Search

Abstract Objective Venous outflow (VO) impairment predicts unfavorable outcomes in patients with acute ischemic stroke caused by large vessel occlusion (AIS‐LVO). Prolonged venous transit (PVT), a visual qualitative VO marker on CT perfusion (CTP) time to maximum (Tmax) maps, has been associated with unfavorable 90‐day functional outcomes despite successful reperfusion. This study investigates the association between PVT and percent change on the National Institutes of Health Stroke Scale (NIHSS) among AIS‐LVO patients who have undergone successful reperfusion. Methods We performed a retrospective analysis of prospectively collected data from consecutive adult AIS‐LVO patients with successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/2c/3). PVT+ was defined as Tmax ≥10 s in the superior sagittal sinus, torcula, or both. The primary outcome was continuous NIHSS percent change and dichotomous NIHSS percent change ≥70%. Regression analyses were performed to assess the effect of PVT on NIHSS percent change. Results In 119 patients of median (IQR) age 71 (63–81) years, the admission and discharge NIHSS scores were significantly higher in PVT+ patients compared to PVT− patients (17 [14–23.5] vs. 13 [9.5–19], p = 0.011, and 7.5 [4–12] vs. 3 [1–7], p 6 s volume, and hemorrhagic transformation, PVT+ was significantly associated with lower NIHSS percent change (B = −0.163, 95%CI −0.326 to −0.001, p = 0.049) and was less likely to achieve higher than 70% NIHSS improvement (OR = 0.331, 95% CI 0.127–0.863, p = 0.024). Interpretation PVT+ was significantly associated with reduced neurological improvement despite successful reperfusion in AIS‐LVO patients, highlighting the critical role of VO impairment in short‐term functional outcomes. These findings further validate PVT as a valuable adjunct imaging biomarker derived from CTP for assessing VO profiles in AIS‐LVO.

Societal Impact Statement Bananas are nutritious fruits of major importance worldwide. Characterizing their diversity is essential to ensure their conservation and use. A catalog showcasing cultivated bananas genomic diversity was compiled and is to be used as a tool to support the classification of banana cultivars. This research revealed that cultivated banana groups are not all made of identical clones. Materials from recent collecting missions indicated that more banana diversity is expected to be found as the exploration of the banana gene pool continues. These discoveries will drive dynamic conservation strategies for banana genetic resources and should increase their use. Summary Banana is an important food crop cultivated in many tropical and subtropical regions around the world. Because banana cultivars often have low fertility, they are typically propagated clonally, which maintains desirable traits across generations. However, different factors, such as synonymy, incomplete passport data, and environmental effects, complicate the morphological‐based assignment of banana cultivars to specific clones or cultivar groups. In this study, we applied a previously developed genomic‐based tool for fine‐scale characterization of banana ancestry, known as in silico chromosome painting, to high‐throughput genotyping data from 317 banana accessions. This dataset covers most of the globally conserved, studied, and cultivated cultivar groups and includes both genebanks and new, uncharacterized materials. By comparing curated morphological assignation to the genomic patterns resulting from in silico chromosome painting, we compiled a diversity catalog referencing curated passport data, pictures, and chromosome painting patterns of the cultivar groups. Examining the genomic patterns obtained, intra‐cultivar group variability was discovered. In some cultivar groups, mitotic recombination or deletions accumulated clonally. In addition, at least four cultivar groups encompassed cultivars from distinct sexual events co‐existing, notably Pisang Awak with five distinct patterns across two ploidy levels. Finally, additional patterns were discovered in the newest materials of the set, showing that a wider diversity of clones still exists on farm.

Abstract Our group previously showed that genetic or pharmacological inhibition of the cystine/glutamate antiporter, system xc−, mitigates excitotoxicity after anoxia by increasing latency to anoxic depolarization, thus attenuating the ischaemic core. Hypoxia, however, which prevails in the ischaemic penumbra, is a condition where neurotransmission is altered, but excitotoxicity is not triggered. The present study employed mild hypoxia to further probe ischaemia‐induced changes in neuronal responsiveness from wild‐type and xCT KO (xCT−/−) mice. Synaptic transmission was monitored in hippocampal slices from both genotypes before, during and after a hypoxic episode. Although wild‐type and xCT−/− slices showed equal suppression of synaptic transmission during hypoxia, mutant slices exhibited a persistent potentiation upon re‐oxygenation, an effect we termed ‘post‐hypoxic long‐term potentiation (LTP)’. Blocking synaptic suppression during hypoxia by antagonizing adenosine A1 receptors did not preclude post‐hypoxic LTP. Further examination of the induction and expression mechanisms of this plasticity revealed that post‐hypoxic LTP was driven by NMDA receptor activation, as well as increased calcium influx, with no change in paired‐pulse facilitation. Hence, the observed phenomenon engaged similar mechanisms as classical LTP. This was a remarkable finding as theta‐burst stimulation‐induced LTP was equivalent between genotypes. Importantly, post‐hypoxic LTP was generated in wild‐type slices pretreated with system xc− inhibitor, S‐4‐carboxyphenylglycine, thereby confirming the antiporter's role in this phenomenon. Collectively, these data indicate that system xc− interference enables neuroplasticity in response to mild hypoxia, and, together with its regulation of cellular damage in the ischaemic core, suggest a role for the antiporter in post‐ischaemic recovery of the penumbra.

Abstract Background Exogenous iodine interferes with the uptake of radioactive iodine (131I) by the thyroid gland. This has potential implications for the treatment of cats with hyperthyroidism that have recently undergone computed tomography (CT) with IV administration of iodinated contrast medium (ICM). Hypothesis To determine the time to normalize urinary iodine clearance after administration of ICM. We hypothesized that it would require 4 weeks for urinary iodine concentration (UIC) to decrease to baseline after IV administration of ICM. Animals Ten healthy adult neutered male cats. Methods All cats were sedated and received Iopamidol at a dose of 2 mL/kg (600 mg/kg). Urinary iodine and creatinine concentrations were measured before administration of Iopamidol and on days 1, 2, 3, 7, 10 and weeks 2 to 6 after administration. The urinary iodine‐to‐creatinine ratio (UICR) was calculated. Outcome variables were modeled using a linear mixed‐effects model. Results Urinary iodine concentration increased 37‐ to 884‐fold on Day 1 after ICM injection and returned to baseline during Week 2. Compared with baseline, UIC was significantly increased for Days 1 to 7 (all P

Abstract Causes, consequences, and potentials for recovery from invasions by the invasive annual grass, cheatgrass (Bromus tectorum), in western North America have been extensively documented. The vast majority of these studies have come from regions where yearly precipitation is dominated by “winter‐wet” patterns, but this species has also demonstrated its ability to invade plant communities in “spring/summer‐wet” areas as well. In grasslands of the Front Range of Colorado, a region experiencing a “spring/summer‐wet” precipitation pattern, cheatgrass can exploit early‐season soil moisture, but moderate rainfall continues into the growing season beyond the time of cheatgrass senescence. In this study, we measured how cheatgrass dominance changed over a 13‐year interval in a disturbed meadow along the Front Range of Colorado with a “spring/summer‐wet” precipitation pattern. Cheatgrass cover declined in absolute abundance by about 50% while total vegetation cover increased over this time period. The site was neither grazed nor burned during this interval. A “spring/summer‐wet” precipitation pattern with high interannual variation in amounts occurred during the study, but no relationships between the seasonality or amounts of precipitation and the directional decline in cheatgrass abundance were observed. Rainout shelter manipulations showed that the seasonality of precipitation influenced cheatgrass abundance, with winter drought treatments reducing cheatgrass cover relative to plots that experienced summer drought treatments. The cheatgrass decline corresponded with a lesser decline in native grass cover and no change in native forb cover, while the abundance of non‐native perennial grasses and forb species increased over the study interval. Although cheatgrass can invade communities across broad climatic gradients following disturbance, results from this study show that the persistence of cheatgrass within invaded areas may depend on the seasonality of precipitation and plant communities that vary across these gradients.

Abstract In the past decade, studies have demonstrated that urban and nonurban wildlife populations exhibit differences in foraging behavior and diet. However, little is known about how environmental heterogeneity shapes dietary variation of organisms within cities. We examined the vertebrate prey components of diets of coyotes (Canis latrans) in San Francisco to quantify territory‐ and individual‐level dietary differences and determine how within‐city variation in land cover and land use affects coyote diet. We genotyped fecal samples for individual coyote identification and used DNA metabarcoding to quantify diet composition and individual niche differentiation. The highest contributor to coyote diet overall was anthropogenic food followed by small mammals. The most frequently detected species were domestic chicken, pocket gopher (Thomomys bottae), domestic pig, and raccoon (Procyon lotor). Diet composition varied significantly across territories and among individuals, with territories explaining most of the variation. Within territories (i.e., family groups), the amount of dietary variation attributed to among‐individual differences increased with green space and decreased with impervious surface cover. The quantity of anthropogenic food in scats also was positively correlated with impervious surface cover, suggesting that coyotes consumed more human food in more urbanized territories. The quantity of invasive, human‐commensal rodents in the diet was positively correlated with the number of food services in a territory. Overall, our results revealed substantial intraspecific variation in coyote diet associated with urban landscape heterogeneity and point to a diversifying effect of urbanization on population diet.

