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Abstract This study is motivated by the observed variability in trace element isotopic and chemical compositions of primitive (SiO2

Abstract Background Diabetes‐related foot infections are common and represent a significant clinical challenge. There are scant data about outcomes from large cohorts. The purpose of this study was to report clinical outcomes from a large cohort of people with diabetes‐related foot infections. Methods A tertiary referral hospital limb preservation service database was established in 2018, and all new episodes of foot infections were captured prospectively using an electronic database (REDCap). People with foot infections between January 2018 and May 2023, for whom complete data were available on infection episodes, were included. Infection outcomes were compared between skin and soft tissue infections (SST‐DFI) and osteomyelitis (OM) using chi‐square tests. Results Data extraction identified 647 complete DFI episodes in 397 patients. The data set was divided into two cohorts identifying each infection episode and its severity as either SST‐DFI (N = 326, 50%) or OM (N = 321, 50%). Most infection presentations were classified as being moderate (PEDIS 3 = 327, 51%), with 36% mild (PEDIS 2 = 239) and 13% severe (PEDIS 4 = 81). Infection resolution occurred in 69% (n = 449) of episodes with failure in 31% (n = 198). Infection failures were more common with OM than SST‐DFI (OM = 140, 71% vs. SST‐DFI = 58, 29%, p

Abstract Introduction Post‐exposure prophylaxis (PEP) is an efficacious prevention method when initiated promptly after an HIV exposure. Yet, PEP has been underutilized, even among healthcare workers (HCWs) with occupational exposure in sites with PEP policies and procedures and access to PEP medications. It is important to understand the dynamics of uneven PEP use in what appears to be an optimal context to better protect the health and wellbeing of HCWs. Methods We conducted a scoping review to elucidate factors influencing HCWs’ use of PEP after occupational exposure. We searched PubMed, PsychInfo and Google Scholar for peer‐reviewed literature published in English from 2014 to 2022 using the terms HIV, postexposure/post‐exposure prophylaxis, acceptability, healthcare workers, and values and preferences. An inductive narrative review of the resulting 53 studies identified core themes. Results Nearly all studies (96%) with various HCW types and settings occurred in low‐ and middle‐income countries (LMICs) in Africa and Asia. Identified themes arrayed along a trajectory of PEP use experience: awareness/knowledge; acceptability; availability/access; uptake/use; adherence/completion. Across studies, awareness of PEP for HIV prevention was high, knowledge about drug regimens and healthcare facility policies was moderate to low; acceptability of PEP was moderate to high; PEP's perceived accessibility/availability was inconsistent and varied by geographic location and setting; HCWs’ uptake of PEP was low, affected by not knowing how to report an exposure and being unaware of PEP availability; and adherence/completion of PEP regimens was moderate to low, impeded by side effects and a belief that completing regimens was unnecessary to avert seroconversion. HCWs consistently expressed concern about HIV stigma. Discussion Findings are limited by the inconsistent use of constructs across studies and a lack of clarity about reporting exposure events. Multi‐level approaches are needed to address the interplay of individual, social and structural barriers that diminish HCWs’ PEP use. Improved training, incident reporting, 24‐hour access to non‐stigmatizing PEP services and monitoring of adherence/completion are essential to optimizing HCWs’ PEP use. Conclusions Lessons from HCWs’ experience in LMICs may inform understanding of PEP under‐use among people in these settings with non‐occupational exposures.

