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The production of white light based on a near-UV LED chip requires incorporating three inorganic phosphors that emit in the blue, green, and red portions of the visible spectrum. Using a near-UV LED has the advantage of generating a light with excellent color quality, but due to the large Stokes’ shift between the LED excitation and the multiple phosphor emissions, these devices can suffer from a low overall efficiency. To minimize this inherent energy loss, the three phosphors employed to convert the LED emission must be very efficient, as measured by the internal photoluminescent quantum yield (Φ). In this work, we report the synthesis of a cubic borate, Ba3Y2B6O15, which when substituted with Ce3+ becomes an efficient blue phosphor. This compound can be prepared using a multistep high temperature solid state synthesis with the ensuing photoluminescent measurements revealing a broad excitation band (300–415 nm) making this phosphor compatible with a 365 or 400 nm LED chip. Ba3Y2B6O15:Ce3+ luminesces bri...

The remote Gulf of Carpentaria (GoC) represents 10% of Australia's coastline. This large, shallow sea supports high-value fishing activities and habitat for threatened species, and is a sink for abandoned, lost and discarded fishing gear (ALDFG) 'ghost nets', most originating from fishing activities outside of Australia's Exclusive Economic Zone. With growing concerns about the plastic waste along the world's coastlines, we retrospectively analyzed ghost net sighting information from four aerial surveys across 15 years, to investigate whether densities of ghost nets are changing through time or in space. We found an increase in ghost nets, despite more than a decade of illegal fishing countermeasure and clean-up efforts in the broader region. This demonstrates that the input of ALDFG into the system currently overwhelms the substantial net removal activities. We make recommendations for improving monitoring and consider the underlying drivers of nets being lost to improve ghost gear management on land and at sea.

Following an investigation proving La2Si4N6C crystallizes in a monoclinic space group, isostructural to Y2Si4N6C, the reportedly hexagonal (La0.5Y0.5)2Si4N6C was reinvestigated to examine the apparent crystal structure change across the solid solution. Initially, calculating the electronic structure and phonon density of states of (La0.5Y0.5)2Si4N6C in the P63mc space group revealed an imaginary phonon mode, which is indicative of a structural instability. Displacing the atoms along the pathway of the imaginary vibration led to a previously unreported space group for carbonitridosilicates, trigonal P31c. The assignment of the trigonal space group was subsequently confirmed by synthesizing (La0.5Y0.5)2Si4N6C using high-temperature, solid state synthesis and analyzing the crystal structure with high-resolution synchrotron X-ray powder diffraction. Preparing the solid solution, (LaδY1−δ)1.98Ce0.02Si4N6C (δ = 0–0.5), showed that the crystal structure changes from the monoclinic to the trigonal space group at ...

The study measured the relative influence of the following 3 factors in consumers' choice of hospitals: (1) cost, (2) out-of-pocket cost, and (3) safety as measured by Leapfrog Hospital Safety Score letter grade.Two hospital-choice questions regarding a hypothetical medical procedure were administered to 2357 online respondents. In question 1, respondents were assigned a scenario in which hospital 1 grade (A through D), hospital 2 grade (B through F), and hospital 2 total cost (3 levels) were randomly varied across respondents. In all cases, hospital 2 had a lower safety grade than hospital 1, and hospital 1 cost was held constant. In question 2, scenarios varied out-of-pocket cost rather than total cost. Demographic characteristics, income level, health status, health literacy, and opinions about value were also measured.On average, 94% and 88% of the respondents chose the safer hospital in questions 1 and 2, respectively. In all but 1 of 30 possible scenarios, where hospital 2 cost the individual $1000 less and was rated a B whereas hospital 1 was rated an A, respondents chose the safer hospital. Higher incomes, higher health literacy, and being female were associated with a stronger preference for hospital 1 (safer). There was a small effect suggesting that approximately 4% of the respondents selected a higher-cost hospital despite lower safety, but it was outweighed by predominant selections of the safer hospital.When shown Hospital Safety Score and cost information, consumers chose safer hospitals in 97% of cost and safety scenarios.

The endemic Australian plants Lepidosperma sp. Flinders Chase (Cyperaceae), Lepidosperma viscidum (Cyperaceae) and Dodonaea humilis (Sapindaceae) were found to be the botanical origin of three propolis types found on Kangaroo Island identified by TLC and 1H NMR matching of propolis and plant resin analytical profiles. Resin samples extracted from the plant, Lepidosperma sp. Flinders Chase, were chromatographically fractionated to give: methyl 3-phenyl-2-(E-cinnamoyloxy)propanoate (1), 3-(E-8-methoxy-8-oxo-3,7-dimethyloct-2-enyl)-4-hydroxy-E-cinnamic acid (2), 3-(E-6,7-dihydroxy-3,7-dimethyloct-2-enyl)-4-hydroxy-E-cinnamic acid (3), previously undescribed; and the known stilbenes, 2-prenyl-3,5-dihydroxy-E-stilbene (6) and 2-prenyl-3-methoxy-5-hydroxy-E-stilbene (7). The resin from L. viscidum gave: 5′-(E-4-hydroxy-3-methylbut-2-enyl)-4,2′,4′-trihydroxydihydrochalcone (4); 5′-(E-4-hydroxy-3-methylbut-2-enyl)-4′-methoxy-4,2′-dihydroxydihydrochalcone (5), previously undescribed; and three known flavanones, farrerol (8), 5,7,3′,5′-tetrahydroxy-6,8-dimethylflavanone (9) and 5,7,3′,5′-tetrahydroxy-6-methylflavanone (10). The major constituent in the propolis identified as being sourced from D. humilis was identified as 6,8-diprenyl-5,7,3′,4′-tetrahydroxyflavanone (11), a known compound identified in several unrelated plant species.

