTHOR]

Location‐specific information is required to support decision making in crop variety management, especially under increasingly challenging climate conditions. Data synthesis can aggregate data from individual trials to produce information that supports decision making in plant breeding programs, extension services, and of farmers. Data from on‐farm trials using the novel approach of triadic comparison of technologies (tricot) are increasingly available, from which more insights could be gained using a data synthesis approach. The objective of our study was to present the applicability of a rank‐based data synthesis approach to several datasets from tricot trials to generate location‐specific information supporting decision making in crop variety management. Our study focuses on tricot data from 14 trials of common bean (Phaseolus vulgaris L.) performed between 2015 and 2018 across four countries in Central America (Costa Rica, El Salvador, Honduras, and Nicaragua). The combined data of 17 common bean genotypes were rank aggregated and analyzed with the Plackett–Luce model. Model‐based recursive partitioning was used to assess the influence of spatially explicit environmental covariates on the performance of common bean genotypes. Location‐specific performance was predicted for the three main growing seasons in Central America. We demonstrate how the rank‐based data synthesis methodology allows integrating tricot trial data from heterogenous sources to provide location‐specific information to support decision making in crop variety management. Maps of genotype performance can support decision making in crop variety evaluation such as variety recommendations to farmers and variety release processes. Core Ideas: We aggregate data from trials established by different organizations across different seasons and locations.We generate location‐specific insights on genotype performance and environmental interaction.We characterize uncertainty of model predictions using Shannon's entropy and area of applicability assessment. [ABSTRACT FROM AUTHOR]

New designer benzodiazepines continue to be identified in the illicit drug market. In December 2021, eight capsules were submitted to ChemCentre for analysis. The samples were analysed by a range of analytical techniques including gas chromatography–mass spectrometry (GC–MS), ultraviolet–visible spectrophotometry, liquid chromatography‐mass spectrometry (LC–MS, low and high resolution), nuclear magnetic resonance (NMR) spectroscopy and X‐ray crystallography, which identified the main component of the capsules to be 4′‐chloro deschloroalprazolam, a new designer benzodiazepine. Alarmingly, the mass spectral data for this alprazolam analogue were very similar to that of alprazolam, such that misidentification could be possible. A minor component of the capsules was also partially characterised, it is believed to be the synthetic precursor 4′‐chloro deschloronordiazepam. The information provided in this paper includes ways to discriminate these analogues from alprazolam and nordiazepam which will enable other laboratories to identify these new drugs. [ABSTRACT FROM AUTHOR]

Objective: To evaluate strategies to increase racial and ethnic diversity in the surgical workforce among trainees and faculty across surgical specialties. Data Sources: Embase, OVID/Medline, and Web of Science Core Collection. Review Methods: A review of US-based, peer-reviewed articles examining the effect of targeted strategies on racial and ethnic diversity in the surgical workforce was conducted from 2000 to 2020 with the PRISMA checklist and STROBE tool. Studies without an outlined strategy and associated outcomes were excluded. Eleven studies met inclusion criteria and were completed in general surgery, orthopaedic surgery, and otolaryngology–head and neck surgery. Conclusions: Efforts to increase exposure to surgery through internship programs and required clerkships with efforts to improve mentorship were common (6 of 11 [54.5%] and 3 of 11 [27.3%] studies, respectively). Three (27.3%) studies aimed to diversify the recruitment and selection process for the residency match and faculty hiring, and 2 (18.2%) aimed to increase representation among trainees, faculty, and leadership through holistic review processes paired with departmental commitment. Outcome metrics included surgical residency applications for individuals underrepresented in medicine, interview and match rates, faculty hiring, measures of a successful academic surgical career, and leadership representation. All strategies were successful in increasing diversity in the surgical workforce. Implications for Practice: A convincing yet limited body of literature exists to describe strategies and outcomes that address racial and ethnic diversity in the surgical workforce. While future inquiry is needed to move this field of interest forward, the evidence presented provides a framework for surgical residency programs/departments to develop approaches to increase racial and ethnic diversity. [ABSTRACT FROM AUTHOR]

