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Abstract Background The age distribution of a mosquito population is a major determinant of its vectorial capacity. To contribute to disease transmission, a competent mosquito vector, carrying a pathogen, must live longer than the extrinsic incubation period of that pathogen to enable transmission to a new host. As such, determining the age of female mosquitoes is of significant interest for vector-borne diseases surveillance and control programs. Methods In this contribution, an automated age-grading system was developed to classify the age of female Culex pipiens, which is the primary vector of West Nile virus and other pathogens of medical and veterinary importance in northern latitudes. The system comprises an optical wingbeat sensor coupled to the entrance of a mosquito trap and a machine learning model. Three age classes were used in the study: young (2–4 days), middle (7–9 days) and old (14–16 days). From a balanced dataset of flight data, four features were extracted: wingbeat fundamental frequency, spectrogram, power spectral density and Mel frequency cepstral coefficients. The features were used for training with the XGBoost algorithm to generate a model for age classification. Results The best performing model was trained with the power spectral density feature on two age classes, ≤ 4 days old and ≥ 7 days old, and had an accuracy of 71.8%. Conclusions An automated mosquito age-grading system was applied for the first time to our knowledge for automated age classification in mosquitoes; and complements the mosquito genus and sex classification capability of the system reported in our previous work. The system may find use in mosquito-borne disease surveillance and control to help to discriminate young mosquitoes (≤ 4 days old) from older mosquitoes, which may act as vectors of arboviruses. Graphical Abstract

Abstract We conduct a synthetic archaeological and ethnohistoric dating program to assess the timing and tempo of the spread of peaches, the first Eurasian domesticate to be adopted across Indigenous eastern North America, into the interior American Southeast by Indigenous communities who quickly “Indigenized” the fruit. In doing so, we present what may be the earliest absolute dates for archaeological contexts containing preserved peach pits in what is today the United States in the early to mid-16th century. Along with our broader chronological modeling, these early dates suggest that peaches were likely in the interior prior to permanent Spanish settlement in the American Southeast and that peaches spread independently of interactions with Spanish colonizers. We further argue that that eventual spread of peaches was structured exclusively by Indigenous communities and the ecologies produced through long-term Indigenous land management and land use practices, highlighting and centering the agency of Indigenous societies in the socioecological process of colonization.

Abstract Introduction The monoclonal antibody therapies bamlanivimab (BAM) + etesevimab (ETE) received emergency use authorization (EUA) from the US Food and Drug Administration (February 9, 2021) for treatment of mild-to-moderate COVID-19. The EUA of BAM + ETE was revoked (December 14, 2023) due to the high prevalence of BAM + ETE-resistant variants of SARS-CoV-2. Efficacy and safety of 700/1400 mg and 2800/2800 mg BAM + ETE are well established and published; however, efficacy and safety of 350/700 mg BAM + ETE have not been disclosed to date. Methods This portion of phase 3, BLAZE-1 trial (J2X-MC-PYAB) enrolled patients (between June 17, 2020 and April 9, 2021) with mild-to-moderate COVID-19 within 3 days of laboratory diagnosis of SARS-CoV-2 infection. In total, 354 patients with at least one risk factor for severe COVID-19 were enrolled, randomized (2:3), and infused with placebo (N = 141) or 350/700 mg BAM + ETE (N = 213), over ~ 8 min. Primary endpoint was to assess proportion of patients with persistently high SARS-CoV-2 viral load (PHVL) (log viral load > 5.27) 7 days after infusion. Results Patients were aged (mean) 53 years, 49.7% female, and 82.7% White. Seven days after drug infusion, 10.8% (95% confidence interval: 6.6, 15.0; p

Abstract Background Mosquito-borne diseases are a major concern for public and veterinary health authorities, highlighting the importance of effective vector surveillance and control programs. Traditional surveillance methods are labor-intensive and do not provide high temporal resolution, which may hinder a full assessment of the risk of mosquito-borne pathogen transmission. Emerging technologies for automated remote mosquito monitoring have the potential to address these limitations; however, few studies have tested the performance of such systems in the field. Methods In the present work, an optical sensor coupled to the entrance of a standard mosquito suction trap was used to record 14,067 mosquito flights of Aedes and Culex genera at four temperature regimes in the laboratory, and the resulting dataset was used to train a machine learning (ML) model. The trap, sensor, and ML model, which form the core of an automated mosquito surveillance system, were tested in the field for two classification purposes: to discriminate Aedes and Culex mosquitoes from other insects that enter the trap and to classify the target mosquitoes by genus and sex. The field performance of the system was assessed using balanced accuracy and regression metrics by comparing the classifications made by the system with those made by the manual inspection of the trap. Results The field system discriminated the target mosquitoes (Aedes and Culex genera) with a balanced accuracy of 95.5% and classified the genus and sex of those mosquitoes with a balanced accuracy of 88.8%. An analysis of the daily and seasonal temporal dynamics of Aedes and Culex mosquito populations was also performed using the time-stamped classifications from the system. Conclusions This study reports results for automated mosquito genus and sex classification using an optical sensor coupled to a mosquito trap in the field with highly balanced accuracy. The compatibility of the sensor with commercial mosquito traps enables the sensor to be integrated into conventional mosquito surveillance methods to provide accurate automatic monitoring with high temporal resolution of Aedes and Culex mosquitoes, two of the most concerning genera in terms of arbovirus transmission. Graphical Abstract

The natural pollinator of the major species of commercially-grown vanilla, Vanilla planifolia, is unknown, and the crop requires hand pollination to achieve significant levels of fruit set; however, the traditional technique (using a toothpick) is costly, as it requires skilled personnel. To overcome this problem, two native Australian bees, Tetragonula carbonaria and Austroplebeia australis, and the blowfly, Lucilia cuprina, were trialled as pollinators. Three alternatives to the toothpick method were also trialled. The appearance of vanilla flowers under ultraviolet radiation was examined to determine the presence of cryptic pollination guides, and the chemical composition of nectar from extrafloral nectaries and aroma volatiles from the flowers were characterised. None of the three insects effected pollination due to their small size and behaviour; other insect pollinators need to be identified. The alternative mechanical methods of pollination trialled resulted in fruit set; however, the percentages of fruit set were lower than the traditional toothpick method, and the fruit were of inferior quality. The nectar produced predominantly consisted of sucrose and melezitose. Melezitose is a strong attractant of various ant species, which may explain the concentration of ants around the nectaries and the apparent lack of nectar production in part of this study. The aroma volatiles included monoterpenoids, terpenes, sesquiterpenoids, aromatics, nitrogen-containing compounds and fatty acids, the most abundant being a-pinene and eucalyptol. Illumination of the flowers with UV-A radiation revealed fluorescence from the stamens, the column and the callus, which is located on the labellum. These observations may aid the identification and use of potential pollinators.

Abstract Background Co-produced research is when all stakeholders, including experts by experience and researchers, work together to conceptualise, design, deliver and disseminate research to enhance understanding and knowledge. This type of participatory inquiry is being increasingly used across health research; however, it continues to be a complex area to navigate given existing institutional structures. Main body We collaborated across three independent co-produced research studies to share insights, reflections, and knowledge of our work in the fields of HIV, mental health, and disability research. We co-designed and delivered a three-hour online workshop at a conference to share these reflections using the metaphor of ‘building bridges’ to describe our co-production journey. We generated key principles of co-production from our different experiences working in each individual research project as well as together across the three projects. Our principles are to: (1) be kind, have fun and learn from each other; (2) share power (as much as you can with people); (3) connect with people you know and don’t know; (4) remain connected; and (5) use clear and simple language. Conclusion We recommend that co-produced research needs additional funding, resource, and flexibility to remain impactful and ethical. Co-produced research teams need to be mindful of traditional power structures and ensure that the process is transparent, fair, and ethical. Addressing equality, diversity, and inclusion of traditionally underrepresented groups in research is essential as are the skills, expertise, and experiences of all members of the co-production team.