Abstract Background Globally, many pollen monitoring networks provide the community with daily pollen information, but there are limited data on health consumer uses and benefits. This research investigated why individuals in the community access pollen information, how they use it, and the perceived benefits. Methods In‐ and post‐pollen season surveys (2017–2018 and 2018–2019) enquired about symptoms, diagnoses, symptom management, access, benefits and usefulness of pollen information provided by the AusPollen Partnership. Open text responses were examined by thematic analysis. Theme frequency and quantitative data were compared across pollen seasons, within and after the season, and between respondents with and without access to AusPollen information. Results Surveys were completed 4044 times by 3604 individuals who predominantly self‐reported severe and frequent allergic rhinitis symptoms. Local AusPollen information was accessible to 84.6% of participants, and was reportedly used for preparation and planning (34.6%), guiding activities (32.9%), and medication decisions (28.2%). When asked how pollen information helped, similar themes were evident; but 16.1% also mentioned safety for themselves and others. However, secondary analysis of survey responses indicated that self‐reported medication use did not differ between those with or without access to pollen information or between time points surveyed. Suggestions for improvement included extended duration (16.4%), wider geographic range (13.5%), and information on other taxa (17.2%). Conclusion There was a perceived need for localised, detailed and timely pollen information by people with pollen allergy. Whilst responses suggested this helped inform behaviours linked to allergen avoidance, further education strategies on allergic rhinitis control are needed to support patients who self‐manage their condition.

The Nile tilapia, a fish of the Teleost group, is economically valuable due to its ease of cultivation, high growth rates and resistance to environmental conditions and is increasingly used for waste conversion. The aim of this study was to evaluate the physiochemical properties and potential applications of oils derived from the entrails of Nile tilapia obtained from four different farming sites in Ghana. The tilapia fish oil (TFO) was extracted by the wet rendering method. The refractive index, fatty acid profile, colour and cholesterol content of the TFO samples (TFS1, TFS2, TFS3 and TFS4) were determined using a refractometer, GC–MS, chromameter and UV spectrophotometer, respectively. More than 65% of fatty acids present in TFS1 to TFS4 were unsaturated fatty acids (UFAs). Oleic acid and its isomer were present in the oils as follows: TFS2 (58.37%), TFS3 (57.28%), TFS1 (43.89%) and TFS4 (41.71%). The following physicochemical properties of TFS1 to TFS4 were determined: vitamin A (0.70–2.15 mg/100 g), vitamin E (0.03–0.009 mg/100 g), acid value (0.27–0.66 mg KOH/g), peroxide value (0.009–4.488 meq/kg), iodine value (77.87–74.62 mg/g), saponification value (247.93–592.27 mg KOH/g), cholesterol content (162.33–438.33 mg/100 mL) and moisture content (1.08%–3.25%). These findings indicate that TFOs have potential applications in the food and pharmaceutical industries. However, the differences in physicochemical properties must be considered during product development to ensure optimal quality and marketability of the final product.

Abstract Maintaining accurate real‐time hindcast and forecast specification of the radiation environment is essential for operators to monitor and mitigate the effects of hazardous radiation on satellite components. The Radiation Belt Forecasting Model and Framework (RBFMF) provides real‐time forecasts and hindcasts of the electron radiation belt environment, which are used as inputs for the Satellite Charging Assessment Tool. We evaluated the long‐term statistical error and bias of the RBFMF by comparing the 10‐hr hindcast of electron phase space densities (PSD) to a multi‐mission data set of PSD observations. We found that, between the years 2016–2018, the RBFMF reproduced the radiation belt environment to within a factor of 1.5. While the error and bias of assimilated observations were found to influence the error and bias of the hindcast, data assimilation resulted in more accurate specification of the radiation belt state than real‐time Van Allen Probe observations alone. Furthermore, when real‐time Van Allen Probe observations were no longer available, the hindcast errors increased by an order of magnitude. This highlights two needs; (a) the development of physics‐based modeling incorporated into this framework, and (b) the need for real‐time observations which span the entire outer radiation belt.

Abstract Background The COVID‐19 pandemic, caused by the SARS‐CoV‐2 virus, has resulted in illness, deaths and societal disruption on a global scale. Societies have implemented various control measures to reduce transmission of the virus and mitigate its impact. Individual behavioural changes are crucial to the successful implementation of these measures. One commonly recommended measure to limit risk of infection is distancing. It is important to identify those factors that can predict the uptake and maintenance of distancing. Objectives We aimed to identify and synthesise the evidence on malleable psychological and psychosocial factors that determine uptake and adherence to distancing aimed at reducing the risk of infection or transmission of COVID‐19. Search Methods We searched various literature sources including electronic databases (Medline ALL, Child Development & Adolescent Studies, ERIC, PsycInfo, CINAHL & Web of Science), web searches, conference proceedings, government reports, other repositories of literature and grey literature. The search strategy was built around three concepts of interest including (1) context (terms relating to COVID‐19), (2) behaviour of interest and (3) terms related to psychological and psychosocial determinants of COVID‐19 Health‐Related Behaviours and adherence or compliance with distancing, to capture malleable determines. Searches capture studies up until October 2021. Selection Criteria Eligibility criteria included observational studies (both retrospective and prospective) and experimental studies that measure and report malleable psychological and psychosocial determinants and distancing (social and/or physical) at an individual level, amongst the general public. We defined physical distancing as, maintaining the recommended distance from others when physically present. And social distancing being defined as, minimising social contact with those outside of your own household. Screening was supported by the Cochrane Crowd. Studies' titles and abstracts were screened against the eligibility criteria by three independent screeners. Following this, all potentially relevant studies were screened at full‐text level by the research team. All conflicts between screeners were resolved by discussion between the core research team. Data Collection and Analysis All data extraction was managed in EPPI‐Reviewer software. All eligible studies, identified through full‐text screening were extracted by one author. We extracted data on study information, population, determinant, behaviour and effects. A second author checked data extraction on 20% of all included papers. All conflicts were discussed by the two authors until consensus was reached. We assessed methodological quality of all included studies using an adapted version of the Joanna Briggs Institute Quality appraisal tool. Main Results A total of 91 studies were suitable for inclusion in the review, representing 199,604 participants. The vast majority of studies had samples from the general public, with 15 of the studies focusing on specific samples. The majority of studies included participants over 18 years old, with 5 reporting on specific ages (adolescents and adults over 65). The quality of 29 of the studies was rated as unclear, 48 were rated as low, and 14 rated high risk of bias, predominately due to lack of reporting of recruitment, sample characteristics and methodology. Overall the majority of these relationships were weak. Stronger relationships were observed between attitudes, social norms, perceived behavioural control and both social and physical distancing. And between worry, response effectiveness, self‐efficacy and social distancing. However, there is a high level of heterogeneity in the findings. This heterogeneity might be, partly, due to the differences in measurement of the determinants and distancing across studies. Authors' Conclusions The findings from this review indicate that social distancing behaviours are more likely to be undertaken by people who are worried about COVID‐19 and who believe that social distancing is an effective way of avoiding COVID‐19. Physical distancing behaviours are more likely to be undertaken by those who believe that they can control physical distancing from others, who believe that physical distancing is the social norm and who have a positive attitude to engaging in this behaviour. It is important to understand how to strengthen these behavioural determinants to develop effective interventions to promote distancing behaviours in any potential future waves of COVID‐19, and other respiratory infections.

Abstract Although sucrose is widely administered to hospitalized infants for single painful procedures, total sucrose volume during the entire neonatal intensive care unit (NICU) stay and associated adverse events are unknown. In a longitudinal observation study, we aimed to quantify and contextualize sucrose administration during the NICU stay. Specifically, we investigated the frequency, nature, and severity of painful procedures; proportion of procedures where neonates received sucrose; total volume of sucrose administered for painful procedures; and incidence and type of adverse events. Neonates

Abstract We evaluated the impacts of COVID‐19 on multi‐organ and metabolic function in patients following severe hospitalised infection compared to controls. Patients (n = 21) without previous diabetes, cardiovascular or cerebrovascular disease were recruited 5–7 months post‐discharge alongside controls (n = 10) with similar age, sex and body mass. Perceived fatigue was estimated (Fatigue Severity Scale) and the following were conducted: oral glucose tolerance (OGTT) alongside whole‐body fuel oxidation, validated magnetic resonance imaging and spectroscopy during resting and supine controlled exercise, dual‐energy X‐ray absorptiometry, short physical performance battery (SPPB), intra‐muscular electromyography, quadriceps strength and fatigability, and daily step‐count. There was a greater insulin response (incremental area under the curve, median (inter‐quartile range)) during the OGTT in patients [18,289 (12,497–27,448) mIU/min/L] versus controls [8655 (7948–11,040) mIU/min/L], P

Abstract Aims/Introduction This study aimed to assess if patients can be divided into different strata, and to explore if these correspond to the risk of diabetic foot complications. Materials and Methods A set of 28 demographic, vascular, neurological and biomechanical measures from 2,284 (1,310 men, 974 women) patients were included in this study. A two‐step cluster analysis technique was utilised to divide the patients into groups, each with similar characteristics. Results Only two distinct groups: group 1 (n = 1,199; 669 men, 530 women) and group 2 (n = 1,072; 636 men, 436 women) were identified. From continuous variables, the most important predictors of grouping were: ankle vibration perception threshold (16.9 ± 4.1 V vs 31.9 ± 7.4 V); hallux vibration perception threshold (16.1 ± 4.7 V vs 33.1 ± 7.9 V); knee vibration perception threshold (18.2 ± 5.1 V vs 30.1 ± 6.5 V); average temperature sensation threshold to cold (29.2 ± 1.1°C vs 26.7 ± 0.7°C) and hot (35.4 ± 1.8°C vs 39.5 ± 1.0°C) stimuli, and average temperature tolerance threshold to hot stimuli at the foot (43.4 ± 0.9°C vs 46.6 ± 1.3°C). From categorical variables, only impaired sensation to touch was found to have importance at the highest levels: 87.4% of those with normal sensation were in group 1; whereas group 2 comprised 95.1%, 99.3% and 90.5% of those with decreased, highly‐decreased and absent sensation to touch, respectively. In addition, neuropathy (monofilament) was a moderately important predictor (importance level 0.52) of grouping with 26.2% of participants with neuropathy in group 1 versus 73.5% of participants with neuropathy in group 2. Ulceration during follow up was almost fivefold higher in group 2 versus group 1. Conclusions Impaired sensations to temperature, vibration and touch were shown to be the strongest factors in stratifying patients into two groups with one group having almost 5‐fold risk of future foot ulceration compared to the other.

