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Background: Women experiencing substance use disorders face barriers to treatment, including childcare, stigma and lack of gender/trauma-informed programming. Several non-government organizations in New South Wales run women-only treatment services to address these needs. Objectives: We aim to assess characteristics of women entering treatment in these services. Design: Data on client characteristics from six women-only non-government organization substance use disorder treatment services in New South Wales between 2014 and 2018 were extracted from a database containing demographics, drug use and treatment characteristics and psychological distress (Kessler-10 scale) of women entering the services. Logistic regression models were used to estimate unadjusted odds ratio and adjusted odds ratio for treatment completion and different drugs on entry. Results: Data were available for 1357 women. Most (91%) episodes were for residential treatment. Women’s mean age was 35.4 years (standard deviation = 9.8; range = 17–67). Residential clients tended to be younger than non-residential clients (35.1 vs 38.5 years, p

BackgroundThere is increasing evidence that co-design can lead to more engaging, acceptable, relevant, feasible, and even effective interventions. However, no guidance is provided on the specific designs and associated methods or methodologies involved in the process. We propose the development of the Preferred Components for Co-design in Research (PRECISE) guideline to enhance the consistency, transparency, and quality of reporting co-design studies used to develop complex health interventions. ObjectiveThe aim is to develop the first iteration of the PRECISE guideline. The purpose of the PRECISE guideline is to improve the consistency, transparency, and quality of reporting on studies that use co-design to develop complex health interventions. MethodsThe aim will be achieved by addressing the following objectives: to review and synthesize the literature on the models, theories, and frameworks used in the co-design of complex health interventions to identify their common elements (components, values or principles, associated methods and methodologies, and outcomes); and by using the results of the scoping review, prioritize the co-design components, values or principles, associated methods and methodologies, and outcomes to be included in the PRECISE guideline. ResultsThe project has been funded by the Canadian Institutes of Health Research. ConclusionsThe collective results of this project will lead to a ready-to-implement PRECISE guideline that outlines a minimum set of items to include when reporting the co-design of complex health interventions. The PRECISE guideline will improve the consistency, transparency, and quality of reports of studies. Additionally, it will include guidance on how to enact or enable the values or principles of co-design for meaningful and collaborative solutions (interventions). PRECISE might also be used by peer reviewers and editors to improve the review of manuscripts involving co-design. Ultimately, the PRECISE guideline will facilitate more efficient use of new results about complex health intervention development and bring better returns on research investments. International Registered Report Identifier (IRRID)PRR1-10.2196/50463

Summary: Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health.

IntroductionThe circadian clock influences many aspects of animal welfare including metabolism, breeding, and behavior. In most species, circadian clocks are internal clocks regulated by external environmental cues called zeitgebers. The most common zeitgebers are light/dark cycles, food, and temperature. However, within captive environments, animals can be housed at latitudes with different light/dark cycles than their natural habitat and most other zeitgebers are controlled by humans. The effects that modified zeitgebers have on captive animals’ circadian and circannual rhythmicity is largely unknown. To explore this and potential welfare implications, we measured and analyzed observational behavioral data of zoo-housed giant pandas for one year utilizing live camera footage from six zoos across the world. The worldwide distribution of the zoos gives us the unique opportunity to investigate how housing giant pandas within and outside of their natural latitudinal range can affect circadian rhythmicity and behavior.MethodsFocal sampling was completed for 11 giant pandas each month for 12 consecutive months to gain an estimate of one circannual cycle. Within each month, we estimated one daylight or 24 h cycle of activity/behavior by conducting 10-min observation sessions systemically each hour the pandas were visible.ResultsZero-inflated negative binomial mixture models found that latitude is associated with activity levels, with pandas housed outside of their natural latitudinal range displaying less activity than those within their latitudinal range. Amount of daylight, temperature minimum, and temperature range were also associated with activity cycles, potentially acting as zeitgebers. An association between sexual-related and stereotypic behavioral cycles was found, with the circannual cycles fluctuating in synchrony throughout several points in a year.DiscussionThese results indicate that changes to common zeitgebers and environmental conditions can influence circadian and circannual cycles. The widespread evolution of circadian rhythms suggests an adaptive advantage to possessing one in an environment with cyclical changes, allowing species to anticipate changes in their environment and respond accordingly. Therefore, although animals are highly adaptive, creating a captive environment that mimics the environmental conditions for which the animal has evolved can encourage naturalistic cycles that ultimately aid in promoting positive welfare states and increasing chances of successful breeding and conservation.

Milkfish (Chanos chanos) by-products were used as raw material for the production of protein hydrolysates. Acid hydrolysis was performed at 121 °C for 90 min at 15 psi using various concentrations of hydrochloric acid (4, 6, and 8M). The protein hydrolysates were characterized for the degree of hydrolysis (DH), and antioxidant and other functional food properties. The yield obtained ranged from 5.14±0.42% to 6.08±1.53%. High DH was observed at a high acid concentration with 43.88±9.50% DH for 8M HCl. Regarding the functional food properties, solubility of over 80% over a wide range of pH (2-12) was observed, and emulsifying and foaming properties were found to depend on the pH (2-10). As for the antioxidant activity, 8M exhibited the highest antioxidant activity among the three treatments. The results showed that milkfish by-products have potential to serve as raw material for protein hydrolysates that can be used as ingredients for food formulations.

Knowledge translation (KT) is the science and practice of dissemination and implementation of evidence. We describe how research funders operationalize and evaluate KT initiatives, identify challenges and opportunities, and suggest strategic considerations for KT support. We conducted an environmental scan, which included a systematic search of published and grey literature and a focus group with Canadian funders. A total of 130 published articles and 2415 grey literature sources were screened; 212 unique data sources were included. Published literature commonly described KT initiatives related to “KT practice and science funding.” These initiatives commonly provided funds for infrastructure development (e.g., clinical technologies, database subscriptions) to facilitate translational or applied research to address regional health priorities. Of the articles, 44% outlined an evaluation plan; few provided validated KT metrics. In the grey literature, 364 initiatives were described; the most commonly described initiatives related to “exchange and integrated KT.” Focus group participants hoped to see increased resources to support KT, exchange opportunities with policy/decision-makers, and evaluate KT initiatives. Funders completed various KT initiatives, which tended to engage stakeholders to set research priorities, collaborate with a range of stakeholders, build KT capacity, and mandate KT requirements. We provide six considerations for funders to support KT.

Measurement(s) temperature of air Technology Type(s) weather stations Sample Characteristic - Environment Air - temperature, precipitation and pressre Sample Characteristic - Location Global Dataset

Abstract Background The CDC recently reported that firearm homicide rates in the United States increased in 2020, particularly among Black/African American individuals and men 25–44 years old. It is unclear whether firearm hospitalizations also increased, and more importantly, what impact the COVID-19 pandemic and COVID-related policies had. Using the North Carolina Trauma Registry, a statewide registry of trauma admissions to eighteen North Carolina hospitals, we calculated weekly GSW hospitalization rates from 1/2019 to 12/2020, overall and stratified by race-ethnicity, age, and sex. Interrupted time-series design and segmented linear regression were used to estimate changes in weekly hospitalization rates over time after (1) U.S. declaration of a public health emergency; (2) statewide Stay-at-Home order; (3) Stay-at-Home order lifted with restrictions (Phase 2: Safer-at-Home); and (4) further lifting of restrictions (Phase 2.5: Safer-at-Home). Non-GSW assault hospitalizations were used as a control to assess whether trends were observed across all assault hospitalizations or if effects were specific to gun violence. Findings Overall, 47.3% (n = 3223) of assault hospitalizations were GSW. Among GSW hospitalizations, median age was 27 years old (interquartile range [IQR] 21–25), 86.2% were male, and 49.5% occurred after the U.S. declared a public health emergency. After the Stay-at-Home order was implemented, weekly GSW hospitalization rates began increasing substantially among Black/African American residents (weekly trend change = 0.775, 95% CI = 0.254 to 1.296), peaking at an average 15.6 hospitalizations per 1,000,000 residents. Weekly hospitalization rates declined after restrictions were lifted but remained elevated compared to pre-COVID levels in this group (average weekly rate 10.6 per 1,000,000 at the end of 2020 vs. 8.9 per 1,000,000 pre-pandemic). The Stay-at-Home order was also associated with increasing GSW hospitalization rates among males 25–44 years old (weekly trend change = 1.202, 95% CI = 0.631 to 1.773); rates also remained elevated among 25–44-year-old males after restrictions were lifted in 2020 (average weekly rate 10.1 vs. 7.9 per 1,000,000). Non-GSW hospitalization rates were relatively stable in 2020. Conclusions The COVID-19 pandemic and statewide Stay-at-Home orders appeared to have placed Black/African American residents and men ages 25–44 at higher risk for GSW hospitalizations, exacerbating pre-existing disparities. Persistent gun violence disparities must be addressed.

