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Abstract Background Individuals with type 1 diabetes are at increased risk of accelerated atherosclerosis, causing coronary artery disease (CAD). The underlying mechanisms remain unclear, but new theories proposed are damage of gut mucosa causing leakage and translocation of gut microbiota products into the circulation, leading to inflammatory responses and atherosclerosis. We therefore aimed to study the associations between gut related inflammatory biomarkers and coronary atherosclerosis in individuals with long-term type 1 diabetes. Methods In this cross-sectional, controlled study of 102 participants with type 1 diabetes and 63 control subjects, we measured circulating levels of intestinal fatty acid binding protein (I-FABP), soluble cluster of differentiation 14 (sCD14), lipopolysaccharide binding protein (LBP) and interleukin 18 (IL-18) by enzyme-linked immunosorbent assay (ELISA), and further gene expression of CD14 and toll-like receptor 4 (TLR4) by real time PCR in circulating leukocytes and peripheral blood mononuclear cells (PBMCs). The participants had either established coronary heart disease (CHD) or underwent computed tomography coronary angiography (CTCA) to assess for coronary atherosclerosis, including total, calcified and soft/mixed plaque volumes. Results In the diabetes group, the levels of I-FABP were significantly higher in participants with established CHD or significant stenosis on CTCA compared to the participants with normal arteries or non-significant stenosis, with median 1.67 ng/ml (interquartile range [IQR] 1.02–2.32) vs. median 1.09 ng/ml (IQR 0.82–1.58), p = 0.003. I-FABP was associated with significant coronary artery stenosis by CTCA (> 50%) or previously established CHD in the adjusted analysis (odds ratio [OR] = 2.32, 95% confidence interval [CI]: 1.09–4.95; p = 0.029). The levels of I-FABP correlated also to total coronary plaque volume (r = 0.22, p

Abstract Background Being born small for gestational age (SGA) is a risk factor for motor difficulties. Previous reviews exploring this topic are mostly focused on children born preterm. We aimed to review the literature to determine the association between being born SGA at term and motor outcomes. Methods PubMed and Embase were searched for relevant articles without any restrictions on publication year or participants’ age. Inclusion criteria were SGA exposure at term (≥ 37 weeks of gestation), cohort studies or randomized controlled trials with motor outcome assessed by standardized motor tests with results reported as continuous scores (mean/median) compared with a control group. Exclusion criteria were abstracts, editorials and commentaries, articles in non-English language or no full text available. Reviews were screened for relevant articles. Quality of included studies was assessed by the Newcastle-Ottawa Scale. Results In total, 674 records were identified by the literature search and screened by two independent authors. Thirteen original articles were eligible and included in a qualitative synthesis, and five (38%) of these were included in a meta-analysis. Nine (69%) studies were from high-income countries. Most studies were carried out in early childhood, and only one study in adulthood. Seven (54%) articles reported that individuals born SGA at term had poorer scores on standardized motor tests compared with controls, while no differences were reported in five (38%) articles. One article did not report p-values, although the differences were comparable to the other studies. Group differences were of small to moderate effect size (0.19 to 0.65 standard deviation units). The pooled effect size was -0.43 (95% confidence interval: -0.60 to -0.25). Adjustment for covariates were reported in seven (54%) articles and did not change the results. Proportions of motor difficulties, reported in five (38%) articles, ranged from 8.9 to 50% in individuals born SGA from infancy to adolescence. Conclusions This systematic review shows that being born SGA, also at term, may be a risk factor for poorer motor outcomes throughout childhood, confirmed by a meta-analysis in early childhood. Further research is needed to establish the risk of adult motor difficulties in individuals born SGA at term.

Abstract Background Integrating behavioral health services in primary care is challenging; a toolkit approach to practice implementation can help. A recent comparative effectiveness randomized clinical trial examined the impact of a toolkit for improving integration on outcomes for patients with multiple chronic conditions. Some aspects of behavioral health integration improved; patient-reported outcomes did not. This report evaluates the implementation strategy (Toolkit) using Proctor’s (2011) implementation outcomes model. Methods Using data from the 20 practices randomized to the active (toolkit strategy) arm (education, redesign workbooks, online learning community, remote coaching), we identified 23 measures from practice member surveys, coach interviews, reports, and field logs to assess Toolkit acceptability, appropriateness, feasibility, and fidelity. A practice survey score was high (met expectations) if its average was ≥ 4 on a scale 1-5; all other data were coded dichotomously, with high = 1. Results Regarding acceptability, 74% (14) of practices had high scores for willingness of providers and staff to use the Toolkit and 68% (13) for quality improvement teams liking the Toolkit. For appropriateness, 95% (19) of practices had high scores for the structured process being a good match and 63% (12) for the Toolkit being a good match. Feasibility, measured by Toolkit prerequisites, was scored lower by site members at project end (e.g., provider leader available as champion: 53% of practices) compared to remote coaches observing practice teams (74%). For “do-ability,” coaches rated feasibility lower for practices (e.g., completion of workbook activities: 32%) than the practice teams (68%). Fidelity was low as assessed across seven measures, with 50% to 78% of practices having high scores across the seven measures. Conclusions Existing data from large trials can be used to describe implementation outcomes. The Toolkit was not implemented with fidelity in at least one quarter of the sites, despite being acceptable and appropriate, possibly due to low feasibility in the form of unmet prerequisites and Toolkit complexity. Variability in fidelity reflects the importance of implementation strategies that fit each organization, suggesting that further study on contextual factors and use of the Toolkit, as well as the relationship of Toolkit use and study outcomes, is needed. Trial registration ClinicalTrials.gov NCT02868983; date of registration: 08/15/2016.

Multiple randomized controlled trials (RCTs) have examined first-line pharmacological agents such as anticholinergics and β3 agonists for the management of overactive bladder symptoms (OAB). Although earlier systematic reviews and (network) meta-analyses aimed to summarize the evidence, a substantial number of trials were not included, so a comprehensive and methodologically rigorous evaluation of the comparative effectiveness of all first-line pharmacological treatments is lacking. We aim to conduct a series of systematic reviews and network meta-analyses (NMAs) for a comprehensive assessment of the effectiveness and safety of first-line pharmacological treatments for OAB. Eligible studies will include RCTs comparing anticholinergics and β3 agonists to one another or to placebo in adults with OAB or detrusor overactivity. Pairs of reviewers with methodological training will independently evaluate candidate studies to determine eligibility and extract relevant data. We will incorporate patient-important outcomes, including urinary urgency episodes, urgency incontinence episodes, any type of incontinence episodes, urinary frequency, nocturia, and adverse events. We will conduct the NMAs using a frequentist framework and a graph theory model for each outcome. Analysis will follow rigorous methodologies, including handling of missing data and assessment of the risk of bias. We will conduct sensitivity and subgroup analyses and will apply the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to rate evidence certainty. Our approach aims to address the knowledge gap in the treatment of OAB by synthesizing evidence from RCTs worldwide. We will employ robust statistical methods, including frequentist NMA, to general clinically relevant and patient-important insights. Sensitivity and subgroup analyses will enhance the robustness and generalizability of our findings. Our reviews strive to inform evidence-based decisions in the management of OAB, to ultimate improve patient outcomes. Our study results may guide health policy decisions, such as reimbursement policies, and future studies in functional urology.The protocol for the review series is registered on PROSPERO as CRD42023266915.

