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Introduction Military–Civilian Partnerships (MCPs) are vital for maintaining the deployment readiness of military health care physicians. However, tracking their clinical activity has proven to be challenging. In this study, we introduce a locally driven process aimed at the passive collection of external clinical workload data. This process is designed to facilitate an assessment of MCP physicians' deployment readiness and the effectiveness of individual MCPs. Materials and Methods From March 2020 to February 2023, we conducted a series of quality improvement projects at the Wright Patterson Medical Center (WPMC) to enhance our data collection efforts for MCP physicians. Our methodology encompassed several steps. First, we assessed our existing data collection processes and their outcomes to identify improvement areas. Next, we tested various data collection methods, including self-reporting, a web-based smart phone application, and an automated process based on billing or electronic health record data. Following this, we refined our data collection process, incorporating the identified improvements and systematically tracking outcomes. Finally, we evaluated the refined process in 2 different MCPs, with our primary outcome measure being the collection of monthly health care data. Results Our examination at the WPMC initially identified several weaknesses in our established data collection efforts. These included unclear responsibility for data collection within the Medical Group, an inadequate roster of participating MCP physicians, and underutilization of military and community resources for data collection. To address these issues, we implemented revisions to our data collection process. These revisions included establishing clear responsibility for data collection through the Office of Military–Civilian Partnerships, introducing a regular "roll call" to match physicians to MCP agreements, passively collecting data each month through civilian partner billing or information technology offices, and integrating Office of Military–Civilian Partnership efforts into regular executive committee meetings. As a result, we observed a 4-fold increase in monthly data capture at WPMC, with similar gains when the refined process was implemented at an Air Force Center for the Sustainment of Trauma and Readiness Skills site. Conclusions The Military–Civilian Partnership Quality Improvement Program concept is an effective, locally driven process for enhancing the capture of external clinical workload data for military providers engaged in MCPs. Further examination of the Military–Civilian Partnership Quality Improvement Program process is needed at other institutions to validate its effectiveness and build a community of MCP champions. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the utilization and costs of non‐insulin glucose‐lowering drugs (GLDs) in Australia from 2013 to 2023. Materials and Methods: We conducted a retrospective analysis of the Australian Pharmaceutical Benefits Scheme (PBS) administrative dataset of 118 727 494 GLD prescriptions. The main outcome measures were the annual number of GLD prescriptions dispensed, accounting for type 2 diabetes mellitus (T2DM) prevalence and healthcare system costs, adjusted for inflation. Results: Utilization of GLDs doubled from 6.4 million prescriptions in 2013 to 15.6 million in 2023. The average annual percent increase in utilization was 8.1%, compared to the average annual increase in prevalence of T2DM of 1.8%. The biggest change was in sodium‐glucose cotransporter‐2 (SGLT2) inhibitors, for which there was an average annual increase in utilization of 59.4% (95% confidence interval [CI] 51.7%, 68.2%; p < 0.05) from 2014 (first full year of PBS listing), followed by glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs), which showed an increase of 31.4% (95% CI 28.5%, 33.8%; p < 0.05) annually (2013 to 2023). Dipeptidyl peptidase‐4 inhibitor utilization tripled, with an average annual increase of 10.9% (95% CI 8.1%, 13.8%; p < 0.05), but this plateaued from 2020. Metformin utilization increased by 4.7% (95% CI 2.0%, 6.9%; p < 0.05) annually. In contrast, sulphonylurea, glitazone and acarbose utilization declined. Total GLD costs increased threefold over the same period. Despite only accounting for 11.7% of utilization, GLP‐1RAs contributed to 35% of the costs. Conclusion: Utilization of GLDs doubled, and associated costs tripled over the past 11 years, with no sign of either utilization or costs plateauing, predominantly due to increased GLP‐1RA and SGLT2 inhibitor prescribing. [ABSTRACT FROM AUTHOR]