Peer review is an important part of the scientific process, but traditional peer review at journals is coming under increased scrutiny for its inefficiency and lack of transparency. As preprints become more widely used and accepted, they raise the possibility of rethinking the peer-review process. Preprints are enabling new forms of peer review that have the potential to be more thorough, inclusive, and collegial than traditional journal peer review, and to thus fundamentally shift the culture of peer review toward constructive collaboration. In this Consensus View, we make a call to action to stakeholders in the community to accelerate the growing momentum of preprint sharing and provide recommendations to empower researchers to provide open and constructive peer review for preprints.

The ability to anticipate the actions of opponents is a significant marker of expertise in many sports. The role of non-kinematic contextual information in anticipation has received increasing attention over the last decade. In this article, we review contemporary research focusing on the specific impact of contextual information related to opponents’ action tendencies on anticipation in sport. This information can be acquired explicitly when probabilistic information about the preferences of the opponent is provided to the athlete before the action commences, or the athlete can pick up this information through exposure to the actions of the opponent. Regardless of how this information is acquired, it has been shown to influence anticipation performance and underlying processing priorities on a wide range of sport tasks. However, factors such as sport-specific expertise, informational reliability, task load, and judgment utility moderate these effects. We discuss methodological issues and gaps in existing knowledge and provide guidance for how to develop more representative research designs in future. Finally, we highlight practical implications that may help coaches and performance analysts in predicting the effectiveness of priming athletes with information about the action tendencies of opponents in various performance situations.

Abstract Introduction Bamlanivimab and etesevimab (BAM + ETE) are monoclonal antibodies (mAbs) effective in reducing COVID-19-related hospitalizations and all-cause mortality in adult participants at increased risk for severe disease. We present pharmacokinetic (PK), efficacy, and safety results from pediatric participants ( 12 to

Background Although adolescent basketballers differ in body size, shape, and composition, less is known about how these factors interact during physical development. Aim We used ontogenetic allometry to identify the optimal body size and shape characteristics associated with physical performance in adolescent basketball players, and investigated the effects of training experience, training volume, maturity status, and club characteristics on physical performance development. Subjects and methods Two hundred and sixty-four male basketballers, from five age-cohorts (11–15 years of age), were followed consecutively over three years. Three physical performance components, anthropometrics, training information, and biological maturation were assessed bi-annually. Longitudinal multiplicative allometric models were developed. Results Players with a physique that had a dominant ectomorphic component performed better in all physical performance components. When adjusting for confounders other than size, the development of running speed was independent of body size. Players advanced in maturation were physically fitter. Training data had no significant effect on developmental trajectories of running speed or lower body explosive strength. Club characteristics had no significant association with any physical performance trajectories. Conclusion Leaner players have advantages in physical performance and individual characteristics play an important role, over and beyond club structure, in developing physical performance.

Summary: Climate change is one of several drivers of recurrent outbreaks and geographical range expansion of infectious diseases in Europe. We propose a framework for the co-production of policy-relevant indicators and decision-support tools that track past, present, and future climate-induced disease risks across hazard, exposure, and vulnerability domains at the animal, human, and environmental interface. This entails the co-development of early warning and response systems and tools to assess the costs and benefits of climate change adaptation and mitigation measures across sectors, to increase health system resilience at regional and local levels and reveal novel policy entry points and opportunities. Our approach involves multi-level engagement, innovative methodologies, and novel data streams. We take advantage of intelligence generated locally and empirically to quantify effects in areas experiencing rapid urban transformation and heterogeneous climate-induced disease threats. Our goal is to reduce the knowledge-to-action gap by developing an integrated One Health—Climate Risk framework.

Introduction: Previous theoretical frameworks focusing on burnout have identified numerous antecedents and psychosocial risk factors; however, the influence of early sport-specific experiences on burnout in developmental athlete populations remains less understood. Objectives: We explored the associations between burnout and prior sports engagement (ie, milestones, practice time, performance, injury history) in a sample of subelite academy alpine ski racers in the United States (N = 169, M age = 15.82 ± 1.80). Methods: Participants completed retrospective practice history profiles (milestones, practice time, injury), while their respective performance data were collected using an online national ranking registry. Simple and mixed-effect regressions were implemented to assess the associations between these measures and subscales of the Athlete Burnout Questionnaire. Results: The results indicated that greater participation in the coach-led group and individual practice during adolescence mitigated burnout responses (ie, greater sense of accomplishment, less sport devaluation), whereas more play earlier in development was associated with greater devaluation. Furthermore, poorer performance and more injury incidences were associated with increased burnout (ie, reduced sense of accomplishment). Conclusions: The structure of training and past experiences during early career years appear to influence burnout among alpine ski racing during their adolescent years, the implications of which are discussed in relation to sport developmental pipelines.

IntroductionSpeech breathing is a term usually used to refer to the manner in which expired air and lung mechanics are utilized for the production of the airflow necessary for phonation. Neurologically, speech breathing overrides the normal rhythms of alveolar ventilation. Speech breathing is generated using the diaphragm, glottis, and tongue. The glottis is the opening between the vocal folds in the larynx; it is the primary valve between the lungs and the mouth, and by varying its degree of opening, the sound can be varied. The use of voice as an indicator of health has been widely reported. Chronic obstructive pulmonary disease (COPD) is the most common long-term respiratory disease. The main symptoms of COPD are increasing breathlessness, a persistent chesty cough with phlegm, frequent chest infections, and persistent wheezing. There is no cure for COPD, and it is one of the leading causes of death worldwide. The principal cause of COPD is tobacco smoking, and estimates indicate that COPD will become the third leading cause of death worldwide by 2030. The long-term aim of this research program is to understand how speech generation, breathing, and lung function are linked in people with chronic respiratory diseases such as COPD.MethodsThis pilot study was designed to test an articulatory speech task that uses a single word (“helicopter”), repeated multiple times, to challenge speech-generated breathing and breathlessness. Specifically, a single-word articulation task was used to challenge respiratory system endurance in people with healthy lungs by asking participants to rapidly repeat the word “helicopter” for three 20-s runs interspersed with two 20-s rest periods of silent relaxed breathing. Acoustic and prosodic features were then extracted from the audio recordings of each adult participant.Results and discussionThe pause ratio increased from the first run to the third, representing an increasing demand for breath. These data show that the repeated articulation task challenges speech articulation in a quantifiable manner, which may prove useful in defining respiratory ill-health.

