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Feeding challenges are a significant concern for autistic children. Literature has yet to comprehensively characterize feeding challenges for autistic children. Further research is needed to understand predictors of feeding severity and identify opportunities for screening and intervention. The purpose of this study was to characterize the presentation of feeding challenges in autistic children and identify predictors of feeding challenge classification and severity. Data from a national cross-sectional survey of caregivers (n = 427) of autistic children with feeding challenges was used. Feeding challenges were characterized using descriptive statistics. Autism diagnosis age and age of onset of feeding challenges was compared using non-parametric testing. Bi-directional stepwise multivariate linear regression was used to identify significant predictors of feeding challenge scores. Sensory-based feeding challenges were the most common. Age of onset of feeding challenges was significantly lower than the age of autism diagnosis. Early feeding challenges differentially predicted feeding challenge severity and classification scores. The results of this study identify the relationships among early feeding challenges and the severity and classification of feeding challenges in later childhood. Results demonstrate the importance of early monitoring of feeding challenges. These findings can be used to inform the identification of critical timepoints for intervention.

Background: The COVID-19 pandemic has brought about disruptions in healthcare for adults with intellectual and developmental disabilities. There is a need to explore ways to promote proactive healthcare and better prepare individuals for healthcare encounters. Methods: A co-designed tool, the COVID Check-in Tool, was introduced as part of a virtual health education programme to encourage proactive healthcare. Implementation of this Health Check-in was evaluated with 36 adults with intellectual and developmental disabilities and 96 family caregivers who completed the programme using surveys, structured interviews and focus groups. Findings: Forty-four percent of participants engaged in the Health Check-in process, resulting in many reported benefits for those who participated. However, there were also barriers to initiating the Check-in, along with challenges using the COVID Check-in Tool, according to both the adults with disabilities who were interviewed and the family caregivers. Conclusions: The study underscores the importance of considering ways to integrate tools into routine healthcare practices, to facilitate improved healthcare delivery for people with intellectual and developmental disabilities during pandemic recovery efforts. As well, involving people with lived experience in the development and implementation of healthcare resources is critical.

