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Background: Skin biorevitalization involves multiple intradermal injections to enhance skin quality, but precise dermal targeting can be challenging due to variations in skin thickness smaller, less painful needles with fewer skin reactions are attractive options. Aims: This study evaluates a new Micro‐Needle device's performance and safety in comparison with the classic needle used in skin biorevitalization. Patients/Methods: Subjects with facial and neck skin aging were enrolled. Safety outcomes, including immediate and local tolerability, were assessed. Performance outcomes measured skin radiance, wrinkles and photoaging grade, hydration, subepidermal low echogenic band, dermis thickness, and skin elasticity. Both subjects and investigators recorded Global Aesthetic Improvement Scale scores. Results: Micro‐Needle injections demonstrated superior performance compared to the classic needle, influenced by the specific skin zones and thickness. Micro‐Needle was superior for skin wrinkles at D49 for periorbital zone and nasolabial folds by −14.5% (p = 0.01) and −15% (p = 0.004), respectively, and for neck by 9.6% (p = 0.0008). The Nanosoft device showed a faster improvement for skin hydration at D42 for the cheek zone (p = 0.04) and at D75 for the neck area (p = 0.01); and for skin radiance at D75 (p = 0.03) and at D120 (p = 0.0098). Ex vivo studies confirmed the Micro‐Needle's accuracy in product placement in the dermis. Adverse events were milder with Micro‐Needle and no serious adverse events occurred. Conclusions: Both needles significantly improved skin quality, but Micro‐Needle enhanced the outcomes of skin biorevitalization procedures, particularly in terms of skin wrinkle reduction, elasticity, and overall skin hydration. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity is a growing burden in our ageing society and is associated with perioperative morbidity and mortality. Despite several modifications to the ASA physical status classification, multimorbidity as such is still not considered. Thus, the aim of this study was to quantify the burden of comorbidities in perioperative patients and to assess, independent of ASA class, its potential influence on perioperative outcome. Methods: In a subpopulation of the prospective ClassIntra® validation study from eight international centres, type and severity of anaesthesia‐relevant comorbidities were additionally extracted from electronic medical records for the current study. Patients from the validation study were of all ages, undergoing any type of in‐hospital surgery and were followed up until 30 days postoperatively to assess perioperative outcomes. Primary endpoint was the number of comorbidities across ASA classes. The associated postoperative length of hospital stay (pLOS) and Comprehensive Complication Index (CCI®) were secondary endpoints. On a scale from 0 (no complication) to 100 (death) the CCI® measures the severity of postoperative morbidity as a weighted sum of all postoperative complications. Results: Of 1421 enrolled patients, the mean number of comorbidities significantly increased from 1.5 in ASA I (95% CI, 1.1–1.9) to 10.5 in ASA IV (95% CI, 8.3–12.7) patients. Furthermore, independent of ASA class, postoperative complications measured by the CCI® increased per each comorbidity by 0.81 (95% CI, 0.40–1.23) and so did pLOS (geometric mean ratio, 1.03; 95% CI, 1.01–1.06). Conclusions: These data quantify the high prevalence of multimorbidity in the surgical population and show that the number of comorbidities is predictive of negative postoperative outcomes, independent of ASA class. [ABSTRACT FROM AUTHOR]

Ammonia (NH3) loss following manure application is an environmental concern and N loss for crop production. Manure injection typically reduces NH3 loss compared to surface application without incorporation but increases emissions of nitrous oxide (N2O), which is a potent greenhouse gas. Synchronizing manure in spring with cover crop (CC) growth may increase N recovery and reduce N2O emissions compared to applying manure later in the absence of growing crops. We compared the two following manure application methods: shallow-disk injection (IM) or surface banding without incorporation (BM) to annual ryegrass (Lolium multiflorum L.) and red clover (Trifolium pratense L.) CC at two times: early spring on growing CC (EARLY) and late spring on terminated CC (LATE). The randomized split-plot block experiment was conducted at Rock Springs, PA, during 2021–2022. After manure application, we measured NH3 for 72 h and N2O throughout the growing season. Aboveground CC biomass, N, and C:N ratio; pre-sidedress soil nitrate; corn (Zea mays L.) stalk nitrate; and silage yield were assessed. Averaged across application times, compared to BM, IM reduced cumulative NH3 loss, increased soil N, and resulted in 13% greater corn yield but increased yield-scaled N2O. Compared to BM LATE, BM EARLY reduced NH3 loss by 43%, increased CC N, reduced N2O emission by 50%, but decreased corn yield by 11%. When IM was EARLY compared to LATE, CC N increased 84%, cumulative N2O loss decreased 55%, and corn yield was similar. Injecting manure to growing CCs offers a strategy for reducing detrimental NH3 and N2O emissions and maintaining corn yield. [ABSTRACT FROM AUTHOR]

Background and Aims: Louse‐borne Bartonella quintana infection and flea‐borne murine typhus are two potentially serious vector‐borne diseases that have led to periodic outbreaks among people experiencing homelessness in the United States. Little is known about louse‐ and flea‐borne disease awareness and prevention among staff who provide services to the population. We surveyed staff in seven US states to identify gaps in knowledge and prevention practices for these diseases. Methods and Results: Surveys were administered to 333 staff at 89 homeless shelters and outreach teams in California, Colorado, Georgia, Maryland, Minnesota, New York and Washington from August 2022 to April 2023. Most participants (>68%) agreed that body lice and fleas are a problem for people experiencing homelessness. About half were aware that diseases could be transmitted by these vectors; however, most could not accurately identify which diseases. Less than a quarter of staff could describe an appropriate protocol for managing body lice or fleas. Misconceptions included that clients must isolate or be denied services until they are medically cleared. Conclusions: Our findings reveal significant knowledge gaps among staff who provide services to people experiencing homelessness in the prevention and control of louse‐ and flea‐borne diseases. This demonstrates an urgent need for staff training to both reduce disease and prevent unnecessary restrictions on services and housing. [ABSTRACT FROM AUTHOR]