Abstract Background Every year, more than 700,000 people die from vector-borne diseases, mainly transmitted by mosquitoes. Vector surveillance plays a major role in the control of these diseases and requires accurate and rapid taxonomical identification. New approaches to mosquito surveillance include the use of acoustic and optical sensors in combination with machine learning techniques to provide an automatic classification of mosquitoes based on their flight characteristics, including wingbeat frequency. The development and application of these methods could enable the remote monitoring of mosquito populations in the field, which could lead to significant improvements in vector surveillance. Methods A novel optical sensor prototype coupled to a commercial mosquito trap was tested in laboratory conditions for the automatic classification of mosquitoes by genus and sex. Recordings of > 4300 laboratory-reared mosquitoes of Aedes and Culex genera were made using the sensor. The chosen genera include mosquito species that have a major impact on public health in many parts of the world. Five features were extracted from each recording to form balanced datasets and used for the training and evaluation of five different machine learning algorithms to achieve the best model for mosquito classification. Results The best accuracy results achieved using machine learning were: 94.2% for genus classification, 99.4% for sex classification of Aedes, and 100% for sex classification of Culex. The best algorithms and features were deep neural network with spectrogram for genus classification and gradient boosting with Mel Frequency Cepstrum Coefficients among others for sex classification of either genus. Conclusions To our knowledge, this is the first time that a sensor coupled to a standard mosquito suction trap has provided automatic classification of mosquito genus and sex with high accuracy using a large number of unique samples with class balance. This system represents an improvement of the state of the art in mosquito surveillance and encourages future use of the sensor for remote, real-time characterization of mosquito populations. Graphical abstract

Abstract Africa has undergone a progressive aridification during the last 20 My that presumably impacted organisms and fostered the evolution of life history adaptations. We test the hypothesis that shift to living in ant nests and feeding on ant brood by larvae of phyto‐predaceous Lepidochrysops butterflies was an adaptive response to the aridification of Africa that facilitated the subsequent radiation of butterflies in this genus. Using anchored hybrid enrichment we constructed a time‐calibrated phylogeny for Lepidochrysops and its closest, non‐parasitic relatives in the Euchrysops section (Poloyommatini). We estimated ancestral areas across the phylogeny with process‐based biogeographical models and diversification rates relying on time‐variable and clade‐heterogeneous birth‐death models. The Euchrysops section originated with the emerging Miombo woodlands about 22 million years ago (Mya) and spread to drier biomes as they became available in the late Miocene. The diversification of the non‐parasitic lineages decreased as aridification intensified around 10 Mya, culminating in diversity decline. In contrast, the diversification of the phyto‐predaceous Lepidochrysops lineage proceeded rapidly from about 6.5 Mya when this unusual life history likely first evolved. The Miombo woodlands were the cradle for diversification of the Euchrysops section, and our findings are consistent with the hypothesis that aridification during the Miocene selected for a phyto‐predaceous life history in species of Lepidochrysops, with ant nests likely providing caterpillars a safe refuge from fire and a source of food when vegetation was scarce.

Abstract Laryngeal angiomyolipoma is a rare tumor with few reported cases in the literature. The case report explains a 62‐year‐old man who presents with dyspnea and found to have a laryngeal angiomyolipoma staining CD34 positive, but HMB45 and Melan‐A negative.

IntroductionThe ability to perform optimally under pressure is critical across many occupations, including the military, first responders, and competitive sport. Despite recognition that such performance depends on a range of cognitive factors, how common these factors are across performance domains remains unclear. The current study sought to integrate existing knowledge in the performance field in the form of a transdisciplinary expert consensus on the cognitive mechanisms that underlie performance under pressure.MethodsInternational experts were recruited from four performance domains [(i) Defense; (ii) Competitive Sport; (iii) Civilian High-stakes; and (iv) Performance Neuroscience]. Experts rated constructs from the Research Domain Criteria (RDoC) framework (and several expert-suggested constructs) across successive rounds, until all constructs reached consensus for inclusion or were eliminated. Finally, included constructs were ranked for their relative importance.ResultsSixty-eight experts completed the first Delphi round, with 94% of experts retained by the end of the Delphi process. The following 10 constructs reached consensus across all four panels (in order of overall ranking): (1) Attention; (2) Cognitive Control—Performance Monitoring; (3) Arousal and Regulatory Systems—Arousal; (4) Cognitive Control—Goal Selection, Updating, Representation, and Maintenance; (5) Cognitive Control—Response Selection and Inhibition/Suppression; (6) Working memory—Flexible Updating; (7) Working memory—Active Maintenance; (8) Perception and Understanding of Self—Self-knowledge; (9) Working memory—Interference Control, and (10) Expert-suggested—Shifting.DiscussionOur results identify a set of transdisciplinary neuroscience-informed constructs, validated through expert consensus. This expert consensus is critical to standardizing cognitive assessment and informing mechanism-targeted interventions in the broader field of human performance optimization.

Virtual reality (VR) is a promising and cost-effective tool that has the potential to reduce the prevalence of falls and locomotor impairments in older adults. However, we believe that existing VR-based approaches to prevent falls do not mimic the full breadth of perceptual, cognitive, and motor demands that older adults encounter in daily life. Researchers have not yet fully leveraged VR to address affective factors related to fall risk, and how stressors such as anxiety influence older adult balance and real-world falls. In this perspective paper, we propose developing VR-based tools that replicate the affective demands of real-world falls (eg, crossing the street) to enhance fall prevention diagnostics and interventions by capturing the underlying processes that influence everyday mobility. An effort to replicate realistic scenarios that precipitate falls in VR environments will inform evidence-based diagnostics and individualize interventions in a way that could reduce falls in older adults in daily life.

Vaccines are one of the most successful tools for protecting the public's health. However, widespread vaccine hesitancy in the Southern United States is preventing effective mitigation of the current COVID-19 pandemic. The purpose of this study was to assess COVID-19 vaccine acceptance among adults living in a largely rural Southern state. This cross-sectional study collected data from 1,164 Arkansas residents between October 3 and October 17, 2020 using random digit dialing. The primary outcome was a multidimensional COVID-19 vaccine acceptance measure with scores between -3 to +3. The full COVID-19 vaccine acceptance scale was measured along with perceived vaccine safety, effectiveness, acceptance, value, and legitimacy subscales. Statistical analyses were conducted using multivariable linear regression. Results indicated Black participants had the lowest overall vaccine acceptance (0.5) compared to White participants (1.2). Hispanic participants had the highest scores (1.4). In adjusted models, Black participants had 0.81 points lower acceptance than White participants, and Hispanic participants had 0.35 points higher acceptance. Hispanic participants had the highest scores for all five vaccine acceptance subscales, relatively equivalent to White participants. Black participants had consistently lower scores, especially perceived vaccine safety (mean -0.2, SD 0.1). In conclusion, the lowest vaccine acceptance rates were among Black participants particularly on perceived vaccine safety. While Black participants had the lowest acceptance scores, Hispanic participants had the highest. This variability shows the value of a multidimensional vaccine acceptance measure to inform COVID-19 vaccination campaign strategies.

Individuals have increasingly high expectations of return to activity following total hip replacement (THR) surgery. The current literature demonstrates marked improvements in pain following THR. However, there is limited evidence showing objective improvement in daily activity. This randomized pilot trial aimed to determine the effect of an intervention where outdoor walking distance is used as a goal to increase daily activity of older adults using a commercial activity monitor at 3 to 6 months post THR. Findings suggested that the participants in the intervention group had higher activity levels after THR, compared to those in the control group. The Cohen’s effect sizes were larger for the changes in the gait, Hip Disability and Osteoarthritis Outcome Score, and Psychosocial Impact of Assistive Devices Scale data in the intervention group in contrast to the control group. However, further research with a larger sample size is required to provide tangible evidence on the significance of the effect of the purposeful walk compared to step count.