Abstract Clear-cell renal cell carcinoma (ccRCC) is the most common origin of pancreatic metastases (PM). Distinct genomic aberrations, favorable prognosis, and clinical observations on high angiogenesis, and succeeding tyrosine kinase inhibitor (TKI) sensitivity have been reported in PM-ccRCC. However, no functional or single-cell studies have been conducted thus far. We recruited five PM-ccRCC patients and investigated the genomic, single-cell transcriptomic, and drug sensitivity profiles of their patient-derived cells (PDCs). The PM depicted both expected and novel genomic alterations. Further, the transcriptomics differed from both primary and metastatic ccRCC, with upregulations of the PI3K/mTOR and – supporting the clinical observations – angiogenesis pathways. Data integration at pathway level showed that transcriptomics explained drug sensitivities the best. Accordingly, PM-ccRCC PDCs shared sensitivity to many PI3K/mTOR inhibitors. Altogether, we show distinct genomic and transcriptomic signatures in PM-ccRCC, highlight the superiority of transcriptomics in interpreting drug sensitivities, and encourage the use of TKIs and PI3K/mTOR inhibitors in PM-ccRCC.

Abstract Background Exposure to alcohol and/or other addictive drugs in pregnancy is a documented risk factor for neurological impairment. We aimed to assess neurodevelopmental outcome at two years of age in infants exposed to prenatal alcohol and/or other addictive drugs and to examine the predictive value of early motor assessment. Methods This was a follow-up at two years of age in the prospective cohort study Children Exposed to Alcohol and/or Drugs in Intrauterine Life (CEADIL). The exposed group comprised 73 infants recruited from primary health care and included in a hospital follow-up programme at St. Olavs Hospital, Trondheim University Hospital, Norway. The control group comprised 93 healthy, unexposed infants recruited from the maternity ward at the same hospital. All children had been assessed by physiotherapists using the General Movement Assessment (GMA) at three months of age. Presence of fidgety movements, movement character and the Motor Optimality Score – Revised (MOS-R) were used. At two years of age, the children were assessed by trained examiners using the Bayley Scales of Infant and Toddler Development – Third Edition (BSID-III), Ages & Stages Questionnaires: Social-Emotional (ASQ:SE) and the Hollingshead Two-Factor Index of Social Position (SES). Results The cognitive, language and motor composite scores of BSID-III were considerably lower in the exposed group than in the control group. Mean differences adjusted for age and parental SES ranged from − 13.3 (95% confidence interval, CI: -18.6 to -8.0) to -17.7 (95% CI: -23.3 to -12.2). Suboptimal fidgety movements and monotonous movement character had high sensitivity (0.94 to 0.74), but low specificity (0.10 to 0.32), while sensitivity and specificity of the MOS-R was around 50 and 60%, respectively. Conclusions Neurodevelopmental outcome at two years of age was poorer in a group of children exposed to alcohol and/or drugs in pregnancy compared with a control group of healthy, unexposed children. Sensitivity of suboptimal fidgety movements and monotonous movement character at three months of age for later neurodevelopmental outcome was high to acceptable, but the MOS-R had limited sensitivity.

Abstract Background Patients with chronic pain on opioids frequently experience loneliness, which is associated with poorer health outcomes and higher risk for opioid misuse and opioid use disorder. Given that almost half of opioids are prescribed in primary care, a critical need exists for the development and testing of interventions to reduce loneliness in primary care patients at risk for opioid misuse. Cognitive behavioral therapy and social prescribing have been shown to be efficacious in reducing loneliness and improving outcomes in other populations but have not been tested in patients at risk for substance use disorder. The overall objective of our study is to reduce opioid misuse and opioid use disorder by addressing loneliness in patients on long-term opioid therapy in real-world primary care settings. Methods We will conduct a 3-arm pragmatic, randomized controlled trial to compare the effectiveness of two group-based, telehealth-delivered interventions with treatment as usual: (1) cognitive behavioral therapy to address maladaptive thought patterns and behaviors around social connection and (2) a social prescribing intervention to connect participants with social opportunities and develop supportive social networks. Our primary outcome is loneliness as measured by the UCLA Loneliness Scale and our dependent secondary outcome is opioid misuse as measured by the Common Opioid Misuse Measure. We will recruit 102 patients on long-term opioid therapy who screen positive for loneliness from 2 health care systems in Washington State. Implementation outcomes will be assessed using the RE-AIM framework. Discussion Our study is innovative because we are targeting loneliness, an under-addressed but critical social risk factor that may prevent opioid misuse and use disorder in the setting where most patients are receiving their opioid prescriptions for chronic pain. If successful, the project will have a positive impact in reducing loneliness, reducing opioid misuse, improving function and preventing substance use disorder. Trial Registration NCT06285032, issue date: February 28, 2024, original.

Abstract Astrocytes respond and contribute to neuroinflammation by adopting inflammatory reactive states. Although recent efforts have characterized the gene expression signatures associated with these reactive states, the cell biology underlying inflammatory reactive astrocyte phenotypes remains under-explored. Here, we used CRISPR-based screening in human iPSC-derived astrocytes to identify mTOR activation a driver of cytokine-induced endolysosomal system remodeling, manifesting as alkalinization of endolysosomal compartments, decreased autophagic flux, and increased exocytosis of certain endolysosomal cargos. Through endolysosomal proteomics, we identified and focused on one such cargo–IL-32, a disease-associated pro-inflammatory cytokine not present in rodents, whose secretion mechanism is not well understood. We found that IL-32 was partially secreted in extracellular vesicles likely to be exosomes. Furthermore, we found that IL-32 was involved in the polarization of inflammatory reactive astrocyte states and was upregulated in astrocytes in multiple sclerosis lesions. We believe that our results advance our understanding of cell biological pathways underlying inflammatory reactive astrocyte phenotypes and identify potential therapeutic targets.

Abstract Ongoing Arctic greening can increase productivity and reindeer pasture quality in the tundra. However, greening may also entail proliferation of unpalatable species, with consequences for pastoral social-ecological systems. Here we show extensive greening across 20 reindeer districts in Norway between 2003 and 2020, which has reduced pasture diversity. The allelopathic, evergreen dwarf-shrub crowberry increased its biomass by 60%, with smaller increases of deciduous shrubs and no increase in forbs and graminoids, the most species rich growth forms. There was no evidence for higher reindeer densities promoting crowberry. The current management decision-making process aims at sustainable pasture management but does not explicitly account for pasture changes and reduced diversity. Large-scale shifts towards evergreening and increased allelopathy may thus undermine the resource base for this key Arctic herbivore and the pastoral social-ecological system. Management that is sensitive to changes in pasture diversity could avoid mismanagement of a social-ecological system in transition.