The normative role of the World Health Organization (WHO) involves creating evidence-based, principled guidelines to guide its Member States in making well-informed public health decisions. While these guidelines often need to be adapted to ensure contextual relevance, foster better implementation and adherence, adapting existing guidelines is more efficient than creating new ones. Here we describe the adaptation of the WHO coronavirus disease 2019 (COVID-19) living guideline on pharmacological interventions for the Caribbean using the grading of recommendations, assessment, development and evaluation (GRADE)-ADOLOPMENT method. The Caribbean Public Health Agency and the Pan American Health Organization led the effort, assembling a diverse panel of 16 experts from seven Caribbean countries and territories. The adaptation process, involving 15 steps, was guided by an experienced methodologist and included selecting relevant clinical questions and prioritizing them based on regional needs. The panel evaluated the latest WHO guidelines and integrated additional local data. They adjusted the direction and strength of several recommendations to better fit the Caribbean context, considering local values and preferences, resources, accessibility, feasibility and impact on health equity. Ultimately, we changed the direction of two recommendations and the strength of five, tailoring them to regional realities. This effort highlights the importance of adapting global guidelines to local settings, improving their applicability and effectiveness. The adaptation process also serves as a valuable opportunity for skill transfer and capacity-building in guideline development. Continued research is needed to assess the impact of these adaptations on health-care outcomes in the Caribbean. [phrase omitted] Le role normatif de l'Organisation mondiale de la sante (OMS) consiste a elaborer des lignes directrices fondees sur des donnees scientifiques et sur des principes afin d'aider ses Etats membres a prendre des decisions eclairees en matiere de sante publique. Bien qu'elles necessitent souvent des adaptations pour garantir leur pertinence par rapport a des contextes precis et pour favoriser une meilleure mise en oeuvre et adhesion, il est plus efficace d'adapter les lignes directrices existantes que d'en creer de nouvelles. La presente publication decrit l'adaptation de la ligne directrice evolutive de l'OMS sur les interventions pharmacologiques dans le cadre de la maladie a coronavirus (COVID-19) pour les Caraibes en appliquant la methodologie GRADE (classement des recommandations, de l'appreciation, du developpement et de l'evaluation)-ADOLOPMENT. LAgence de sante publique des Caraibes et l'Organisation panamericaine de la Sante ont dirige les travaux en reunissant un groupe diversifie de 16 experts issus de sept pays et territoires des Caraibes. Le processus d'adaptation, comptant 15 etapes et encadre par un methodologiste experimente, a consiste a selectionner des questions cliniques pertinentes et a les classer par ordre de priorite selon les besoins regionaux. Ce groupe a evalue les dernieres lignes directrices de l'OMS et a integre des donnees locales supplementaires. Il a ensuite ajuste l'orientation et le poids de plusieurs recommandations afin de mieux les adapter au contexte des Caraibes, en tenant compte des valeurs et des preferences locales, des ressources, de l'accessibilite, de la faisabilite et de l'impact sur l'equite en matiere de sante. En fin de compte, l'orientation de deux recommandations et le poids de cinq autres ont ete modifies, en les adaptant aux realites regionales. Cet effort souligne l'importance d'adapter des lignes directrices mondiales aux contextes locaux, afin d'en ameliorer l'applicabilite et l'efficacite. Le processus d'adaptation represente egalement une occasion precieuse de transfert de competences et de renforcement des capacites en matiere d'elaboration de lignes directrices. Des recherches continues s'imposent pour evaluer l'impact de ces adaptations sur les resultats des soins de sante dans les Caraibes. [phrase omitted] La funcion normativa de la Organizacion Mundial de la Salud (OMS) consiste en elaborar directrices basadas en pruebas y principios para orientar a sus Estados Miembros en la toma de decisiones de salud publica bien fundamentadas. Aunque con frecuencia es necesario adaptar estas directrices para garantizar su pertinencia contextual y fomentar una mejor implementacion y observancia, la adaptacion de directrices existentes es mas eficiente que la creacion de otras nuevas. Aqui describimos la adaptacion de la directriz vigente de la OMS sobre la enfermedad por coronavirus (COVID-19) relativa a las intervenciones farmacologicas para el Caribe utilizando el metodo de clasificacion de valoracion, elaboracion y evaluacion de las recomendaciones (GRADE)ADOLOPMENT. La Agencia de Salud Publica del Caribe y la Organizacion Panamericana de la Salud lideraron la iniciativa, que reunio a un variado grupo de 16 expertos de siete paises y territorios caribenos. El proceso de adaptacion, que comprendio 15 pasos y fue guiado por un metodologo experimentado, Incluyo la seleccion de preguntas clinicas pertinentes y su priorizacion en funcion de las necesidades regionales. El grupo evaluo las ultimas directrices de la OMS e integro datos locales adicionales. Ajustaron la orientacion y la fuerza de varias recomendaciones para adaptarlas mejor al contexto caribeno, teniendo en cuenta los valores y preferencias locales, los recursos, la accesibilidad, la viabilidad y el impacto en la equidad sanitaria. Finalmente, cambiamos la orientacion de dos recomendaciones y la fuerza de cinco para adaptarlas a las realidades regionales. Esta iniciativa destaca la importancia de adaptar las directrices mundiales a los contextos locales, lo que mejora su aplicabilidad y eficacia. El proceso de adaptacion tambien constituye una valiosa oportunidad para la transferencia de conocimientos y el desarrollo de capacidades en la elaboracion de directrices. Es necesario seguir investigando para evaluar el impacto de estas adaptaciones en los resultados de la atencion sanitaria en el Caribe., Introduction Although the coronavirus disease 2019 (COVID-19) pandemic was a global catastrophe, its impact was not felt equally around the world. Despite being home to only 8% of the world's [...]

This study provides an overview of efforts to improve experiential learning outcomes by integrating the curriculum of an upper-level Project Management (PM) course with an Introductory Programming (IP) course using a game-making project. Students in the PM course applied PM methods and techniques while supervising teams of students in the IP course in making a gaming app. Paradoxically, it was found that transitioning from complex, real-world client projects to more structured and guided student projects increased realism and enhanced experiential learning. Positive results were not automatically derived by employing experiential learning tools. More important was a focus on the process through which student experiences resulted in knowledge acquisition and creation. The findings of this study encourage educators to pay special attention to the implementation and integration of learning tools to create synergy in the learning process.

