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BackgroundPatients receiving peritoneal dialysis (PD) endure an ongoing regimen of daily fluid exchanges and are at risk of potentially life-threatening complications and debilitating symptoms that can limit their ability to participate in life activities. The aim of the study was to identify the characteristics, content and psychometric properties of measures for life participation used in research in PD.MethodsWe searched MEDLINE, Embase, PsychInfo, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane Central Register of Controlled Trials from inception to May 2020 for all studies that reported life participation in patients on PD. The characteristics, dimensions of life participation and psychometric properties of these measures were extracted and analyzed.ResultsOf the 301 studies included, 17 (6%) were randomized studies and 284 (94%) were nonrandomized studies. Forty-two different measures were used to assess life participation. Of these, 23 (55%) were used in only one study. Fifteen (36%) measures were specifically designed to assess life participation, while 27 (64%) measures assessed broader constructs, such as quality of life, but included questions on life participation. The 36-Item Short Form Health Survey and Kidney Disease Quality of Life Short Form were the most frequently used measures [122 (41%) and 86 (29%) studies, respectively]. Eight (19%) measures had validation data to support their use in patients on PD.ConclusionsThe many measures currently used to assess life participation in patients receiving PD vary in their characteristics, content and validation. Further work to pilot and validate potential measures is required to establish a core patient-reported outcome measure to assess life participation in patients receiving PD.

In this article the authors overview how the recently revised (version 9) Australian Curriculum (Australian Curriculum Assessment and Reporting Authority, 2022) and student difficulties with fractions relate to five developmental Fraction Schemes developed from multiple research projects in the literature. The article shares research findings from a recent survey of teachers from Victoria, Australia on their preferences when solving Fraction Scheme tasks themselves and for teaching fraction big ideas. Three implications of the research for teachers' practice are discussed using nine illustrative fraction learning tasks. Each task targets conceptual development of fraction big ideas and can be differentiated for students' learning across primary and early secondary curriculum levels. The tasks are different from typical fraction tasks in that students solve the same task with both area and linear manipulatives (not static drawings) and compare what they see in each visual representation. These comparative reasoning experiences encourage student sense-making with fractions--crucial to students becoming both numerate in life and well-prepared for higher-level mathematics learning.

Effective student feedback is a central issue in higher education and has been closely aligned to satisfaction and overall experience. Technology-enabled models of feedback may have the capacity to overcome some of the limitations that previously made high quality feedback on formative tasks challenging or impractical. This study adopted live synchronised video feedback incorporating digital video recordings of student performance in assessment activities with real-time, synthesised, synchronous tutor audio feedback. Almost 300 unique incidences of technology-enabled feedback on formative assessment were provided during an undergraduate Physical Education and Sports Coaching module. Thematic analysis of group interviews revealed the availability of engaging feedback, the positive impact of technology, and the facilitation of reflective practice as overarching themes. Employment of this feedback strategy enabled the realisation of high quality, frequent, effective, sustainable feedback that positively impacted on students' experiences of formative assessments leading to their perceived development as learners and reflective practitioners.

Basement membranes (BMs) are thin layers of extracellular matrix that separate epithelia, endothelia, muscle cells, and nerve cells from adjacent interstitial connective tissue. BMs are ubiquitous in almost all multicellular animals, and their composition is highly conserved across the Metazoa. There is increasing interest in the mechanical functioning of BMs, including the involvement of altered BM stiffness in development and pathology, particularly cancer metastasis, which can be facilitated by BM destabilization. Such BM weakening has been assumed to occur primarily through enzymatic degradation by matrix metalloproteinases. However, emerging evidence indicates that non-enzymatic mechanisms may also contribute. In brittlestars (Echinodermata, Ophiuroidea), the tendons linking the musculature to the endoskeleton consist of extensions of muscle cell BMs. During the process of brittlestar autotomy, in which arms are detached for the purpose of self-defense, muscles break away from the endoskeleton as a consequence of the rapid destabilization and rupture of their BM-derived tendons. This contribution provides a broad overview of current knowledge of the structural organization and biomechanics of non-echinoderm BMs, compares this with the equivalent information on brittlestar tendons, and discusses the possible relationship between the weakening phenomena exhibited by BMs and brittlestar tendons, and the potential translational value of the latter as a model system of BM destabilization.

The meta-analysis described in this paper evaluated the relationships between 11 types of leadership practices and 7 organizational, teaming, leader, and employee outcomes. A main focus of analysis was whether the leadership practices were differentially related to the study outcomes. Studies were eligible for inclusion if the correlations between leadership subscale measures (rather than global measures of leadership) and outcomes of interest were reported. The random effects weighted average correlations between the independent and dependent measures were used as the sizes of effects for evaluating the influences of the leadership practices on the outcome measures. One hundred and twelve studies met the inclusion criteria and included 39,433 participants. The studies were conducted in 31 countries in different kinds of programs, organizations, companies, and businesses. Ninety-six percent of the practice-outcome effect sizes were statistically significant where approximately half of the relationships were moderated by organizational types (for-profit, not-for-profit, education, healthcare, government, etc.). Results indicated that the 11 types of leadership practices were differentially related to the study outcomes even in the presence of considerable between study heterogeneity. Implications for leadership development are described.

