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Heat stress events in dairy cows are associated with behavioral and physiological changes such as seeking shade, increased respiration rate and body temperature, reduced milk production, and psychological distress. Knowledge of the relationship between weather and animal responses to heat stress enables automated alerts using forecast weather, aiding early provision of shade or other mitigation practices. While numerous heat stress indices for cattle have been developed, these have limitations for cows exposed to wind and solar radiation (i.e., predominantly grazing outdoors or managed on pasture). To develop a predictive model for heat stress events in pasture-based dairy systems, rumen temperature data from smaXtec (smaXtec animal care GmbH, Graz, Austria) rumen boluses in 443 cows on 3 dairy farms in Northland, New Zealand, were used to identify heat stress events and these were matched with automated weather station data collected on or near the farm. Heat stress rate (HSR) was defined as the percentage of cows within an age-breed group having a rumen temperature greater than 3 standard deviations above an individual cow's mean and heat stress events were defined as HSR >25%. Single and multiple linear regression models, including published heat stress indices, were generally able to predict a high proportion of heat stress events (sensitivity 34%–68%), but were insufficiently discriminating, predicting also a high number of false positives (precision only 9%–27%). A machine learning algorithm, cubist, was the best performing model, predicting 79% of heat stress events with a precision of 52% for this dataset. Our proof-of-concept study demonstrates the potential of this approach, using climate data to predict and forecast heat stress events in pasture-based dairy systems. Further work should test the cubist model using independent data, refine dataset construction, investigate the value of including known animal variables such as cow age or breed, and incorporate other measures of heat stress such as respiration rate.

This study aimed to compare grazing behavior of dairy cows with highly contrasting pasture allocation frequencies. The study ran from September 9, 2022, to December 2, 2022 (12 wk), during a time when daily pasture growth was expected to exceed daily herd intake. Three pasture allocation frequencies were compared, each with 11 spring-calving cows grazing a 4-ha farmlet. The allocations were high frequency rotational grazing (HFRG; 32.5 m2/cow per allocation and 4 allocations/d), rotational grazing with weekly allocations (7RG; 909 m2/cow per allocation and each allocated area continuously grazed over 7 d), and continuous grazing (CG; 1,818 m2/cow per allocation). Animal behavior was monitored using IceQube accelerometers (Peacock Technology) and CowManager ear tags (Agis Automatisering BV). Milk yield and composition were measured and pasture cover was estimated. Daily eating time was highest for CG animals, whereas lying time, lying bouts, and ruminating time were lowest, with no differences between HFRG and 7RG. There were no differences in fat- and protein-corrected milk yield between farmlets; however, estimated accumulated pasture yield was greater with more frequent allocations. Although milk production did not differ between treatment groups, this appeared to be achieved through greater eating times when allocated pasture less frequently, at the expense of time spent lying.

Background: Population-based analyses of Métis-specific health outcomes in Canada are limited. This study aimed to address this gap and examine cardiovascular disease outcomes in citizens of the Métis Nation of Ontario (MNO) over a 9-year period. Methods: Under a data governance and sharing agreement between the MNO and ICES, registered MNO citizens aged ≥ 20 years were linked to administrative health data in Ontario. Existing algorithms were used to determine the burden of heart failure and hypertension. In the most recent year, prevalence rates were compared for income quintiles, age, and sex. Results: Age-adjusted prevalence rates of hypertension decreased, and age-adjusted prevalence rates of heart failure increased in MNO citizens from 2012 to 2020. A larger decrease in prevalence of hypertension was observed for female citizens, by 12% from 28.9 per 100 (confidence interval [CI]: 27.6-30.2) in 2012 to 25.4 per 100 (CI: 24.5-26.3) in 2020. As for heart failure, the age-adjusted prevalence rates for male citizens had the largest increase, by 47% from 2.6 per 100 (CI: 2.1-3.1) in 2012 to 3.8 per 100 (CI: 3.3-4.2) in 2020. Hypertension and heart failure were more prevalent in male citizens, those of advanced age, and those living in areas within the lowest income quintile. Conclusions: This study is the first in nearly 10 years to investigate trends in cardiovascular outcomes among MNO citizens. Understanding this burden is critical to the MNO’s ability to guide program and policy planning, as well as to advocate within and beyond the health system for Métis-specific needs. Résumé: Contexte: Les analyses basées sur la santé des citoyens métis sont limitées au Canada. Cette étude visait à combler cette lacune et à examiner les résultats des maladies cardiovasculaires chez les citoyens de la Nation métisse de l’Ontario (NMO) sur une période de 9 ans. Méthodes: Dans le cadre d’un accord de gouvernance et de partage des données entre la NMO et ICES, les citoyens inscrits de la NMO âgés de 20 ans et plus ont été reliés aux données de santé administrative en Ontario. Des algorithmes existants ont été utilisés pour déterminer le fardeau de l’insuffisance cardiaque et de l’hypertension. Au cours de l’année la plus récente, les taux de prévalence ont été comparés pour les quintiles de revenu, ainsi que pour les sous-groupes selon l’âge et le sexe. Résultats: Les taux de prévalence ajustés selon l'âge de l'hypertension ont diminué tandis que les taux de prévalence ajustés selon l'âge de l'insuffisance cardiaque ont augmenté chez les citoyens de la NMO de 2012 à 2020. Une plus forte diminution de la prévalence de l'hypertension a été observée chez les femmes, de 12 % passant de 28,9 pour 100 (IC : 27,6-30,2) en 2012 à 25,4 pour 100 (IC : 24,5-26,3) en 2020. En ce qui concerne l'insuffisance cardiaque, les taux de prévalence ajustés selon l'âge chez les hommes ont connu la plus forte augmentation, de 47 % passant de 2,6 pour 100 (IC : 2,1-3,1) en 2012 à 3.8 pour 100 (IC : 3,3-4,2) en 2020. L'hypertension et l'insuffisance cardiaque étaient plus prévalentes chez les hommes, les personnes âgées et celles vivant dans des zones du quintile de revenu le plus bas. Conclusion: Il s'agit de la première étude en presque 10 ans à examiner les tendances des résultats cardiovasculaires chez les citoyens de la Nation métisse de l'Ontario. Comprendre ce fardeau est crucial pour la NMO afin de guider la planification des programmes et des politiques, ainsi que la défense des besoins spécifiques aux Métis au sein du système de santé.

Daylight is essential for ecosystems and for the physical and mental well-being of people. In densely populated cities, only a small proportion of total daylight is available to support urban greenery and most people have little daily exposure to natural daylight. Despite this, many cities have followed a strategy of densification as a way of preventing urban sprawl and reducing energy consumption. In this article, we review the biological importance of daylight and show that urban densification leads to a reduction in the daylight available for both people and nature. We conclude that daylight in cities should be treated as a limiting resource that needs to be planned and managed carefully, much like water or energy. We suggest elements for a policy framework aimed at optimizing urban daylight, including how to determine daylight needs, how to determine the maximum viable urban density, and policy options for built and unbuilt areas.

