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Background: In the phase II, randomized, double-blind FIGHT trial (NCT03694522), treatment with bemarituzumab plus mFOLFOX6 resulted in improvements in progression-free survival and overall survival relative to mFOLFOX6 alone in previously untreated locally advanced or metastatic gastric or gastroesophageal junction cancer with fibroblast growth factor receptor 2b overexpression. Using data from the final analysis, we analyzed patient-reported outcomes (PROs) to evaluate the impact of adding bemarituzumab to mFOLFOX6 on health-related quality of life (HRQoL). Materials and methods: Patients were randomized 1 : 1 to bemarituzumab plus mFOLFOX6 (n = 77) or placebo plus mFOLFOX (n = 78). European Organisation for Research and Treatment of Cancer Core 30-item Quality of Life (EORTC QLQ-C30) and the EuroQol EQ-5D-5L questionnaires were administered at baseline, week 6, every 8 weeks thereafter, and at end-of-treatment visit. Least-squares mean changes from baseline in PRO scale scores were estimated using mixed models for repeated measures; time to deterioration and improvement were assessed using Cox proportional hazards models. Analyses were exploratory post hoc. Results: PRO scale scores at baseline and compliance rates across PRO assessments over time were similar between the bemarituzumab and placebo arms. Least-squares mean changes from baseline on key EORTC QLQ-C30 scales (global health status/QoL, physical functioning, fatigue, nausea and vomiting, and appetite loss) and the EQ-5D-5L visual analog scale were similar over time between treatment arms. Analyses of time to deterioration, sustained deterioration, and improvement suggested similar HRQoL between treatment arms. Conclusions: Treatment with bemarituzumab plus mFOLFOX6 was associated with sustained HRQoL relative to mFOLFOX6 alone.

BackgroundChildhood and adolescent obesity are persistent public health issues in the United States. Childhood obesity Electronic Health Record (EHR) tools strengthen provider-patient relationships and improve outcomes, but there are currently limited EHR tools that are linked to adolescent mHealth apps. This study is part of a larger study entitled, CommitFit, which features both an adolescent-targeted mobile health application (mHealth app) and an ambulatory EHR tool. The CommitFit mHealth app was designed to be paired with the CommitFit EHR tool for integration into clinical spaces for shared decision-making with patients and clinicians.ObjectivesThe objective of this sub-study was to identify the functional and design needs and preferences of healthcare clinicians and professionals for the development of the CommitFit EHR tool, specifically as it relates to childhood and adolescent obesity management.MethodsWe utilized a user-centered design process with a mixed-method approach. Focus groups were used to assess current in-clinic practices, deficits, and general beliefs and preferences regarding the management of childhood and adolescent obesity. A pre- and post-focus group survey helped assess the perception of the design and functionality of the CommitFit EHR tool and other obesity clinic needs. Iterative design development of the CommitFit EHR tool occurred throughout the process.ResultsA total of 12 healthcare providers participated throughout the three focus group sessions. Two themes emerged regarding EHR design: (1) Functional Needs, including Enhancing Clinical Practices and Workflow, and (2) Visualization, including Colors and Graphs. Responses from the surveys (n = 52) further reflect the need for Functionality and User-Interface Design by clinicians. Clinicians want the CommitFit EHR tool to enhance in-clinic adolescent lifestyle counseling, be easy to use, and presentable to adolescent patients and their caregivers. Additionally, we found that clinicians preferred colors and graphs that improved readability and usability. During each step of feedback from focus group sessions and the survey, the design of the CommitFit EHR tool was updated and co-developed by clinicians in an iterative user-centered design process.ConclusionMore research is needed to explore clinician actual user analytics for the CommitFit EHR tool to evaluate real-time workflow, design, and function needs. The effectiveness of the CommitFit mHealth and EHR tool as a weight management intervention needs to be evaluated in the future.