Because Antarctic surface melt is mostly driven by local processes, its simulation necessitates high‐resolution regional climate models (RCMs). However, the current horizontal resolution of RCMs (≈25–30 km) is inadequate for capturing small‐scale melt processes. To address this limitation, we present SUPREME (SUPer‐REsolution‐based Melt Estimation over Antarctica), a deep learning method to downscale surface melt to 5.5 km resolution using a physically‐informed super‐resolution model. The physical information integrated into the model originates from observations tied to surface melt, specifically remote sensing‐derived albedo and elevation. These remote sensing data, in addition to a Regional Atmospheric Climate Model (RACMO) run at 27 km resolution, account for the diverse drivers of surface melt across Antarctica, facilitating effective generalization beyond the training region of the Antarctic Peninsula. A comparison of SUPREME with a dynamically downscaled RACMO run at 5.5 km over the Antarctic Peninsula shows high accuracy, with average yearly RMSE and bias of 5.5 mm w.e. yr−1 and 4.5 mm w.e. yr−1, respectively. Validation at five automatic weather stations reveals SUPREME's marked improvement with substantially lower average RMSE (81 mm w.e.) compared to RACMO 27 km (129 mm w.e.). Beyond the training region, SUPREME aligns more closely with remote sensing products associated with surface melt than super‐resolution models lacking physical constraints. While further validation of SUPREME is needed, our study highlights the potential of super‐resolution techniques with physical constraints for high‐resolution surface melt monitoring in Antarctica, providing insights into the impacts of localized melting on processes affecting ice shelf integrity such as hydrofracturing. Plain Language Summary: To improve surface melt monitoring in Antarctica, high‐resolution climate models are essential. Existing models, like the Regional Atmospheric Climate Model (RACMO), do not have a fine enough spatial resolution to capture small‐scale melt processes. To overcome this, we introduce SUPREME (SUPer‐REsolution‐based Melt Estimation over Antarctica), a method that refines surface melt data to a higher resolution of 5.5 km using an advanced super‐resolution model. We enhance this model with physical information derived from observations directly related to surface melt, specifically using albedo and elevation data from remote sensing. By incorporating these observations, along with RACMO data at 27 km resolution, we account for the various triggers of surface melt across Antarctica. SUPREME accurately predicts high‐resolution surface melt beyond the training region of the Antarctic Peninsula, showing promising results compared to existing melt observations. Further validation is needed, but this approach, combining super‐resolution techniques and remote sensing data, holds potential for accurate surface melt monitoring in Antarctica. This may advance our understanding of the impacts of localized features on processes affecting ice shelf integrity such as meltwater‐induced hydrofracturing. Key Points: Our method downscales Antarctic surface melt from a regional climate model, employing a physically‐informed super‐resolution architectureThe super‐resolution model relies on physical information derived from remote sensing data, specifically surface albedo and elevationIncorporating physical information boosts model generalization, enabling accurate high‐resolution surface melt beyond the training region [ABSTRACT FROM AUTHOR]

Soils contribute 15%–75% of total atmospheric nitrogen oxide (NOx) emissions in agricultural regions during the growing season. However, the impacts of cropland fertilizer management on spatially heterogeneous, temporally episodic NOx emission patterns are highly uncertain. We examine the effects of liquid slurry dairy manure application practices on soil NOx emissions in rainfed, corn‐soybean rotations during spring 2016 and 2017. Daily soil NOx emissions and weekly soil inorganic N measurements were performed in a randomized split–split plot design for 1–4 weeks following manure applications. NOx emissions and soil N with shallow‐disk injection and chisel‐disk manure incorporation methods were compared with unincorporated broadcast practices. Injected manure and chisel‐disk incorporation exhibited two–four times larger mean NOx emissions than those with unincorporated broadcast manure. Larger soil NOx emissions with manure incorporation practices were driven by the predominance of nitrification in these treatments with evidence of soil nitrate production. Soil NOx emission differences between treatments were detectable across order of magnitude changes in daily NOx emissions during two growing seasons. Larger soil NOx emissions associated with manure incorporation practices compared with unincorporated broadcast practices occur alongside larger N2O and smaller NH3 emissions, highlighting important air quality and climate impact tradeoffs for cropland manure fertilizer management choices. Core Ideas: Soil NOx emissions were characterized following rainfed liquid dairy manure applications in the northeastern United States.Soil NOx emissions with manure incorporation were two–four times larger than with unincorporated broadcast manure.Larger soil NOx emissions with manure incorporation were associated with the predominance of nitrification. [ABSTRACT FROM AUTHOR]

