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Abstract Background and Aims While the number of female physicians has increased since the 1970s, there continues to be a lack of female surgeons compared to their male counterparts, with the gender gap more prominent in surgical subspecialties such as neurosurgery. While surgical subspecialities have accelerated initiatives to close the gap, potential disparities in research opportunities may position women at a disadvantage, particularly in neurosurgery, where academic publications are an indicator of residency match success. In this paper, we sought to investigate whether gender disparities exist in preresidency neurosurgery publications among current neurosurgery residents. Methods The present study selected residency programs from the top 25 neurology and neurosurgery hospitals in US News & World Report's 2022 Ranking. A database of neurosurgery residents and their publications was created using PubMed, neurosurgery residency program websites, and supplementary search. Articles published between the time of birth and December 31st of the year of graduation (medical degree) were used to determine publications before residency. Results Our research indicates that 25.7% (n = 135/526) of US neurosurgery residents at top 25 hospitals are women and 74.3% (n = 391/526) are men. Men (n = 391) had a median of 7 (interquartile range [IQR], 3–14.5; range, 0–129) publications before residency, and women (n = 135) had a median of 7 (IQR, 4–11.0; range, 0–74) publications before residency. There were no significant differences in the median number of publications between genders (p = 0.65). Conclusion In conclusion, our research indicates there is no gender disparity in preresidency publications among neurosurgery residents. To improve women's representation in the field, further study is needed to better understand gender inequality among neurosurgeons, particularly in the earlier stages of medical training.

Abstract Propylene glycol (PG) is a diol (a double alcohol) that is commonly used as a food additive to preserve shelf life and enhance flavors, texture, and appearance. Although PG makes up only a small percentage of cornstarch, ingestion of large doses can cause lactic acidosis leading to hyperosmolarity, high anion gap metabolic acidosis (HAGMA), and a sepsis‐like syndrome. A 17‐year‐old female presented to our emergency department (ED) with chronic chest pain, dyspnea, nausea, and vomiting. Laboratory testing showed an elevated anion gap of 18 mEq/L with no osmolar gap. Toxicology screening was negative. Twelve hours after ED arrival, she admitted to consuming one box of cornstarch daily for the past 6 months. She was admitted to the intensive care unit (ICU) with multisystem organ failure due to propylene glycol toxicity. After empiric treatment with fomepizole and continuous renal replacement therapy, her clinical status gradually improved. This case highlights the importance of obtaining a thorough dietary history in patients with suspected toxicities, especially when laboratory values demonstrate an unexplained HAGMA and/or lactic acidosis. Prompt recognition and therapeutic intervention with fomepizole, a potent inhibitor of alcohol dehydrogenase, is essential in reducing life‐threatening sequelae following toxic alcohol ingestions.

Abstract Genomic methods are becoming increasingly valuable and established in ecological research, particularly in nonmodel species. Supporting their progress and adoption requires investment in resources that promote (i) reproducibility of genomic analyses, (ii) accessibility of learning tools and (iii) keeping pace with rapidly developing methods and principles. We introduce marineomics.io, an open‐source, living document to disseminate tutorials, reproducibility tools and best principles for ecological genomic research in marine and nonmodel systems. The website's existing content spans population and functional genomics, including current recommendations for whole‐genome sequencing, RAD‐seq, Pool‐seq and RNA‐seq. With the goal to facilitate the development of new, similar resources, we describe our process for aggregating and synthesizing methodological principles from the ecological genomics community to inform website content. We also detail steps for authorship and submission of new website content, as well as protocols for providing feedback and topic requests from the community. These web resources were constructed with guidance for doing rigorous, reproducible science. Collaboration and contributions to the website are encouraged from scientists of all skill sets and levels of expertise.