Abstract Introduction Measuring the coverage of HIV prevention services for key populations (KPs) has consistently been a challenge for national HIV programmes. The current frameworks and measurement methods lack emphasis on effective coverage, occur infrequently, lack timeliness and limit the participation of KPs. The Effective Programme Coverage framework, which utilizes a programme science approach, provides an opportunity to assess gaps in various coverage domains and explore the underlying reasons for these gaps, in order to develop targeted solutions. We have demonstrated the application of this framework in partnership with the KP community in Nairobi, Kenya, using an expanded Polling Booth Survey (ePBS) method. Methods Data were collected between April and May 2023 among female sex workers (FSWs) and men who have sex with men (MSM) using (a) PBS, (b) bio‐behavioural survey and (c) focus group discussions. Data collection and analysis involved both KP community and non‐community researchers. Descriptive analysis was performed, and proportions were used to assess the programme coverage gaps. The data were weighted to account for the sampling design and unequal selection probabilities. Thematic analysis was conducted on the qualitative data. Results The condom programme for FSW and MSM had low availability (60.2% and 50.9%), contact (68.8% and 65.9%) and utilization (52.1% and 43.9%) coverages. The pre‐exposure prophylaxis (PrEP) programme had very low utilization coverage for FSW and MSM (4.4% and 2.8%), while antiretroviral therapy utilization coverage was higher (86.6% and 87.7%). Reasons for coverage gaps included a low peer educator‐to‐peer ratio, longer distance to the clinics, shortage of free condoms supplied by the government, experienced and anticipated side effects related to PrEP, and stigma and discrimination experienced in the facilities. Conclusions The Effective Programme Coverage framework allows programmes to assess coverage gaps and develop solutions and a research agenda targeted at specific domains of coverage with large gaps. The ePBS method works well in collecting data to understand coverage gaps rapidly and allows for the engagement of the KP community.

Objective We estimated the association between immunosuppressive and immunomodulatory agent (IIA) exposure and severe COVID‐19 outcomes in a population‐based cohort study. Methods Participants were 18 years or older, tested positive for SARS‐CoV‐2 between February 6, 2020, and August 15, 2021, and were from administrative health data for the entire province of British Columbia, Canada. IIA use within 3 months prior to positive SARS‐CoV‐2 test included conventional disease‐modifying antirheumatic drugs (antimalarials, methotrexate, leflunomide, sulfasalazine, individually), immunosuppressants (azathioprine, mycophenolate mofetil/mycophenolate sodium [MMF], cyclophosphamide, cyclosporine, individually and collectively), tumor necrosis factor inhibitor (TNFi) biologics (adalimumab, certolizumab, etanercept, golimumab, infliximab, collectively), non‐TNFi biologics or targeted synthetic disease‐modifying antirheumatic drugs (tsDMARDs) (rituximab separately from abatacept, anakinra, secukinumab, tocilizumab, tofacitinib and ustekinumab collectively), and glucocorticoids. Severe COVID‐19 outcomes were hospitalizations for COVID‐19, ICU admissions, and deaths within 60 days of a positive test. Exposure score–overlap weighting was used to balance baseline characteristics of participants with IIA use compared with nonuse of that IIA. Logistic regression measured the association between IIA use and severe COVID‐19 outcomes. Results From 147,301 participants, we identified 515 antimalarial, 573 methotrexate, 72 leflunomide, 180 sulfasalazine, 468 immunosuppressant, 378 TNFi biologic, 49 rituximab, 144 other non‐TNFi biologic or tsDMARD, and 1348 glucocorticoid prescriptions. Risk of hospitalizations for COVID‐19 was significantly greater for MMF (odds ratio [95% CI]): 2.82 [1.81‐4.40], all immunosuppressants: 2.08 [1.51‐2.87], and glucocorticoids: 1.63 [1.36‐1.96], relative to nonuse. Similar outcomes were seen for ICU admission and MMF: 2.52 [1.34‐4.74], immunosuppressants: 2.88 [1.73‐4.78], and glucocorticoids: 1.86 [1.37‐2.54]. Only glucocorticoids use was associated with a significant increase in 60‐day mortality: 1.58 [1.21‐2.06]. No other IIAs displayed statistically significant associations with severe COVID‐19 outcomes. Conclusion Current use of MMF and glucocorticoids were associated with an increased risk of severe COVID‐19 outcomes compared with nonuse. These results emphasize the variety of circumstances of patients taking IIAs.

