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Writing is a key disciplinary practice in STEM used to construct scientific knowledge and communicate research findings. With its role in the scientific process, writing is often incorporated into STEM classrooms to train students in scientific writing. The importance of incorporating writing in STEM classrooms is heightened by the role it can play in supporting student learning of disciplinary knowledge and thinking. However, the characteristics of a writing assignment can shape how and what students are learning. Although faculty recognize the value of writing in instruction, they often face barriers that constrain the amount and types of writing they incorporate into their classes. This article describes the design and propagation of Writing-to-Learn assignments in introductory STEM courses at the University of Michigan through the MWrite program. Our aim is to present a framework that could inform similar efforts from the classroom to institutional levels. The Writing-to-Learn assignment design described herein incorporates a context-driven prompt followed by content-focused peer review and revision. We also describe the structures incorporated into the MWrite program to support the large-scale implementation of writing in high-enrollment introductory STEM courses.

ObjectiveHousing insecurity has been linked to high-risk behaviors and chronic disease, although less is known about the pathways leading to poor health. We sought to determine whether housing insecurity is associated with access to preventive and primary care.MethodsWe conducted weighted univariate, bivariate, and multivariate analyses by using 2011 to 2015 Behavioral Risk factor Surveillance Survey data (N = 228,131 adults). The independent variable was housing insecurity derived from the question on worry about paying rent or mortgage. The outcome measures were health services utilization (no usual source of care, no routine checkup in the past 1 year, and delayed medical care due to cost), self-rated health (number of days reported physical, mental health not good, and poor overall health), and number of chronic diseases (0, 1, 2 or more). The covariates included age, sex, race/ethnicity, income, level of education, marital status, and number of children in the family. We also adjusted for state fixed effects and survey year. We performed χ2 tests and binary logistic regressions on categorical variables and ran t tests and estimated linear regression models on continuous variables. Multinomial logistic regressions were estimated for the number of chronic diseases.ResultsOf the 228,131 adults in the study sample, 28,704 adults reported housing insecurity. We found that those with housing insecurity were more likely to forgo routine check-ups and lack usual sources of care. Low-income individuals, minorities, the unmarried, and middle-aged adults were more likely to report housing insecurity.ConclusionHousing insecurity is associated with worse access to preventive and primary care. Interventions to enhance access for these patients should be developed and studied.

The temperature of the nutrient solution is one of the main obstacles of hydroponic production in hot climates and can affect the nutrient absorption of plants. Additionally, the hydroponic cultivation of cut flowers is rarely done, and hence, there is a lack of studies on this topic. The objective of this experiment was to determine the ideal temperature of the nutrient solution as well as the influence of the plant density factor for hydroponic cultivation in NFT (Nutrient Film Technique) of the cultivar Girassol de Jardim Amarelo Alto, ISLA®. The experiment was installed in a greenhouse, with 50% shading. The experiment adopted a completely randomized design in a factorial scheme with plots subdivided in space, with the main plots composed of two densities (15 and 30 plants m-2) and the subplots of four temperatures of the nutrient solution (20, 25, 30 °C and uncontrolled temperature) with three replications each. The variables analyzed were plant height, stem diameter, internal and external diameter of the flower, number of leaves, number of buds and flowers, dry and fresh root mass, dry and fresh shoot mass, and cultivation cycle. The data were submitted to an analysis of variance using the statistical software SISVAR. The density of 15 plants m-2 proved to be more efficient, presenting plants of commercialization standard. Cooling the nutrient solution did not improve the production and quality of sunflower flowers.