Objective Patients with early rheumatoid arthritis (RA) may present with more tender than swollen joints, which can persist. Elevated tender‐swollen joint difference (TSJD) is often challenging, because there may be multiple causes and it may contribute to overestimating disease activity. Little is known about the phenotype and impact of TSJDs on patient function. Our objective was to evaluate the impact of TSJD on functional outcomes in early RA and to see whether associations vary by joint size. Methods Data were from patients with active, early RA (≤12 months) enrolled in the Canadian Early Arthritis Cohort, who completed assessments of general function (Multidimensional Health Assessment Questionnaire [MDHAQ]), upper extremity (UE) function (Quality of Life in Neurological Disorders [Neuro‐QoL] UE scale), and work/activity impairment (Work Productivity and Activity Impairment RA) over their first year of follow‐up. A total of 28 joint counts were performed. TSJDs were calculated. Adjusted associations between TSJDs and functional outcomes were estimated in separate multivariable linear mixed effects models. Separate analyses were performed for large‐ versus small‐joint TSJD. Results Patients (N = 547) were 70% female, mean age 56 (SD 15) years, mean disease duration 5.3 (SD 2.9) months. At baseline, 287 (52%) had TSJD >0 (43% involved large joints and 34% small joints), decreasing to 32% at 12 months. A one‐point increase in TSJD was significantly associated with worse function (MDHAQ: adjusted mean change 0.10, 95% confidence interval [CI] 0.08–0.13; Neuro‐QoL UE function T score: adjusted mean change −0.59, 95% CI −0.76 to −0.43; and greater work impairment: adjusted mean change 1.95%, 95% CI 0.85%–3.05%). Higher large‐joint TSJDs were associated with the worst functional outcomes. Conclusion Having more tender than swollen joints is common in early RA and is associated with worse function, most notably when involving large joints. Early identification and targeted intervention strategies may be needed.

Abstract TQS‐168, a first‐in‐class small‐molecule inducer of peroxisome proliferator‐activated receptor gamma coactivator 1‐alpha gene expression, is in development for the treatment of amyotrophic lateral sclerosis. A single‐ascending‐dose (SAD) and multiple‐ascending‐dose (MAD) study of TQS‐168 was carried out in healthy male subjects to investigate safety, tolerability, pharmacokinetics (PK), food effect, and preliminary pharmacodynamic effects (PD). Since solubility enhancement could be beneficial, assessment of three formulations was incorporated into the study using an integrated rapid manufacturing and clinical testing approach. Dosing in the SAD part was initiated with a crystalline methylcellulose (MC) suspension, and then spray‐dried dispersion (SDD) and hot‐melt extrusion (HME) suspensions were evaluated. The HME and SDD formulations showed two and fourfold higher exposure than the MC suspension, respectively, and the SDD formulation was selected for progression to subsequent SAD and MAD cohorts, in which there was further investigation of the food effect on exposure in addition to assessments of safety, tolerability, PK, and PD. Cmax and AUC plasma exposures of TQS‐168 were supra‐proportional at higher doses, irrespective of formulation. Median Tmax for TQS‐168 occurred between 0.5 and 4.0 h post‐dose and occurred later with higher doses. Geometric mean half‐lives (T1/2) for TQS‐168 were independent of formulation and food, ranging from 3.2 to 10.5 h following single doses and 4.1 to 7.3 h following multiple doses. Food blunted TQS‐168 Cmax but had minimal impact on AUC. TQS‐168 was considered to be safe and generally well tolerated following single and multiple oral doses. The SDD formulation was selected for future patient studies.

Abstract Introduction Perspectives on long‐acting injectable cabotegravir/rilpivirine (CAB/RPV‐LA) from HIV health disparity populations are under‐represented in current literature yet crucial to optimize delivery. Methods Between August 2022 and May 2023, we conducted in‐depth interviews with people with HIV (PWH) at four HIV clinics in Atlanta, Chicago and San Francisco. Eligibility criteria were current CAB/RPV‐LA use with receipt of ≥3 injections or CAB/RPV‐LA discontinuation. We purposefully sampled for PWH who initiated with viraemia (plasma HIV RNA >50 copies/ml) due to adherence challenges, discontinuers, and cis and trans women. Interviews were coded and analysed using thematic methods grounded in descriptive phenomenology. Clinical data were abstracted from the medical record. Results The sample (San Francisco n = 25, Atlanta n = 20, Chicago n = 14 for total n = 59, median number of injections = 6) consisted of 48 PWH using CAB/RPV‐LA and 11 who had discontinued. The median age was 50 (range 25–73) and 40 (68%) identified as racial/ethnic minorities, 19 (32%) cis or trans women, 16 (29%) were experiencing homelessness/unstable housing, 12 (20%) had recently used methamphetamine or opioids and 11 (19%) initiated with viraemia. All participants except one (who discontinued) had evidence of viral suppression at interview. Typical benefits of CAB/RPV‐LA included increased convenience, privacy and freedom from being reminded of HIV and reduced anxiety about forgetting pills. However, PWH who became virally suppressed through CAB/RPV‐LA use also experienced an amelioration of feelings of shame and negative self‐worth related to oral adherence challenges. Regardless of baseline viral suppression status, successful use of CAB/RPV‐LA amplified positive provider/clinic relationships, and CAB/RPV‐LA was often viewed as less “work” than oral antiretroviral therapy, which created space to attend to other aspects of health and wellness. For some participants, CAB/RPV‐LA remained “work,” particularly with regard to injection site pain and visit frequency. At times, these burdens outweighed the aforementioned benefits, resulting in discontinuation. Conclusions CAB/RPV‐LA offers a range of logistical, psychosocial and care engagement benefits, which are experienced maximally by PWH initiating with viraemia due to adherence challenges; however, benefits do not always outweigh treatment burdens and can result in discontinuation. Our findings on rationales for persistence versus discontinuation can inform both initial and follow‐up patient counselling.

Abstract The southern tropical Indian Ocean (TIO) displays large mixed layer salinity (MLS) variation. Circulation in this region is governed by the Indian Ocean tropical gyre (IOTG), where the source water proportion and associated mixing remain unclear. Particles integrating into the IOTG and entering the central southern TIO originate from the Bay of Bengal, Malacca Strait, western Indian Ocean, and Indonesian Throughflow. Surprisingly, cross‐equatorial advection is particularly important, implying a significant connection between both the Bay of Bengal and the South China Sea via Malacca Strait into the southern TIO. The anomalous anticlockwise circulation weakens the IOTG during positive Indian Ocean Dipole (IOD). An opposite pattern is observed in the negative IOD. A particle experiment reveals that water masses are modulated by the anomalous circulation that drives the redistribution of MLS by changing the proportion of the different source waters. This represents a potential predictability for the southern TIO MLS variability.

Abstract The Core Concepts of Pharmacology (CCP) initiative is developing educational resources to transform pharmacology education into a concept‐based approach. This study evaluated the quality of global educator‐created MCQs in generating items for the pharmacology concept inventory (PCI) instrument and developed as a resource for learning pharmacology fundamental concepts. A panel of 22 global pharmacology experts recruited from the CCP initiative research team participated in the MCQ pilot database design and evaluation. The quality analysis framework of the MCQs in the pilot database included four assessment tools: item writing guidelines (IWGs), Bloom's taxonomy, the CCP, and the MCQ design format. A two‐phase evaluation process was involved, including inter‐rater agreement on item quality, followed by resolving conflicts that occurred in quality assessment. The chi‐square (χ2) test of independence and Cramer's V correlation tests were utilized to measure the relationship among quality assessment attributes. About 200 MCQs were gathered and 98% underwent expert evaluation. Nearly 80% addressed one or more CCP, with 52% designed using a context‐dependent format. However, only 40% addressed higher levels of Bloom's cognitive domain and 10% adhered to all IWGs. A strong positive correlation was observed between the context‐based item format and its effectiveness in assessing the higher cognitive domain, the main CCP and improved IWGs adherence. Context‐based item construction can assess the higher cognitive skills and fundamental pharmacology concepts, showing potential for rigorous PCI development. The pilot database will store items to create the PCI, aiding the development of a concept‐based pharmacology curriculum.