Abstract Background Individuals of South Asian origin have a greater risk of cardiovascular disease after gestational diabetes mellitus (GDM) than European individuals. B-type natriuretic peptide (BNP) and the amino-terminal fragment of its prohormone (NT-proBNP) are commonly used for heart failure screening and diagnosis, but biologically BNP exerts several beneficial cardiovascular effects primarily by counteracting the renin-angiotensin-aldosterone-system. We asked whether ethnic differences in circulating NT-proBNP levels could be explained by the differences in cardiometabolic and inflammatory risk markers? Methods We examined 162 South Asian and 107 Nordic women in Norway 1–3 years after GDM with a clinical examination, fasting blood samples and an oral glucose tolerance test. We measured the levels of NT-proBNP, high-sensitivity cardiac troponin T, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), leptin, adiponectin and markers of insulin sensitivity, such as the Matsuda insulin sensitivity index (ISI). Finally, we tried to identify which independent covariate best mediated the ethnic differences in NT-proBNP. Results The mean (SD) age was 35.3 (4.5) years, BMI 29.1 (6.0) kg/m2, waist-height ratio 0.60 (0.08) and 164 women (61%) had prediabetes/diabetes. Notably, South Asian women had lower levels of NT-proBNP than Nordic women in both the normoglycemic and prediabetes/diabetes groups (median (IQR) 26 (15–38) vs. 42 (22–66) ng/L, p

# Background Little is known about the influence of kinetic chain strength and power on shoulder problems in handball players or the impact of participation-related shoulder load (PSL) during a season. Suboptimal activity of the kinetic chain during throwing might make the shoulder more vulnerable. # Purpose The purpose of this study was to assess 1) the association between pre-season measurements and shoulder problems among handball players and 2) whether pre-season strength and power influence the association between PSL and severity of shoulder problems. # Study Design Prospective observational cohort study. # Methods Pre-season measurements were done using the Isometric mid-thigh pull for lower body strength, a seated test for trunk rotation power (TRP) and isometric testing of external (ER) and internal rotation shoulder strength on 42 male players. Shoulder problems (prevalence, substantial prevalence, and severity score) were documented weekly through a season (31 weeks) with The Oslo Sports Trauma Research Center Overuse Questionnaire (OSTRC-O2) and PSL with the modified Borg rate of perceived exertion scale. Spearman´s correlation coefficient was applied to examine the association within the first aim, while a mixed model ANOVA was conducted to analyze the second aim. # Results A weak and negative correlation (rs=-0.34) was found between pre-season ER strength and the individual prevalence of shoulder problems (p=0.029). A main effect was found between PSL and the OSTRC-O2 severity score (p=

Research on health-related quality of life (HRQoL) of school-aged children born preterm (< 37 weeks of gestational age) is scarce and there are few studies examining the relationship with medical and family factors. The aims were to analyze HRQoL in a sample of 8-year-old children born preterm with very low birth weight (VLBW), to test a proposed theoretical model that examines the relationship with medical and socio-family factors, and to explore the mediation effects of maternal factors between perinatal variables, demographic characteristics and HRQoL. A total of 147 VLBW children and 116 mothers were assessed. The measures included for assessment were self-and parent-reported HRQoL, functional social support, maternal stress, socio-family risk index and neonatal medical risk index. Mediation analysis was applied to investigate mediation effects of the maternal factors. Mean self-and parent-reported KIDSCREEN scores were 55.1 (SD 10.1) and 58.2 (SD 9.1), respectively, indicating better HRQoL than the normed sample with a mean of 50 (p

We evaluate different methods to detect benzene at a parts-per-billion level regarding their potential to be used in a wearable sensor. Benzene is a carcinogenic molecule, regarded as a major health threat by the World Health Organization. A wearable sensor is necessary to detect leaks immediately, but it is challenging to achieve such low limits of detection and quantification, even with laboratory equipment. A wearable sensor must, in addition to good selectivity and sensitivity, meet stricter requirements of size, weight, temperature, repeatability, and power consumption. We conclude that the most promising techniques for a wearable sensor are either infrared photoacoustic spectroscopy near 14.8 μm, or a photoionization detector combined with one of three selective devices: micro-gas chromatography, cavitands, or catalytic filters (WO3, for example). Ultraviolet photoacoustic spectroscopy may also be a suitable future technique for a wearable benzene sensor when efficient LEDs and lasers become available at many UV-C wavelengths.

The article is a response by Kari Aga Myklebost (UiT The Arctic University of Norway) to a commentary by Arnt Bjarne Aronsen (Vardøhus museumsforening) on her previously published article, 'Minnediplomati i grenseland. De russisk-norske patriotiske minneturene 2011–2019', DOI: https://doi.org/10.23865/noros.v37.5514

BackgroundThere is a growing prevalence of nonhealing wounds and chronic diseases in society, and there is an associated need for wound management solutions that include the use of telemedicine. A broad spectrum of factors influences the planning and execution of interventions within telemedicine in chronic wound management, spanning organizations, technologies, and individuals, including professionals and patients. The Telemedicine and Ambulatory Wound Care Team (TELE-AMBUS) project applies a whole-system research approach to account for this spectrum of factors. ObjectiveThe primary objective of this study was to explore and analyze the implementation and consequences of an outpatient wound management model, comprising 2 interconnected quality improvement interventions (ie, telemedicine and ambulatory wound care team) aimed at older and vulnerable patients with chronic wounds, across the specialist and primary health care sectors. Embedded in this objective is the aim to improve the competence levels of health care providers and, consequently, the service quality of outpatient wound management across specialist and primary health care services. MethodsThis project examines the implementation and consequences of an outpatient wound management model through a combined process and economic evaluation research strategy. A sociotechnical system theory approach and multiple work package design support the examination. The project uses observations, conversations, interviews, and economic assessments to gather rich, in-depth insights and understanding on why and how the new wound management model contributes to a change or not compared with the traditional treatment model. ResultsThe project has been funded from 2021 to 2025. Baseline interviews have been conducted since April 2022 and concluded in January 2024. Fieldwork, including nonparticipant observations, semistructured interviews, and informal conversations, has been conducted since November 2022 and is expected to conclude in March 2025. In parallel and as part of the cost-effectiveness analyses, time usage data on the outpatient and regular clinical models are being gathered during the fieldwork. ConclusionsWe applied a whole-system approach in multiple ways, that is, to design or inform our fieldwork and to explore, evaluate, and translate project findings into practice across services. To our knowledge, this approach has not been undertaken in telemedicine in chronic wound management literature and associated human factors and ergonomics research. Thus, our approach can produce both original and novel research and theoretical results internationally. International Registered Report Identifier (IRRID)DERR1-10.2196/55502