Key Points: Question: How does use of a liberal or restrictive strategy of blood transfusion influence neurological outcome among patients with acute brain injury? Findings: In this randomized clinical trial that included 850 patients with acute brain injury and a hemoglobin level below 9 g/dL, those who were treated with a liberal transfusion strategy triggered by hemoglobin below 9 g/dL had a lower probability of unfavorable neurological outcome at 180 days than those treated with a restrictive strategy triggered by hemoglobin below 7 g/dL (62.6% vs 72.6%, respectively; adjusted relative risk, 0.86). Meaning: A liberal transfusion strategy compared with a restrictive strategy resulted in a lower rate of unfavorable neurological outcome among patients with acute brain injury. Importance: Blood transfusions are commonly administered to patients with acute brain injury. The optimal hemoglobin transfusion threshold is uncertain in this patient population. Objective: To assess the impact on neurological outcome of 2 different hemoglobin thresholds to guide red blood cell transfusions in patients with acute brain injury. Design, Setting, and Participants: Multicenter, phase 3, parallel-group, investigator-initiated, pragmatic, open-label randomized clinical trial conducted in 72 intensive care units across 22 countries. Eligible patients had traumatic brain injury, aneurysmal subarachnoid hemorrhage, or intracerebral hemorrhage; hemoglobin values below 9 g/dL within the first 10 days after injury; and an expected intensive care unit stay of at least 72 hours. Enrollment occurred between September 1, 2017, and December 31, 2022. The last day of follow-up was June 30, 2023. Interventions: Eight hundred fifty patients were randomly assigned to undergo a liberal (transfusion triggered by hemoglobin <9 g/dL; n = 408) or a restrictive (transfusion triggered by hemoglobin <7 g/dL; n = 442) transfusion strategy over a 28-day period. Main Outcomes and Measures: The primary outcome was occurrence of an unfavorable neurological outcome, defined as a Glasgow Outcome Scale Extended score between 1 and 5, at 180 days following randomization. There were 14 prespecified serious adverse events, including occurrence of cerebral ischemia after randomization. Results: Among 820 patients who completed the trial (mean age, 51 years; 376 [45.9%] women), 806 had available data on the primary outcome, 393 in the liberal strategy group and 413 in the restrictive strategy group. The liberal strategy group received a median of 2 (IQR, 1-3) units of blood, and the restrictive strategy group received a median of 0 (IQR, 0-1) units of blood, with an absolute mean difference of 1.0 unit (95% CI, 0.87-1.12 units). At 180 days after randomization, 246 patients (62.6%) in the liberal strategy group had an unfavorable neurological outcome compared with 300 patients (72.6%) in the restrictive strategy group (absolute difference, −10.0% [95% CI, −16.5% to −3.6%]; adjusted relative risk, 0.86 [95% CI, 0.79-0.94]; P =.002). The effect of the transfusion thresholds on neurological outcome at 180 days was consistent across prespecified subgroups. In the liberal strategy group, 35 (8.8%) of 397 patients had at least 1 cerebral ischemic event compared with 57 (13.5%) of 423 in the restrictive strategy group (relative risk, 0.65 [95% CI, 0.44-0.97]). Conclusions and Relevance: Patients with acute brain injury and anemia randomized to a liberal transfusion strategy were less likely to have an unfavorable neurological outcome than those randomized to a restrictive strategy. Trial Registration: ClinicalTrials.gov Identifier: NCT02968654 This randomized clinical trial assesses the effect of a liberal vs a restrictive hemoglobin threshold for red blood cell transfusion on unfavorable neurological outcome in patients with acute brain injury. [ABSTRACT FROM AUTHOR]

Thigh-worn accelerometry is commonly implemented to measure step cadence. The default activPAL CREA algorithm is a valid measure of cadence during walking, but its validity during running is unknown. The ActiPASS software is designed to analyse tri-axial accelerometry data from various brands. We tested the validity of CREA v1.3 and ActiPASS 2023.12 to measure step cadence against manually-counted steps. Forty-five participants (26♀, 23.4 ± 4.6 years) completed 5 walking (6 min each, 2–4 mph) and 5 running treadmill (5–7 mph) stages (423 total stages completed). Based on equivalence testing, walking cadence (stages 1–5: 92–124 steps/min) from CREA was statistically equivalent (zone: <±2.2% of the manually-counted mean) to manual counts (92–125 steps/min). However, CREA underpredicted cadence during running stages (stages 6–10: 143–135 steps/min) by ~ 11–20 steps/min (p < 0.001). The ActiPASS-derived cadences were equivalent (zone: <±3.3%) to manual counts for all walking stages (99–127 steps/min) except Stage 1 (zone: ±10.5%). ActiPASS underpredicted cadences during running (stages 6–10: 137–153 steps/min) by ~ 10–16 steps/min (p < 0.001) compared to manual counts (stages 6–10: 154–164 steps/min). The CREA v1.3 algorithm is a valid measure of cadence during walking while ActiPASS 2023.12 is a valid measure of cadence during medium-fast walking. Further research is required to improve step cadence estimation across ambulation speeds. [ABSTRACT FROM AUTHOR]