Addiction to illicit substances continues to be a persistent and growing public health crisis, resulting in an increasing need for effective research and subsequent implementation in addiction research. Currently, research and treatment opinions and perspectives are limited to those of providers and professionals while failing to include patients as partners. The lived experiences of patient research partners who have experienced addictions are not well incorporated into research and interventions. Stigma and biases influence addiction research by excluding patients as partners, resulting in less robust solutions and potential biases. Related patient as partners challenges may be mitigated by maintaining open communication, inclusive recruitment, appropriate training and assessment of researcher-partner collaboration. The implementation of these strategies may allow for meaningful partnerships. As drug-involved overdoses and/or deaths continue to climb, using patients as partners in addiction research is crucial to improving research. Thus, patients as partners who have experienced addiction are needed to combat stigma and bias, and create impactful and translational research outcomes.

JET, the world’s largest operating tokamak with unique Be/W wall and tritium handling capability, completed a Deuterium-Tritium (D-T) campaign in 2021 (Maggi et al 29th Fusion Energy Conf. ) following a decade of preparatory experiments, dedicated enhancements, technical rehearsals and training (Horton et al 2016 Fusion Eng. Des. 109–111 925). Operation with tritium raises significant technical, safety and scientific challenges not encountered in standard protium or deuterium operation. This contribution describes the tritium operational requirements, pulses and technical preparations, new operating procedures, lessons learned and details on the achieved operational availability and performance. The preparation and execution of the recent JET tritium experiments benefitted from the previous experience in 1991 (Preliminary Tritium Experiment), 1997 (DTE1 campaign) and 2003 (Trace Tritium Campaigns) and consisted of the following five phases: technical rehearsals and scenario preparation, tritium commissioning, 100% tritium campaign, D-T campaign (DTE2), tritium clean-up. Following the clean-up JET resumed normal operation and is currently undertaking a further D-T campaign (DTE3).

We have investigated the electronic and magnetic ground state of La1−xSrxMnO3 thin films, especially around doping x = 0.50 in comparison to the well studied system of x = 0.33 and the low doped system of x = 0.04. The films discussed here were grown by molecular-beam epitaxy, epitaxially strained to (001) oriented strontium titanate substrates. Apart from resistivity and magnetization measurements probing the electronic and magnetic ground state, we also study the temperature dependence of the coercive field of these samples. Our measurements reveal that the coercive field increases as the doping is changed from x = 0.33. The coercive field at 5 K for the x = 0.50 sample is Hc = 0.0450 T compared to Hc = 0.0080 T for the x = 0.33 sample. The temperature dependent coercive field measurements on the x = 0.50 sample show a dramatic cusp around 100 K that is coincident with more subtle features observed in both magnetization and resistivity data at this temperature.

The i-STAT1 clinical analyzer has become an increasingly popular tool in clinical production animal medicine as it can provide pen-side results in a cost effective and timely manner when compared to standard benchtop serum biochemistry blood gas and chemistry analyses. This study compares the results of the portable Abbott i-STAT1 analyzer and the Abaxis VetScan VS2 for glucose (Glu, mg/dL), ionized Ca (mmol/L), Na (mmol/L), and K (mmol/L) values. Three genetically distinct commercial varieties (CV) of Hy-Line white-egg laying hens are used in this study (Hy-Line W-36, Hy-Line W-80, and Hy-Line W-80+). Thirty blood samples (n = 10 per CV) were obtained in the production house from the brachial vein and concurrently analyzed by the i-STAT1 portable device. Serum from 22 of these same samples was analyzed via VetScan VS2, a benchtop serum clinical biochemistry analyzer, using VetScan Avian/Reptilian Profile Plus reagent rotors. A paired T-test was used to test for statistical differences in means between the 2 instruments for each of the parameters. Parameters with significant mean differences were then subject to correlation and regression analysis to further evaluate relationships between the results from the 2 methods. Significant differences between means were found for Glu, Na, and K levels. Ca levels were found to be not directly comparable by the 2 analysis instruments. This comparison elucidates the importance of clinical analyzer validations when applying different strategies of diagnostic medicine in poultry.

