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The current United Nations Decade of Ocean Science for Sustainable Development (2021–2030; hereafter, the Decade) offers a unique opportunity and framework to globally advance ocean science and policy. Achieving meaningful progress within the Decade requires collaboration and coordination across Decade Actions (Programs, Projects, and Centres). This coordination is particularly important for the deep ocean, which remains critically under‐sampled compared to other ecosystems. Despite the limited sampling, the deep ocean accounts for over 95% of Earth's habitable space, plays a crucial role in regulating the carbon cycle and global temperatures, and supports diverse ecosystems. To collectively advance deep‐ocean science, we gathered representatives from 20 Decade Actions that focus at least partially on the deep ocean. We identified five broad themes that aim to advance deep‐ocean science in alignment with the Decade's overarching 10 Challenges: natural capital and the blue economy, biodiversity, deep‐ocean observing, best practices in data sharing, and capacity building. Within each theme, we propose concrete objectives (termed Cohesive Asks) and milestones (Targets) for the deep‐ocean community. Developing these Cohesive Asks and Targets reflects a commitment to better coordination across deep‐ocean Decade Actions. We aim to build bridges across deep‐ocean disciplines, which encompass natural science, ocean observing, policy, and capacity development. [ABSTRACT FROM AUTHOR]

Background: Responsive deep brain stimulation (rDBS) uses physiological signals to deliver stimulation when needed. rDBS is hypothesized to reduce stimulation‐induced speech effects associated with continuous DBS (cDBS) in patients with essential tremor (ET). Objective: To determine if rDBS reduces cDBS speech‐related side effects while maintaining tremor suppression. Methods: Eight ET participants with thalamic DBS underwent unilateral rDBS. Both speech evaluations and tremor severity were assessed across three conditions (DBS OFF, cDBS ON, and rDBS ON). Speech was analyzed using intelligibility ratings. Tremor severity was scored using the Fahn‐Tolosa‐Marin Tremor Rating Scale (TRS). Results: During unilateral cDBS, participants experienced reduced speech intelligibility (P = 0.025) compared to DBS OFF. rDBS was not associated with a deterioration of intelligibility. Both rDBS (P = 0.026) and cDBS (P = 0.038) improved the contralateral TRS score compared to DBS OFF. Conclusions: rDBS maintained speech intelligibility without loss of tremor suppression. A larger prospective chronic study of rDBS in ET is justified. © 2024 International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

Freshwater cyanobacterial harmful algal blooms (CHABs) are a well‐known global public health threat. Monitoring and early detection of CHAB toxins are currently accomplished using labor‐intensive sampling techniques and subsequent shore‐based analyses, with results typically reported 24–48 h after sample collection. We have developed and implemented an uncrewed, autonomous mobile sampler‐analytical system capable of conducting targeted in situ toxin measurements in < 2 h. A surface plasmon resonance (SPR) instrument was combined with the environmental sample processor (ESP) to fully automate detection and quantification of particle‐associated cyanobacterial microcystins (pMC). This sensor‐sampler system was integrated with a long‐range autonomous underwater vehicle (LRAUV) and deployed in western Lake Erie for field trials in the summer of 2021. The LRAUV was remotely piloted to acquire samples at selected locations within and adjacent to a CHAB. Sixteen pMC measurements ranging from 0.09 to 0.55 μg/L lake water were obtained over a 14‐day period without recovery of the LRAUV. The SPR/ESP/LRAUV system complements existing satellite, aerial, and manual sampling CHAB survey techniques, and could be used to enhance predictive models that underpin bloom and toxicity forecasts. This system is also extensible to detection of other algal toxins in freshwater and marine environments, with its near real‐time assessment of bloom toxin levels potentially offering additional socioeconomic benefits and public health protection in a variety of settings. [ABSTRACT FROM AUTHOR]

The Paleocene‐Eocene thermal maximum (PETM, 56 Ma) is an ancient global warming event closely coupled to the release of massive amounts of 13C‐depleted carbon into the ocean‐atmosphere system, making it an informative analogue for future climate change. However, uncertainty still exists regarding tropical sea‐surface temperatures (SSTs) in open ocean settings during the PETM. Here, we present the first paired δ13C:Mg/Ca record derived in situ from relatively well‐preserved subdomains inside individual planktic foraminifer shells taken from a PETM record recovered in the central Pacific Ocean at Ocean Drilling Program Site 865. The δ13C signature of each individual shell was used to confirm calcification during the PETM, thereby reducing the unwanted effects of sediment mixing that secondarily smooth paleoclimate signals constructed with fossil planktic foraminifer shells. This method of "isotopic screening" reveals that shells calcified during the PETM have elevated Mg/Ca ratios reflecting exceptionally warm tropical SSTs (∼33–34°C). The increase in Mg/Ca ratios suggests ∼6°C of warming, which is more congruent with SST estimates derived from organic biomarkers in PETM records at other tropical sites. These extremely warm SSTs exceed the maximum temperature tolerances of modern planktic foraminifers. Important corollaries to the findings of this study are (a) the global signature of PETM warmth was uniformly distributed across different latitudes, (b) our Mg/Ca‐based SST record may not capture peak PETM warming at tropical Site 865 due to the thermally‐induced ecological exclusion of planktic foraminifers, and (c) the record of such transitory ecological exclusion has been obfuscated by post‐depositional sediment mixing at Site 865. Plain Language Summary: The Paleocene‐Eocene thermal maximum (PETM, about 56 million years ago) is a global warming event that is widely regarded as an ancient analogue for climate change being driven by the current rise in atmospheric carbon dioxide (CO2) levels. Accurate measurements of PETM warmth in the tropical oceans are crucial to validating climate model simulations and gauging the effect of global warming on oceanic ecosystems. However, chemical analyses of marine microfossils (foraminifera) typically yield tropical sea surface temperatures (SSTs) for the PETM that are cooler than those computed by climate models. Primary reasons for this discrepancy are poor preservation of the foraminifer shells and displacement of shells from the cooler pre‐PETM interval into overlying PETM sediments via sediment mixing processes. Here, we use in situ microanalytical techniques to measure both the carbon isotope composition (δ13C) and Mg/Ca ratio within the same individual shells. The δ13C values of shells were used to identify displaced pre‐PETM specimens with higher, background δ13C ratios and exclude them from our Mg/Ca‐based temperature record. Our new "isotopically filtered" Mg/Ca‐based temperature record suggests ∼6°C of warming in the tropical Pacific, with SSTs (33–34°C) likely exceeding the maximum temperature tolerances of many calcifying plankton during the PETM. Key Points: Microanalytical techniques used to measure paired δ13C and Mg/Ca ratios in individual foraminifer shells from a pelagic Paleocene‐Eocene thermal maximum (PETM) recordδ13C values of individual foraminifers used to identify and exclude reworked non‐PETM specimens from Mg/Ca‐based sea‐surface temperature (SST) recordUnmixed Mg/Ca‐based temperature record indicates tropical SSTs increased by ∼6°C in central Pacific Ocean during PETM [ABSTRACT FROM AUTHOR]