The objectives of this symposium review are to summarize relevant research and key welfare issues relative to calf transportation and identify strategies to mitigate welfare challenges. An important animal welfare concern across the US dairy industry is the transportation of preweaning calves from the source dairy to a calf-raising facility (e.g., calf ranches, heifer raising facilities, veal operations), auction, livestock market, or directly to slaughter. Millions of calves are transported annually in the United States and calf transport has garnered increased attention. Transportation stressors include limited (if any) access to food and water, commingling, environmental temperature changes, and a variety of handling techniques. Calves in the United States are often transported at an average age of 3 d, and in many cases, less than 24 h of age. Neonates are particularly vulnerable to transportation stressors due to their decreased ability to thermoregulate, underdeveloped immune system, and immature physiologic stress responses. In addition to age, fitness for transport is a key welfare consideration; recent data from the United States demonstrate that some source dairies transport compromised calves (i.e., dehydration, diarrhea, navel inflammation, and so on), leading to important welfare challenges during transportation. Calves arriving at US veal facilities have been reported to be dehydrated, lethargic, hypoglycemic, and may also have poor body condition, navel inflammation, and diarrhea. Thus, there is ample opportunity to target decision-making and producer-focused education not only at the source dairy, but also at each stage of transportation to address critical welfare concerns. In addition, the supply chain and procurement model that influence calf transport practices should be evaluated to determine potential opportunities to improve calf welfare. Here, we provide 5 potential strategies to improve the welfare of transported calves: (1) provide excellent newborn care that “preconditions” calves for transport, (2) assess calves' fitness-for-transport to ensure they can withstand the journey, (3) handle calves with care, (4) wait until calves are older to transport, and (5) reduce transport duration.

ABSTRACT: The significant role of dairy caretakers in maintaining animal welfare on dairy farms emphasizes the necessity of appropriate training and education to ensure the implementation of practices that promote good animal welfare. This study explored the potential of case-based learning as a novel approach to training for dairy caretakers by investigating dairy caretakers' perspectives on case study discussions. Additionally, this study sought to understand thoughts and feelings of caretakers during case study discussions to help identify information that caretakers use to evaluate cases and make decisions. Two case studies were developed and presented to participants, and thematic analysis of case study discussion transcripts was performed. Pre- and post-training questionnaires for 21 caretakers (n = 21) were summarized. The study found that caretaker reactions to case studies were generally positive. Thematic analysis revealed that caretakers use previous knowledge to make treatment decisions for cattle, and valued discussion with coworkers. The results of this study suggest the need for further investigation into the use of case studies and other activities that provide opportunities for critical thinking as training opportunities on dairy farms.

ABSTRACT: In the western United States, it is common practice for dairy and beef × dairy calves to be sold and shipped within the first few days of life, making transportation one of the first challenges that a calf will experience. To date, no published research has examined the effects of calf transport within the western United States. The objectives of this observational study were to describe the health status of calves leaving the source dairy, characterize transportation conditions and calf behavior during transportation, and determine if age at transportation and transportation duration are associated with dehydration, blood glucose and lactate, and behavior. An observational study was performed on 2 source dairies in the western United States. Initial enrollment consisted of dairy bull calves and beef × dairy calves (n = 126 total) across 16 transport cohorts which were sold and transported to separate calf-raising facilities approximately 80 km from the source dairy. Health exams and measurements were performed on all study participants 2 to 3 h before transport and ≤2 h after transport. Two researchers performed health exams using the Wisconsin calf health score, which included clinical respiratory scores, lung ultrasound, and fecal, navel, and joint scores. Hydration status was assessed using skin tent duration. Blood samples were collected and immediately analyzed for blood glucose and lactate using glucose and lactate meters. Accelerometers were attached at the source dairy on ≤10 calves in each of the 16 transport groups to record movement and behavior during transport (n = 90 had accelerometers attached). Results showed that about half of calves (49%) were identified with at least one health abnormality before transport. Researchers found an association between age and dehydration status in which calves

Summary: Genomic imprinting involves differential DNA methylation and gene expression between homologous paternal and maternal loci. It remains unclear, however, whether DNA replication also shows parent-of-origin-specific patterns at imprinted or other genomic regions. Here, we investigate genome-wide asynchronous DNA replication utilizing uniparental human embryonic stem cells containing either maternal-only (parthenogenetic) or paternal-only (androgenetic) DNA. Four clusters of imprinted genes exhibited differential replication timing based on parent of origin, while the remainder of the genome, 99.82%, showed no significant replication asynchrony between parental origins. Active alleles in imprinted gene clusters replicated earlier than their inactive counterparts. At the Prader-Willi syndrome locus, replication asynchrony spanned virtually the entirety of S phase. Replication asynchrony was carried through differentiation to neuronal precursor cells in a manner consistent with gene expression. This study establishes asynchronous DNA replication as a hallmark of large imprinted gene clusters.

The bacterial diseases black leg and soft rot in potatoes cause heavy losses of potatoes worldwide. Bacteria within the genus Pectobacteriaceae are the causative agents of black leg and soft rot. The use of antibiotics in agriculture is heavily regulated and no other effective treatment currently exists, but bacteriophages (phages) have shown promise as potential biocontrol agents. In this study we isolated soft rot bacteria from potato tubers and plant tissue displaying soft rot or black leg symptoms collected in Danish fields. We then used the isolated bacterial strains as hosts for phage isolation. Using organic waste, we isolated phages targeting different species within Pectobacterium. Here we focus on seven of these phages representing a new genus primarily targeting P. brasiliense; phage Ymer, Amona, Sabo, Abuela, Koroua, Taid and Pappous. TEM image of phage Ymer showed siphovirus morphotype, and the proposed Ymer genus belongs to the class Caudoviricetes, with double-stranded DNA genomes varying from 39 kb to 43 kb. In silico host range prediction using a CRISPR-Cas spacer database suggested both P. brasiliense, P. polaris and P. versatile as natural hosts for phages within the proposed Ymer genus. A following host range experiment, using 47 bacterial isolates from Danish tubers and plants symptomatic with soft rot or black leg disease verified the in silico host range prediction, as the genus as a group were able to infect all three Pectobacterium species. Phages did, however, primarily target P. brasiliense isolates and displayed differences in host range even within the species level. Two of the phages were able to infect two or more Pectobacterium species. Despite no nucleotide similarity with any phages in the NCBI database, the proposed Ymer genus did share some similarity at the protein level, as well as gene synteny, with currently known phages. None of the phages encoded integrases or other genes typically associated with lysogeny. Similarly, no virulence factors nor antimicrobial resistance genes were found, and combined with their ability to infect several soft rot-causing Pectobacterium species from Danish fields, demonstrates their potential as biocontrol agents against soft rot and black leg diseases in potatoes.

Background: An increase in opioid-related overdoses, notably from potent synthetic opioids like fentanyl, prompted this consideration of characteristics of emergency department (ED) patients with evidence for illicit fentanyl use or exposure, the correlation with intentional opioid misuse, and subsequent ED management. Methods: A retrospective review was performed of patients presenting to an urban academic medical center ED with evidence for illicit fentanyl use, determined by positive urine drug screens (UDS), from 6/2021 through 11/2021. Participant demographics, comorbidities, ED chief complaint and disposition, and evidence of intentional opioid misuse were considered. Secondary outcomes included provision of buprenorphine/naloxone and/or naloxone kits at discharge, ED recidivism, and six-month mortality. Bivariate comparisons and logistic regression models were performed. Results: Among 409 unique patients, most were white and male with a mean age of 39.4. Approximately half presented with opioid-related complaints. Evidence of intentional opioid misuse was identified in 72.6 % of patients. Black patients had 79 % lower odds of intentional opioid misuse compared to white patients. Regarding ED management, 28.8 % were discharged with buprenorphine/naloxone and 14.0 % with a naloxone kit. Black patients had 63 % lower odds of receiving buprenorphine/naloxone compared to white patients after controlling for covariates. Nearly 6 % of the study population died within six months of the initial ED visit. Conclusion: This fentanyl-focused review describes patient characteristics which largely mirror the epidemiology of the current opioid epidemic; however, despite evidence of objective exposure, it also suggests that Black patients may be less likely to use fentanyl intentionally. It also highlights potential disparities related to ED-based opioid misuse patient management.