In degraded ecosystems, soil microbial communities (SMCs) may influence the outcomes of ecological restoration. Restoration practices can affect SMCs, though it is unclear how variation in the onset of restoration activities in woodlands affects SMCs, how those SMCs influence the performance of hard‐to‐establish woodland forbs, and how different woodland forbs shape SMCs. In this study, we quantified soil properties and species abundances in an oak woodland restoration chronosequence (young, intermediate, and old restorations). We measured the growth of three woodland forb species when inoculated with live whole‐soil from young, intermediate, or old restorations. We used DNA metabarcoding to characterize SMCs of each inoculum treatment and the soil after conditioning by each plant species. Our goals were to (1) understand how time since the onset of restoration affected soil abiotic properties, plant communities, and SMCs in a restoration chronosequence, (2) test growth responses of three forb species to whole‐soil inoculum from restoration sites, and (3) characterize changes in SMCs before and after conditioning by each forb species. Younger restored woodlands had greater fire‐sensitive tree species and lower concentrations of soil phosphorous than intermediate or older restored woodlands. Bacterial and fungal soil communities varied significantly among sites. Forbs exhibited the greatest growth in soil from the young restoration. Each forb species developed a unique soil microbial community. Our results highlight how restoration practices affect SMCs, which can in turn affect the growth of hard‐to‐establish forb species. Our results also highlight that the choice of forb species can alter SMCs, which could have long‐term potential consequences for restoration success. [ABSTRACT FROM AUTHOR]

Background: Evidence to guide intrapartum care when an unborn baby has died is limited. Aims: To explore parents' experiences of care during labour of an antepartum stillbirth. Materials and Methods: Semi‐structured interviews with 18 bereaved parents from across Australia. Content analysis was conducted. Findings: Two broad themes were identified: 'explaining every step' and 'helping us feel like parents.' Sub‐themes under the first broad theme, 'explaining every step', were 'how and when information was given' and 'what happens next.' 'Like any other parent', 'feeling the pain' and 'everything is clouded' were sub‐themes of the second broad theme. These findings mapped to current Australian clinical practice guidelines for bereavement care around stillbirth and neonatal death, ie good communication, recognition of parenthood, shared decision making and effective support. Conclusions: This study on parents' experiences of labour with a fetal death in utero brings an important perspective to intrapartum care for this group. As far as we are aware, this study is the first to focus solely on this aspect of care. Our findings could be readily mapped to the four perinatal bereavement care goals. Parents wanted care providers to facilitate their choices, their sense of control, their autonomy and their agency. They wanted to feel that they had received the 'best' care available. [ABSTRACT FROM AUTHOR]

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Modular polyketide synthases (PKSs) are giant assembly lines that produce an impressive range of biologically active compounds. However, our understanding of the structural dynamics of these megasynthases, specifically the delivery of acyl carrier protein (ACP)‐bound building blocks to the catalytic site of the ketosynthase (KS) domain, remains severely limited. Using a multipronged structural approach, we report details of the inter‐domain interactions after C−C bond formation in a chain‐branching module of the rhizoxin PKS. Mechanism‐based crosslinking of an engineered module was achieved using a synthetic substrate surrogate that serves as a Michael acceptor. The crosslinked protein allowed us to identify an asymmetric state of the dimeric protein complex upon C−C bond formation by cryo‐electron microscopy (cryo‐EM). The possible existence of two ACP binding sites, one of them a potential "parking position" for substrate loading, was also indicated by AlphaFold2 predictions. NMR spectroscopy showed that a transient complex is formed in solution, independent of the linker domains, and photochemical crosslinking/mass spectrometry of the standalone domains allowed us to pinpoint the interdomain interaction sites. The structural insights into a branching PKS module arrested after C−C bond formation allows a better understanding of domain dynamics and provides valuable information for the rational design of modular assembly lines. [ABSTRACT FROM AUTHOR]

Genetic counseling students with minoritized identities have reported experiencing microaggressions throughout graduate training, including from fieldwork supervisors. However, the impacts of these fieldwork experiences have not been thoroughly investigated. As supervision is known to be integral to genetic counseling students' skill development and success, the purpose of this qualitative study was to explore the impact of microaggressions on student training, with a specific focus on the supervisory working alliance. To achieve this goal, we conducted 11 interviews with recent genetic counseling graduates (2019–2021) who reported experiencing at least one microaggression from a fieldwork supervisor during graduate school training. Purposive sampling was used to prioritize interviewees who identified as underrepresented in the field due to race, ethnicity, gender identity, sexual orientation, and/or disability status. All interviewees were initially recruited as part of a larger mixed‐methods study investigating the frequency and types of microaggressions genetic counseling students experience from fieldwork supervisors. Interview questions explored the time period before a microaggression event, during the event, and after. Qualitative thematic analysis resulted in four themes, three of which are presented in this paper: (1) Impact of microaggressions, (2) Barriers to reporting microaggressions, and (3) Experience reporting microaggressions. Microaggressions from supervisors were shown to impair the psychological well‐being of participants and hinder learning opportunities. These experiences led participants to question their choice of profession and avoid time in clinic, ultimately constraining the development of strong supervisory working alliances. Some participants did not report microaggressions due to fear of negative repercussions, and those who did described defensive responses which harmed students' relationships with program leadership. This study reveals opportunities for supervisors to improve student training conditions by centering students' feelings and experiences, increasing open and honest communication, and extending psychosocial tools to supervision. Additionally, graduate programs are encouraged to establish structured reporting protocols for students and evaluate current shortcomings in equity and inclusion initiatives. [ABSTRACT FROM AUTHOR]