Aims: The aim of this investigation was to explore and characterize alterations in coronary circulatory function in function of increasing body weight with medically controlled cardiovascular risk factors and, thus, "metabolically" unhealthy obesity. Materials and Methods: We prospectively enrolled 106 patients with suspected CAD but with normal stress‐rest myocardial perfusion on 13N‐ammonia PET/CT and with medically controlled or no cardiovascular risk factors. 13N‐ammonia PET/CT concurrently determined myocardial blood flow (MBF) during pharmacologically induced hyperaemia and at rest. Based on body mass index (BMI), patients were grouped into normal weight (BMI: 20.0–24.9 kg/m2, n = 22), overweight (BMI: 25.0–29.9 kg/m2, n = 27), obese (BMI: 30.0–39.9 kg/m2, n = 31), and morbidly obese (BMI ≥ 40kg/m2, n = 26). Results: Resting MBF was comparable among groups (1.09 ± 0.18 vs. 1.00 ± 0.15 vs. 0.96 ± 0.18 vs.. 1.06 ± 0.31 ml/g/min; p =.279 by ANOVA). Compared to normal weight individuals, the hyperaemic MBF progressively decreased in in overweight and obese groups, respectively (2.54 ± 0.48 vs. 2.02 ± 0.27 and 1.75 ± 0.39 ml/g/min; p <.0001), while it increased again in the group of morbidly obese individuals comparable to normal weight (2.44 ± 0.41 vs. 2.54 ± 0.48 ml/g/min, p =.192). The BMI of the study population correlated with the hyperaemic MBF in a quadratic or U‐turn fashion (r =.34, SEE = 0.46; p ≤.002). Conclusions: The U‐turn of hyperaemic MBF from obesity to morbid obesity is likely to reflect contrasting effects of abdominal versus subcutaneous adipose tissue on coronary circulatory function indicative of two different disease entities, but needing further investigations. [ABSTRACT FROM AUTHOR]

We present source design and process results of a linearly scalable ribbon ion beam for modifying materials by an ion implantation technique. Our source technology enables beam currents up to 30 mA/cm2 and ion implant energies up to 60keV enabling economically viable large format and high throughput processing. In this paper, we demonstrate application of this ion source towards the production of glass and sapphire substrates with durable broadband anti‐reflection surfaces with reflectance <0.5% in the visible spectra. In addition, the anti‐reflection surface is shown to remain after subsequent tempering and chemical strengthening processes. [ABSTRACT FROM AUTHOR]

We investigated the association between respiratory symptoms and psychological distress in the context of a prolonged smoke event, and evaluated whether smoke exposure, or pre‐existing respiratory and mental health conditions, influenced the association. Three thousand ninety‐six residents of a rural town heavily exposed to smoke from the 6‐week Hazelwood coal mine fire, and 960 residents of a nearby unexposed town, completed Kessler's psychological distress questionnaire (K10) and a modified European Community Respiratory Health Survey. Logistic regression models evaluated associations between distress and respiratory symptoms, with interactions fitted to evaluate effect modification. Smoke exposed participants reported higher levels of distress than those unexposed, and participants reporting respiratory symptoms recorded higher levels of distress than participants without respiratory symptoms, irrespective of exposure. 5‐unit increments in K10 scores were associated with 21%–48% increases in the odds of reporting respiratory symptoms. There were significant interactions with pre‐existing asthma, chronic obstructive pulmonary disease and mental health conditions, but not with smoke exposure. Although participants with pre‐existing conditions were more likely to report respiratory symptoms, increasing distress was most strongly associated with respiratory symptoms among those without pre‐existing conditions. Communities exposed to landscape fire smoke could benefit from interventions to reduce both psychological and respiratory distress. [ABSTRACT FROM AUTHOR]