Abstract Male postsmolt maturation (“jacking”) is undesired in Atlantic salmon aquaculture due to economic and welfare impacts. Unfortunately, incidence of jacking has increased linked to intensive rearing conditions. This study subjected 1000 salmon (52.1 ± 5.2 g) to one of two temperatures (15, 12.5°C) and one of two photoperiods (constant light‐LL, a 5‐week LD12:12 winter signal regime‐WS) to assess their effects on spermatogenesis regulation. Indicators included testis histology images, mRNA transcription of gonadotropin receptors for follicle‐stimulating hormone (fshr) and luteinizing hormone (lhr), and of factors regulating spermatogenesis like anti‐Müllerian hormone (amh), gonadal‐soma‐derived factors 1 and 2 (gsdf1 and gsdf2), and insulin‐like growth factor‐3 (igf3). High temperature (15°C) induced early testis development processes irrespective of photoperiod, evidenced by presence of type B spermatogonia before clear increases in testis size or any transcriptional changes. The winter signal at 15°C caused a synchronized onset of spermatogenesis not present under constant light. This was evidenced by a pronounced downregulation of the spermatogenesis‐inhibiting factor amh and a clear upregulation in the stimulating factor igf3. Consequently, combining high temperatures with winter signal regimes pose risk; high temperature can stimulate early cellular/endocrine processes of spermatogenesis, which can later be synchronized in the population by an increase in daylength.

Abstract Background Healthcare costs are rising worldwide. At the same time, a considerable proportion of care does not benefit or may even be harmful to patients. We aimed to explore attitudes towards low-value care and identify the most important barriers to the de-implementation of low-value care use in primary care in high-income countries. Methods Between May and June 2022, we email surveyed primary care physicians in six high-income countries (Austria, Finland, Greece, Italy, Japan, and Sweden). Physician respondents were eligible if they had worked in primary care during the previous 24 months. The survey included four sections with categorized questions on (1) background information, (2) familiarity with Choosing Wisely recommendations, (3) attitudes towards overdiagnosis and overtreatment, and (4) barriers to de-implementation, as well as a section with open-ended questions on interventions and possible facilitators for de-implementation. We used descriptive statistics to present the results. Results Of the 16,935 primary care physicians, 1,731 answered (response rate 10.2%), 1,505 had worked in primary care practice in the last 24 months and were included in the analysis. Of the respondents, 53% had read Choosing Wisely recommendations. Of the respondents, 52% perceived overdiagnosis and 50% overtreatment as at least a problem to some extent in their own practice. Corresponding figures were 85% and 81% when they were asked regarding their country’s healthcare. Respondents considered patient expectations (85% answered either moderate or major importance), patient’s requests for treatments and tests (83%), fear of medical error (81%), workload/lack of time (81%), and fear of underdiagnosis or undertreatment (79%) as the most important barriers for de-implementation. Attitudes and perceptions of barriers differed significantly between countries. Conclusions More than 80% of primary care physicians consider overtreatment and overdiagnosis as a problem in their country’s healthcare but fewer (around 50%) in their own practice. Lack of time, fear of error, and patient pressures are common barriers to de-implementation in high-income countries and should be acknowledged when planning future healthcare. Due to the wide variety of barriers to de-implementation and differences in their importance in different contexts, understanding local barriers is crucial when planning de-implementation strategies.

Abstract Targeted therapy is effective in many tumor types including lung cancer, the leading cause of cancer mortality. Paradigm defining examples are targeted therapies directed against non-small cell lung cancer (NSCLC) subtypes with oncogenic alterations in EGFR, ALK and KRAS. The success of targeted therapy is limited by drug-tolerant persister cells (DTPs) which withstand and adapt to treatment and comprise the residual disease state that is typical during treatment with clinical targeted therapies. Here, we integrate studies in patient-derived and immunocompetent lung cancer models and clinical specimens obtained from patients on targeted therapy to uncover a focal adhesion kinase (FAK)-YAP signaling axis that promotes residual disease during oncogenic EGFR-, ALK-, and KRAS-targeted therapies. FAK-YAP signaling inhibition combined with the primary targeted therapy suppressed residual drug-tolerant cells and enhanced tumor responses. This study unveils a FAK-YAP signaling module that promotes residual disease in lung cancer and mechanism-based therapeutic strategies to improve tumor response.

An oral Controlled Human Infection Model (CHIM) with wild-type S. Typhi was re-established allowing us to explore the development of immunity. In this model, ~55% of volunteers who received the challenge reached typhoid diagnosis criteria (TD), while ~45% did not (NoTD). Intestinal macrophages are one of the first lines of defense against enteric pathogens. Most organs have self-renewing macrophages derived from tissue-resident progenitor cells seeded during the embryonic stage; however, the gut lacks these progenitors, and all intestinal macrophages are derived from circulating monocytes. After infecting gut-associated lymphoid tissues underlying microfold (M) cells, S. Typhi causes a primary bacteremia seeding organs of the reticuloendothelial system. Following days of incubation, a second bacteremia and clinical disease ensue. S. Typhi likely interacts with circulating monocytes or their progenitors in the bone marrow. We assessed changes in circulating monocytes after CHIM. The timepoints studied included 0 hours (pre-challenge) and days 1, 2, 4, 7, 9, 14, 21 and 28 after challenge. TD participants provided extra samples at the time of typhoid diagnosis, and 48-96 hours later (referred as ToD). We report changes in Classical Monocytes -CM-, Intermediate Monocytes -IM- and Non-classical Monocytes -NCM-. Changes in monocyte activation markers were identified only in TD participants and during ToD. CM and IM upregulated molecules related to interaction with bacterial antigens (TLR4, TLR5, CD36 and CD206). Of importance, CM and IM showed enhanced binding of S. Typhi. Upregulation of inflammatory molecules like TNF-α were detected, but mechanisms involved in limiting inflammation were also activated (CD163 and CD354 downregulation). CM upregulated molecules to interact/modulate cells of the adaptive immunity, including T cells (HLA-DR, CD274 and CD86) and B cells (CD257). Both CM and IM showed potential to migrate to the gut as integrin α4β7 was upregulated. Unsupervised analysis revealed 7 dynamic cell clusters. Five of these belonged to CM showing that this is the main population activated during ToD. Overall, we provide new insights into the changes that diverse circulating monocyte subsets undergo after typhoid diagnosis, which might be important to control this disease since these cells will ultimately become intestinal macrophages once they reach the gut.