While research has shown that genetic counseling students with minoritized racial or ethnic identities face microaggressions throughout graduate training, quantitative data regarding the frequency of these experiences have not been reported. The purpose of this mixed‐methods study was to investigate the frequency and types of microaggressions experienced by graduates of accredited genetic counseling programs in the United States during fieldwork rotations. A quantitative survey was administered to assess how frequently 14 different types of microaggressions occurred in interactions with supervisors. Survey responses were analyzed using situation‐based coding (the number of different types of microaggressions experienced) and frequency‐based coding (the sum of participants' weighted Likert answers). Select survey respondents with minoritized identities were interviewed to better contextualize and categorize microaggression experiences. Analysis of 87 survey responses revealed that participants with minoritized racial and ethnic identities experience significantly more types of microaggressions (t(61) = 2.77; p = 0.007) at a significantly higher frequency (t(55) = 2.67; p = 0.010) than their white counterparts. Participants who identified as part of the disability community were also found to experience significantly more types of microaggressions (t(10) = 3.25; p = 0.009) at a significantly higher frequency (t(9) = 2.32; p = 0.045) than those who did not. Qualitative analysis of 11 interviews revealed that microaggressions from supervisors included offensive and inappropriate comments, unequal treatment, cultural intolerance, and disparaging feedback. Overall, our data present evidence that students with minoritized racial and ethnic identities and students with disabilities are subjected to a variety of inequitable, exclusionary, and harmful interactions. As a result, we recommend that all supervisors receive training about recognizing and preventing microaggressions to ensure that students are provided with an equitable and inclusive training experience, regardless of identity. [ABSTRACT FROM AUTHOR]

Maternal psychological factors, including anxiety, depression, and substance use, may negatively affect parenting. Previous works with mothers have often assessed each of these factors in isolation despite their frequent co‐occurrence. Psychological factors have also been associated with neural processing of facial stimuli, specifically the amplitude (i.e., size) and latency (i.e., timing) of the face‐specific N170 event‐related potential. In the current study, 106 mothers completed measures assessing maternal psychological factors—anxiety, depression, and substance use. A latent profile analysis was used to identify profiles of psychological factors and assess profile associations with the N170 elicited by infant faces and with parental reflective functioning (PRF) as a measure related to caregiving. Two profiles (termed high and low psychological risk) were identified, with the higher risk profile associated with delayed N170 latency responses to infant faces. An exploratory analysis evidenced an indirect effect between the higher psychological risk profile and lower PRF through delayed N170 latency responses to infant faces. Taken together, maternal psychological risk across multiple indicators may together shape neural processing of infant faces, which may have downstream consequences for caregiving. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the diagnostic performance of serum inflammatory biomarkers in salivary gland tumors with dubious results following cytological analysis. Methods: A retrospective analysis of 239 cases following surgery between January 2011 and June 2022 was performed. Receiver Operating Characteristic curves were drawn and areas under the curves were computed to evaluate the diagnostic performance of the inflammatory biomarkers (SII, SIRI, PLR, and NLR). Optimal cut‐offs for each marker were determined by maximizing the Youden index. Results: Analysis showed that among the major biomarkers examined, SIRI performed an AUC of 0.77. The best SIRI cut‐off was 0.94 with an accuracy of 79.9%. The accuracy, sensitivity, and specificity of cytological analysis were 77.8%, 59.6%, and 90.7% respectively. By combining SIRI with cytological analysis we demonstrated an increase in sensitivity to 82.8%. Conclusions: Inflammatory biomarkers could be evaluated to support the diagnosis and treatment of salivary gland tumors in difficult cases. [ABSTRACT FROM AUTHOR]

Background: Lung cancer screening (LCS) with low‐dose computed tomography (LDCT) of the chest of eligible patients remains low. Accordingly, augmentation of appropriate LCS referrals by primary care providers (PCPs) was sought. Methods: The quality improvement (QI) project was performed between April 2021 and June 2022. It incorporated patient education, shared decision‐making (SDM) with PCPs, and tracking of initial LDCT completion. In each case, lag time (LT) to LCS and pack‐years (PYs) were calculated from initial LCS eligibility. The cohort's scores were compared to national scores. Patient zip codes were used to create a geographic map of our cohort for comparison with public health data. Results: An immediate and sustained increase in weekly LCS referrals from PCPs was recorded. Of 337 initial referrals, 95% were men, consisting of 66.2% Black, 28.4% White, and 5.4% other. Mean PY was less for minorities (45.3 vs. 37.3 years; p =.0002) but mean LT was greater for Whites (7.9 vs. 6.2 years; p =.03). Twenty‐five percent of veterans failed to report to their scheduled screening, and two declined referrals. Notably, most no‐show patients lived in transit deserts. Furthermore, Lung‐RADS scores 4B/4X were more than double the expected prevalence (p =.008). Conclusions: The PCPs in this study successfully augmented LCS referrals. A substantial proportion of these patients were no‐shows, and our data suggest complex racial and socioeconomic factors as contributing variables. In addition, a higher‐than‐expected number of initial Lung‐RADS scores 4B/4X were reported. A large, multisite QI project is warranted to address overcoming potential transportation barriers in high‐risk patient populations. In this article, a process is outlined of how a quality improvement project can be used to increase lung cancer screening rates. More importantly, data from this project can be used to further characterize an underserved population and understand the socioeconomic impacts of society on these populations. [ABSTRACT FROM AUTHOR]