Abstract Background To combat the coronavirus pandemic, states implemented several public health policies to reduce infection and transmission. Increasing evidence suggests that these prevention strategies also have had a profound impact on non-COVID healthcare utilization. The goal of this study was to determine the impact of a statewide Stay-at-Home order and other COVID-related policies on trauma hospitalizations, stratified by race/ethnicity, age, and sex. Methods We used the North Carolina Trauma Registry, a statewide registry of trauma hospitalizations for 18 hospitals across North Carolina, including all North Carolina trauma centers, to calculate weekly rates of assault, self-inflicted, unintentional motor vehicle collision (MVC), and other unintentional injury hospitalizations between January 1, 2019, and December 31, 2020. Interrupted time-series design and segmented linear regression were used to estimate changes in hospitalization rates after several COVID-related executive orders, overall and stratified by race/ethnicity, age, and sex. Changes in hospitalization rates were assessed after 1) USA declaration of a public health emergency; 2) North Carolina statewide Stay-at-Home order; 3) Stay-at-Home order lifted with restrictions (Phase 2: Safer-at-Home); and 4) further lifting of restrictions (Phase 2.5: Safer-at-Home). Results There were 70,478 trauma hospitalizations in North Carolina, 2019–2020. In 2020, median age was 53 years old and 59% were male. Assault hospitalization rates (per 1,000,000 NC residents) increased after the Stay-at-Home order, but substantial increases were only observed among Black/African American residents (weekly trend change = 1.147, 95% CI = 0.634 to 1.662) and 18–44-year-old males (weekly trend change = 1.708, 95% CI = 0.870 to 2.545). After major restrictions were lifted, assault rates decreased but remained elevated compared to pre-COVID levels. Unintentional non-MVC injury hospitalizations decreased after the USA declared a public health emergency, especially among women ≥ 65 years old (weekly trend change = -4.010, 95% CI = -6.166 to -1.855), but returned to pre-pandemic levels within several months. Conclusions Statewide Stay-at-Home orders placed Black/African American residents at higher risk of assault hospitalizations, exacerbating pre-existing disparities. Males 18–44 years old were also at higher risk of assault hospitalization. Fear of COVID-19 may have led to decreases in unintentional non-MVC hospitalization rates, particularly among older females. Policy makers must anticipate policy-related harms that may disproportionately affect already disadvantaged communities and develop mitigation approaches.

Abstract Background There is a need to match characteristics of tobacco users with cessation treatments and risks of tobacco attributable diseases such as lung cancer. The rate in which the body metabolizes nicotine has proven an important predictor of these outcomes. Nicotine metabolism is primarily catalyzed by the enzyme cytochrone P450 (CYP2A6) and CYP2A6 activity can be measured as the ratio of two nicotine metabolites: trans-3’-hydroxycotinine to cotinine (NMR). Measurements of these metabolites are only possible in current tobacco users and vary by biofluid source, timing of collection, and protocols; unfortunately, this has limited their use in clinical practice. The NMR depends highly on genetic variation near CYP2A6 on chromosome 19 as well as ancestry, environmental, and other genetic factors. Thus, we aimed to develop prediction models of nicotine metabolism using genotypes and basic individual characteristics (age, gender, height, and weight). Results We identified four multiethnic studies with nicotine metabolites and DNA samples. We constructed a 263 marker panel from filtering genome-wide association scans of the NMR in each study. We then applied seven machine learning techniques to train models of nicotine metabolism on the largest and most ancestrally diverse dataset (N=2239). The models were then validated using the other three studies (total N=1415). Using cross-validation, we found the correlations between the observed and predicted NMR ranged from 0.69 to 0.97 depending on the model. When predictions were averaged in an ensemble model, the correlation was 0.81. The ensemble model generalizes well in the validation studies across ancestries, despite differences in the measurements of NMR between studies, with correlations of: 0.52 for African ancestry, 0.61 for Asian ancestry, and 0.46 for European ancestry. The most influential predictors of NMR identified in more than two models were rs56113850, rs11878604, and 21 other genetic variants near CYP2A6 as well as age and ancestry. Conclusions We have developed an ensemble of seven models for predicting the NMR across ancestries from genotypes and age, gender and BMI. These models were validated using three datasets and associate with nicotine dosages. The knowledge of how an individual metabolizes nicotine could be used to help select the optimal path to reducing or quitting tobacco use, as well as, evaluating risks of tobacco use.

Abstract During the SARS-CoV-2 pandemic, astonishingly rapid research averted millions of deaths worldwide through new vaccines and repurposed and new drugs. Evidence use informed life-saving national policies including non-pharmaceutical interventions. Simultaneously, there was unprecedented waste, with many underpowered trials on the same drugs. We identified lessons from COVID-19 research responses by applying WHO’s framework for research systems. It has four functions—governance, securing finance, capacity-building, and production and use of research—and nine components. Two linked questions focused the analysis. First, to what extent have achievements in knowledge production and evidence use built on existing structures and capacity in national health research systems? Second, did the features of such systems mitigate waste? We collated evidence on seven countries, Australia, Brazil, Canada, Germany, New Zealand, the United Kingdom and the United States, to identify examples of achievements and challenges. We used the data to develop lessons for each framework component. Research coordination, prioritization and expedited ethics approval contributed to rapid identification of new therapies, including dexamethasone in the United Kingdom and Brazil. Accelerated vaccines depended on extensive funding, especially through the Operation Warp Speed initiative in the United States, and new platforms created through long-term biomedical research capacity in the United Kingdom and, for messenger ribonucleic acid (mRNA) vaccines, in Canada, Germany and the United States. Research capacity embedded in the United Kingdom’s healthcare system resulted in trial acceleration and waste avoidance. Faster publication of research saved lives, but raised challenges. Public/private collaborations made major contributions to vastly accelerating new products, available worldwide, though unequally. Effective developments of living (i.e. regularly updated) reviews and guidelines, especially in Australia and Canada, extended existing expertise in meeting users’ needs. Despite complexities, effective national policy responses (less evident in Brazil, the United Kingdom and the United States) also saved lives by drawing on health research system features, including collaboration among politicians, civil servants and researchers; good communications; and willingness to use evidence. Comprehensive health research strategies contributed to success in research production in the United Kingdom and in evidence use by political leadership in New Zealand. In addition to waste, challenges included equity issues, public involvement and non-COVID research. We developed recommendations, but advocate studies of further countries.

BackgroundThe use of mobile health (mHealth) in asthma and chronic obstructive pulmonary disease (COPD) is growing, and as the population ages, a greater number of older adults stand to benefit from mHealth-enhanced airway disease care. Though older adults are a heterogeneous population of health technology users, older age represents a potential barrier to health technology adoption, and there is currently a lack of knowledge on how older age influences mHealth use in asthma and COPD. ObjectiveIn this qualitative study, we sought to explore the experiences and perspectives of adults who were aged 65 years and older with asthma and COPD toward mHealth use. MethodsSemistructured individual interviews were conducted with adults who were aged 65 years and older with asthma or COPD and owned a smartphone. Applying phenomenological methodology, we analyzed interview transcripts in order to develop themes and propose an essential experience of mHealth use among older adults with airway disease. We then summarized our qualitative findings and proposed strategies to leverage our results in order to guide future research and implementation efforts targeting older adults’ use of airway mHealth. ResultsTwenty participants (mean age 79.8, SD 4.4 years) were interviewed. Participants described a central tension between (1) the perception that mHealth could help maintain independence throughout aging and (2) an apprehension toward the ways in which mHealth could negatively affect established health care experiences. Several elements of these 2 themes are absent from previous research focusing on younger adults with asthma and COPD. The individual elements of these 2 themes informed potential strategies to optimize future older adults’ use of asthma and COPD mHealth tools. ConclusionsFocusing on the perspectives and experiences of older adults with asthma and COPD in their use of mHealth identified novel understandings of health technology use in this important demographic in need of greater care. These lessons were translated into potential strategies that will need to be objectively evaluated in future airway mHealth research, development, and implementation efforts.