Abstract Objective The objective of this scoping review is to identify and understand the available evidence on the delivery of dietary messages to patients with type 2 diabetes in a dental setting. The outcome of a scoping review in this area will inform the development of a clinical intervention for dietary counseling at the chairside. Introduction Diabetics are at a higher risk for developing periodontal disease, and the severity of periodontal disease can impact the ability to control glucose levels. Considering the prevalence of diabetes within the community, dental practitioners are well placed to provide dietary messages to support this cohort during the management of periodontal disease. Inclusion Criteria Studies that consider the population affected by type 2 diabetes and a dietary intervention in the context of a dental setting will be included. Methods The databases selected for sources of studies are MEDLINE, EMBASE, CINAHL and SCOPUS. The scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. Only English language studies are eligible for inclusion in this review. Terms relating to dietary advice, diabetes, dental practitioner and health education will be used to search for related studies. Screening based on abstract, and titles will be followed by full text screening with results supplied in PRISMA‐SCR diagram. A data extraction tool will be used to chart the details of selected studies then presented in a venn diagram and word map along with a narrative synthesis of results.

ABSTRACT Background People with dementia have complex palliative care needs that are often unmet, including physical and psycho‐social needs. It is essential to empower people with dementia, family carers and professionals to better assess and manage care needs. We aimed to co‐design a palliative dementia care Framework delivered through a digital app to support holistic assessment and decision making for care in the community and care homes—the EMBED‐Care Framework. Methods A systematic co‐design approach was adopted to develop the EMBED‐Care Framework across three stages: 1) Framework analysis to synthesise data from preceding evidence reviews, large routine clinical data and cohort studies of unmet palliative dementia care need; 2) Co‐design using iterative workshops with people with dementia, family carers and health and social care professionals to construct the components, design of the app and implementation requirements; and 3) User testing to refine the final Framework and app, and strengthen use for clinical practice and methods of evaluation. Results The Framework was co‐designed for delivery through an app delivered by aTouchAway. It comprised five main components: 1) holistic assessment of palliative care needs using the Integrated Palliative care Outcome Scale‐Dementia (IPOS‐Dem); 2) alert system of IPOS‐Dem scores to highlight unmet needs; 3) IPOS‐Dem scores and alerts enable shared decision making between the practitioner, patient and/or carer to support priority setting and goals of care; 4) evidence‐informed clinical decision support tools automatically linked with identified needs to manage care; and 5) Training package for users incorporating face‐to‐face sessions, clinical champions who received additional face‐to‐face sessions, animated videos and manual covering the main intervention components and email and telephone support from the research team. Conclusions This is a novel digital palliative dementia care intervention to link holistic assessment with clinical decision support tools that are practical and easy to use but address the complexity of palliative dementia care. The Framework is ready for feasibility testing and pilot studies for people with dementia residing at home or in a care home. Patient or Public Contribution We were guided by our Patient and Public Involvement (PPI) group consisting of three people with mild dementia, including younger onset dementia, and seven family carers throughout the project. They supported the overall development of the Framework, including planning of workshops, interpreting findings and testing the framework in our PPI meetings.

Abstract Canola (Brassica napus L. and B. rapa L. [Brassicales: Brassicaceae]) is a major oilseed crop grown globally as a source of vegetable oil, animal feed and biofuel feedstock. The global demand for canola oil as a biofuel feedstock has increased due to recent regulations in the European Union, United States, and Canada. In North America, canola production is centered on the northern Great Plains where it is challenged by two highly destructive flea beetle species, the crucifer (Phyllotreta cruciferae Goeze, 1777) and the striped (Phyllotreta striolata Fabricius, 1803) flea beetles. In the spring, adult P. cruciferae and P. striolata begin feeding on canola seedlings, creating a ‘shot hole’ appearance, which can reduce the plant's photosynthetic capacity leading to uneven plant emergence and growth, reduced plant stand density, and reduced seed yield. Losses resulting from flea beetles are estimated in the tens of millions of dollars annually. At present, the principle means for flea beetle control are insecticides applied as systemic seed treatments and/or subsequent foliar sprays. The continued use of these products is being questioned due to environmental concerns and acquisition of resistance. As such, significant research effort is being directed toward the development of an integrated pest management system for these abundant and hard to manage pests of canola. Here, we review the ecology, pest status, and management of flea beetles in North America and discuss future research needed to promote flea beetle management and sustainable canola production.

ABSTRACT Background The coronavirus pandemic has profoundly affected global health, economic stability, and environmental sustainability. Despite these challenges, significant gaps in data remain, particularly in effectively assessing and engaging diverse communities such as color, LGBTQIA+ individuals, and low‐income groups. This shortage of comprehensive research limits our capacity to undertake sensitive studies, specifically in dealing with the complexities of long COVID, which some individuals continue to suffer from after their initial recovery. Objective This review delves into the ongoing repercussions of long‐term COVID‐19, a postinfectious syndrome marked by neurological symptoms such as cognitive deficits and sensory impairments, which may last well beyond the acute phase of the illness. These symptoms frequently overlap with mental health issues (e.g., anxiety and depression), which can aggravate the socioeconomic challenges faced by vulnerable populations, especially within the LGBTQA+ communities. Methods To tackle these complex interactions, we have introduced a novel public health framework: model‐based systems thinking (MBST), which incorporates System Dynamics and causal loop diagrams (CLD). Results and Discussion The articles were selected on the basis of their discussion of COVID‐19‐associated anosmia, exploration of olfactory dysfunction alongside neurocognitive disorders, and the challenges experienced in LGBQA+ communities. This approach offers a robust framework for dissecting the intricate ties between socioeconomic factors, health outcomes, and the extended recovery trajectories associated with long‐term COVID‐19, with a particular focus on olfactory dysfunction. We also explore strategies to make our models more accessible to healthcare providers and the LGBTQA+ communities, encouraging its broader adoption. Conclusion Long COVID's impact on public health and marginalized communities highlights the urgent need for adopting systems thinking models. Additionally, this article calls for a concerted effort from all experts to foster multidisciplinary, team‐based research and implement effective support measures for COVID‐19 survivors across all communities, mainly focusing on the scientific, social, and behavioral challenges LGBTQIA+ and low‐income individuals face.

Abstract Background It has been described in mice models that myeloproliferative neoplasm (MPN) with JAK2‐V617F mutation has an increased expression of programmed death‐ligand 1 (PD‐L1) in megakaryocytes leading to cancer immune evasion by inhibiting the T‐lymphocytes. Aims To quantify and compare the PD‐L1 expression on bone marrow (BM) of patients with MPN JAK2 positive, negative, and normal controls. Methods We collected BM of patients with MPN JAK2 positive, negative and normal controls from 1990 to 2019. We also created a scoring system to quantify PD‐L1 expression in megakaryocytes. Results We obtained 14 BM with JAK2 positive PMF, 5 JAK2 negative PMF, and 10 patients with normal BM biopsies. PD‐L1 expression was higher in the JAK2 positive group compared with the control group with a score of 212.6 versus 121.1 (t‐value 2.05, p‐value 0.025). In addition, the score was higher in the PMF group regardless of JAK2 mutational status when compared with the control group with score of 205.9 versus 121.1 (t‐value 2.12, p‐value 0.021). There was no difference in the PD‐L1 score between the JAK2 negative versus the control group 187.2 versus 121.1 (t‐value 1.02, p‐value 0.162). Conclusion These findings suggest that PMF patients with a JAK2 mutation have a higher PD‐L1 expression in megakaryocytes compared with the control group. We postulate that the combination of checkpoint and JAK2 inhibitors may be an active treatment option in JAK2 mutated PMF given the higher PD‐L1 expression.

Objective No fatigue‐specific programs exist for people with systemic sclerosis (SSc) despite the burden of fatigue and negative impact on daily activities. This study used a convergent parallel mixed methods design to evaluate the impact of an adapted virtual intervention, Fatigue and Activity Management Education in Systemic Sclerosis (FAME‐iSS), in the United States. Methods Eighteen people with SSc participated in three separate six‐week FAME‐iSS programs. Participants completed the modified Fatigue Impact Scale (m‐FIS), the Self‐Efficacy for Performing Energy Conservation Strategies Assessment (SEPESCA), the Patient‐Reported Outcomes Measurement Information System (PROMIS) Self‐Efficacy for Managing Symptoms, and the Hospital Anxiety and Depression Scale (HADS) before, immediately after, and three months post intervention. Data were analyzed using descriptive and nonparametric inferential statistics. Participants’ perceptions of the program and their use of fatigue management strategies were qualitatively analyzed using content analysis. Results Eighty‐nine percent of participants were women with a mean ± SD age of 52.0 ± 11.6 years and a mean ± SD disease duration of 13.7 ± 14.5 years, and more than 70% had a college degree. Significant improvements were observed for self‐efficacy on the PROMIS Self‐Efficacy for Managing Symptoms (P = 0.002) and SEPESCA (P = 0.016) immediately post intervention, which continued to significantly improve up to the three‐month follow‐up (P = 0.006 and 0.035, respectively). Significant improvements were also observed for the m‐FIS between baseline and the three‐month follow‐up (P = 0.029). Participants reported a deeper understanding of fatigue and that they liked sharing strategies and experiences with each other along with the facilitator, citing that “there was a power in our group because we had a common condition.” Conclusion FAME‐iSS resulted in improvements in the impact of fatigue and self‐efficacy for managing symptoms and performing energy conservation strategies. Feedback was positive, and the virtual format allowed for greater accessibility and sharing of strategies.