Abstract Individuals born with very low birth weight (VLBW;

Abstract Background Causes of death other than COVID-19 seem to contribute significantly to the excess mortality observed during the 2020–2022 pandemic. In this study, we explore changes in non-COVID-19 causes of death in Norway during the COVID-19 pandemic from March 2020 to December 2022. Methods We performed a population-based cross-sectional study on data from the Norwegian Cause of Death Registry. All recorded deaths from 1st January 2010 to 31st December 2022 were included. The main outcome measures were the number of deaths and age-standardised death rate (ASMR) per 100000 population from the major cause of death groups in 2020, 2021 and 2022. The predicted number of deaths and ASMRs were forecasted with a 95% prediction interval constructed from a general linear regression model based on the corresponding number of deaths and rates from the preceding ten prepandemic years (2010–2019). We also examined whether there were deviations from expected seasonality in the pandemic period based on prepandemic monthly data from 2010–2019. The cumulative number of deaths and ASMR were estimated based on monthly mortality data. Results There was significant excess mortality (number of deaths) in 2021 and 2022 for all causes (3.7% and 14.5%), for cardiovascular diseases (14.3% and 22.0%), and for malignant tumours in 2022 (3.5%). In terms of ASMR, there was excess mortality in 2021 and 2022 for all causes (2.9% and 13.7%), and for cardiovascular diseases (16.0% and 25,8%). ASMR was higher than predicted in 2022 for malignant tumours (2.3%). There were fewer deaths than predicted from respiratory diseases (except COVID-19) in 2020 and 2021, and from dementia in 2021 and 2022. From March 2020 to December 2022, there were cumulatively 3754 (ASMR 83.8) more non-COVID-19 deaths than predicted, of which 3453 (ASMR: 79.6) were excess deaths from cardiovascular disease, 509 (ASMR 4.0) from malignant tumours. Mortality was lower than predicted for respiratory diseases (-1889 (ASMR: -44.3)), and dementia (-530 (ASMR -18.5)). Conclusions There was considerable excess non-COVID-19 mortality in Norway from March 2020 until December 2022, mainly due to excess cardiovascular deaths. For respiratory diseases and dementia, mortality was lower than predicted.

Objective: Recess contributes meaningfully to physical activity (PA), but recess time has declined. The study’s purpose was to report PA by age, gender, and playground feature to inform potential playground configurations more conducive to PA during recess. Methods: Using the System for Observing Play and Leisure Activity in the Youth, kindergarten through 5th grade recesses were observed on at least four days at four schools in Little Rock, Arkansas, United States during May 2023. Target playground features were ball courts, grass, pavement, play structures, and swings. To provide inferential analysis, a comparison of conditional means across playground features, age, and gender was conducted using linear regression with robust standard errors clustered by school. Results: 3,356 playground scans (intercoder correlation = 0.93) were collected and aggregated by school, day, gender, age (grade), and target feature for a sample size of 292 observations. The gender gap was widest among 4-5th graders, 79 % (95 % CI: 72, 86) for males and 64 % (95 % CI: 58, 70) for females. Among females, PA was highest on swings [82 % (95 % CI: 77, 86)] and lowest on paved areas [56 % (95 % CI: 43, 69)]. Among males, it was highest on both swings [81 % (95 % CI: 75, 86)] and ball courts [83 % (95 % CI: 77, 89)] and lowest on grassy areas [64 % (95 % CI: 60, 67)]. Conclusion: Swings, courts, and play structures were associated with a higher proportion of children being engaged in PA. Research is needed to identify whether physical improvements to facilitate access to these features increase PA.

This systematic review addresses the gap in the literature regarding sibling relationship quality among Latinx families, a topic that has not been comprehensively examined to date. This study aimed to synthesize current research on sibling relationship quality in Latinx families, focusing on the influence of cultural factors, identifying key variables associated with sibling relationship quality, and evaluating the methodological approaches used. This paper is a systematic review based on a recently published evidence and gap map (EGM) that identified and visually presented all published studies investigating sibling relationship quality. Additional inclusion criteria were applied to select articles that specifically examined sibling relationship quality in the United States samples with at least 50% Latinx participants. The review included 12 articles representing 6 distinct studies, revealing significant findings on the roles of familism, simpatía, and gender in shaping sibling dynamics. Results indicated that cultural values such as familism and simpatía positively influence sibling intimacy and warmth, while gender dynamics further moderate these relationships. Methodologically, the articles employed longitudinal and cross-sectional designs, utilizing various quantitative measures. The findings underscore the importance of culturally sensitive approaches in studying sibling relationships and highlight the need for further research to explore these dynamics in diverse Latinx subgroups.

This paper presents a discussion of Radcliffe’s pedagogy-space-technology (PST) framework for the development, implementation, and evaluation of learning spaces in light of Merleau-Ponty’s Phenomenology of Perception. The following research questions have guided the theoretical discussion: In which ways can Merleau-Ponty’s body-subject phenomenology enlighten Radcliffe’s framework? How can Merleau-Ponty’s body-subject paradigm be integrated into the development and implementation of hybrid learning environments? The reference to an exploratory case study within the frame of a larger research project will support the theoretical argumentation. In the study, the genesis of an innovative learning environment linked to a cross-institution master’s program located at two Norwegian universities will serve as an example.

A long-standing problem in the study of mutualism is to understand the effects of non-mutualistic community members that exploit the benefits of mutualism without offering commodities in exchange (i.e., ‘exploiters’). Mutualisms are continually challenged by exploiters and their persistence may depend on the costliness of exploitation or on adaptations that allow mutualists to avoid the negative effects of exploiters. Coevolution could lead to changes in mutualists and exploiters that allow mutualisms to persist. Although coevolution is considered essential for mutualism persistence and resistance to disturbance, we have yet to obtain direct experimental evidence of the role of coevolution in resistance to exploitation. Additionally, resistance to exploitation via coevolutionary processes might vary with the degree of dependency between mutualistic partners, as facultative mutualisms are thought to be under weaker coevolutionary selection than obligate mutualisms. Here, we conducted an experimental evolution study using a synthetic yeast mutualism to test how coevolution in facultative and obligate mutualisms affects their resistance to exploitation. We found that naïve facultative mutualisms were more likely to breakdown under exploitation than naïve obligate mutualisms. After 15 weeks of coevolution, both facultative and obligate evolved mutualists were more likely to survive exploitation than naïve mutualists when we reassembled mutualist communities. Additionally, coevolved exploiters were more likely to survive with mutualists, whereas naïve exploiters frequently went extinct. These results suggest that coevolution between mutualists and exploiters can lead to mutualism persistence, potentially explaining why exploitation is ubiquitous but rarely associated with mutualism breakdown.

Preoperative nasopharyngeal viral screening may reduce clinical uncertainty of upper respiratory infections prior to pediatric cardiac surgery but with unclear benefit. From March 2018 to March 2020, patients aged

While the early effects of the COVID-19 pandemic on the United States labor market are well-established, less is known about the long-term impact of SARS-CoV-2 infection and Long COVID on employment. To address this gap, we analyzed self-reported data from a prospective, national cohort study to estimate the effects of SARS-CoV-2 symptoms at three months post-infection on missed workdays and return to work. The analysis included 2,939 adults in the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE) study who tested positive for their initial SARS-CoV-2 infection at the time of enrollment, were employed before the pandemic, and completed a baseline and three-month electronic survey. At three months post-infection, 40.8% of participants reported at least one SARS-CoV-2 symptom and 9.6% of participants reported five or more SARS-CoV-2 symptoms. When asked about missed work due to their SARS-CoV-2 infection at three months, 7.2% of participants reported missing ≥10 workdays and 13.9% of participants reported not returning to work since their infection. At three months, participants with ≥5 symptoms had a higher adjusted odds ratio of missing ≥10 workdays (2.96, 95% CI 1.81-4.83) and not returning to work (2.44, 95% CI 1.58-3.76) compared to those with no symptoms. Prolonged SARS-CoV-2 symptoms were common, affecting 4-in-10 participants at three-months post-infection, and were associated with increased odds of work loss, most pronounced among adults with ≥5 symptoms at three months. Despite the end of the federal Public Health Emergency for COVID-19 and efforts to "return to normal", policymakers must consider the clinical and economic implications of the COVID-19 pandemic on people's employment status and work absenteeism, particularly as data characterizing the numerous health and well-being impacts of Long COVID continue to emerge. Improved understanding of risk factors for lost work time may guide efforts to support people in returning to work.