Medical tourism is becoming increasingly popular. The most popularly sought operations are cosmetic procedures. With the increase in cosmetic tourism, it is unsurprising that there has also been a rise in skin and soft tissue infections caused by nontuberculous mycobacteria (NTM); in particular by the rapidly growing mycobacteria species.Here we provide a case of a 35 year-old woman who presented after autologous fat grafting with multiple painful, violaceous, and purulent nodules on her arms, legs, and breasts. Infection was found to be due to Mycobacterium abscessus. She was successfully treated with azithromycin, clofazimine, rifabutin, amikacin, imipenem-cilastatin-relebactam (Recarbrio™) and imipenem-cilastatin. This is the first described case of a M. abscessus infection successfully treated using this combination.

The exquisite angular resolution and sensitivity of JWST are opening a new window for our understanding of the Universe. In nearby galaxies, JWST observations are revolutionizing our understanding of the first phases of star formation and the dusty interstellar medium. Nineteen local galaxies spanning a range of properties and morphologies across the star-forming main sequence have been observed as part of the PHANGS-JWST Cycle 1 Treasury program at spatial scales of ∼5–50 pc. Here, we describe pjpipe , an image-processing pipeline developed for the PHANGS-JWST program that wraps around and extends the official JWST pipeline. We release this pipeline to the community as it contains a number of tools generally useful for JWST NIRCam and MIRI observations. Particularly for extended sources, pjpipe products provide significant improvements over mosaics from the MAST archive in terms of removing instrumental noise in NIRCam data, background flux matching, and calibration of relative and absolute astrometry. We show that slightly smoothing F2100W MIRI data to 0.″9 (degrading the resolution by about 30%) reduces the noise by a factor of ≈3. We also present the first public release (DR1.1.0) of the pjpipe processed eight-band 2–21 μ m imaging for all 19 galaxies in the PHANGS-JWST Cycle 1 Treasury program. An additional 55 galaxies will soon follow from a new PHANGS-JWST Cycle 2 Treasury program.

Theories of spiral structure traditionally separate into tight-winding Lin–Shu spiral density waves and the swing-amplified material patterns of Goldreich & Lynden-Bell and Julian & Toomre. In this paper we consolidate these two types of spirals into a unified description, treating density waves beyond the tight-winding limit, in the regime of shearing and nonsteady open spirals. This shearing wave scenario novelly captures swing amplification that enables structure formation above conventional Q thresholds. However, it also highlights the fundamental role of spiral forcing on the amplification process in general, whether the wave is shearing or not. Thus it captures resonant and nonresonant mode growth through the donkey effect described by Lynden-Bell & Kalnajs and, critically, the cessation of growth when donkey behavior is no longer permitted. Our calculations predict growth exclusive to trailing spirals above the Jeans length, the prominence of spirals across a range of orientations that increases with decreasing arm multiplicity, and a critical orientation where growth is fastest that is the same for both modes and material patterns. Predicted structures are consistent with highly regular, high-multiplicity gaseous spur features and long filaments spaced close to the Jeans scale in spirals and bars. Applied to stellar disks, conditions favor low multiplicity ( m < 5) open trailing spirals with pitch angles in the observed range 10° < i _p < 50°. The results of this work serve as a basis for describing spirals as a unified class of transient waves, abundantly stimulated but narrowly selected for growth depending on local conditions.

Risk for transmission of monkeypox virus (MPXV) (clade IIb) to healthcare workers (HCWs) is low. Although many cases have been reported among HCW, only a few have been occupationally acquired. We report a case of non–needle stick MPXV transmission to an HCW in the United States.

Abstract Background Despite improvement, sepsis mortality rates remain high, with an estimated 11 million sepsis-related deaths globally in 2017 (Rudd et. al, Lancet 395:200-211, 2020). Low- and middle-income countries (LMICs) are estimated to account for 85% of global sepsis mortality; however, evidence for improved sepsis mortality in LMICs is lacking. We aimed to improve sepsis care and outcomes through development and evaluation of a sepsis treatment protocol tailored to the Tikur Anbessa Specialized Hospital Emergency Department, Ethiopia, context. Methods We employed a mixed methods design, including an interrupted times series study, pre-post knowledge testing, and process evaluation. The primary outcome was the proportion of patients receiving appropriate sepsis care (blood culture collection before antibiotics and initiation of appropriate antibiotics within 1 h of assessment). Secondary outcomes included time to antibiotic administration, 72-h sepsis mortality, and 90-day all-cause mortality. Due to poor documentation, we were unable to assess our primary outcome and time to antibiotic administration. We used segmented regression with outcomes as binomial proportions to assess the impact of the intervention on mortality. Pre-post knowledge test scores were analyzed using the Student’s t-test to compare group means for percentage of scenarios with correct diagnosis. Results A total of 113 and 300 patients were enrolled in the pre-implementation and post-implementation phases respectively. While age and gender were similar across the phases, a higher proportion (31 vs. 57%) of patients had malignancies in the post-implementation phase. We found a significant change in trend between the phases, with a trend for increasing odds of survival in the pre-implementation phase (OR 1.24, 95% CI 0.98–1.56), and a shift down, with odds of survival virtually flat (OR 0.95, 95% CI. 0.88–1.03) in the post-implementation phases for 72-h mortality, and trends for survival pre- and post-implementation are virtually flat for 90-day mortality. We found no significant difference in pre-post knowledge test scores, with interpretation limited by response rate. Implementation quality was negatively impacted by resource challenges. Conclusion We found no improvement in sepsis outcomes, with a trend for increasing odds of survival lost post-implementation and no significant change in knowledge pre- and post-implementation. Variable availability of resources was the principal barrier to implementation. Trial registration Open Science Framework osf.io/ju4ga . Registered June 28, 2017

Abstract Background Transparent reporting of rapid reviews enables appropriate use of research findings and dissemination strategies can strengthen uptake and impact for the targeted knowledge users, including policy-makers and health system managers. The aim of this literature review was to understand reporting and dissemination approaches for rapid reviews and provide an overview in the context of health policy and systems research. Methods A literature review and descriptive summary of the reporting and disseminating approaches for rapid reviews was conducted, focusing on available guidance and methods, considerations for engagement with knowledge users, and optimizing dissemination. MEDLINE, PubMed, Google scholar, as well as relevant websites and reference lists were searched from January 2017 to March 2021 to identify the relevant literature with no language restrictions. Content was abstracted and charted. Results The literature review found limited guidance specific to rapid reviews. Building on the barriers and facilitators to systematic review use, we provide practical recommendations on different approaches and methods for reporting and disseminating expedited knowledge synthesis considering the needs of health policy and systems knowledge users. Reporting should balance comprehensive accounting of the research process and findings with what is “good enough” or sufficient to meet the requirements of the knowledge users, while considering the time and resources available to conduct a review. Typical approaches may be used when planning the dissemination of rapid review findings; such as peer-reviewed publications or symposia and clear and ongoing engagement with knowledge users in crafting the messages is essential so they are appropriately tailored to the target audience. Consideration should be given to providing different products for different audiences. Dissemination measures and bibliometrics are also useful to gauge impact and reach. Conclusions Limited guidance specific to the reporting and dissemination of rapid reviews is available. Although approaches to expedited synthesis for health policy and systems research vary, considerations for the reporting and dissemination of findings are pertinent to all.

Abstract Background Due to the explosion in rapid reviews in the literature during COVID-19, their utility in universal health coverage and in other routine situations, there is now a need to document and further advance the application of rapid review methods, particularly in low-resource settings where a scarcity of resources may preclude the production of a full systematic review. This is the introductory article for a series of articles to further the discussion of rapid reviews for health policy and systems decision-making. Main body The series of papers builds on a practical guide on the conduct and reporting of rapid reviews that was published in 2019. The first paper provides an evaluation of a rapid review platform that was implemented in four centers in low-resource settings, the second paper presents approaches to tailor the methods for decision-makers through rapid reviews, the third paper focuses on selecting different types of rapid review products, and the fourth pertains to reporting the results from a rapid review. Conclusion Rapid reviews have a great potential to inform universal health coverage and global health security interventions, moving forward, including preparedness and response plans to future pandemics. This series of articles will be useful for both researchers leading rapid reviews, as well as decision-makers using the results from rapid reviews.