Abstract Modeling the relationships between covariates and pharmacometric model parameters is a central feature of pharmacometric analyses. The information obtained from covariate modeling may be used for dose selection, dose individualization, or the planning of clinical studies in different population subgroups. The pharmacometric literature has amassed a diverse, complex, and evolving collection of methodologies and interpretive guidance related to covariate modeling. With the number and complexity of technologies increasing, a need for an overview of the state of the art has emerged. In this article the International Society of Pharmacometrics (ISoP) Standards and Best Practices Committee presents perspectives on best practices for planning, executing, reporting, and interpreting covariate analyses to guide pharmacometrics decision making in academic, industry, and regulatory settings.

Abstract Aims Reducing preventable hospitalization for congestive heart failure (CHF) patients is a challenge for health systems worldwide. CHF patients who also have a recent or ongoing mental disorder may have worse health outcomes compared with CHF patients with no mental disorders. This study examined the impact of mental disorders on 28 day unplanned readmissions of CHF patients. Methods and results This retrospective cohort study used population‐level linked public and private hospitalization and death data of adults aged ≥18 years who had a CHF admission in New South Wales, Australia, between 1 January 2014 and 31 December 2020. Individuals' mental disorder diagnosis and Charlson comorbidity and hospital frailty index scores were derived from admission records. Competing risk and cause‐specific risk analyses were conducted to examine the impact of having a mental disorder diagnosis on all‐cause hospital readmission. Of the 65 861 adults with index CHF admission discharged alive (mean age: 78.6 ± 12.1; 48% female), 19.2% (12 675) had at least one unplanned readmission within 28 days following discharge. Adults with CHF with a mental disorder diagnosis within 12 months had a higher risk of 28 day all‐cause unplanned readmission [hazard ratio (HR): 1.21, 95% confidence interval (CI): 1.15–1.27, P‐value

Objective To compare a remotely supervised weight loss and exercise intervention to lifestyle counseling for effects on cardiovascular disease risk, disease activity, and patient‐reported outcomes in older patients with rheumatoid arthritis (RA) and overweight/obesity. Methods Twenty older (60–80 years), previously sedentary participants with seropositive RA and overweight/obesity were randomized to 16 weeks of either Supervised Weight loss and Exercise Training (SWET) or Counseling Health As Treatment (CHAT). The SWET group completed aerobic training (150 minutes/week moderate‐to‐vigorous intensity), resistance training (two days/week), and a hypocaloric diet (7% weight loss goal). The CHAT control group completed two lifestyle counseling sessions followed by monthly check‐ins. The primary outcome was a composite metabolic syndrome z‐score (MSSc) derived from fasting glucose, triglycerides, high density lipoprotein–cholesterol, minimal waist circumference, and mean arterial pressure. Secondary outcomes included RA disease activity and patient‐reported outcomes. Results Both groups improved MSSc (absolute change −1.67 ± 0.64 in SWET; −1.34 ± 1.30 in CHAT; P

Abstract Social rank theory states that achieving enhanced social rank is an essential biosocial goal for human beings, with individuals considering themselves to be high or low social rank on the basis of how they perceive that others view them. High social rank is associated with assertiveness, competence, and talent, whereas low social rank is associated with feelings of defeat and inferiority and submissive behavior. This theory has been applied to understand the etiology and psychopathology of eating disorders (EDs). The objective of this narrative systematic review was to summarize existing literature exploring perceptions of social rank and related constructs (e.g., submissiveness and inferiority) in EDs, to shed light on how individuals with EDs perceive their social rank, and to examine the relationship between perceived social rank and ED psychopathology. A systematic search of cross‐sectional or longitudinal studies involving a clinical sample of individuals with EDs and using a validated measure of social rank or a related construct was conducted for studies published up to September 12, 2023 (PROSPERO, CRD42021227028). Five databases (Embase, Medline, PsycINFO, Web of Science, and PubMed) were systematically searched. Altogether, 1106 studies were included in the title and abstract screening. Seventeen studies (13 cross‐sectional, 3 prospective cohort studies, and 1 ecological momentary assessment study) were included in the analysis and data extraction. The methodological quality of the studies was rated as generally good. There was evidence that individuals with EDs perceive their social rank as lower compared with healthy controls (N = 5 studies) and present features indicative of perceptions of low social rank (N = 9 studies). The perception of being of low social rank was significantly associated with more severe ED psychopathology (N = 10 studies). The findings of the review are discussed alongside limitations, implications for treatment models, and directions for future research.

Abstract Objective Cross‐sectional research has demonstrated that internalized weight stigma (IWS) is associated with less engagement in weight management behaviors, including physical activity. However, limited research has explored longitudinal relationships among IWS, physical activity, and weight loss. This study examined longitudinal associations of changes in IWS, physical activity, and weight and tested whether physical activity mediated the relationship between IWS and weight change. Methods Individuals with obesity and high IWS (N = 105) participated in a 72‐week behavioral weight loss intervention, with or without a weight stigma intervention. Measures of IWS (Weight Self‐Stigma Questionnaire), physical activity (accelerometry and self‐report), and weight were collected at baseline and weeks 20, 46 and 72. Correlations examined relationships among changes in variables from baseline to all timepoints, controlling for treatment condition. Mediation, controlling for treatment condition, tested whether IWS reductions during the first 20 weeks predicted greater weight loss at weeks 46 and 72 via increased physical activity between weeks 20 and 46 or 72. Results Decreases in IWS at week 20 were associated with greater week‐20 weight loss (r = 0.265, p = 0.012). Physical activity was not a significant mediator, but greater reductions in IWS at week 20 predicted greater week‐46 weight loss with or without controlling for physical activity (WSSQ: b = 0.30, confidence interval: 0.12, 0.54). Significant associations were not found at week 72. Conclusion Initial reductions in IWS were associated with greater week‐46 weight loss. Further research should investigate whether reducing IWS early in obesity treatment enhances long‐term outcomes. Clinical trial registration ClinicalTrials.gov (NCT03704064).

ABSTRACT Background and Aims Communication is important in determining how patients understand the diagnostic process. Empirical studies involving direct observation of communication within diagnostic processes are relatively limited. This ethnographic study aimed to identify communicative practices facilitating or inhibiting shared understanding between patients and doctors in UK acute secondary care settings. Methods Data were collected in acute medical sectors of three English hospitals. Researchers observed doctors as they assessed patients; semistructured interviews were undertaken with doctors and patients directly afterwards. Patients were also interviewed 2–4 weeks later. Case studies of individual encounters (consisting of these interviews and observational notes) were created, and were cross‐examined by an interdisciplinary team to identify divergence and convergence between doctors' and patients' narratives. These data were analysed thematically. Results We conducted 228 h of observation, 24 doctor interviews, 32 patient interviews and 15 patient follow‐up interviews. Doctors varied in their communication. Patient diagnostic understanding was sometimes misaligned with that of their doctors; interviews revealed that they often made incorrect assumptions to make sense of the fragmented information received. Thematic analysis identified communicative practices that seemed to facilitate, or inhibit, shared diagnostic understanding between patient and doctor, revealing three themes: (1) communicating what has been understood from the medical record, (2) sharing the thought process and diagnostic reasoning and (3) closing the loop and discharge communication. Shared understanding was best fostered by clear communication about the diagnostic process, what had already been done and what was achievable in acute settings. Written information presents an underutilised tool in such communication. Conclusions In UK acute secondary settings, the provision of more information about the diagnostic process often fostered shared understanding between doctor and patient, helping to minimise the confusion and dissatisfaction that can result from misaligned expectations or conclusions about the diagnosis, and the uncertainty therein. Patient/Public Contribution A patient and public involvement group (of a range of ages and backgrounds) was consulted. They contributed to the design of the protocol, including the timing of interviews, the acceptability of a follow‐up telephone interview, the development of the interview guides and the participant information sheets.

Background The period around pregnancy is a critical window in the primordial prevention of cardiovascular disease, but little is known about the role of dietary patterns in cardiometabolic health. Our objective was to determine the association between alignment of periconceptional diet with the 2020 to 2025 Dietary Guidelines for Americans and the risk of metabolic syndrome. Methods and Results We used data from the Nulliparous Pregnancy Outcomes Study: monitoring mothers‐to‐Be Heart Health Study, a pregnancy cohort study that followed pregnant participants to a median of 3 years postpartum (n=4423). Usual dietary intake in the 3 months around conception was estimated from a Food Frequency Questionnaire. Alignment with the Dietary Guidelines was measured using the Healthy Eating Index‐2020, where higher scores represent greater alignment. Postpartum metabolic syndrome was defined using the American Heart Association/National Heart, Lung, and Blood Institute guideline. The prevalence of metabolic syndrome at 3 years postpartum was 20%. After adjusting for confounders, the prevalence of metabolic syndrome was flat up to a periconceptional Healthy Eating Index‐2020 total score of ≈60, and then declined steeply as scores increased. Compared with a Healthy Eating Index‐2020 score of 60, having scores of 70, 80, and 90 were associated with 2, 4, and 7 fewer cases of metabolic syndrome per 100 individuals, respectively (prevalence differences: −0.02 [95% CI, −0.03, 0]; −0.04 [−0.08, −0.1]; −0.07 [−0.13, −0.02]). Conclusions Dietary interventions around conception and systems‐level changes to support high diet quality may be important for improving postpartum cardiometabolic health, and helping to reverse or slow the decline in women's cardiometabolic health.