Objectives: To describe the diagnostic tests used and their comparative performance in dogs diagnosed with sinonasal aspergillosis in the United Kingdom. A secondary objective was to describe the signalment, clinical findings and common clinicopathologic abnormalities in sinonasal aspergillosis. Materials and Methods: A multi‐centre retrospective survey was performed involving 23 referral centres in the United Kingdom to identify dogs diagnosed with sinonasal aspergillosis from January 2011 to December 2021. Dogs were included if fungal plaques were seen during rhinoscopy or if ancillary testing (via histopathology, culture, cytology, serology or PCR) was positive and other differential diagnoses were excluded. Results: A total of 662 cases were entered into the database across the 23 referral centres. Four hundred and seventy‐five cases met the study inclusion criteria. Of these, 419 dogs had fungal plaques and compatible clinical signs. Fungal plaques were not seen in 56 dogs with turbinate destruction that had compatible clinical signs and a positive ancillary test result. Ancillary diagnostics were performed in 312 of 419 (74%) dogs with observed fungal plaques permitting calculation of sensitivity of cytology as 67%, fungal culture 59%, histopathology 47% and PCR 71%. Clinical Significance: The sensitivities of ancillary diagnostics in this study were lower than previously reported challenging the clinical utility of such tests in sinonasal aspergillosis. Treatment and management decisions should be based on a combination of diagnostics including imaging findings, visual inspection, and ancillary testing, rather than ancillary tests alone. [ABSTRACT FROM AUTHOR]

Objectives: Low‐profile cystostomy tubes provide an alternative to conventional cystostomy tubes with external tubing. Previously, these have been placed surgically involving coeliotomy, cystotomy and cystopexy, or have been used as replacement tubes in existing stoma sites. The purpose of this study is to describe a technique for, and the outcomes of, single‐step, non‐surgical low‐profile cystostomy tube placement. Materials and Methods: All cases that had single‐step, non‐surgical placement of low‐profile cystotomy tube attempted at the authors' institutions were included in this study. Data, including success rates, outcomes and complications, were extracted from the medical records. Results: Ten client‐owned dogs were inclided. Single‐step, non‐surgical placement was successful in eight out of 10 dogs, with placement being unsuccessful in two thus necessitating coeliotomy. The median duration that low‐profile cystostomy tubes were in place was 7.0 months (range 4 days to 38 months). Seven of the eight dogs required replacement of their cystostomy tube. Mean time until first tube replacement was 103 days (range 13 to 363 days). Clinical Significance: Single‐step, non‐surgical placement of a low‐profile cystostomy tube is a viable alternative to surgical placement. Lack of cystopexy does not appear to result in complications. Conversion to coeliotomy might be required if tube placement is not successful with this technique. Complications seen with non‐surgical tube placement such as inadvertent tube removal were similar to those previously reported for surgically placed tubes. [ABSTRACT FROM AUTHOR]

Cyanobacterial harmful algal blooms (CyanoHABs) in the Great Lakes pose risks to residential drinking water use, fisheries, and recreation. Active mitigation of these risks requires rapid detection of CyanoHABs and quantification of the toxins they produce. Here, we present a method of using a long‐range autonomous underwater vehicle (LRAUV) equipped with a 3rd‐generation Environmental Sample Processor (3G‐ESP) to search for and adaptively sample areas of high chlorophyll potentially representative of CyanoHAB biomass. In August 2021, this method was used in western Lake Erie. The experiment highlighted the effectiveness of the LRAUV autonomous search‐and‐sample methodology, and demonstrated how an interdisciplinary team located in different states virtually coordinated LRAUV operations and directed sampling activities via Internet connectivity using shared, web‐based situational awareness tools. The advancements made provide a foundation for future work to increase LRAUV autonomy and adaptiveness for CyanoHAB studies and monitoring in both freshwater and marine settings. [ABSTRACT FROM AUTHOR]