Objectives: Evidence-based guidelines recommend that HIV care providers offer retention-in-care services, but data are needed to assess service provision. Methods: We surveyed a probability sample of 1234 HIV care providers to estimate the percentage of providers whose practices offered 5 recommended retention services and describe providers’ perceptions of barriers to care among patients. Results: An estimated 21% of providers’ practices offered all 5 retention services. Providers at smaller (400 patients), private, and non-Ryan White HIV/AIDS Program (RWHAP)-funded practices, and practices without on-site case management were significantly less likely to provide patient navigation services or do systematic monitoring of retention. Providers’ most commonly perceived barriers to care among patients were mental health (40%), substance abuse (36%), and transportation (34%) issues. Conclusion: Deficiencies in the provision of key retention services are substantial. New strategies may be needed to increase the delivery of recommended retention services, especially among private, non-RWHAP-funded, and smaller facilities.

This study examines the relationships between trial of new marijuana or hashish products and unexpected highs, and use of edible products and unexpected highs.We conducted an online survey of 634 adult, past-year marijuana users in Colorado. We used logistic regression models to examine the relationship between new product trial or edible use and unexpected highs.In the first year that recreational marijuana was legal in Colorado, 71.4% of respondents tried a new marijuana or hashish product, and 53.6% used an edible product. Trial of new products was associated with greater odds of experiencing an unexpected high after controlling for age, gender, education, mental health status, current marijuana or hashish use, and mean amount of marijuana or hashish consumed in the past month (OR=2.13, p0.001). Individuals who reported having used edibles had greater odds of experiencing an unexpected high, after controlling for the same set of variables (OR=1.56, p0.05).People who try new marijuana or hashish products, or use edible marijuana or hashish products, are at greater risk for an unexpected high. It is possible that some negative outcomes associated with marijuana use and unexpected highs may be averted through a better understanding of how to use product packaging to communicate with consumers.

The preparation of cerium-substituted barium lutetium borate, Ba2Lu5B5O17:Ce3+, is achieved using high temperature solid state synthesis. This compound crystallizes in the Ba2Y5B5O17-type structure and shows an efficient blue emission (λmax = 447 nm) when excited by UV-light (λex = 340 nm) with a photoluminescent quantum yield near 90%, a fast luminescence decay time (

Mangroves invade some very marginal habitats for woody plants—at the interface between land and sea. Since mangroves anchor tropical coastal communities globally, their origin, diversification and adaptation are of scientific significance, particularly at a time of global climate change. In this study, a combination of single-molecule long reads and the more conventional short reads are generated from Rhizophora apiculata for the de novo assembly of its genome to a near chromosome level. The longest scaffold, N50 and N90 for the R. apiculata genome, are 13.3 Mb, 5.4 Mb and 1.0 Mb, respectively. Short reads for the genomes and transcriptomes of eight related species are also generated. We find that the ancestor of Rhizophoreae experienced a whole-genome duplication ∼70 Myrs ago, which is followed rather quickly by colonization and species diversification. Mangroves exhibit pan-exome modifications of amino acid (AA) usage as well as unusual AA substitutions among closely related species. The usage and substitution of AAs, unique among plants surveyed, is correlated with the rapid evolution of proteins in mangroves. A small subset of these substitutions is associated with mangroves’ highly specialized traits (vivipary and red bark) thought to be adaptive in the intertidal habitats. Despite the many adaptive features, mangroves are among the least genetically diverse plants, likely the result of continual habitat turnovers caused by repeated rises and falls of sea level in the geologically recent past. Mangrove genomes thus inform about their past evolutionary success as well as portend a possibly difficult future.

INTRODUCTION HIV treatment guidelines recommend initiating antiretroviral therapy (ART) regardless of CD4 cell (CD4) count, barring contraindications or barriers to treatment. An estimated 6% of persons receiving HIV care in 2013 were not prescribed ART. We examined reasons for this gap in the care continuum. METHODS During 2013-2014, we surveyed a probability sample of HIV care providers, of whom 1234 returned surveys (64.0% adjusted response rate). We estimated percentages of providers who followed guidelines and their characteristics, and who deferred ART prescribing for any reason. RESULTS Barring contraindications, 71.2% of providers initiated ART regardless of CD4 count. Providers less likely to initiate had caseloads ≤20 vs. >200 patients [adjusted prevalence ratios (aPR) 0.69, 95% confidence interval (CI): 0.47 to 1.02, P = 0.03], practiced at non-Ryan White HIV/AIDS Program-funded facilities (aPR 0.85, 95% CI: 0.74 to 0.98, P = 0.02), or reported pharmaceutical assistance programs provided insufficient medication to meet patients' needs (aPR 0.79, 95% CI: 0.65 to 0.98, P = 0.02). In all, 17.0% never deferred prescribing ART, 69.6% deferred for 1%-10% of patients, and 13.3% deferred for >10%. Among providers who had deferred ART, 59.4% cited patient refusal as a reason in >50% of cases, 31.1% reported adherence concerns because of mental health disorders or substance abuse, and 21.4% reported adherence concerns because of social problems, eg, homelessness, as factors in >50% of cases when deferring ART. CONCLUSIONS An estimated 29% of HIV care providers had not adopted recommendations to initiate ART regardless of CD4 count, barring contraindications, or barriers to treatment. Low-volume providers and those at non-Ryan White HIV/AIDS Program-funded facilities were less likely to follow this guideline. Among all providers, leading reasons for deferring ART included patient refusal and adherence concerns.

In November 2014, the United States Senate Select Committee on Intelligence (SSCI) released a report on its inquiry into the Detainee and Interrogation Program conducted by the Central Intelligence...