Background: Integrated approaches to mapping skin Neglected Tropical Diseases (NTDs) may be cost-effective way to guide decisions on resource mobilization. Pilot studies have been carried out, but large-scale data covering multiple countries endemic for skin NTDs are lacking. Within the LAMP4YAWS project, we collected integrated data on the burden of multiple skin NTDs. Methods: From March 2021 to March 2023, integrated case searches for yaws alongside other skin conditions were performed in endemic health districts of yaws in Cameroon, Côte d'Ivoire, and Ghana. Integrated activities included training, social mobilization and active case detection. Initial screening involved a brief clinical examination of participants to determine if any skin conditions were suspected. Cases of skin NTDs were then referred to a health facility for appropriate management. Results: Overall 61,080 individuals screened, 11,387 (18.6%) had skin lesions. The majority of individuals (>90%) examined were children aged 15 years old and under. The proportion of serologically confirmed yaws cases was 8.6% (18/210) in Cameroon, 6.8% (84/1232) in Côte d'Ivoire, and 26.8% (440/1643) in Ghana. Other skin conditions based on clinical examination included: scabies, Buruli ulcer, leprosy, lymphatic filariasis (lymphoedema and hydrocele), tungiasis, and fungal infections. The most common conditions were scabies and superficial fungal infections. In Cameroon, scabies and superficial fungal infections accounted for 5.1% (214/4204) and 88.7% (3730/4204) respectively, 25.2% (1285/5095) and 50.4% (2567/5095) in Côte d'Ivoire. In Ghana, 20% (419/2090) of individuals had scabies but superficial fungal infections were not routinely recorded and were reported in only 1.3% (28/2090). Other skin NTDs were less common across all three countries. Conclusion: This study confirms that integrated screening allows simultaneous detection of multiple skin NTDs, maximising use of scarce resources. Author summary: Many Neglected Tropical Diseases (NTDs) predominantly affect the skin and are referred to as skin NTDs. The World Health Organization (WHO) has developed a number of strategies for the control, eradication and elimination of skin NTDs and recognizes the importance of integrated approaches to mapping skin NTDs. We conducted a study adopting integrated screening for multiple skin NTDs and other skin conditions in Cameroon, Côte d'Ivoire, and Ghana. This ran alongside a study focused on diagnostic tests for one specific skin NTD–yaws. The results showed that integrated screening is a feasible and cost-effective way to detect multiple skin NTDs in a single intervention. Of more than 60,000 individuals screened almost one in five had a skin lesion. Cases of yaws confirmed by blood tests were detected more frequently in Ghana compared to Côte d'Ivoire and Cameroon. The most common skin conditions were scabies and superficial fungal infections. Other skin NTDs such as Buruli ulcer, leprosy, lymphatic filariasis and tungiasis were less common. Integrated screening allowed detection of skin conditions and co-endemicity of skin NTDs and the data can guide decisions on resource mobilization to manage skin NTDs. [ABSTRACT FROM AUTHOR]

Osteoporosis and other metabolic bone diseases are prevalent in the aging population. While bone has the capacity to regenerate throughout life, bone formation rates decline with age and contribute to reduced bone density and strength. Identifying mechanisms and pathways that increase bone accrual in adults could prevent fractures and accelerate healing. G protein-gated inwardly rectifying K+ (GIRK) channels are key effectors of G protein-coupled receptor signaling. Girk3 was recently shown to regulate endochondral ossification. Here, we demonstrate that deletion of Girk3 increases bone mass after 18 weeks of age. Male 24-week-old Girk3-/- mice have greater trabecular bone mineral density and bone volume fraction than wildtype (WT) mice. Osteoblast activity is moderately increased in 24-week-old Girk3-/- mice compared to WT mice. In vitro, Girk3-/- bone marrow stromal cells (BMSCs) are more proliferative than WT BMSCs. Calvarial osteoblasts and BMSCs from Girk3-/- mice are also more osteogenic than WT cells, with altered expression of genes that regulate the wingless-related integration site (Wnt) family. Wnt inhibition via Dickkopf-1 (Dkk1) or β-catenin inhibition via XAV939 prevents enhanced mineralization, but not proliferation, in Girk3-/- BMSCs and slows these processes in WT cells. Finally, selective ablation of Girk3 from cells expressing Cre recombinase from the 2.3 kb-Col1a1 promoter, including osteoblasts and osteocytes, is sufficient to increase bone mass and bone strength in male mice at 24 weeks of age. Taken together, these data demonstrate that Girk3 regulates progenitor cell proliferation, osteoblast differentiation, and bone mass accrual in adult male mice. Lay Summary: Osteoporosis is a prevalent, debilitating disease characterized by low bone mass. Identifying pathways that enhance bone formation could lead to therapies that prevent fractures and increase bone mass. In this study, we show that whole-body or osteoblast-specific deletion of G protein-gated inwardly rectifying K+ channel 3 (Girk3) increases bone mass in male adult mice. Osteoblast progenitor cells from Girk3-/- animals are more proliferative and differentiate more quickly into mature osteoblasts. Taken together, we show that Girk3 is a novel regulator of bone mass in adult mice. Graphical Abstract [ABSTRACT FROM AUTHOR]