Purpose: This literature review focuses on the main clinical symptoms and prevention tactics for two tropical infectious diseases that are endemic to Kenya, schistosomiasis and brucellosis. Due to the impact of these diseases on the musculoskeletal system, they can severely affect one's ability to perform simple daily activities necessary to survive such as fetching water or chopping firewood. The objective of this literature review is to highlight the significant impact these diseases have on the lives of those in endemic areas and provide insight into various solutions that have been developed to prevent these infectious diseases. Methods & Materials: A review was conducted using UpToDate, DynaMed, PubMed, CINAHL, and TripPro with around 200 articles meeting inclusion criteria. Keywords included: Schistosomiasis and Brucellosis in combination with Arthralgias, Joints, Joint Pain, Polyarthralgia, Prevention, Health Education, Health Behavior, Prevention and Control. Results: Both schistosomiasis and brucellosis most often affect similar joints which include the knees, hips, and lower back. With lower extremity joints being a main target for schistosomiasis and brucellosis, it proves the devastating impact that becoming infected with these diseases can have on activities of daily living. In many endemic areas, a turn towards more unique, community-driven solutions has been the key to lessening the transmission of schistosomiasis and brucellosis. Conclusion: It is difficult to walk into a community as an outsider and tell the people to stop drinking from the river or washing their clothes in the stream when that is their only option. For both schistosomiasis and brucellosis, more innovative interventions are needed in order to significantly reduce transmission and allow for these interventions to sustainably take root. For example, a solution in the Senegal River Basin was to introduce predator shrimp into schistosome infected waters to interrupt the host snail population. In Brazil, a community-driven solution allowed students to collect specimens and learn more about these diseases. This approach allows students to play a vital role in protecting their communities.

Purpose: Analysis of alterations in the United States prevalence of coccidiomycosis in geographic regions historically considered to not be endemic for the Coccidioides spp. pathogen taken with an evaluation of changing climate patterns within those areas. Methods & Materials: The databases MEDLINE, Google Scholar, PubMed, and CINAHL were searched for English-language sources with combinations of the following keywords: climate change, Coccidioides, distribution, and United States with relevant synonyms. Preference was given within the inclusion criteria to sources published in the past 20 years. The bibliographies of the retrieved publications were also searched. Exclusion criteria included sources relative to areas outside the continental United States. Results: Although Coccidioides species have classically been recognized as endemic to the southwestern United States, isolates have been found far outside this area and recent investigations have demonstrated a growing endemic zone. Ecological and outbreak data supports the conclusion that these findings result from a growing endemic range that is estimated to be as far east as Texas and as far north as Washington State. Investigations point to climate change as the underlying cause primarily via regional climate changes and large dust storms. Conclusion: The geographic distribution of Coccidioides fungus is known to be larger than classically recognized or potentially considered in the formation of diagnostic differentials in the clinical setting. Timely diagnosis, appropriate treatment approaches, and accurate reporting for public health surveillance rely on a recognition of endemic range expansion. Physician education (via medical school curriculums and continuing education offerings), interprofessional team-based approach, and enhancement of surveillance in locations in potentially geographically novel areas are appropriate measures in improving the identification of coccidiomycosis cases.Case studies from local outbreaks and natural disasters support adding coccidioidomycosis to a list of other infectious diseases (e.g., those that are vector borne) whose endemic areas are spreading due to climate change. Recognition of underlying climate change related mechanisms should also prompt steps to reduce environmental spread where mitigation is possible. Current climate model predictions support an expected increase in Coccidioides spp. infection; further research is recommended to clearly define the relationship between climate change and Coccidioides spp. geographic expansion.

The skin is a habitat for microbes that commonly infect preterm infants, but the use of sequencing for fine-scale study of the microbial communities of skin that develop in these infants has been limited by technical barriers. We treated skin swabs of preterm infants with a photoreactive dye that eliminates DNA from nonviable microbes and then sequenced the remaining DNA.