Rhizonin A and B are hepatotoxic cyclopeptides produced by bacterial endosymbionts (Mycetohabitans endofungorum) of the fungus Rhizopus microsporus. Their toxicity critically depends on the presence of 3‐furylalanine (Fua) residues, which also occur in pharmaceutically relevant cyclopeptides of the endolide and bingchamide families. The biosynthesis and incorporation of Fua by non‐ribosomal peptide synthetases (NRPS), however, has remained elusive. By genome sequencing and gene inactivation we elucidated the gene cluster responsible for rhizonin biosynthesis. A suite of isotope labeling experiments identified tyrosine and l‐DOPA as Fua precursors and provided the first mechanistic insight. Bioinformatics, mutational analysis and heterologous reconstitution identified dioxygenase RhzB as necessary and sufficient for Fua formation. RhzB is a novel type of heme‐dependent aromatic oxygenases (HDAO) that enabled the discovery of the bingchamide biosynthesis gene cluster through genome mining. [ABSTRACT FROM AUTHOR]

Dr. Joleen Blom's interdisciplinary text, "Video Game Characters and Transmedia Storytelling: The Dynamic Game Character," explores the unique narratives of video game characters shaped by player experiences. Blom contrasts Japanese and Euro-American approaches to character studies, highlighting the flexibility of character understanding in the Japanese media mix framework. She argues for a dynamic understanding of game characters, emphasizing the impact of player actions on character development across media. Blom's work offers a fresh perspective on character studies in video games, appealing to scholars in game studies, Japanology, and literary studies. [Extracted from the article]

During research conducted in the summer of 2020, I observed the advanced marginality of the refugees in Ankara, Turkey. While some authors have examined this precarity, and some others have examined how refugees have begun to live in a spatially distinct section of certain cities, the combination of these two phenomena demands further investigation. If the underpinning truly is spatial as claimed by Lefebvre (The production of space. Oxford and Cambridge: Blackwell, 1991), then the precarious subject and the precarious space co‐produce each other. What this paper intends to do is to combine space and precarity using the observations of Wacquant (Urban poverty and the underclass: a reader. Oxford and Cambridge: Blackwell, 1996, Urban Studies, 2016, 53, 1077) in his various analyses on the ghetto in France and the United States. In Wacquant's work, we can begin to see a spatial conception of precarity, and we can further extend this to the point that as space is a production and its subjects are also a co‐constitution of that space. Nevertheless, Sampson (Ethnic & Racial Studies, 2014, 37, 1732) points out a certain state centrism in Wacquant's analysis. Building upon this, as well as the work of Roy (International Journal of Urban and Regional Research, 2011, 35, 223 and Territories of poverty: rethinking north and south. Athens: University of Georgia Press, 2015), we can offer the refugee neighbourhood in Ankara as an example of "bottom‐up" agency, alternative to Wacquant's original state‐centric analysis. In the course of this paper, this possibility of a "bottom‐up" refugee solidarity and related refugee space will be analysed. [ABSTRACT FROM AUTHOR]

Objective: To understand the perspectives of home health aides (HHAs) toward their own health and health behaviors, and how their job impacts both. Data Sources and Study Setting: Interviews were conducted with 28 HHAs from 16 unique home care agencies from August 2021 to January 2022. The study was conducted in partnership with the 1199SEIU Training and Employment Fund, a labor‐management fund of the largest health care union in the US. Study Design: A qualitative study with English and Spanish‐speaking HHAs. Interviews were conducted using a semi‐structured topic guide, informed by Pender's Health Promotion Model and the National Institute for Occupational Safety and Health's Total Worker Health Model. To be eligible, HHAs had to be currently employed by a home care agency in New York, NY. Data Collection/Extraction Methods: Interviews were recorded, professionally transcribed, and analyzed thematically. Principal Findings: The 28 HHAs had a mean age of 47.6 years (SD 11.1), 39% were non‐Hispanic Black, 43% were Hispanic, and they had a mean of 14.1 years (SD 7.8) of job experience. Five themes emerged; HHAs were: (1) Healthy enough to work, but were managing their own chronic conditions while working; (2) Motivated to be healthy, in part driven by their desire to care for others; (3) Worked closely with sick patients, which influenced their perceptions of health; (4) Experienced occupational and patient‐level barriers to practicing healthy behaviors; (5) Sought support and resources to improve their health and wellbeing. Conclusions: HHAs have numerous health challenges, many of which are influenced by their job. Culturally and occupationally tailored interventions may mitigate the barriers that HHAs experience to achieve optimal health. [ABSTRACT FROM AUTHOR]

Background: In Africa, pediatric liver transplantation (PLT) is currently only performed in Egypt and South Africa, leaving those who require treatment in Kenya to travel abroad. The aim of this study was to determine whether sufficient capacity and need exists in Kenya to establish a safe and sustainable PLT program. Methods: A descriptive analysis of the intensive care unit (ICU) beds, surgical workforce, current hepatobiliary volume, and estimated prevalence of pediatric liver disease (PLD) was conducted across 17 hospitals in Kenya between July and September 2020. Data were collected from medical superintendents, directors of surgical departments, or nominated proxies at Kenyan Level 5 and 6 hospitals via a web‐based survey. Results: A total of 165 ICU beds were reported at 17 facilities, with 15 facilities reporting five or more beds. About 39% of general surgeons at responding hospitals performed hepatobiliary procedures, and 30% performed pediatric surgeries. Only 10% of surgeons had pediatric training. Over half (57%) of hospitals performed hepatobiliary procedures; at the maximum, 1–5 cases were performed per week including cholecystectomy to Kasai portoenterostomy and hepatectomy. Across 13 hospitals, there were an estimated 192–570 cases of PLD seen per month. The most common PLDs were hepatitis B, neonatal hepatitis, cirrhosis, and acute hepatic failure. Overall, two hospitals possessed the minimum workforce and resources to attempt PLT. Conclusions: In Kenya, ICU bed availability, pediatric surgical training, and hepatobiliary volume are limited. However, the high prevalence of PLD demonstrated a significant need for PLT across all Kenyan hospitals. [ABSTRACT FROM AUTHOR]