Background: In Australia, lung cancer is the leading cause of cancer‐related deaths. In Victoria, the mortality risk is assumed to vary across Local Government Areas (LGAs) due to variations in socioeconomic advantage, remoteness, and healthcare accessibility. Thus, we applied Bayesian spatial survival models to examine the geographic variation in lung cancer survival in Victoria. Methods: Data on lung cancer cases were extracted from the Victorian Lung Cancer Registry (VLCR). To account for spatial dependence and risk factors of survival in lung cancer patients, we employed a Bayesian spatial survival model. Conditional Autoregressive (CAR) prior was assigned to model the spatial dependence. Deviance Information Criterion (DIC), Watanabe Akaike Information Criterion (WAIC), and Log Pseudo Marginal Likelihood (LPML) were used for model comparison. In the final best‐fitted model, the Adjusted Hazard Ratio (AHR) with the 95% Credible Interval (CrI) was reported. The outcome variable was the survival status of lung cancer patients, defined as whether they survived or died during the follow‐up period (death was our interest). Results: Our study revealed substantial variations in lung cancer mortality in Victoria. Poor Eastern Cooperative Oncology Group (ECOG) performance status, diagnosed at a regional hospital, Small Cell Lung Cancer (SCLC), advanced age, and advanced clinical stage were associated with a higher risk of mortality, whereas being female, presented at Multidisciplinary Team (MDT) meeting, and diagnosed at a metropolitan private hospital were significantly associated with a lower risk of mortality. Conclusion: Identifying geographical disparities in lung cancer survival may help shape healthcare policy to implement more targeted and effective lung cancer care services. [ABSTRACT FROM AUTHOR]

Aedes mosquito-borne viruses (ABVs) place a substantial strain on public health resources in the Americas. Vector control of Aedes mosquitoes is an important public health strategy to decrease or prevent spread of ABVs. The ongoing Targeted Indoor Residual Spraying (TIRS) trial is an NIH-sponsored clinical trial to study the efficacy of a novel, proactive vector control technique to prevent dengue virus (DENV), Zika virus (ZIKV), and chikungunya virus (CHIKV) infections in the endemic city of Merida, Yucatan, Mexico. The primary outcome of the trial is laboratory-confirmed ABV infections in neighborhood clusters. Despite the difficulties caused by the COVID-19 pandemic, by early 2021 the TIRS trial completed enrollment of 4,792 children aged 2–15 years in 50 neighborhood clusters which were allocated to control or intervention arms via a covariate-constrained randomization algorithm. Here, we describe the makeup and ABV seroprevalence of participants and mosquito population characteristics in both arms before TIRS administration. Baseline surveys showed similar distribution of age, sex, and socio-economic factors between the arms. Serum samples from 1,399 children were tested by commercially available ELISAs for presence of anti-ABV antibodies. We found that 45.1% of children were seropositive for one or more flaviviruses and 24.0% were seropositive for CHIKV. Of the flavivirus-positive participants, most were positive for ZIKV-neutralizing antibodies by focus reduction neutralization testing which indicated a higher proportion of participants with previous ZIKV than DENV infections within the cohort. Both study arms had statistically similar seroprevalence for all viruses tested, similar socio-demographic compositions, similar levels of Ae. aegypti infestation, and similar observed mosquito susceptibility to insecticides. These findings describe a population with a high rate of previous exposure to ZIKV and lower titers of neutralizing antibodies against DENV serotypes, suggesting susceptibility to future outbreaks of flaviviruses is possible, but proactive vector control may mitigate these risks. [ABSTRACT FROM AUTHOR]

