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Background Coronary risk stratification is recommended for emergency department patients with chest pain. Many protocols are designed as “rule‐out” binary classification strategies, while others use graded‐risk stratification. The comparative performance of competing approaches at varying levels of risk tolerance has not been widely reported. Methods and Results This is a prospective cohort study of adult patients with chest pain presenting between January 2018 and December 2019 to 13 medical center emergency departments within an integrated healthcare delivery system. Using an electronic clinical decision support interface, we externally validated and assessed the net benefit (at varying risk thresholds) of several coronary risk scores (History, ECG, Age, Risk Factors, and Troponin [HEART] score, HEART pathway, Emergency Department Assessment of Chest Pain Score Accelerated Diagnostic Protocol), troponin‐only strategies (fourth‐generation assay), unstructured physician gestalt, and a novel risk algorithm (RISTRA‐ACS). The primary outcome was 60‐day major adverse cardiac event defined as myocardial infarction, cardiac arrest, cardiogenic shock, coronary revascularization, or all‐cause mortality. There were 13 192 patient encounters included with a 60‐day major adverse cardiac event incidence of 3.7%. RISTRA‐ACS and HEART pathway had the lowest negative likelihood ratios (0.06, 95% CI, 0.03–0.10 and 0.07, 95% CI, 0.04–0.11, respectively) and the greatest net benefit across a range of low‐risk thresholds. RISTRA‐ACS demonstrated the highest discrimination for 60‐day major adverse cardiac event (area under the receiver operating characteristic curve 0.92, 95% CI, 0.91–0.94, P

Student attitude and involvement in the sciences may be positively or negatively influenced through both formal academic experiences and informal experiences outside the classroom. Researchers have reported that differences in science interest between genders begin early in a student’s career and that attitudes towards a particular field of science can be correlated to achievement in that field. In this study, we approach the question of how attitudes towards science have been shaped using college-age students. Survey data from students in similar academic positions were employed to control for differences in cultural and academic progress. Results from a self-reflection survey indicated that general personal interest in both science as a process and field-specific content increased from elementary school through high school until entering college. Differences arose between self-identified genders in student experiences with science, both while in groups and when on their own. Female students had higher rates of participation and enjoyment with science in groups, while male students more frequently enjoyed science alone. Students, regardless of gender, rarely had negative experiences with science outside of the classroom. However, male students’ interest in science surpassed female students’ during high school. Declining interests in quantitative aspects of science (mathematics and statistics) were more frequently reported by female students and non-STEM majors during and before their college experience. Connecting student attitudes regarding science to their pre-college experiences with science early in their college career may be important to understanding how to best engage all genders, as well as non-STEM majors, in their college science courses.

Abstract Community science, the enlisting of volunteers to collect biodiversity data, is now common and widespread. In theory, the benefits of this model are complementary: community science programs produce useful datasets while engaging the public in conservation. However, in practice there may be tradeoffs regarding data quality, economic cost, and public engagement, which are rarely quantified. To assess program structure and relative outputs, we evaluated the tradeoffs associated with (a) employing paid technicians or (b) recruiting community science volunteers to collect bird and butterfly data for an urban biodiversity project. We found mixed results for data quality; the probability of detecting human‐adapted species was similar between technicians and community scientists, but community scientists were less likely to detect human‐sensitive species and overreported the abundance of human‐adapted birds. Habitat use estimates for four out of five species were comparable between the two datasets, although uncertainty was greater for community science data. Community scientists were more efficient in terms of economic cost, producing one and a half times more bird and two times more butterfly surveys and detections per paid work‐hour. Community scientists improved their ability to identify local species (birds by 16%; butterflies by 31%). Lastly, community scientists reported an increased interest in educational or volunteer programs after participating in monitoring but were less likely to report an increased interest in taking conservation action. To improve data quality, we recommend that training focus on identifying human‐sensitive species and tracking multiple individuals of the same species during surveys. To catalyze changes in attitudes, programs should focus on recruiting members of the public with diverse preexisting attitudes toward conservation. Although we demonstrate some shortcomings, our findings add to a growing body of literature that suggests community science can increase scientific literacy and efficiently produce data of similar quality to technicians, particularly for common species.

Turbulent events in leadership and in life can challenge even those most stoic in the face of adversity and loss. Prefacing with a combined definition of resilience, this paper illustrates the complete lifecycle of resilience in the face of adversity and its resultant rewards when and if appropriately applied. Phases included in this lifecycle are: normalcy, deterioration, adaptation, recovery, and growth. The paper then discusses the application of the revised Leader Resilience Profile® (LRP) data, comparing leader resilience according to gender and age. Results from this ongoing study on resilience clearly show as people age, their resilience increases. The 60+ age group, in particular, had significantly higher resilience scores than participants in other age groups. Men between the ages of 20–29 had significantly higher resilience scores than women of the same age group. Other age groups provided no notable differences or substantial correlations when it came to gender and age. A framework is presented for how to become more resilient throughout the life course. This framework includes positive well-being, assessing and strengthening meaningful intrinsic and extrinsic resources, self-efficacy, future-focus, and important strategic avenues for resilient aging. The paper then raises the questions: who ages resiliently, and how, and what differences are there between young, old, retired, and elderly individuals when it comes to living and working resiliently? The paper concludes that support and proactivity are the means for achieving positive growth orientation, quality of life, self-identity, purpose, inhibiting stress-related debilitation, and resilient aging.

