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Background: The incidence of thyroid cancer in the United States has risen dramatically since the 1970s, driven by an increase in the diagnosis of small tumors. There is a paucity of published New Mexico (NM) specific data regarding thyroid cancer. We hypothesized that due to New Mexico's unique geographic and cultural makeup, the incidence of thyroid cancer and tumor size at diagnosis in this state would differ from that demonstrated on a national level. Methods: The New Mexico Tumor Registry (NMTR) was queried to include all NM residents diagnosed with thyroid cancer between 1992 and 2019. For 2010 to 2019, age-adjusted incidence rates were calculated via direct method using the 2000 United States population as the adjustment standard. Differences in incidence rate and tumor size by race/ethnicity and residence (metropolitan vs non-metropolitan) were assessed with rate ratios between groups. For 1992 to 2019, temporal trends in age-adjusted incidence rates for major race/ethnic groups in NM [Non-Hispanic White (NHW), Hispanic, and American Indian (AI)] were assessed by joinpoint regression using National Cancer Institute software. Results: Our study included 3,161 patients for the time period 2010 to 2019, including NHW (1518), Hispanic (1425), and AI (218) cases. The overall incidence rates for NM AIs were lower than those for Hispanics and NHWs because of a decreased incidence of very small tumors (<1.1 cm). The incidence rates for large tumors (>5.1 cm) was equivalent among groups. In the early 2000s, Hispanics also had lower rates of small tumors when compared to NHWs but this trend disappeared over time. Conclusion: AIs in New Mexico have been left out of the nationwide increase in incidental diagnosis of small thyroid tumors. This same pattern was noted for Hispanics in the early 2000s but changed over time to mirror incidence rates for NHWs. These data are illustrative of the health care disparities that exist among New Mexico's population and how these disparities have changed over time. [ABSTRACT FROM AUTHOR]

The increase in sport participation among adolescents has led to the rise in sport-related injuries, many of which have unique characteristics based on the patient, their perceptions, and the pressures faced when returning to sport. The purpose of this study was to identify the underlying factors that contributed to adolescents’ perceptions of injury and the various pressures they experienced when returning to sport. Two themes emerged from the study: support and fear. Support was provided to participants through development, care, and the environment. Fear was the factor that affected the participant in their return to sport, which came in the form of worry and doubt.

A climate-driven water resource model of California's Sacramento River Basin (SACB) is presented, based on the Water Evaluation and Planning model Version 21 (WEAP21). The model's configuration, calibration, testing, and limitations are presented. The major contribution includes an integration of the watershed's surface and subsurface hydrology, consumptive, and nonconsumptive use, and the water management infrastructure and controls that determine how water naturally flows and is managed. The SACB was subdivided into numerous catchments; groundwater basins; irrigated areas; urban/export use; environmental requirements; and canals, diversions, and reservoirs in an attempt to characterize the forces that act on water throughout the basin. A monthly climate time series forced an embedded hydrologic model that simulates runoff, groundwater-surface water interactions, and consumptive agriculture and urban water uses. Results show that the model can reproduce both local and regional water balances, including managed and unmanaged streamflow, reservoir storage, agriculture and urban water uses, and the allocation of ground water and surface water supplies, which should be useful for various California water planning processes. CE Database subject headings: Water resources; Climatology; Hydrology; Water supply; California; River basins.