Background: Pediatric acute myeloid leukemia (AML) chemotherapy increases the risk of life‐threatening complications, including septic shock (SS). An area‐based measure of social determinants of health, the social disorganization index (SDI), was hypothesized to be associated with SS and SS‐associated death (SS‐death). Methods: Children treated for de novo AML on two Children's Oncology Group trials at institutions contributing to the Pediatric Health Information System (PHIS) database were included. The SDI was calculated via residential zip code data from the US Census Bureau. SS was identified via PHIS resource utilization codes. SS‐death was defined as death within 2 weeks of an antecedent SS event. Patients were followed from 7 days after the start of chemotherapy until the first of end of front‐line therapy, death, relapse, or removal from study. Multivariable‐adjusted Cox regressions estimated hazard ratios (HRs) comparing time to first SS by SDI group. Results: The assembled cohort included 700 patients, with 207 (29.6%) sustaining at least one SS event. There were 233 (33%) in the SDI‐5 group (highest disorganization). Adjusted time to incident SS did not statistically significantly differ by SDI (reference, SDI‐1; SDI‐2: HR, 0.84 [95% confidence interval (CI), 0.51–1.41]; SDI‐3: HR, 0.70 [95% CI, 0.42–1.16]; SDI‐4: HR, 0.97 [95% CI, 0.61–1.53]; SDI‐5: HR, 0.72 [95% CI, 0.45–1.14]). Nine patients (4.4%) with SS experienced SS‐death; seven of these patients (78%) were in SDI‐4 or SDI‐5. Conclusions: In a large, nationally representative cohort of trial‐enrolled pediatric patients with AML, there was no significant association between the SDI and time to SS. Time to first septic shock event was not associated with the social disorganization index (SDI), an area‐based measure of social determination of health, in children with acute myeloid leukemia treated on two Children's Oncology Group trials. Septic shock–associated mortality is rare in children with acute myeloid leukemia, and differences by SDI were not able to be detected. [ABSTRACT FROM AUTHOR]

Background: Despite the widespread implementation of telemedicine, there are limited data regarding its impact on key components of care for patients with incurable or high‐risk cancer. For these patients, high‐quality care requires detailed conversations regarding treatment priorities (advance care planning) and clinical care to minimize unnecessary acute care (unplanned hospitalizations). Whether telemedicine affects these outcomes relative to in‐person clinic visits was examined among patients with cancer at high risk for 6‐month mortality. Methods: This retrospective cohort study included adult patients with cancer with any tumor type treated at the University of Pennsylvania who were newly identified between April 1 and December 31, 2020, to be at high risk for 6‐month mortality via a validated machine learning algorithm. Separate modified Poisson regressions were used to assess the occurrence of advance care planning and unplanned hospitalizations for telemedicine as compared to in‐person visits. Additional analyses were done comparing telemedicine type (video or phone) as compared to in‐person clinic visits. Results: The occurrence of advance care planning was similar between telemedicine and in‐person visits (6.8% vs. 6.0%; adjusted risk ratio [aRR], 1.25; 95% CI, 0.92–1.69). In regard to telemedicine subtype, patients exposed to video encounters were modestly more likely to have documented advance care planning in comparison to those seen in person (7.5% vs. 6.0%; aRR, 1.48; 95% CI, 1.03–2.11). The 3‐month risk for unplanned hospitalization was comparable for telemedicine compared to in‐person clinic encounters (21% vs. 18%; aRR, 1.06; 95% CI, 0.81–1.38). Conclusions: In this study, care delivered by telemedicine, compared to in‐person clinic visits, produced comparable rates of advance care planning conversations without increasing hospitalizations, which suggests that vulnerable patients can be managed safely by telemedicine. In this study, care delivered by telemedicine, compared to in‐person clinic visits, produced comparable rates of advance care planning conversations without increasing hospitalizations, which suggests that vulnerable patients can be managed safely by telemedicine. [ABSTRACT FROM AUTHOR]

Purpose: Two‐dimensional radiotherapy is often used to treat cervical cancer in low‐ and middle‐income countries, but treatment planning can be challenging and time‐consuming. Neural networks offer the potential to greatly decrease planning time through automation, but the impact of the wide range of hyperparameters to be set during training on model accuracy has not been exhaustively investigated. In the current study, we evaluated the effect of several convolutional neural network architectures and hyperparameters on 2D radiotherapy treatment field delineation. Methods: Six commonly used deep learning architectures were trained to delineate four‐field box apertures on digitally reconstructed radiographs for cervical cancer radiotherapy. A comprehensive search of optimal hyperparameters for all models was conducted by varying the initial learning rate, image normalization methods, and (when appropriate) convolutional kernel size, the number of learnable parameters via network depth and the number of feature maps per convolution, and nonlinear activation functions. This yielded over 1700 unique models, which were all trained until performance converged and then tested on a separate dataset. Results: Of all hyperparameters, the choice of initial learning rate was most consistently significant for improved performance on the test set, with all top‐performing models using learning rates of 0.0001. The optimal image normalization was not consistent across architectures. High overlap (mean Dice similarity coefficient = 0.98) and surface distance agreement (mean surface distance < 2 mm) were achieved between the treatment field apertures for all architectures using the identified best hyperparameters. Overlap Dice similarity coefficient (DSC) and distance metrics (mean surface distance and Hausdorff distance) indicated that DeepLabv3+ and D‐LinkNet architectures were least sensitive to initial hyperparameter selection. Conclusion: DeepLabv3+ and D‐LinkNet are most robust to initial hyperparameter selection. Learning rate, nonlinear activation function, and kernel size are also important hyperparameters for improving performance. [ABSTRACT FROM AUTHOR]