We examine the incentives for and the effects of vertical integration in the electricity sector. We find that vertical integration often reduces retail prices and increases industry capacity investment, consumer surplus, and total welfare. Unilateral vertical integration often is profitable, and so arises in equilibrium. However, ubiquitous vertical integration can reduce aggregate industry profit. [ABSTRACT FROM AUTHOR]

We examine allegations that firms in Alberta's electricity industry manipulated public information to coordinate in the wholesale market. We investigate whether bids by firms who employed unique pricing patterns were consistent with unilateral expected profit maximization. Our results suggest that these firms could have increased expected profits through unilateral deviations. For one firm, the potential to increase profits is greater on days when certain offer patterns are observed, providing support for the claim that such patterns may have assisted coordination on high‐priced outcomes. These results suggest that regulators should exercise caution when designing information disclosure policies in concentrated electricity markets. [ABSTRACT FROM AUTHOR]

Constructing causal mechanistic explanations of observable phenomena is a key science practice that is often challenging for students as most mechanisms involve interactions of unobservable entities and activities. In this study, we examined how gesturing with a computer simulation that depicts the molecular mechanism of thermal conduction supported middle‐school students in constructing causal mechanistic explanations. We designed a gesture‐augmented computer simulation in which students were cued to use hand gestures to control the simulation. These cued gestures represent core causal interactions of conduction and they prompt students to physically engage with the simulation in conceptually meaningful ways. In this study, we examined how 21 students used the simulation and explained thermal conduction in a semi‐structured interview, followed by a mixed‐methods analysis. Quantitative analysis shows that students moved toward articulating the canonical causal mechanistic explanation of thermal conduction using the simulation. Three representative cases were identified to explore how students' explanations were facilitated by cued gestures. The analysis shows two main ways the cued gestures supported all students in the study: (a) by helping them attribute causal agency to molecules rather than an entity called Heat, and (b) by reifying the core mechanism of molecular collisions in conduction. Furthermore, the case studies show how each student's unique ways of sensemaking impacted their gesture use. Implications for instruction with gestures and design of augmented environments are discussed. [ABSTRACT FROM AUTHOR]

Dermal scarring from motor vehicle accidents, severe burns, military blasts, etc. is a major problem affecting over 80 million people worldwide annually, many of whom suffer from debilitating hypertrophic scar contractures. These stiff, shrunken scars limit mobility, impact quality of life, and cost millions of dollars each year in surgical treatment and physical therapy. Current tissue engineered scaffolds have mechanical properties akin to unwounded skin, but these collagen‐based scaffolds rapidly degrade over 2 months, premature to dampen contracture occurring 6–12 months after injury. This study demonstrates a tissue engineered scaffold can be manufactured from a slow‐degrading viscoelastic copolymer, poly(ι‐lactide‐co‐ε‐caprolactone), with physical and mechanical characteristics to promote tissue ingrowth and support skin‐grafts. Copolymers were synthesized via ring‐opening polymerization. Solvent casting/particulate leaching was used to manufacture 3D porous scaffolds by mixing copolymers with particles in an organic solvent followed by casting into molds and subsequent particle leaching with water. Scaffolds characterized through SEM, micro‐CT, and tensile testing confirmed the required thickness, pore size, porosity, modulus, and strength for promoting skin‐graft bioincorporation and dampening fibrosis in vivo. Scaffolds were Oxygen Plasma Treatment and collagen coated to encourage cellular proliferation. Porosity ranging from 70% to 90% was investigated in a subcutaneous murine model and found to have no clinical effect on tissue ingrowth. A swine full‐thickness skin wound model confirmed through histology and Computer Planimetry that scaffolds promote skin‐graft survival, with or without collagen coating, with equal safety and efficacy as a commercially available tissue engineered scaffold. This study validates a scalable method to create poly(ι‐lactide‐co‐ε‐caprolactone) scaffolds with appropriate characteristics and confirms in mouse and swine wound models that the scaffolds are safe and effective at supporting skin‐grafts. The results of this study have brought us closer towards developing an alternative technology that supports skin grafts with the potential to investigate long‐term hypertrophic scar contractures. [ABSTRACT FROM AUTHOR]