Background Emergency and essential surgical, obstetric and anaesthesia (SOA) care are now recognized components of universal health coverage, necessary for a functional health system. To improve surgical care at a national level, strategic planning addressing the six domains of a surgical system is needed. This paper details a process for development of a national surgical, obstetric and anaesthesia plan (NSOAP) based on the experiences of frontline providers, Ministry of Health officials, WHO leaders, and consultants. Methods Development of a NSOAP involves eight key steps: Ministry support and ownership; situation analysis and baseline assessments; stakeholder engagement and priority setting; drafting and validation; monitoring and evaluation; costing; governance; and implementation. Drafting a NSOAP involves defining the current gaps in care, synthesizing and prioritizing solutions, and providing an implementation and monitoring plan with a projected cost for the six domains of a surgical system: infrastructure, service delivery, workforce, information management, finance and governance. Results To date, four countries have completed NSOAPs and 23 more have committed to development. Lessons learned from these previous NSOAP processes are described in detail. Conclusion There is global movement to address the burden of surgical disease, improving quality and access to SOA care. The development of a strategic plan to address gaps across the SOA system systematically is a critical first step to ensuring countrywide scale‐up of surgical system‐strengthening activities.

Antarctic ice cores have often been dated by matching distinctive features of atmospheric methane to those detected in annually dated ice cores from Greenland. Establishing the timescale between these tie-point ages requires interpolation. While the uncertainty at tie points is relatively well described, uncertainty of the interpolation is not. Here we assess the accuracy of three interpolation schemes using data from the WAIS Divide ice core in West Antarctica; we compare the interpolation methods with the annually resolved timescale for the past 30 kyr. Linear interpolation yields large age errors (up to 380 years) between tie points, abrupt changes in duration of climate events at tie points, and an age bias. Interpolations based on the smoothest accumulation rate (ACCUM) or the smoothest annual-layer thickness (ALT) yield timescales that more closely agree with the annually resolved timescale and do not have abrupt changes in duration at tie points. We use ALT to assess the uncertainty in existing timescales for the past 30 kyr from Byrd, Siple Dome, and Law Dome. These ice-core timescales were developed with methods similar to linear interpolation. Maximum age differences exceed 1000 years for Byrd and Siple Dome, and 500 years for Law Dome. For the glacial–interglacial transition (21 to 12 kyr), the existing timescales are, on average, older than ALT by 40 years for Byrd, 240 years for Siple Dome, and 150 years for Law Dome. Because interpolation uncertainty is often not considered, age uncertainties for ice-core records are often underestimated.

Knowledge of symbols, which can be influenced by school ethos, informs identity construction in primary school children. This study aimed to explore Gaelscoil (Irish-medium) and English-medium primary school children's familiarity with Irish and European symbols. Thirty 9-12-year-old children in Ireland participated in this study; 15 from two Irish-medium and 15 from an English-medium primary school. A draw-and-tell data collection design was used and qualitative data was analysed using the constant comparative method. Results indicate children from both school types shared a number of Irish symbols, namely Irish emblems, Irish mythology, sports and material aspects of culture. Irish-medium primary school children had two further Irish symbol categories, the past as a symbol and physical characteristics of Ireland. European symbols shared across children from both school types included signifiers of the European Union (EU), monetary symbols and European countries. The Irish-medium primary school children had two further categories, Europe through an Irish lens and European cuisine, while the English-medium children had one further category, sport. The results suggest that by middle childhood, children in both school types have knowledge about a number of symbols associated with both national and European identities. Implications for future research are discussed.