Abstract A significant challenge in measurements of neutrino oscillations is reconstructing the incoming neutrino energies. While modern fully-active tracking calorimeters such as liquid argon time projection chambers in principle allow the measurement of all final state particles above some detection threshold, undetected neutrons remain a considerable source of missing energy with little to no data constraining their production rates and kinematics. We present the first demonstration of tagging neutrino-induced neutrons in liquid argon time projection chambers using secondary protons emitted from neutron-argon interactions in the MicroBooNE detector. We describe the method developed to identify neutrino-induced neutrons and demonstrate its performance using neutrons produced in muon-neutrino charged current interactions. The method is validated using a small subset of MicroBooNE’s total dataset. The selection yields a sample with $$60\%$$ 60 % of selected tracks corresponding to neutron-induced secondary protons. At this purity, the integrated efficiency is 8.4% for neutrons that produce a detectable proton.

Clasina Leslie Smith,1,2,* Bill Reddy,3,* Charis M Wolf,4,5,* Rosa N Schnyer,6,7,* Korina St John,8,* Lisa Conboy,4,7,9– 14,* Jen Stone,15 Lixing Lao16– 18 1Chicago Healing Center, Chicago, IL, USA; 2School of Medicine, Southern Illinois University, Springfield, IL, USA; 3Vital Point Acupuncture, Annandale, VA, USA; 4Seattle Institute of East Asian Medicine, Seattle, WA, USA; 5Middle Way Acupuncture Institute, Seattle, WA, USA; 6School of Nursing, University of Texas, Austin, TX, USA; 7Oregon College of Oriental Medicine, Portland, OR, USA; 8Modern Medicine Woman, LLC, Palmer, AK, USA; 9Beth Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; 10California Institute of Integral Studies, San Francisco, CA, USA; 11Pacific College of Oriental Medicine, San Diego, CA, USA; 12YoSan University, Los Angeles, CA, USA; 13Five Branches University, Santa Cruz, CA, USA; 14American Academy of Health and Wellness, Roseville, MN, USA; 15CTSI, Indiana University School of Medicine, Indianapolis, IN, USA; 16Virginia University of Integrative Medicine, Vienna, VA, USA; 17School of Medicine, University of Maryland, Baltimore, MD, USA; 18School of Chinese Medicine, University of Hong Kong, Pokfulam, Hong Kong*These authors contributed equally to this workCorrespondence: Clasina Leslie Smith, Chicago Healing Center, 1560 N Sandburg Ter, Unit 3215, Chicago, IL, 60610, USA, Tel +1-773-217-0567, Email LeslieTCM@gmail.comAbstract: The term “acupuncture” commonly refers to a non-pharmacologic therapy that is increasingly employed by diverse segments of the population for a wide variety of complaints including pain, insomnia, anxiety, depression, frozen shoulder, and other issues. The term is also used as a short-hand for the wider medical system from which the placement of needles into the skin for therapeutic benefit and related techniques evolved. Thus “acupuncture” refers both to the therapeutic technique and the therapeutic system of Acupuncture and Herbal Medicine (AHM). The other modalities included within AHM include a wide variety of physical and mechanical manipulations, herbal medicines, dietary recommendations, and lifestyle modifications. Clinically, acupuncture is increasingly offered in a variety of conventional medical settings such as hospitals, medical school clinics, veterans’ healthcare centers, oncology facilities, and rehabilitation centers, and its safety profile is excellent overall. Barriers to further incorporation of acupuncture into biomedical sites include insurance coverage of acupuncture, education of conventional medical practitioners and other stakeholders about the utility, efficacy, and evidence base of acupuncture. Acupuncturists in the United States are skilled practitioners who are highly educated in the complex therapeutic system from which acupuncture arose and in the technical aspects of its utility as a treatment modality. The training, certification, licensure, and regulation of acupuncturists is similar to that of conventional providers such has physician’s assistants, advanced practice nurses, and medical and osteopathic doctors. While clinical use and acceptance of acupuncture continues to grow, there is to date no definitive composite document explaining the utility of acupuncture in various healthcare settings, the current understanding of how acupuncture works, and the training, professional regulation, and certification of acupuncture practitioners. This article will address these topics and strive to create a reference for practitioners, administrators, legislators, insurance providers, patients and their families, and other stakeholders.Plain Language Summary: Acupuncture refers to the placement of thin, sterile needles into the skin to stimulate healing effects, and, in the United States, it also refers to the medical system from which the technique of acupuncture evolved. That system, Acupuncture and Herbal Medicine (AHM), uses acupuncture, dietary and lifestyle advice, herbal medicines, and other therapies to facilitate health and healing. Acupuncture is increasingly being used for a wide variety of medical problems including pain, difficulty sleeping, mental health concerns, and other issues in a wide variety of settings and is supported by a growing scientific basis for understanding why and how it works. Training and licensure of acupuncturists are similar to many conventional practitioners, and the process is accredited and overseen by various governmental and regulatory bodies. This paper aims to provide an overview of the use of acupuncture in the United States, the scientific basis for acupuncture, the training and licensure of acupuncturists, and the ways in which acupuncture is and might be incorporated into conventional medical settings.Keywords: acupuncture, herbal medicine, traditional Chinese medicine, integrative medicine, integrative health, medical policy