Abstract Background The field of knowledge translation (KT) has been criticized for neglecting contextual and social considerations that influence health equity. Intersectionality, a concept introduced by Black feminist scholars, emphasizes how human experience is shaped by combinations of social factors (e.g., ethnicity, gender) embedded in systemic power structures. Its use has the potential to advance equity considerations in KT. Our objective was to develop and conduct usability testing of tools to support integrating intersectionality in KT through three key phases of KT: identifying the gap; assessing barriers to knowledge use; and selecting, tailoring, and implementing interventions. Methods We used an integrated KT approach and assembled an interdisciplinary development committee who drafted tools. We used a mixed methods approach for usability testing with KT intervention developers that included semi-structured interviews and the System Usability Scale (SUS). We calculated an average SUS score for each tool. We coded interview data using the framework method focusing on actionable feedback. The development committee used the feedback to revise tools, which were formatted by a graphic designer. Results Nine people working in Canada joined the development committee. They drafted an intersectionality primer and one tool that included recommendations, activities, reflection prompts, and resources for each of the three implementation phases. Thirty-one KT intervention developers from three countries participated in usability testing. They suggested the tools to be shorter, contain more visualizations, and use less jargon. Average SUS scores of the draft tools ranged between 60 and 78/100. The development committee revised and shortened all tools, and added two, one-page summary documents. The final toolkit included six documents. Conclusions We developed and evaluated tools to help embed intersectionality considerations in KT. These tools go beyond recommending the use of intersectionality to providing practical guidance on how to do this. Future work should develop guidance for enhancing social justice in intersectionality-enhanced KT.

BackgroundFamily meals are associated with adolescent health outcomes. Studies have reported that girls are less likely than boys to have dinner with their families.PurposeThis study examined gender differences in family meal frequency and the relationship between meal frequency and other health measures, using a large and representative sample of California middle and high school students.MethodsThis study analyzed data from the 2019–2020 California Student Tobacco Survey (159,904 students in grades 8, 10, and 12). Dinner with the family 5–7 times per week was defined as high frequency. Students reported substance use (of tobacco, marijuana, and alcohol) and rated their mental health and happiness in their home life. All analyses were weighted to reflect the California student population.ResultsFewer than half (44.7%) of students reported a high frequency of family meals, with boys more likely than girls and those who identified their gender in another way the least likely to do so (48.3%, 42.2%, 34.0%, respectively). Gender differences persisted across demographics and the quality of family relationships, and were evident as early as eighth grade. Less frequent family meals were associated with poorer mental health (OR = 1.34, 95% CI: 1.29–1.40) and substance use (OR = 1.27, 95% CI: 1.21–1.32), controlling for the effects of demographics and family dynamics.ConclusionGender differences in family meal frequency emerge early in adolescence and persist across demographics and family relationships. Given that family meals play a protective role in an adolescent’s life, these gender differences are concerning.

BackgroundThe COVID-19 pandemic has led to stigmatization of individuals based on race/ethnicity, age, gender, and occupation, among other factors. We canvassed Canadian residents to explore perceptions of and experiences with stigma during the COVID-19 pandemic.MethodsWe conducted an online survey between June 10 and December 31 2020. The survey was rooted in the Health Stigma and Discrimination Framework and included multiple choice, Likert and open-ended questions related to perceived and experienced stigma. Residents of Ontario, Canada were eligible to participate and we aimed to recruit a sample that was diverse by race/ethnicity and age.ResultsA total of 1,823 individuals participated in the survey (54% women, 39% men; 54% 18–40 years old, 28% 41–60 years old, 12% 61+ years old; 33% White, 26% East/SouthEast Asian, 14% Black, 12% South Asian). Fifty-one percent of participants agreed/strongly agreed that racist views had increased toward certain racial/ethnic groups in Canada during the pandemic. Participants perceived that people in Canada were stigmatized during the pandemic because of race/ethnicity (37%), political beliefs (26%), older age (24%), being a healthcare worker (23%), younger age (22%), being an essential worker (21%), and gender (11%). Thirty-nine percent of respondents feared experiencing and 37% experienced stigmatization during the pandemic. Men, individuals aged 18–40, and racialized participants were more likely to fear or experience stigma. With respect to health behaviors, 74, 68, and 59% of respondents were comfortable masking in public, seeking medical care if they became ill, and getting tested for COVID-19, respectively. Men were less likely to indicate comfort with mask wearing or seeking medical care. Participants aged 18–40 and Black participants were less likely to indicate comfort with all three behaviors compared to those over age 41 and White participants, respectively. South Asian participants were less likely to be comfortable seeking medical care compared to White Participants.DiscussionParticipants feared or experienced stigmatization towards various demographic characteristics during the COVID-19 pandemic. It is critical that the factors driving stigma during health emergencies in Canada be better understood in order to develop effective public health messaging and interventions.

Abstract Background There is an urgent need to understand the determinants (i.e., barriers and facilitators) of de-implementation. The purpose of this study was to develop a comprehensive list of determinants of the de-implementation of low-value care from the published literature and to compare this list to determinants identified by a group of stakeholders with lived experience with de-implementation. Methods This was a two-phase multi-method study. First, a systematic review examined published barriers and facilitators to de-implementation. Articles were identified through searches within electronic databases, reference lists and the grey literature. Citations were screened independently and in duplicate and included if they were: 1) written in English; and 2) described a barrier or facilitator to de-implementation of any clinical practice in adults (age ≥ 18 years). ‘Raw text’ determinants cited within included articles were extracted and synthesized into a list of representative determinants using conventional content analysis. Second, semi-structured interviews were conducted with decision-makers (unit managers and medical directors) and healthcare professionals working in adult critical care medicine to explore the overlap between the determinants found in the systematic review to those experienced in critical care medicine. Thematic content analysis was used to identify key themes emerging from the interviews. Results In the systematic review, reviewers included 172 articles from 35,368 unique citations. From 437 raw text barriers and 280 raw text facilitators, content analysis produced 29 distinct barriers and 24 distinct facilitators to de-implementation. Distinct barriers commonly cited within raw text included ‘lack of credible evidence to support de-implementation’ (n = 90, 21%), ‘entrenched norms and clinicians’ resistance to change (n = 43, 21%), and ‘patient demands and preferences’ (n = 28, 6%). Distinct facilitators commonly cited within raw text included ‘stakeholder collaboration and communication’ (n = 43, 15%), and ‘availability of credible evidence’ (n = 33, 12%). From stakeholder interviews, 23 of 29 distinct barriers and 20 of 24 distinct facilitators from the systematic review were cited as key themes relevant to de-implementation in critical care. Conclusions The availability and quality of evidence that identifies a clinical practice as low-value, as well as healthcare professional willingness to change, and stakeholder collaboration are common and important determinants of de-implementation and may serve as targets for future de-implementation initiatives. Trial registration The systematic review was registered in PROSPERO CRD42016050234 .

Abstract Mammalian captive dietary specialists like folivores are prone to gastrointestinal distress and primate dietary specialists suffer the greatest gut microbiome diversity losses in captivity compared to the wild. Marmosets represent another group of dietary specialists, exudivores that eat plant exudates, but whose microbiome remains relatively less studied. The common occurrence of gastrointestinal distress in captive marmosets prompted us to study the Callithrix gut microbiome composition and predictive function through bacterial 16S ribosomal RNA V4 region sequencing. We sampled 59 wild and captive Callithrix across four species and their hybrids. Host environment had a stronger effect on the gut microbiome than host taxon. Wild Callithrix gut microbiomes were enriched for Bifidobacterium, which process host-indigestible carbohydrates. Captive marmoset guts were enriched for Enterobacteriaceae, a family containing pathogenic bacteria. While gut microbiome function was similar across marmosets, Enterobacteriaceae seem to carry out most functional activities in captive host guts. More diverse bacterial taxa seem to perform gut functions in wild marmosets, with Bifidobacterium being important for carbohydrate metabolism. Captive marmosets showed gut microbiome composition aspects seen in human gastrointestinal diseases. Thus, captivity may perturb the exudivore gut microbiome, which raises implications for captive exudivore welfare and calls for husbandry modifications.