Aims: After failed acetabular fractures, total hip arthroplasty (THA) is a challenging procedure and considered the gold standard treatment. The complexity of the procedure depends on the fracture pattern and the initial fracture management. This study’s primary aim was to evaluate patient-reported outcome measures (PROMs) for patients who underwent delayed uncemented acetabular THA after acetabular fractures. The secondary aims were to assess the radiological outcome and the incidence of the associated complications in those patients. Methods: A total of 40 patients underwent cementless acetabular THA following failed treatment of acetabular fractures. The postoperative clinical and radiological outcomes were evaluated for all the cohort. Results: The median (interquartile range (IQR)) Oxford Hip Score (OHS) improved significantly from 9.5 (7 to 11.5), (95% confidence interval (CI) (8 to 10.6)) to 40 (39 to 44), (95% CI (40 to 43)) postoperatively at the latest follow-up (p < 0.001). It was worth noting that the initial acetabular fracture type (simple vs complex), previous acetabular treatment (ORIF vs conservative), fracture union, and restoration of anatomical centre of rotation (COR) did not affect the final OHS. The reconstructed centre of rotation (COR) was restored in 29 (72.5%) patients. The mean abduction angle in whom acetabular fractures were managed conservatively was statistically significantly higher than the surgically treated patients 42.6° (SD 7.4) vs 38° (SD 5.6)) (p = 0.032). We did not have any case of acetabular or femoral loosening at the time of the last follow-up. We had two patients with successful two-stage revision for infection with overall eight-year survival rate was 95.2% (95% CI 86.6% to 100%) with revision for any reason at a median (IQR) duration of follow-up 50 months (16 to 87) months following THA. Conclusion: Delayed cementless acetabular THA in patients with previous failed acetabular fracture treatments produces good clinical outcomes (PROMS) with excellent survivorship, despite the technically demanding nature of the procedure. The initial fracture treatment does not influence the outcome of delayed THA. In selected cases of acetabular fractures (either nondisplaced or with secondary congruency), the initial nonoperative treatment neither resulted in large acetabular defects nor required additional acetabular reconstruction at the time of THA. Cite this article: Bone Jt Open 2021;2(12):1067–1074.

Abstract “Knowledge graphs” (KGs) have become a common approach for representing biomedical knowledge. In a KG, multiple biomedical data sets can be linked together as a graph representation, with nodes representing entities, such as “chemical substance” or “genes,” and edges representing predicates, such as “causes” or “treats.” Reasoning and inference algorithms can then be applied to the KG and used to generate new knowledge. We developed three KG‐based question‐answering systems as part of the Biomedical Data Translator program. These systems are typically tested and evaluated using traditional software engineering tools and approaches. In this study, we explored a team‐based approach to test and evaluate the prototype “Translator Reasoners” through the application of Medical College Admission Test (MCAT) questions. Specifically, we describe three “hackathons,” in which the developers of each of the three systems worked together with a moderator to determine whether the applications could be used to solve MCAT questions. The results demonstrate progressive improvement in system performance, with 0% (0/5) correct answers during the first hackathon, 75% (3/4) correct during the second hackathon, and 100% (5/5) correct during the final hackathon. We discuss the technical and sociologic lessons learned and conclude that MCAT questions can be applied successfully in the context of moderated hackathons to test and evaluate prototype KG‐based question‐answering systems, identify gaps in current capabilities, and improve performance. Finally, we highlight several published clinical and translational science applications of the Translator Reasoners.

Abstract The transition from hunting to herding transformed the cold, arid steppes of Mongolia and Eastern Eurasia into a key social and economic center of the ancient world, but a fragmentary archaeological record limits our understanding of the subsistence base for early pastoral societies in this key region. Organic material preserved in high mountain ice provides rare snapshots into the use of alpine and high altitude zones, which played a central role in the emergence of East Asian pastoralism. Here, we present the results of the first archaeological survey of melting ice margins in the Altai Mountains of western Mongolia, revealing a near-continuous record of more than 3500 years of human activity. Osteology, radiocarbon dating, and collagen fingerprinting analysis of wooden projectiles, animal bone, and other artifacts indicate that big-game hunting and exploitation of alpine ice played a significant role during the emergence of mobile pastoralism in the Altai, and remained a core element of pastoral adaptation into the modern era. Extensive ice melting and loss of wildlife in the study area over recent decades, driven by a warming climate, poaching, and poorly regulated hunting, presents an urgent threat to the future viability of herding lifeways and the archaeological record of hunting in montane zones.

Global and local biological motion processing are likely influenced by an observer’s perceptual experience. Skilled athletes anticipating an opponent’s movements use globally distributed motion information, while less skilled athletes focus on single kinematic cues. Published reports have demonstrated that attention can be primed globally or locally before perceptual tasks; such an intervention could highlight motion processing mechanisms used by skilled and less skilled observers. In this study, we examined skill differences in biological motion processing using attentional priming. Skilled (N = 16) and less skilled (N = 16) players anticipated temporally occluded videos of volleyball attacks after being primed using a Navon matching task while parietal EEG was measured. Skilled players were more accurate than less skilled players across priming conditions. Global priming improved performance in both skill groups. Skilled players showed significantly reduced alpha and beta power in the right compared to left parietal region, but brain activity was not affected by the priming interventions. Our findings highlight the importance of right parietal dominance for skilled performers, which may be functional for inhibiting left hemispheric local processing or enhancing visual spatial attention for dynamic visual scenes. Further work is needed to systematically determine the function of this pattern of brain activity during skilled anticipation.

There is a lot of uncertainty about what Earth’s climate and geography were like in the early Cambrian, when animal life diversified throughout the oceans. Here we show that numeric comparisons of model simulations and climatically influenced rocks can help constrain geography and climate during this time.

Hospitals not only provide access to healthcare services in rural areas; they also serve as major employers and economic drivers. The goal of this pilot study was to improve our understanding of how a rural healthcare system in Appalachian Kentucky could be leveraged to expand access to fresh fruits and vegetables. We conducted 11 semi-structured interviews with food system and healthcare stakeholders in Hazard, Kentucky, to (1) improve our understanding of key barriers to accessing and utilizing fresh produce for healthcare worker and patient populations, (2) identify models for direct-to-consumer market channels and farm-to-institution programming in collaboration with a local hospital, and (3) explore the potential of those models to foster greater consumption of fruit and vegetables among community members. Stakeholders emphasized the need for staff support and funding during program development and discussed the difficulty in maintaining prior local food and health promotion efforts when pilot funding expired. Other considerations included the importance of community ownership, robust communication and coordination among stakeholders, and attunement to the opportunities and challenges of a hospital-based approach. Direct farm-to-consumer models were considered feasible but would require accommodation for low-income consumers, such as vouchers, sliding-scale payment methods, or “double dollar” programs. Farm-to-hospital initiatives were discussed in the context of the COVID-19 pandemic and reduced hospital cafeteria usage, which may limit the success of some events but highlights the potential for to-go options such as pre-prepared salads, lightly processed snacks, and medically tailored meal kits. Results of this study illustrate the challenges and opportunities of leveraging a rural hospital as an anchor institution for expanding local food system development in rural Appalachia. This study also offers insights into the intersections of health, culture, and economy in an Appalachian community, and provides a framework for expanding local food system initiatives.

The purpose of this evaluation is to describe COVID-19 vaccine hesitancy among a sample of youth aged 12–15 and inform efforts to increase vaccination uptake among youth populations. We used data collected in May 2021 through a health education program for 9th graders (N = 345). We used Spearman correlations and chi-square tests to assess the statistical significance of bivariate relationships. Less than half of students (42%) reported they are not hesitant at all about getting a COVID-19 vaccine. The remainder reported they were “a little hesitant” (22%), “somewhat hesitant” (21%), or “very hesitant” (15%). There were no statistically significant differences across age, gender, race/ethnicity, parental education, self-reported grades, or hours playing video games during school days. There was a statistically significant relationship between COVID-19 vaccine hesitancy and hours of TV watched during school days. The prevalence of COVID-19 vaccine hesitancy in this sample is high, but more research is needed to estimate its prevalence for youth at the state or national level. Correlates of COVID-19 vaccine hesitancy among adult populations may not match those found in youth populations. Research which recognizes youth as agentic rather than passive participants in decision-making opens opportunities for developing age-appropriate health communication and interventions for vaccination.