There is a growing interest in understanding the connection between Indigenous art, nature, and art therapy, however information on the health implications of Indian Indigenous art practices is scarce. This case study highlights the application of nature-based Indian Indigenous art form "Gond" and explores its therapeutic potential in art therapy. A workshop was organized, combining nature-based guided imagery visualization with "Gond" folktale narration, followed by "Gond"-inspired artmaking using natural pigments and repetitive patterns. Workshop participants' responses indicated that this approach fostered engagement, intense concentration, present moment awareness, a relaxed meditative state, and personal expression. Sensitively adapting Indigenous knowledge, like "Gond" practices, can promote awareness about interconnectedness with nature, artmaking, and storytelling, offering therapeutic benefits for self-care in art therapy.

Placement tests are used to support a particular need in a local context--to determine the best starting place for a student entering a specific programme of language study. This brief report will focus on the development of an innovative placement test with self-directed elements for our local needs at a university in Canada for students studying English or French as a second language. Our goals are to produce a more efficient assessment instrument while allowing students more agency through the process. We hope that sharing these details will encourage others to consider the potential of incorporating self-directed elements in low-stakes placement decision-making.

Design education in Australia is still largely dominated by Westphalian perspectives, values, histories and ways of learning. The focus on Euro-western aesthetics, technologies, timelines and processes marginalises other identities, cultures and places. This signals to students that they should internalise, value and master dominant narratives, knowledges and ways of designing. Responding to this legacy, this article details the development of an intersectional and transformative framework to guide pedagogy for design education futures. Drawing from intersectional, student-centred and transformative learning theories, we argue that students can develop self-awareness and critical evaluation skills through understanding and designing within their own histories and cultures. In applying our framework, we reflect on how we developed a communication design history curriculum that centres on previously marginalised designers and prioritises pluralistic work that comes out of diverse cosmologies, perspectives and points of view. Early results demonstrate that offering spaces for students to connect design to their own intersectional identities increases self-reflection and belonging, while engaging students to contribute new knowledges and perspectives to design history than we have had in the past. We hope this framework contributes to design education moving towards and respecting expanded ways of thinking, seeing and teaching design.

Did anyone believe one life mattered More than any other or that lives In a sketchbook held anything Beyond a few gestures caught out of time Always more by accident [...]

Abstract Objective New characterized carbohydrate-active enzymes are needed for use as tools to discriminate complex carbohydrate structural features. Fungal glycoside hydrolase family 3 (GH3) β-xylosidases have been shown to be useful for the structural elucidation of glucuronic acid (GlcA) and arabinofuranose (Araf) substituted oligoxylosides. A homolog of these GH3 fungal enzymes from the bacterium Segatella baroniae (basonym Prevotella bryantii), Xyl3C, has been previously characterized, but those studies did not address important functional specificity features. In an interest to utilize this enzyme for laboratory methods intended to discriminate the structure of the non-reducing terminus of substituted xylooligosaccharides, we have further characterized this GH3 xylosidase. Results In addition to verification of basic functional characteristics of this xylosidase we have determined its mode of action as it relates to non-reducing end xylose release from GlcA and Araf substituted oligoxylosides. Xyl3C cleaves xylose from the non-reducing terminus of β-1,4-xylan until occurrence of a penultimate substituted xylose. If this substitution is O2 linked, then Xyl3C removes the non-reducing xylose to leave the substituted xylose as the new non-reducing terminus. However, if the substitution is O3 linked, Xyl3C does not hydrolyze, thus leaving the substitution one-xylose (penultimate) from the non-reducing terminus. Hence, Xyl3C enables discrimination between O2 and O3 linked substitutions on the xylose penultimate to the non-reducing end. These findings are contrasted using a homologous enzyme also from S. baroniae, Xyl3B, which is found to yield a penultimate substituted nonreducing terminus regardless of which GlcA or Araf substitution exists.