Introduction: The use of extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest is increasing globally. However, providing equity of access to all patients is challenging, and to date, access has been limited to inner city areas surrounding major hospitals. To increase the availability of ECPR in our jurisdiction, we sought to train pre-hospital physicians with no experience in extracorporeal membrane oxygenation cardiopulmonary resuscitation (ECPR). To enable this, we sort to develop and teach a syllabus that would provide novice ECPR providers the skill to perform ECPR safely and effectively in the pre-hospital environment. Methods: This training programme consisted of 11 pre-hospital physicians and six critical care paramedics. All participants had no prior hospital experience instituting or managing ECPR patients. The training programme was multimodal utilising a porcine model of heart failure to teach time pressured dynamic physiological troubleshooting, cadaver labs to teach cannulation, didactic teaching and simulation. Key knowledge and skill domains were identified. Each learning framework was built upon with a final focus on integrating all skill domains required to successfully initiate ECPR. Results: The training program was completed from February 2022 to August 2023. Knowledge progression was assessed at key stages via written and practical examination. Each participant demonstrated clear knowledge and skill progression at the key stages of the training programme. At the end of the training programme, participants met the pre-defined standards to progress to ECPR provision in the pre-hospital environment. Conclusion: We present a training program for novice ECPR providers performing ECPR in the pre-hospital setting. The outcomes of this training program can provide a training framework for both novices, low volume ECMO centres and pre-hospital clinicians.

Brassica species, globally cultivated as economically important vegetable and oilseed crops, face challenges from pathogens impacting their growth and productivity. Among these, blackleg, caused by the fungal pathogen Leptosphaeria maculans, stands out as a significant concern. Genetic resistance, primarily mediated by resistance gene analogues (RGAs), is key to sustainable blackleg control. Utilising wild relatives of Brassica species presents a promising avenue for enhancing resistance to blackleg in cultivated crops. In this study, we employed the newly published Hirschfeldia incana reference genome to identify the genome-wide RGAs in H. incana. A total of 914 candidate RGAs were identified; the receptor-like protein kinases (RLK) family contained the highest number with 608 (66.53%), followed by the Transmembrane coiled-coil (TM-CC) family with 167 (18.27%), nucleotide-binding site-leucine-rich repeats (NLR) family with 98 (10.72%) and receptor-like proteins (RLPs) with 41 (4.48%). We conducted duplication analysis on the 914 candidate RGAs, which revealed gene duplication occurs frequently to expand the RGAs in H. incana and significantly contributes to plant defence responsiveness. The phylogenetic analysis provided insights into the diversification and functional implications of the identified groups. We used the sequences of the 49 cloned R genes to identify homologs across H. incana. A total of 75 cloned disease-resistance gene homologs (CDRHs) were found. Cis-acting elements (CREs) were analysed in promoter sequences of 914 RGAs in H. incana, which confirmed their potential function in disease defence. Overall, the results suggest that the wild species H. incana could be a potential R gene source for various disease resistances, including blackleg.

Glucagon-like peptide-1 agonists are effective weight loss treatments, yet few data are available regarding their use in patients with durable left ventricular assist devices. We report our single-center experience with glucagon-like peptide-1 agonist use in 21 patients with World Health Organization class I to III obesity on durable left ventricular assist device support. During therapy, patients experienced a median weight change of −12.4 (−20.0 to −2.9) kg and a −7.4% (−16.3 to −2.1) change in body weight with a median time on glucagon-like peptide-1 agonist therapy of 12 (6-22) months. Of these, 17 of 21 patients lost weight (median change −14.0kg [−21.8 to −5.3], −9.5% [−18.0 to −4.0] body weight) and 9 of 21 had a speed reduction. No major adverse events were attributed to glucagon-like peptide-1 agonist therapy. At our center, glucagon-like peptide-1 agonists use was well tolerated, safe, and associated with weight loss in patients with durable left ventricular assist devices.

Background: Women with a history of adverse pregnancy outcomes have a higher risk of coronary heart disease. Emerging evidence suggests that women with a history of preeclampsia have a different pattern of overall coronary atherosclerosis and that they at the time of myocardial infarction (MI) more frequently present with ST-segment elevation MI (STEMI) compared to women with no such history. Objectives: The purpose of this study was to determine whether among women with MI, those with a history of adverse pregnancy outcomes are more likely to present with STEMI or other clinical characteristics indicating a more severe myocardial injury. Methods: The study sample consisted of 8,320 women aged ≤65 years with first MI in Sweden 2007 to 2022. Regression models were used to estimate the association between adverse pregnancy outcomes (hypertensive disorders of pregnancy [non-preeclamptic hypertension and preeclampsia], small for gestational age [SGA] infant, and preterm delivery) and STEMI, invasive revascularization, and high troponin, while considering known predictors of coronary heart disease. Results: In total, 3,128 (38%) of women suffered STEMI. The adjusted OR of presenting with STEMI were higher in women with a history of preterm preeclampsia (OR: 1.40; 95% CI: 1.05-1.88), or an SGA infant (OR: 1.30; 95% CI: 1.13-1.50) compared to women with no such history, as well as for in-hospital revascularization. Stratified by infarct type, troponin levels did not differ by adverse pregnancy outcome history. Conclusions: Among women with a first MI, a history of preterm preeclampsia or SGA infant were associated with STEMI and invasive revascularization.

We report a case series of two patients with chronic kidney disease (CKD) who developed erythropoietin-induced pure red cell aplasia following a change in erythropoietin preparation. Both patients responded well to immunosuppressive treatments, but unfortunately developed severe infections as a result of being immunosuppressed.

Trace metal pollution is globally widespread, largely resulting from human activities. Due to the persistence and high toxicity of trace metals, these pollutants can have serious effects across ecosystems. However, few studies have directly assessed the presence and impact of trace metal pollution across ecosystems, specifically across multiple environmental sources and animal taxa. This study was designed to assess the environmental health impacts of trace metal pollution by assessing its extent and possible transfer into wildlife in the areas surrounding two abandoned metalliferous mine complexes in Wales in the UK. Water, sediment, and soil at the mine sites and in areas downstream had notably elevated concentrations of Pb, Zn, and, to a lesser extent, Cd and Cu, when compared to nearby control sites. These high trace metal concentrations were mirrored in the body burdens of aquatic invertebrates collected in the contaminated streams both at, and downstream of, the mines. Wood mice collected in contaminated areas appeared to be able to regulate their Zn and Cu tissue concentrations, but, when compared to wood mice from a nearby control site, they had significantly elevated concentrations of Cd and, particularly, Pb, detected in their kidney, liver, and bone samples. The Pb concentrations found in these tissues correlated strongly with local soil concentrations (kidney: ρ = 0.690; liver: ρ = 0.668, bone: ρ = 0.649), and were potentially indicative of Pb toxicity in between 10 % and 82 % of the rodents sampled at the mine sites and in areas downstream. The high trace metal concentrations found in the environment and in common prey species (invertebrates and rodents) indicates that trace metal pollution can have far-reaching, ecosystem-wide health impacts long after the polluting activity has ceased, and far beyond the originating site of the pollution.