Purpose: The purpose of this pilot study was to evaluate the potential of an innovative high school neuroscience-based health course for implementation feasibility and impact on student outcomes. Methods: Thirteen teachers from two high schools participated in this quasi-experimental pilot study including 395 students (202 in the intervention classes and 193 in the comparison classes). Students completed pre/post online surveys assessing their knowledge, beliefs, and behaviors. Our analysis strategy for multi-item measures was to estimate the effects of the intervention on latent change scores in structural equation models (SEM). Results: Students in the neuroscience health classes showed a significant increase in neuroscience knowledge as compared to students in the comparison group (difference estimate in proportion correct metric, adjusted for covariates = 0.04; 95% CI [0.01, 0.06]). However, none of the other primary outcomes showed a significant difference between conditions. Teachers in the intervention group were observed implementing the neuroscience and health components more often than the self-regulation and growth mindset components. Students in the neuroscience group were more likely to mention the importance of caring for their brain and its link to health behaviors. Conclusions: Findings demonstrate that information about the link between health behaviors and brain functioning can be successfully integrated into a high school health education course, although effects on student health beliefs and behaviors were not observed. Additional development work should focus on clarifying the theoretical mechanisms of change, integrating the neuroscience content with self-regulation and growth mindset, and providing additional professional development for teachers.

Rationale & Objective: Stigma contributes to ineffective treatment for pain among individuals with kidney failure on dialysis, particularly with buprenorphine pain treatment. To address stigma, we adapted a Design Sprint, an industry-developed structured exercise where an interdisciplinary group works over 5 days to clarify the problem, identify and choose a solution, and build and test a prototype. Study Design: Adapted Design Sprint which clarified the problem to be solved, proposed solutions, and created a blueprint for the selected solution. Settings & Participants: Five individuals with pain and kidney disease receiving dialysis, 5 physicians (nephrology, palliative care, and addiction medicine) and 4 large dialysis organization leaders recruited for specific expertise or experience. Conducted through online platform (Zoom) and virtual white board (Miro board). Analytical Approach: Descriptions of the Design Sprint adaptations and processes. Results: To facilitate patient comfort, a patient-only phase included four 90-minute sessions over 2-weeks, during which patient participants used a mapping process to define the critical problem and sketch out solutions. In a physician-only phase, consisting of two 120-minute sessions, participants accomplished the same tasks. During a combined phase of two 120-minute sessions, patients, physicians, and large dialysis organization representatives vetted and developed solutions from earlier phases, leading to an intervention blueprint. Videoconferencing technology allowed for geographically diverse representation and facilitated participation from patients experiencing medical illness. The electronic whiteboard permitted interactive written contributions and voting on priorities instead of only verbal discussion, which may privilege physician participants. A skilled qualitative researcher facilitated the sessions. Limitations: Challenges included the time commitment of the sessions, absences owing to illness or emergencies, and technical difficulties. Conclusions: An adapted Design Sprint is a novel method of efficiently and rapidly incorporating multiple stakeholders to develop solutions for clinical challenges in kidney disease. Plain Language Summary: Stigma contributes to ineffective treatment for pain among individuals with kidney failure on dialysis, particularly when using buprenorphine, an opioid pain medicine with a lower risk of sedation used to treat addiction. To develop a stigma intervention, we adapted a Design Sprint, an industry-developed structured exercise where an interdisciplinary group works over 5 days to clarify the problem, identify and choose a solution, and build and test a prototype. We conducted 3 sprints with (1) patients alone, (2) physicians alone, and (3) combined patients, physicians, and dialysis organization representatives. This paper describes the adaptations and products of sprints as a method for gathering diverse stakeholder voices to create an intervention blueprint efficiently and rapidly.

BackgroundWhile peritoneal dialysis (PD) can offer patients more independence and flexibility compared with in-center hemodialysis, managing the ongoing and technically demanding regimen can impose a burden on patients and caregivers. Patient empowerment can strengthen capacity for self-management and improve treatment outcomes. We aimed to describe patients' and caregivers' perspectives on the meaning and role of patient empowerment in PD.MethodsAdult patients receiving PD (n = 81) and their caregivers (n = 45), purposively sampled from nine dialysis units in Australia, Hong Kong and the USA, participated in 14 focus groups. Transcripts were thematically analyzed.ResultsWe identified six themes: lacking clarity for self-management (limited understanding of rationale behind necessary restrictions, muddled by conflicting information); PD regimen restricting flexibility and freedom (burden in budgeting time, confined to be close to home); strength with supportive relationships (gaining reassurance with practical assistance, comforted by considerate health professionals, supported by family and friends); defying constraints (reclaiming the day, undeterred by treatment, refusing to be defined by illness); regaining lost vitality (enabling physical functioning, restoring energy for life participation); and personal growth through adjustment (building resilience and enabling positive outlook, accepting the dialysis regimen).ConclusionsUnderstanding the rationale behind lifestyle restrictions, practical assistance and family support in managing PD promoted patient empowerment, whereas being constrained in time and capacity for life participation outside the home undermined it. Education, counseling and strategies to minimize the disruption and burden of PD may enhance satisfaction and outcomes in patients requiring PD.