Targeted oxygen delivery during cardiopulmonary bypass (CPB) has received significant attention due to its influence on patient outcomes, especially in mitigating acute kidney injury. While it has gained popularity in select institutions, there remains a gap in establishing it globally across multiple centers. The purpose of this investigation was to describe the development of a quality improvement process of targeted oxygen delivery during CPB across hospitals throughout the United States. A systematic approach to utilize oxygen delivery index (DO2i) as a key performance indicator within hospitals serviced by a national provider of perfusion services. The process included a review of the current literature on DO2i, which yielded a target nadir value (272 mL/min/m2) and an area under the curve (DO2i272AUC) cut off of 632. All data is displayed on a dashboard with results categorized across multiple levels from system-wide to individual clinician performance. From January 2020 through December 2022, DO2i data from 91 hospitals and 11,165 coronary artery bypass graft procedures were collected. During this period the monthly proportion of DO2i measurements above the target nadir DO2i272 ranged from 60.5% to 78.4% with a mean+/−SD of 70.8 +/- 4.2%. Binary logistic regression for the first 7 months following monthly DO2i performance reporting has shown a statistically significant positive linear trend in the probability of achieving the target DO2i272 (p <.001), with a crude increase of approximately 7.8% for DO2i272AUC, and a 73.8% success rate (p <.001). A survey was sent to all individuals measuring oxygen delivery during CPB to assess why a target DO2i272 could not be reached. The two most common responses were an 'inability to improve CPB flow rates' and 'restrictive allogeneic red blood cell transfusion policies'. This study demonstrates that targeting a minimum level of oxygen delivery can serve as a key performance indicator during CPB using a structured quality improvement process. [ABSTRACT FROM AUTHOR]

Insulin is a key regulator of amino acid metabolism. Many plasma amino acids, including lysine and its metabolite, α-aminoadipic acid (α-AA), a predictor for developing diabetes, are elevated in insulin resistance (IR). In 18 overweight women with IR and polycystic ovary syndrome compared with 12 lean control women, high physiological insulin during a euglycemic clamp failed to normalize many elevated amino acid metabolites, including branched-chain and aromatic amino acids, α-aminobutyric acid, and lysine, but normalized α-AA. To understand the underpinnings of differential responses of lysine and its metabolic product α-AA to high physiological insulin in IR compared with control participants, we developed a kinetic model using [α-15N1]-lysine and [13C1]-α-AA as tracers and measured the two tracers simultaneously in α-AA by innovative mass spectrometry. High insulin increased lysine conversion to α-AA in the IR and control groups but failed to normalize plasma lysine concentrations in IR due to a decrease in lysine metabolic clearance rate (MCR). In contrast, despite higher conversion rates of lysine to α-AA by high insulin, α-AA concentration decreased in IR because of the sustained greater MCR of α-AA. The abnormal amino acids and metabolites, even while on high physiological insulin, could potentially explain many functional derangements in IR. Article Highlights: This study aimed to determine whether high physiological insulin normalizes abnormal plasma amino metabolites in individuals with insulin resistance. High insulin levels failed to normalize many amino acids, including lysine, but normalized the lysine metabolite α-aminoadipic acid (α-AA) reported to predict future diabetes. A novel kinetic model was developed using two stable isotope tracers to measure lysine and α-AA kinetics simultaneously in humans during a single protocol using innovative mass spectrometry that can be applied to study other amino acid kinetics. High physiological insulin normalized α-AA in insulin resistance by maintaining its higher metabolic clearance, suggesting that high α-AA resulted from insulin resistance. [ABSTRACT FROM AUTHOR]