Introduction Growing up with disfigurement and functional limitations resulting from childhood burns can be challenging. Initial stages of care involve painful surgeries/dressing changes, strenuous physical & occupational therapy, pressure garments and time away from family/school activities. Few studies have examined the voiced issues faced by youth while maturing with burns. This study’s purpose was to determine if experiences in the post-injury phase differed between currently burn-injured youth vs. young adults burned as children. Methods A prior study asked Child Burn Survivors (CBS -10–16 yrs.) and Young Adults (YAs -17-25yrs.) to answer the statement: “The hardest thing about being burned is…” The most common issues included: People Staring, Getting Unwanted Questions, Being Bullied, Remembering When I Was Burned, Having Additional Surgeries and My Scars. The current study asked participants to rate items on a 4-point scale from (1) Not at all to (4) Really a lot. The YAs were asked to consider issues they encountered maturing with burns. Results Child Survivors (CBS, n=147) mean age 13.4 years, male (n=46%) female (n=54%), and YA Survivors (YA, n = 81) male(n=39%) female (n=61%) mean age =19.1 yrs., and were predominately racial/ethnic minorities (CBS=67%; YA = 58%). No differences existed for age burned (CBS=6 yrs. vs. YA = 6.4 yrs.) hidden & visible scars (CBS=55% vs. YA=68%) and TBSA ≥ 50% (CBS=19% vs. YA =20%). Top mean scores for CBS’s included: Remembering the Burn (2.05) & Getting Unwanted Questions (2.0). The YA group’s top mean scores included Being Bullied (2.10) & People Staring (2.0). The CBS group reported that Getting Unwanted Questions was more problematic than the YA Group (p =003). YAs shared that Being Bullied was their biggest problem vs. CVS, significantly more so (p=.01). Conclusions Bullying appears to be less of a problem for current child burn survivors than those previously burned. The difference may be due to a recent emphasis placed on anti-bullying in US schools. Findings highlight an ongoing need to address the psycho/social issues related to burns. Teaching interventions like the Phoenix Society’s Rehearse Your Response can help youth address unwanted questions and staring. Providing children an opportunity to process the injury event may also improve their ability to cope with burn stressors. Applicability of Research to Practice This research has clinical implications as issues shared by participants can be addressed by burn healthcare providers and therapists. Results endorse the delivery of supportive strategies which complement surgical/medical treatment and should help improve their social interactions/quality of life.

We compared the mollusc assemblages of planted mono-specific Rhizophora mangroves of known different ages. As forest age increased, there was a shift in species composition, abundance and biomass of mollusc assemblages for all faunal types (infauna, epifauna and arboreal fauna). This shift was correlated with the changes in vegetation (increasing forest cover and above-ground biomass) and sediment characteristics (increasing organic matter and decreasing sand content). Some species dominate in young plantations ( 15 years; Terebralia sulcata, Nerita planospira). The two former groups of species are mostly species of infaunal and epifaunal habitats, while the latter group is mainly composed of arboreal species. The shift in mollusc species composition and dominance may serve as a useful indicator of restoration patterns in planted mangroves.

HIV disproportionately affects persons in Southeast United States. Primary care providers (PCPs) are vital for HIV prevention. Data are limited about their prescribing of antiretrovirals (ARVs) for prevention, including non-occupational post-exposure prophylaxis (nPEP), pre-exposure prophylaxis (PrEP), and antiretroviral therapy (ART). We examined these practices to assess gaps. During April–August 2017, we conducted an online survey of PCPs in Atlanta, Baltimore, Baton Rouge, Miami, New Orleans, and Washington, DC to assess HIV-related knowledge, attitudes and practices. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were used to estimate correlates of nPEP, PrEP and ART prescribing practices. Adjusting for MSA and specialty, the weighted sample (n = 820, 29.6% adjusted response rate) comprised 60.2% white and 59.4% females. PCPs reported ever prescribing nPEP (31.0%), PrEP (18.1%), and ART (27.2%). Prescribing nPEP was associated with nPEP familiarity (aPR = 2.63, 95% CI 1.59, 4.35) and prescribing PrEP (aPR = 3.57, 95% CI 2.78, 4.55). Prescribing PrEP was associated with PrEP familiarity (aPR = 4.35, 95% CI 2.63, 7.14), prescribing nPEP (aPR = 5.00, 95% CI 2.00, 12.50), and providing care for persons with HIV (aPR = 1.56, 95% CI 1.06, 2.27). Prescribing ART was associated with nPEP familiarity (aPR = 1.89, 95% CI 1.27, 2.78) and practicing in outpatient public practice versus hospital-based facilities (aPR = 2.14 95% CI 1.51, 3.04), and inversely associated with collaborations involving specialists (aPR = 0.60, 95% CI 0.42, 0.86). A minority of PCPs surveyed from the Southeast report ever prescribing ARVs for prevention. Future efforts should include enhancing HIV care coordination and developing strategies to increase use of biomedical tools.

The monoheme outer membrane cytochrome F (OmcF) from Geobacter sulfurreducens plays an important role in Fe(III) reduction and electric current production. The electrochemical characterization of this cytochrome has shown that its redox potential is modulated by the solution pH (redox-Bohr effect) endowing the protein with the necessary properties to couple electron and proton transfer in the physiological range. The analysis of the OmcF structures in the reduced and oxidized states showed that with the exception of the side chain of histidine 47 (His47), all other residues with protonatable side chains are distant from the heme iron and, therefore, are unlikely to affect the redox potential of the protein. The protonatable site at the imidazole ring of His47 is in the close proximity to the heme and, therefore, this residue was suggested as the redox-Bohr center. In the present work, we tested this hypothesis by replacing the His47 with non-protonatable residues (isoleucine – OmcFH47I and phenylalanine – OmcFH47F). The structure of the mutant OmcFH47I was determined by X-ray crystallography to 1.13 Å resolution and showed only minimal changes at the site of the mutation. Both mutants were 15N-labeled and their overall folding was confirmed to be the same as the wild-type by NMR spectroscopy. The pH dependence of the redox potential of the mutants was measured by cyclic voltammetry. Compared to the wild-type protein, the magnitude of the redox-Bohr effect in the mutants was smaller, but not fully abolished, confirming the role of His47 on the pH modulation of OmcF’s redox potential. However, the pH effect on the heme substituents’ NMR chemical shifts suggested that the heme propionate P13 also contributes to the overall redox-Bohr effect in OmcF. In physiological terms, the contribution of two independent acid–base centers to the observed redox-Bohr effect confers OmcF a higher versatility to environmental changes by coupling electron/proton transfer within a wider pH range.