This paper analyzes the impact of college athletic reclassification for educational institutions in the United States. Most of America's colleges and universities offer athletic opportunities for their students under NCAA governance. The level of competition and associated resource requirements range from relatively low (Division 3) to high (Division 1). In recent years, there has been an increase in the number of institutions that have either reclassified to a higher division, or publicly considered such a move. The resource obligations of reclassification are significant, and administrators must carefully weigh expected benefits and costs with respect to the institution's mission and vision. While several studies (Bell, 2017; Schwarzber, 2014; Frieder & Fulks, 2007; Tomasini, 2005) have focused on reclassification from Division 1-FCS to FBS--the highest level of competition--less attention has been paid to colleges in Division 2 and 3--which comprise two-thirds of NCAA membership. Our study addresses a gap in the literature by analyzing athletic reclassification among schools moving up from Division 2 to Division 1 (FCS and no-football) during the period of 2001-2018. Drawing upon multiple data sources, we construct a panel of 33 schools (14 treatments and 19 controls) to evaluate the impact of reclassification on applications and athletic department budgets. Results from quasi-experimental methods (difference in differences, event study, and synthetic control models) suggest that reclassification significantly increased basketball program revenues and athletic department expenses among the treatment schools. However, we do not find evidence that reclassification raises student applications in the short term.

This collective self-study chronicles the experiences and reflections of four women teacher educators living and working during the COVID-19 pandemic. Data collected between March 2020 and December 2021 centered on the following question: what were we, as teacher educators, experiencing professionally and personally as a result of the pandemic? The COVID-19 context presented a unique set of challenges and an additional layer of complexity highlighting intersections of policy, teacher education, and societal expectations. Findings connected to our professional identities as teacher educators included the need to reframe professional expectations and the impacts to historical narratives in teacher education. Personally, the complexity of mixing the personal and professional spheres and increased personal responsibilities emerged. Findings from this study reaffirm that when we have opportunities to access and learn from the lived experiences of others, we are better positioned to understand ourselves and the personal and professional roles we take on.

Refractory black carbon aerosols (rBC) emitted by biomass burning (fires) and fossil fuel combustion, affect global climate and atmospheric chemistry. In the Southern Hemisphere (SH), rBC is transported in the atmosphere from low- and mid-latitudes to Antarctica and deposited to the polar ice sheet preserving a history of emissions and atmospheric transport. Here, we present two high-resolution Antarctic rBC ice core records drilled from the West Antarctic Ice Sheet divide and Law Dome on the periphery of the East Antarctic ice sheet. Separated by ~3500 km, the records span calendar years 1850–2001 and reflect the rBC distribution over the Indian and Pacific ocean sectors of the Southern Ocean. Concentrations of rBC in the ice cores displayed significant variability at annual to decadal time scales, notably in ENSO-QBO and AAO frequency bands. The delay observed between rBC and ENSO variability suggested that ENSO does not directly affect rBC transport, but rather continental hydrology, subsequent fire regimes, and aerosol emissions. From 1850 to 1950, the two ice core records were uncorrelated but were highly correlated from 1950 to 2002 (cross-correlation coefficient at annual resolution: r = 0.54, p < 0.01) due to a common decrease in rBC variability. The decrease in ice-core rBC from the 1950s to late 1980s displays similarities with inventories of SH rBC grass fires and biofuel emissions, which show reduced emission estimates over that period.