Background Internationally, stresses related to the COVID-19 pandemic negatively affected the mental health of family caregivers of adults with intellectual and developmental disabilities (IDDs). Aims This cross-sectional study investigated demographic, situational and psychological variables associated with mental wellbeing among family caregivers of adults with IDDs during the COVID-19 pandemic. Method Baseline data from 202 family caregivers participating in virtual courses to support caregiver mental well-being were collected from October 2020 to June 2022 via online survey. Mental well-being was assessed using total scores from the Warwick-Edinburgh Mental Wellbeing Scale. Demographic, situational and psychological contributors to mental well-being were identified using hierarchical regression analysis. Results Variables associated with lower levels of mental well-being were gender (women); age (

This manuscript presents a proof-of-concept for a generalizable strategy, the full algorithm, designed to estimate disease risk using real-world clinical tabular data systems, such as electronic health records (EHR) or claims databases. By integrating classic statistical methods and modern artificial intelligence techniques, this strategy automates the production of a disease prediction model that comprehensively reflects the dynamics contained within the underlying data system. Specifically, the full algorithm parses through every facet of the data (e.g., encounters, diagnoses, procedures, medications, labs, chief complaints, flowsheets, vital signs, demographics, etc.), selects which factors to retain as predictor variables by evaluating the data empirically against statistical criteria, structures and formats the retained data into time-series, trains a neural network-based prediction model, then subsequently applies this model to current patients to generate risk estimates. A distinguishing feature of the proposed strategy is that it produces a self-adaptive prediction system, capable of evolving the prediction mechanism in response to changes within the data: as newly collected data expand/modify the dataset organically, the prediction mechanism automatically evolves to reflect these changes. Moreover, the full algorithm operates without the need for a-priori data curation and aims to harness all informative risk and protective factors within the real-world data. This stands in contrast to traditional approaches, which often rely on highly curated datasets and domain expertise to build static prediction models based solely on well-known risk factors. As a proof-of-concept, we codified the full algorithm and tasked it with estimating 12-month risk of initial stroke or myocardial infarction using our hospital's real-world EHR. A 66-month pseudo-prospective validation was conducted using records from 558,105 patients spanning April 2015 to September 2023, totalling 3,424,060 patient-months. Area under the receiver operating characteristic curve (AUROC) values ranged from .830 to .909, with an improving trend over time. Odds ratios describing model precision for patients 1-100 and 101-200 (when ranked by estimated risk) ranged from 15.3 to 48.1 and 7.2 to 45.0, respectively, with both groups showing improving trends over time. Findings suggest the feasibility of developing high-performing disease risk calculators in the proposed manner.

Abstract Background Following the legalization of cannabis in Canada in 2018, people aged 65 + years reported a significant increase in cannabis consumption. Despite limited research with older adults regarding the therapeutic benefits of cannabis, there is increasing interest and use among this population, particularly for those who have chronic illnesses or are at end of life. Long-term Care (LTC) facilities are required to reflect on their care and policies related to the use of cannabis, and how to address residents’ cannabis use within what they consider to be their home. Methods Using an exploratory case study design, this study aimed to understand how one LTC facility in western Canada addressed the major policy shift related to medical and non-medical cannabis. The case study, conducted November 2021 to August 2022, included an environmental scan of existing policies and procedures related to cannabis use at the LTC facility, a quantitative survey of Healthcare Providers’ (HCP) knowledge, attitudes, and practices related to cannabis, and qualitative interviews with HCPs and administrators. Quantitative survey data were analyzed using descriptive statistics and content analysis was used to analyze the qualitative data. Results A total of 71 HCPs completed the survey and 12 HCPs, including those who functioned as administrators, participated in the interview. The largest knowledge gaps were related to dosing and creating effective treatment plans for residents using cannabis. About half of HCPs reported providing care in the past month to a resident who was taking medical cannabis (54.9%) and a quarter (25.4%) to a resident that was taking non-medical cannabis. The majority of respondents (81.7%) reported that lack of knowledge, education or information about medical cannabis were barriers to medical cannabis use in LTC. From the qualitative data, we identified four key findings regarding HCPs’ attitudes, cannabis access and use, barriers to cannabis use, and non-medical cannabis use. Conclusions With the legalization of medical and non-medical cannabis in jurisdictions around the world, LTC facilities will be obligated to develop policies, procedures and healthcare services that are able to accommodate residents’ use of cannabis in a respectful and evidence-informed manner.