In this work, we used Raman spectroscopy to identify compounds present at different maturation stages of the exocarp of scarlet eggplant and two banana cultivars, ‘prata’ and ‘nanica’. Raman spectral analyses of both fruits showed bands attributed to phenolic acids, flavonoids, carotenoids, and fatty acids. During the scarlet eggplant's maturation process, Raman spectral profile changes are mainly observed in the carotenoid content rather than flavonoids. Furthermore, it is suggested that naringenin chalcone together with β-carotene determines the orange-red color of the ripe stage. Variations in chemical composition among the maturation stages of bananas were observed predominantly in ‘prata’ when compared to ‘nanica’. In contrast to scarlet eggplant changes in the spectral profile were more evident in the content of the flavonoid/phenolic acids. The in situ analysis was demonstrated to be useful as a guide in selecting bioactive compounds on demand from low-cost horticultural waste.

Background: It is well known that stretch training can induce prolonged increases in joint range of motion (ROM). However, to date more information is needed regarding which training variables might have greater influence on improvements in flexibility. Thus, the purpose of this meta-analysis was to investigate the effects of stretch training on ROM in healthy participants by considering potential moderating variables, such as stretching technique, intensity, duration, frequency, and muscles stretched, as well as sex-specific, age-specific, and/or trained state-specific adaptations to stretch training. Methods: We searched through PubMed, Scopus, Web of Science, and SportDiscus to find eligible studies and, finally, assessed the results from 77 studies and 186 effect sizes by applying a random-effect meta-analysis. Moreover, by applying a mixed-effect model, we performed the respective subgroup analyses. To find potential relationships between stretch duration or age and effect sizes, we performed a meta-regression. Results: We found a significant overall effect, indicating that stretch training can increase ROM with a moderate effect compared to the controls (effect size = –1.002; Z = –12.074; 95% confidence interval: –1.165 to –0.840; p < 0.001; I2 = 74.97). Subgroup analysis showed a significant difference between the stretching techniques (p = 0.01) indicating that proprioceptive neuromuscular facilitation and static stretching produced greater ROM than did ballistic/dynamic stretching. Moreover, there was a significant effect between the sexes (p = 0.04), indicating that females showed higher gains in ROM compared to males. However, further moderating analysis showed no significant relation or difference. Conclusion: When the goal is to maximize ROM in the long term, proprioceptive neuromuscular facilitation or static stretching, rather than ballistic/dynamic stretching, should be applied. Something to consider in future research as well as sports practice is that neither volume, intensity, nor frequency of stretching were found to play a significant role in ROM yields.

Establishing accurate illness and treatment rates in dairy calves is crucial, yet calf health records are often incomplete. Thus, the objective of this study was to investigate barriers for dairy farmers for recording calf illnesses and treatments on dairy farms in Ontario, Canada. An online survey was completed by a convenience sample of 88 Ontario dairy farms in 2022, with 34 questions regarding farm demographics, current practices surrounding record keeping and analysis, and factors that would improve recording compliance. Multivariable models were built to assess associations between explanatory variables and the following outcomes: likelihood of making management or treatment protocol changes based on records analysis, factors that would increase the use of electronic recording methods, and whether all calf illnesses and treatments are recorded. Pearson's chi-squared tests were also used to investigate associations between explanatory variables and whether the respondent agreed or disagreed with a proposed reason for why a calf illness or treatment would not be recorded on their farm. Producers had 3.45 times greater odds of recording all antimicrobial treatments if they used a computer software system compared with those that did not. With respect to anti-inflammatory treatments, producers had 3.11 times greater odds of recording these treatments if records were located in the calf barn than elsewhere. Nonfamily employees had 6.08 times greater odds of recording all supportive therapy treatments than farm owners. When calf health records were kept in the calf barn, respondents were less likely to report that illnesses were not recorded due to time constraints (5% vs. 36% if records were elsewhere) or because calf health records were not analyzed (10% vs. 34% if records were elsewhere). On farms that recorded calf treatments in a paper booklet, respondents were more likely to report that treatments were not recorded because calf health records were not analyzed (44% for paper records vs. 21% for other systems). The most commonly indicated factors that would increase recording of illness were recording with a mobile app (27% of respondents) and for the recording system to be easy to use (31% of respondents). Overall, these data indicate that recording may be improved by keeping calf health records in close proximity to the calves and using a recording method that allows for data analysis. An easy-to-use mobile app may also improve recording if it could be used in the calf barn, provide data analytics, and allow for time-efficient data entry.

Objectives: This population-based study aimed to investigate the risk factors and effect of extended-spectrum beta-lactamase (ESBL) production on clinical outcomes in Escherichia coli bloodstream infection (BSI) patients. Methods: The study population was defined as patients aged ≥15 years with E. coli BSI in Queensland, Australia, from 2000 to 2019. Outcomes were defined as 30-day case fatality, hospital length of stay (LOS), and recurrent E. coli BSI. Results: A total of 27,796 E. coli BSIs were identified, of which 1112 (4.0%) were ESBL-producers. Patients with ESBL-Ec BSI were more frequently older, male, with comorbidity, recurrent E. coli BSI, and less likely with community-associated community-onset infections as compared to non-ESBL-Ec BSI patients. The standardized mortality rate of ESBL-Ec BSI increased 8-fold from 2000 to 2019 (1 to 8 per million residents) and case fatality was 12.8% (n = 142) at 30 days from positive blood culture. Patients with ESBL-Ec BSI were not at higher risk of 30-day case fatality (adjusted hazard ratio [HR] = 0.98, 95% CI: 0.83-1.17), but had higher risk of recurring episodes (adjusted subdistribution HR = 1.58, 95% CI: 1.29-1.92) and observed 14% longer LOS (adjusted incidence rate ratio = 1.14, 95% CI: 1.10-1.18) than non-ESBL-Ec BSI patients. Conclusion: In this large patient cohort, ESBL-Ec BSI did not increase case fatality risk but observed higher hospital LOS and recurrent E. coli BSI than non-ESBL-Ec BSI. Clinical resources are warranted to account for the higher morbidity risk associated with ESBL production and incidence.

Background and Aims: Metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis are pressing public health problems occurring alongside the rising prevalence of obesity and diabetes. This feasibility study explored the use of a novel prescription digital therapeutic (PDT) in this patient population. Methods: A prospective, open-label study was conducted at two hepatology clinics. Eligible patients had a baseline FibroScan controlled attenuation parameter >274 dB/m. Participants were given access to a PDT containing a novel form of cognitive behavioral therapy designed to treat cardiometabolic disease. Laboratory assessments, FibroScan, and magnetic resonance imaging proton density fat fraction (MRI-PDFF) imaging were conducted preintervention and postintervention. Results: Twenty-two participants were enrolled. Mean baseline fat fraction on MRI-PDFF was 18.7%. After the 90-day intervention, the mean relative reduction in MRI-PDFF was −16.2% (P = .011) in those with baseline PDFF ≥10%. Mean alanine transaminase decreased by −17.1 IU/L (P = .002). Participants achieved an average total body weight loss of −2.9% (P = .008) and controlled attenuation parameter score was reduced by −18.8 dB/m (P = .021). No serious or device-related adverse events were reported. An average improvement in health-related quality of life of +2.2 Healthy Days per month (P = .500) and high treatment satisfaction (mean Net Promoter Score of +75) were reported. Conclusion: After 90 days of digitally delivered cognitive behavioral therapy, improvements were observed in multiple endpoints without any adverse device effects. The safety, efficacy, and usability data observed strengthen the hypothesis that PDTs provide a scalable tool to address unmet behavioral treatment needs in metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis (ClinicalTrials.gov number, NCT05357248).