A high-affinity anti-cocaine monoclonal antibody, designated h2E2, is entering phase 1 clinical trials for cocaine abuse therapy. To gain insight into the molecular details of its structure that are important for binding cocaine and cocaine metabolites, the Fab fragment was generated and crystallized with and without ligand. Structures of the unliganded Fab and the Fab fragment bound to benzoylecgonine were determined, and were compared with each other and with other crystallized anti-cocaine antibodies. The affinity of the h2E2 antibody for cocaine is 4 nM, while that of the cocaine metabolite benzoylecgonine is 20 nM. Both are higher than the reported affinity for cocaine of the two previously crystallized anti-cocaine antibodies. Consistent with cocaine fluorescent quenching binding studies for the h2E2 mAb, four aromatic residues in the CDR regions of the Fab (TyrL32, TyrL96, TrpL91 and TrpH33) were found to be involved in ligand binding. The aromatic side chains surround and trap the tropane moiety of the ligand in the complex structure, forming significant van der Waals interactions which may account for the higher affinity observed for the h2E2 antibody. A water molecule mediates hydrogen bonding between the antibody and the carbonyl group of the benzoyl ester. The affinity of binding to h2E2 of benzoylecgonine differs only by a factor of five compared with that of cocaine; therefore, it is suggested that h2E2 would bind cocaine in the same way as observed in the Fab–benzoylecgonine complex, with minor rearrangements of some hypervariable segments of the antibody.

Allopatric speciation requiring an unbroken period of geographical isolation has been the standard model of neo-Darwinism. While doubts have been repeatedly raised, strict allopatry without any gene flow remains a plausible mechanism in most cases. To rigorously reject strict allopatry, genomic sequences superimposed on the geological records of a well-delineated geographical barrier will be necessary. The Strait of Malacca, narrowly connecting the Pacific and Indian Ocean coasts, serves at different times either as a geographical barrier or a conduit of gene flow for coastal/marine species. We surveyed 1,700 plants from 29 populations of five common mangrove species by large scale DNA sequencing and added several whole-genome assemblies. Speciation between the two oceans is driven by cycles of isolation and gene flow due to the fluctuations in sea level leading to the opening/closing of the Strait to ocean currents. Because the time required for speciation in mangroves is longer than the isolation phases, speciation in these mangroves has proceeded through many cycles of mixing-isolation-mixing, or MIM cycles. The MIM mechanism, by relaxing the condition of no gene flow, can promote speciation in many more geographical features than strict allopatry can. Finally, the MIM mechanism of speciation is also efficient, potentially yielding mn (m>1) species after n cycles.Significance statementMechanisms of species formation have always been a conundrum. Speciation between populations that are fully geographically isolated, or allopatric speciation, has been the standard solution in the last 50 years. Complete geographical isolation with no possibility of gene flow, however, is often untenable and is inefficient in generating the enormous biodiversity. By studying mangroves on the Indo-Malayan coasts, a global hotspot of coastal biodiversity, we were able to combine genomic data with geographical records on the Indo-Pacific barrier that separates Pacific and Indian Ocean coasts. We discovered a novel mechanism of speciation, that we call mixing-isolation-mixing (MIM) cycles. By permitting intermittent gene flow during speciation, MIM can potentially generate species at an exponential rate, thus combining speciation and biodiversity in a unified framework.

Background: Our previous study demonstrated that lower level of education was associated with increased rates of postoperative hospital visits following bariatric surgery, potentially seco...

In the conventional view, species are separate gene pools delineated by reproductive isolation (RI). However, species may also be delineated by merely a small set of “speciation genes” without full RI. It is thus important to know whether “good species” (defined by the “secondary sympatry” test) do continue to exchange genes. Here, we carry out sequencing andde novohigh-quality assembly of the genomes of two closely related mangrove species (Rhizophora mucronataandR. stylosa). Whole-genome re-sequencing of individuals across their range on the tropical coasts shows their genomes to be well delineated in allopatry. They became sympatric in northeastern Australia but remain distinct species in contact. Nevertheless, their genomes harbor ∼ 4,000 to 10,000 introgression blocks, each averaging only about 3-4 Kb. These fine-grained introgressions indicate that gene flow has continued long after speciation. Non-introgressable “genomic islets,” averaging only 1.4 Kb, may contribute to speciation as they often harbor diverging genes underlying flower development and gamete production. In conclusion, RI needs not be the main criterion of species delineation even though all species would eventually be fully reproductively isolated.

Cutaneous immune-related adverse events (irAEs) are a known consequence of immune checkpoint inhibitor (ICI) therapy and may exhibit a spectrum of morphologic features both clinically and histologically. Lichenoid dermatitis associated with ICI therapy (LD-ICI) is the most frequently encountered histopathologic type of irAE biopsied by dermatologists. There is frequent clinical and histologic overlap between irAEs and several reactive and neoplastic dermatologic disorders; thus, clinical information is essential. LD-ICI with histologic, immunohistochemical, and molecular features typical of mycosis fungoides (MF) are unique. Here, we report a patient who developed LD-ICI with MF-like morphologic features with monoclonal T-cell receptor gene rearrangement on consecutive biopsies during ICI therapy. The development of monoclonal LD-ICI is important for clinicians and pathologists to recognize in patients receiving ICI therapy.

The triheme cytochrome PpcA from Geobacter sulfurreducens is highly abundant under several growth conditions and is important for extracellular electron transfer. PpcA plays a central role in transferring electrons resulting from the cytoplasmic oxidation of carbon compounds to the cell exterior. This cytochrome is designed to couple electron and proton transfer at physiological pH, a process achieved via the selection of dominant microstates during the redox cycle of the protein, which are ultimately regulated by a well-established order of oxidation of the heme groups. The three hemes are covered only by a polypeptide chain of 71 residues and are located in the small hydrophobic core of the protein. In this work, we used NMR and X-ray crystallography to investigate the structural and functional role of a conserved valine residue (V13) located within van der Waals contact of hemes III and IV. The residue was replaced by alanine (V13A), isoleucine (V13I), serine (V13S), and threonine (V13T) to probe the effects of the side chain volume and polarity. All mutants were found to be as equally thermally stable as the native protein. The V13A and V13T mutants produced crystals and their structures were determined. The side chain of the threonine residue introduced in V13T showed two conformations, but otherwise the two structures did not show significant changes from the native structure. Analysis of the redox behavior of the four mutants showed that for the hydrophobic replacements (V13A and V13I) the redox properties, and hence the order of oxidation of the hemes, were unaffected in spite of the larger side chain, isoleucine, showing two conformations with minor changes of the protein in the heme core. On the other hand, the polar replacements (V13S and V13T) showed the presence of two more distinctive conformations, and the oxidation order of the hemes was altered. Overall, it is striking that a single residue with proper size and polarity, V13, was naturally selected to ensure a unique conformation of the protein and the order of oxidation of the hemes, endowing the cytochrome PpcA with the optimal functional properties necessary to ensure effectiveness in the extracellular electron transfer respiratory pathways of G. sulfurreducens.