ObjectiveTo compare complication rates and visual outcomes following phacoemulsification in Pugs versus dogs of other breeds.Animals studiedThirty-two pure-bred Pugs (55 eyes) and 32 dogs of other breeds (56 eyes) undergoing phacoemulsification.ProceduresMulti-institutional retrospective medical record review of perioperative factors, postoperative complications, and visual outcomes. The reference population of dogs of varying breeds included surgical cases following each Pug case at the same institutions. Perioperative risk factors and postoperative complication rates were compared between the two populations.ResultsPigmentary keratitis and diabetes mellitus were the most common preoperative comorbidities, found in 75% (P

Our previous genome-wide association study (GWAS) for sagittal nonsyndromic craniosynostosis (sNCS) provided important insights into the genetics of midline CS. In this study, we performed a GWAS for a second midline NCS, metopic NCS (mNCS), using 215 non-Hispanic white case-parent triads. We identified six variants with genome-wide significance (P ≤ 5 × 10–8): rs781716 (P = 4.71 × 10–9; odds ratio [OR] = 2.44) intronic to SPRY3; rs6127972 (P = 4.41 × 10–8; OR = 2.17) intronic to BMP7; rs62590971 (P = 6.22 × 10–9; OR = 0.34), located ~ 155 kb upstream from TGIF2LX; and rs2522623, rs2573826, and rs2754857, all intronic to PCDH11X (P = 1.76 × 10–8, OR = 0.45; P = 3.31 × 10–8, OR = 0.45; P = 1.09 × 10–8, OR = 0.44, respectively). We performed a replication study of these variants using an independent non-Hispanic white sample of 194 unrelated mNCS cases and 333 unaffected controls; only the association for rs6127972 (P = 0.004, OR = 1.45; meta-analysis P = 1.27 × 10–8, OR = 1.74) was replicated. Our meta-analysis examining single nucleotide polymorphisms common to both our mNCS and sNCS studies showed the strongest association for rs6127972 (P = 1.16 × 10–6). Our imputation analysis identified a linkage disequilibrium block encompassing rs6127972, which contained an enhancer overlapping a CTCF transcription factor binding site (chr20:55,798,821–55,798,917) that was significantly hypomethylated in mesenchymal stem cells derived from fused metopic compared to open sutures from the same probands. This study provides additional insights into genetic factors in midline CS.

Air monitoring networks developed by communities have potential to reduce exposures and affect environmental health policy, yet there have been few performance evaluations of networks of these sensors in the field. We developed a network of over 40 air sensors in Imperial County, CA, which is delivering real-time data to local communities on levels of particulate matter. We report here on the performance of the Network to date by comparing the low-cost sensor readings to regulatory monitors for 4 years of operation (2015-2018) on a network-wide basis. Annual mean levels of PM10 did not differ statistically from regulatory annual means, but did for PM2.5 for two out of the 4 years. R2s from ordinary least square regression results ranged from 0.16 to 0.67 for PM10, and increased each year of operation. Sensor variability was higher among the Network monitors than the regulatory monitors. The Network identified a larger number of pollution episodes and identified under-reporting by the regulatory monitors. The participatory approach of the project resulted in increased engagement from local and state agencies and increased local knowledge about air quality, data interpretation, and health impacts. Community air monitoring networks have the potential to provide real-time reliable data to local populations.

Varnish removal from easel paintings is a restoration procedure that is regularly undertaken by cultural heritage conservators. In very few cases, traditional methods (chemical and mechanical) do not allow them to reach the goal of a perfectly controlled and selective cleaning. UV laser ablation has been considered since the 1990s to overcome these limitations, but its application to real cases is far from common practice. This study proposes a calibrated procedure based on ablation by an ns UV Nd:YAG laser at 266 nm combined with optical coherence tomography for micrometric laser varnish removal from inhomogeneous and highly photosensitive pictorial layers. The use of this wavelength for varnish removal, not adapted according to the literature, is discussed again after the beam shaping leading to a homogeneous and controlled intensity distribution. The innocuity is controlled by laser-induced luminescence, and some solutions for the transparency loss of the residual varnish following ablation are proposed.