Colleges and universities are closely examining their practices for engaging campus constituents in multicultural education. One method that has received increased attention is the use of intergroup dialogue (IGD). Although there is mounting research evidence of the effectiveness of IGD in meeting the goals and objectives of multicultural education, there remains a need to demonstrate its ability to be integrated into an existing curriculum and what specifically it adds to typical methods for teaching about diversity. The current study compared undergraduate diversity-topic courses that were taught with and without an IGD component integrated into the existing curriculum. One hundred twelve undergraduate students enrolled in 1 of 5 courses completed survey measures at the beginning and end of the semester. Results from split-plot ANOVAs demonstrated that students enrolled in courses with IGD showed greater increases over the course of the semester on measures of racial oppression awareness, openness to diversity, and empathic feeling and acting as an ally than students enrolled in courses without the IGD component. Further, main effects demonstrated that students enrolled in both course formats had increased scores on awareness of systems of oppression and privilege as well as anxiety and lack of multicultural self-efficacy over the course of the semester. These findings add to the growing literature on the effectiveness of IGD and extend the generalizability to campuses integrating IGD teaching methods to an existing curriculum.

Purpose: Early language and speech acquisition can be delayed in twin children, a twinning effect that diminishes between 4 and 6 years of age in a population-based sample. The purposes of this study were to examine how twinning effects influence the identification of children with language impairments at 4 and 6 years of age, comparing children with specific language impairment (SLI) and nonspecific language impairment (NLI); the likelihood that affectedness will be shared within monozygotic versus dizygotic twin pairs; and estimated levels of heritability for SLI and NLI. Twinning effects are predicted to result in elevated rates of language impairments in twins. Method: The population-based twin sample included 1,354 children from 677 twin pairs, 214 monozygotic and 463 dizygotic, enrolled in a longitudinal study. Nine phenotypes from the same comprehensive direct behavioral assessment protocol were investigated at 4 and 6 years of age. Twinning effects were estimated for each phenotype at each age using structural equation models estimated via diagonally weighted least squares. Heritabilities were calculated for SLI and NLI. Results: As predicted, the twinning effect increased the percentage of affected children in both groups across multiple language phenotypes, an effect that diminished with age yet was still not aligned to singleton age peers. Substantial heritability estimates replicated across language phenotypes and increased with age, even with the most lenient definition of affectedness, at -1 SD. Patterns of outcomes differed between SLI and NLI groups. Conclusions: Nonverbal IQ is not on the same causal pathway as language impairments. Twinning effects on language acquisition affect classification of 4- and 6-year-old children as SLI and NLI, and heritability is most consistent in the SLI group. Clinical practice requires monitoring language acquisition of twins to avoid misdiagnosis when young or a missed diagnosis of language impairments at school entry.

Spanish-English cognates (words from ancestrally related languages similar in appearance and meaning) are plentiful in students' reading materials, but few researchers have documented elementary-age bilingual (Spanish-English) students' actual use of cognates. The authors drew from two qualitative research studies to show how bilingual students can be taught to use cognates to improve their spelling, writing, and reading. The third-grade teacher's instruction included a cognate definition and examples, identification of the written similarities and differences in Spanish-English cognates, and the completion of cognate lessons related to the students' English instruction on electricity. The fourth graders received cognate instruction to support their English reading comprehension. After instruction, most of the third graders used cognates for spelling and writing but not for reading, whereas most of the fourth graders used cognates to improve their English reading comprehension. Recommendations are made for how to teach cognates to bilingual students in bilingual, English-only, and English as a second language classrooms.

This qualitative study utilized sociocultural and heteroglossic perspectives to examine the oral translanguaging practices of four Korean-American first-graders in a Korean heritage language (HL) classroom. The research method was discourse analysis. The students attended all-English American schools during the school week and a Korean HL school on Saturdays. All four students drew from their integrated linguistic resources to translanguage for sociolinguistic, metalinguistic, metacognitive, and sociocultural purposes. The three students who preferred English and who had older siblings translanguaged more and for a wider range of translanguaging practices than the student who preferred Korean and who had a younger sibling.