This paper introduces the ‘Australian Park Life Project’ and describes a protocol to standardise the capture and collation of public open greenspace spatial data across Australian cities. This method will progress greenspace research allowing for unique coherent national analyses and comparative research across Australia. We also outline the development of the Park Life public participatory geographic information system (PPGIS) to spatially explore what, and how, public open greenspaces are being used by Australian communities. The combination of community crowdsourced spatial data providing location-specific information on the green public open spaces used, in combination with the national spatial layer of greenspace allows for unique analyses exploring the role of greenspace provision and design on use and represents a transformative strategy in shaping public open space policy and strategy. • A spatial layer of public open greenspace was created for the eight Australian State and Territory capital cities using a standardised data capture and collection method from local government planning schemes and land use data, and listings of managed and demarcated parks and reserves. • The Park Life public participatory geographic information system (PPGIS) was built to capture spatially referenced information on the use of greenspaces - specifically what spaces are used, and how they are used.

Background: Rugby league is a popular collision sport among Australian adolescent and young adult men. Concussion is one of the more common injuries in rugby league. Few studies have examined concussion in youth rugby league. To examine medically diagnosed concussions from a single season within two elite-level pathway rugby league competitions by evaluating game play risk factors and conducting a video review of potential concussion signs. Methods: All players involved in the Queensland Rugby League's (QRL) under 18 years and under 20 years age group competitions during the 2019 season were included in this study. Data included all head injury assessments (HIAs) identified in real-time through the QRL injury surveillance system for these two QRL age group competitions. The purpose of this study was to (i) report the rates of HIAs and medically diagnosed concussions; (ii) examine video signs of potential concussion; (iii) review game play risk factors related to HIAs and concussions; and (iv) determine the number of days until a concussed player returned to match play and the number of subsequent games missed by concussed players. Results: There were 86 HIAs and 30 medically diagnosed concussions from the two competitions. The concussion incidence was 2.93 per 1000 player match hours in the under 18-year age group and 5.75 per 1000 player match hours in the under 20-year age group. Slow to stand was the most commonly observed video sign (78.6%; 22/28 concussions). Most concussed players (91%, 21/23) missed at least one subsequent game (M ​= ​1.4, SD ​= ​1.7, range ​= ​0–7 games), with the average days to return-to-play being 15.7 (SD ​= ​7.0, range ​= ​7–41 days). Conclusions: In elite-level pathway rugby league, the incidences of HIAs and medically diagnosed concussions were higher in the under 20 age group than the under 18 age group. Both age groups had lower incidences of HIAs and concussions than professional adult rugby league players. Return-to-play following concussion was similar across the two age groups and differed considerably compared to the elite level, with a longer time before return to play for the younger elite level development pathway players.

Oxytocin is a key hormone in the transition to motherhood. The maternal endogenous oxytocin system facilitates many physiological and biological adaptations, including breastfeeding, maternal wellbeing, and brain plasticity. Additionally, maternal endogenous oxytocin works as a finetuned orchestrator prior to, during, and after the birth of a child to support birth progression and mother-infant bonding. Exogenous oxytocin may be administered to induce or augment labour when this is not progressing naturally and is a common obstetric intervention worldwide. However, the lasting impact of these widely varying levels of systemic exogenous oxytocin on mother-infant bonding is currently unknown. This study aimed to investigate the association between exogenous oxytocin administered to induce or augment labour and quality of observed mother-infant bonding.Thirty-eight mother and infant dyads participated (mothers aged 24–48 years; infants aged 2–5 months). Mother-infant bonding quality was assessed via the Recorded Interaction Task and hospital birth records were consulted to obtain exogenous oxytocin administration data. Demographic information and possible confounding factors were collected from dyads, and salivary oxytocin concentration was measured for both mother and infant.Mother's perception of infant sleep difficulty was identified as a confounding factor for quality of mother-infant bonding. After controlling for the confounding factor, receiving exogenous oxytocin to induce or augment labour, as opposed to not, was found to be significantly positively associated with higher quality of observed mother-infant bonding (p = 0.029). These novel findings highlight the need for further exploration, both of the impact of the treatment and of the mechanisms of action of intrapartum exogenous oxytocin on the endogenous oxytocin system. It is argued that particular focus be given to investigate action on the central oxytocin receptors, and if this may play a role in subsequent mother-infant bonding outcomes. It is vital to understand the full breadth and the clinical implications of this commonplace procedure.

Purpose: Diabetic macular edema (DME), a leading cause of visual impairment, can occur regardless of diabetic retinopathy (DR) stage. Poor metabolic control is hypothesized to contribute to DME development, although large-scale studies have yet to identify such an association. This study aims to determine whether measurable markers of dysmetabolism are associated with DME development in persons with diabetes. Design: Retrospective cohort study. Participants: Using data from the Sight Outcomes Research Collaborative (SOURCE) repository, patients with diabetes mellitus and no preexisting DME were identified and followed over time to see what factors associated with DME development. Methods: Cox proportional hazard modeling was used to assess the relationship between demographic variables, diabetes type, smoking history, baseline DR status, blood pressure (BP), lipid profile, body mass index (BMI), hemoglobin A1C (HbA1C), and new onset of DME. Main Outcome Measures: Adjusted hazard ratio (HR) of developing DME with 95% confidence intervals (CIs). Results: Of 47 509 eligible patients from 10 SOURCE sites (mean age 63 ± 12 years, 58% female sex, 48% White race), 3633 (7.6%) developed DME in the study period. The mean ± standard deviation time to DME was 875 ± 684 days (∼2.4 years) with those with baseline nonproliferative DR (HR 3.67, 95% CI: 3.41–3.95) and proliferative DR (HR 5.19, 95% CI: 4.61–5.85) more likely to develop DME. There was no difference in DME risk between type 1 and type 2 patients; however, Black race was associated with a 40% increase in DME risk (HR 1.40, 95% CI: 1.30–1.51). Every 1 unit increase in HbA1C had a 15% increased risk of DME (HR 1.15, 95% CI: 1.13–1.17), and each 10 mmHg increase in systolic BP was associated with a 6% increased DME risk (HR 1.06, 95% CI: 1.02–1.09). No association was identified between DME development and BMI, triglyceride levels, or high-density lipoprotein levels. Conclusions: These findings suggest that in patients with diabetes modifiable risk factors such as elevated HbA1C and BP confer a higher risk of DME development; however, other modifiable systemic markers of dysmetabolism such as obesity and dyslipidemia did not. Further work is needed to identify the underlying contributions of race in DME. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social, and emotional development beginning prenatally and planned through early childhood. This article outlines methodological considerations and the decision-making process for measurement selection for child behavior, parenting/caregiver-child interactions, and the family/home environment for HBCD. The decision-making process is detailed, including formation of a national workgroup (WG-BEH) that focused on developmentally appropriate measures that take a rigorous and equitable approach and aligned with HBCD objectives. Multi-level-observational and caregiver-report measures were deemed necessary for capturing the desired constructs across multiple contexts while balancing the nuance of observational data with pragmatic considerations. WG-BEH prioritized developmentally sensitive, validated assessments with psychometrics supporting use in diverse populations and focused on mechanistic linkages and prediction of desired constructs. Other considerations included participant burden and retention, staff training needs, and cultural sensitivity. Innovation was permitted when it was grounded in evidence and filled key gaps. Finally, this article describes the rationale for the selected constructs (e.g., temperament, social-emotional development, parenting behaviors, family organization) and corresponding measures chosen for HBCD visits from early infancy through 17 months of age.