PREGCARE is a new strategy for families who had a child with a pathogenic de novo mutation, that efficiently identifies couples at higher recurrence risk due to parental mosaicism, while reassuring many others that their recurrence risk is negligible.

Formative assessment practices for secondary mathematics have been advocated as valuable for students, but difficult for teachers to learn. There have been calls in the literature to increase the emphasis on formative assessment in mathematics teacher preparation courses. This study explored the use of peer-assessment strategies for helping pre-service secondary mathematics teachers (PSTs) cultivate formative assessment principles and practices for assessing school students. Twenty-seven PSTs participated in a peer-assessment cycle comprised of: sourcing a rich mathematics task; constructing an assessment rubric for it; and collecting and analysing a selection of secondary student responses to the task. Each PST then provided written and verbal feedback to a peer on his/her rubric and student solution assessments. We draw on theoretical conceptions of Teacher Assessment Literacy in Practice to characterize the PSTs' perceptions of their experience of formative assessment processes for learning to assess school students, in terms of cognitive and affective dimensions of their conceptions of assessment. The cohort evidenced a wide range of levels of confidence with the various aspects of formative assessment practices but on average less confidence in assessing school student task responses themselves than in assessing peer work. In addition to highlighting specific changes to different types of assessment knowledge, the PSTs also evidenced an awareness of shifts in their attitudes, in coming to view student task responses with more appreciation and humility.

Abstract Background The spread of unvetted scientific information about COVID-19 presents a significant challenge to public health, adding to the urgency for increased understanding of COVID-19 information-seeking preferences that will allow for the delivery of evidence-based health communication. This study examined factors associated with COVID-19 information-seeking behavior. Methods An online survey was conducted with US adults (N = 1800) to identify key interpersonal (e.g., friends, health care providers) and mediated (e.g., TV, social media) sources of COVID-19 information. Logistic regression models were fitted to explore correlates of information-seeking. Results Study findings show that the first sought and most trusted sources of COVID-19 information had different relationships with sociodemographic characteristics, perceived discrimination, and self-efficacy. Older adults had greater odds of seeking information from print materials (e.g., newspapers and magazines) and TV first. Participants with less educational attainment and greater self-efficacy preferred interpersonal sources first, with notably less preference for mass media compared to health care providers. Those with more experiences with discrimination were more likely to seek information from friends, relatives, and co-workers. Additionally, greater self-efficacy was related to increased trust in interpersonal sources. Conclusion Study results have implications for tailoring health communication strategies to reach specific subgroups, including those more vulnerable to severe illness from COVID-19. A set of recommendations are provided to assist in campaign development.

Abstract Background A functioning vascular access (VA) is crucial to providing adequate hemodialysis (HD) and considered a critically important outcome by patients and healthcare professionals. A validated, patient-important outcome measure for VA function that can be easily measured in research and practice to harvest reliable and relevant evidence for informing patient-centered HD care is lacking. Vascular Access outcome measure for function: a vaLidation study In hemoDialysis (VALID) aims to assess the accuracy and feasibility of measuring a core outcome for VA function established by the international Standardized Outcomes in Nephrology (SONG) initiative. Methods VALID is a prospective, multi-center, multinational validation study that will assess the accuracy and feasibility of measuring VA function, defined as the need for interventions to enable and maintain the use of a VA for HD. The primary objective is to determine whether VA function can be measured accurately by clinical staff as part of routine clinical practice (Assessor 1) compared to the reference standard of documented VA procedures collected by a VA expert (Assessor 2) during a 6-month follow-up period. Secondary outcomes include feasibility and acceptability of measuring VA function and the time to, rate of, and type of VA interventions. An estimated 612 participants will be recruited from approximately 10 dialysis units of different size, type (home-, in-center and satellite), governance (private versus public), and location (rural versus urban) across Australia, Canada, Europe, and Malaysia. Validity will be measured by the sensitivity and specificity of the data acquisition process. The sensitivity corresponds to the proportion of correctly identified interventions by Assessor 1, among the interventions identified by Assessor 2 (reference standard). The feasibility of measuring VA function will be assessed by the average data collection time, data completeness, feasibility questionnaires and semi-structured interviews on key feasibility aspects with the assessors. Discussion Accuracy, acceptability, and feasibility of measuring VA function as part of routine clinical practice are required to facilitate global implementation of this core outcome across all HD trials. Global use of a standardized, patient-centered outcome measure for VA function in HD research will enhance the consistency and relevance of trial evidence to guide patient-centered care. Trial registration Clinicaltrials.gov: NCT03969225. Registered on 31st May 2019.