Introduction: Syncope is common among emergency department (ED) patients with acute pulmonary embolism (PE) and indicates a higher acuity and worse prognosis than in patients without syncope. Whether presyncope carries the same prognostic implications has not been established. We compared incidence of intensive care unit (ICU) admission in three groups of ED PE patients: those with presyncope; syncope; and neither. Methods: This retrospective cohort study included all adults with acute, objectively confirmed PE in 21 community EDs from January 2013–April 2015. We combined electronic health record extraction with manual chart abstraction. We used chi-square test for univariate comparisons and performed multivariate analysis to evaluate associations between presyncope or syncope and ICU admission from the ED, reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results: Among 2996 PE patients, 82 (2.7%) had presyncope and 109 (3.6%) had syncope. ICU admission was similar between groups (presyncope 18.3% vs syncope 25.7%) and different than their non-syncope counterparts (either 22.5% vs neither 4.7%; p

Abstract Background Portfolio effects were first described as a basis for mitigating against financial risk by diversifying investments. Distributing investment across several different assets can stabilize returns and reduce risks by statistical averaging of individual asset dynamics that often correlate weakly or negatively with each other. The same simple probability theory is equally applicable to complex ecosystems, in which biological and environmental diversity stabilizes ecosystems against natural and human-mediated perturbations. Given the fundamental limitations to how well the full complexity of ecosystem dynamics can be understood or anticipated, the portfolio effect concept provides a simple framework for more critical data interpretation and pro-active conservation management. Applied to conservation ecology purposes, the portfolio effect concept informs management strategies emphasizing identification and maintenance of key ecological processes that generate complexity, diversity and resilience against inevitable, often unpredictable perturbations. Implications Applied to the reciprocal goal of eliminating the least valued elements of global biodiversity, specifically lethal malaria parasites and their vector mosquitoes, simply understanding the portfolio effect concept informs more cautious interpretation of surveillance data and simulation model predictions. Malaria transmission mediated by guilds of multiple vectors in complex landscapes, with highly variable climatic and meteorological conditions, as well as changing patterns of land use and other human behaviours, will systematically tend to be more resilient to attack with vector control than it appears based on even the highest quality surveillance data or predictive models. Conclusion Malaria vector control programmes may need to be more ambitious, interpret their short-to-medium term assessments of intervention impact more cautiously, and manage stakeholder expectations more conservatively than has often been the case thus far.

Abstract Recent research has shown lakes play an outsized role in carbon cycling, but long‐term continuous observations and analysis of carbon dynamics are rare, limiting our understanding of interannual variation, important timescales of variability, and drivers of efflux. Therefore, we examined lake‐atmosphere carbon fluxes with the goal of quantifying annual trends and patterns in lake carbon efflux and identifying important timescales. To do so, this study integrated 6 yr of eddy‐covariance flux tower observations of lake‐atmosphere fluxes with high‐frequency observations of in‐lake temperature, dissolved oxygen, and partial pressure of CO2, for a eutrophic lake in Wisconsin, U.S.A. While growing season fluxes are variable and switch between source and sink, annual net carbon fluxes show the lake acts as an annual sink of carbon, with the magnitude depending on climate, along with the timing and strength of fall turnover, with half of the total annual carbon uptake happening in October and November.

Abstract Background Ensuring patients benefit from the latest medical and technical advances remains a major challenge, with rational-linear and reductionist approaches to translating evidence into practice proving inefficient and ineffective. Complexity thinking, which emphasises interconnectedness and unpredictability, offers insights to inform evidence translation theories and strategies. Drawing on detailed insights into complex micro-systems, this research aimed to advance empirical and theoretical understanding of the reality of making and sustaining improvements in complex healthcare systems. Methods Using analytical auto-ethnography, including documentary analysis and literature review, we assimilated learning from 5 years of observation of 22 evidence translation projects (UK). We used a grounded theory approach to develop substantive theory and a conceptual framework. Results were interpreted using complexity theory and ‘simple rules’ were identified reflecting the practical strategies that enhanced project progress. Results The framework for Successful Healthcare Improvement From Translating Evidence in complex systems (SHIFT-Evidence) positions the challenge of evidence translation within the dynamic context of the health system. SHIFT-Evidence is summarised by three strategic principles, namely (1) ‘act scientifically and pragmatically’ – knowledge of existing evidence needs to be combined with knowledge of the unique initial conditions of a system, and interventions need to adapt as the complex system responds and learning emerges about unpredictable effects; (2) ‘embrace complexity’ – evidence-based interventions only work if related practices and processes of care within the complex system are functional, and evidence-translation efforts need to identify and address any problems with usual care, recognising that this typically includes a range of interdependent parts of the system; and (3) ‘engage and empower’ – evidence translation and system navigation requires commitment and insights from staff and patients with experience of the local system, and changes need to align with their motivations and concerns. Twelve associated ‘simple rules’ are presented to provide actionable guidance to support evidence translation and improvement in complex systems. Conclusion By recognising how agency, interconnectedness and unpredictability influences evidence translation in complex systems, SHIFT-Evidence provides a tool to guide practice and research. The ‘simple rules’ have potential to provide a common platform for academics, practitioners, patients and policymakers to collaborate when intervening to achieve improvements in healthcare.

The high-school-to-college transition can be difficult as students are adapting to a multitude of academic and social changes simultaneously. The University of Wyoming has created a first-semester program targeted at development of student skills for at-risk students using paired first-year seminar classes. Using student survey data from both pre- and post-course series, students were asked how important they thought academic and non-academic skills were as well as how much preparation time they were spending outside of class. Results from this work show large changes in the importance of skills and time spent studying during the transition from high school to college. This highlights the need to focus specifically on teaching skills to help students through the transition and suggests that not all skills are equal and data shows that students take longer than one semester to match their expected and actual amounts of time they spend outside of class studying.