Objective Hypophosphatasia (HPP) is a rare disease characterized by incomplete or defective bone mineralization due to a mutation in the alkaline phosphatase (ALP) gene causing low levels of ALP. Disease presentation is heterogeneous and can present as a chronic pain syndrome like fibromyalgia (FM). Our objective was to determine if there are any potential patients with HPP in the group of patients who were diagnosed with FM. Antiresorptive therapy use can trigger atypical femur fractures in patients with HPP. Methods We performed a retrospective chart review of all patients 18 years or older at a single academic center who were diagnosed with FM and had either a low or a normal ALP level. The following characteristics were reviewed: biological sex; age; history of fractures; diagnosis of osteoporosis, osteopenia, osteoarthritis, and chondrocalcinosis; genetic testing; vitamin B6 level testing; and medications. Results Six hundred eleven patients with FM were identified. Two hundred had at least one low ALP level, and 57 had at least three consecutively low measurements of ALP, 44% of which had a history of fractures. No patients had vitamin B6 levels checked. None of the patients had previous genetic testing for HPP or underwent testing for zinc or magnesium levels. Conclusion The percentage of patients with FM who were found to have consistently low ALP levels was 9.3%. None had vitamin B6 level or genetic testing, suggesting that the diagnosis was not suspected. It is important to diagnose HPP given the availability of enzyme replacement therapy to prevent complications from HPP such as fractures. Our data support screening for this condition as a part of the initial workup of FM.

Abstract Objective Intranasal medications have been proposed as adjuncts to out‐of‐hospital cardiac arrest (OHCA) care. We sought to quantify the effects of intranasal medication administration (INMA) in OHCA workflows. Methods We conducted separate randomized OHCA simulation trials with lay rescuers (LRs) and first responders (FRs). Participants were randomized to groups performing hands‐only cardiopulmonary resuscitation (CPR)/automated external defibrillator with or without INMA during the second analysis phase. Time to compression following the second shock (CPR2) was the primary outcome and compression quality (chest compression rate (CCR) and fraction (CCF)) was the secondary outcome. We fit linear regression models adjusted for CPR training in the LR group and service years in the FR group. Results Among LRs, INMA was associated with a significant increase in CPR2 (mean diff. 44.1 s, 95% CI: 14.9, 73.3), which persisted after adjustment (p = 0.005). We observed a significant decrease in CCR (INMA 95.1 compressions per min (cpm) vs control 104.2 cpm, mean diff. −9.1 cpm, 95% CI −16.6, −1.6) and CCF (INMA 62.4% vs control 69.8%, mean diff. −7.5%, 95% CI −12.0, −2.9). Among FRs, we found no significant CPR2 delays (mean diff. −2.1 s, 95% CI −15.9, 11.7), which persisted after adjustment (p = 0.704), or difference in quality (CCR INMA 115.5 cpm vs control 120.8 cpm, mean diff. −5.3 cpm, 95% CI −12.6, 2.0; CCF INMA 79.6% vs control 81.2% mean diff. −1.6%, 95% CI −7.4, 4.3%) Conclusions INMA in LR resuscitation was associated with diminished resuscitation performance. INMA by FR did not impede key times or quality.

Abstract Background No recent studies have evaluated the association between clinical signs of lower urinary tract disease (LUTD) and positive urine culture in dogs with diabetes mellitus. Objective Determine the prevalence of subclinical bacteriuria (ie, positive urine culture without signs of LUTD) in dogs with diabetes mellitus. Animals One hundred seven dogs with diabetes mellitus were evaluated at a university veterinary hospital. Methods Retrospective study evaluating diabetic dogs with a single sample paired urinalysis and urine culture. Relationship between the presence of signs of LUTD, pyuria, and bacteriuria and urine culture results were compared using Fisher exact testing. Results Fifteen dogs (14%) had a positive urine culture via cystocentesis or free catch, of which 8 (53%) had pyuria, and 4 (27%) had signs of LUTD. Of the 88 dogs (82%) without signs of LUTD, 11 (13%) had a positive culture. A significant association was found between a positive urine culture and pyuria (OR infinity; 95% CI 20.34‐infinity, P