Abstract Aims A cardiopulmonary exercise (CPX) test is considered the gold standard in evaluating maximal oxygen uptake. This study aimed to evaluate the predictive validity of equations provided by Burr et al., Ross et al., Adedoyin et al., and Cahalin et al. in predicting peak VO2 from 6 min walk test (6MWT) distance in patients with heart failure (HF). Methods and Results New York Heart Association Class I–III HF patients performed a maximal effort CPX test and two 6MWTs. Correlations between CPX VO2 peak and the predicted VO2 peak, coefficient of determination (R2), and mean absolute percentage error (MAPE) scores were calculated. P‐values were set at 0.05. A total of 106 participants aged 62.5 ± 11.5 years completed the tests. The mean VO2 peak from CPX testing was 16.4 ± 3.9 mL/kg/min, and the mean 6MWT distance was 419.2 ± 93.0 m. The predicted mean VO2 peak (mL/kg/min) by Burr et al., Ross et al., Adedoyin et al., and Cahalin et al. was 22.8 ± 8.8, 14.6 ± 2.1, 8.30 ± 1.4, and 16.6 ± 2.8. A significant correlation was observed between the CPX test VO2 peak and predicted values. The mean difference (0.1 mL/kg/min), R2 (0.97), and MAPE (0.14) values suggest that the Cahalin et al. equation provided the best predictive validity. Conclusions The equation provided by Cahalin et al. is simple and has a strong predictive validity, and researchers may use the equation to predict mean VO2 peak in patients with HF. Based on our observation, equations to predict individual maximal oxygen uptake should be used cautiously.

Aims: The increase in prescription opioid misuse and dependence is now a public health crisis in the UK. It is recognized as a whole-person problem that involves both the medical and the psychosocial needs of patients. Analyzing aspects of pathophysiology, emotional health, and social wellbeing associated with persistent opioid use after injury may inform safe and effective alleviation of pain while minimizing risk of misuse or dependence. Our objectives were to investigate patient factors associated with opioid use two to four weeks and six to nine months after an upper limb fracture. Methods: A total of 734 patients recovering from an isolated upper limb fracture were recruited in this study. Opioid prescription was documented retrospectively for the period preceding the injury, and prospectively at the two- to four-week post-injury visit and six- to nine-month post-injury visit. Bivariate and multivariate analysis sought factors associated with opioid prescription from demographics, injury-specific data, Patient Reported Outcome Measurement Instrumentation System (PROMIS), Depression computer adaptive test (CAT), PROMIS Anxiety CAT, PROMIS Instrumental Support CAT, the Pain Catastrophizing Scale (PCS), the Pain Self-efficacy Questionnaire (PSEQ-2), Tampa Scale for Kinesiophobia (TSK-11), and measures that investigate levels of social support. Results: A new prescription of opioids two to four weeks after injury was independently associated with less social support (odds ratio (OR) 0.26, p < 0.001), less instrumental support (OR 0.91, p < 0.001), and greater symptoms of anxiety (OR 1.1, p < 0.001). A new prescription of opioids six to nine months after injury was independently associated with less instrumental support (OR 0.9, p < 0.001) and greater symptoms of anxiety (OR 1.1, p < 0.001). Conclusion: This study demonstrates that potentially modifiable psychosocial factors are associated with increased acute and chronic opioid prescriptions following upper limb fracture. Surgeons prescribing opioids for upper limb fractures should be made aware of the screening and management of emotional and social health.

Human energy consumption and productivity have steeply risen around 1950 CE, leading to a departure from the Earth’s Holocene state into the Anthropocene, suggests a quantitative analysis of humanity’s influence on the Earth system.

The use of GIS, remote sensing, and other geographic tools in geoconservation and geotourism is increasing. These tools – hereafter referred to as ‘Geographic Information Technology’ (GIT) tools – have the potential to simplify workflow in geoconservation assessment and inventory, be employed as decision support and decision making tools for complex decisions, or be used to enhance communication and user experience in geotourism. In this paper, we review the progress on the use of GIT tools in geoheritage and geotourism to date, highlighting current gaps in practice. By way of an interview of prominent global geoconservation and geotourism professionals conducted in 2018, we show that approximately 25% of the surveyed workforce use some type of GIT tool to aid in decision support, decision making, or for communication(s) of inventory elements and features of interest. Upon review of the literature, it appears that the vast majority of tools are used for communications of inventory, features and site maps. Opportunities for further improvement in the field will most likely be realised when more sophisticated decision-making tools become available for geoconservationists and geotourism professionals, especially in the use of GIS Multi-Criteria Decision Analysis (GIS-MCDA) to rank and curate inventory, geosites or geotouristic experiences. We conclude our discussion with a case study demonstrating the use of selected GIT tools in the process of decision support, decision-making, and communications. We show that at each step in the process of geoconservation, there is a GIT tool that can simplify workflow, and be used to cross-collaborate with other users or platforms. With further refinement, GIT tools should be able to support geoconservationists and geotouristic professionals in global decision making – for assessment, inventory, and standardisation of interpretations of landscape values and potential use.

We examined the effect of physiological workload on gaze behaviour during defensive performance in 2 vs. 1 +goalkeeper game situations in football. Twenty-two players were assigned to either a high- or low-performing group based on a validated measure of tactical performance. A total of 12 game sequences (trials) were presented under high- and low-workload conditions. At the end of each sequence, participants were asked to indicate their perceived exertion using the Rating Scale of Mental Effort and the Borg Scale. The low- and high-workload conditions were defined when the players achieved 60 and 90% of their maximal heart rate, respectively, as per their performance in the Yo-Yo Intermittent Recovery Test. Visual search behaviours were recorded using Tobii Pro eye-movement registration glasses. Players reported higher rates of perceived exertion on the high- compared to low-workload condition. Participants in the low-performing group increased their average fixation duration and decreased the number of fixations and number of fixation locations from the low- to high-workload conditions. The low- and high-performing groups displayed different visual search strategies with regards the areas of interest fixated upon. Participants in the high-performing group focused on the SpaceFrontPlayer, followed by Ball, and AnotherOpponent. The low-performing group spent more time focusing on the SpaceFrontPlayer and SpacePlayer than Ball and AnotherOpponent. It appears that physiological workload and tactical expertise interact in constraining visual search behaviours in football players. Coaches and practitioners should consider ways to manipulate individual and task constraints while attending to the close interplay between physiological workload, visual behaviour, and tactical performance during practise.

ObjectiveBulimia nervosa (BN) and binge eating disorder (BED) are eating disorders (EDs) characterized by recurrent binge eating (BE) episodes. Overlap exists between ED diagnostic groups, with BE episodes presenting one clinical feature that occurs transdiagnostically. Neuroimaging of the responses of those with BN and BED to disorder-specific stimuli, such as food, is not extensively investigated. Furthermore, to our knowledge, there have been no previous published studies examining the neural response of individuals currently experiencing binge eating, to low energy foods. Our objective was to examine the neural responses to both low energy and high energy food images in three emotive categories (disgust; fear; and happy) in BN and BED participants.MethodsNineteen females with BN (n = 14) or BED (n = 5), comprising the binge eating group (BEG; N = 19), and 19 age-matched healthy control (HC)’s completed thorough clinical assessment prior to functional MRI (fMRI). Neural response to low energy and high energy foods and non-food images was compared between groups using whole-brain exploratory analyses, from which six regions of interest (ROI) were then selected: frontal, occipital, temporal, and parietal lobes; insula and cingulate.ResultsIn response to low energy food images, the BEG demonstrated differential neural responses to all three low energy foods categories (disgust; fear; and happy) compared to HCs. Correlational analyses found a significant association between frequency of binge episodes and diminished temporal lobe and greater occipital lobe response. In response to high energy food images, compared to HC’s, the BEG demonstrated significantly decreased neural activity in response to all high energy food images. The HC’s had significantly greater neural activity in the limbic system, occipital lobe, temporal lobe, frontal lobe, and limbic system in response to high energy food images.ConclusionResults in the low energy food condition indicate that binge frequency may be related to increased aberrant neural responding. Furthermore, differences were found between groups in all ROI’s except the insula. The neural response seen in the BEG to disgust food images may indicate disengagement with this particular stimuli. In the high energy food condition, results demonstrate that neural activity in BN and BED patients may decrease in response to high energy foods, suggesting disengagement with foods that may be more consistent with those consumed during a binge eating episode.