Abstract Aim Phenobarbital, a long‐acting barbiturate, presents an alternative to conventional benzodiazepine treatment for alcohol withdrawal syndrome (AWS). Currently, existing research offers only modest guidance on the safety and effectiveness of phenobarbital in managing AWS in hospital settings. The study objective was to assess if a phenobarbital protocol for the treatment of AWS reduces respiratory complications when compared to a more traditionally used benzodiazepine protocol. Methods A retrospective cohort study analyzing adults who received either phenobarbital or benzodiazepine‐based treatment for AWS over a 4‐year period, 2015–2019, in a community teaching hospital in a large academic medical system. Results A total of 147 patient encounters were included (76 phenobarbital and 71 benzodiazepine). Phenobarbital was associated with a significantly decreased risk of respiratory complications, defined by the occurrence of intubation (15/76 phenobarbital [20%] vs. 36/71 benzodiazepine [51%]) and decreased incidence of the requirement of six or greater liters of oxygen when compared with benzodiazepines (10/76 [13%] vs. 28/71 [39%]). There was a significantly higher incidence of pneumonia in benzodiazepine patients (15/76 [20%] vs. 33/71 [47%]). Mode Richmond Agitation Sedation Scale (RASS) scores were more frequently at goal (0 to −1) between 9 and 48 h after the loading dose of study medication for phenobarbital patients. Median hospital and ICU length of stay were significantly shorter for phenobarbital patients when compared with benzodiazepine patients (5 vs. 10 days and 2 vs. 4 days, respectively). Conclusion Parenteral phenobarbital loading doses with an oral phenobarbital tapered protocol for AWS resulted in decreased risk of respiratory complications when compared to standard treatment with benzodiazepines.

Abstract Objectives We aimed to evaluate the activity of selinexor, an oral selective inhibitor of nuclear export, in patients with recurrent or metastatic salivary gland tumors (SGT). Methods GEMS‐001 is an open‐label Phase 2 study for patients with recurrent or metastatic SGT with two parts. In Part 1 of the protocol, patients had tumor samples profiled with targeted next generation sequencing as well as immunohistochemistry for androgen receptor, HER‐2 and ALK. For Part 2, patients with no targeted therapies available were eligible to receive selinexor 60 mg given twice weekly every 28 days. The primary endpoint was objective response rate. Secondary endpoints included progression‐free survival (PFS) and prevalence of druggable alterations across SGT. Results One hundred patients were enrolled in GEMS‐001 and underwent genomic and immunohistochemistry profiling. A total of 21 patients who lacked available matched therapies were treated with selinexor. SGT subtypes (WHO classification) included adenoid cystic carcinoma (n = 10), salivary duct carcinoma (n = 3), acinic cell carcinoma (n = 2), myoepithelial carcinoma (n = 2), carcinoma ex pleomorphic adenoma (n = 2) and other (n = 2). Of 18 evaluable patients, stable disease (SD) was observed in 17 patients (94%) (SD ≥6 months in 7 patients (39%)). However, no objective responses were observed. The median PFS was 4.9 months (95% confidence interval, 3.4–10). The most common treatment‐related Grade 1–2 adverse events were nausea [17 patients (81%)], fatigue [16 patients (76%)], and dysgeusia [12 patients (57%)]. Most common treatment‐related Grade 3–4 adverse events were hyponatremia [3 patients (14%)], neutrophil count decrease [3 patients (14%)] and cataracts [2 patients (10%)]. No treatment‐related deaths were observed. Conclusions Although tumor reduction was observed across participants, single agent selinexor anti‐tumor activity was limited.

Abstract Geoelectric fields are generated at the Earth's surface and can lead to the induction of hazardous geomagnetically induced currents (GIC) in infrastructure like power grids, railways and pipelines during geomagnetic storms. Magnitude and orientation of the geoelectric fields, in relation to the infrastructure, are key features needed to determine the intensity of GIC. Here, we developed the first geoelectric hazard map for the island of Ireland, with the aim of providing detailed information that can help stakeholders mitigate the impact of GICs. The hazard map was developed by modeling and mapping the geoelectric field across Ireland for 28 years (1991–2018) using magnetic field data with magnetotelluric transfer functions. The approach for developing the hazard map calculates the probability of exceeding a hazardous geoelectric field threshold (500 mV/km) during large geomagnetic storms, taking directionality and amplitude into account. We found hazardous geoelectric fields to be mostly localized in areas in the west, south‐west and northern coast. We observed that the geoelectric field have a stronger dominant orientation than the orientation of the geomagnetic field, often constraining the hazardous geoelectric field in particular directions only. We demonstrate a seasonal/diurnal effect is present in the geoelectric field time series. The impact of galvanic distortion was also assessed, and we demonstrate that there is a significant difference in terms of amplitude and direction between both models.