Background and objective: E-cigarette use has become increasingly prevalent, but there is some evidence demonstrating potential harms with frequent use. We aimed to identify the profiles of e-cigarette users from a regional community in Australia and investigate the associations of e-cigarettes with respiratory symptoms and lung function. Methods: A total of 519 participants completed a cross-sectional study. Exposure to ecigarettes was collected via a validated questionnaire. Respiratory symptoms were evaluated via a self-reported questionnaire and lung function measured with spirometry and forced oscillation technique (FOT). Linear and logistic regression models were fitted to investigate the associations between e-cigarettes and outcomes, while controlling for confounders such as tobacco smoking. Results: Of the 519 participants, 46 (9%) reported e-cigarette use. Users tended to be younger (mean x SD 45.2 x 14.5 vs. 55.3 x 16.0 years in non-users), concurrently using tobacco products (63% vs. 12% in non-users), have a mental health diagnosis (67% vs. 37% in non-users) and have self-reported asthma (63% vs. 42% in nonusers). After controlling for known confounders, chest tightness (OR = 2.4, 95% CI 1.2-4.9, p = 0.02) was associated with e-cigarette use. Spirometry was not different after adjustment for confounding. However, FOT showed more negative reactance and a greater area under the reactance curve in e-cigarette users than non-users. Conclusion: E-cigarette use was associated with increased asthma symptoms and abnormal lung mechanics in our sample, supporting a potential health risk posed by these products. Vulnerable populations such as young adults and those with mental health conditions have higher usage, while there is high concurrent tobacco smoking. [ABSTRACT FROM AUTHOR]

Aims The Fontan operation has resulted in improved survival in patients with single-ventricle congenital heart disease. As a result, there is a growing population of teenagers and adults with a Fontan circulation. Many co-morbidities have been increasingly recognized in this population due to the unique features of the Fontan circulation. Standardization of how Fontan co-morbid conditions are defined will help facilitate understanding, consistency and interpretability of research and clinical experience. Unifying common language usage in Fontan is a critical precursor step for data comparison of research findings and clinical outcomes and ultimately accelerating improvements in management for this growing group of patients. This manuscript aimed to create unified definitions for morbidities seen after the Fontan palliation. Methods In association of many congenital heart disease organizations, this work used Delphi methodology to reach a broad consensus among recognized experts regarding commonly used terms in Fontan care and research. Each definition underwent at least three rounds of revisions to reach a final definition through surveys sent to experts in the field of single-ventricle care. Results The process of reaching a consensus on multiple morbidities associated with the Fontan procedure is summarized in this manuscript. The different versions that preceded reaching the consensus are also presented in the Supporting Information. Table 1 represents the final definitions according to the consensus. Conclusions We propose the use of these definitions for clinical care, future research studies, registry development and clinical trials. [ABSTRACT FROM AUTHOR]

Background and objective: In 2014, a 6‐week‐long fire at the Hazelwood coal mine exposed residents in the adjacent town of Morwell to high concentrations of fine particulate matter with an aerodynamic diameter < 2.5 μm (PM2.5). The long‐term health consequences are being evaluated as part of the Hazelwood Health Study. Methods: Approximately 3.5–4 years after the mine fire, adults from Morwell (n = 346) and the comparison town Sale (n = 173) participated in the longitudinal Respiratory Stream of the Study. Individual PM2.5 exposure was retrospectively modelled. Lung mechanics were assessed using the forced oscillation technique (FOT), utilizing pressure waves to measure respiratory system resistance (Rrs) and reactance (Xrs). Multivariate linear regression was used to evaluate associations between PM2.5 and transformed Rrs at 5 Hz, area under the reactance curve (AX5) and Xrs at 5 Hz controlling for key confounders. Results: There were clear dose–response relationships between increasing mine fire PM2.5 and worsening lung mechanics, including a reduction in post‐bronchodilator (BD) Xrs5 and an increase in AX5. A 10 μg/m3 increase in mine fire‐related PM2.5 was associated with a 0.015 (95% CI: 0.004, 0.027) reduction in exponential (Xrs5) post‐BD, which was comparable to 4.7 years of ageing. Similarly, the effect of exposure was associated with a 0.072 (0.005, 0.138) increase in natural log (lnAX5) post‐BD, equivalent to 3.9 years of ageing. Conclusion: This is the first study using FOT in adults evaluating long‐term respiratory outcomes after medium‐term ambient PM2.5 exposure to coal mine fire smoke. These results should inform public health policies and planning for future events. [ABSTRACT FROM AUTHOR]