Abstract There have been numerous risk tools developed to enable triaging of SARS-CoV-2 positive patients with diverse levels of complexity. Here we presented a simplified risk-tool based on minimal parameters and chest X-ray (CXR) image data that predicts the survival of adult SARS-CoV-2 positive patients at hospital admission. We analysed the NCCID database of patient blood variables and CXR images from 19 hospitals across the UK using multivariable logistic regression. The initial dataset was non-randomly split between development and internal validation dataset with 1434 and 310 SARS-CoV-2 positive patients, respectively. External validation of the final model was conducted on 741 Accident and Emergency (A&E) admissions with suspected SARS-CoV-2 infection from a separate NHS Trust. The LUCAS mortality score included five strongest predictors (Lymphocyte count, Urea, C-reactive protein, Age, Sex), which are available at any point of care with rapid turnaround of results. Our simple multivariable logistic model showed high discrimination for fatal outcome with the area under the receiving operating characteristics curve (AUC-ROC) in development cohort 0.765 (95% confidence interval (CI): 0.738–0.790), in internal validation cohort 0.744 (CI: 0.673–0.808), and in external validation cohort 0.752 (CI: 0.713–0.787). The discriminatory power of LUCAS increased slightly when including the CXR image data. LUCAS can be used to obtain valid predictions of mortality in patients within 60 days of SARS-CoV-2 RT-PCR results into low, moderate, high, or very high risk of fatality.

This publication explains what happens when stormwater runoff enters constructed environments, its impacts on water bodies, and how individuals can take steps to lower their own stormwater runoff footprint. This guide can increase awareness of ways to reduce each person's role in water quality impairment by stormwater pollution. This publication is intended primarily for urban residential readers and does not focus on agricultural runoff.

Megakaryocytes (MK) undergo extensive cytoskeletal rearrangements as they give rise to platelets. While cortical microtubule sliding has been implicated in proplatelet formation, the role of the actin cytoskeleton in proplatelet elongation is less understood. It is assumed that actin filament reorganization is important for platelet generation given that mouse models with mutations in actin-associated proteins exhibit thrombocytopenia. However, due to the essential role of the actin network during MK development, a differential understanding of the contribution of the actin cytoskeleton on proplatelet release is lacking. Here, we reveal that inhibition of actin polymerization impairs the formation of elaborate proplatelets by hampering proplatelet extension and bead formation along the proplatelet shaft, which was mostly independent of changes in cortical microtubule sliding. We identify Cdc42 and its downstream effectors, septins, as critical regulators of intracellular actin dynamics in MK, inhibition of which, similarly to inhibition of actin polymerization, impairs proplatelet movement and beading. Super-resolution microscopy revealed a differential association of distinctive septins with the actin and microtubule cytoskeleton, respectively, which was disrupted upon septin inhibition and diminished intracellular filamentous actin dynamics. In vivo, septins, similarly to F-actin, were subject to changes in expression upon enforcing proplatelet formation through prior platelet depletion. In summary, we demonstrate that a Cdc42/septin axis is not only important for MK maturation and polarization, but is further required for intracellular actin dynamics during proplatelet formation.

BackgroundThe virus neutralization assay is a principal method to assess the efficacy of antibodies in blocking viral entry. Due to biosafety handling requirements of viruses classified as hazard group 3 or 4, pseudotyped viruses can be used as a safer alternative. However, it is often queried how well the results derived from pseudotyped viruses correlate with authentic virus. This systematic review and meta-analysis was designed to comprehensively evaluate the correlation between the two assays.MethodsUsing PubMed and Google Scholar, reports that incorporated neutralisation assays with both pseudotyped virus, authentic virus, and the application of a mathematical formula to assess the relationship between the results, were selected for review. Our searches identified 67 reports, of which 22 underwent a three-level meta-analysis.ResultsThe three-level meta-analysis revealed a high level of correlation between pseudotyped viruses and authentic viruses when used in an neutralisation assay. Reports that were not included in the meta-analysis also showed a high degree of correlation, with the exception of lentiviral-based pseudotyped Ebola viruses.ConclusionPseudotyped viruses identified in this report can be used as a surrogate for authentic virus, though care must be taken in considering which pseudotype core to use when generating new uncharacterised pseudotyped viruses.

BackgroundScientists have speculated genetic variants may contribute to an individual's unique pain experience. Although research exists regarding the relationship between single nucleotide polymorphisms and sickle cell disease-related pain, this literature has not been synthesized to help inform future precision health research for sickle cell disease-related pain. Our primary aim of this systematic review was to synthesize the current state of scientific literature regarding single nucleotide polymorphisms and their association with sickle cell disease-related pain.MethodsUsing the Prisma guidelines, we conducted our search between December 2021–April 2022. We searched PubMed, Web of Science, CINAHL, and Embase databases (1998–2022) and selected all peer-reviewed articles that included reports of associations between single nucleotide polymorphisms and sickle cell disease-related pain outcomes.ResultsOur search yielded 215 articles, 80 of which were duplicates, and after two reviewers (GG, JD) independently screened the 135 non-duplicate articles, we retained 22 articles that met the study criteria. The synthesis of internationally generated evidence revealed that this scientific area remains predominantly exploratory in nature, with only three studies reporting sufficient power for genetic association. Sampling varied across studies with a range of children to older adults with SCD. All of the included articles (n = 22) examined acute pain, while only nine of those studies also examined chronic pain.ConclusionCurrently, the evidence implicating genetic variation contributing to acute and chronic sickle cell disease-related pain is characterized by modestly powered candidate-gene studies using rigorous SCD-pain outcomes. Effect sizes and directions vary across studies and are valuable for informing the design of future studies. Further research is needed to replicate these associations and extend findings with hypothesis-driven research to inform precision health research.