Temperature is highly influential on the physiology and behaviour of ectotherms. In fish, temperature affects social interactions such as schooling behaviour, a common defence against predation. However, the effect of temperature on the ability of schooling fish to collectively respond to a predator is unknown. Here we used a loom stimulus to simulate an approaching predator that elicited a fleeing response in schooling fish over a range of water temperatures (9–29°C) and group sizes (1–16 fish). While speed and acceleration always exhibited a positive curvilinear response to temperature, the optimal temperature at which performance peaked was different during the predation threat versus when they were unperturbed. Similarly, group‐level metrics were sensitive to temperature immediately after a loom stimulus but showed no response to temperature during unperturbed swimming. The time taken for fish to respond to the loom stimulus was minimal at 20°C. The proportion of fish that startled, during a loom, peaked at 13°C – around the same temperature at which speed, and acceleration was maximum. Taken together, our results suggest that ectothermic fish may be able to compensate for their slower swim speeds at lower temperatures during unperturbed swimming by increasing their sensitivity to startle in response to a predation threat. More generally, we show that in ectotherms the qualitative and quantitative effect of temperature on a behavioural trait may be dependent on the context. [ABSTRACT FROM AUTHOR]

Climate warming is considered to be among the most serious of anthropogenic stresses to the environment, because it not only has direct effects on biodiversity, but it also exacerbates the harmful effects of other human‐mediated threats. The associated consequences are potentially severe, particularly in terms of threats to species preservation, as well as in the preservation of an array of ecosystem services provided by biodiversity. Among the most affected groups of animals are insects—central components of many ecosystems—for which climate change has pervasive effects from individuals to communities. In this contribution to the scientists' warning series, we summarize the effect of the gradual global surface temperature increase on insects, in terms of physiology, behavior, phenology, distribution, and species interactions, as well as the effect of increased frequency and duration of extreme events such as hot and cold spells, fires, droughts, and floods on these parameters. We warn that, if no action is taken to better understand and reduce the action of climate change on insects, we will drastically reduce our ability to build a sustainable future based on healthy, functional ecosystems. We discuss perspectives on relevant ways to conserve insects in the face of climate change, and we offer several key recommendations on management approaches that can be adopted, on policies that should be pursued, and on the involvement of the general public in the protection effort. [ABSTRACT FROM AUTHOR]

The THRA gene, encoding the thyroid hormone nuclear receptor TRα1, is expressed in an increasing gradient at the bottom of intestinal crypts, overlapping with high Wnt and Notch activities. Importantly, THRA is upregulated in colorectal cancers, particularly in the high‐Wnt molecular subtype. The basis of this specific and/or altered expression pattern has remained unknown. To define the mechanisms controlling THRA transcription and TRα1 expression, we used multiple in vitro and ex vivo approaches. Promoter analysis demonstrated that transcription factors important for crypt homeostasis and altered in colorectal cancers, such as transcription factor 7‐like 2 (TCF7L2; Wnt pathway), recombining binding protein suppressor of hairless (RBPJ; Notch pathway), and homeobox protein CDX2 (epithelial cell identity), modulate THRA activity. Specifically, although TCF7L2 and CDX2 stimulated THRA, RBPJ induced its repression. In‐depth analysis of the Wnt‐dependent increase showed direct regulation of the THRA promoter in cells and of TRα1 expression in murine enteroids. Given our previous results on the control of the Wnt pathway by TRα1, our new results unveil a complex regulatory loop and synergy between these endocrine and epithelial‐cell‐intrinsic signals. Our work describes, for the first time, the regulation of the THRA gene in specific cell and tumor contexts. [ABSTRACT FROM AUTHOR]

Understanding antibiotic resistance mechanisms is central to the development of anti‐infective therapies and genomics‐based drug discovery. Yet, many knowledge gaps remain regarding the resistance strategies employed against novel types of antibiotics from less‐explored producers such as anaerobic bacteria, among them the Clostridia. Through the use of genome editing and functional assays, we found that CtaZ confers self‐resistance against the copper chelator and gyrase inhibitor closthioamide (CTA) in Ruminiclostridium cellulolyticum. Bioinformatics, biochemical analyses, and X‐ray crystallography revealed CtaZ as a founding member of a new group of GyrI‐like proteins. CtaZ is unique in binding a polythioamide scaffold in a ligand‐optimized hydrophobic pocket, thereby confining CTA. By genome mining using CtaZ as a handle, we discovered previously overlooked homologs encoded by diverse members of the phylum Firmicutes, including many pathogens. In addition to characterizing both a new role for a GyrI‐like domain in self‐resistance and unprecedented thioamide binding, this work aids in uncovering related drug‐resistance mechanisms. [ABSTRACT FROM AUTHOR]