ObjectiveIndividuals born very preterm (Study designCohorts with data on physical activity and cognitive function in adults born very preterm/very low birth weight and term-born controls were recruited from the Research on European Children and Adults Born Preterm, and the Adults Born Preterm International Collaboration Consortia. A systematic literature search was performed in PubMed and Embase.ResultsFive cohorts with 1644 participants aged 22-28 years (595 very preterm/very low birth weight and 1049 controls) were included. Adults born very preterm/very low birth weight reported 1.11 (95% CI: 0.68 to 1.54) hours less moderate to vigorous physical activity per week than controls, adjusted for cohort, age and sex. The difference between individuals born very preterm/very low birth weight and controls was larger among women than among men. Neither intelligence quotient nor self-reported executive function mediated the association between very preterm/very low birth weight and moderate to vigorous physical activity. Results were essentially the same when we excluded individuals with neurosensory impairments.ConclusionAdults born very preterm/very low birth weight, especially women, reported less moderate to vigorous physical activity than their term-born peers. Cognitive function did not mediate this association. Considering the risk of adverse health outcomes among individuals born preterm, physical activity could be a target for intervention.

IntroductionThere is increasing evidence that the in utero environment affects the health and disease risk of offspring throughout their lives. The long-term effect of maternal hyperglycaemia on offspring glucose metabolism is of interest in a public health perspective. The aim of this study was to examine the association between in utero exposure to maternal glycaemia and offspring glucose metabolism.MethodsMother-child pairs were recruited from an RCT to prevent gestational diabetes mellitus where 855 healthy pregnant women were randomised to exercise or standard antenatal care. The original RCT detected no group differences in gestational diabetes mellitus prevalence or insulin resistance. The two groups were analysed as one group in the present study. Maternal glucose levels were assessed after 2-hour 75-gram oral glucose tolerance tests in pregnancy week ~34. Offspring outcomes were evaluated at ~9 years of age and included fasting glucose and homeostatic model assessment of insulin resistance. Multivariable regression models were performed, controlling for potential hereditary and lifestyle confounding factors.ResultsComplete data were available for 105 mother-child pairs. The regression analysis showed a positive association between maternal and offspring fasting glucose that was borderline significant (beta=0.18, 95% CI [-0.00027, 0.37], p=0.050). We did not find significant associations between maternal fasting glucose and offspring insulin resistance (beta=0.080, 95% CI [-0.087, 0.25], p=0.34), or between maternal 2-hour glucose and offspring fasting glucose (beta=0.016, 95% CI [-0.038, 0.070], p=0.56) or insulin resistance (beta=0.017, 95% CI [-0.032, 0.065], p=0.49).ConclusionsAssessing a homogeneous group of healthy mother-child pairs, we found a borderline significant positive association between maternal and offspring fasting glucose, which persisted after adjustment for potential hereditary and lifestyle confounding factors. Our findings support other similar studies and highlight that improving the metabolic health of pregnant women, and women in childbearing age, should remain a key public health priority.Clinical trial registrationClinicalTrials.gov, identifier NCT00476567.

IntroductionData on ethnic and racial differences in symptoms and health-related impacts following SARS-CoV-2 infection are limited. We aimed to estimate the ethnic and racial differences in symptoms and health-related impacts 3 and 6 months after the first SARS-CoV-2 infection.MethodsParticipants included adults with SARS-CoV-2 infection enrolled in a prospective multicenter US study between 12/11/2020 and 7/4/2022 as the primary cohort of interest, as well as a SARS-CoV-2-negative cohort to account for non-SARS-CoV-2-infection impacts, who completed enrollment and 3-month surveys (N = 3,161; 2,402 SARS-CoV-2-positive, 759 SARS-CoV-2-negative). Marginal odds ratios were estimated using GEE logistic regression for individual symptoms, health status, activity level, and missed work 3 and 6 months after COVID-19 illness, comparing each ethnicity or race to the referent group (non-Hispanic or white), adjusting for demographic factors, social determinants of health, substance use, pre-existing health conditions, SARS-CoV-2 infection status, COVID-19 vaccination status, and survey time point, with interactions between ethnicity or race and time point, ethnicity or race and SARS-CoV-2 infection status, and SARS-CoV-2 infection status and time point.ResultsFollowing SARS-CoV-2 infection, the majority of symptoms were similar over time between ethnic and racial groups. At 3 months, Hispanic participants were more likely than non-Hispanic participants to report fair/poor health (OR: 1.94; 95%CI: 1.36–2.78) and reduced activity (somewhat less, OR: 1.47; 95%CI: 1.06–2.02; much less, OR: 2.23; 95%CI: 1.38–3.61). At 6 months, differences by ethnicity were not present. At 3 months, Other/Multiple race participants were more likely than white participants to report fair/poor health (OR: 1.90; 95% CI: 1.25–2.88), reduced activity (somewhat less, OR: 1.72; 95%CI: 1.21–2.46; much less, OR: 2.08; 95%CI: 1.18–3.65). At 6 months, Asian participants were more likely than white participants to report fair/poor health (OR: 1.88; 95%CI: 1.13–3.12); Black participants reported more missed work (OR, 2.83; 95%CI: 1.60–5.00); and Other/Multiple race participants reported more fair/poor health (OR: 1.83; 95%CI: 1.10–3.05), reduced activity (somewhat less, OR: 1.60; 95%CI: 1.02–2.51; much less, OR: 2.49; 95%CI: 1.40–4.44), and more missed work (OR: 2.25; 95%CI: 1.27–3.98).DiscussionAwareness of ethnic and racial differences in outcomes following SARS-CoV-2 infection may inform clinical and public health efforts to advance health equity in long-term outcomes.

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s12889-024-18629-0.