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social, and emotional development beginning prenatally and planned through early childhood. Given its aim to examine the impact of adversity and protective factors on children’s outcomes, the recruitment and retention of families who have a wide diversity in experiences are essential. However, the unfortunate history of inequitable treatment of underrepresented families in research and the risks with which some participants will contend (e.g., substance use) makes their recruitment and retention in social science and neuroscience research particularly challenging.This article explores strategies that the HBCD Study has developed to recruit and retain participants, including marginalized, underserved, and hard-to-reach populations, capitalizing on the extant literature and the researchers’ own experiences. In this paper, we address strategies to recruit and retain families within HBCD, including: 1) creating experiences that engender trust and promote relationships; 2) maintaining connections with participants over time; 3) ensuring appropriate compensation and supports; 4) considerations for study materials and procedures; and 5) community engagement. The implementation of these strategies may increase representation and inclusiveness, as well as improve the quality of the resulting data.

Background: Transforming growth factor β-activated protein kinase-1 (TAK1) plays an important role in MAPK and NFκB pathways and has been associated with colorectal cancer. The aim of this study was to determine how cytoplasmic and juxtanuclear punctate staining of TAK1 relates to immune checkpoint expression and cancer specific survival in colorectal cancer. Methods: Protein expression was assessed by immunohistochemistry on tissue microarrays from primary curative colorectal cancer resected specimens. Expression levels of cytoplasmic TAK1 by QuPath digital quantification and punctate TAK1 staining was scored using a manual point scoring technique and correlated with clinicopathological features, immune checkpoint expression and cancer-specific survival. Bulk RNA sequencing was performed in specimens to determine mutational profiles and differentially expressed genes. Results: A cohort of 875 patients who had undergone colorectal cancer resection were assessed for TAK1 expression. Higher levels of cytoplasmic TAK1 expression correlated with elevated PD1 and PD-L1 expression (p < 0.010). High punctate TAK1 expression was more commonly identified in poorly differentiated colorectal cancers (p = 0.036), had dysregulated mutational and transcriptional profiles with decreased insulin-like growth factor 2(IGF2) expression (p < 0.010), and independently predicted poor cancer-specific survival (HR 2.690, 95% CI 1.419–5.100, p = 0.002). The association of punctate TAK1 expression and recurrence remained after subgroup analysis for microsatellite-stable colorectal cancer (p = 0.028). Discussion: Punctate TAK1 expression is associated with worse cancer specific survival. TAK1 signalling may be an important pathway to investigate underlying mechanisms for recurrence in microsatellite-stable colorectal cancer.

Summary: Despite extensive global research into genetic predisposition for severe COVID-19, knowledge on the role of rare host genetic variants and their relation to other risk factors remains limited. Here, 52 genes with prior etiological evidence were sequenced in 1,772 severe COVID-19 cases and 5,347 population-based controls from Spain/Italy. Rare deleterious TLR7 variants were present in 2.4% of young (

Measures of physical growth, such as weight and height have long been the predominant outcomes for monitoring child health and evaluating interventional outcomes in public health studies, including those that may impact neurodevelopment. While physical growth generally reflects overall health and nutritional status, it lacks sensitivity and specificity to brain growth and developing cognitive skills and abilities. Psychometric tools, e.g., the Bayley Scales of Infant and Toddler Development, may afford more direct assessment of cognitive development but they require language translation, cultural adaptation, and population norming. Further, they are not always reliable predictors of future outcomes when assessed within the first 12–18 months of a child’s life. Neuroimaging may provide more objective, sensitive, and predictive measures of neurodevelopment but tools such as magnetic resonance (MR) imaging are not readily available in many low and middle-income countries (LMICs). MRI systems that operate at lower magnetic fields (< 100mT) may offer increased accessibility, but their use for global health studies remains nascent. The UNITY project is envisaged as a global partnership to advance neuroimaging in global health studies. Here we describe the UNITY project, its goals, methods, operating procedures, and expected outcomes in characterizing neurodevelopment in sub-Saharan Africa and South Asia.

Greenspaces and urban trees play an important role in moderating and improving urban environments to make them more comfortable and healthy for people. While trees provide important wellbeing benefits to people, urban planning and maintenance practices can create inhospitable and stressful environments where trees are unable to flourish or reach their potential. As the impacts of climate change intensify, the health of urban trees will become increasingly important. To explore how planning and maintenance practices are affecting urban trees, we draw on a case study of 31 street and park trees adjacent to high-use pedestrian areas in Wellington, New Zealand. We analysed these trees using six key factors that influence tree health to identify how planning and maintenance practices could be adjusted to support tree health and ecosystem function. We suggest that the six key factors have planning and maintenance implications for urban trees which are relevant to a variety of urban contexts, but particularly space-constrained urban streets requiring multiple functions and infrastructure. We argue that as climate impacts intensify, using these six key factors can help promote urban tree health and ecosystem function and avoid mal-adaptive planning and maintenance practices.

A pangenome encompasses the complete genetic diversity of a species, by assembling a range of representative individuals from various populations. This review describes the advances in plant pangenomics, tracing its evolution since the initial plant genome sequencing in 2000, and provides comprehensive best-practice advice to build a linear or graphical pangenome, delineating the strengths and limitations of different pangenome construction methods. The review also examines the challenges in pangenome data visualisation, the challenges of graph-based pangenomes and their utility in investigating the potential function of genome variation. Furthermore, we examine the application of pangenomes in plant breeding, including the identification of genetic diversity for crop improvement, and the integration of multi-omics data into pangenome databases to advance plant breeding.

Introduction: The World Health Organisation (WHO) has set targets for the elimination of Hepatitis B virus (HBV), which include preventing new infections and reducing deaths. We explored beliefs, behaviours and barriers to diagnosis, prevention and treatment for people living with HBV infection (PLWHB) and those with liver disease in a rural South African population in KwaZulu-Natal, to gather information to inform research and support the development of improved clinical and public health services. Methods: Using an interdisciplinary approach (combining public engagement, social science, clinical and laboratory team members) we conducted a community dialogue with members of the Africa Health Research Institute (AHRI) Community Advisory Board (CAB). Notes from the discussions were used to write up an account from which themes were identified during a team debrief session for data analysis. Results: There was a lack of knowledge and awareness of HBV infection and transmission and prevention amongst CAB members, also reported among community members and healthcare workers. The participants recognised liver disease symptoms. Perceived causes of liver disease reported by the CAB were alcohol and non-adherence to HIV treatment. Barriers to care included stigma, poverty, and delays in referrals for HBV diagnosis and management. Conclusion: Understanding barriers to care is important to shape future services for diagnosis, treatment and prevention of HBV and liver disease which are accessible, affordable and acceptable to the local population. Education, awareness and advocacy for improved liver health care pathways are required to make them effective for local communities.

The NFκB pathway, known as the central regulator of inflammation, has a well-established role in colorectal cancer (CRC) initiation, progression, and therapy resistance. Due to the pathway's overarching roles in CRC, there have been efforts to characterise NFκB family members and target the pathway for therapeutic intervention. Initial research illustrated that the canonical NFκB pathway, driven by central kinase IKKβ, was a promising target for drug intervention. However, dose limiting toxicities and specificity concerns have resulted in failure of IKKβ inhibitors in clinical trials. The field has turned to look at targeting the less dominant kinase, IKKα, which along with NFκB inducing kinase (NIK), drives the lesser researched non-canonical NFκB pathway. However prognostic studies of the non-canonical pathway have produced conflicting results. There is emerging evidence that IKKα is involved in other signalling pathways, which lie outside of canonical and non-canonical NFκB signalling. Evidence suggests that some of these alternative pathways involve a truncated form of IKKα, and this may drive poor cancer-specific survival in CRC. This review aims to explore the multiple components of NFκB signalling, highlighting that NIK may be the central kinase for non-canonical NFκB signalling, and that IKKα is involved in novel pathways which promote CRC.