Abstract In 2013, the World Health Organisation (WHO) updated the recommendations for micronutrient deficiency correction in hospitalised under‐5 children with complicated severe acute malnutrition (SAM). This study aimed to describe the micronutrient deficiency correction practices in relation to WHO 2013 recommendations. Data from medical records of under‐5 children admitted for SAM management at two hospitals in South Africa and three tertiary hospitals in Ghana were extracted. Micronutrient correction practices were compared to the WHO 2013 recommendations by considering the dosage, timing of micronutrient supplementation (vitamin A, iron and folic acid) and therapeutic feeds administered. In total, 723 medical records were included. Nearly half (48.3%) of the children received at least one of the studied micronutrients as a supplement. Vitamin A was supplemented in 27.4% of the children, while iron and folic acid were supplemented in 9.5% and 34.9%, respectively. Among the children who received vitamin A, 60.1% received the first dose on Day 1 of admission. Also, 46.4% of the iron‐supplemented children received iron within the first week of admission. Vitamin A, iron and folic acid were administered within the dose range of 100,000–180,000 IU, 3.1–7.7 mg per kg per day, and 3–5 mg per day, respectively. Additionally, 71.7% of the children reportedly received therapeutic feeds that met WHO recommendations. The micronutrient deficiency correction practices regarding dose and timing differed from the 2013 WHO guidelines. Qualitative studies investigating the reasons for the disparities are recommended.

Abstract Health professional competency building is one of nine national responsibilities (to achieve universal coverage and sustainability) described in the 2018 World Health Organization (WHO)/United Nations Children's Fund (UNICEF) implementation guidance for the Baby‐Friendly Hospital Initiative (BFHI). With stagnating rates of exclusive breastfeeding worldwide, skilled breastfeeding support as a standard of newborn care is critical to the establishment of lactation and exclusive breastfeeding. Few studies exist on how low‐income countries are integrating BFHI into their standards of care. This qualitative case study describes Malawi's experience. We interviewed 48 key informants and conducted a desk review of the literature on BFHI programming, national plans, policies and other related documents. We explored the findings using the seven key domains and 16 competencies to implement the Ten Steps to successful breastfeeding from the WHO and UNICEF Competency Verification Toolkit. The study found that although the focus of the guidance is on preservice training, continuing education and in‐service training remain important. To achieve universal coverage for health professional competency, Malawi uses preservice, in‐service and refresher training. However, their main limitations to aligning with the new guidance are a lack of preservice BFHI‐ and breastfeeding‐specific curricula, experienced lecturers and sufficient time to dedicate to practical skill development. Conducted during the coronavirus disease 2019 pandemic, this study confirmed disruptions to BFHI training and service delivery, while also documenting Malawi's resilient attempts to mitigate impacts on breastfeeding support through mentoring and coaching. Opportunities exist for strengthening and scaling up, including engaging preservice training institutions and standardizing mentoring, coaching and competency verification.

Abstract Burrowing ecosystem engineers, such as termites, crabs, marmots, and foxes, can profoundly affect the biological structure and ecosystem functions of their environments. However, the relative importance of the effects of burrowing engineers on sediments are challenging to predict and are expected to be influenced by engineer density, engineer functional traits (e.g., burrow morphology), and environmental conditions (e.g., geomorphology, vegetation presence). To develop robust hypotheses predicting the impacts of burrowing ecosystem engineers, we conducted a systematic meta‐analysis evaluating the effects of burrowing crabs on sediment properties, nutrient stocks, and ecosystem functions in soft‐sediment coastal habitats (e.g., salt marshes, mangrove forests, tidal flats). Additionally, we tested the impacts of crab burrow density, burrowing crab superfamily (a proxy for crab burrow morphology and diet), and biotic conditions (i.e., vegetation) on the effects of burrowing crab engineers on coastal sediments. Burrowing crabs rework and oxygenate sediments and accelerate rates of nutrient cycling (i.e., nitrification and CO2 flux). However, the magnitude and direction of burrowing crab effects depend on burrowing crab superfamily, the presence of vegetation, and their interaction. Crab burrow density did not consistently predict burrowing engineer effects on sediments. Future efforts need to focus on implementing rigorous manipulative experiments to assess crab ecosystem engineering effects, since methodological variation has hindered efforts to generalize their effects. Our findings suggest that crab engineering effects are predictable across environmental contexts, and understanding the context dependency of crab engineering effects may promote the management and restoration of the critical ecosystem services that are mediated by crab engineers.

Abstract Aim To explore the assumptions and values that influence nursing health assessment practices among registered general nurses in general medical and surgical wards. Design The study was designed as a focused ethnography. Methods A semi‐structured interview guide was used to explore prevailing nursing health assessment practices of 13 registered general nurses in an attempt to explore the assumptions and values influencing health assessment practices in the study setting. Data were analysed inductively using an interpretive qualitative content analysis method. Results Nursing health assessment practices, and underlying assumptions and values were underpinned by a central theme of a culture of low expectation relating to nursing health assessment. The culture of low expectation was highlighted in five themes: (1) Unsystematic Assessment of Health Status, (2) Purpose of Nursing Health Assessment, (3) The Role of Nursing Educational and Regulatory Institutions, (4) Ward Ethos and (5) The Role of Organizational and Ward Leadership. Implication The adoption of a holistic nursing health assessment framework with a clearly defined purpose of aiding nursing diagnoses can guide patient‐centred care delivery and facilitate early recognition of physiological deterioration. Patient or Public Contribution Thirteen registered general nurses were interviewed, and the initial findings returned to them for validation. Conclusion The potential contribution of nursing health assessment to nursing practice and patient outcomes may not be fully realized if nursing health assessment is not situated within a holistic health assessment model with a clearly defined purpose for nursing practice.

Abstract The muskrat (Ondatra zibethicus) is considered a ubiquitous inhabitant of wetlands across Canada and the United States, but recent studies indicate that muskrat populations in many parts of North America have experienced substantial declines over the last 40–60 years. Monitoring of muskrat abundance is therefore an important task for wildlife managers, but traditional methods such as house counts conducted during ground‐based surveys can be labor‐intensive and time‐consuming. Poor conditions or a lack of access may limit how much of a wetland can be surveyed. Aerial imagery has previously been used to census a diverse array of wildlife populations but is not yet a common tool for muskrat surveys. To investigate the accuracy of this alternative survey method, we collected aerial imagery from coastal wetlands along the north shore of Lake Ontario during the winter of 2014 for examination in both 2D orthorectified and 3D stereoscopic formats. We compared muskrat house counts obtained from imagery to counts recorded by ground survey crews in the same wetlands during the same winter. We found no significant difference between mean muskrat house counts obtained by ground survey crews and orthoimagery observers. In contrast, stereoscopic imagery observers overestimated mean house counts compared to ground survey crews, which we interpret was due to an increase in false positives. Our results indicate that orthoimagery is a promising tool for assessing muskrat occupancy, provides comparable broad‐scale results to traditional ground survey methods, and may be preferable to wildlife managers for a variety of reasons.

Abstract Background Though cancer is more prevalent in the older population, this patient group are underrepresented in phase I oncology trials. Aims We evaluated the use of a geriatric screening tool (SAOP3) in patients of 70 years of age or older who attended a Phase I Clinical Trials Unit, with the aim of assessing the feasibility of the tool and identifying potential unmet needs in this patient group. Methods Twenty‐two patients over the age of 70 completed the SAOP3 questionnaire. Geriatric impairments and needs were analysed with descriptive statistics. Qualitative responses were grouped in themes using structured thematic analysis. Results All of patients triggered at least 1 geriatric domain, most commonly mobility. Six core themes were identified as being important to the patient including family, friends and positivity. On cognition assessment over 20% of patients triggered as requiring further cognitive assessment. The group had a relatively high screen fail risk. Conclusion In conclusion, routine geriatric screening withSAOP3 was feasible and identified areas of patient need. Results highlight the prevalence of psychological distress and cognitive impairment. Geriatric screening offers an opportunity for prehabilitation prior to trial and support during trial participation to optimise safety and improve trial access.