Background Day‐to‐day variability in sleep patterns and eating timing may disrupt circadian rhythms and has been linked with various adverse cardiometabolic outcomes. However, the extent to which variability in sleep patterns and eating timing relate to atherosclerotic development in subclinical stages remains unclear. Methods and Results Generally healthy adults (N=62, 29.3±7.3 years, 66% female) completed 14 days of sleep and dietary assessments via wrist accelerometry and photo‐assisted diet records, respectively. Variability in sleep duration, sleep onset, eating onset (time of first caloric consumption), eating offset (time of last caloric consumption), and caloric midpoint (time at which 50% of total daily calories are consumed) were operationalized as the SD across 14 days for each variable. Separate regression models evaluated the cross‐sectional associations between sleep and eating variability metrics with end‐diastolic carotid intima‐media thickness (CIMT) measured via ultrasonography. Models adjusted for age, sex, systolic blood pressure, sleep duration, and total energy intake. Each 60‐minute increase in sleep duration SD and sleep onset SD were associated with a 0.049±0.016 mm (P=0.003) and 0.048±0.017 mm (P=0.007) greater CIMT, respectively. Variability in eating onset and offset were not associated with CIMT; however, each 60‐minute increase in caloric midpoint SD was associated with a 0.033±0.015 mm greater CIMT (P=0.029). Exploratory post hoc analyses suggested that sleep duration SD and sleep onset SD were stronger correlates of CIMT than caloric midpoint SD. Conclusions Variability in sleep patterns and eating timing are positively associated with clinically relevant increases in CIMT, a biomarker of subclinical atherosclerosis, in early adulthood.

Abstract Understanding global space weather effects is of great importance to the international scientific community, but more localized space weather predictions are important on a national level. In this study, data from a ground magnetometer at Valentia Observatory is used to characterize space weather effects on the island of Ireland. The horizontal component of magnetometer observations and its time derivative are considered, and extreme values of these are identified. These extremes are fit to a generalized extreme value distribution, and from this model return values (the expected magnitude of an observation within a given time window) are predicted. The causes of extreme values are investigated both in a case study, and also statistically by looking at contributions from geomagnetic storms, substorms, and sudden commencements. This work characterizes the extreme part of the distribution of space weather effects on Ireland (and at similar latitudes), and hence examines those space weather observations which are likely to have the greatest impact on susceptible technologies.

Abstract Here we designed a motor adaptation video game that could be played remotely (at home) through a web browser. This required the child to adapt to a visuomotor rotation between their hand movement and a ball displayed in the game. The task had several novel features, specifically designed to allow the study of the developmental trajectory of adaptation across a wide range of ages. We test the concurrent validity by comparing children's performance on our remote task to the same task performed in the laboratory. All participants remained engaged and completed the task. We quantified feedforward and feedback control during this task. Feedforward control, a key measure of adaptation, was similar at home and in the laboratory. All children could successfully use feedback control to guide the ball to a target. Traditionally, motor learning studies are performed in a laboratory to obtain high quality kinematic data. However, here we demonstrate concurrent validity of kinematic behavior when conducted at home. Our online platform provides the flexibility and ease of collecting data that will enable future studies with large sample sizes, longitudinal experiments, and the study of children with rare diseases.

Abstract Background Testicular cancer survivors often have impaired gonadal function possibly related to chemotherapy. Platinum is a heavy metal that can be detected at low levels in serum many years after treatment, it is not known whether platinum also persists in semen and if platinum persistence in semen is associated with impaired fertility. Methods Adult cisplatin‐treated testicular cancer survivors were enrolled. High‐Performance Liquid Chromatography‐tandem mass spectrometry was used to measure semen and serum platinum levels. Semen quality and DNA Fragmentation Index (DFI) were assessed. Results From 11/2017 to 12/2019, 38 patients (median age 32 years; range: 19–52) were enrolled. Median cumulative cisplatin dose was 301 mg/m2 (range: 274–404). Platinum levels were higher in semen than in blood (p = 0.03). Semen platinum levels were not significantly associated with time from last cisplatin dosing (r = −0.34; p = 0.09) nor cumulative dose (r = −0.10, p = 0.63). Sperm concentration was correlated with time from last cisplatin dosing (r = 0.58, p