The late Katian Elkhorn event is a biogeochemical perturbation preceding the Late Ordovician mass extinction (LOME) with an exceptional record in the United States (U.S.). Results of our recent studies in this interval allow revised temporal ordering to strata across multiple basins providing insights into the magnitude of environmental disturbance and associated processes and feedbacks. The record of the Elkhorn event spans portions of the Appalachian and Midcontinent basins in the eastern U.S. and the Williston Basin and Cordilleran margin in the west. Our work focuses heavily on the Midcontinent Basin in particular, as it shares many characteristics of size, tectonic setting, and lithofacies with the Baltic Basin, providing the potential for resolving global signatures of the event. In its type-area, the Cincinnatian Series ends with the Elkhorn event. The succession is marked by shallowing from subtidal to marginal marine facies, capped by a karstic sequence boundary. Our new conodont data demonstrate that an overlying white to pink crinoidal grainstone package, previously assigned to the basal Silurian âwhiteâ Brassfield Formation near the Ohio-Indiana state line, is in fact Upper Ordovician. Further, δ13Ccarb values in this unit are elevated, in line with later phases of the Elkhorn event (2â° more positive than reported Rhuddanian values). These findings support a correlation of the grainstone interval with the Fernvale Formation of central Tennessee. To the east, much of the northern Appalachian Basin was overfilled with widespread marginal marine to terrestrial red beds by the onset of the Elkhorn event, while the Midcontinent Basin to the west remained relatively sediment starved. In the southern Midcontinent, the mid-Elkhorn event sequence boundary was onlapped by ironstone deposition (lower Fernvale Formation). The ironstones are overlain by sparry and hematitic grainstones with localized bioherms. In Arkansas, where the Fernvale is thickest (>30 m), the sparry phase gives way upward to manganese carbonates and bioherms. Across the region, the Fernvale is, in turn, cut by a sequence boundary, suggesting a yet higher Katian sequence, and is perforated by paleokarst pockets that are filled and overlain by upper Katian (Ka4) sediments. This sequence boundary is onlapped by black shales and the thickest (>10 m) phosphorite of the Ordovician at the end of the Elkhorn event. Previous studies have suggested age equivalence of the Elkhorn and Paroveja δ13Ccarb excursions in Laurentia and Baltica. Despite the attraction of aligning the latest Richmondian and Pirgu regional stages, our data sets demonstrate that this is a miscorrelation. Critical to this revision are new integrated biostratigraphic and chemostratigraphic data sets in a transect from the margin of the Appalachian Basin into the Midcontinent Basin. The new data reveal that the Elkhorn Shale and Fernvale Formation are overlain by the Brainard and laterally equivalent Sylvan, and Mannie shales. These shale successions contain graptolites of the complanatusand pacificus zones. Thus, the Elkhorn event occurred in the latest manitoulinensis Zone, suggesting correlation with the Baltic Moe δ13Ccarb excursion. Our extensive new data sets provide regional chronostratigraphic correlation of strata deposited during the Elkhorn event. When temporally ordered, these records provide evidence for high amplitude sea level oscillations, major redox fluctuations, and reef pulses that demonstrate the waxing and waning of continental ice sheets on Gondwana and the spread of oceanic anoxia only a few million years before the LOME. These findings further call into question traditional models of rapid glaciation during a long-lived greenhouse state as the sole driver of the LOME and emphasize the need for new integrated Upper Ordovician research initiatives to better characterize Katian events.

Ostracods are tiny bivalved crustaceans with a fossil record extending into rocks of the Lower Ordovician. They occupy almost all aquatic environments today, from the ocean abyssal planes to damp forest leaf litter. Their stratigraphical record suggests they had diversified into a wide range of marine and non-marine habitats already during the Palaeozoic. Through the Ordovician, ostracods are mostly known from marine shelf depositional settings. These are mostly podocope ostracods that appear to have had a benthic mode of life like their modern counterparts; myodocope ostracods, though known from the Ordovician, likely became pelagic only in the Silurian. As they are considered benthic, and possessed no pelagic larval stage, Ordovician podocope ostracods have been widely used as key biogeographical index species for much of the early Palaeozoic. A fundamental question in the oceanographic evolution of ostracods is: when did a psychrosphere evolve (a fauna inhabiting cool waters below the thermocline)? A psychrospheric ostracod fauna in the Ordovician would question some of their biogeographic utility, given that such taxa might have a much wider dispersal capability than more shallow shelf faunas. Here we describe a new ostracod fauna from a palaeotropical South China plate setting, preserved in Upper Ordovician mudstones and siltstones from northern Vietnam. The fauna contains taxa endemic to the South China palaeoplate, but also yields several taxa at the generic level that are known from European and North American Ordovician settings. We discuss whether these latter taxa might be indicative of a more widely dispersed deeper marine psychrospheric Ordovician ostracod fauna, and the implications this would have on traditional biogeographic models. We also discuss other possibilities for these apparently more cosmopolitan taxa, including homeomorphy, previously unknown palaeogeographical connections, and the possibility of pelagic podocope taxa.