Corso et al. employ a novel 25-year time series to show how variability in sea ice coverage and ocean temperatures impact larval abundance of an important forage fish, the Antarctic Silverfish. The authors provide insight into how current reductions of this keystone species might impact the vulnerable pelagic ecosystem along the western Antarctic Peninsula.

Abstract Current breast tumor margin detection methods are destructive, time-consuming, and result in significant reoperative rates. Dual-modality photoacoustic tomography (PAT) and ultrasound has the potential to enhance breast margin characterization by providing clinically relevant compositional information with high sensitivity and tissue penetration. However, quantitative methods that rigorously compare volumetric PAT and ultrasound images with gold-standard histology are lacking, thus limiting clinical validation and translation. Here, we present a quantitative multimodality workflow that uses inverted Selective Plane Illumination Microscopy (iSPIM) to facilitate image co-registration between volumetric PAT-ultrasound datasets with histology in human invasive ductal carcinoma breast tissue samples. Our ultrasound-PAT system consisted of a tunable Nd:YAG laser coupled with a 40 MHz central frequency ultrasound transducer. A linear stepper motor was used to acquire volumetric PAT and ultrasound breast biopsy datasets using 1100 nm light to identify hemoglobin-rich regions and 1210 nm light to identify lipid-rich regions. Our iSPIM system used 488 nm and 647 nm laser excitation combined with Eosin and DRAQ5, a cell-permeant nucleic acid binding dye, to produce high-resolution volumetric datasets comparable to histology. Image thresholding was applied to PAT and iSPIM images to extract, quantify, and topologically visualize breast biopsy lipid, stroma, hemoglobin, and nuclei distribution. Our lipid-weighted PAT and iSPIM images suggest that low lipid regions strongly correlate with malignant breast tissue. Hemoglobin-weighted PAT images, however, correlated poorly with cancerous regions determined by histology and interpreted by a board-certified pathologist. Nuclei-weighted iSPIM images revealed similar cellular content in cancerous and non-cancerous tissues, suggesting malignant cell migration from the breast ducts to the surrounding tissues. We demonstrate the utility of our nondestructive, volumetric, region-based quantitative method for comprehensive validation of 3D tomographic imaging methods suitable for bedside tumor margin detection.

Abstract Background To meet the needs of older adults with frailty better, it is essential to understand which aspects of care are important from their perspective. We therefore sought to assess the importance of a set of quality indicators (QI) for monitoring outcomes in this population. Methods In this mixed-method study, key stakeholders completed a survey on the importance of 36 QIs, and then explained their ratings in a semi-structured interview. Stakeholders included older adults with frailty and their caregivers, healthcare providers (HCPs), and healthcare administrators or policy/decision makers (DMs). We conducted descriptive statistical analyses of quantitative variables, and deductive thematic qualitative analyses of interview transcripts. Results The 42 participants (8 older adults, 18 HCPs, and 16 DMs) rated six QIs as more important: increasing the patients’ quality of life; increasing healthcare staff skills; decreasing patients’ symptoms; decreasing family caregiver burden; increasing patients’ satisfaction with care; and increasing family doctor continuity of care. Conclusions Key stakeholders prioritized QIs that focus on outcomes targeted to patients and caregivers, whereas the current healthcare systems generally focus on processes of care. Quality improvement initiatives should therefore take better account of aspects of care that are important for older adults with frailty, such as having a chance to express their individual goals of care, receiving quality communications from HCPs, or monitoring symptoms that they might not spontaneously describe. Our results point to the need for patient-centred care that is oriented toward quality of life for older adults with frailty.

This is the introductory paper in a collection of four papers on the Strategy for Patient-Oriented Research (SPOR) Evidence Alliance, a pan-Canadian research initiative that was funded by the Canadian Institutes of Health Research in September of 2017. Here, we introduce the SPOR enterprise in Canada, provide a rationale for the creation of the SPOR Evidence Alliance, provide information on the mandate and approach, and describe how the SPOR Evidence Alliance adds to the health research ecosystem in Canada and beyond.

Abstract Background Intensive care unit (ICU) patients undergoing transitions in care are at increased risk of adverse events and gaps in medical care. We evaluated existing patient- and family-centered transitions in care tools and identified facilitators, barriers, and implementation considerations for the application of a transitions in care bundle in critically ill adults (i.e., a collection of evidence-based patient- and family-centred tools to improve outcomes during and after transitions from the intensive care unit [ICU] to hospital ward or community). Methods We conducted a concurrent mixed methods (quan + QUAL) study, including stakeholders with experience in ICU transitions in care (i.e., patient/family partners, researchers, decision-makers, providers, and other knowledge-users). First, participants scored existing transitions in care tools using the modified Appraisal of Guidelines, Research and Evaluation (AGREE-II) framework. Transitions in care tools were discussed by stakeholders and either accepted, accepted with modifications, or rejected if consensus was achieved (≥70% agreement). We summarized quantitative results using frequencies and medians. Second, we conducted a qualitative analysis of participant discussions using grounded theory principles to elicit factors influencing AGREE-II scores, and to identify barriers, facilitators, and implementation considerations for the application of a transitions in care bundle. Results Twenty-nine stakeholders attended. Of 18 transitions in care tools evaluated, seven (39%) tools were accepted with modifications, one (6%) tool was rejected, and consensus was not reached for ten (55%) tools. Qualitative analysis found that participants’ AGREE-II rankings were influenced by: 1) language (e.g., inclusive, balance of jargon and lay language); 2) if the tool was comprehensive (i.e., could stand alone); 3) if the tool could be individualized for each patient; 4) impact to clinical workflow; and 5) how the tool was presented (e.g., brochure, video). Participants discussed implementation considerations for a patient- and family-centered transitions in care bundle: 1) delivery (e.g., tool format and timing); 2) continuity (e.g., follow-up after ICU discharge); and 3) continuous evaluation and improvement (e.g., frequency of tool use). Participants discussed existing facilitators (e.g., collaboration and co-design) and barriers (e.g., health system capacity) that would impact application of a transitions in care bundle. Conclusions Findings will inform future research to develop a transitions in care bundle for transitions from the ICU, co-designed with patients, families, providers, researchers, decision-makers, and knowledge-users.

Abstract Background Identification of clinically significant genetic alterations involved in human disease has been dramatically accelerated by developments in next-generation sequencing technologies. However, the infrastructure and accessible comprehensive curation tools necessary for analyzing an individual patient genome and interpreting genetic variants to inform healthcare management have been lacking. Results Here we present the ClinGen Variant Curation Interface (VCI), a global open-source variant classification platform for supporting the application of evidence criteria and classification of variants based on the ACMG/AMP variant classification guidelines. The VCI is among a suite of tools developed by the NIH-funded Clinical Genome Resource (ClinGen) Consortium and supports an FDA-recognized human variant curation process. Essential to this is the ability to enable collaboration and peer review across ClinGen Expert Panels supporting users in comprehensively identifying, annotating, and sharing relevant evidence while making variant pathogenicity assertions. To facilitate evidence-based improvements in human variant classification, the VCI is publicly available to the genomics community. Navigation workflows support users providing guidance to comprehensively apply the ACMG/AMP evidence criteria and document provenance for asserting variant classifications. Conclusions The VCI offers a central platform for clinical variant classification that fills a gap in the learning healthcare system, facilitates widespread adoption of standards for clinical curation, and is available at https://curation.clinicalgenome.org

Canada has made great progress in synthesizing, disseminating, and integrating research findings into health systems and clinical decision-making; yet gaps exist in the research-to-practice continuum. The Strategy for Patient-Oriented Research (SPOR) Evidence Alliance aims to help close gaps by providing decision-makers with evidence that is timely, context sensitive, and demand driven to better inform patient-oriented practices and policies in health systems. In this article, we introduce a model established in Canada to support decision-maker needs for high-quality evidence that is patient oriented to enhance health systems performance. We provide an overview of how this model was implemented, who is involved, who it serves, as well as its organizational structure and remit. We discuss key milestones achieved to date and the impact this initiative has made within the health research community. The strength of the SPOR Evidence Alliance lies in its unique ability to simultaneously: (i) serve as a national platform for researchers to stay connected and collaborate to minimize duplication of efforts and (ii) facilitate access to research knowledge for patient partners and decision-makers. In doing so, the SPOR Evidence Alliance is supporting health policy and practice decisions that support and strengthen Canada’s dynamic health systems.