Background: Outcomes after oesophagogastric cancer surgery remain poor. Cardiopulmonary exercise testing (CPET) used for risk stratification before oesophagogastric cancer surgery is based on conflicting evidence. This study explores the relationship between CPET and postoperative outcomes, specifically for patients undergoing neoadjuvant treatment. Methods: Patients undergoing oesophagogastric cancer resection and CPET (pre- or post-neoadjuvant treatment, or both) were retrospectively enrolled into a multicentre pooled cohort study. Oxygen uptake at peak exercise (VO2 peak) was compared with 1-yr postoperative survival. Secondary analyses explored relationships between patient characteristics, tumour pathology characteristics, CPET variables (absolute, relative to weight, ideal body weight, and body surface area), and postoperative outcomes (morbidity, 1-yr and 3-yr survival) were assessed using logistic regression analyses. Results: Seven UK centres recruited 611 patients completing a 3-yr postoperative follow-up period. Oesophagectomy was undertaken in 475 patients (78%). Major complications occurred in 25%, with 18% 1-yr and 43% 3-yr mortality. No association between VO2 peak or other selected CPET variables and 1-yr survival was observed in the overall cohort. In the overall cohort, the anaerobic threshold relative to ideal body weight was associated with 3-yr survival (P=0.013). Tumour characteristics (ypT/ypN/tumour regression/lymphovascular invasion/resection margin; P

We have created two isogenic iPSC lines from fibroblasts of a healthy male donor of European ancestry. The cell lines express common pluripotency markers, are free of chromosomal aberrations and are able to differentiate into cells of all three germ layers. These iPSC are now a resource for genome editing with the aim of creating models of genetic disorders without having to depend on patient cells.

Background: This retrospective study evaluated the efficacy and safety of intraoperative methadone compared with short-acting opioids. Methods: Patients undergoing cardiac surgery with cardiopulmonary bypass (n=11 967) from 2018 to 2023 from a single health system were categorised into groups based on intraoperative opioid administration: no methadone (Group O), methadone plus other opioids (Group M+O), and methadone only (Group M). Results: Patients in Groups M and M+O had lower mean pain scores until postoperative day (POD) 7 compared with Group O after adjusting for covariates (P

Accounting for approximately 70 % of dementia cases and rising globally, Alzheimer's Disease Dementia (ADD) is a formidable challenge to patients, carers and healthcare professionals worldwide. ADD has a significant impact on patient's and carers’ quality of life, as well as substantial economical and societal costs. Therefore, understanding the pathogenesis of ADD to identify potential treatment targets is becoming an important research priority. For several decades, the amyloid cascade hypothesis has dominated ADD research, however recent critiques have called this into question. Research suggests there may be a significant vascular component, which may occur earlier, potentiate, and drive further amyloid pathology in the brain. One potential area for further exploration is the role of vascular dysregulation in the pathogenesis of ADD. In this review, we examine the current literature regarding vascular dysregulation, and its role in the development of ADD. We further explore the complexity involved in the intersection between vascular insults and the amyloid-cascade hypothesis, and call for further research in the use of cerebral blood flow for a diagnostic and therapeutic target for ADD.

Summary: Oxygen is the most used drug in anaesthesia. Despite such widespread use, optimal perioperative oxygen administration remains highly controversial because of concerns about the competing harms of both hyperoxia and hypoxia.Notwithstanding a Cochrane review concluding that routinely administering a fractional inspired oxygen concentration (FiO2) >0.6 intraoperatively might increase postoperative morbidity and mortality, the World Health Organization (WHO) currently recommends all anaesthetised patients receive 0.8 FiO2 during and immediately after surgery to reduce surgical site infections. Results from the largest trial available at the time of these two reviews (suggesting long-term survival may be worse with high FiO2, particularly in patients with malignant disease) were considered ‘biologically implausible’ by the WHO's Guideline Development Group. In addition, the integrity of some perioperative oxygen studies has been challenged. Resolving these controversies is of fundamental importance to all perioperative clinicians.This narrative review is based on the inaugural BJA William Mapleson lecture delivered by the senior author (AC) at the 2023 annual meeting of the Royal College of Anaesthetists in Birmingham. We present the current evidence for perioperative oxygen administration and contrast this with how oxygen therapy is targeted in other specialties (e.g. intensive care medicine). We will explore whether anaesthetists follow the WHO recommendations and consider how oxygen administration affects the stress response to surgery. We reason that novel clinical trial designs in combination with targeted experimental medicine studies will be required to improve our understanding of how best to optimise individualised perioperative oxygenation—a cornerstone of anaesthesia.

At the start of the COVID-19 global pandemic, many American universities and colleges abruptly shifted online to reduce the spread of infection. The shift, while framed as a way to accommodate and care for the broader campus community, created new inequalities and exacerbated existing inequities among students, faculty, and staff. Faculty were introduced to forms of technology and digital media used to surveil students, such as anti-plagiarism software, invasive online exam proctoring, and recorded Zoom class sessions. Universities framed the use of technology students during a time of crisis as an act of care, but also engendered spaces of surveillance, distrust, and harm in the digital landscape. Rooted in neoliberal ideologies, care within university digital spaces is framed as an objective or function wherein the university cares about or cares for its students, faculty, and staff, rather than pursuing more equitable, democratic, and socially just models of care ethics. Based on qualitative research conducted on university responses to the COVID-19 pandemic, we argue that universities frame surveillance within digital spaces as an act of care, specifically through the antiquated model in loco parentis. We provide recommendations for universities to move towards more equitable care and discuss the ethics of care concerning surveillance in digital spaces.

Introduction: The study assessed longitudinal transitions among adult (18 and older) past 30-day daily and non-daily dual users of cigarettes and electronic nicotine delivery systems (ENDS). Methods: Using data from Wave 4 (W4; 2016/17) and Wave 5 (W5; 2018/19) of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal cohort study of US adults, multivariable regressions were conducted among W4 dual users of cigarettes and ENDS to examine past 30-day cigarette smoking at W5. The study also analyzed changes in frequency of past 30-day smoking and cigarettes smoked per day between W4 and W5, stratified by W4/W5 daily/non-daily ENDS use among W4 daily and non-daily cigarette smokers. Results: Among W4 dual users, those smoking daily and using ENDS non-daily had higher odds of daily cigarette smoking at W5 than daily users of both products (AOR: 2.32, 95 % CI: 1.38–3.90). W4 daily smokers who used ENDS daily at Wave 5 smoked cigarettes on fewer days at Wave 5 than W4 daily smokers who were either daily ENDS users at Wave 4 (B = −4.59; SE = 1.43, p

Insect pathogenic fungi (IPF) and insects have ubiquitous interactions in nature. The extent of these interkingdom host-pathogen interactions are both complex and diverse. Some IPF, notably of the order Entomophthorales, manipulate their species-specific host before death. The fungus-induced altered insect behaviours are sequential and can accurately be repeatedly characterised temporally, making them a valuable model for understanding the molecular and chemical underpinnings of behaviour and host-pathogen co-evolutionary biology. Here, we present methods for the isolation and laboratory culturing of the emerging behaviourally manipulating model IPF Entomophthora muscae for experimentation. • E. muscae isolation and culturing in vitro. • Establishing and maintaining an E. muscae culture in vivo in houseflies (Musca domestica). • Controlled E. muscae infections for virulence experiments and quantification of conidia discharge per cadaver.