Abstract Background Specifying early developmental differences among neurodevelopmental disorders with distinct etiologies is critical to improving early identification and tailored intervention during the first years of life. Recent studies have uncovered important differences between infants with fragile X syndrome (FXS) and infants with familial history of autism spectrum disorder who go on to develop autism themselves (FH-ASD), including differences in brain development and behavior. Thus far, there have been no studies longitudinally investigating differential developmental skill profiles in FXS and FH-ASD infants. Methods The current study contrasted longitudinal trajectories of verbal (expressive and receptive language) and nonverbal (gross and fine motor, visual reception) skills in FXS and FH-ASD infants, compared to FH infants who did not develop ASD (FH-nonASD) and typically developing controls. Results Infants with FXS showed delays on a nonverbal composite compared to FH-ASD (as well as FH-nonASD and control) infants as early as 6 months of age. By 12 months an ordinal pattern of scores was established between groups on all domains tested, such that controls > FH-nonASD > FH-ASD > FXS. This pattern persisted through 24 months. Cognitive level differentially influenced developmental trajectories for FXS and FH-ASD. Conclusions Our results demonstrate detectable group differences by 6 months between FXS and FH-ASD as well as differential trajectories on each domain throughout infancy. This work further highlights an earlier onset of global cognitive delays in FXS and, conversely, a protracted period of more slowly emerging delays in FH-ASD. Divergent neural and cognitive development in infancy between FXS and FH-ASD contributes to our understanding of important distinctions in the development and behavioral phenotype of these two groups.

The authors' aim was to present a practical decision-making framework for decision makers (DMs) to use in evaluating interdisciplinary strategic approaches to degree program development. A framework based on ordinal game theory was applied using a recent decision to create an interdisciplinary business analytics program at a small, public university. The optimal Nash, in which each decision maker receives the most desirable outcome, was determined. The proposed methodological framework can be used for the design, evaluation, and postcommitment support of any interdisciplinary degree program.

Teamwork skills are an important part of business school curriculum typically taught using project-based experiential methods. This paper presents best practices for teaching teamwork skills to Gen Z students using a project-based learning, peer mentoring approach. With experiential learning theory as a guide, an interdisciplinary process was developed between an introductory programming course and a capstone business project management course to improve experiential learning and overcome issues like the free-rider problem. The opinions and sentiments of peer mentors were examined using text analysis and sentiment analysis. Peer mentoring between two interdisciplinary courses was found to reduce the free-rider problem and was beneficial for both classes.

Summary: Kaposi sarcoma (KS) punch biopsies present unique challenges for extracting nucleic acids, which can be exacerbated by their long-term stabilization in RNAlater. Here, we present a protocol for simultaneously isolating DNA, RNA, and miRNA from a single KS punch biopsy. We detail the steps for preparing reagents and supplies, disrupting KS tissue using manual and mechanical methods, isolating DNA and total RNA, evaluating nucleic acid quality, and storing nucleic acids long-term. : Publisher’s note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics.

Abstract Phenotypic covariation among suites of traits may constrain or promote diversification both within and between species, yet few studies have empirically tested this relationship. In this study, we investigate whether phenotypic covariation of craniofacial traits is associated with diversification in an adaptive radiation of pupfishes found only on San Salvador Island, Bahamas (SSI). The radiation includes generalist, durophagous, and lepidophagous species. We compared phenotypic variation and covariation (i.e., the P matrix) between (1) allopatric populations of generalist pupfish from neighboring islands and estuaries in the Caribbean, (2) SSI pupfish allopatric lake populations with only generalist pupfish, and (3) SSI lake populations containing the full radiation in sympatry. Additionally, we examine patterns observed in the P matrices of two independent lab‐reared F2 hybrid crosses of the two most morphologically distinct members of the radiation to make inferences about the underlying mechanisms contributing to the variation in craniofacial traits in SSI pupfishes. We found that the P matrix of SSI allopatric generalist populations exhibited higher levels of mean trait correlation, constraints, and integration with simultaneously lower levels of flexibility compared to allopatric generalist populations on other Caribbean islands and sympatric populations of all three species on SSI. We also document that while many craniofacial traits appear to result from additive genetic effects, variation in key traits such as head depth, maxilla length, and lower jaw length may be produced via non‐additive genetic mechanisms. Ultimately, this study suggests that differences in phenotypic covariation significantly contribute to producing and maintaining organismal diversity.