The Strategy for Patient Oriented Research (SPOR) Evidence Alliance is a research initiative in Canada whose mission is to promote the synthesis, dissemination, and integration of research results into health care and public health decision-making and clinical practice. The aim of this paper is to (i) outline the governance and committee structure of the SPOR Evidence Alliance, (ii) outline the procedures for patient and health system decision-maker engagement, and (iii) present the capacity-building strategy for governance members. The governance structure includes the following six standing committees: the International Advisory Committee, Steering Committee, Executive Committee, Knowledge Translation Committee, Partnerships Committee, and Training and Capacity Development Committee. The guiding principles embrace inclusiveness, support, mutual respect, transparency, and co-building. There are currently 64 committee members across the six committees, 13 patient and public partners, 8 health system decision-makers, 7 research trainees, and 36 researchers. A multi-disciplinary and diverse group of people in Canada are represented from all regions and at various levels of training in knowledge generation, exchange, and translation. This collaborative model makes the SPOR Evidence Alliance strong and sustainable by leveraging the knowledge, lived experiences, expertise, skills, and networks among its 342 members and 12 principal investigators.

Atypical disease presentations are common in older adults with COVID-19. The objective of this study was to determine the prevalence of atypical and typical symptoms in older adults with COVID-19 through progressive pandemic waves and the association of these symptoms with in-hospital mortality. This retrospective cohort study included consecutive adults aged over 65 years with confirmed COVID-19 infection who were admitted to seven hospitals in Toronto, Canada, from 1 March 2020 to 30 June 2021. The median age for the 1786 patients was 78.0 years and 847 (47.5%) were female. Atypical symptoms (as defined by geriatric syndromes) occurred in 1187 patients (66.5%), but rarely occurred in the absence of other symptoms (n = 106; 6.2%). The most common atypical symptoms were anorexia (n = 598; 33.5%), weakness (n = 519; 23.9%), and delirium (n = 449; 25.1%). Dyspnea (adjusted odds ratio [aOR] 2.05; 95% confidence interval [CI] 1.62–2.62), tachycardia (aOR 1.87; 95% CI 1.14–3.04), and delirium (aOR 1.52; 95% CI 1.18–1.96) were independently associated with in-hospital mortality. In a cohort of older adults hospitalized with COVID-19 infection, atypical presentations frequently overlapped with typical symptoms. Further research should be directed at understanding the cause and clinical significance of atypical presentations in older adults.

In 2009, the Canadian Institutes of Health Research, Health Canada, and other stakeholders established the Drug Safety and Effectiveness Network (DSEN) to address the paucity of information on drug safety and effectiveness in real-world settings. This unique network invited knowledge users (e.g., policy makers) to submit queries to be answered by relevant research teams. The research teams were launched via open calls for team grants focused in relevant methodologic areas. We describe the development and implementation of one of these collaborating centres, the Methods and Application Group for Indirect Comparisons (MAGIC). MAGIC was created to provide high-quality knowledge synthesis including network meta-analysis to meet knowledge user needs. Since 2011, MAGIC responded to 54% of queries submitted to DSEN. In the past 5 years, MAGIC produced 26 reports and 49 publications. It led to 15 trainees who entered industry, academia, and government. More than 10 000 people participated in courses delivered by MAGIC team members. Most importantly, MAGIC knowledge syntheses influenced practice and policy (e.g., use of biosimilars for patients with diabetes and use of smallpox vaccinations in people with contraindications) provincially, nationally, and internationally.

Objectives To chart the global literature on gender equity in academic health research.Design Scoping review.Participants Quantitative studies were eligible if they examined gender equity within academic institutions including health researchers.Primary and secondary outcome measures Outcomes related to equity across gender and other social identities in academia: (1) faculty workforce: representation of all genders in university/faculty departments, academic rank or position and salary; (2) service: teaching obligations and administrative/non-teaching activities; (3) recruitment and hiring data: number of applicants by gender, interviews and new hires for various rank; (4) promotion: opportunities for promotion and time to progress through academic ranks; (5) academic leadership: type of leadership positions, opportunities for leadership promotion or training, opportunities to supervise/mentor and support for leadership bids; (6) scholarly output or productivity: number/type of publications and presentations, position of authorship, number/value of grants or awards and intellectual property ownership; (7) contextual factors of universities; (8) infrastructure; (9) knowledge and technology translation activities; (10) availability of maternity/paternity/parental/family leave; (11) collaboration activities/opportunities for collaboration; (12) qualitative considerations: perceptions around promotion, finances and support.Results Literature search yielded 94 798 citations; 4753 full-text articles were screened, and 562 studies were included. Most studies originated from North America (462/562, 82.2%). Few studies (27/562, 4.8%) reported race and fewer reported sex/gender (which were used interchangeably in most studies) other than male/female (11/562, 2.0%). Only one study provided data on religion. No other PROGRESS-PLUS variables were reported. A total of 2996 outcomes were reported, with most studies examining academic output (371/562, 66.0%).Conclusions Reviewed literature suggest a lack in analytic approaches that consider genders beyond the binary categories of man and woman, additional social identities (race, religion, social capital and disability) and an intersectionality lens examining the interconnection of multiple social identities in understanding discrimination and disadvantage. All of these are necessary to tailor strategies that promote gender equity.Trial registration number Open Science Framework: https://osf.io/8wk7e/.

Objectives To identify ML tools in hospital settings and how they were implemented to inform decision-making for patient care through a scoping review. We investigated the following research questions: What ML interventions have been used to inform decision-making for patient care in hospital settings? What strategies have been used to implement these ML interventions?Design A scoping review was undertaken. MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews (CDSR) were searched from 2009 until June 2021. Two reviewers screened titles and abstracts, full-text articles, and charted data independently. Conflicts were resolved by another reviewer. Data were summarised descriptively using simple content analysis.Setting Hospital setting.Participant Any type of clinician caring for any type of patient.Intervention Machine learning tools used by clinicians to inform decision-making for patient care, such as AI-based computerised decision support systems or “‘model-based’” decision support systems.Primary and secondary outcome measures Patient and study characteristics, as well as intervention characteristics including the type of machine learning tool, implementation strategies, target population. Equity issues were examined with PROGRESS-PLUS criteria.Results After screening 17 386 citations and 3474 full-text articles, 20 unique studies and 1 companion report were included. The included articles totalled 82 656 patients and 915 clinicians. Seven studies reported gender and four studies reported PROGRESS-PLUS criteria (race, health insurance, rural/urban). Common implementation strategies for the tools were clinician reminders that integrated ML predictions (44.4%), facilitated relay of clinical information (17.8%) and staff education (15.6%). Common barriers to successful implementation of ML tools were time (11.1%) and reliability (11.1%), and common facilitators were time/efficiency (13.6%) and perceived usefulness (13.6%).Conclusions We found limited evidence related to the implementation of ML tools to assist clinicians with patient healthcare decisions in hospital settings. Future research should examine other approaches to integrating ML into hospital clinician decisions related to patient care, and report on PROGRESS-PLUS items.Funding Canadian Institutes of Health Research (CIHR) Foundation grant awarded to SES and the CIHR Strategy for Patient Oriented-Research Initiative (GSR-154442).Scoping review registration https://osf.io/e2mna.

This pilot study provides preliminary insights into whether Latino preschool children living in an emerging Latino community (ELC) are meeting recommendations for healthy diet and activity behaviours and whether those behaviours are associated with sociodemographic or home environment variables. Secondary data analysis was conducted utilising cross-sectional baseline survey data from ANDALE Pittsburgh, a home-based intervention study. Measures included parent-reported information on child dietary intake, screen time and the home environment, and objectively measured physical activity and anthropometry. χ2 and Fischer's exact tests were used to determine associations. The study was conducted in an ELC in western Pennsylvania in the US. Fifty-one Latina mothers (age: 33⋅5 ± 6⋅1 years; 63 % Mexican origin; 86 % low acculturation) and their children (age: 3⋅9 ± 1⋅3 years; 55 % male) 2–5 years of age. On average, children consumed 2⋅25 ± 1⋅44 cups of fruits/vegetables, viewed 98⋅7 ± 74⋅2 min of screen time, accumulated 12⋅9 ± 2⋅9 min/h of total physical activity and consumed 15⋅5 ± 26⋅0 kcals of sugar-sweetened beverages per day. Forty-one percent met the fruit/vegetable recommendation, 54 % met the screen time recommendation, 27 % met the physical activity recommendation and 58 % met the sugary drink recommendation. Country of origin (P = 0⋅032) and acculturation (P = 0⋅048) were significantly associated with children meeting sugary drink recommendations. No other relationships were significant. The proportion of children in this sample meeting diet and activity recommendations was mixed. More research with larger sample sizes is needed in ELCs to identify effective intervention strategies for improving health behaviours.