Introduction The Florida-California Cancer Research, Education, and Engagement (CaRE 2 ) Health Equity Center is a triad partnership committed to increasing institutional capacity for cancer disparity research, the diversity of the cancer workforce, and community empowerment. This article provides an overview of the structure, process innovations, and initial outcomes from the first 4 years of the CaRE 2 triad partnership. Methods CaRE 2 serves diverse populations in Florida and California using a “molecule to the community and back” model. We prioritize research on the complex intersection of biological, environmental, and social determinants health, working together with scientific and health disparities communities, sharing expertise across institutions, bidirectional training, and community outreach. Partnership progress and outcomes were assessed using mixed methods and four Program Steering Committee meetings. Results Research capacity was increased through development of a Living Repository of 81 cancer model systems from minority patients for novel cancer drug development. CaRE 2 funded 15 scientific projects resulting in 38 publications. Workforce diversity entailed supporting 94 cancer trainees (92 URM) and 34 ESIs (32 URM) who coauthored 313 CaRE 2 -related publications and received 48 grants. Community empowerment was promoted via outreaching to more than 3000 individuals, training 145 community cancer advocates (including 28 Community Scientist Advocates), and publishing 10 community reports. CaRE 2 members and trainees together have published 639 articles, received 61 grants, and 57 awards. Conclusion The CaRE 2 partnership has achieved its initial aims. Infrastructure for translational cancer research was expanded at one partner institution, and cancer disparities research was expanded at the two cancer centers.

BackgroundThe proliferation of health care data in electronic health records (EHRs) is fueling the need for clinical decision support (CDS) that ensures accuracy and reduces cognitive processing and documentation burden. The CDS format can play a key role in achieving the desired outcomes. Building on our laboratory-based pilot study with 60 registered nurses (RNs) from 1 Midwest US metropolitan area indicating the importance of graph literacy (GL), we conducted a fully powered, innovative, national, and web-based randomized controlled trial with 203 RNs. ObjectiveThis study aimed to compare care planning time (CPT) and the adoption of evidence-based CDS recommendations by RNs randomly assigned to 1 of 4 CDS format groups: text only (TO), text+table (TT), text+graph (TG), and tailored (based on the RN’s GL score). We hypothesized that the tailored CDS group will have faster CPT (primary) and higher adoption rates (secondary) than the 3 nontailored CDS groups. MethodsEligible RNs employed in an adult hospital unit within the past 2 years were recruited randomly from 10 State Board of Nursing lists representing the 5 regions of the United States (Northeast, Southeast, Midwest, Southwest, and West) to participate in a randomized controlled trial. RNs were randomly assigned to 1 of 4 CDS format groups—TO, TT, TG, and tailored (based on the RN’s GL score)—and interacted with the intervention on their PCs. Regression analysis was performed to estimate the effect of tailoring and the association between CPT and RN characteristics. ResultsThe differences between the tailored (n=46) and nontailored (TO, n=55; TT, n=54; and TG, n=48) CDS groups were not significant for either the CPT or the CDS adoption rate. RNs with low GL had longer CPT interacting with the TG CDS format than the TO CDS format (P=.01). The CPT in the TG CDS format was associated with age (P=.02), GL (P=.02), and comfort with EHRs (P=.047). Comfort with EHRs was also associated with CPT in the TT CDS format (P

Objectives To compare the annual and period prevalence of modifiable cardiovascular risk factors (MCVRFs) between populations with and without osteoarthritis (OA) in the UK over 25 years.Methods 215 190 patients aged 35 years and over from the UK Clinical Practice Research Datalink GOLD database who were newly diagnosed OA between 1992 and 2017, as well as 1:1 age-matched, sex-matched, practice-matched and index year-matched non-OA individuals, were incorporated. MCVRFs including smoking, hypertension, type 2 diabetes, obesity and dyslipidaemia were defined by Read codes and clinical measurements. The annual and period prevalence and prevalence rate ratios (PRRs) of individual and clustering (≥1, ≥2 and ≥3) MCVRFs were estimated by Poisson regression with multiple imputations for missing values.Results The annual prevalence of MCVRFs increased in the population with OA between 1992 and 2017 and was consistently higher in the population with OA compared with the population without OA between 2004 and 2017. Trends towards increased or stable annual PRRs for individuals and clustering of MCVRFs were observed. A 26-year period prevalence of single and clustering MCVRFs was significantly higher in individuals with OA compared with non-OA individuals. Period PRRs were higher in Southern England, women and increased with age for most MCVRFs except for obesity, which has the higher PRR in the youngest age group.Conclusions A consistently higher long-term prevalence of MCVRFs was observed in individuals with OA compared to those without OA. The higher prevalence of obesity in the youngest age group with OA highlights the need for public health strategies. Further research to understand MCVRF management in OA populations is necessary.