Wastewater‐based surveillance can be used as an early warning system to identify COVID‐19 outbreaks because the viral load can be observed in sewage before it is clinically verified. Wastewater surveillance of SARS‐CoV‐2 can trace the transmission dynamics of infection in communities when using the scale of a wastewater diversion and treatment system. Using this early detection method can help protect human health and mitigate socio‐economic losses. It can help quantify the epidemiological data of a given population in real‐time and circumvent the need for other epidemiological indicators. There are challenges in using this technique in areas with underdeveloped sewerage infrastructure. It is especially the case in developing nations where uniform protocols for viral detection are lacking, and wastewater is heterogeneous because of environmental and operational conditions. This article explains the need for and importance of wastewater‐based surveillance for SARS‐CoV‐2. It lays out the most recent methodological approaches for detecting SARS‐CoV‐2 in municipal wastewater and outlines the main challenges associated with wastewater‐based epidemiology (WBE). The article includes a case study of surveillance work across India to demonstrate how a developing nation manages research and locational challenges. The socio‐economic, ethical, and policy dimensions of WBE for SARS‐CoV‐2 are also discussed. This article is categorized under:Engineering Water > Water, Health, and SanitationEngineering Water > Sustainable Engineering of WaterEngineering Water > Methods [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the lived experiences of grandparents raising their grandchildren with foetal alcohol spectrum disorder (FASD). Specifically, we sought to identify how caregivers make meaning of their experience, what challenges are faced by grandparents while raising a second generation and what positive experiences are encountered. Ten grandparents raising a child with FASD in Ontario, Canada, participated in semi‐structured interviews. Interpretative phenomenological analysis was used to analyse the interviews to determine reoccurring themes. Three main themes were identified: (i) challenges when raising a grandchild with FASD, including kinship adoption struggles and intergenerational issues; (ii) worries about the future, including financial planning and health concerns; and (iii) rewards, such as shifts in priorities and the opportunity to raise a second generation. Grandparents raising their grandchildren with FASD face challenges and thus require specific supports so that they may adequately provide a safe and nurturing home environment for children with often challenging learning and social needs. [ABSTRACT FROM AUTHOR]

The current study aims to apply a staged approach to document heterogeneity in discussions in mentoring relationships, chiefly, discussion topics from weekly mentoring sessions with undergraduate women mentors (n = 40), then link each of the eight topics (relationships with friends, family, teachers, and romantic relationships, as well as goals, academic skills, academic problems, and hopes for the future) to developmental outcomes for middle school girls (n = 41) who participated in a school‐based mentoring program. In doing so, the authors hope to better understand the mechanisms that influence variability in mentoring treatment effects. Mentoring dyads engaged in unstructured one‐on‐one sessions and structured group meetings across the 2018−2019 academic year. The primary predictors for this study are weekly mentor‐reported discussion topics and activities addressed during unstructured one‐on‐one mentoring sessions, with 11 social‐emotional, academic, and behavioral outcomes measured via pre‐ and postsurveys administered by research assistants to mentees during the fall and spring. A series of 11 path analyses indicate small to moderate associations, both beneficial and negative, between key discussion topics, such as hopes for the future, family relationships, and goals, and several mentee‐reported outcomes of interest at the end of the intervention, including extrinsic motivation, life satisfaction, and self‐esteem. Study findings provide information about heterogeneity in mentoring practices to inform how various mechanisms of mentoring (e.g., discussions focused on relationships, goals and skills, and strengths) influence developmentally‐relevant effects for youth. [ABSTRACT FROM AUTHOR]

Research shows comorbidity between posttraumatic stress symptoms (PTSS) and externalizing problems among polyvictimized youth. However, the impact of polyvictimization on the longitudinal co‐development of PTSS and distinct forms of externalizing problems remains unclear. Growth trajectory modeling was used to address this gap. At ages 8, 12, and 16, polyvictimization was measured using youth, caregiver, and official records; whereas youth self‐reported PTSS and caregivers reported aggression and delinquency. Results demonstrate that changes in PTSS and each externalizing domain were independent. Further, polyvictimization and PTSS/aggression were only associated at concurrent time points. In contrast, polyvictimization and delinquency were generally associated at concurrent and distal time points, suggesting that polyvictimization may have a more enduring impact on youths' delinquent behaviors than other symptoms. [ABSTRACT FROM AUTHOR]

Aims: Guidelines for the management of heart failure (HF) are evolving, and increasing emphasis is placed on patient‐centred care. As part of the REWOLUTION HF (REal WOrLd EdUcaTION in HF) programme, we conducted two international surveys aimed at assessing healthcare professionals' (HCPs) educational needs and patients' perspectives on the care of HF. Methods and results: Anonymous online questionnaires co‐developed by HF experts and patients assessed HCPs' educational needs (520 respondents, mostly cardiologists, in 67 countries) and patients' perceptions on HF impact and management (98 respondents in 18 countries). Among HCPs, 62.7% prioritized rapid initiation of all guideline‐mandated medications over up‐titration of some medications, and 87.7% always or frequently discussed treatment goals with patients. There was good agreement between HCPs and patients on key treatment goals, except for a greater emphasis on reducing hospitalizations among HCPs. The most frequently cited barriers to the provision of guideline‐recommended pharmacological therapy were treatment side effects/intolerance, complex treatment regimens, low blood pressure, cost/reimbursement issues, and low estimated glomerular filtration rate. Most patients (81.6%) reported no difficulties taking medications as prescribed, although 21.4% felt they were taking too many pills. Patients wanted more information about HF and its consequences, prognosis, and treatments (70.4%, 74.5% and 76.6%, respectively). Cardiologists were the preferred source of information about HF, followed by general practitioners and HF nurses. Conclusions: These surveys provide valuable insights into HCPs' needs about personalized care for patients with HF, as well as patients' perceptions, expectations and preferences. These findings will be helpful to develop patient‐centred, needs‐driven quality improvement programmes. [ABSTRACT FROM AUTHOR]

Background: Young adults experiencing homelessness (YAEH) experience more stressors compared to housed peers, yet little is known about the impact of the COVID‐19 pandemic on these youth. The purpose of this qualitative study was to explore how YAEH perceived the pandemic's impact on their well‐being and coping. Methods: YAEH were recruited from those participating in an HIV prevention study. Semi‐structured interviews were conducted and analysis was guided by Lazarus and Folkman's transactional theory of stress and coping. Results: Four major themes were identified from interviews with 40 youth: (1) ongoing harms, (2) COVID‐19 as a stressor, (3) mental health impacts, and (4) coping strategies. Participants described unmet basic needs, emotions of frustration and anxiety, and several coping strategies including substance use. Conclusion: Many YAEH reported experiencing continued challenges that were compounded by the stressors related to the COVID‐19 pandemic. Special considerations are needed to address pandemic‐related exacerbations of mental health symptoms and substance use among YAEH. [ABSTRACT FROM AUTHOR]