Changing environmental conditions are forcing natural resource managers and communities to adapt their strategies to account for global shifts in precipitation, temperature, sea level and more, all of which are occurring in addition to local human impacts. Adapting to threats from climate change requires a fundamental shift in the practice of natural resource management through the development of forward-looking "climate-smart" goals and strategies. Here we present a proof-of-concept application of a decision-support tool to help design climate-smart management actions for the watershed and coral reef management plan for Guánica Bay watershed in southwest Puerto Rico. We also explore the connection between adaptation planning and coral reef resilience, using a recently developed Puerto Rico-wide reef resilience assessment. In the first phase of the study, we used the publicly available Adaptation Design Tool to draft initial climate-smart versions of twelve proposed management actions. In the second phase, two actions (dirt road management on steep slopes, and coral reef restoration) were further refined through consultations with local experts to make more detailed design adjustments; this included the option to use information from the coral reef resilience assessment to inform design improvements. The first phase resulted in moderately detailed assessments that broadly accounted for anticipated direct and indirect effects of climate change on the planned management actions. The second phase resulted in more site-specific technical assessments and additional important design details. The expert panel charged with discussing climate-smart reef restoration around Guánica used the reef resilience assessment to guide discussion of reef restoration, highlighting the importance of having such information available for adaptation planning. This study demonstrates how climate change impacts can be effectively incorporated into a management plan at the most granular level of planning and how a structured, formalized process can be as valuable as the resulting adaptation information. [ABSTRACT FROM AUTHOR]

Globally increasing sea surface temperatures threaten coral reefs, both directly and through interactions with local stressors. More resilient reefs have a higher likelihood of returning to a coral-dominated state following a disturbance, such as a mass bleaching event. To advance practical approaches to reef resilience assessments and aid resilience-based management of coral reefs, we conducted a resilience assessment for Puerto Rico's coral reefs, modified from methods used in other U.S. jurisdictions. We calculated relative resilience scores for 103 sites from an existing commonwealth-wide survey using eight resilience indicators—such as coral diversity, macroalgae percent cover, and herbivorous fish biomass—and assessed which indicators most drove resilience. We found that sites of very different relative resilience were generally highly spatially intermixed, underscoring the importance and necessity of decision making and management at fine scales. In combination with information on levels of two localized stressors (fishing pressure and pollution exposure), we used the resilience indicators to assess which of seven potential management actions could be used at each site to maintain or improve resilience. Fishery management was the management action that applied to the most sites. Furthermore, we combined sites' resilience scores with projected ocean warming to assign sites to vulnerability categories. Island-wide or community-level managers can use the actions and vulnerability information as a starting point for resilience-based management of their reefs. This assessment differs from many previous ones because we tested how much information could be yielded by a "desktop" assessment using freely-available, existing data rather than from a customized, resilience-focused field survey. The available data still permitted analyses comparable to previous assessments, demonstrating that desktop resilience assessments can substitute for assessments with field components under some circumstances. [ABSTRACT FROM AUTHOR]

Debriefing is an essential part of healthcare training that utilizes a planned conversation to allow clinicians to analyze their actions, thought processes, and emotions with the goal of improving patient care and outcomes. Debriefing requires two-way communications between the athletic training student and facilitating preceptor. The process is more than providing feedback on clinical performance, but a communication process that fosters reflective insight into of behaviors and decisions. Debriefing after patient care encounters has been shown to increase critical thinking, confidence, clinical skills and clinical reasoning. With this enhancement in cognition and behavior, debriefing allows the student to strengthen their own capabilities and efficacy, better preparing themselves for real time clinical practice. Facilitating effective debriefing is challenging for seasoned educators, as well as untrained practitioners. [ABSTRACT FROM AUTHOR]