The latest country‐specific regulatory guidance for assessing effectiveness of risk minimization measures (RMM) strategies was identified across five continents—Africa (Egypt, South Africa), Asia (Australia, China, Japan, South Korea, Singapore), Europe (EU‐27, United Kingdom), North America (Unites States, Canada) and South America (Brazil)—and compared to the Reporting recommendation Intended for pharmaceutical Risk Minimization Evaluation Studies (RIMES) checklist, developed to assess the quality of effectiveness evaluations and endorsed by the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP). RIMES checklist items address study hypothesis, participants, measures, statistical analysis and results. European Medical Agency (EMA) and Food and Drug Administration (FDA) guidance only partially aligned with RIMES, primarily for measures and results. In the absence of country‐specific guidance, most countries recommended following EMA or FDA guidelines; Japan and South Africa mentioned the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH E2E) guideline; Brazil and China had no guidance/recommendations. Worldwide, there was a lack of RMM‐specific guidance and, when guidance existed, they were not harmonized, and alignment with the RIMES checklist was limited. [ABSTRACT FROM AUTHOR]

Aims: To characterise the genetic alterations in adult primary uterine rhabdomyosarcomas (uRMSs) and to investigate whether these tumours are genetically distinct from uterine carcinosarcomas (UCSs). Methods and results: Three tumours originally diagnosed as primary adult pleomorphic uRMS were subjected to massively parallel sequencing targeting 468 cancer‐related genes and RNA‐sequencing. Mutational profiles were compared with those of UCSs (n = 57) obtained from The Cancer Genome Atlas. Sequencing data analyses were performed using validated bioinformatic approaches. Pathogenic TP53 mutations and high levels of genomic instability were detected in the three cases. uRMS1 harboured a likely pathogenic YTHDF2–FOXR1 fusion. uRMS2 harboured a PPP2R1A hotspot mutation and amplification of multiple genes, including WHSC1L1, FGFR1, MDM2, and CCNE1, whereas uRMS3 harboured an FBXW7 hotspot mutation and an ANKRD11 homozygous deletion. Hierarchical clustering of somatic mutations and copy number alterations revealed that these tumours initially diagnosed as pleomorphic uRMSs and UCSs were similar. Subsequent comprehensive pathological re‐review of the three uRMSs revealed previously unidentified minute pan‐cytokeratin‐positive atypical glands in one case (uRMS3), favouring its reclassification as UCS with extensive rhabdomyosarcomatous overgrowth. Conclusions: Adult pleomorphic uRMSs harbour TP53 mutations and high levels of copy number alterations. Our findings underscore the challenge in discriminating between uRMS and UCS with rhabdomyosarcomatous differentiation. [ABSTRACT FROM AUTHOR]

Whether attempting to eliminate parasitic Li metal plating on graphite (and other Li‐ion anodes) or enabling stable, uniform Li metal formation in 'anode‐free' Li battery configurations, the detection and characterization (morphology, microstructure, chemistry) of Li that cannot be reversibly cycled is essential to understand the behavior and degradation of rechargeable batteries. In this review, various approaches used to detect and characterize the formation of Li in batteries are discussed. Each technique has its unique set of advantages and limitations, and works towards solving only part of the full puzzle of battery degradation. Going forward, multimodal characterization holds the most promise towards addressing two pressing concerns in the implementation of the next generation of batteries in the transportation sector (viz. reducing recharging times and increasing the available capacity per recharge without sacrificing cycle life). Such characterizations involve combining several techniques (experimental‐ and/or modeling‐based) in order to exploit their respective advantages and allow a more comprehensive view of cell degradation and the role of Li metal formation in it. It is also discussed which individual techniques, or combinations thereof, can be implemented in real‐world battery management systems on‐board electric vehicles for early detection of potential battery degradation that would lead to failure. [ABSTRACT FROM AUTHOR]