Abstract Objective The objective of this study was to assess the frequency of potential germline pathogenic variants that may contribute to risk of development of adult granulosa cell tumors (AGCT) given the paucity of germline testing guidelines for these patients. Methods This was a retrospective cross‐sectional study analyzing comprehensive genomic profiling (CGP) results of AGCT with the FOXL2 p.C134W mutation submitted to Foundation Medicine between 2012 and 2022. Cases with a potential germline pathogenic variant were identified by filtering single nucleotide variants and short indels by variant allele frequency (VAF) and presence in ClinVar for select cancer susceptibility genes. Odds ratios for AGCT risk were calculated compared to a healthy population. Results Prior to analysis, 595 patients were screened and 516 with a somatic FOXL2 p.C134W mutation were included. Potential germline pathogenic variants in a DNA repair‐related gene (ATM, BRCA1, BRCA2, CHEK2, PALB2, PMS2, RAD51C, or RAD51D) were found in 6.6% of FOXL2‐mutated AGCT. Potential germline pathogenic CHEK2 variants were found in 3.5% (18/516) of AGCT patients, a rate that was 2.8‐fold higher than Genome Aggregation Database non‐cancer subjects (95% CI 1.8–4.6, p

Abstract Background High‐income countries offer social assistance (welfare) programs to help alleviate poverty for people with little or no income. These programs have become increasingly conditional and stringent in recent decades based on the premise that transitioning people from government support to paid work will improve their circumstances. However, many people end up with low‐paying and precarious jobs that may cause more poverty because they lose benefits such as housing subsidies and health and dental insurance, while incurring job‐related expenses. Conditional assistance programs are also expensive to administer and cause stigma. A guaranteed basic income (GBI) has been proposed as a more effective approach for alleviating poverty, and several experiments have been conducted in high‐income countries to investigate whether GBI leads to improved outcomes compared to existing social programs. Objectives The aim of this review was to conduct a synthesis of quantitative evidence on GBI interventions in high‐income countries, to compare the effectiveness of various types of GBI versus “usual care” (including existing social assistance programs) in improving poverty‐related outcomes. Search Methods Searches of 16 academic databases were conducted in May 2022, using both keywords and database‐specific controlled vocabulary, without limits or restrictions on language or date. Sources of gray literature (conference, governmental, and institutional websites) were searched in September 2022. We also searched reference lists of review articles, citations of included articles, and tables of contents of relevant journals in September 2022. Hand searching for recent publications was conducted until December 2022. Selection Criteria We included all quantitative study designs except cross‐sectional (at one timepoint), with or without control groups. We included studies in high income countries with any population and with interventions meeting our criteria for GBI: unconditional, with regular payments in cash (not in‐kind) that were fixed or predictable in amount. Although two primary outcomes of interest were selected a priori (food insecurity, and poverty level assessed using official, national, or international measures), we did not screen studies on the basis of reported outcomes because it was not possible to define all potentially relevant poverty‐related outcomes in advance. Data Collection and Analysis We followed the Campbell Collaboration conduct and reporting guidelines to ensure a rigorous methodology. The risk of bias was assessed across seven domains: confounding, selection, attrition, motivation, implementation, measurement, and analysis/reporting. We conducted meta‐analyses where results could be combined; otherwise, we presented the results in tables. We reported effect estimates as standard mean differences (SMDs) if the included studies reported them or provided sufficient data for us to calculate them. To compare the effects of different types of interventions, we developed a GBI typology based on the characteristics of experimental interventions as well as theoretical conceptualizations of GBI. Eligible poverty‐related outcomes were classified into categories and sub‐categories, to facilitate the synthesis of the individual findings. Because most of the included studies analyzed experiments conducted by other researchers, it was necessary to divide our analysis according to the “experiment” stage (i.e., design, recruitment, intervention, data collection) and the “study” stage (data analysis and reporting of results). Main Results Our searches yielded 24,476 records from databases and 80 from other sources. After screening by title and abstract, the full texts of 294 potentially eligible articles were retrieved and screened, resulting in 27 included studies on 10 experiments. Eight of the experiments were RCTs, one included both an RCT site and a “saturation” site, and one used a repeated cross‐sectional design. The duration ranged from one to 5 years. The control groups in all 10 experiments received “usual care” (i.e., no GBI intervention). The total number of participants was unknown because some of the studies did not report exact sample sizes. Of the studies that did, the smallest had 138 participants and the largest had 8019. The risk of bias assessments found “some concerns” for at least one domain in all 27 studies and “high risk” for at least one domain in 25 studies. The risk of bias was assessed as high in 21 studies due to attrition and in 22 studies due to analysis and reporting bias. To compare the interventions, we developed a classification framework of five GBI types, four of which were implemented in the experiments, and one that is used in new experiments now underway. The included studies reported 176 poverty‐related outcomes, including one pre‐defined primary outcome: food insecurity. The second primary outcome (poverty level assessed using official, national, or international measures) was not reported in any of the included studies. We classified the reported outcomes into seven categories: food insecurity (as a category), economic/material, physical health, psychological/mental health, social, educational, and individual choice/agency. Food insecurity was reported in two studies, both showing improvements (SMD = −0.57, 95% CI: −0.65 to −0.49, and SMD = −0.41, 95% CI: −0.57 to −0.26) which were not pooled because of different study designs. We conducted meta‐analyses on four secondary outcomes that were reported in more than one study: subjective financial well‐being, self‐rated overall physical health, self‐rated life satisfaction, and self‐rated mental distress. Improvements were reported, except for overall physical health or if the intervention was similar to existing social assistance. The results for the remaining 170 outcomes, each reported in only one study, were summarized in tables by category and subcategory. Adverse effects were reported in some studies, but only for specific subgroups of participants, and not consistently, so these results may have been due to chance. Authors' Conclusions The results of the included studies were difficult to synthesize because of the heterogeneity in the reported outcomes. This was due in part to poverty being multidimensional, so outcomes covered various aspects of life (economic, social, psychological, educational, agency, mental and physical health). Evidence from future studies would be easier to assess if outcomes were measured using more common, validated instruments. Based on our analysis of the included studies, a supplemental type of GBI (provided along with existing programs) may be effective in alleviating poverty‐related outcomes. This approach may also be safer than a wholesale reform of existing social assistance approaches, which could have unintended consequences.

Abstract The greatest burden of sickle cell anemia (SCA) globally occurs in sub‐Saharan Africa, where significant morbidity and mortality occur secondary to SCA‐induced vasculopathy and stroke. Transcranial Doppler ultrasound (TCD) can grade the severity of vasculopathy, with disease modifying therapy resulting in stroke reduction in high‐risk children. However, TCD utilization for vasculopathy detection in African children with SCA remains understudied. The objective was to perform a prospective, observational study of TCD findings in a cohort of children with SCA from the Democratic Republic of the Congo, Zambia, and Malawi. A total of 770 children aged 2–17 years without prior stroke underwent screening TCD. A study was scored as low risk when the time‐averaged maximum of the mean (TAMMX) in the middle cerebral artery or terminal internal carotid artery was 50 cm/s, conditional risk when 170–200 cm/s, and high risk when >200 cm/s. Low‐risk studies were identified in 604 children (78%), conditional risk in 129 children (17%), and high risk in three children (0.4%). Additionally, 34 (4%) were scored as having an unknown risk study (TAMMX

Abstract Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of cardiovascular disorders, with recent evidence linking pre‐eclampsia with vascular dementia. We examined associations of HDP with cognitive performance measured in midlife, in a prospective cohort study, the Avon Longitudinal Study of Parents and Children. Six cognitive function domains were measured 20 years after pregnancy at a mean age of 51 years. The cognition tests were repeated at clinics in the following two years. Cognitive function domains measured were immediate and delayed verbal episodic memory, working memory, processing speed, verbal intelligence, and verbal fluency. Exposures were pre‐eclampsia, gestational hypertension (GH), and a combined category of any HDP, all compared to normotensive pregnancy. Of 3393 pregnancies included in the analysis, GH was experienced by 417 (12.3%) and pre‐eclampsia by 57 (1.7%). GH was associated with lower verbal episodic memory, in the delayed logic memory test (‐0.16 SDs; 95% CI ‐0.30, ‐0.03; p = .015) and there was weak evidence of an association with the immediate logic memory test (‐0.13 SDs; ‐0.27, 0.001; p = .058). However, we did not see steeper declines by age for women with GH and there was no evidence of associations with other cognitive domains or for pre‐eclampsia with any domains. Results were not substantially changed after controlling for midlife blood pressure. Our findings suggest that a history of GH is associated with slightly reduced episodic memory 20 years after pregnancy, but we found no evidence of a quicker age‐related decline compared to women with normotensive pregnancies.

Abstract Aim Evidence showed self‐efficacy was relevant to rural females' cervical cancer screening behaviour. However, little is known about sources of self‐efficacy in cervical cancer screening among rural females. This study aimed to explore sources of self‐efficacy in cervical cancer screening among rural females. Design A qualitative descriptive study was conducted. Both users and providers of cervical cancer screening services in rural areas of China were recruited through maximum variation sampling. Methods Individual semi‐structured interviews through telephone calls were conducted. Data were analysed via six main stages of the framework method, with the social cognitive theory as a reference. Results Four main sources were identified, including personal screening experience, hearing about other women's screening experiences, professional health education and consultation, and emotional status. Personal screening experience included enactive mastery of completing the screening behaviour and cognitive mastery of internalisation of the screening. Only the experience of completing cervical cancer screening behaviour was not strong enough to improve self‐efficacy. Cognitive mastery showed more critical influence. Conclusion These four sources of rural females' cervical cancer screening self‐efficacy matched with the major sources of self‐efficacy of the social cognitive theory. Cognition was critical to influencing the screening self‐efficacy. Intervention strategies aimed at enhancing rural females' cervical cancer screening self‐efficacy can be developed from these four major sources. Public Contribution A registered nurse with rich experience in cervical cancer‐related research and qualitative study was the interviewer of this study. Rural females and cervical cancer screening services providers (healthcare professionals and village staff) were recruited as interviewees. The interview guides were developed by the research team and evaluated by an expert panel including two nurse leaders of gynaecological cancer, one doctor specialised in cervical cancer, and one medical director in a local rural hospital.