This chapter provides a case study highlighting the importance of ICT use in researcher development, exploring both training pedagogy and ICT skill development, utilizing the authors' experience of managing and delivering ICT-based researcher development across a wide range of disciplines for researchers, including part-time and distance researchers who conduct their research away from campus. Participant feedback and examples of best practice will be highlighted alongside potential challenges to encourage readers to confidently utilize a wide variety of ICT in order to create innovative researcher development material to best support the next generation of researchers.

ObjectiveTo assess the return on investment (ROI) of the Florida tobacco control programme, the Bureau of Tobacco Free Florida (BTFF), in terms of healthcare expenditure savings and mortality cost saved as a result of reduced mortality due to the programme from 1999 to 2015.MethodsWe use a synthetic control method to estimate the impact of the BTFF on smoking-attributable mortality, years of life lost (YLL), healthcare expenditures, and the economic value of premature mortality due to smoking in Florida from 1999 through 2015. We calculated an ROI for healthcare expenditures and for the value of life years saved.ResultsFrom 1999 to 2015, adult smoking prevalence in Florida averaged 0.98 percentage points lower than prevalence in the synthetic control states (19.6% vs 20.6%). The ROI over the period from 1999 to 2015 was 9.61 for healthcare expenditures and 112.44 for premature mortality. These ROIs suggest that for every US$1 of expenditure by BTFF, smoking-attributable healthcare expenditures decreased by almost US$11 and reductions in the economic costs associated with YLL due to smoking-attributable mortality totaled approximately US$113.ConclusionsOur results suggest the BTFF resulted in fewer YLL, substantial healthcare cost savings and substantial savings in terms of mortality costs. The positive ROIs for healthcare expenditures and premature mortality suggest that the BTFF is a good investment of public funds.

The conservation of mangrove forests has become an important international policy priority in recent decades, and is mirrored by a large increase in research interest. Multiple disciplines now use mangroves as a study system, from molecular biology to social science. The variety of research conducted in mangroves is exemplified by the Mangrove Macrobenthos & Management (MMM) conference series, the world's largest gathering of researchers and practitioners dedicated to the science and conservation of the mangrove ecosystem. Established in 2000, MMM is a useful barometer with which to identify and measure research trends over the last 20 years. This study describes the history of the MMM conference series, and analyses the research presented in this series as a potential proxy of how the broader mangrove research field has changed through time. Presentations in early MMM conferences were dominated by macrobenthos studies, reflective of the origins of MMM as a forum specifically for mangrove macrobenthos research. However, later conferences have come to reflect the broader interests of the mangrove research field, and have tracked the emergence of blue carbon and other ecosystem services. Mangrove forests continue to be a rich and diverse ecosystem of study, and future MMM conferences will continue to provide a platform for impactful research and management., SCOPUS: cp.j, info:eu-repo/semantics/published

Around the world, the effects of changing plant phenology are evident in many ways: from earlier and longer growing seasons to altering the relationships between plants and their natural pollinators. Plant phenology is often monitored using satellite images and parametric methods. Parametric methods assume that ecosystems have unimodal phenologies and that the phenology model is invariant through space and time. In evergreen ecosystems such as mangrove forests, these assumptions may not hold true. Here we present a novel, data-driven approach to extract plant phenology from Landsat imagery using Generalized Additive Models (GAMs). Using GAMs, we created models for six different mangrove forests across Australia. In contrast to parametric methods, GAMs let the data define the shape of the phenological curve, hence showing the unique characteristics of each study site. We found that the Enhanced Vegetation Index (EVI) model is related to leaf production rate (from in situ data), leaf gain and net leaf production (from the published literature). We also found that EVI does not respond immediately to leaf gain in most cases, but has a two- to three-month lag. We also identified the start of season and peak growing season dates at our field site. The former occurs between September and October and the latter May and July. The GAMs allowed us to identify dual phenology events in our study sites, indicated by two instances of high EVI and two instances of low EVI values throughout the year. We contribute to a better understanding of mangrove phenology by presenting a data-driven method that allows us to link physical changes of mangrove forests with satellite imagery. In the future, we will use GAMs to (1) relate phenology to environmental variables (e.g., temperature and rainfall) and (2) predict phenological changes.

True human tails are rare vestigial structures that are typically removed in childhood. Here a case is presented in which an inconspicuous sacrococcygeal tail was incidentally discovered in late adulthood. A 56-year-old man with no significant past medical history presented to a dermatology clinic with a chief complaint of a hyperpigmented lesion on his central back. However, on full body skin exam, a separate flesh-colored 0.7 cm × 0.5 cm appendage was discovered in the midline sacrococcygeal region. This lesion had been present and unchanged since childhood. This particular lesion was removed via shave biopsy. Microscopic exam found it to be consistent with a diagnosis of a true human tail. There were no apparent involved spinal cord structures, and no further treatment was thought to be necessary. Human tails are congenital anomalies associated with occult spinal lesions in about 50% of cases. Therefore, it is in these patients' best interest to thoroughly evaluate for spinal cord involvement prior to biopsy. There is a relative lack of literature published on the topic, and a greater awareness of human tails would be helpful to ensure their inclusion in a differential diagnosis for persistent sacrococcygeal lesions in patients of any age.