Abstract Improving the effectiveness of conservation practice requires better use of evidence. Since 2004, researchers from the Conservation Evidence group (University of Cambridge) have engaged with over 1100 named practitioners, policymakers, funders and other academics from across the world to identify needs and develop a range of principles, tools and resources to embed evidence in decision making. The goal of this engagement (the Conservation Evidence Programme) was to deliver improved conservation practice leading to benefits for nature and society. Together, we developed a theory of change with five key strategies for delivering change, alongside a freely available Evidence Toolkit to support decision makers in achieving that change. The authors describe the toolkit, a collection of freely available tools and resources developed by the collaborative programme, and how co‐design, employing different levels of partner engagement, enabled its development. Reflecting on our experiences highlighted a number of insights and recommendations, including the need to identify where deep engagement is a necessary condition for success; the importance of collective agreement of the roles of different partners; the need to consider how to facilitate uptake of new tools or practices, particularly where that requires changes to organisational practices or culture; and the importance of establishing processes/channels for ongoing engagement with stakeholders, with a willingness to be flexible and open to incorporating new suggestions and perspectives as needed. The Conservation Evidence Programme has enabled practitioners, funders and policymakers to become part of a network of forward‐thinking organisations that is working collaboratively to help drive more effective conservation practice through improved evidence use.

Abstract COVID‐19 has been linked to dysautonomia in the current literature, as has uncontrolled diabetes. Here, we present a case report of severe dysautonomia following a COVID‐19 infection in a patient with pre‐existing poorly controlled type‐1 diabetes. This patient exhibited symptoms consistent with both postural orthostatic tachycardia syndrome (POTS), as well as orthostatic hypotension. His symptoms became so severe that he was unable to come to a standing position without experiencing syncope. Extensive workup was completed to identify an alternative cause of his dysautonomia with inconclusive results. Dysautonomia can have devastating consequences in regard to physical, social, and psychological health. Counseling individuals with poorly controlled diabetes about the importance of maintaining tight blood glucose control and avoiding COVID‐19 infection should be primary interventions when treating patients with this DM1. Early detection and management of diabetes mellitus, COVID‐19, and of possible resultant dysautonomia through medical interventions, as well as lifestyle changes, are extremely important measures to avoid development of dangerous and potentially life‐threatening consequences.

Abstract Host‐associated microbial communities are fundamental to host physiology, yet it is unclear how these communities will respond to environmental disturbances. Here, we disentangle the environment‐linked and host‐linked effects of ocean acidification on oyster‐associated microbial communities. We exposed adult oysters (Crassostrea virginica) to CO2‐induced ocean acidification (400 vs. 2800 ppm) for 80 d. We measured the oyster extrapallial fluid pH and sampled the gills for microbial analysis at six time points. We found that different subsets of microbes were linked to acidification (n = 34 amplicon sequence variants [ASVs]) and to host response (n = 20 ASVs) with little overlap (n = 8 ASVs), suggesting that some members of the oyster microbiome were more responsive to environmental conditions while others were more tightly linked to host condition. Our results provide insight into which members of the oyster microbiome may contribute to the health and resistance of their host, and which members are the most vulnerable to changing environmental conditions.

Objective Patient‐reported outcomes (PROs) are an integral part of treat‐to‐target approaches in managing rheumatoid arthritis (RA). In clinical practice, however, routine collection, documentation, and discussion of PROs with patients are highly variable. The RISE LC (Rheumatology Informatics System for Effectiveness Learning Collaborative) was established to develop and share best practices in PRO collection and use across adult rheumatology practices in the United States Methods The goals of the RISE LC were developed through site surveys and in‐person meetings. Participants completed a baseline survey on PRO collection and use in their practices. RISE LC learning sessions focused on improving communication around PROs with patients and enhancing shared decision‐making in treatment plans. During the coronavirus disease 2019 (COVID‐19) pandemic, the RISE LC pivoted to adapt PRO tools for telehealth. Results At baseline, all responding sites (n = 15) had established workflows for collecting PROs. Most sites used paper forms alone. PRO documentation in electronic health records was variable, with only half of the sites using structured data fields. To standardize and improve the use of PROs, participants iteratively developed a Clinical Disease Activity Index–based RA Disease Activity Communication Tool to solicit treatment goals and improve shared decision‐making across sites. The COVID‐19 pandemic necessitated developing a tool to gauge PROs via telehealth. Conclusion The RISE LC is a continuous, structured method for implementing strategies to improve PRO collection and use in rheumatological care, initially adapting from the Learning Collaborative model and extending to include features of a learning network. Future directions include measuring the impact of standardized PRO collection and discussion on shared decision‐making and RA outcomes.