Study of a subsurface core (named F688) from northern Indiana provides integrated data sets linking Katian chronostratigraphic records of the Appalachian and Midcontinent basins. The F688 core shows a variety of shallow- and deep-water facies containing numerous, well-preserved and zonally significant fossil species and diagnostic chemostratigraphic patterns. The succession belonging to the Cincinnatian Regional Stage in the F688 core is 210 m thick. Detailed benchtop examination of the succession revealed several phosphatic intervals, rich brachiopod faunas, multiple graptolitic horizons, and at least two tephras. Elemental analysis was conducted at 60 cm spacing quantifying lithofacies composition. Based on these results, the succession was assigned to six previously defined lithostratigraphic units (Kope, Waynesville, Liberty, Whitewater, Elkhorn, and Fort Atkinson formations). This lithostratigraphic succession shares components with both the Appalachian and Midcontinent basins, suggesting deposition near their shared margin. Twenty samples yielded abundant, well-preserved, low-diversity conodont assemblages with long-ranging taxa that clearly demarcate the position of the OrdovicianâSilurian boundary at the top of the succession in the core. More than fifty palynologic samples, targeting graptolite-bearing intervals, were processed for chitinozoans and produced important new insights. The Kope Formation contains the chitinozoan species Belonechitina kjellstromi, Hercochitina downiei, and Clathrochitina sp. nov., co-occurring with a graptolite assemblage suggestive of the Geniculograptus pygmaeus Zone. Samples from the overlying Waynesville Formation produced graptolites indicative of the upper G. pygmaeus to Paraorthograptus manitoulinensis zones co-occurring with the long-ranging chitinozoan species Belonechitina micracantha and Plectochitina spongiosa as well as several new species of the genera Tanuchitina and Hercochitina. Higher in the core, the Liberty, Whitewater, Elkhorn, and Fort Atkinson formations yielded chitinozoan species characteristic of the upper Katian biozones of Anticosti Island and Nevada, such as Tanuchitina anticostiensis, Hercochitina longi, and Eisenackitina ripae. Results of δ13Ccarb analysis reveal partial preservation of the Kope, Waynesville, and Elkhorn excursions. A tephra in the rising limb of the Waynesville Excursion yielded needle-shaped clear zircons that will provide a high-precision U-Pb age. The Fort Atkinson Formation is overlain by the Brassfield Formation containing Silurian conodonts and δ13Ccarb values suggesting an Aeronian age. Chronostratigraphic data from our study of the F688 core resolves longstanding uncertainty about correlations between strata of Katian Age in the Appalachian and Midcontinent basins. Integration of core F688 with our other regional chronostratigraphic data in the Midcontinent Basin demonstrates that the Fort Atkinson Formation of the Indiana and Illinois subsurface is age equivalent to the Fernvale Formation of Tennessee, Arkansas, and Oklahoma. Across this area, the Fernvale is overlain by graptolitic shales of the uppermost P. manitoulinensis to basal Dicellograptus complanatus graptolite zones. By contrast, the type Fort Atkinson Formation of Iowa is interpreted to occur completely within the younger D. complanatus Zone. These regional correlations taken as a whole suggest that the uppermost Katian (all of Ka4) and all but the uppermost Hirnantian are missing throughout much of the Appalachian Basin. By contrast, the Midcontinent Basin contains a much more complete upper Katian and Hirnantian succession. Our comprehensive approach is correcting temporal miscorrelation and providing robust chronostratigraphic context for study of biogeochemical events, which will further enable us to disentangle proxy data and identify the processes that drove the Katian diversity peak and culminated in the Late Ordovician mass extinction.

The purpose of this cross-sectional study was to estimate the proportion of Arkansas residents who were infected with the SARS-CoV-2 virus between May and December 2020 and to assess the determinants of infection. To estimate seroprevalence, a state-wide population-based random-digit dial sample of non-institutionalized adults in Arkansas was surveyed. Exposures were age, sex, race/ethnicity, education, occupation, contact with infected persons, comorbidities, height, and weight. The outcome was past COVID-19 infection measured by serum antibody test. We found a prevalence of 15.1% (95% CI: 11.1%, 20.2%) by December 2020. Seropositivity was significantly elevated among participants who were non-Hispanic Black, Hispanic (prevalence ratio [PRs]:1.4 [95% CI: 0.8, 2.4] and 2.3 [95% CI: 1.3, 4.0], respectively), worked in high-demand essential services (PR: 2.5 [95% CI: 1.5, 4.1]), did not have a college degree (PR: 1.6 [95% CI: 1.0, 2.4]), had an infected household or extra-household contact (PRs: 4.7 [95% CI: 2.1, 10.1] and 2.6 [95% CI: 1.2, 5.7], respectively), and were contacted in November or December (PR: 3.6 [95% CI: 1.9, 6.9]). Our results indicate that by December 2020, one out six persons in Arkansas had a past SARS-CoV-2 infection.

Abstract Quantifying the impact of long‐term agricultural management on nutrient fate and transport is critical for developing sustainable management solutions. In this study, the utility of a dual‐isotope approach, combining soil δ15N with analysis of δ18O of phosphate (δ18Op), was assessed at the Riesel Watershed in the Texas Blackland Prairies. The objective was to examine changes in soil nutrient concentration and isotopic signal from fields with contrasting nutrient source (inorganic fertilizer vs. poultry litter) and land use (remnant prairie vs. row crops) over a long‐term study (2002–2017). Results showed that soil δ15N varied between land use at the study onset likely because of greater N loss and cycling in row crops, with differences between row‐cropped fields becoming apparent following application of litter to one field. In contrast, soil δ18Op in row‐cropped fields only differed from the prairie following the long‐term nutrient trial; however, signatures were similar irrespective of P source. Results from this proof‐of‐concept study highlight the potential of a dual‐isotope approach for quantifying nutrient dynamics within soil systems when coupled with knowledge of long‐term management practices. Findings and study limitations also emphasize the need for future research and application of a dual‐isotope framework in agricultural landscapes for identifying and tracing nutrient fate and transport.

Objectives To identify differences in average basic pay between groups of National Health Service (NHS) doctors cross-classified by ethnicity and gender. Analyse the extent to which characteristics (grade, specialty, age, hours, etc.) can explain these differences.Design Retrospective observational study using repeated cross-section design.Setting Hospital and Community Health Service (HCHS) in England.Participants All HCHS doctors in England employed by the NHS between 2016 and 2020 appearing in the Digital Electronic Staff Record dataset (average N=99 953 per year).Main outcome measures Hours-adjusted full-time equivalent pay gaps; given as raw data and further adjusted for demographic, job, and workplace characteristics (such as grade, specialty, age, whether British nationality, region) using multivariable regression and statistical decomposition techniques.Results Pay gaps relative to white men vary with the ethnicity-gender combination. Indian men slightly out-earn white men and Bangladeshi women have a 40% pay gap. In most cases, pay gaps can largely be explained by characteristics that can be measured, especially grade, with the extent varying by specific ethnicity-gender group. However, a portion of pay gaps cannot be explained by characteristics that can be measured.Conclusions This study presents new evidence on ethnicity-gender pay gaps among NHS doctors in England using high quality administrative and payroll data. The findings indicate all ethnicity-gender groups earn less than white men on average, except for Indian men. In some cases, these differences cannot be explained giving rise to discussions about the role of discrimination.

COVID-19 has disproportionally burdened racial and ethnic minorities. Minority populations report greater COVID-19 vaccine hesitancy; however, no studies document COVID-19 vaccine willingness among Marshallese or any Pacific Islander group, who are often underrepresented in research. This study documents United States (US) Marshallese Pacific Islanders’: willingness to get the COVID-19 vaccine, willingness to participate in vaccine trials, and sociodemographic factors associated with willingness. From July 27, 2020-November 22, 2020, a convenience sample of US Marshallese adults were recruited through e-mail, phone calls, and a Marshallese community Facebook page to participate in an online survey. Of those surveyed (n = 120), 32.5% were extremely likely to get the COVID-19 vaccine; 20.8% were somewhat likely; 14.2% were unlikely or very unlikely; and 26.7% stated they did not know or were not sure. Only 16.7% stated they were willing to participate in a COVID-19 vaccine trial. Vaccine willingness was positively associated with older age, higher income, and longer US residence. Health insurance status and having a primary care provider were positively associated with vaccine willingness. Findings demonstrate within-group variation in COVID-19 vaccine willingness.

Abstract Background The National Review of Asthma Deaths UK highlighted that 46% of deaths could be avoided and recommended that all sufferers receive a structured asthma annual review which assess asthma control. In primary care this is commonly achieved using symptom-based questionnaires such as the Asthma Control Test (ACT). A newer method of assessing asthma control is Fractional Exhaled Nitric Oxide (FeNO) testing, which is currently recommended for the diagnosis of asthma, but not for monitoring of asthma control. The study aim was to assess the correlation between self-reported symptoms as measured by the ACT and FeNO testing and the subsequent impact of FeNO testing on prescribing of asthma medication. Methods A retrospective review of 65 patients who had received both ACT and FeNO testing as part of their asthma annual review. A spearman correlation was used to estimate the correlation between ACT scores and FENO levels. A χ2 test was used to compare prompting frequency of the measures and Kendalls τ statistic was made to estimate their concordance and influence on subsequent ICS medication prescription. Results The mean age of the participants was 41 years (4–93 years). There was no statistically significant correlation between ACT and FeNO (ρ = 0.195, p = 0.120). The median FeNO was 26 ppb (range 8–279 ppb), and the ACT score 20 (range 5 to 25 points). Furthermore, FeNO more frequently prompts a change in medication than ACT, 66% versus 42% (p = 0.005). A low concordance between the measures was found (Kendall’s τ statistic − 0.321). Conclusion FeNO should be considered for monitoring of control in asthma. To balance the cost of implementing this technology into primary care a risk stratified approach could be applied to testing.