Saline coastal wetlands, such as mangrove and coastal salt marsh, provide many ecosystem services. In Australia, large areas have been lost since European colonization, particularly as a result of drainage, infilling and flood-mitigation works, often starting in the mid-19th century and aimed primarily towards converting land to agricultural, urban or industrial uses. These threats remain ongoing, and will be exacerbated by rapid population growth and climate change in the 21st century. Establishing the effect of wetland loss on the delivery of ecosystem services is confounded by the absence of a nationally consistent approach to mapping wetlands and defining the boundaries of different types of coastal wetland. In addition, climate change and its projected effect on mangrove and salt marsh distribution and ecosystem services is poorly, if at all, acknowledged in existing legislation and policy. Intensifying climate change means that there is little time to be complacent; indeed, there is an urgent need for proper valuation of ecosystem services and explicit recognition of ecosystem services within policy and legislation. Seven actions are identified that could improve protection of coastal wetlands and the ecosystem services they provide, including benchmarking and improving coastal wetland extent and health, reducing complexity and inconsistency in governance arrangements, and facilitating wetland adaptation and ecosystem service delivery using a range of relevant mechanisms. Actions that build upon the momentum to mitigate climate change by sequestering carbon – ‘blue carbon’ – could achieve multiple desirable objectives, including climate-change mitigation and adaptation, floodplain rehabilitation and habitat protection.

A series of Eu 2+ -substituted yellow-green emitting phosphors based on the compound, Sr 6 M 2 Al 4 O 15 ( M = Y, Lu, Sc) were identified as potential efficient phosphors based on their high calculated Debye temperatures (Θ D > 450 K), which acts as a proxy for photoluminescent quantum yield (PLQY). The crystal structure contains corner-sharing [ M O 6 ] octahedra and [AlO 4 ] tetrahedra leading to a highly connected, densely packed crystal structure. However, contrary to prediction, these compounds all showed a low PLQY ( T 50 ) occurring well below room temperature. These results suggest that even though Debye temperature (Θ D ) is a valid proxy for PLQY, it does not describe thermal quenching.

Climate change with human direct pressures represent significant threats to the resilience of shoreline habitats like mangroves. A rapid, whole-of-system assessment strategy is needed to evaluate such threats, better linking innovative remote sensing with essential on-ground evaluations. Using the Shoreline Video Assessment Method, we surveyed around 190 km of the mostly mangrove-fringed (78%) coastline of Kien Giang Province, Vietnam. The aim was to identify anthropogenic drivers of degradation, establishing baseline for specific rehabilitation and protection strategies. Fish traps occupy at least 87% of shoreline mangroves, around which there were abundant human activities – like fishing, crabbing, farming, plus collecting firewood and foliage. Such livelihoods were associated with remnant, fringing mangrove that were largely degraded and threatened by erosion retreat, herbivory, and excessive cutting. Our assessment quantified associated threats to shoreline stability, along with previous rehabilitation intervention measures. The method offers key opportunities for effective conservation and management of vulnerable shoreline habitats.

Objectives: Evidence-based guidelines have long recommended that HIV care providers deliver HIV transmission risk-reduction (RR) services, but recent data are needed to assess their adoption. Methods: The authors surveyed a probability sample of 1234 US HIV care providers on delivery of 9 sexual behavior– and 7 substance use–related HIV transmission RR services and created an indicator of “adequate” delivery of services in each area, defined as performing approximately 70% or more of applicable services. Results: Providers were most likely to encourage patients to disclose HIV status to all partners since HIV diagnosis (81%) and least likely to ask about disclosure to new sex and drug injection partners at follow-up visits (both 41%). Adequate delivery of sexual behavior– and substance use–related RR services was low (37% and 43%, respectively). Conclusion: The majority of US HIV care providers may need additional support to improve delivery of comprehensive HIV transmission RR services.

This study examines the relationship between self-reports of being high on marijuana and perceptions about driving high or drunk. Data were collected in 2014 from an online convenience sample of adult, past 30-day marijuana and hashish users in Colorado and Washington (n = 865). Respondents were asked, "Were you high or feeling the effects of marijuana or hashish when you took this survey?" Logistic regression was used to assess the relationship between being high and beliefs about driving high, controlling for demographics and marijuana use. Respondents who reported being high at the time of survey administration had higher odds of agreeing with the statements, "I can safely drive under the influence of marijuana" (OR = 3.13, P < 0.001) and "I can safely drive under the influence of alcohol" (OR = 3.71, P < 0.001) compared with respondents who did not report being high. Respondents who were high also had higher odds of being open to driving high under certain circumstances. Being high may influence perceptions about the safety of drugged and drunk driving. The effectiveness of public health messages to prevent drugged and drunk driving may depend in part on how persuasive they are among individuals who are high.

Aim: Population genomics data were used to determine the genetic diversity, genetic divergence and genetic structure of the mangrove, Rhizophora apiculata, across its distributional range and to re-assess the evolutionary processes that shaped its current distribution. Location: The Indo-Malesian region section of the Indo-West Pacific region. Methods: Next-generation sequencing technology was used to sequence 81 nuclear loci from a pooled DNA sample of 31–44 individuals of Rhizophora apiculata from 11 populations. Five nuclear loci from six to eight individuals from 18 populations were sequenced using conventional Sanger sequencing technology to validate the results. Results: Genetic diversity at the population level was low (π and θ were < 1.0 × 10−3 in most of the populations), but relatively high at the species level (π = 2.419 × 10−3 and θ = 1.362 × 10−3). The populations of R. apiculata in the Indo-Malesian region were genetically differentiated and grouped into three clusters: east Indian Ocean (EIO), South China Sea (SCS) and Australasia (AUA). Based on the genetic distance matrices, two genetic discontinuities were observed, and they correspond to the Malay Peninsula land barrier and the Wallacea zone. The admixture observed in populations from the Malacca Strait was attributed to asymmetric gene flow through the strait, which was simulated by the isolation-with-migration (IM) model. Main conclusion: Both the Sunda shelf barrier and ocean currents in Wallacea contributed to the observed genetic discontinuity, which separated R. apiculata into three clusters (SCS, EIO and AUA). The cycle between extinction and recolonization in the SCS in response to Pleistocene sea level fluctuations reduced the genetic diversity within populations. The repeated opening and closing of the gene flow corridors, such as the Malacca Strait, may have blurred the genetic discontinuities to an extent and introduced an admixture into populations in boundary areas.