Using virtual reality (VR) in educational settings is becoming increasingly popular. The feasibility of replacing an instrumentation-based organic chemistry lab with a VR experience has been evaluated. A VR laboratory experience was designed to teach students how to use an infrared spectrometer and elucidate an unknown structure from the resulting infrared spectrum. The resulting first-person VR experience is immersive and realistic, with a teaching assistant guiding the user along the steps required to complete the experiment, including feedback as needed. The VR experience was developed in WondaVR with selections made using gaze navigation. The resulting product was tested with a group of students, and the outcomes for short- and long-term recall were compared with a group of students that did the same experiment in a traditional lab. Results indicate that there are no significant differences in learning outcomes between the two groups, which indicates the possibility of using this tool to offer this organic chemistry lab experiment via distance education. Students that tried the VR experience reported a high degree of satisfaction with the product and no significant usability barriers. These VR experiences could be useful for students who are unable to be present in lab due to disabilities, attendance challenges such as pregnancy, or safety concerns.

Awareness-making (AM) describes a process by which visitors bring with them past experiences and knowledge, all of which help them make sense of museum exhibits. Meaning-making (MM) is when museum visitors' memories transform their museum experience into new knowledge and meaning. This article explores how AM elicits MM in museum visitors. We conducted research at a natural history museum exhibition called "Minnesota Journeys," based on a moose natural habitat display and accompanying touchscreen. The exhibition was developed in Minnesota by the Bell Museum for all ages. We report findings from a mixed-methods study incorporating surveys (n = 243) and interviews (n = 30) with adult museum visitors. The findings of this paper: (1) describe how, after visiting both the moose habitat display and touchscreen, most visitors learned to identify specific moose biology and ecology characteristics, such as behavior and habitat; and (2) demonstrate how in a natural history museum setting visitor awareness-making can facilitate visitor meaning-making. We discuss implications for how to utilize these findings in other museum settings and exhibits.

Epigenetic mechanisms result in persistent changes at the cellular level that can lead to long-lasting behavioral adaptations. Nucleosome remodeling is a major epigenetic mechanism that has not been well explored with regards to drug-seeking behaviors. Nucleosome remodeling is performed by multi-subunit complexes that interact with DNA or chromatin structure and possess an ATP-dependent enzyme to disrupt nucleosome-DNA contacts and ultimately regulate gene expression. Calcium responsive transactivator (CREST) is a transcriptional activator that interacts with enzymes involved in both histone acetylation and nucleosome remodeling. Here, we examined the effects of knocking down CREST in the nucleus accumbens (NAc) core on drug-seeking behavior and synaptic plasticity in male mice as well as drug-seeking in male rats. Knocking down CREST in the NAc core results in impaired cocaine-induced conditioned place preference (CPP) as well as theta-induced long-term potentiation in the NAc core. Further, similar to the CPP findings, using a self-administration procedure, we found that CREST knockdown in the NAc core of male rats had no effect on instrumental responding for cocaine itself on a first-order schedule, but did significantly attenuate responding on a second-order chain schedule, in which responding has a weaker association with cocaine. Together, these results suggest that CREST in the NAc core is required for cocaine-induced CPP, synaptic plasticity, as well as cocaine-seeking behavior.SIGNIFICANCE STATEMENT This study demonstrates a key role for the role of Calcium responsive transactivator (CREST), a transcriptional activator, in the nucleus accumbens (NAc) core with regard to cocaine-induced conditioned place preference (CPP), self-administration (SA), and synaptic plasticity. CREST is a unique transcriptional regulator that can recruit enzymes from two different major epigenetic mechanisms: histone acetylation and nucleosome remodeling. In this study we also found that the level of potentiation in the NAc core correlated with whether or not animals formed a CPP. Together the results indicate that CREST is a key downstream regulator of cocaine action in the NAc.

In the original version of this Article, the affiliation details for Peter Groszkowski and Jens Koch were incorrectly given as 'Department of Physics, University of Chicago, Chicago, IL, 60637, USA', instead of the correct 'Department of Physics and Astronomy, Northwestern University, Evanston, Illinois 60208, USA'. This has now been corrected in both the PDF and HTML versions of the Article.