Peer review is useful for providing students with formative feedback, yet it is used less frequently in STEM classrooms and for supporting writing-to-learn (WTL). While research indicates the benefits of incorporating peer review into classrooms, less research is focused on students' perceptions thereof. Such research is important as it speaks to the mechanisms whereby peer review can support learning. This study examines students' self-reported approaches to and perceptions of peer review and revision associated with WTL assignments implemented in an organic chemistry course. Students responded to a survey covering how they approached peer review and revision and the benefits they perceived from participating in each. Findings indicate that the assignment materials guided students' approaches during both peer review and revision. Furthermore, students described various ways both receiving feedback from their peers and reading their peers' drafts were beneficial, but primarily connected their revisions to receiving feedback. [ABSTRACT FROM AUTHOR]

BACKGROUND: Sustained acoustic medicine (SAM) is a noninvasive long-term treatment that provides essential mechanical and thermal stimulus to accelerate soft tissue healing, alleviate pain, and improve physical activity. SAM increases localized deep tissue temperature, blood flow, cellular proliferation, migration, and nutrition exchange, resulting in reduced inflammation and an increased rate of tissue regeneration. OBJECTIVE: To assess the efficacy of SAM treatment of discogenic back pain in the lower spinal column to reduce pain, improve quality of life, and lower pharmacotherapy use. METHODS: Sixty-five subjects with chronic low back pain were randomly assigned to SAM (N = 33) or placebo (N = 32) groups. Subjects self-applied SAM device bilaterality on the lower lumbar region for 4 hours daily for 8 weeks and completed daily pain diaries before, during, and after treatment. Subjects recorded pain reduction using a numeric rating scale (NRS), medication use, and physical activity using the Global Rating of Change (GROC) and Oswestry Disability Index (ODI). RESULTS: SAM treatment significantly reduced chronic lower back pain from baseline relative to placebo treatment (p < 0.0001). SAM treated subjects reported significantly lower back pain at 4 weeks, with the highest pain reduction (- 2.58 points NRS, p < 0.0001) reported at 8 weeks. Similar trends were observed in improved physical activity (3.48 GROC, p < 0.0001, 69–88% ODI, p < 0.0001) and 22.5% (15.2 morphine milligram equivalent) reduction in the use of opioid medication from baseline to 8 weeks. CONCLUSION: Daily, home-use SAM treatment significantly improves the clinical symptoms of chronic lower back pain, improves physical mobility, and reduces daily medication use. SAM treatment is well-tolerated by patients and may be considered a safe, non-invasive treatment option for chronic discogenic, lower back pain. [ABSTRACT FROM AUTHOR]

When Kathryn Tanner delivered the Gifford Lectures in May 2016, she developed a cold. As one may observe from watching the online lectures, Tanner, armed with lozenges, hoarsely battled through. [...]

Geoscientists are involved in both the upstream and downstream side of the extractive industries. As explorationists and field geologists, they are often the first technical people related to extractive industries that communities meet. It is imperative in an increasingly globalized and holistic world that geoscientists gain greater awareness of the socio-economic impact of extractive industries and become a more proactive part of improving outcomes for all with respect to extractive industries. When Jigme Singye Wangchuk, the King of Bhutan, first suggested the concept of ‘Gross National Happiness’ (GNH) in 1972, it was met with widespread cynicism and puzzlement. Was the concept meaningful in a hard, economically competitive world? A series of measures, including the Human Development Index (HDI), the Gini Coefficient (GC), and the now annual World Happiness Report (WHR), are evolutionary responses to the 1972 GNH and are widely accepted as proxy measures of holistic human progress. These measures go beyond the narrow confines of Gross Domestic Product and similar economic proxies, placing economic parameters alongside the social, environmental, spiritual, human rights, health, and holistic societal issues. The broad conclusions of the plethora of metrics are that ‘happiness’ links to issues and ideas such as equity, minimal economic inequality, excellent governance, human rights, individual freedom, and so forth. We ask the question: what is the relationship between extractive industries (EIs) and GNH? We present a wide range of data and analytical diagrams/text examining potential correlations and associations between GNH and EIs. We examine potential relationships using global data and case studies for Papua New Guinea, Mongolia, the DRC, and Jamaica. The conclusions of this analysis of course suggest a complex relationship between EIs and GNH. We acknowledge that in situations of weak governance and institutions, EIs struggle to make any tangible difference with respect to GNH. A counter conclusion that EIs may even be a major cause of weak governance, which in turn suppresses happiness, must be seriously considered. We document examples where EIs have made a definitive positive improvement to GNH. Data suggest that hydrocarbon-rich countries have made better progress with respect to GNH than mineral-rich countries. However, the main conclusion is that the link between EIs and GNH remains a work in progress, and that a narrow focus on profit and shareholder return is an antithetical approach to the GNH paradigm. A key recommendation is that industry must adopt a far more active role (rather than merely a passive role) with respect to translating the many potential benefits of EIs into GNH than has hitherto been the case.