INTRODUCTION Studies suggest that exposure to televised electronic cigarette (e-cigarette) advertising contributes to the recent increase in e-cigarette use among youth. This study examines the relationship between perceptions of e-cigarette advertisements and attitudes toward and intentions to use e-cigarettes among youth who had never used e-cigarettes. METHODS In May 2014, we conducted an online survey of 5020 youth aged 13 to 17. Participants were randomly assigned to answer questions about their attitudes toward and intentions to use e-cigarettes before or after viewing e-cigarette advertisements. Perceived effectiveness (PE) of advertisements was measured after ad exposure. Ordinary least squares models were used to assess the relationship between PE and study outcomes. RESULTS Among never e-cigarette users, greater PE was associated with more positive attitudes toward e-cigarettes (b = 0.74, P < .001) and intentions to use e-cigarettes (b = 0.16, P < .001). Findings suggest that PE is predictive of outcomes controlling for study condition, youth demographics, and media use variables. CONCLUSIONS After ad exposure, youth who have never used e-cigarettes previously perceive e-cigarettes as cooler, more fun, healthier, and more enjoyable. Youth who thought the ads were more effective were more likely to have a positive attitude toward e-cigarettes and greater intention to try e-cigarettes in the future. Restricting televised e-cigarette advertising may reduce e-cigarette initiation among youth. IMPLICATIONS Previous studies demonstrate that, among adults, PE is antecedent to actual ad effectiveness across a range of behaviors. To our knowledge, this is the first study to document the relationship between PE and advertising effectiveness among youth. It provides evidence that PE may be a useful tool to quantify the potential influence of advertising on youth-advertising that, in this case, is designed to market a consumer good that may be harmful to youth but that may also be used to develop public health campaigns.

Importance Bariatric surgery can lead to substantial improvements in type 2 diabetes (T2DM), but outcomes vary across procedures and populations. It is unclear which bariatric procedure has the most benefits for patients with T2DM. Objective To evaluate associations of bariatric surgery with T2DM outcomes. Design, Setting, and Participants This cohort study was conducted in 34 US health system sites in the National Patient-Centered Clinical Research Network Bariatric Study. Adult patients with T2DM who had bariatric surgery between January 1, 2005, and September 30, 2015, were included. Data analysis was conducted from April 2017 to August 2019. Interventions Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Main Outcome and Measures Type 2 diabetes remission, T2DM relapse, percentage of total weight lost, and change in glycosylated hemoglobin (hemoglobin A1c). Results A total of 9710 patients were included (median [interquartile range] follow-up time, 2.7 [2.9] years; 7051 female patients [72.6%]; mean [SD] age, 49.8 [10.5] years; mean [SD] BMI, 49.0 [8.4]; 6040 white patients [72.2%]). Weight loss was significantly greater with RYGB than SG at 1 year (mean difference, 6.3 [95% CI, 5.8-6.7] percentage points) and 5 years (mean difference, 8.1 [95% CI, 6.6-9.6] percentage points). The T2DM remission rate was approximately 10% higher in patients who had RYGB (hazard ratio, 1.10 [95% CI, 1.04-1.16]) than those who had SG. Estimated adjusted cumulative T2DM remission rates for patients who had RYGB and SG were 59.2% (95% CI, 57.7%-60.7%) and 55.9% (95% CI, 53.9%-57.9%), respectively, at 1 year and 86.1% (95% CI, 84.7%-87.3%) and 83.5% (95% CI, 81.6%-85.1%) at 5 years postsurgery. Among 6141 patients who experienced T2DM remission, the subsequent T2DM relapse rate was lower for those who had RYGB than those who had SG (hazard ratio, 0.75 [95% CI, 0.67-0.84]). Estimated relapse rates for those who had RYGB and SG were 8.4% (95% CI, 7.4%-9.3%) and 11.0% (95% CI, 9.6%-12.4%) at 1 year and 33.1% (95% CI, 29.6%-36.5%) and 41.6% (95% CI, 36.8%-46.1%) at 5 years after surgery. At 5 years, compared with baseline, hemoglobin A1cwas reduced 0.45 (95% CI, 0.27-0.63) percentage points more for patients who had RYGB vs patients who had SG. Conclusions and Relevance In this large multicenter study, patients who had RYGB had greater weight loss, a slightly higher T2DM remission rate, less T2DM relapse, and better long-term glycemic control compared with those who had SG. These findings can help inform patient-centered surgical decision-making.

In the quest to predict photoluminescent efficiency in rare-earth substituted inorganic phosphors, research has shown that materials consisting of ordered, rigid crystal structures tend to possess the highest photoluminescent quantum yields. A compound's Debye temperature (ΘD), which can be calculated using ab initio calculations, is an ideal proxy for quantitatively comparing structural rigidity among different inorganic compounds, allowing potentially efficient phosphors to be selected from large crystal structure databases. However, the high computational cost of these calculations limits estimating ΘD for unsubstituted host crystal structures only. It is assumed that the low substitution concentration of the rare-earth luminescent center does not significantly influence a material's Debye temperature. This work evaluates the validity of this approximation by examining the effect of luminescent center substitution on a host structure's ΘD. Two well-known phosphors, (Y1–xCex)3Al5O12 (x = 0 − 0.05) and Ba1-δEuδMgAl10O17 (δ = 0 − 0.15), were synthesized with varying rare-earth concentrations, while ΘD was computationally estimated and then determined by ultrasonic pulse-echo speed-of-sound and low-temperature heat capacity measurements. The ensuing results provide key implications for using ΘD as a proxy for structural rigidity in substituted inorganic compounds.