Metaplastic breast carcinoma (MBC) and uterine carcinosarcoma (UCS) are rare aggressive cancers, characterized by an admixture of adenocarcinoma and areas displaying mesenchymal/sarcomatoid differentiation. We sought to define whether MBCs and UCSs harbor similar patterns of genetic alterations, and whether the different histologic components of MBCs and UCSs are clonally related. Whole‐exome sequencing (WES) data from MBCs (n = 35) and UCSs (n = 57, The Cancer Genome Atlas) were reanalyzed to define somatic genetic alterations, altered signaling pathways, mutational signatures, and genomic features of homologous recombination DNA repair deficiency (HRD). In addition, the carcinomatous and sarcomatous components of an additional cohort of MBCs (n = 11) and UCSs (n = 6) were microdissected separately and subjected to WES, and their clonal relatedness was assessed. MBCs and UCSs harbored recurrent genetic alterations affecting TP53, PIK3CA, and PTEN, similar patterns of gene copy number alterations, and an enrichment in alterations affecting the epithelial‐to‐mesenchymal transition (EMT)‐related Wnt and Notch signaling pathways. Differences were observed, however, including a significantly higher prevalence of FAT3 and FAT1 somatic mutations in MBCs compared to UCSs, and conversely, UCSs significantly more frequently harbored somatic mutations affecting FBXW7 and PPP2R1A as well as HER2 amplification than MBCs. Genomic features of HRD and biallelic alterations affecting bona fide HRD‐related genes were found to be more prevalent in MBCs than in UCSs. The distinct histologic components of MBCs and UCSs were clonally related in all cases, with the sarcoma component likely stemming from a minor subclone of the carcinoma component in the samples with interpretable chronology of clonal evolution. Despite the similar histologic features and pathways affected by genetic alterations, UCSs differ from MBCs on the basis of FBXW7 and PPP2R1A mutations, HER2 amplification, and lack of HRD, supporting the notion that these entities are more than mere phenocopies of the same tumor type in different anatomical sites. [ABSTRACT FROM AUTHOR]

Urbanisation and the expansion of US metropolitan regions have blurred the spatial and social boundaries that are typically thought to separate urban from rural America. Our objective is to highlight both the conceptual limitations of the so‐called rural–urban divide, while also recognising the spatial interdependence of America's 'rural' and 'urban' people and places. Our analyses nest rural and urban population and places within metropolitan and non‐metropolitan counties, while acknowledging that rural places often grow into urban places (i.e., urbanisation) and that many non‐metropolitan counties are reclassified over time as metropolitan areas (i.e., metropolitanisation). Analyses show that most rural people—as officially defined—now live in metropolitan counties, often at the fringe. Reclassification to metropolitan areas was a major reason why. Small towns and thinly settled areas at the metropolitan fringe have grown rapidly since 1980 and have become increasingly integrated within metropolitan areas nationally. The heuristic value of our analytical approach at the national level is further demonstrated at the local‐area level, in Chicago and Atlanta, metro areas with very different demographic and economic histories. Our study highlights the dynamic and multidimensional nature of spatial boundaries (i.e., urban–rural and metro–nonmetro) that both separate and connect rural and urban areas in the United States. Metro–nonmetro and rural–urban boundaries are neither fixed nor impermeable. [ABSTRACT FROM AUTHOR]