Abstract INTRODUCTION The Centiloid scale aims to harmonize amyloid beta (Aβ) positron emission tomography (PET) measures across different analysis methods. As Centiloids were created using PET/computerized tomography (CT) data and are influenced by scanner differences, we investigated the Centiloid transformation with data from Insight 46 acquired with PET/magnetic resonanceimaging (MRI). METHODS We transformed standardized uptake value ratios (SUVRs) from 432 florbetapir PET/MRI scans processed using whole cerebellum (WC) and white matter (WM) references, with and without partial volume correction. Gaussian‐mixture‐modelling–derived cutpoints for Aβ PET positivity were converted. RESULTS The Centiloid cutpoint was 14.2 for WC SUVRs. The relationship between WM and WC uptake differed between the calibration and testing datasets, producing implausibly low WM‐based Centiloids. Linear adjustment produced a WM‐based cutpoint of 18.1. DISCUSSION Transformation of PET/MRI florbetapir data to Centiloids is valid. However, further understanding of the effects of acquisition or biological factors on the transformation using a WM reference is needed. HIGHLIGHTS Centiloid conversion of amyloid beta positron emission tomography (PET) data aims to standardize results. Centiloid values can be influenced by differences in acquisition. We converted florbetapir PET/magnetic resonance imaging data from a large birth cohort. Whole cerebellum referenced values could be reliably transformed to Centiloids. White matter referenced values may be less generalizable between datasets.

Abstract Background There are limited data regarding the quality of patient‐reported outcome (PRO) data in immune checkpoint inhibitor (ICI) clinical trial publications. Methods A systematic search of citations from various databases was conducted to identify prospective clinical trials involving ICI in advanced tumors from 2003 to 2020. A 30‐point score was adapted from the CONSORT PRO extension statement to assess adherence to CONSORT PRO reporting. Linear regression was used to identify factors associated with quality reporting. Results After the review of 8058 articles, 33 trials were included with ICIs as either monotherapy (91%) or part of a combination regimen (9%). The median score was 23.5 points (range 15–29). In the majority of cases (82%), PROs were reported in a separate publication from the original study. Most of the trials were conducted in the metastatic setting and predominantly in melanoma, lung, and renal cell carcinoma (RCC) (73%). Univariate analysis revealed that trials with greater than 250 patients were associated with a higher score. The score was more likely to be lower in disease sites other than melanoma, lung, and RCC and was higher in the KEYNOTE than in the CHECKMATE trial series. There was no significant correlation between the score and whether a trial met its primary end‐point or if the trial improved or worsened the quality of life. In the multivariate analysis, the number of patients enrolled to the trial, disease site, and trial series remained significant. Conclusions The quality of reporting of PROs in ICI phase II and III clinical trials is heterogeneous across various cancer sites. As PRO data are increasingly used to counsel patients and complement clinical decision making, innovative and collaborative efforts are required to improve the reporting of these essential data.

Abstract Aim To investigate whether the frequently advocated climate‐matching species distribution modeling approach could predict the well‐characterized colonization of Florida by the Madagascar giant day gecko Phelsuma grandis. Location Madagascar and Florida, USA. Methods To determine the climatic conditions associated with the native range of P. grandis, we used native‐range presence‐only records and Bioclim climatic data to build a Maxent species distribution model and projected the climatic thresholds of the native range onto Florida. We then built an analogous model using Florida presence‐only data and projected it onto Madagascar. We constructed a third model using native‐range presences for both P. grandis and the closely related parapatric species P. kochi. Results Despite performing well within the native range, our Madagascar Bioclim model failed to identify suitable climatic habitat currently occupied by P. grandis in Florida. The model constructed using Florida presences also failed to reflect the distribution in Madagascar by overpredicting distribution, especially in western areas occupied by P. kochi. The model built using the combined P. kochi/P. grandis dataset modestly improved the prediction of the range of P. grandis in Florida, thereby implying competitive exclusion of P. grandis by P. kochi from habitat within the former's fundamental niche. These findings thus suggest ecological release of P. grandis in Florida. However, because ecological release cannot fully explain the divergent occupied niches of P. grandis in Madagascar versus Florida, our findings also demonstrate some degree of in situ adaptation in Florida. Main conclusions Our models suggest that the discrepancy between the predicted and observed range of P. grandis in Florida is attributable to either in situ adaptation by P. grandis within Florida, or a combination of such in situ adaptation and competition with P. kochi in Madagascar. Our study demonstrates that climate‐matching species distribution models can severely underpredict the establishment risk posed by non‐native herpetofauna.

