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Large wood is an integral part of many rivers, often defining river‐corridor morphology and habitat, but its occurrence, magnitude, and evolution in a river system are much less well understood than the sedimentary and hydraulic components, and due to methodological limitations, have seldom previously been mapped in substantial detail. We present a new method for this, representing a substantial advance in automated deep‐learning‐based image segmentation. From these maps, we measured large wood and sediment deposits from high‐resolution orthoimages to explore the dynamics of large wood in two reaches of the Elwha River, Washington, USA, between 2012 and 2017 as it adjusted to upstream dam removals. The data set consists of a time series of orthoimages (12.5‐cm resolution) constructed using Structure‐from‐Motion photogrammetry on imagery from 14 aerial surveys. Model training was optimized to yield maximum accuracy for estimated wood areas, compared to manually digitized wood, therefore model development and intended application were coupled. These fully reproducible methods and model resulted in a maximum of 15% error between observed and estimated total wood areas and wood deposit size‐distributions over the full spatio‐temporal extent of the data. Areal extent of wood in the channel margin approximately doubled in the years following dam removal, with greatest increases in large wood in wider, lower‐gradient sections. Large‐wood deposition increased between the start of dam removal (2011) and winter 2013, then plateaued. Sediment bars continued to grow up until 2016/17, assisted by a partially static wood framework deposited predominantly during the period up to winter 2013. Plain Language Summary: We measure the large wood in the Elwha River, Washington, USA, during and after dam removal. The presence of two dams had previously limited the movement of sediment and wood through the system. The removal of those dams liberated large amounts of sediment and wood from the former reservoir bottoms, which traveled downstream and deposited in the river channel. We develop an Artificial Intelligence (AI) model to measure all wood and sediment in the Elwha River corridor downstream of the two former dams, from a time‐series of high‐resolution imagery collected from aircraft. These measurements, accurate to within 15% of true values, provide a unique opportunity to understand how large wood occurs and behaves over multiple years and tens of kilometers. We found that the deposition of large wood on bars was coincident with and promoted the growth of sediment bars. The AI model we made could be powerful enough to find large wood in other places and images for similar purposes. Our data sets and models are made available to stimulate further studies of changes in river form resulting from interactions between water flow, wood, sediment, and vegetation. Key Points: We develop automated methods for detection and mapping of large wood, sediment, vegetation, and water from a time‐series of orthoimageryHigh‐resolution, reach‐wide measurements reveal wood dynamics in two Elwha River reaches adjusting to upstream dam removals over 5.5 yearsLarge wood deposition increased after dam removal, then plateaued, and bars continued to grow assisted by a partially static wood framework [ABSTRACT FROM AUTHOR]

Introduction Despite simulation being widely recognized as an essential component of medical education, there remains a dearth of literature on its implementation and effectiveness in pre-clerkship medical education. In order to effectively encompass healthcare simulations within medical instruction, it is imperative to first address the often neglected gap in faculty development and training. With this in mind, we aim to present our experience in implementing the Debriefing Assessment for Simulation in Healthcare (DASH) tool in training faculty at Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA. Methods Twenty participating faculty practiced instructing a simulation session and completed the DASH tool. Quantitative and qualitative approaches were used to report the findings. Results The Survey Rater and Student DASH version results were analyzed using the Mann-Whitney U test to see if there was a difference between the two groups for each question. Conclusions All faculty participating in healthcare simulations should be trained in order to deliver a structured debriefing experience. In healthcare medical simulation, the identification of faculty training is imperative to address many of the challenges of healthcare today, including patient safety issues and limitations of medical training in hospital settings. Implications The study aims to serve as a template that researchers can use in identifying potential faculty training development, as the benefits of having faculty trained in simulation methodology are successful in higher educational settings. Further studies in simulation-based education faculty training are recommended., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Nova Southeastern University Institutional Review Board issued approval IRB number 2022-4 Institutional Review Board Dr. Kiran C. Patel College of Allopathic Medicine. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Al-Khayat et al.)

Introduction This study aims to identify the influence of social determinants of health (SDoH) on patients with systemic lupus erythematosus (SLE), emphasizing racial and ethnic disparities in healthcare. Methods A cross-sectional study used the National Institute of Health's (NIH) All of Us Research Program (AoU). From 727,000 patients, SLE patients were categorized by race, ethnicity, and responses to the Social Determinants of Health survey from May 2018 until March 2023. Survey questions addressed transportation access, neighborhood safety, provider biases, and food insecurity. JMP Pro 16.0 and R 4.2.2 were used for statistical analysis. Results Significant racial disparities were evident amongst SLE patients for transportation access, neighborhood safety, food security, and respect from healthcare providers (p-value < 0.001). African Americans, Asians, and White participants showed different perceptions regarding neighborhood crime, healthcare provider courtesy, and feeling unheard by providers, with respective p-values of 0.001, 0.010, and 0.023. Hispanic participants perceived higher neighborhood crime rates, felt unsafe during nighttime walks, felt unheard by healthcare providers, and reported worrying about food security compared to non-Hispanic participants, with respective p-values of 0.003, 0.003, 0.009, and <0.001.  Discussion SLE is affected by access to care, treatments, stress, and lifestyle habits. Therefore, identifying SDoH for SLE patients is critical as it impacts disease progression, leading to delays in diagnosis, improper management, and worsening morbidity.  Conclusion Targeted social and community-based interventions may improve access to care, identify implicit biases among providers, and alleviate food insecurity., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. All of Us Institutional Review Board (IRB) issued approval not applicable. As a single IRB, the All of Us IRB is charged with reviewing the protocol, informed consent, and other participant-facing materials for the All of Us Research Program. The IRB follows the regulations and guidance of the Office for Human Research Protections for all studies, ensuring that the rights and welfare of research participants are overseen and protected uniformly. . Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Addanki et al.)