Qubit connectivity is an important property of a quantum processor, with an ideal processor having random access-the ability of arbitrary qubit pairs to interact directly. This a challenge with superconducting circuits, as state-of-the-art architectures rely on only nearest-neighbor coupling. Here, we implement a random access superconducting quantum information processor, demonstrating universal operations on a nine-qubit memory, with a Josephson junction transmon circuit serving as the central processor. The quantum memory uses the eigenmodes of a linear array of coupled superconducting resonators. We selectively stimulate vacuum Rabi oscillations between the transmon and individual eigenmodes through parametric flux modulation of the transmon frequency. Utilizing these oscillations, we perform a universal set of quantum gates on 38 arbitrary pairs of modes and prepare multimode entangled states, all using only two control lines. We thus achieve hardware-efficient random access multi-qubit control in an architecture compatible with long-lived microwave cavity-based quantum memories.

Treeline advance is a well-established response of treeline ecotones to climate change. However, the degree to which tree growth and establishment drives treeline movement is widely debated. We used geographic information system (GIS) analysis of aerial photographs and dendrochronological analysis of tree growth and age structure to examine treeline dynamics on Pikes Peak (Colorado). The rate of treeline advance at the site (1938-2017) was 0.235 m [year.sup.-1], and it accelerated through time. Several sites have transformed from abrupt to diffuse topology. Regional temperatures significantly increased after the 1890s, particularly in the last half-century. Tree growth was inhibited by late spring snow in the 1935-1985 window and enhanced by growing season temperature in the 1965-2009 window. Tree establishment above treeline appears to have transformed treeline topology and set up the potential for further treeline advance. We conclude that if current climatic trends and system relationships continue, treeline should continue to advance because (i) there are large numbers of seedlings and saplings above the treeline due to continuous significant seedling recruitment and (ii) growth of trees in the treeline ecotone is positively related to growing season temperatures, which are increasing. Other limits to the system, such as drought or topographic barriers, may arise in the future. Key words: treeline advance, tree establishment, tree growth, GIS. L'avancee de la limite des arbres est une reaction au changement climatique bien connue des ecotones de la limite des arbres. Cependant, la mesure dans laquelle l'etablissement et la croissance des arbres determinent le mouvement de la limite des arbres fait l'objet d'un vaste debat. Nous avons utilise l'analyse de photographies aeriennes a l'aide d'un systeme d'information geographique (SIG) et l'analyse dendrochronologique de la croissance et de la structure d'age des arbres pour etudier la dynamique de la limite des arbres au Pic Pikes, dans l'Etat du Colorado. Le taux de deplacement de la limite des arbres au site d'etude (1938-2017) etait de 0,235 m [an.sup.-1] et a augmente avec le temps. Plusieurs sites se sont transformes, passant d'une topologie abrupte a diffuse. Les temperatures regionales ont significativement augmente apres les annees 1890, particulierement au cours du dernier demi-siecle. La croissance des arbres a ete inhibee par la neige tardive au printemps durant la periode de 1935 a 1985 et favorisee par la temperature durant la saison de croissance durant la periode de 1965 a 2009. L'etablissement des arbres au-dela de la limite des arbres semble avoir transforme la topologie de la limite des arbres et enclenche la possibilite d'une avancee ulterieure de la limite des arbres. En conclusion, si les tendances courantes du climat et des relations du systeme persistent, la limite des arbres devrait continuer a avancer parce que : (i) il y a un grand nombre de semis et de gaules au-dela de la limite des arbres a cause du recrutement important et continu de semis et (ii) la croissance des arbres dans l'ecotone de la limite des arbres est positivement reliee a la temperature qui va en augmentant durant la saison de croissance. D'autres limites du systeme, telles que la secheresse ou des barrieres topographiques, pourraient survenir dans le futur. [Traduit par la Redaction] Mots-cles: avancee de la limite des arbres, etablissement des arbres, croissance des arbres, SIG., Introduction As average global temperature continues to increase (IPCC 2018), ecosystems that have climatically constrained boundaries are beginning to undergo significant geographical shifts (Walther et al. 2002). The alpine treeline [...]

During widespread community transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), transmission chains are sometimes unclear. Although often unavailable, viral genome sequencing can complement epidemiologic investigations. In fall 2020, [...]