Climatic frost indicators, including the dates of the last spring frost (LSF), the dates of the first fall frost (FFF), and the length of the frost‐free season (FFSL), are critical factors in anthropogenic and natural ecosystem management and can be directly calculated from daily minimum temperatures. Daily minimum temperature from the Applied Climate Information System was used to determine long‐term trends of frost indicators across the U.S. Southern Great Plains. The results demonstrated statistically significant trends of earlier LSF in eastern Kansas, western and eastern Oklahoma, and eastern Texas from 1950 to 2017. However, significantly later FFF trends and longer FFSL trends were mainly identified in eastern Oklahoma and eastern Texas. Overall, the region was characterized by the trends toward earlier LSF, later FFF, and longer FFSL from 1950 to 2017. In addition, the choice of time period in the climatic time series played an important role in LSF, FFF, and FFSL trends. Furthermore, the results from the correlation analysis of LSF and FFF with multiple climate indices indicated that the increasing trends in the spring Arctic Oscillation (AO) were consistent with the earlier onset of spring in Kansas and Texas, and the fall Atlantic Multidecadal Oscillation (AMO) was positively correlated with the later FFF dates in Kansas. [ABSTRACT FROM AUTHOR]

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Objective: Create and validate an objective structured assessment of technical skills (OSATS) for otolaryngology residents learning how to perform a tonsillectomy.Study Design: Multicenter prospective longitudinal validation study.Methods: A multi-institutional study at six tertiary academic otolaryngology residency programs from July 2009 to May 2012. Using the modified Delphi technique, a panel of pediatric otolaryngologists created a tonsillectomy task-based checklist (TBC) for a tonsil OSATS using a 5-point Likert-type scale. Residents were assessed by pediatric otolaryngology staff at the time of surgery with the TBC and a global rating scale. Procedure time, patient age, number of previously performed tonsillectomies, and surgical technique were also collected.Results: One hundred sixty-seven tonsil OSATS were completed for 38 residents, and competency was recorded for 99 (59.2%). Residents scored as competent had performed significantly more previous tonsillectomies than those deemed noncompetent, 44.4 ± 35.6 and 13.5 ± 11.6, respectively (P < .001). The mean overall score on the tonsil TBC was 4.0 ± 0.8 and 2.6 ± 1.0 for competent and noncompetent, respectively (P < .001). Higher number of tonsillectomies performed and mean tonsil TBC score significantly increased the likelihood of competency (P < .001). Each additional tonsillectomy performed increased the likelihood of achieving competency by 6.3% (P = .006, 95% confidence interval (CI): 1.330-1.110), and each 1.0 point increase in mean tonsil TBC score increased the likelihood of competency by a factor of 2.71 (P = .006, 95% CI:1.330-5.513). There is a 95% likelihood of competency at 48 tonsillectomies or a tonsil TBC score of 4.91.Conclusion: The tonsil OSATS is a valid and feasible instrument to assess resident competency with tonsillectomy and provides timely objective feedback.Level Of Evidence: 4. Laryngoscope, 131:E359-E366, 2021. [ABSTRACT FROM AUTHOR]

The growth in macro‐level income inequality in the United States is well established, but less is known about patterns of inequality at subnational scales and how they vary between and within rural and urban localities. Using data from the Decennial Census and American Community Survey, we produce estimates of within‐county income inequality from 1970 to 2016 and analyze differences in inequality levels, the persistence of high (low) inequality, and populations' exposure to high (low) inequality across the rural‐urban continuum. We find that income inequality has historically been higher in non‐metropolitan than metropolitan counties, but inequality levels converged by 2016 due to growing inequality in metropolitan counties. Additionally, levels of inequality were generally persistent within counties over time, except that counties characterized by low inequality in 1970 were unlikely to remain as such in 2016. Third, non‐trivial shares of the metropolitan population resided in low‐inequality contexts in 1970, but virtually none of the U.S. population resided in such places by 2016. Residence in high‐inequality counties is normative in rural and urban America. This statistical analysis provides an updated portrait of income inequality across the rural‐urban continuum, and should spur additional research on stratification in rural America during an era of growing inequality. [ABSTRACT FROM AUTHOR]

See relatedLetter [ABSTRACT FROM AUTHOR]