We examined data from a nationally implemented mentoring program over a 4‐year period, to identify demographic and relationship characteristics associated with premature termination. Data were drawn from a sample of 82,224 mentor and mentees. We found matches who reported shared racial or ethnic identities were associated with lower likelihood of premature termination as was mentee's positive feelings of the relationship. We also found that, if data were used as a screening tool, the data were suboptimal for accuracy classifying premature closure with sensitivity and specificity values equal to 0.43 and 0.75. As programs and policymakers consider ways to improve the impact of mentoring programs, these results suggest programs consider the types of data being collected to improve impact of care. Highlights: Mentors and mentees sharing racial identity had a lower risk of premature termination.The quality of the mentoring relationship was, on average, associated with premature termination.The quality of an individual mentoring relationship did not predict premature termination. [ABSTRACT FROM AUTHOR]

Background: Despite the nearly ubiquitous reported use of peer review among reputable medical journals, there is limited evidence to support the use of peer review to improve the quality of biomedical research and in particular, imaging diagnostic test accuracy (DTA) research. Purpose: To evaluate whether peer review of DTA studies published by imaging journals is associated with changes in completeness of reporting, transparency for risk of bias assessment, and spin. Study Type: Retrospective cross‐sectional study. Study Sample: Cross‐sectional study of articles published in Journal of Magnetic Resonance Imaging (JMRI), Canadian Association of Radiologists Journal (CARJ), and European Radiology (EuRad) before March 31, 2020. Assessment: Initial submitted and final versions of manuscripts were evaluated for completeness of reporting using the Standards for Reporting Diagnostic Accuracy Studies (STARD) 2015 and STARD for Abstracts guidelines, transparency of reporting for risk of bias assessment based on Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS‐2), and actual and potential spin using modified published criteria. Statistical Tests: Two‐tailed paired t‐tests and paired Wilcoxon signed‐rank tests were used for comparisons. A P value <0.05 was considered to be statistically significant. Results: We included 84 diagnostic accuracy studies accepted by three journals between 2014 and 2020 (JMRI = 30, CARJ = 23, and EuRad = 31) of the 692 which were screened. Completeness of reporting according to STARD 2015 increased significantly between initial submissions and final accepted versions (average reported items: 16.67 vs. 17.47, change of 0.80 [95% confidence interval 0.25–1.17]). No significant difference was found for the reporting of STARD for Abstracts (5.28 vs. 5.25, change of −0.03 [−0.15 to 0.11], P = 0.74), QUADAS‐2 (6.08 vs. 6.11, change of 0.03 [−1.00 to 0.50], P = 0.92), actual "spin" (2.36 vs. 2.40, change of 0.04 [0.00 to 1.00], P = 0.39) or potential "spin" (2.93 vs. 2.81, change of −0.12 [−1.00 to 0.00], P = 0.23) practices. Conclusion: Peer review is associated with a marginal improvement in completeness of reporting in published imaging DTA studies, but not with improvement in transparency for risk of bias assessment or reduction in spin. Level of Evidence: 3 Technical Efficacy Stage: 1 [ABSTRACT FROM AUTHOR]

Prior studies have shown that parent and adolescent cortisol are associated across days and that this covariation may be adolescent‐driven. This study extends this literature by (a) testing whether parents' cognitive interference (i.e., distracting and ruminative thoughts potentially due to worry) mediates the linkages between adolescent and next‐day parent cortisol and (b) whether these linkages were moderated by parent gender or warmth. Daily diary data, including bedtime cortisol, were collected on two samples of employees and their adolescent‐aged children (N = 318 dyads, Myouth age = 13.18 years, 74% mothers). We tested mediation with autoregressive cross‐lagged models. Moderated mediation by parent gender was found in our bedtime cortisol models. Higher adolescent bedtime cortisol levels were associated with higher next‐day levels of mothers' cognitive interference. In turn, higher levels of mothers' cognitive interference were linked to higher mothers' same‐day bedtime cortisol levels. These linkages were not significant for fathers. Cognitive interference did not mediate the associations between child and parent area under the curve or cortisol awakening response. No moderation was evident for parental warmth. Results suggest that mothers' cognitions play a key role in the transmission of elevated bedtime cortisol levels from adolescents to their mothers. [ABSTRACT FROM AUTHOR]

Although the rates of disease gene discovery have steadily increased with the expanding use of genome and exome sequencing by clinical and research laboratories, only ~16% of genes in the genome have confirmed disease associations. Here we describe our clinical laboratory's experience utilizing GeneMatcher, an online portal designed to promote disease gene discovery and data sharing. Since 2016, we submitted 246 candidates from 243 unique genes to GeneMatcher, of which 111 (45%) are now clinically characterized. Submissions meeting our candidate gene‐reporting criteria based on a scoring system using patient and molecular‐weighted evidence were significantly more likely to be characterized as of October 2021 versus genes that did not meet our clinical‐reporting criteria (p = 0.025). We reported relevant findings related to these newly characterized gene–disease associations in 477 probands. In 218 (46%) instances, we issued reclassifications after an initial negative or candidate gene (uncertain) report. We coauthored 104 publications delineating gene–disease relationships, including descriptions of new associations (60%), additional supportive evidence (13%), subsequent descriptive cohorts (23%), and phenotypic expansions (4%). Clinical laboratories are pivotal for disease gene discovery efforts and can screen phenotypes based on genotype matches, contact clinicians of relevant cases, and issue proactive reclassification reports. [ABSTRACT FROM AUTHOR]