Abstract Objective To assess associations between head injury (HI) with loss of consciousness (LOC), ageing and markers of later‐life cerebral pathology; and to explore whether those effects may help explain subtle cognitive deficits in dementia‐free individuals. Methods Participants (n = 502, age = 69–71) from the 1946 British Birth Cohort underwent cognitive testing (subtests of Preclinical Alzheimer Cognitive Composite), 18F‐florbetapir Aβ‐PET and MR imaging. Measures include Aβ‐PET status, brain, hippocampal and white matter hyperintensity (WMH) volumes, normal appearing white matter (NAWM) microstructure, Alzheimer’s disease (AD)‐related cortical thickness, and serum neurofilament light chain (NFL). LOC HI metrics include HI occurring: (i) >15 years prior to the scan (ii) anytime up to age 71. Results Compared to those with no evidence of an LOC HI, only those reporting an LOC HI>15 years prior (16%, n = 80) performed worse on cognitive tests at age 69–71, taking into account premorbid cognition, particularly on the digit‐symbol substitution test (DSST). Smaller brain volume (BV) and adverse NAWM microstructural integrity explained 30% and 16% of the relationship between HI and DSST, respectively. We found no evidence that LOC HI was associated with Aβ load, hippocampal volume, WMH volume, AD‐related cortical thickness or NFL (all p > 0.01). Interpretation Having a LOC HI aged 50’s and younger was linked with lower later‐life cognitive function at age ~70 than expected. This may reflect a damaging but small impact of HI; explained in part by smaller BV and different microstructure pathways but not via pathology related to AD (amyloid, hippocampal volume, AD cortical thickness) or ongoing neurodegeneration (serum NFL).

Abstract Background Genetic disorders contribute to significant morbidity and mortality in critically ill newborns. Despite advances in genome sequencing technologies, a majority of neonatal cases remain unsolved. Complex structural variants (SVs) often elude conventional genome sequencing variant calling pipelines and will explain a portion of these unsolved cases. Methods As part of the Utah NeoSeq project, we used a research‐based, rapid whole‐genome sequencing (WGS) protocol to investigate the genomic etiology for a newborn with a left‐sided congenital diaphragmatic hernia (CDH) and cardiac malformations, whose mother also had a history of CDH and atrial septal defect. Results Using both a novel, alignment‐free and traditional alignment‐based variant callers, we identified a maternally inherited complex SV on chromosome 8, consisting of an inversion flanked by deletions. This complex inversion, further confirmed using orthogonal molecular techniques, disrupts the ZFPM2 gene, which is associated with both CDH and various congenital heart defects. Conclusions Our results demonstrate that complex structural events, which often are unidentifiable or not reported by clinically validated testing procedures, can be discovered and accurately characterized with conventional, short‐read sequencing and underscore the utility of WGS as a first‐line diagnostic tool.

Abstract Background Diabetes‐related foot infections cause substantial morbidity and mortality, both globally and in Australia. There is a need for up‐to‐date evidence‐based guidelines to ensure optimal management of patients with diabetes‐related foot infections. We aimed to identify and adapt high quality international guidelines to the Australian context to become the new Australian evidence‐based guideline for people with a diabetes‐related foot infection. Methods Following Australian National Health and Medical Research Council (NHMRC) procedures we identified the 2019 International Working Group on the Diabetic Foot (IWGDF) guidelines as suitable for adaptation to the Australian context. Guidelines were screened, assessed and judged by an expert panel for the Australian context using the guideline adaptation frameworks ADAPTE and Grading of Recommendations Assessment, Development and Evaluation (GRADE). Judgements led to recommendations being adopted, adapted or excluded, with additional consideration regarding their implementation, monitoring and future research for the Australian context. Clinical pathways were then developed to assist implementation. Results Of 36 original diabetes‐related foot infection IWGDF sub‐recommendations, 31 were adopted, four were adapted and one was excluded. Adaption was primarily undertaken due to differences or clarification of the sub‐recommendations' intended population. One sub‐recommendation was excluded due to substantial differences in judgements between the panel and IWGDF and unacceptable heterogeneity of the target population. Therefore, we developed 35 evidence‐based sub‐recommendations for the Australian context that should guide best practice diagnosis and management of people with diabetes‐related foot infection in Australia. Additionally, we incorporated these sub‐recommendations into two clinical pathways to assist Australian health professionals to implement these evidence‐based sub‐recommendations into clinical practice. The six guidelines and the full protocol can be found at: https://www.diabetesfeetaustralia.org/new‐guidelines/. Conclusions A new national guideline for the diagnosis and management of people with diabetes‐related foot infections were successfully developed for the Australian context. In combination with simplified clinical pathway tools they provide an evidence‐based framework to ensure best management of individuals with diabetes‐related foot infections across Australia and highlight considerations for implementation and monitoring.