Background: Autism is a complex neurodevelopmental disability with global prevalence of one in 100 individuals. Poor access to interventions in both under-resourced regions of high-income countries and low- and middle-income countries has deleterious effects on the health and wellbeing of individuals with autism and their families. Our objective was to utilize a reciprocal innovation framework and participatory methods to adapt and co-develop a culturally grounded group-based wellbeing and naturalistic developmental behavioural intervention (NDBI) training program for caregivers of young children with autism to be implemented in Kenya and rural Indiana., Methods: This study was conducted within the Academic Model Providing Access to Healthcare (AMPATH) program. An evidence-informed Naturalistic Developmental Behavioral Intervention (NDBI) previously utilized in Indiana was adapted and iteratively refined using the Ecological Validity Framework (EVF) by a team of US and Kenyan disability experts. Key adaptations to the program were made across the EVF domains of language, persons, metaphors/content, concepts, goals, methods, and context., Results: Substantial cultural adaptations were made to the NDBI following the EVF model, including the addition of traditional Kenyan cultural practices, use of narrative principles, and focus on daily routines over play. Pepea, the adapted program, involves 10 group sessions covering content in basic education on autism, positive caregiver coping strategies, and behavioural skills training to promote child communication and reduce challenging behaviour. Key adaptations for Pepea were integrated back into a US NDBI caregiver training program., Conclusions: This study fills a critical gap by detailing the adaptation process of a caregiver wellbeing and naturalistic developmental behavioural training program for caregivers of children with autism in low-resource settings. Our next steps are to report on mixed-methods outcomes from pilot implementation. Our long-term goal is to apply these insights to advance sustainable and scalable autism intervention services across the globe., (© 2024 The Author(s). Child: Care, Health and Development published by John Wiley & Sons Ltd.)

Purpose: Core roles of medical school faculty are increasingly diverse, substantial, and evolving. In alignment with this dynamic nature of medical education, faculty effort should be accurately appraised, constantly evaluated, and rewarded to ensure faculty satisfaction and promote a culture of belonging. The study goal was to examine the imbalance in official assignments and perceptions of medical school faculty effort in various educator domains., Materials and Methods: An 80-item survey was designed to collect quantitative and qualitative measures of faculty perceptions of effort. Survey questions collected data on faculty demographics, intent to stay, and perceptions of effort in the following educator domains: teaching, educational leadership and administration, research and scholarship, and service. A mixed methods approach was utilized in data analysis., Results: Eighty-eight complete survey responses were collected between February and May of 2022 from respondents from 27 states. There was a significant disparity between assigned and perceived effort in the educator domains of teaching, research, and service (P < 0.01). Faculty satisfaction with percent effort dedicated to teaching significantly correlated with intent to stay (P < 0.05). Satisfaction with workload assignments was higher with advanced academic rank and male gender. Qualitative analysis identified many key themes in the categories of promotion, workload, resources, and retention., Conclusions: Our study revealed that satisfaction with workload directly correlates with intent to stay, and principles of equitable workload distribution are violated from the perspective of the medical educator. This data provides critical information that can be used to assist medical schools in developing metrics to evaluate faculty performance in medical education and improve retention in academic medicine., Competing Interests: Conflict of InterestThe authors have no conflicts of interest to disclose., (© The Author(s) under exclusive licence to International Association of Medical Science Educators 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Evidence suggests that TNF inhibitors (TNFi) used to treat rheumatoid arthritis (RA) may protect against Alzheimer's disease progression by reducing inflammation., Objective: To investigate whether RA patients with mild cognitive impairment (MCI) being treated with a TNFi show slower cognitive decline than those being treated with a conventional synthetic disease-modifying anti-rheumatic drug (csDMARD)., Methods: 251 participants with RA and MCI taking either a csDMARD (N = 157) or a TNFi (N = 94) completed cognitive assessments at baseline and 6-month intervals for 18 months. It was hypothesized that those taking TNFis would show less decline on the primary outcome of Free and Cued Selective Reminding Test with Immediate Recall (FCSRT-IR) and the secondary outcome of Montreal Cognitive Assessment (MoCA)., Results: No significant changes in FCSRT-IR scores were observed in either treatment group. There was no significant difference in FCSRT-IR between treatment groups at 18 months after adjusting for baseline (mean difference = 0.5, 95% CI = -1.3, 2.3). There was also no difference in MoCA score (mean difference = 0.4, 95% CI = -0.4, 1.3)., Conclusions: There was no cognitive decline in participants with MCI being treated with TNFis and csDMARDs, raising the possibility both classes of drug may be protective. Future studies should consider whether controlling inflammatory diseases using any approach is more important than a specific therapeutic intervention.