Access to genetic testing, namely, diagnostic exome sequencing (DES), has significantly improved, subsequently increasing the likelihood of discovering incidental findings, such as misattributed relationships and specifically misattributed parentage (MP). Until the recently published ACMG statement, there had been no consensus for laboratories and clinicians to follow when addressing such findings. Family‐based genomic testing is valuable for accurate variant interpretation but has the potential to uncover misattributed familial relationships. Here, we present the first published data on the frequency of MP identified through DES at a clinical laboratory. We also investigated clinicians' decisions on how to proceed with analysis, reporting, and disclosure. A database of 6,752 families who underwent parent‐proband ('trio') DES was retrospectively reviewed for molecular identification of MP and clinicians' MP disclosure decisions. Among 6,752 trios, 39 cases of MP were detected (0.58%). Non‐paternity was detected in all cases, and in one instance, non‐maternity was also identified. All clinicians decided to proceed by omitting the MP individual from the analysis. Clinicians chose to proceed with duo analysis (87.2%), modify information on the report (74.4%), and communicate MP results to the mother (71.8%), suggesting a trend toward not disclosing to the putative father or proband. The data show that trio DES involves a chance of detecting MP and that clinician disclosure practices do not appear to routinely include direct disclosure to the putative father. MP identified in our parent‐proband trios sent in for DES is lower than the reported frequency of MP in the general population due in part to ascertainment bias as families with known or suspected MP are presumably less likely to pursue trio testing. These data may inform laboratory policies and clinician practices for addressing incidental findings such as MP. [ABSTRACT FROM AUTHOR]

Objectives: To describe clinical signs, diagnostics, treatments and outcomes of prostatitis and prostatic abscesses of dogs in a referral population. Animals: Eighty‐two dogs diagnosed with prostatitis and/or prostatic abscesses from three referral hospitals. Procedures: Retrospective case series. Results: A total of 82 dogs were included, and the median age was nine years. Acute prostatitis was diagnosed in 63% of cases, chronic prostatitis in 37% of cases and 40% of cases had prostatic abscessation. Prostatomegaly was the most common ultrasonographic finding. Mineralisation was identified in 20% of cases. The results of urine and prostatic bacterial culture were concordant in only 50% of cases. Antimicrobial resistance was encountered commonly, with 29% of cultures resistant to one antimicrobial and 52% resistant to two or more antimicrobials. Abscesses were treated with either antimicrobials alone, ultrasound‐guided needle drainage or surgical drainage. Conclusions and clinical relevance: With antimicrobial treatment and castration, the prognosis for canine prostatitis appears good. Prostatic abscessation is commonly encountered and does not appear to infer a worse prognosis and antimicrobials alone, ultrasound‐guided needle drainage and surgical drainage all appear to be reasonable treatment options. Antimicrobial resistance is commonly encountered, and the results of urine culture and susceptibility testing are frequently discordant with those from samples from the prostate. Sampling of the prostate is required to confirm a diagnosis and exclude other pathologies such as neoplasia, particularly as mineralisation is seen in a reasonable number of cases of dogs with prostatitis. [ABSTRACT FROM AUTHOR]

Background: Timely targeted treatment initiation can be challenging because additional biomarker testing is needed for eligibility. The authors hypothesized that timely targeted treatment improves survival relative to nontimely initiation in metastatic HER2+ gastroesophageal adenocarcinoma (GEA). Methods: The authors performed a retrospective cohort study of metastatic HER2+ GEA treated with first‐line (1L) systemic therapy from January 2011 to December 2017 using a nationwide electronic health record–derived deidentified database. Timely targeted treatment—trastuzumab initiation within 14 days after starting 1L chemotherapy—was assessed as a time‐varying exposure. Nontimely targeted treatment included patients who initiated trastuzumab after 14 days or who lacked documentation of receiving trastuzumab. Extended Cox regressions compared overall survival (OS) and progression‐free survival (PFS) between timely and nontimely groups. Results: A total of 320 patients were included; 59.1% received timely trastuzumab. Relative to nontimely initiation, timely trastuzumab was associated with significantly higher OS (2‐year OS, 32.1% vs 15.3%; adjusted hazard ratio [HR], 0.67; 95% CI, 0.51‐0.88) and PFS (2‐year PFS, 9.2% vs 3.7%; adjusted HR, 0.71; 95% CI, 0.55‐0.93). Results remained similar in sensitivity analyses 1) using alternative "timeliness" definitions up to 70 days after starting 1L chemotherapy, 2) comparing any trastuzumab, regardless of timing of initiation, to no trastuzumab, and 3) excluding patients lacking documentation of receiving trastuzumab. Conclusions: Improved survival was observed among metastatic HER2+ GEA patients treated with trastuzumab versus those who were not, regardless of timing of initiation. Although these results reassure clinicians that modest targeted treatment delays may not be detrimental to outcomes, efforts should still ensure that all metastatic HER2+ GEA patients receive trastuzumab. Time‐to‐treatment initiation is an important quality metric in oncology, but there is a paucity of data on the impact of timely targeted treatment for which additional biomarker testing is needed to identify eligible patients. In this study of patients with metastatic HER2‐overexpressing gastroesophageal adenocarcinoma, overall and progression‐free survival rates were higher for patients treated with trastuzumab compared to those who were not, regardless of the timing of initiation. [ABSTRACT FROM AUTHOR]

Non‐inflammatory joint effusion with characteristically increased synovial fluid viscosity is a rare but well‐recognised rheumatic manifestation of hypothyroidism in people and based on the literature search, this is the first report of the condition in dogs. A 2‐year‐old Pyrenean Mountain dog presented for lameness and multiple joint effusions. CT confirmed effusions affecting multiple limb joints along with delayed closure of multiple physes. Synovial fluid analysis from the effused joints showed no evidence of inflammation but the fluid viscosity was markedly increased. Serum total thyroxine concentration was decreased, thyroid‐stimulating hormone concentration was increased and antithyroglobulin autoantibody measurement returned a positive result. Oral levothyroxine supplementation resulted in relatively rapid and complete resolution of the clinical signs, in association with attaining a euthyroid state. Follow‐up examination and CT six months later confirmed resolution of the joint effusions and significant improvement or resolution of the other documented skeletal changes. [ABSTRACT FROM AUTHOR]