The Diabetes Prevention Program (DPP) is a 12-month behavior change program designed to increase physical activity and improve dietary patterns among patients at risk for Type 2 diabetes, in order to facilitate modest weight loss and improve cardio-metabolic profiles. It is unknown whether baseline patient activation is related to increased DPP uptake, and whether DPP attendance leads to subsequent improvement in patient activation. We analyzed data from 352 adult participants in the Prediabetes Informed Decisions and Education (PRIDE) trial of shared decision-making (SDM) in diabetes prevention, collected from November 2015 through September 2017. PRIDE participants completed baseline and 4-month follow-up surveys, including the Altarum Consumer Engagement (ACE) Measure™ of patient activation. We tracked DPP attendance over 8 months using data from partnering DPP providers. In multivariate models, we measured whether self-reported baseline activation was associated with DPP "uptake" (1+ session attended) or DPP "attendance" (9+ sessions). We also examined whether DPP attendance was associated with change in activation at 4-months follow-up. We did not find an association between baseline activation and DPP uptake or attendance. However, we did find that DPP attendance was associated with an increase in the overall ACE score (6.68 points, 95% CI 1.97-11.39, p = 0.005) and increased activation in 2 of the 3 ACE subscales (Commitment and Informed Choice). Our finding of increased patient activation with DPP attendance suggests a mechanism for the improved health outcomes seen in DPP real-world translational studies. This work has important implications for diabetes prevention and other behavior change programs.

In 2016, the U.S. Congress mandated that federal intelligence interrogators adhere to the methods of the U.S. Army Field Manual FM 2-22.3 (AFM) and that the manual be revised based upon empirically based evaluations of the interrogation methods' effectiveness with interviewees motivated to withhold information. In the present study, 120 participants took part in a testing situation in which half were induced to cheat. All participants were then accused of cheating and interrogated with either (a) a combination of AFM interrogation approaches that focused on the potential benefits of cooperation with the interviewer (cooperation-focused condition), or (b) a combination of AFM approaches that focused on the potential risks of withholding information (withholding-focused condition). Participants who cheated on the test were significantly more likely to admit their wrongdoing and to provide additional relevant information when interrogated with the withholding-focused approaches than when questioned with the cooperation-focused approaches. The "we know all" AFM approach was especially effective for eliciting truthful admission-related details. Participants reported high rapport with the interrogator in both the cooperation-focused and withholding-focused conditions. These findings indicate that the we-know-all approach can be effective for maintaining rapport and eliciting accurate information in brief interrogations. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Objectives: Insulin access with intent to overdose coupled with limited forethought and higher impulsivity during childhood and adolescence, makes identification of suicidal ideation (SI) among youth with type 1 diabetes (T1D) of high importance. Correlations between SI and poor diabetes self-management have been identified, with 13% of adolescents with T1D endorsing SI in the last 12 months. The present study aimed to determine feasibility and effectiveness of screening for SI in youth with T1D. Methods: Data were obtained during routine behavioral health screening of youth (ages 11-18) with T1D at a regional diabetes center. SI data were derived from question 9 of the Patient Health Questionnaire-9 (PHQ-9), “Thoughts that you would be better off dead or of hurting yourself in some way.” Results: PHQ-9 was completed by a total of 587 pediatric patients (Males =289; Females =298) with a mean HbA1c of 9.1% (SD= 2.2). Findings suggest a significant relationship between gender and endorsement of SI with more females endorsing SI (n=52) than males (n = 26). SI was significantly and positively associated with HbA1c. Of the 13% of youth who screened positive for SI, 3/4 indicated SI for several days in the last 7 days and received an on-site behavioral health consultation. Approximately, 1/5 indicated SI for more than 1/2 of the days in the last week and received an onsite referral and a telephone follow-up, and 5% indicated SI nearly every day in the last week and received an on-site clinical assessment with one youth requiring emergency services. Conclusions: SI screening in youth with T1D is necessary to address this concern. Results suggest our protocol was effective in identifying SI, allowed for rapid clinical assessment, and referral for additional care. In addition, SI rates in youth with T1D were consistent with the general population, suggesting that diabetes does not put youth at higher risk for SI, but imposes greater concern for suicide given the immediate availability of insulin. Disclosure H. Nagra: None. D.C. Duke: None. M. Jones: None. K. Kraus: None. M.A. Harris: Consultant; Self; Eli Lilly and Company.

Objectives: The ADA has recommended routine behavioral health screening of youth with T1D given the associations among psychological factors (e.g., depression and anxiety), the skills necessary to manage diabetes (executive functioning), and adherence and health outcomes. Anecdotally, concerns of healthcare providers and staff have included stigma, inconvenience, time, and/or unacceptable burden. However, family acceptance of behavioral health screening has not been systematically assessed. Methods: After administering a screening protocol for youth with T1D, we administered a brief patient satisfaction questionnaire. The screening protocol included the PHQ-9, GAD-7, DREFS-SF, and the DSMP-SF. During this pilot, 57 youth (11-18 years), and 84 parents completed the screenings. Youth and parents completed the brief quality improvement survey after completing the behavioral health screening. Youth and parents responded to questions using a five-point scale from “strongly agree” to “strongly disagree.” Results:QuestionsParentChild1.Completing questionnaires was an inconvenience4.8%1.8%2.The Information from questionnaires is important for diabetes care providers98.8%94.6%3.Completing the questionnaire was a burden to me or my family6.1%7.1%4.The questionnaires were too long2.4%1.8%5.The questionnaire about how well diabetes has been managed was helpful98.8%96.4% Conclusions: Concerns regarding family satisfaction with behavioral health screening of youth with T1D were unfounded. Behavioral health screening was very acceptable to the vast majority of youth and parents with no indication that there was stigma associated with behavioral health issues. Disclosure D.C. Duke: None. H. Nagra: None. M. Jones: None. M. Bolen: None. M.A. Harris: Consultant; Self; Eli Lilly and Company.

This study provides estimates of the long-term cumulative impact of the Centers for Disease Control and Prevention's national tobacco education campaign, Tips From Former Smokers (Tips), on population-level smoking cessation. We used recently published estimates of the association between increased Tips campaign media doses and quit attempts to calculate campaign-attributable population sustained (6-month) quits during 2012-2015. Tips led to approximately 522,000 sustained quits during 2012-2015. These findings indicate that the Tips campaign's comprehensive approach to combining evidence-based messages with the promotion of cessation resources was successful in achieving substantial long-term cigarette cessation at the population level over multiple years.