Abstract Background Assays that specifically measure α‐synuclein seeding activity in biological fluids could revolutionize the diagnosis of Parkinson’s disease. Recent improvements in α‐synuclein real‐time quaking‐induced conversion assays of cerebrospinal fluid have dramatically reduced reaction times from 5‐13 days down to 1‐2 days. Objective To test our improved assay against a panel of cerebrospinal fluid specimens from patients with Parkinson’s disease and healthy controls from the MJ Fox Foundation/NINDS BioFIND collection. Methods Specimens collected from healthy controls and patients with clinically typical moderate‐to‐advanced Parkinson’s disease were tested without prior knowledge of disease status. Correlative analyses between assay parameters and clinical measures were performed by an independent investigator. Results BioFIND samples gave positive signals in 105/108 (97%) Parkinson’s disease cases versus 11/85 (13%) healthy controls. Receiver operating characteristic analyses of diagnosis of cases versus healthy controls gave areas under the curve of 95%. Beyond binary positive/negative determinations, only weak correlations were observed between various assay response parameters and Parkinson’s disease clinical measures or other cerebrospinal fluid analytes. Of note, REM sleep behavioral disorder questionnaire scores correlated with the reaction times needed to reach 50% maximum fluorescence. Maximum fluorescence was inversely correlated with Unified Parkinson's Disease Rating Scale motor scores, which was driven by the patients without REM sleep behavioral disorder. Conclusions Our improved α‐synuclein seed amplification assay dramatically reduces the time needed to diagnose Parkinson’s disease while maintaining the high‐performance standards associated with previous α‐synuclein seed assays, supporting the clinical utility of this assay for Parkinson’s disease diagnosis.

Abstract Many types of guidance documents inform conservation by providing practical recommendations for the management of species and habitats. To ensure effective decisions are made, such guidance should be based upon relevant and up‐to‐date evidence. We reviewed conservation guidance for mitigation and management of species and habitats in the United Kingdom and Ireland, identifying 301 examples produced by over 50 organizations. Of these, only 29% provided a reference list, of which only 32% provided reference(s) relevant to justify the recommended actions (9% of the total). Furthermore, even this guidance was often outdated, lacked a methodology for production, or did not highlight uncertainty in the key evidence that supported the recommendations. These deficiencies can lead to misguided and ineffective conservation practices, policies, and decisions, and a waste of resources. Based on this review and co‐design by experts from 14 organizations, we present a set of principles for ensuring sufficient and relevant evidence is transparently incorporated into future conservation guidance. Producing evidence‐based guidance in line with these principles would enable more effective conservation outcomes.

Abstract Making the reasoning and evidence behind conservation management decisions clear and transparent is a key challenge for the conservation community. Similarly, combining evidence from diverse sources (e.g., scientific and local knowledge) into decision‐making is also difficult. Our group of conservation researchers and practitioners has co‐produced an intuitive tool and template (Evidence‐to‐Decision [E2D] tool: www.evidence2decisiontool.com) to guide practitioners through a structured process to transparently document and report the evidence and reasoning behind decisions. The tool has three major steps: (1). Define the Decision Context; (2). Gather Evidence; and (3). Make an Evidence‐Based Decision. In each step, practitioners enter information (e.g., from the scientific literature, practitioner knowledge and experience, and costs) to inform their decision‐making and document their reasoning. The tool packages this information into a customized downloadable report (or is documented if using the offline template), which we hope can stimulate the exchange of information on decisions within and between organizations. By enabling practitioners to revisit how and why past decisions were made, and integrate diverse forms of evidence, we believe our open‐access tool's template can help increase the transparency and quality of decision‐making in conservation.

Abstract Cranial internal hemipelvectomy can be successful for excision of ilial CSA with minimal complications. Iliectomy with adjuvant radiation therapy was well tolerated in a dog with grade II ilial CSA. The dog survived 1,271 days postoperatively and supposedly succumbed to a disease process unrelated to the CSA.