Background: Both short and long interpregnancy intervals (IPIs) have been associated with adverse birth outcomes. We undertook a multistate study to describe the prevalence of selected birth defects by IPI. Methods: We obtained data from nine population‐based state birth defects registries for singleton live births in 2000–2009 among mothers with a previous live birth identified through birth certificates. IPI was calculated as the difference between prior birthdate and start of the current pregnancy (conception date). We estimated prevalence of selected defects per 10,000 live births and prevalence ratios (PRs) with 95% confidence intervals (CIs) overall and stratified by maternal age at previous birth and race/ethnicity. Primary analyses focused on short IPI < 6 months and long IPI ≥ 60 months compared to 18–23 months (referent). Sensitivity analyses limited to active‐surveillance states and those with<10% missing IPI. Results: Among 5,147,962 eligible births, 6.3% had short IPI while 19.8% had long IPI. Compared to referent, prevalence with short IPI was elevated for gastroschisis (3.7, CI: 3.0–4.5 vs. 2.0, CI: 1.6–2.4) and with both short and long IPI for tetralogy of Fallot (short: 3.4, 2.8–4.2 long: 3.8, 3.4–4.3 vs. 2.7, 2.3–3.2) and cleft lip ± palate (short: 9.9, 8.8–11.2 long: 9.2, 8.5–9.8 vs. 8.4, 7.6–9.2). Stratified analyses identified additional associations, including elevated prevalence of anencephaly with short IPI in younger mothers and limb defects with long IPI in those ages 25–34 at prior birth. Sensitivity analyses showed similar results. Conclusion: In this population‐based study, we observed increased prevalence of several birth defects with short and long IPI. [ABSTRACT FROM AUTHOR]

Objective: Treat‐to‐target (T2T) and shared decision‐making are valued features of current guidelines for rheumatoid arthritis (RA) management. Although T2T has demonstrated value for improving RA outcomes, implementation remains inconsistent and lacks standardization and procedures for including patient input. We sought to better understand the impact of shared decisions on T2T and how treatment goal discussions between patients and providers impact RA treatment improvement and satisfaction. Methods: An anonymous, web‐based questionnaire was presented to United States residents aged 18 years or older with a self‐reported diagnosis of RA by a medical professional with 28 questions regarding socio‐demographics, RA disease activity (DA), diagnosis, treatments, outcomes, and goals. Analyses included descriptive statistics with χ2 and rank sum tests for comparisons. Results: The questionnaire was completed by 907 people (mean age of 58 years; mean 11 years since diagnosis; 90% female). The majority (571; 63%) did not discuss RA treatment goals with providers. Patients engaging in treatment goal discussions with their providers were three times more likely to be satisfied with their treatment plans. Patients discussing treatment goals with their providers were more likely to have improved DA levels and 68% more likely to reach remission. Conclusion: A majority of patients with RA report having no treatment goal discussion with their providers; however, these discussions are associated with greater DA improvement and treatment satisfaction. Further research should seek understanding of how shared treatment goal discussions relate to successful RA management and explore the development of practical tools to implement them in regular clinic practice as part of a T2T regimen. [ABSTRACT FROM AUTHOR]

For many years, researchers have explored the complex challenges experienced by individuals with fetal alcohol spectrum disorder (FASD). This research has been important for documenting the brain‐ and body‐based impacts of prenatal alcohol exposure and the psychosocial vulnerabilities and environmental adversities frequently associated with FASD. It has also supported advocacy efforts and highlighted the necessity of providing FASD services and supports. However, with the focus on deficits and needs, there is a considerable gap in the literature on the strengths and successes of individuals with FASD. The lack of strengths‐based FASD research has likely perpetuated the stress and stigma experienced by individuals with FASD and their families. Thus, there is a critical need to shift the direction of the field. Here we provide a narrative review of the literature on strengths in FASD. Our goals are to: (1) understand the state of strengths‐based research related to individuals with FASD across the lifespan, and (2) describe positive characteristics, talents, and abilities of individuals with FASD that may be cultivated to promote their fulfillment and well‐being. We identified a total of 19 studies, most of which were conducted to explore the lived experiences of adults with FASD. This preliminary but critical body of evidence highlights the intrinsic strengths of individuals with FASD, including strong self‐awareness, receptiveness to support, capacity for human connection, perseverance through challenges, and hope for the future. Despite the importance of this emerging evidence, appraisal of the literature indicates a need for more intentional, methodologically rigorous, participatory, and theory‐driven research in this area. Findings from this study, including the identified gaps in the literature, can be used to inform research, practice, and policy to meaningfully advance the field of FASD and promote positive outcomes in this population. [ABSTRACT FROM AUTHOR]

Summary: Emerging evidence indicates that industrially produced endocrine‐disrupting chemicals (EDCs) may be as obesogenic as poor dietary patterns and should be considered in obesity prevention policies. The authors conducted two reviews: (a) a systematic search of four electronic databases for papers published since January 2010 to identify the policy recommendations contained in scientific reviews of EDC exposure and obesity risk and (b) a narrative review of obesity policy documents published since January 2012 to identify the recommendations of national and international agencies. A search of four electronic databases found 63 scientific reviews with policy recommendations, of which 26 suggested individual responsibility to avoid exposure, 11 suggested medical interventions to counter the effects of exposure, and 42 suggested regulatory control of hazardous chemicals. Of sixty policy documents examined, six mentioned pollutants as a possible risk factor for obesity, and only one made explicit reference to strategies for reducing exposure to EDCs. The UN Sustainable Development Goals include targets to prevent ill health from hazardous chemicals (Targets 3.9 and 12.4) and to remove unsafe industrial chemicals from the environment (Targets 6.3, 11.6, 12.4, and 14.1). The authors suggest these should be explicitly linked to World Health Assembly targets to halt the rise in obesity. [ABSTRACT FROM AUTHOR]