Abstract We have built a quantitative systems toxicology modeling framework focused on the early prediction of oncotherapeutic‐induced clinical intestinal adverse effects. The model describes stem and progenitor cell dynamics in the small intestinal epithelium and integrates heterogeneous epithelial‐related processes, such as transcriptional profiles, citrulline kinetics, and probability of diarrhea. We fitted a mouse‐specific version of the model to quantify doxorubicin and 5‐fluorouracil (5‐FU)‐induced toxicity, which included pharmacokinetics and 5‐FU metabolism and assumed that both drugs led to cell cycle arrest and apoptosis in stem cells and proliferative progenitors. The model successfully recapitulated observations in mice regarding dose‐dependent disruption of proliferation which could lead to villus shortening, decrease of circulating citrulline, increased diarrhea risk, and transcriptional induction of the p53 pathway. Using a human‐specific epithelial model, we translated the cytotoxic activity of doxorubicin and 5‐FU quantified in mice into human intestinal injury and predicted with accuracy clinical diarrhea incidence. However, for gefitinib, a specific‐molecularly targeted therapy, the mice failed to reproduce epithelial toxicity at exposures much higher than those associated with clinical diarrhea. This indicates that, regardless of the translational modeling approach, preclinical experimental settings have to be suitable to quantify drug‐induced clinical toxicity with precision at the structural scale of the model. Our work demonstrates the usefulness of translational models at early stages of the drug development pipeline to predict clinical toxicity and highlights the importance of understanding cross‐settings differences in toxicity when building these approaches.

Abstract Introduction We aim to characterize the magnitude of the work burden (weeks off from work) associated with prostate cancer (PCa) treatment over a 10‐year period after PCa diagnosis and identify those at greatest risk. Materials and Methods We identified men diagnosed with PCa treated with radical prostatectomy, radiation therapy, or active surveillance/watchful waiting within CaPSURE. Patients self‐reported work burden and SF36 general health scores via surveys before and 1,3,5, and 10 years after treatment. Using multivariate repeated measures generalized estimating equation modeling we examined the association between primary treatment with risk of any work weeks lost due to care. Results In total, 6693 men were included. The majority were White (81%, 5% Black, and 14% Other) with CAPRA low‐ (60%) or intermediate‐risk (32%) disease and underwent surgery (62%) compared to 29% radiation and 9% active surveillance. Compared to other treatments, surgical patients were more likely to report greater than 7 days off work in the first year, with relatively less time off over time. Black men (RR 0.64, 95% CI 0.54–0.77) and those undergoing radiation (vs. surgery, RR 0.46, 95% CI 0.41–0.51) were less likely to report time off from work over time. Mean baseline GH score (73 [SD 18]) was similar between race and treatment groups, and stable over time. Conclusions The work burden of cancer care continued up to 10 years after treatment and varied across racial groups and primary treatment groups, highlighting the multifactorial nature of this issue and the call to leverage greater resources for those at greatest risk.

Abstract Objective Among neonates with acute symptomatic seizures, we evaluated whether the inability to take full feeds at the time of hospital discharge from neonatal seizure admission is associated with worse neurodevelopmental outcomes, after adjusting for relevant clinical variables. Methods This prospective, nine‐center study of the Neonatal Seizure Registry (NSR) assessed characteristics of infants with seizures, including evidence of brainstem injury on magnetic resonance imaging (MRI), mode of feeding upon discharge, and developmental outcomes at 12, 18, and 24 months. The inability to take oral feeds was identified through a review of medical records. Brainstem injury was identified through a central review of neonatal MRIs. Developmental outcomes were assessed with the Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA‐FS) at 12, 18, and 24 months corrected age. Results Among 276 infants, inability to achieve full oral feeds was associated with lower total WIDEA‐FS scores (160.2 ± 25.5 for full oral feeds vs. 121.8 ± 42.9 for some/no oral feeds at 24 months, p

Abstract Introduction In South Africa, the HIV care cascade remains suboptimal. We investigated the impact of small conditional financial incentives (CFIs) and male‐targeted HIV‐specific decision‐support application (EPIC‐HIV) on the HIV care cascade. Methods In 2018, in uMkhanyakude district, 45 communities were randomly assigned to one of four arms: (i) CFI for home‐based HIV testing and linkage to care within 6 weeks (R50 [US$3] food voucher each); (ii) EPIC‐HIV which are based on self‐determination theory; (iii) both CFI and EPIC‐HIV; and (iv) standard of care. EPIC‐HIV consisted of two components: EPIC‐HIV 1, provided to men through a tablet before home‐based HIV testing, and EPIC‐HIV 2, offered 1 month later to men who tested positive but had not yet linked to care. Linking HITS trial data to national antiretroviral treatment (ART) programme data and HIV surveillance programme data, we estimated HIV status awareness after the HITS trial implementation, ART status 3 month after the trial and viral load suppression 1 year later. Analysis included all known individuals living with HIV in the study area including those who did not participated in the HITS trial. Results Among the 33,778 residents in the study area, 2763 men and 7266 women were identified as living with HIV by the end of the intervention period and included in the analysis. After the intervention, awareness of HIV‐positive status was higher in the CFI arms compared to non‐CFI arms (men: 793/908 [87.3%] vs. 1574/1855 [84.9%], RR = 1.03 [95% CI: 0.99−1.07]; women: 2259/2421 [93.3%] vs. 4439/4845 [91.6%], RR = 1.02 [95% CI: 1.00−1.04]). Three months after the intervention, no differences were found for linkage to ART between arms. One year after the intervention, only 1829 viral test results were retrieved. Viral suppression was higher but not significant in the EPIC‐HIV intervention arms among men (65/99 [65.7%] vs. 182/308 [59.1%], RR = 1.11 [95% CI: 0.88−1.40]). Conclusions Small CFIs can contribute to achieve the first step of the HIV care cascade. However, neither CFIs nor EPIC‐HIV was sufficient to increase the number of people on ART. Additional evidence is needed to confirm the impact of EPIC‐HIV on viral suppression.

Background Established cardiovascular disease (CVD) risk prediction functions may not accurately predict CVD risk in people with HIV. We assessed the performance of 3 CVD risk prediction functions in 2 HIV cohorts. Methods and Results CVD risk scores were calculated in the Mass General Brigham and Kaiser Permanente Northern California HIV cohorts, using the American College of Cardiology/American Heart Association atherosclerotic CVD function, the FHS (Framingham Heart Study) hard coronary heart disease function and the Framingham Heart Study hard CVD function. Outcomes were myocardial infarction or coronary death for FHS hard coronary heart disease function; and myocardial infarction, stroke, or coronary death for American College of Cardiology/American Heart Association and FHS hard CVD function. We calculated regression coefficients and assessed discrimination and calibration by sex; predicted to observed risk of outcome was also compared. In the combined cohort of 9412, 158 (1.7%) had a coronary heart disease event, and 309 (3.3%) had a CVD event. Among women, CVD risk was generally underestimated by all 3 risk functions. Among men, CVD risk was underestimated by the American College of Cardiology/American Heart Association and FHS hard CVD function, but overestimated by the FHS hard coronary heart disease function. Calibration was poor for women using the FHS hard CVD function and for men using all functions. Discrimination in all functions was good for women (c‐statistics ranging from 0.78 to 0.90) and moderate for men (c‐statistics ranging from 0.71 to 0.72). Conclusions Established CVD risk prediction functions generally underestimate risk in people with HIV. Differences in model performance by sex underscore the need for both HIV‐specific and sex‐specific functions. Development of CVD risk prediction models tailored to HIV will enhance care for aging people with HIV.

Abstract Objectives The perio‐restorative approach to maintaining supracrestal tissue attachment (STA; formerly known as biologic width) is a fundamental goal in modern dentistry. This article aims to review the clinical impact of biologic shaping (BS) as an innovative alternative to traditional crown lengthening procedures, reflecting over two decades of clinical experience. Material and Methods As a review paper, it is crucial to highlight that BS stands as a unique approach designed to optimize STA while emphasizing minimal to no removal of supporting bone. The review spans over two decades, consistently demonstrating clinical efficacy and predictability. Remarkably, BS focuses on addressing issues such as root concavities, developmental grooves, irregularities, furcation lips, and CEJ offering a remarkable level of clinical precision. Results The reviewed literature underscores that BS has consistently achieved substantial clinical success in fulfilling its objectives. This method presents a biologically sound alternative to traditional crown lengthening, placing a strong emphasis on the preservation of essential bone tissue and the establishment of durable STA. Conclusions The results suggest that BS is a logical and biologically driven approach for maintaining STA, making it a promising alternative to traditional crown lengthening. The method offers a predictable and reproducible way to preserve bone tissue while achieving durable STA. This innovation holds great promise in the field of periodontal and restorative dentistry.