Objectives: The landscape of availability, policies, and norms around e-cigarette use and cessation has changed rapidly in the last few years. There is also high interest in quitting vaping among teens and young adults. Understanding the motivation of those who want to quit vaping is important for effective intervention development. This analysis compares user-submitted reasons for quitting (RFQ) vaping from 2022 to a previous analysis from 2019 to determine whether motivations have shifted among young people. Methods: We reviewed 2000 RFQ submissions from users who enrolled in a vaping cessation text message program in 2022. Each response was coded by ≥ 2 researchers and categorized into one of 16 themes. Findings were compared to the 2019 analysis using item-wise comparisons. Results: The most frequent RFQ in 2022 were health (56.1%), social influence (15.8%), and other (11.7%). In comparison to 2019, health remained the top reason, but the rank order of all other reasons shifted. Theme prevalence changed significantly, with cost decreasing and health increasing. Among health-related sub-categories, current and mental health increased compared to 2019 submissions. Discussion: RFQ among young people shifted between 2019 and 2022. We observed greater concern about current and mental health, possibly from experiencing negative health impacts from vaping or from increased awareness of these impacts. The lower prevalence of cost may reflect the widespread availability of cheaper e-cigarettes. RFQ likely change rapidly with the fluctuating e-cigarette landscape and should be considered in cessation interventions, promotional campaigns, and policy.

Background: Approximately a quarter of the global population is physically inactive, increasing the prevalence of chronic health conditions such as cardiovascular disease. Clearly, a population shift is needed to increase physical activity participation. Given almost half of American and Australian households have at least one dog, dog walking has the potential to increase physical activity. The objective of this study was to characterize the exercise intensity of dog walking using physiological measures to determine whether it achieved a threshold for health-enhancement. Method: From February 2020 to September 2022, dog owners (aged > 18 years, without impediment to walking) who resided in metropolitan Sydney participated in an on-leash dog walk for a minimum of 20 minutes, while wearing a heart rate monitor and carrying a phone to track cadence, route and duration. Results: Forty-three participants were recruited (aged 34.26 ± 16 years). Data from measures of %heart rate reserve (38 ± 10.8 %HRR), %heart rate max (61 ± 7.2 %HRmax) and average cadence (45 ± 8.4steps/min) classified dog-walking as light intensity. However, when using average walking speed (4.29 ± 0.8 km/hr) and metabolic equivalents (3.53 ± 0.6METs), the walk was classified as moderate intensity. Conclusion: Overall, depending on the intensity measure used, dog walking was positioned in the upper range of light intensity and the lower range of moderate intensity. Although dog walking at a certain intensity may be difficult to prescribe as strategy for meeting current moderate-to-vigorous focused physical activity recommendations, it should be recognised as a beneficial activity that may reach moderate intensity on some occasions.

Background: The importance of physical rehabilitation in optimizing outcomes in critically ill patients is recognized. However, the frequency and benefit of mobilization in pediatric patients undergoing veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) are unclear. This study evaluates a cohort of pediatric VA-ECMO patients to characterize the spectrum of mobility and evaluate associations of mobilization with clinical outcomes. Methods: We analyzed 688 patients (8-18 years) who underwent primary ECMO runs and had mobilization data collected in the Extracorporeal Life Support Organization Registry. Demographics, pre-ECMO support, location and duration of support, and outcomes, including survival to hospital discharge, heart transplant, and ECMO-related complications, were collected. Propensity score modeling was performed with entropy weighting to compare outcomes between mobile and nonmobile patients. Results: Of the 688 patients included, 10% achieved some degree of mobility (69/688); the majority of those exercised in bed. After propensity score matching, mobility was associated with an increased likelihood of being discharged alive (odds ratio (OR) 1.16, 95% cardiac index (CI) 1.04, 1.30) and receiving a heart transplant (OR 1.15, 95% CI 1.02, 1.29), and a lower likelihood of dying on ECMO (OR 0.90, 95% CI 0.81, 1.00). There was no association between mobility and ECMO being discontinued due to complication (OR 1.03, 95% CI 0.97, 1.10). Conclusion: Mobilization in a pediatric VA-ECMO cohort was achieved by 1/10 patients, is associated with heart transplant and survival to hospital discharge, and is not associated with ECMO-related adverse events. Mobility in certain pediatric VA-ECMO patients is feasible and may represent an opportunity to improve outcomes.

Background: Children being considered for heart transplantation (HT) undergo structured evaluation to determine HT candidacy. Some are determined not to be candidates after evaluation, but outcomes in these patients are not well known. Methods: We retrospectively reviewed patients evaluated for HT at our institution (freestanding children’s hospital) between 2013 and 2022. Patients who completed HT evaluation but were determined not to be candidates were identified. Clinical characteristics, reasons for noncandidacy, and outcomes of these noncandidates were described using summary statistics. Results: During the study period, 264 patients were evaluated for HT. Of these, 75 patients (28.4%) were determined not to be candidates. The median age of noncandidates was 2.5 years. The most common diagnosis was single ventricle congenital heart disease (SV CHD) in 61.3%; cardiomyopathy was seen in 21.3%. The most common reason for noncandidacy was being too well for HT (36.7%), followed by too sick for HT (27.8%). With median follow-up duration of 3.5 years, 49.3% of patients were alive without undergoing HT; for noncandidates on the basis of being too well, 81.5% were alive without undergoing HT. Of the 36% of patients who died after determination of noncandidacy, 58.6% had SV CHD. Conclusions: A substantial proportion of children undergoing evaluation for HT are ultimately determined not to be candidates. Outcomes for noncandidates vary depending on the reason for noncandidacy. The majority of patients who died after determination of noncandidacy had SV CHD, indicating opportunities for increasing access to HT and other advanced therapies in this patient population.

Purpose: Advances in artificial intelligence have enabled the development of predictive models for glaucoma. However, most work is single-center and uncertainty exists regarding the generalizability of such models. The purpose of this study was to build and evaluate machine learning (ML) approaches to predict glaucoma progression requiring surgery using data from a large multicenter consortium of electronic health records (EHR). Design: Cohort study. Participants: Thirty-six thousand five hundred forty-eight patients with glaucoma, as identified by International Classification of Diseases (ICD) codes from 6 academic eye centers participating in the Sight OUtcomes Research Collaborative (SOURCE). Methods: We developed ML models to predict whether patients with glaucoma would progress to glaucoma surgery in the coming year (identified by Current Procedural Terminology codes) using the following modeling approaches: (1) penalized logistic regression (lasso, ridge, and elastic net); (2) tree-based models (random forest, gradient boosted machines, and XGBoost), and (3) deep learning models. Model input features included demographics, diagnosis codes, medications, and clinical information (intraocular pressure, visual acuity, refractive status, and central corneal thickness) available from structured EHR data. One site was reserved as an “external site” test set (N = 1550); of the patients from the remaining sites, 10% each were randomly selected to be in development and test sets, with the remaining 27 999 reserved for model training. Main Outcome Measures: Evaluation metrics included area under the receiver operating characteristic curve (AUROC) on the test set and the external site. Results: Six thousand nineteen (16.5%) of 36 548 patients underwent glaucoma surgery. Overall, the AUROC ranged from 0.735 to 0.771 on the random test set and from 0.706 to 0.754 on the external test site, with the XGBoost and random forest model performing best, respectively. There was greatest performance decrease from the random test set to the external test site for the penalized regression models. Conclusions: Machine learning models developed using structured EHR data can reasonably predict whether glaucoma patients will need surgery, with reasonable generalizability to an external site. Additional research is needed to investigate the impact of protected class characteristics such as race or gender on model performance and fairness. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.