Background: Early and accurate diagnosis of systemic amyloidosis (SA) is critical for optimal patient outcomes. Biopsy of clinically uninvolved skin and subcutaneous tissue including abdominal skin punch biopsy (ASPB) is often used as a surrogate for affected organ sampling. There is a lack of published data on the sensitivity and specificity of ASPB for diagnosing SA. Methods: Retrospective chart review between 2000 and 2020 of all ASPB was performed to diagnose SA. Amyloid deposition was confirmed by Congo red stain. Study group includes patients with histopathologically and clinically confirmed diagnosis of SA. Control group includes patients without histopathology of amyloid deposition and no clinical SA. Results: Forty‐one patients meeting inclusion criteria were analyzed; 23 study group and 18 control group patients. The overall diagnostic sensitivity of ASPB was 43% (95% CI 23%‐66%) and the specificity 100% (95% CI 81%‐100%). The AL amyloidosis diagnostic sensitivity was 64% (95% CI 35%‐87%). ASPB >10 mm in depth had 100% (95% CI 54%‐100%) sensitivity compared to 24% for depth ≤10 mm (P =.002). Conclusions: ASPB is a minimally invasive and highly specific method of diagnosing SA. It is particularly sensitive for diagnosing AL amyloidosis and the diagnostic sensitivity can be significantly improved with adequate biopsy depth and diameter. [ABSTRACT FROM AUTHOR]

DNA metabarcoding is an important tool for molecular ecology. However, its effectiveness hinges on the quality of reference sequence databases and classification parameters employed. Here we evaluate the performance of MiFish 12S taxonomic assignments using a case study of California Current Large Marine Ecosystem fishes to determine best practices for metabarcoding. Specifically, we use a taxonomy cross‐validation by identity framework to compare classification performance between a global database comprised of all available sequences and a curated database that only includes sequences of fishes from the California Current Large Marine Ecosystem. We demonstrate that the regional database provides higher assignment accuracy than the comprehensive global database. We also document a tradeoff between accuracy and misclassification across a range of taxonomic cutoff scores, highlighting the importance of parameter selection for taxonomic classification. Furthermore, we compared assignment accuracy with and without the inclusion of additionally generated reference sequences. To this end, we sequenced tissue from 597 species using the MiFish 12S primers, adding 252 species to GenBank's existing 550 California Current Large Marine Ecosystem fish sequences. We then compared species and reads identified from seawater environmental DNA samples using global databases with and without our generated references, and the regional database. The addition of new references allowed for the identification of 16 additional native taxa representing 17.0% of total reads from eDNA samples, including species with vast ecological and economic value. Together these results demonstrate the importance of comprehensive and curated reference databases for effective metabarcoding and the need for locus‐specific validation efforts. [ABSTRACT FROM AUTHOR]

BACKGROUND: Anti human epidermal growth factor receptor 2 (anti‐HER2) therapy with trastuzumab improves overall survival in patients with advanced, HER2‐positive gastroesophageal adenocarcinoma (GEA) and is now incorporated into national guidelines. However, little is known about adherence to and determinants of timely HER2 testing and trastuzumab initiation in routine practice. METHODS: The authors performed a cross‐sectional study of patients who had advanced GEA diagnosed between January 2011 and June 2019 in a nationwide electronic health record‐derived database. The annual prevalences of both timely HER2 testing (defined within 21 days after advanced diagnosis) and timely trastuzumab initiation (defined within 14 days after a positive HER2 result) were calculated. Log‐binomial regressions estimated adjusted prevalence ratios comparing timely HER2 testing and trastuzumab initiation by patient and tumor characteristics. RESULTS: In total, the cohort included 6032 patients with advanced GEA of whom 1007 were HER2‐positive. Between 2011 and 2019, timely HER2 testing increased from 22.4% to 44.5%, whereas timely trastuzumab initiation remained stable at 16.3%. No appreciable differences in timely testing or trastuzumab initiation were noted by age, sex, race, or insurance status. Compared with patients who had metastatic disease at diagnosis, patients who had early stage GEA who did not undergo surgery were less likely to receive timely HER2 testing and trastuzumab initiation (testing prevalence ratio, 0.69; 95% CI, 0.64‐0.75; treatment prevalence ratio, 0.32; 95% CI, 0.18‐0.56), as were patients with early stage disease who subsequently developed a distant recurrence (testing prevalence ratio, 0.56; 95% CI, 0.47‐0.65; treatment prevalence ratio, 0.61; 95% CI, 0.24‐1.55). CONCLUSIONS: In patients with advanced GEA, guideline‐recommended HER2 testing and anti‐HER2 therapy remain underused. Uptake may improve with universal HER2 testing regardless of stage. Timely HER2 biomarker testing and targeted therapy administration remain in use for patients with advanced gastroesophageal adenocarcinoma. Compared with patients initially diagnosed with de novo metastatic disease, those diagnosed with early stage disease who develop a recurrence or who do not undergo curative surgery are less likely to receive timely precision oncology care. [ABSTRACT FROM AUTHOR]

Key Takeaways: Power plant wastewaters contain bromide, and their discharge to the environment can increase bromide concentrations in surface waters used for potable water supply, increasing brominated disinfection byproducts in finished water. Drinking water utilities should assess upstream bromide sources to determine their contribution to bromide and brominated disinfection byproducts at drinking water intakes. Analysis of bromide sources and receiving water conditions helps in developing control strategies for bromide discharges that affect drinking water supplies. [ABSTRACT FROM AUTHOR]