Objective: To quantify parents' experiences of respectful care around stillbirth globally. Design: Multi‐country, online, cross‐sectional survey. Setting and population: Self‐identified bereaved parents (n = 3769) of stillborn babies from 44 high‐ and middle‐income countries. Methods: Parents' perspectives of seven aspects of care quality, factors associated with respectful care and seven bereavement care practices were compared across geographical regions using descriptive statistics. Respectful care was compared between country‐income groups using multivariable logistic regression. Main outcome measures: Self‐reported experience of care around the time of stillbirth. Results: A quarter (25.4%) of 3769 respondents reported disrespectful care after stillbirth and 23.5% reported disrespectful care of their baby. Gestation less than 30 weeks and primiparity were associated with disrespect. Reported respectful care was lower in middle‐income countries than in high‐income countries (adjusted odds ratio 0.35, 95% CI 0.29–0.42, p < 0.01). In many countries, aspects of care quality need improvement, such as ensuring families have enough time with providers. Participating respondents from Latin America and southern Europe reported lower satisfaction across all aspects of care quality compared with northern Europe. Unmet need for memory‐making activities in middle‐income countries was high. Conclusions: Many parents experience disrespectful care around stillbirth. Provider training and system‐level support to address practical barriers are urgently needed. However, some practices (which are important to parents) can be readily implemented such as memory‐making activities and referring to the baby by name. One in four experience disrespectful care after stillbirth. Parents want more time with providers and their babies, to talk and memory‐make. One in four experience disrespectful care after stillbirth. Parents want more time with providers and their babies, to talk and memory‐make. Linked article: This article is commented on by Mehali Patel, pp. 1740 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17146. Linked article: This article is commented on by Susannah H. Leisher, pp. 1741‐1742 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17157. [ABSTRACT FROM AUTHOR]

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There is increasing interest in the application of natural plant extracts for the postharvest management of food crops. This study investigates the potential for hydro‐distilled natural essential oils to inhibit the germination of potato tubers in storage. Four completely randomized design experiments were undertaken with extracts of seven medicinal plants [(Zataria multiflora L.), peppermint (Mentha piperita L.), fennel (Foeniculum vulgare L.), summer savory (Satureja hortensis L.), cloves (Eugenia caryophylium L.), lavender (Lavandula officinalis L.), and black cumin (Bunium persicum L.)], at four concentrations (0, 150, 300, and 450 μl/L) and three replications. Tubers were treated with essential oil vapor and then stored for 6 months at 8°C in the dark. Peppermint and fennel essential oils, at a concentration of 300 μl/L, completely inhibited tuber germination. In pregermination experiments, the dimensional and mass weight of tubers before germination increased by 18.4% and 21.11%, respectively, in the control treatment compared with the treated tubers with a concentration of 150 μl/L. However, the highest rate for the mentioned parameters in postgermination experiments was observed at a concentration of 300 μl/L fennel treatments. Peppermint and fennel essential oil with a concentration of 300 μl/L completely inhibited germination and tubers had acceptable volume, mass, dry matter, protein, and potassium. Also, the highest concentration of sugar (44.44 mg/g) occurred in tubers treated with fennel (300 μl/L), but the starch levels were lower than in tubers treated with the other essential oils. From these results, peppermint essential oil was identified as the best treatment and it is recommended for use in commercial harvests. Novelty impact statement: Plant essential oils are safe substances for the environment and human health. Therefore, for the first time, these essential oils with different concentrations were evaluated for an Iranian potato cultivar. The innovation of this article was the use of a range of concentrations and diversity of important plant essential oils to provide a novel solution for Iranian farmers in controlling potato germination and storage conditions. [ABSTRACT FROM AUTHOR]

Summary: Red blood cells (RBCs) lose plasma membrane in the spleen as they age, but the cells and molecules involved are yet to be identified. Sickle cell disease and infection by Plasmodium falciparum cause oxidative stress that induces aggregates of cross‐linked proteins with N‐linked high‐mannose glycans (HMGs). These glycans can be recognised by mannose‐binding lectins, including the mannose receptor (CD206), expressed on macrophages and specialised phagocytic endothelial cells in the spleen to mediate the extravascular haemolysis characteristic of these diseases. We postulated this system might also mediate removal of molecules and membrane in healthy individuals. Surface expression of HMGs on RBCs from patients who had previously undergone splenectomy was therefore assessed: high levels were indeed observable as large membrane aggregates. Glycomic analysis by mass spectrometry identified a mixture of Man5‐9GlcNAc2 structures. HMG levels correlated well with manual pit counts (r = 0.75–0.85). To assess further whether HMGs might act as a splenic reticuloendothelial function test, we measured levels on RBCs from patients with potential functional hyposplenism, some of whom exhibited high levels that may indicate risk of complications. [ABSTRACT FROM AUTHOR]

Glycosylation can be a critical quality attribute in biologic manufacturing. In particular, it has implications on the half‐life, immunogenicity, and pharmacokinetics of therapeutic monoclonal antibodies (mAbs), and must be closely monitored throughout drug development and manufacturing. To address this, advances have been made primarily in upstream processing, including mammalian cell line engineering, to yield more predictably glycosylated mAbs and the addition of media supplements during fermentation to manipulate the metabolic pathways involved in glycosylation. A more robust approach would be a conjoined upstream–downstream processing strategy. This could include implementing novel downstream technologies, such as the use of Fc γ‐based affinity ligands for the separation of mAb glycovariants. This review highlights the importance of controlling therapeutic antibody glycosylation patterns, the challenges faced in terms of glycosylation during mAb biosimilar development, current efforts both upstream and downstream to control glycosylation and their limitations, and the need for research in the downstream space to establish holistic and consistent manufacturing processes for the production of antibody therapies. [ABSTRACT FROM AUTHOR]