A sequence of magnetized target fusion devices built by General Fusion has compressed magnetically confined deuterium plasmas inside imploding aluminum liners. Here we describe the best-performing compression experiment, PCS-16, which was the fifth of the most recent experiments that compressed a spherical tokamak plasma configuration. In PCS-16, the plasma remained axisymmetric with $\delta B_\textrm{pol}/B_\textrm{pol} \lt 20\%$ to a high radial compression factor ( $C_\mathrm R \gt 8$ ) with significant poloidal flux conservation (77% up to $C_\mathrm R = $ 1.7, and ${\approx}30\%$ up to $C_\mathrm R = 8.65$ ) and a total compression time of 167 $\mu\mathrm{s}$ . Magnetic energy of the plasma increased from 0.96 kJ poloidal and 17 kJ toroidal to a peak of 1.14 kJ poloidal and 29.9 kJ toroidal during the compression, while the thermal energy was in the range of 350 ± 25 J. Plasma equilibrium was a low- β state with $\beta_\textrm{tor} \approx 4\%$ and $\beta_\textrm{pol} \approx 15\%$ . Ingress of impurities from the lithium-coated aluminum wall was not the dominant effect. Neutron yield from D-D fusion increased significantly during compression. Thermodynamics during the early phase of compression ( $C_\mathrm R \lt 1.7$ ) were consistent with increasing Ohmic heating of the electrons due to a geometric increase in the current density at near-constant resistivity, and with increasing ion cooling that approximately matched ion compression heating power. Ion cooling by electrons was significant because the electrons were much cooler than the ions ( $T_\mathrm e = 200\,\mathrm{eV}, T_\mathrm i = 600\,\mathrm{eV}$ ). Magnetohydrodynamic simulations were used to model the emergence of instabilities that increase electron thermal transport in the final phase of compression. Conditions for ideal stability were actively maintained during compression through a current ramp applied to the central shaft and, after this current ramp reached its peak two-thirds of the way through compression, we measured a transition in plasma behavior across multiple diagnostics.

The DIII-D tokamak has elucidated crucial physics and developed projectable solutions for ITER and fusion power plants in the key areas of core performance, boundary heat and particle transport, and integrated scenario operation, with closing the core-edge integration knowledge gap being the overarching mission. New experimental validation of high-fidelity, multi-channel, non-linear gyrokinetic turbulent transport models for ITER provides strong confidence it will achieve Q ⩾ 10 operation. Experiments identify options for easing H-mode access in hydrogen, and give new insight into the isotopic dependence of transport and confinement. Analysis of 2,1 islands in unoptimized low-torque IBS demonstration discharges suggests their onset time occurs randomly in the constant β phase, most often triggered by non-linear 3-wave coupling, thus identifying an NTM seeding mechanism to avoid. Pure deuterium SPI for disruption mitigation is shown to provide favorable slow cooling, but poor core assimilation, suggesting paths for improved SPI on ITER. At the boundary, measured neutral density and ionization source fluxes are strongly poloidally asymmetric, implying a 2D treatment is needed to model pedestal fuelling. Detailed measurements of pedestal and SOL quantities and impurity charge state radiation in detached divertors has validated edge fluid modelling and new self-consistent ‘pedestal-to-divertor’ integrated modeling that can be used to optimize reactors. New feedback adaptive ELM control minimizes confinement reduction, and RMP ELM suppression with sustained high core performance was obtained for the first time with the outer strike point in a W-coated, compact and unpumped small-angle slot divertor. Advances have been made in integrated operational scenarios for ITER and power plants. Wide pedestal intrinsically ELM-free QH-modes are produced with more reactor-relevant conditions, Low torque IBS with W-equivalent radiators can exhibit predator-prey oscillations in T _e and radiation which need control. High- β _P scenarios with q _min > 2, q _95 –7.9, β _N > 4, β _T –3.3% and H _98y2 > 1.5 are sustained with high density ( $\bar n$ = 7E19 m ^−3 , f _G –1) for 6 τ _E , improving confidence in steady-state tokamak reactors. Diverted NT plasmas achieve high core performance with a non-ELMing edge, offering a possible highly attractive core-edge integration solution for reactors.