Based on our Chandra imaging-spectroscopic observations, we present the latest evolution of the X-ray remnant of SN 1987A. Recent changes in the electron temperatures and volume emission measures suggest that the blast wave in SN 1987A is moving out of the dense inner ring structure, also called the equatorial ring (ER). The 0.5–2.0 keV X-ray light curve shows a linearly declining trend (by ∼4.5% yr ^−1 ) between 2016 and 2020 as the blast wave heats the hitherto unknown circumstellar medium (CSM) outside the ER. While the peak X-ray emission in the latest 0.3–8.0 keV image is still within the ER, the radial expansion rate in the 3.0–8.0 keV images suggests an increasing contribution of the X-ray emission from less dense CSM since 2012, at least partly from beyond the ER. It is remarkable that, since 2020, the declining soft X-ray flux has stabilized around ∼7 × 10 ^−12 erg s ^−1 cm ^−2 , which may signal a contribution from the reverse-shocked outer layers of ejecta as predicted by the three-dimensional magnetohydrodynamic models. In the latest ACIS spectrum of supernova remnant 1987A in 2022 we report a significant detection of the Fe K line at ∼6.7 keV, which may be due to changing thermal conditions of the X-ray emitting CSM and/or the onset of reverse shock interactions with the Fe ejecta.

Fieldwork is an integral phase of occupational therapy education, bolstered by a small but growing evidence base. A broad understanding of the state of that evidence base is necessary to inform the directions for future growth. The purpose of this work was to establish the current state of occupational therapy fieldwork literature, map that literature to recognized criteria for educational research, and identify gaps in the existing literature. Authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct a mapping review of articles with a primary focus on fieldwork education of occupational therapy (OT) or occupational therapy assistant (OTA) students in United States (Accreditation for Occupational Therapy Education)-based programs. Mapping criteria included level of education [OT, OTA], level of fieldwork [Level I, Level II], and categories of the AOTA "Education Research Agenda -- Revised" (2018). Sources included four databases (Academic Search Premier, CINAHL, ERIC, PubMed) and one additional journal (Journal of Occupational Therapy Education). A total of 1,619 articles were identified, with 67 articles meeting inclusion criteria. The 67 included articles disproportionately focused on Level II OT fieldwork (53%, n=36), with sparse representation of Level I OTA fieldwork (1.5%, n=1), and addressed only two categories of the Education Research Agenda (2018; 80%, n=54). Level I fieldwork, occupational therapy assistant programs, and large swaths of the association's Education Research Agenda (2018) were dramatically (or completely) underrepresented in fieldwork education research, suggesting important priorities for the immediate future of occupational therapy fieldwork education.

Medical school curriculum integrates pre-clinical coursework with clinical experiences to impart understanding of pathophysiologic processes and requisite skills for future physicians. Evaluation through examinations measures students' knowledge and skills acquisition, while practice exam questions remain underexplored in studies on student study habits and exam performance. This study addresses the study habits, perceptions, and utilization of practice questions among first-year medical students (M1s). A survey conducted in 2023 revealed that a substantial proportion of students dedicate extensive time to independent study, with a majority expressing a strong preference for utilizing practice questions in their exam preparation. Notably, the survey findings underscored the perceived effectiveness of practice questions in assessing comprehension and identifying crucial content areas. Furthermore, students emphasized the value of practice questions that integrate and synthesize information across different curriculum blocks. The majority of students reported improved perceived performance on content accompanied by practice questions, highlighting the potential benefits of integrating these resources into medical school curricula. By understanding and supporting effective study strategies, educators can potentially mitigate student stress and enhance overall academic performance.

This paper describes and compares primary school students' perceptions of science learning skills in a teacher-centered approach (TCA) and in inquiry-based science fieldwork (IBSF). This comparison was prompted by primary school students' perceptions of science learning skills, which has recently gained momentum, and the Namibian primary schools' recent curriculum shift from TCA to IBSF. The study utilized quantitative cross-sectional data (n = 237) collected from two primary schools in the Oshana region of Namibia. The data were gathered via an online survey and were analyzed using descriptive statistics. The Mann-Whitney U test was used to compare the TCA and IBSF groups. The results revealed that the students had positive to fairly positive perceptions of science learning skills in IBSF and very negative to negative perceptions of science learning skills in TCA, with the difference between the two perceptions being statistically significant. This may indicate that Namibian primary school students find it hard to develop science learning skills under TCA. Therefore, the current study provided evidence for the need to focus more on supporting students' science learning skills, particularly problem-solving, communication and teamwork skills. This implies that the IBSF teaching approach, which allows students to become aware of the importance of science learning skills, must be adopted in Namibian primary schools. The paper also discusses the benefits of IBSF of science learning skills in students.

Background: School engagement is a positive, malleable aspect of youth functioning that may be influenced by familial factors. Both risk and protective factors may affect youth's school engagement. Objective: Utilizing an intergenerational transmission of risk framework, the current study examined how maternal factors (i.e., maternal psychopathology, maternal trauma history, maternal education) and youth factors (i.e., social support) relate to school engagement. Methods: Participants were 117 youth of color aged 8-13 years (M[subscript age] = 9.96, SD = 1.40), 51% female, 89% Black or African American and their female primary caregivers; all families had experienced adversity. Using a single-group, cross-sectional design, hierarchical linear regression models examined direct and interactive effects. The first block included maternal psychopathology (i.e., anxiety or depression), maternal trauma history, maternal education, and child social support. The second block added the interaction between maternal psychopathology and child social support. Results: Results revealed a direct, positive relation between child social support and school engagement. Social support also moderated the association between maternal anxiety and school engagement; for individuals with extremely low social support, higher maternal anxiety was related to lower school engagement. Conclusions: Results illustrate the value of an intergenerational approach to exploring how maternal factors have implications for youth functioning. Findings also highlight the importance of social support among families of color exposed to adversity. Limitations include the cross-sectional design; thus, future research would benefit from longitudinal examination of maternal and child factors related to school engagement to assess temporal and directional effects.

Background: Engineering educators prepare students for responsible, ethical, and socially aware engineering practice by "contextualizing" engineering in a variety of ways. Recently, ABET and the NAE have prioritized engineers' ability to make judgments considering a variety of contexts and specifically advocated for building engineers' contextual competencies. Purpose: Educators can often agree that contextualizing engineering work and problems is beneficial, while taking different approaches to that contextualization. It is important for engineering educators to know how their modes of contextualization compare with others, as well as how they define and achieve success. Scope/Method: This scoping literature review answers two research questions: How are engineering educators contextualizing engineering through their programs, courses, and pedagogies? And what are the justifications, motivations, or desired ends of engineering educators' contextualization? The original search yielded 500 articles from pertinent engineering education venues. After detailed exclusion and inclusion criteria were applied, 104 relevant articles were analyzed. Results: These remaining articles were sorted into six modes of contextualization: context tools, professional skills, real-world problems, design, sociotechnical thinking, and social impact. The categorization and analysis led to a complex understanding of the multiplicity of contextualization in engineering education. Conclusions: The wide variety of modes of contextualization results in a variety of bettering strategies, or ways that these forms of pedagogy can improve engineering education, and, in turn, larger engineering contexts. We conclude that engineering content and context are "interactional" and co-constructed, showing how different modes of contextualization demarcate different images of what engineering content and contexts are and ought to be.