Abstract In the United Kingdom and European Union, legal protection of species from the impacts of infrastructure development depends upon a number of ecological mitigation and compensation (EMC) measures to moderate the conflict between development and conservation. However, the scientific evidence supporting their effectiveness has not yet been comprehensively assessed. This study compiled the measures used in practice, identified and explored the guidance that informed them and, using the Conservation Evidence database, evaluated the empirical evidence for their effectiveness. In a sample of 50 U.K. housing applications, we identified the recommendation of 446 measures in total, comprising 65 different mitigation measures relating to eight taxa. Although most (56%) measures were justified by citing published guidance, exploration of the literature underpinning this guidance revealed that empirical evaluations of EMC measure effectiveness accounted for less than 10% of referenced texts. Citation network analysis also identified circular referencing across bat, amphibian and reptile EMC guidance. Comparison with Conservation Evidence synopses showed that over half of measures recommended in ecological reports had not been empirically evaluated, with only 13 measures assessed as beneficial. As such, most EMC measures recommended in practice are not evidence based. The limited reference to empirical evidence in published guidance, as well as the circular referencing, suggests potential ‘evidence complacency’, in which evidence is not sought to inform recommendations. In addition, limited evidence availability indicates a thematic gap between conservation research and mitigation practice. More broadly, absence of evidence on the effectiveness of EMC measures calls into question the ability of current practice to compensate for the impact of development on protected species, thus highlighting the need to strengthen requirements for impact avoidance. Given the recent political drive to invest in infrastructure expansion, high‐quality, context‐specific evidence is urgently needed to inform decision‐making in infrastructure development.

Abstract Aims Fibroblast to myofibroblast trans‐differentiation with altered bioenergetics precedes cardiac fibrosis (CF). Either prevention of differentiation or promotion of de‐differentiation could mitigate CF‐related pathologies. We determined whether 3‐hydroxy‐3‐methyl‐glutaryl‐coenzyme A (HMG‐CoA) reductase inhibitors—statins, commonly prescribed to patients at risk of heart failure (HF)—can de‐differentiate myofibroblasts, alter cellular bioenergetics, and impact the human ventricular fibroblasts (hVFs) in HF patients. Methods and results Either in vitro statin treatment of differentiated myofibroblasts (n = 3–6) or hVFs, isolated from human HF patients under statin therapy (HF + statin) vs. without statins (HF) were randomly used (n = 4–12). In vitro, hVFs were differentiated by transforming growth factor‐β1 (TGF‐β1) for 72 h (TGF‐72 h). Differentiation status and cellular oxygen consumption rate (OCR) were determined by α‐smooth muscle actin (α‐SMA) expression and Seahorse assay, respectively. Data are mean ± SEM except Seahorse (mean ± SD); P

Abstract Making effective decisions in conservation requires a broad and robust evidence base describing the likely outcomes of potential actions to draw on. Such evidence is typically generated from experiments or trials that evaluate the effectiveness of actions, but for many actions evidence is missing or incomplete. We discuss how evidence can be generated by incorporating experiments into conservation practice. This is likely to be most efficient if opportunities for carrying out informative, well‐designed experiments are identified at an early stage during conservation management planning. We consider how to navigate a way between the stringent requirements of statistical textbooks and the complexities of carrying out ecological experiments in the real world by considering practical approaches to the key issues of replication, controls and randomization. We suggest that routinely sharing the results of experiments could increase both the value for money and effectiveness of conservation practice. We argue that with early planning and a small additional input of effort, important new learning can be gained during the implementation of many conservation actions.

Abstract 1. To be effective, the next generation of conservation practitioners and managers need to be critical thinkers with a deep understanding of how to make evidence‐based decisions and of the value of evidence synthesis. 2. If, as educators, we do not make these priorities a core part of what we teach, we are failing to prepare our students to make an effective contribution to conservation practice. 3. To help overcome this problem we have created open access online teaching materials in multiple languages that are stored in Applied Ecology Resources. So far, 117 educators from 23 countries have acknowledged the importance of this and are already teaching or about to teach skills in appraising or using evidence in conservation decision‐making. This includes 145 undergraduate, postgraduate or professional development courses. 4. We call for wider teaching of the tools and skills that facilitate evidence‐based conservation and also suggest that providing online teaching materials in multiple languages could be beneficial for improving global understanding of other subject areas.