Abstract It is a critical time to reflect on the National Ecological Observatory Network (NEON) science to date as well as envision what research can be done right now with NEON (and other) data and what training is needed to enable a diverse user community. NEON became fully operational in May 2019 and has pivoted from planning and construction to operation and maintenance. In this overview, the history of and foundational thinking around NEON are discussed. A framework of open science is described with a discussion of how NEON can be situated as part of a larger data constellation—across existing networks and different suites of ecological measurements and sensors. Next, a synthesis of early NEON science, based on >100 existing publications, funded proposal efforts, and emergent science at the very first NEON Science Summit (hosted by Earth Lab at the University of Colorado Boulder in October 2019) is provided. Key questions that the ecology community will address with NEON data in the next 10 yr are outlined, from understanding drivers of biodiversity across spatial and temporal scales to defining complex feedback mechanisms in human–environmental systems. Last, the essential elements needed to engage and support a diverse and inclusive NEON user community are highlighted: training resources and tools that are openly available, funding for broad community engagement initiatives, and a mechanism to share and advertise those opportunities. NEON users require both the skills to work with NEON data and the ecological or environmental science domain knowledge to understand and interpret them. This paper synthesizes early directions in the community’s use of NEON data, and opportunities for the next 10 yr of NEON operations in emergent science themes, open science best practices, education and training, and community building.

Abstract How climate and habitat drive variation in aquatic metabolism in wetlands remains uncertain. To quantify differences in seasonal aquatic metabolism among wetlands, we estimated aquatic ecosystem metabolism (gross primary productivity, GPP; ecosystem respiration, ER; net aquatic productivity, NAP) in subtropical ridge and slough wetlands of the Florida Everglades from more than 2 yr of continuously measured water column dissolved oxygen, photosynthetically active radiation (PAR), water temperature, and water depth. Gross primary productivity and ER were modeled from light, temperature, and water depth using non‐linear minimization and maximum likelihood. Reaeration rates were estimated from wind speed. Dissolved oxygen was below saturation at all sites during both wet and dry seasons. Water depth interacted with vegetation to influence PAR, water temperature, and spatiotemporal patterns in aquatic metabolism. Gross primary productivity and ER were highest at the slough with lowest submerged aquatic vegetation (low‐SAV slough), intermediate in the sawgrass (Cladium jamaicense) ridge site, and lowest at the slough with highest submerged aquatic vegetation (high‐SAV slough). Ecosystem respiration was strongly positively correlated with GPP at the sawgrass ridge and low‐SAV slough sites. Gross primary productivity increased with water temperature and PAR across all habitat types, whereas ER decreased (more respiration) with water temperature and PAR. Net aquatic productivity was negatively correlated with water temperature and positively correlated with PAR, suggesting that ER was more sensitive than GPP to water temperature. Aquatic metabolism was largely net heterotrophic in all wetlands, and high‐SAV appeared to buffer seasonal variation in PAR and water temperatures that drive NAP in subtropical wetlands. Our results suggest that aquatic ecosystem metabolism in wetlands with seasonal hydrology is sensitive to changes in water depth and vegetation density that influence temperature and light. Expanding our understanding of how metabolic processes and carbon cycling in wetland ecosystems vary across gradients in hydrology, vegetation, and organic matter could enhance our understanding and protection of conditions that maximize carbon storage.