ABSTRACT Severe COVID-19 has been associated with coinfections with bacterial and fungal pathogens. Notably, patients with COVID-19 who develop Staphylococcus aureus bacteremia exhibit higher rates of mortality than those infected with either pathogen alone. To understand this clinical scenario, we collected and examined S. aureus blood and respiratory isolates from a hospital in New York City during the early phase of the pandemic from both SARS-CoV-2+ and SARS-CoV-2− patients. Whole genome sequencing of these S. aureus isolates revealed broad phylogenetic diversity in both patient groups, suggesting that SARS-CoV-2 coinfection was not associated with a particular S. aureus lineage. Phenotypic characterization of the contemporary collection of S. aureus isolates from SARS-CoV-2+ and SARS-CoV-2− patients revealed no notable differences in several virulence traits examined. However, we noted a trend toward overrepresentation of S. aureus bloodstream strains with low cytotoxicity in the SARS-CoV-2+ group. We observed that patients coinfected with SARS-CoV-2 and S. aureus were more likely to die during the acute phase of infection when the coinfecting S. aureus strain exhibited high or low cytotoxicity. To further investigate the relationship between SARS-CoV-2 and S. aureus infections, we developed a murine coinfection model. These studies revealed that infection with SARS-CoV-2 renders mice susceptible to subsequent superinfection with low cytotoxicity S. aureus. Thus, SARS-CoV-2 infection sensitizes the host to coinfections, including S. aureus isolates with low intrinsic virulence.IMPORTANCEThe COVID-19 pandemic has had an enormous impact on healthcare across the globe. Patients who were severely infected with SARS-CoV-2, the virus causing COVID-19, sometimes became infected with other pathogens, which is termed coinfection. If the coinfecting pathogen is the bacterium Staphylococcus aureus, there is an increased risk of patient death. We collected S. aureus strains that coinfected patients with SARS-CoV-2 to study the disease outcome caused by the interaction of these two important pathogens. We found that both in patients and in mice, coinfection with an S. aureus strain lacking toxicity resulted in more severe disease during the early phase of infection, compared with infection with either pathogen alone. Thus, SARS-CoV-2 infection can directly increase the severity of S. aureus infection.

Abstract Populations may adapt to similar environments via parallel or non‐parallel genetic changes, but the frequency of these alternative mechanisms and underlying contributing factors are still poorly understood outside model systems. We used QTL mapping to investigate the genetic basis of highly divergent craniofacial traits between the scale‐eater (Cyprinodon desquamator) and molluscivore (C. brontotheroides) pupfish adapting to two different hypersaline lake environments on San Salvador Island, Bahamas. We lab‐reared F2 scale‐eater x molluscivore intercrosses from two different lake populations, estimated linkage maps, scanned for significant QTL for 29 skeletal and craniofacial traits, female mate preference, and sex. We compared the location of QTL between lakes to quantify parallel and non‐parallel genetic changes. We detected significant QTL for six craniofacial traits in at least one lake. However, nearly all shared QTL loci were associated with a different craniofacial trait within each lake. Therefore, our estimate of parallel evolution of craniofacial genetic architecture could range from one out of six identical trait QTL (low parallelism) to five out of six integrated trait QTL (high parallelism). We suggest that pleiotropy and trait integration can affect estimates of parallel evolution, particularly within rapid radiations. We also observed increased adaptive introgression in shared QTL regions, suggesting that gene flow contributed to parallel evolution. Overall, our results suggest that the same genomic regions may contribute to parallel adaptation across integrated suites of craniofacial traits, rather than specific traits, and highlight the need for a more expansive definition of parallel evolution.

Background Major bile duct injuries during laparoscopic cholecystectomy (LC), often stemming from errors in surgical judgment and visual misperception of critical anatomy, significantly impact morbidity, mortality, disability, and health care costs. Objective To enhance safe LC learning, we developed an educational mobile game, LapBot Safe Chole, which uses an artificial intelligence (AI) model to provide real-time coaching and feedback, improving intraoperative decision-making. Methods LapBot Safe Chole offers a free, accessible simulated learning experience with real-time AI feedback. Players engage with intraoperative LC scenarios (short video clips) and identify ideal dissection zones. After the response, users receive an accuracy score from a validated AI algorithm. The game consists of 5 levels of increasing difficulty based on the Parkland grading scale for cholecystitis. Results Beta testing (n=29) showed score improvements with each round, with attendings and senior trainees achieving top scores faster than junior residents. Learning curves and progression distinguished candidates, with a significant association between user level and scores (P=.003). Players found LapBot enjoyable and educational. Conclusions LapBot Safe Chole effectively integrates safe LC principles into a fun, accessible, and educational game using AI-generated feedback. Initial beta testing supports the validity of the assessment scores and suggests high adoption and engagement potential among surgical trainees.