Background: Macrophages play a crucial role in the interaction between tumor and immune system, and iNOS is known as a surrogate marker of M1 macrophages activation. The goal of the study was to investigate the role of iNOS polymorphisms as prognostic marker in mCRC patients. Materials and methods: Functional significant polymorphisms in the promoter of INOS gene were analyzed by PCR-based and direct DNA sequencing in 4 cohorts of patients receiving bevacizumab based first-line chemotherapy: two evaluation cohorts (TRIBE ARM A and ARM B) and two validation cohorts (FIRE 3 arm A and MOMA). The relation of the SNPs with PFS and OS was evaluated through Kaplan-Meier method and log-rank test. Subgroup analyses according to RAS status were preplanned. Results: In the exploratory cohort 1 (TRIBE A), patients with CCTTT any>13repeats (N = 57) showed improved median PFS compared with patients carrying the ≤13/≤13 repeats variant (N = 152) (HR, 0.64; 95%CI 0.44–0.92, p = 0.010). Similar results were shown adopting the >26repeats/≤26 repeats (HR, 0.56; 95%CI 0.36–0.87, p = 0.005). In RAS mutant, patient with any>13 repeats (N = 24) had improved PFS results compared with those carrying the ≤13/≤13 repeats variant (N = 81) (HR, 0.51; 95%CI 0.30–0.87, p = 30.009). Similar results were found adopting the >26 repeats/≤26 repeats cut off: (HR, 0.52; 95%CI 0.27–0.98, p = 0.035). These data were partially confirmed in the exploratory cohort 2 (TRIBE B): a better median PFS was observed in patients with >26 repeats vs ≤26 repeats (N = 205) patients. However, these data were not confirmed in the two validation cohorts. Conclusion: We failed to replicate the exploratory findings in both validation sets. The CCTTT polymorphic region of the INOS gene does not predict outcome in mCRC receiving bevacizumab based first line chemotherapy. Further investigations are needed to reveal mechanisms between tumor, immune system and chemotherapy response. [ABSTRACT FROM AUTHOR]

The Insulin-like growth factor (IGF)/IGF-receptor pathway with its scaffolding proteins Insulin Receptor Substrate (IRS)1 and IRS2 are crucial regulators of metabolism and progression in metastatic colorectal cancer (mCRC). The goal of the study was the identification of predictive and prognostic markers among IRS1, IRS2, IGF1 and IGF- 1R SNPs in mCRC patients enrolled in the FIRE-3 trial. Four SNPs of IRS ( IRS1 rs1801278, rs1801123; IRS2 rs1805097, rs2289046) and four SNPs of IGF1- IGFR1 (rs6214, rs6220, rs2946834, rs2016347) were analyzed by PCR/direct-sequencing in the FIRE-3 trial. The relation of SNPs with PFS and OS was evaluated through Kaplan-Meier method and log-rank test in the overall population and in subgroup according to RAS status and treatment arm. In the overall population IRS1 rs1801123 C/- carriers ( N= 105) achieved significantly worse OS compared to T/T ( N = 464) in univariate (HR = 1.32 [95%CI 1.03-1.70], p = 0.029) and in multivariable. Similar results were observed among RAS wild type. Patients with IGF1 rs2946834 T/- variant ( N= 280) achieved improved PFS compared to C/C ( N = 257) in univariate (HR = 0.77 [95%CI 0.64-0.92], p = 0.004) and in multivariable. In the RAS wild-type subgroup IGF1 rs2946834 T/- carriers showed better PFS and OS compared to C/C (univariate HR for PFS = 0.65 [95%CI 0.51-0.81], p < 0.001; multivariable HR for PFS = 0.63 [95%CI 0.50-0.81], p < 0.001). IRS1 rs1801123 SNP was identified as a new prognostic marker for mCRC. IGF1 rs2946834 was confirmed as prognostic factor in the overall population and in RAS wild type patients. Our findings underline the importance of IGF downstream signaling pathway in RAS wild-type mCRC patient. [ABSTRACT FROM AUTHOR]

Worldwide, many species are responding to ongoing climate change with shifts in distribution, abundance, phenology, or behavior. Consequently, natural-resource managers face increasingly urgent conservation questions related to biodiversity loss, expansion of invasive species, and deteriorating ecosystem services. We argue that our ability to address these questions is hampered by the lack of explicit consideration of species' adaptive capacity (AC). AC is the ability of a species or population to cope with climatic changes and is characterized by three fundamental components: phenotypic plasticity, dispersal ability, and genetic diversity. However, few studies simultaneously address all elements; often, AC is confused with sensitivity or omitted altogether from climate-change vulnerability assessments. Improved understanding, consistent definition, and comprehensive evaluations of AC are needed. Using classic ecological-niche theory as an analogy, we propose a new paradigm that considers fundamental and realized AC: the former reflects aspects inherent to species, whereas the latter denotes how extrinsic factors constrain AC to what is actually expressed or observed. Through this conceptualization, we identify ecological attributes contributing to AC, outline areas of research necessary to advance understanding of AC, and provide examples demonstrating how the inclusion of AC can better inform conservation and natural-resource management. [ABSTRACT FROM AUTHOR]