Pest management in cucurbit (Cucurbitaceae) cropping systems is challenging. As a result, pesticides are heavily used for managing insect pests and diseases. This work focused on the application of integrated pest management (IPM) techniques to control pests and reduce reliance on insecticide sprays while maintaining the quality and quantity of marketable yields in two commonly grown cucurbit crops: muskmelon (Cucumis melo) and summer squash (Cucurbita pepo). Plasticulture (raised beds covered in black plastic mulch) and strip tillage, two soil management systems commonly used for cucurbit IPM production, were compared to determine their impact on yield and pest numbers during the 2013–14 growing seasons. Additionally, the use of early season rowcovers and their impact on yield and pest pressure were investigated. Plasticulture use increased marketable yields compared with strip tillage for both summer squash and muskmelon, but strip tillage resulted in fewer total pests for both crops. Rowcover use did not have a consistent effect on insect pest numbers and showed a negative impact on the yield of both summer squash and muskmelon. No significant impacts on yield were observed when the interaction between rowcovers and the tillage system was investigated. The use of rowcovers impacted pest numbers, but these impacts were not consistent between insect pest species. Insecticide use was reduced in covered treatments, but only by one application. We concluded that these management techniques have the potential to be used in an IPM system, but the reduced marketable yield of strip tillage systems may reduce the adoption of this IPM technique for these crops.

Abstract Background Lymphoedema is a chronic condition that causes swelling in the body tissues. Presently, there is no cure for lymphoedema; instead, current treatment is aimed at lifelong management to help control symptoms. Intermittent pneumatic compression (IPC) therapy can be considered as an adjunct to standard lymphoedema care; however, research regarding the efficacy of this treatment modality is limited. Methods Twenty participants were recruited from an outpatient lymphoedema clinic (South Wales, UK) to a feasibility randomised control trial designed to evaluate the efficacy of an IPC device (LymphAssist, Huntleigh Healthcare) in reducing lower limb volume. The primary objective was to assess feasibility in terms of (1) study feasibility, including recruitment, retention and assessment of outcome measures, and (2) intervention feasibility, including intervention fidelity and acceptability to participants. Participants were randomly assigned to a control group (n = 10) or intervention group (n = 10). The control group received their standard lymphoedema care only for a 6-month period, whereas the intervention group received their standard lymphoedema care plus an IPC device to use for 6 months. A bilateral lower limb assessment and quality of life survey were undertaken at baseline and 3- and 6-month time points. Results The study recruited to target within the planned time frame with a retention rate of 80%. Issues relating to potential recruitment bias and study attrition were identified and possible solutions explored. In addition, supplementary primary outcome measures that are important to the study population were identified and will be incorporated into the design of future studies. Conclusion This feasibility study identified that a larger randomised controlled trial investigating the efficacy of home use IPC devices is feasible with modifications to the study protocol. Trial registration This trial is registered with clinicaltrials.gov (NCT03825263).

Abstract Background The first Multi-center Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals. We sought to implement the MARQUIS toolkit in more diverse hospitals, incorporating lessons learned from MARQUIS1. Methods MARQUIS2 is a pragmatic, mentored implementation QI study which collected clinical and implementation outcomes. Sites implemented a revised toolkit, which included interventions from these domains: 1) best possible medication history (BPMH)-taking; 2) discharge medication reconciliation and patient/caregiver counseling; 3) identifying and defining clinician roles and responsibilities; 4) risk stratification; 5) health information technology improvements; 6) improved access to medication sources; 7) identification and correction of real-time discrepancies; and, 8) stakeholder engagement. Eight hospitalists mentored the sites via one site visit and monthly phone calls over the 18-month intervention period. Each site’s local QI team assessed opportunities to improve, implemented at least one of the 17 toolkit components, and accessed a variety of resources (e.g. implementation manual, webinars, and workshops). Outcomes to be assessed will include unintentional medication discrepancies per patient. Discussion A mentored multi-center medication reconciliation QI initiative using a best practices toolkit was successfully implemented across 18 medical centers. The 18 participating sites varied in size, teaching status, location, and electronic health record (EHR) platform. We introduce barriers to implementation and lessons learned from MARQUIS1, such as the importance of utilizing dedicated, trained medication history takers, simple EHR solutions, clarifying roles and responsibilities, and the input of patients and families when improving medication reconciliation.

Newly collected material reveals that the Silurian myodocope ostracods from the Holy Cross Mountains, Poland comprise ten species (one new to science) belonging to four families: Bolbozoidae, Entomozoidae, Rhomboentomozoidae, and Cypridinidae. Biostratigraphic control using graptolites indicates that all three Polish outcrops investigated are of about the same chronostratigraphical level: middle Gorstian, lower Ludlow. The new occurrences in Poland extend the known distribution of several species and reinforce data that show many Silurian myodocope species with wide dispersal. Our new observations on the Holy Cross Mountains material confirm that the occurrences of Silurian myodocopes are mostly associated with pelagic animals and with rocks ranging from mudstone, siltstone or shale deposited in open- or deep-shelf marine settings. The cosmopolitan distribution of these ostracods, coupled with their facies and faunal associations, supports the notion of an ostracod (myodocope) ecological shift from benthic to planktonic habitats during the late Wenlock and Ludlow.

This article describes the formation of The Tasmanian Historical Dataset a longitudinal data resource spanning the 19th and early 20th century. This resource contains over 1.6 million records drawn from digitised prison and hospital admission registers, military enlistment papers, births, deaths and marriages, census and muster records, arrival and departure lists, bank accounts and property valuations, maps and plans and meteorological observations. As well as providing an account of the many different sources that have been digitised coded and linked as part of this initiative, the article outlines current and past research uses to which this data has been put. Further information on tables and key variables is provided in an appendix.

While inertial measurement units (IMU) have become an integral part of sports performance analysis, upper body-mounted IMUs have been found to exhibit poor reliability in measuring lower-limb loading. In racket sports, IMUs have been placed in a number of positions on the upper body, lower body and racket in a research setting. A potential limitation to the concurrent use of multiple IMUs is that coaches may be reluctant to allow their athletes to wear the units during training and competition due to concerns that the units would interfere with athlete movement. This study seeks to understand the perceptions of racket sports coaches towards the use of IMUs in training and competition. A total of 58 racket sport coaches responded to a survey on the use of IMUs during training and competition. Based on the responses, 96.6% (56 out of 58) of coaches indicated that they would allow their athletes to wear IMUs in training, while 65.5% (38 out of 58) would allow their athletes to wear IMUs during competition. For use in training, 9 of the 14 suggested IMU placements received significant positive responses. However, none of the suggested IMU placements received significant positive responses for use during competition and 11 of the 14 received significant negative responses. This suggests that while coaches understand the benefits of collecting data from IMUs during competition. Despite this, for use in training, a number of upper and lower body-mounted IMUs placements have the potential to be part of regular monitoring in racket sports.