Introduction Central venous access devices (CVADs) are commonly used for the treatment of paediatric cancer patients. Catheter locking is a routine intervention that prevents CVAD-associated adverse events, such as infection, occlusion and thrombosis. While laboratory and clinical data are promising, tetra-EDTA (T-EDTA) has yet to be rigorously evaluated or introduced in cancer care as a catheter lock.Methods and analysis This is a protocol for a two-arm, superiority type 1 hybrid effectiveness-implementation randomised controlled trial conducted at seven hospitals across Australia and New Zealand. Randomisation will be in a 3:2 ratio between the saline (heparinised saline and normal saline) and T-EDTA groups, with randomly varied blocks of size 10 or 20 and stratification by (1) healthcare facility; (2) CVAD type and (3) duration of dwell since insertion. Within the saline group, there will be a random allocation between normal and heparin saline. Participants can be re-recruited and randomised on insertion of a new CVAD. Primary outcome for effectiveness will be a composite of CVAD-associated bloodstream infections (CABSI), CVAD-associated thrombosis or CVAD occlusion during CVAD dwell or at removal. Secondary outcomes will include CABSI, CVAD-associated-thrombosis, CVAD failure, incidental asymptomatic CVAD-associated-thrombosis, other adverse events, health-related quality of life, healthcare costs and mortality. To achieve 90% power (alpha=0.05) for the primary outcome, data from 720 recruitments are required. A mixed-methods approach will be employed to explore implementation contexts from the perspective of clinicians and healthcare purchasers.Ethics and dissemination Ethics approval has been provided by Children’s Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC) (HREC/22/QCHQ/81744) and the University of Queensland HREC (2022/HE000196) with subsequent governance approval at all sites. Informed consent is required from the substitute decision-maker or legal guardian prior to participation. In addition, consent may also be obtained from mature minors, depending on the legislative requirements of the study site. The primary trial and substudies will be written by the investigators and published in peer-reviewed journals. The findings will also be disseminated through local health and clinical trial networks by investigators and presented at conferences.Trial registration number ACTRN12622000499785.

BackgroundLipoprotein(a) [Lp(a)] is a genetically determined risk factor for atherosclerotic cardiovascular disease (CVD). Limited data are available on Lp(a) testing from the Middle-East region. Therefore, we aim to evaluate the utilization and yield of Lp(a) testing over time and characterize CVD profiles of patients with abnormal Lp(a) tasting at a single-quaternary-care center in the United Arab Emirates.MethodsUnique Lp(a) tests conducted between 07/2017 and 10-2023 were included. Overtime trends in Lp(a) test utilization and abnormal Lp(a) [defined as Lp(a) > 125 nmol/L] test findings were described. CVD rates in patients with abnormal Lp(a) were compared to those with Lp(a) ≤ 125 nmol/L using appropriate methods.ResultsIn our center, 0.95% of the patients (n = 5,677) had their Lp(a) measured, with a median level of 32 [11–82] nmol/L. Lp(a) was abnormal in 15.9% of the tests. Over the years 2018–2022, there was a 109% increase in Lp(a) testing, with concomitant up-trends in findings of abnormal Lp(a) (11.8% to 16.4%, P = 0.02). Compared to patients with Lp(a) ≤ 125 nmol/I, those with abnormal Lp(a) had higher rates of any prevalent CVD (34% vs. 25.1%, P

The current study, a part of a bigger study, explored how teachers in Indonesia implemented cooperative learning (CL) in their distinct contexts. This multiple case study design used a qualitative interpretative approach. Following semi-structured interviews with 18 teachers who had attended CL professional development and used CL in their classrooms, four were purposefully selected as cases of teachers. Classroom observations, post classroom observation interviews, and field notes were employed to investigate the implementation of CL. The data were analysed using Miles, Huberman and Saldaña's framework. Five themes were generated from cross-case analysis: "implementation of CL principles," "a lack of CL structures," "a greater need of group orientation," "group composition," and "informal CL." The findings indicate that when an innovative pedagogical practice such as CL is implemented in a culture different from the one in which it was constructed, unique contexts both enable and disrupt the successful implementation of CL. This study proposes that further research attention must be given to understanding the challenges faced by teachers shifting away from direct teaching to student-centred pedagogies such as CL.