The 31P-NMR technique has been used to assess the intracellular ratios and concentrations of mobile ATP and ADP and the intracellular pH in an insulin-secreting cell line, RINm5F. The single-channel current-recording technique has been used to investigate the effects of changes in the concentrations of ATP and ADP on the gating of nucleotide-dependent K+ channels. Adding ATP to the membrane inside closes these channels. However, in the continued presence of ATP adding ADP invariably leads to the reactivation of ATP-inhibited K+ channels, even at ATP4-/ADP3- concentration ratios greater than 7:1. Interactions between ATP4- and ADP3- seem competitive. An increase in the concentration ratio ATP4-/ADP3- consistently evoked a decrease in the open-state probability of K+ channels; conversely, a decrease in ATP4-/ADP3- increased the frequency of K+ channel opening events. Channel gating was also influenced by changes in the absolute concentrations of ATP4- and ADP3-, at constant free concentration ratios. ADP-evoked stimulation of ATP-inhibited channels did not result from phosphorylation of the channel, as ADP-beta-S, a nonhydrolyzable analog of ADP, not only stimulated but enhanced ADP-induced activation of K+ channels, in the presence of ATP. Similarly, ADP was able to activate K+ channels in the presence of two nonhydrolyzable derivatives of ATP, AMP-PNP and beta gamma methylene ATP. [ABSTRACT FROM AUTHOR]

Wetlands are known to provide a myriad of vital ecosystem functions and services, which may be under threat from a changing climate. However, these effects may not be homogenous across ecosystem functions, wetland types, ecoregions, or meso‐scale watersheds, making broad application of the same management techniques inappropriate. Here, we present a relative wetland vulnerabilities framework, applicable across a range of spatial and temporal scales, to assist in identifying effective and robust management strategies in light of climate change. We deconstruct vulnerability into dimensions of exposure and sensitivity/adaptive capacity, and identify relevant measures of these as they pertain to the attributes of wetland extent and plant community composition. As a test of the framework, we populate it with data for three primary hydrogeomorphic wetland types (riverine, slope, and depression) in seven small watersheds across four ecoregions (Ridge and Valley, Piedmont, Unglaciated Plateau, and Glaciated Plateau) in the Susquehanna River watershed in Pennsylvania. We use data generated from the SRES A2 emissions experiment and MRI‐CGCM2.3.2 climate model as input to the Penn State Integrated Hydrologic Model to simulate future exposure to altered hydrologic conditions in our seven watersheds, as expressed in two hydrologic metrics: % time groundwater levels occur in the upper 30 cm (rooting zone) during the growing season, and median difference between spring and summer mean water levels. We then examine the spatial and temporal scales at which each of the components of vulnerability (exposure and sensitivity/adaptive capacity) shows significant relative differences. Overall, we find that relative differences in exposure persist at a very fine spatial grain, exhibiting high variability even among individual watersheds in a given ecoregion. For temporal scale, we find strong seasonal but weak annual relative differences in exposure resulting from a magnification of summer dry‐down combined with winter and spring wet periods becoming wetter. Sensitivities/adaptive capacities show significant differences among wetland types. A comparison between our anticipated hydrologic alterations under climate change and historical changes in hydrology due to anthropogenic disturbance indicates potential shifts in hydrologic patterns that are far beyond anything that wetland managers have experienced in the past. [ABSTRACT FROM AUTHOR]