The first JWST observations of nearby galaxies have unveiled a rich population of bubbles that trace the stellar-feedback mechanisms responsible for their creation. Studying these bubbles therefore allows us to chart the interaction between stellar feedback and the interstellar medium, and the larger galactic flows needed to regulate star formation processes globally. We present the first catalog of bubbles in NGC 628, visually identified using Mid-Infrared Instrument F770W Physics at High Angular resolution in Nearby GalaxieS (PHANGS)–JWST observations, and use them to statistically evaluate bubble characteristics. We classify 1694 structures as bubbles with radii between 6 and 552 pc. Of these, 31% contain at least one smaller bubble at their edge, indicating that previous generations of star formation have a local impact on where new stars form. On large scales, most bubbles lie near a spiral arm, and their radii increase downstream compared to upstream. Furthermore, bubbles are elongated in a similar direction to the spiral-arm ridgeline. These azimuthal trends demonstrate that star formation is intimately connected to the spiral-arm passage. Finally, the bubble size distribution follows a power law of index p = −2.2 ± 0.1, which is slightly shallower than the theoretical value by 1–3.5 σ that did not include bubble mergers. The fraction of bubbles identified within the shells of larger bubbles suggests that bubble merging is a common process. Our analysis therefore allows us to quantify the number of star-forming regions that are influenced by an earlier generation, and the role feedback processes have in setting the global star formation rate. With the full PHANGS–JWST sample, we can do this for more galaxies.

The earliest stages of star formation, when young stars are still deeply embedded in their natal clouds, represent a critical phase in the matter cycle between gas clouds and young stellar regions. Until now, the high-resolution infrared observations required for characterizing this heavily obscured phase (during which massive stars have formed, but optical emission is not detected) could only be obtained for a handful of the most nearby galaxies. One of the main hurdles has been the limited angular resolution of the Spitzer Space Telescope. With the revolutionary capabilities of the James Webb Space Telescope (JWST), it is now possible to investigate the matter cycle during the earliest phases of star formation as a function of the galactic environment. In this Letter, we demonstrate this by measuring the duration of the embedded phase of star formation and the implied time over which molecular clouds remain inert in the galaxy NGC 628 at a distance of 9.8 Mpc, demonstrating that the cosmic volume where this measurement can be made has increased by a factor of >100 compared to Spitzer. We show that young massive stars remain embedded for ${5.1}_{-1.4}^{+2.7}$ Myr ( ${2.3}_{-1.4}^{+2.7}$ Myr of which being heavily obscured), representing ∼20% of the total cloud lifetime. These values are in broad agreement with previous measurements in five nearby ( D < 3.5 Mpc) galaxies and constitute a proof of concept for the systematic characterization of the early phase of star formation across the nearby galaxy population with the PHANGS–JWST survey.

JWST/Mid-Infrared Instrument imaging of the nearby galaxies IC 5332, NGC 628, NGC 1365, and NGC 7496 from PHANGS reveals a richness of gas structures that in each case form a quasi-regular network of interconnected filaments, shells, and voids. We examine whether this multiscale network of structure is consistent with the fragmentation of the gas disk through gravitational instability. We use FilFinder to detect the web of filamentary features in each galaxy and determine their characteristic radial and azimuthal spacings. These spacings are then compared to estimates of the most Toomre-unstable length (a few kiloparsecs), the turbulent Jeans length (a few hundred parsecs), and the disk scale height (tens of parsecs) reconstructed using PHANGS–Atacama Large Millimeter/submillimeter Array observations of the molecular gas as a dynamical tracer. Our analysis of the four galaxies targeted in this work indicates that Jeans-scale structure is pervasive. Future work will be essential for determining how the structure observed in gas disks impacts not only the rate and location of star formation but also how stellar feedback interacts positively or negatively with the surrounding multiphase gas reservoir.

The PHANGS collaboration has been building a reference data set for the multiscale, multiphase study of star formation and the interstellar medium (ISM) in nearby galaxies. With the successful launch and commissioning of JWST, we can now obtain high-resolution infrared imaging to probe the youngest stellar populations and dust emission on the scales of star clusters and molecular clouds (∼5–50 pc). In Cycle 1, PHANGS is conducting an eight-band imaging survey from 2 to 21 μ m of 19 nearby spiral galaxies. Optical integral field spectroscopy, CO(2–1) mapping, and UV-optical imaging for all 19 galaxies have been obtained through large programs with ALMA, VLT-MUSE, and Hubble. PHANGS–JWST enables a full inventory of star formation, accurate measurement of the mass and age of star clusters, identification of the youngest embedded stellar populations, and characterization of the physical state of small dust grains. When combined with Hubble catalogs of ∼10,000 star clusters, MUSE spectroscopic mapping of ∼20,000 H ii regions, and ∼12,000 ALMA-identified molecular clouds, it becomes possible to measure the timescales and efficiencies of the earliest phases of star formation and feedback, build an empirical model of the dependence of small dust grain properties on local ISM conditions, and test our understanding of how dust-reprocessed starlight traces star formation activity, all across a diversity of galactic environments. Here we describe the PHANGS–JWST Treasury survey, present the remarkable imaging obtained in the first few months of science operations, and provide context for the initial results presented in the first series of PHANGS–JWST publications.

We present a high-resolution view of bubbles within the Phantom Galaxy (NGC 628), a nearby (∼10 Mpc), star-forming (∼2 M _⊙ yr ^−1 ), face-on ( i ∼ 9°) grand-design spiral galaxy. With new data obtained as part of the Physics at High Angular resolution in Nearby GalaxieS (PHANGS)-JWST treasury program, we perform a detailed case study of two regions of interest, one of which contains the largest and most prominent bubble in the galaxy (the Phantom Void, over 1 kpc in diameter), and the other being a smaller region that may be the precursor to such a large bubble (the Precursor Phantom Void). When comparing to matched-resolution H α observations from the Hubble Space Telescope, we see that the ionized gas is brightest in the shells of both bubbles, and is coincident with the youngest (∼1 Myr) and most massive (∼10 ^5 M _⊙ ) stellar associations. We also find an older generation (∼20 Myr) of stellar associations is present within the bubble of the Phantom Void. From our kinematic analysis of the H I , H _2 (CO), and H ii gas across the Phantom Void, we infer a high expansion speed of around 15 to 50 km s ^−1 . The large size and high expansion speed of the Phantom Void suggest that the driving mechanism is sustained stellar feedback due to multiple mechanisms, where early feedback first cleared a bubble (as we observe now in the Precursor Phantom Void), and since then supernovae have been exploding within the cavity and have accelerated the shell. Finally, comparison to simulations shows a striking resemblance to our JWST observations, and suggests that such large-scale, stellar-feedback-driven bubbles should be common within other galaxies.

A primary new capability of JWST is the ability to penetrate the dust in star-forming galaxies to identify and study the properties of young star clusters that remain embedded in dust and gas. In this Letter we combine new infrared images taken with JWST with our optical Hubble Space Telescope (HST) images of the starbursting barred (Seyfert2) spiral galaxy NGC 1365. We find that this galaxy has the richest population of massive young clusters of any known galaxy within 30 Mpc, with ∼30 star clusters that are more massive than 10 ^6 M _⊙ and younger than 10 Myr. Sixteen of these clusters are newly discovered from our JWST observations. An examination of the optical images reveals that 4 of 30 (∼13%) are so deeply embedded that they cannot be seen in the Hubble I band ( A _V ≳ 10 mag), and that 11 of 30 (∼37%) are missing in the HST B band, so age and mass estimates from optical measurements alone are challenging. These numbers suggest that massive clusters in NGC 1365 remain completely obscured in the visible for ∼1.3 ± 0.7 Myr and are either completely or partially obscured for ∼3.7 ± 1.1 Myr. We also use the JWST observations to gain new insights into the triggering of star cluster formation by the collision of gas and dust streamers with gas and dust in the bar. The JWST images reveal previously unknown structures (e.g., bridges and overshoot regions from stars that form in the bar) that help us better understand the orbital dynamics of barred galaxies and associated star-forming rings. Finally, we note that the excellent spatial resolution of the NIRCAM F200W filter provides a better way to separate barely resolved compact clusters from individual stars based on their sizes.