Tritium is a radioactive form of hydrogen and is a by-product of energy production in Canadian Deuterium Uranium (CANDU) reactors. The release of this radioisotope into the environment is carefully managed at CANDU facilities in order to minimize radiation exposure to the public. However, under some circumstances, small accidental releases to the environment can occur. The radiation doses to humans and non-human biota from these releases are low and orders of magnitude less than doses received from naturally occurring radioisotopes or from manmade activities, such as medical imaging and air travel. There is however a renewed interest in the biological consequences of low dose tritium exposures and a new limit for tritium levels in Ontario drinking water has been proposed. The Ontario Drinking Water Advisory Council (ODWAC) issued a formal report in May 2009 in response to a request by the Minister of the Environment, concluding that the Ontario Drinking Water Quality Standard for tritium should be revised from the current 7,000 Bq/L level to a new, lower 20 Bq/L level. In response to this recommendation, an international scientific symposium was held at McMaster University to address the issues surrounding this change in direction and the validity of a new policy. Scientists, regulators, government officials, and industrial stakeholders were present to discuss the potential health risks associated with low level radiation exposure from tritium. The regulatory, economic, and social implications of the new proposed limit were also considered. The new recommendation assumed a linear-no-threshold model to calculate carcinogenic risk associated with tritium exposure, and considered tritium as a non-threshold chemical carcinogen. Both of these assumptions are highly controversial given that recent research suggests that low dose exposures have thresholds below which there are no observable detrimental effects. Furthermore, mutagenic and carcinogenic risk calculated from tritium exposure at 20 Bq/L would be orders of magnitude less than that from exposure to natural background sources of radiation. The new proposed standard would set the radiation dose limit for drinking water to 0.0003 mSv/year, which is equivalent to approximately three times the dose from naturally occurring tritium in drinking water. This new standard is incongruent with national and international standards for safe levels of radiation exposure, currently set at 1 mSv/year for the general public. Scientific research from leading authorities on the carcinogenic health effects of tritium exposure supports the notion that the current standard of 7,000 Bq/L (annual dose of 0.1 mSv) is a safe standard for human health. Policy-making for the purpose of regulating tritium levels in drinking water is a dynamic multi-stage process that is influenced by more than science alone. Ethics, economics, and public perception also play important roles in policy development; however, these factors sometimes undermine the scientific evidence that should form the basis of informed decision making. Consequently, implementing a new standard without a scientific basis may lead the public to perceive that risks from tritium have been historically underestimated. It was concluded that the new recommendation is not supported by any new scientific insight regarding negative consequences of low dose effects, and may be contrary to new data on the potential benefits of low dose effects. Given the lack of cost versus benefit analysis, this type of dramatic policy change could have detrimental effects to society from an ethical, economical, and public perception perspective.

Infants with congenital diaphragmatic hernia (CDH) benefit from comprehensive multidisciplinary teams that have experience in caring for the unique and complex issues associated with CDH. Despite prenatal referral to specialized high-volume centers, advanced ventilation strategies and pulmonary hypertension management, and extracorporeal membrane oxygenation, mortality and morbidity remain high. These infants have unique and complex issues that begin in fetal and infant life, but persist through adulthood. Here we will review the literature and share our clinical care pathway for neonatal care and follow up. While many advances have occurred in the past few decades, our work is just beginning to continue to improve the mortality, but also importantly the morbidity of CDH. [ABSTRACT FROM AUTHOR]

BackgroundSkin and soft tissue infections (SSTIs) are a key antimicrobial stewardship target because they are a common infection in hospitalized patients, and non-guideline-concordant antibiotic use is frequent. To inform antimicrobial stewardship interventions, we evaluated the proportion of veterans hospitalized with SSTIs who received guideline-concordant empiric antibiotics or an appropriate total duration of antibiotics.MethodsA retrospective medication use evaluation was performed in 34 Veterans Affairs Medical Centers between 2016 and 2017. Hospitalized patients who received antibiotics for uncomplicated SSTI were included. Exclusion criteria were complicated SSTI, severe immunosuppression, and antibiotics for any non-SSTI indication. Data were collected by manual chart review. The primary outcome was the proportion of patients receiving both guideline-concordant empiric antibiotics and appropriate treatment duration, defined as 5-10 days of antibiotics. Data were analyzed and reported using descriptive statistics.ResultsOf the 3890 patients manually evaluated for inclusion, 1828 patients met inclusion criteria. There were 1299 nonpurulent (71%) and 529 purulent SSTIs (29%). Overall, 250 patients (14%) received guideline-concordant empiric therapy and an appropriate duration. The most common reason for non-guideline-concordance was receipt of antibiotics targeting methicillin-resistant Staphylococcus aureus (MRSA) in 906 patients (70%) with a nonpurulent SSTI. Additionally, 819 patients (45%) received broad-spectrum Gram-negative coverage, and 860 patients (48%) received an antibiotic duration >10 days.ConclusionsWe identified 3 common opportunities to improve antibiotic use for patients hospitalized with uncomplicated SSTIs: use of anti-MRSA antibiotics in patients with nonpurulent SSTIs, use of broad-spectrum Gram-negative antibiotics, and prolonged durations of therapy.