In this essay, we argue that pupils in compulsory school education seem to be exposed to conflicting pressures from an (internal) tendency towards individualisation and an (external) tendency towards standardisation. Drawing on Luc Bolanski and Laurent Thévenot's pragmatic sociology of orders of worth, we develop a theoretical framework to discuss the two conflicting cultures. In the first part of the analysis, we present the broad and enhanced tendency towards individualisation in terms of methods and content in Norwegian compulsory education -- the construction of an "inspirational pupil" -- and in the second part of the analysis, we present the development of standards for assessment -- the construction of an "industrial pupil." In the final section we discuss two forms of processes -- individualisation and standardisation -- rooted in two incompatible orders of worth, the inspirational and industrial order, respectively, and argue that these processes represent a major challenge in schools, a conflicting pressure to which pupils are being subjected.

The sanctioned language around "mathematics teacher knowledge" in the US centers pedagogy, content (mathematical knowledge), and students. Yet, this teacher learning approach often promotes (explicitly or implicitly) teaching and learning of mathematics that operationalizes mathematics as rigid, as a gatekeeper, and only useful for global competition in STEM-related fields. These tacit capitalist goals result in teachers being expected to convey "clear and useful" mathematical information to students, not question why mathematics is being taught, who benefits, and/or how to intervene if the learning environment is harmful for students who are Black, Indigenous, students of Color, multilingual, dis/abled, queer, nonbinary, and/or of immigrant backgrounds. In this article, we build upon a form of relational knowing that intertwines mathematics, pedagogies, students, and politics called Political Conocimiento in Teaching Mathematics. Focusing on political knowledge brings the margins to the center by recognizing political issues cannot be separated from other dimensions or added on, as if politics are not already present in mathematics teaching and learning. As three women of Color, we present empirical results from three teacher education programs in the USA with teacher candidates (n = 55) who range in intersectional identities. Using scenario-based activities that support their development of political knowledge, we apply the lens of "The Mirror Test" to highlight how teacher candidates' intersectional identities influenced the ethical identities they enacted. Some candidates focused more on "accountability" while others focused on "performativity." We offer implications for future research on ethical identities in mathematics education with teachers and teacher candidates of various intersectional identities.

The purpose of this phenomenological study was to explore the "lived experience" of choral music teacher educators (MTEs) in hybrid positions at tier 1 research universities. After interviews with eight choral MTEs from across the United States, three themes emerged from our data: inseparable identity components, reciprocity of selves, and externally derived tension. Inseparable identity components described the ways in which participants sought to align the components of their job with their holistic teacher-researcher-conductor identities. Reciprocity of selves referred to how participants' teacher, researcher, and conductor selves informed and were informed by each other. Finally, participants maintained security in their own holistic sense of self but experienced externally derived tension as they navigated the structural divide of performance and education in higher education.

The purpose of this intrinsic case study was to examine how preservice music teachers' participation in a 4-year lab choir setting contributed to their teacher identity construction. This lab choir represents an uncommon case of peer teaching because preservice teachers enroll in the course each semester of their undergraduate career and participate as singers for multiple semesters before taking on the teacher role, at which point they are teaching an ensemble made up largely of younger students. The eight participants in this study were choral music education majors who had been members of the lab choir since their first semester at the university. Three themes emerged from the data: "culture of identity construction", "evolution through coursework", and "peers as future selves." Participants felt the lab choir experience contributed positively to their identity construction and skill acquisition. Implications for music teacher education are discussed.

Systemic low-grade inflammation is a feature of chronic disease. C-reactive protein (CRP) is a common biomarker of inflammation and used as an indicator of disease risk; however, the role of inflammation in disease is not completely understood. Methylation is an epigenetic modification in the DNA which plays a pivotal role in gene expression. In this study we evaluated differential DNA methylation patterns associated with blood CRP level to elucidate biological pathways and genetic regulatory mechanisms to improve the understanding of chronic inflammation. The racially and ethnically diverse participants in this study were included as 50% White, 41% Black or African American, 7% Hispanic or Latino/a, and 2% Native Hawaiian, Asian American, American Indian, or Alaska Native (total n = 13,433) individuals. We replicated 113 CpG sites from 87 unique loci, of which five were novel (CADM3, NALCN, NLRC5, ZNF792, and cg03282312), across a discovery set of 1,150 CpG sites associated with CRP level (p

Myasthenia gravis (MG) is a rare autoantibody-mediated disease affecting the neuromuscular junction. We performed a genome-wide association study of 5708 MG cases and 432,028 controls of European ancestry and a replication study in 3989 cases and 226,643 controls provided by 23andMe Inc. We identified 12 independent genome-wide significant hits (P

Exposure to polychlorinated biphenyls (PCBs) is linked to neurotoxic effects. This study aims to close knowledge gaps regarding the specific modes of action of PCBs in female C57BL/6J mice (>6 weeks) orally exposed for 7 weeks to a human-relevant PCB mixture (MARBLES mix) at 0, 0.1, 1, and 6 mg/kg body weight/day. PCB and hydroxylated PCB (OH-PCBs) levels were quantified in the brain, liver, and serum; RNA sequencing was performed in the striatum, prefrontal cortex, and liver, and metabolomic analyses were performed in the striatum. Profiles of PCBs but not their hydroxylated metabolites were similar in all tissues. In the prefrontal cortex, PCB exposure activated the oxidative phosphorylation respiration pathways, while suppressing the axon guidance pathway. PCB exposure significantly changed the expression of genes associated with neurodevelopmental and neurodegenerative diseases in the striatum, impacting pathways like growth hormone synthesis and dendrite development. PCBs did not affect the striatal metabolome. In contrast to the liver, which showed activation of metabolic processes following PCB exposure and the induction of cytochrome P450 enzymes, the expression of xenobiotic processing genes was not altered by PCB exposure in either brain region. Network analysis revealed complex interactions between individual PCBs (e.g., PCB28 [2,4,4'-trichlorobiphenyl]) and their hydroxylated metabolites and specific differentially expressed genes (DEGs), underscoring the need to characterize the association between specific PCBs and DEGs. These findings enhance the understanding of PCB neurotoxic mechanisms and their potential implications for human health.

Limited reporting of Indigenous-led planetary health education programmes has constrained efforts to expand planetary health education, in Indigenous communities and beyond, despite urgent need. Although incorporation of Indigenous knowledge and cultures cannot be standardised, showcasing successful programmes could reveal good practices and aid replicability. In this Personal View, we highlight how shellfish toxin education programmes, designed and organised by the Sitka Tribe of Alaska, reduce local environmental health risks and support youth in pathways towards careers in planetary health. We describe how programmes build awareness and understanding of the local environment, environmental and health risks, and context-appropriate adaptation strategies by centring Tlingit culture and using hands-on activities that integrate Tlingit culture with western science. Lesson plans and resources created by Sitka Tribe of Alaska staff for these programmes are available in the US National Institute for Environmental Health Sciences Partnerships for Environmental Public Health resources web database.