We use PHANGS–James Webb Space Telescope (JWST) data to identify and classify 1271 compact 21 μ m sources in four nearby galaxies using MIRI F2100W data. We identify sources using a dendrogram-based algorithm, and we measure the background-subtracted flux densities for JWST bands from 2 to 21 μ m. Using the spectral energy distribution (SED) in JWST and HST bands plus ALMA and MUSE/VLT observations, we classify the sources by eye. Then we use this classification to define regions in color–color space and so establish a quantitative framework for classifying sources. We identify 1085 sources as belonging to the ISM of the target galaxies with the remainder being dusty stars or background galaxies. These 21 μ m sources are strongly spatially associated with H ii regions (>92% of sources), while 74% of the sources are coincident with a stellar association defined in the HST data. Using SED fitting, we find that the stellar masses of the 21 μ m sources span a range of 10 ^2 –10 ^4 M _⊙ with mass-weighted ages down to 2 Myr. There is a tight correlation between attenuation-corrected H α and 21 μ m luminosity for L _ν _,F2100W > 10 ^19 W Hz ^−1 . Young embedded source candidates selected at 21 μ m are found below this threshold and have M _⋆ < 10 ^3 M _⊙ .

We present maps of the 3.3 μ m polycyclic aromatic hydrocarbon (PAH) emission feature in NGC 628, NGC 1365, and NGC 7496 as observed with the Near-Infrared Camera imager on JWST from the PHANGS–JWST Cycle 1 Treasury project. We create maps that isolate the 3.3 μ m PAH feature in the F335M filter (F335M _PAH ) using combinations of the F300M and F360M filters for removal of starlight continuum. This continuum removal is complicated by contamination of the F360M by PAH emission and variations in the stellar spectral energy distribution slopes between 3.0 and 3.6 μ m. We modify the empirical prescription from Lai et al. to remove the starlight continuum in our highly resolved galaxies, which have a range of starlight- and PAH-dominated lines of sight. Analyzing radially binned profiles of the F335M _PAH emission, we find that between 5% and 65% of the F335M intensity comes from the 3.3 μ m feature within the inner 0.5 r _25 of our targets. This percentage systematically varies from galaxy to galaxy and shows radial trends within the galaxies related to each galaxy’s distribution of stellar mass, interstellar medium, and star formation. The 3.3 μ m emission is well correlated with the 11.3 μ m PAH feature traced with the MIRI F1130W filter, as is expected, since both features arise from C–H vibrational modes. The average F335M _PAH /F1130W ratio agrees with the predictions of recent models by Draine et al. for PAHs with size and charge distributions shifted toward larger grains with normal or higher ionization.

JWST observations of polycyclic aromatic hydrocarbon (PAH) emission provide some of the deepest and highest resolution views of the cold interstellar medium (ISM) in nearby galaxies. If PAHs are well mixed with the atomic and molecular gas and illuminated by the average diffuse interstellar radiation field, PAH emission may provide an approximately linear, high-resolution, high-sensitivity tracer of diffuse gas surface density. We present a pilot study that explores using PAH emission in this way based on Mid-Infrared Instrument observations of IC 5332, NGC 628, NGC 1365, and NGC 7496 from the Physics at High Angular resolution in Nearby GalaxieS-JWST Treasury. Using scaling relationships calibrated in Leroy et al., scaled F1130W provides 10–40 pc resolution and 3 σ sensitivity of Σ _gas ∼ 2 M _⊙ pc ^−2 . We characterize the surface densities of structures seen at

We compare mid-infrared (mid-IR), extinction-corrected H α , and CO (2–1) emission at 70–160 pc resolution in the first four PHANGS–JWST targets. We report correlation strengths, intensity ratios, and power-law fits relating emission in JWST’s F770W, F1000W, F1130W, and F2100W bands to CO and H α . At these scales, CO and H α each correlate strongly with mid-IR emission, and these correlations are each stronger than the one relating CO to H α emission. This reflects that mid-IR emission simultaneously acts as a dust column density tracer, leading to a good match with the molecular-gas-tracing CO, and as a heating tracer, leading to a good match with the H α . By combining mid-IR, CO, and H α at scales where the overall correlation between cold gas and star formation begins to break down, we are able to separate these two effects. We model the mid-IR above I _ν = 0.5 MJy sr ^−1 at F770W, a cut designed to select regions where the molecular gas dominates the interstellar medium (ISM) mass. This bright emission can be described to first order by a model that combines a CO-tracing component and an H α -tracing component. The best-fitting models imply that ∼50% of the mid-IR flux arises from molecular gas heated by the diffuse interstellar radiation field, with the remaining ∼50% associated with bright, dusty star-forming regions. We discuss differences between the F770W, F1000W, and F1130W bands and the continuum-dominated F2100W band and suggest next steps for using the mid-IR as an ISM tracer.

We explore the relationship between mid-infrared (mid-IR) and CO rotational line emission from massive star-forming galaxies, which is one of the tightest scalings in the local universe. We assemble a large set of unresolved and moderately (∼1 kpc) spatially resolved measurements of CO (1–0) and CO (2–1) intensity, I _CO , and mid-IR intensity, I _MIR , at 8, 12, 22, and 24 μ m. The I _CO versus I _MIR relationship is reasonably described by a power law with slopes 0.7–1.2 and normalization I _CO ∼ 1 K km s ^−1 at I _MIR ∼ 1 MJy sr ^−1 . Both the slopes and intercepts vary systematically with choice of line and band. The comparison between the relations measured for CO (1–0) and CO (2–1) allow us to infer that ${R}_{21}\propto {I}_{\mathrm{MIR}}^{0.2}$ , in good agreement with other work. The 8 μ m and 12 μ m bands, with strong polycyclic aromatic hydrocarbon (PAH) features, show steeper CO versus mid-IR slopes than the 22 and 24 μ m, consistent with PAH emission arising not just from CO-bright gas but also from atomic or CO-dark gas. The CO-to-mid-IR ratio correlates with global galaxy stellar mass ( M _⋆ ) and anticorrelates with star formation rate/ M _⋆ . At ∼1 kpc resolution, the first four PHANGS–JWST targets show CO-to-mid-IR relationships that are quantitatively similar to our larger literature sample, including showing the steep CO-to-mid-IR slopes for the JWST PAH-tracing bands, although we caution that these initial data have a small sample size and span a limited range of intensities.

We present maps tracing the fraction of dust in the form of polycyclic aromatic hydrocarbons (PAHs) in IC 5332, NGC 628, NGC 1365, and NGC 7496 from JWST/MIRI observations. We trace the PAH fraction by combining the F770W (7.7 μ m) and F1130W (11.3 μ m) filters to track ionized and neutral PAH emission, respectively, and comparing the PAH emission to F2100W, which traces small, hot dust grains. We find the average R _PAH = (F770W + F1130W)/F2100W values of 3.3, 4.7, 5.1, and 3.6 in IC 5332, NGC 628, NGC 1365, and NGC 7496, respectively. We find that H ii regions traced by MUSE H α show a systematically low PAH fraction. The PAH fraction remains relatively constant across other galactic environments, with slight variations. We use CO+H i +H α to trace the interstellar gas phase and find that the PAH fraction decreases above a value of ${{\rm{I}}}_{{\rm{H}}\alpha }/{{\rm{\Sigma }}}_{{\rm{H}}{\rm\small{I}}+{{\rm{H}}}_{2}}\sim {10}^{37.5}\,\mathrm{erg}\,{{\rm{s}}}^{-1}\,{\mathrm{kpc}}^{-2}\,{({M}_{\odot }\,{\mathrm{pc}}^{-2})}^{-1}$ in all four galaxies. Radial profiles also show a decreasing PAH fraction with increasing radius, correlated with lower metallicity, in line with previous results showing a strong metallicity dependence to the PAH fraction. Our results suggest that the process of PAH destruction in ionized gas operates similarly across the four targets.