We present observations, numerical simulations, and analysis from experiments in the Lithium Tokamak Experiment-Beta (LTX- β ) in which the electron temperature profile ( T _e ( r )) shifts from flat to peaked and a tearing mode is also destabilized when the average density ( n _e ^ave ) exceeds ∼10 ^19 m ^−3 . Flat T _e ( r ) is obtained routinely in LTX- β , with a lithium coated, low-recycling first wall, once the external fueling is stopped and density decays [Boyle et al 2023 Nucl. Fusion 63 056020]. In the present experiment, flat T _e profiles can be sustained while maintaining constant n _e ^ave below a line averaged density threshold ( n _e ^ave _th ) of ∼10 ^19 m ^−3 . Above n _e ^ave _th , T _e ( r ) shifts from flat to peaked and a tearing mode is destabilized. Due to low recycling, the achieved n _e ^ave can be controlled precisely by external fueling and hence, a certain threshold of the edge neutral inventory from the external fueling is experimentally manifested through n _e ^ave _th . The goal of the present work is to investigate the role of edge neutrals in determining T _e ( r ) and MHD stability in the unique low-recycling regime of LTX- β . Our hypothesis is that the peaking of T _e ( r ) beyond n _e ^ave _th is due ultimately to the edge cooling by the cold neutrals beyond a critical fueling flux. At lower fueling flux, flat T _e ( r ) results in broader pressure profile and lower resistivity, which in turn stabilizes the tearing mode. This hypothesis is supported by edge neutral density estimation by DEGAS 2 code. Mode analysis by singular value decomposition confirms the tearing mode structure to be m / n = 2/1 ( m and n being the poloidal and toroidal mode numbers). Linear tearing stability analysis with M3D-C1 predicts that plasmas with n _e ^ave > 10 ^19 are highly susceptible to a n = 1 tearing mode. ORBIT simulations, however, confirmed that the tearing modes do not contribute to the loss of fast ions from neutral beam injection. This study shows for the first time that the neutral inventory at the edge could be one of the deciding factors for the achievability of the unique operation regime of flat T _e ( r ) and the excitation of tearing activity that could be disruptive for the plasmas.

Strong poloidal refueling asymmetry in the DIII-D tokamak is inferred from line radiation measurements. Synthetic diagnostics in neutral transport modeling coupled to gyrokinetic simulations illuminate implications for the plasma flow profile in the scrape-off layer of single-null beam-driven discharges. Recycling occurs primarily either on the inner or outer divertor legs, depending on the toroidal magnetic field direction. By reversing the toroidal magnetic field, the observed line radiation asymmetry is nearly eliminated or reversed. It is determined that, while relatively simple physics can describe the observed ionization asymmetry, predicting the overall brightness of the hydrogenic Lyman- α signal requires detailed simulation of the plasma and resulting turbulence. To this end, kinetic plasma simulations fully coupled to comprehensive neutral transport calculations—a novel capability—provide first-principles reproduction of Lyman- α observations on DIII-D.

The mineral processing industry faces a pressing challenge of declining productivity, particularly in metal minerals production, driven by soaring operational costs, with crushing and grinding operations accounting for a substantial portion of the energy consumption. To mitigate these challenges, early gangue rejection or preconcentration is proposed as an effective solution. This approach involves the removal of non-valuable materials and the concentration of valuable minerals at the initial processing stages, leading to increased efficiency, higher ore feed grades, cost savings, and reduced environmental impact. Various methods for gangue rejection exist, with gravity-based separation and ore sorting being the predominant options. Gravity-based separation stands out for its simplicity and versatility, making it the preferred choice in many scenarios. This study introduces a novel approach for evaluating gangue rejection potential, optimizing data distribution, and generating theoretical separation potential curves that account for both grade and density criteria. These curves provide insights into material rejection, metal losses, and optimal separation points, offering valuable guidance for mineral processing operations. Additionally, the study investigates the correlation between raw ore grade and density data, highlighting a strong relationship across different size fractions. This finding suggests that gravity-based separation can effectively rely on both grade and density parameters, resolving previous disparities observed in distribution models. By shedding light on advanced gangue rejection strategies, this research contributes to improved productivity and informed decision-making in the mineral processing industry.

Echinoderms (starfish, sea-urchins and their close relations) possess a unique type of collagenous tissue that is innervated by the motor nervous system and whose mechanical properties, such as tensile strength and elastic stiffness, can be altered in a time frame of seconds. Intensive research on echinoderm ‘mutable collagenous tissue’ (MCT) began over 50 years ago, and over 20 years ago, MCT first inspired a biomimetic design. MCT, and sea-cucumber dermis in particular, is now a major source of ideas for the development of new mechanically adaptable materials and devices with applications in diverse areas including biomedical science, chemical engineering and robotics. In this review, after an up-to-date account of present knowledge of the structural, physiological and molecular adaptations of MCT and the mechanisms responsible for its variable tensile properties, we focus on MCT as a concept generator surveying biomimetic systems inspired by MCT biology, showing that these include both bio-derived developments (same function, analogous operating principles) and technology-derived developments (same function, different operating principles), and suggest a strategy for the further exploitation of this promising biological resource.