Thinning and removal of woody vegetation is the first step in restoring ecosystem structure to systems altered by woody encroachment. However, pile burning—a common method of eliminating woody residue at restoration sites—can promote the establishment of exotic species and adversely impact soils and native vegetation via extreme soil heating. Despite its widespread use, pile burning effects remain poorly understood in oak woodlands compared to coniferous forests. We examined how pile burning influenced soil properties and herb‐layer recovery in a Midwestern, U.S. oak woodland undergoing restoration via exotic shrub removal, tree thinning, and prescribed burning. We quantified soil properties and passive vegetation recovery inside and adjacent to pile burn scars after 3 years, and tested whether native seed additions in year 1 increased native cover and reduced exotic cover in year 3. Bare ground cover, soil pH, and concentrations of P and Ca remained elevated 3 years after pile burning. In contrast, native cover, native richness, and floristic quality recovered to levels similar to adjacent control locations. Pile burning did not promote exotic invasions, increase inorganic forms of N, or alter patterns of the native cover of most growth forms. However, Carex species failed to reestablish in burn scars. Compared to passive recovery, seed additions increased native cover in burn scars and reduced exotic cover in adjacent control locations. Our results indicate that burn scars can naturally recover in oak woodland, but native seed additions may accelerate this process and improve restoration outcomes. [ABSTRACT FROM AUTHOR]

Background: Children and adolescents with mild to moderate chronic kidney disease (CKD) are at high risk for mild but persistent impairment in executive functions, which have been associated with low health‐related quality of life (HRQOL) among children and adolescents with chronic health conditions. However, no similar link has been established among children and adolescents with mild to moderate CKD. Given the essential role executive functions play in the development of adequate cognitive, emotional and social skills, it is essential to gain a clearer understating of the magnitude and attributes of executive functions and its link to HRQOL in order to inform appropriate medical and educational interventions for this patient population. Objective: The aim of this study is to examine the relationship between executive functions, socio‐emotional functioning and HRQOL in children and adolescents with mild to moderate CKD. Methods: A cross‐sectional design was used for this secondary data analysis of 199 children and adolescents (ages 6–17) with mild to moderate CKD from the United States and Canada who receive care at hospitals associated with the Chronic Kidney Disease in Children Study (CKiD). Results: The presence of impairment in executive functions and socio‐emotional functioning (internalizing problems) significantly predicted lower HRQOL after controlling for key covariates (i.e., maternal education, anaemia and hypertension). Further, internalizing problems partially mediated the relationship between executive functions and HRQOL such that impairment in executive functions predicted lower HRQOL directly and indirectly by contributing to higher internalizing problems, which further contributed to low HRQOL. Conclusion: This study underscores the importance of executive functions and socio‐emotional functioning in the manifestation of HRQOL. Given that HRQOL is potentially compromised for many children and adolescents with mild to moderate CKD, it will be important for both clinicians and researchers to examine a range of factors, including executive functions and socio‐emotional functioning, in order to optimize HRQOL. [ABSTRACT FROM AUTHOR]

This paper explores the critical roles of researchers in research involving vulnerable populations. Its purpose is to reflect on the complex nature of vulnerability of Bhutanese refugee women who had resettled in Australia involved in research looking at the barriers to accessing preventive cancer screening. First, we describe the vulnerabilities considered prior to the research study and the actions taken to protect participants while the study was conducted. Second, we discuss those vulnerabilities that we did not anticipate, but were subsequently revealed during the study and consequently included in the study findings. These vulnerabilities should be considered for future research involving similar populations. It is important for researchers to use appropriate research designs that enable the voice of vulnerable people to be heard and to use research strategies that ensure findings are robust and participants are protected and empowered. Potential implications include the development of research practices that take account of the sources of vulnerabilities and consideration of how different vulnerabilities can evolve and affect findings and research recommendations. [ABSTRACT FROM AUTHOR]

Objective: This project aims to prospectively and objectively assess otolaryngological manifestations and quality of life of children with primary ciliary dyskinesia (PCD) and compare these findings with healthy pediatric controls. Study Design: Cross-sectional. Setting: Two high-volume pediatric PCD specialty centers. Methods: Standardized clinical assessment; Sino-Nasal Outcome Test 22 (SNOT-22); Hearing Environment and Reflection Quality of Life (HEAR-QL); Reflux Symptom Index (RSI); standardized physical examination of the sinonasal, laryngeal, and otological systems; and investigations including pure-tone audiograms (PTAs) and sinonasal cultures were collected. Results: Forty-seven children with PCD and 25 control participants were recruited. Children with PCD had more upper airway symptoms than healthy children. They had significantly higher scores in both SNOT-22 and RSI, indicating worse sinonasal and reflux symptoms, with worse quality of life on the HEAR-QL index compared to healthy children (P <.05). Fifty-two percent of children with PCD-related hearing loss were not aware of their hearing deficit that was present on audiological assessment, and only 23% of children who had ventilation tubes had chronic otorrhea, most of which was easily controlled with ototopic drops. Furthermore, although all children with PCD had chronic rhinosinusitis, only 36% of them were using topical nasal treatment. The most common bacteria cultured from the middle meatus were Staphylococcus aureus in 11 of 47 (23%), followed by Streptococcus pneumoniae in 10 of 47 (21%). Conclusion: This multisite cohort highlights the importance of otolaryngology involvement in the management of children with PCD. More rigorous otolaryngological management may lead to reductions in overall morbidity and improve quality of life for children with PCD. [ABSTRACT FROM AUTHOR]