Ambitle in the Feni Island Group is located within the NW trending Tabar–Lihir–Tanga–Feni (TLTF) volcanic island chain, Melanesian Arc, northeastern Papua New Guinea. The TLTF chain is renowned for its alkaline magmatism, geothermal activity, copper–gold mineralization, and world-class gold mining. Although its geochemical patterns indicate island arc signatures (i.e., high LILE and depleted HFSE), TLTF volcanism is not directly related to the older Melanesian Arc subduction system. However, it may have been influenced by source mantle metasomatism linked to the older subduction. The purpose of this study is to (1) present and interpret the petrographic, mineralogical, and geochemical data from Feni within the context of the tectonic evolution of the TLTF and (2) propose a geodynamic, petrogenetic model for the Feni volcanic rocks. The key methodologies used in this study are field mapping and sampling, petrographic analysis using the optical microscope, whole-rock geochemical analysis via XRF and ICP MS, and mineralogical analysis using an electron microprobe. The main rock types sampled in this study include feldspathoid-bearing basalt, trachybasalt, phonotephrite, trachyandesite, and trachydacite. Minerals identified include forsteritic olivine, diopside, augite, labradorite, andesine, anorthitic plagioclase, nepheline, and leucite in the primitive mafic suites, whereas the more evolved intermediate and felsic hypabyssal suites contain amphibole, albite, orthoclase, biotite, and either rare quartz or feldspathoids. Amphibole composition is primarily magnesiohastingsite with minor pargasite formed under polybaric conditions. Accessory minerals include apatite, titanite, and Ti-magnetite. We propose that limestone assimilation followed by fractional crystallization are plausible dominant processes in the geochemical evolution of the Ambitle volcanics. Clinopyroxene fractionation is dominant in the mafic volcanics whereas hornblende fractionation is a major petrologic process within the intermediate suites proven by the enrichment of LREE and depletions in MREE and HREE. Feni magmas are also highly enriched in REEs relative to neighboring arcs. This study is globally significant as alkaline magmas are important sources of Cu, Au, and REE as critical elements for green energy and modern technology.

The COVID-19 disease, caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), emerged in late 2019 and rapidly spread worldwide, becoming a pandemic that infected millions of people and caused significant deaths. COVID-19 continues to be a major threat, and there is a need to deepen our understanding of the virus and its mechanisms of infection. To study the cellular responses to SARS-CoV-2 infection, we performed an RNA sequencing of infected vs. uninfected Calu-3 cells. Total RNA was extracted from infected (0.5 MOI) and control Calu-3 cells and converted to cDNA. Sequencing was performed, and the obtained reads were quality-analyzed and pre-processed. Differential expression was assessed with the EdgeR package, and functional enrichment was performed in EnrichR for Gene Ontology, KEGG pathways, and WikiPathways. A total of 1040 differentially expressed genes were found in infected vs. uninfected Calu-3 cells, of which 695 were up-regulated and 345 were down-regulated. Functional enrichment analyses revealed the predominant up-regulation of genes related to innate immune response, response to virus, inflammation, cell proliferation, and apoptosis. These transcriptional changes following SARS-CoV-2 infection may reflect a cellular response to the infection and help to elucidate COVID-19 pathogenesis, in addition to revealing potential biomarkers and drug targets.

Organic chemistry is a required course sequence for many STEM students. However, research indicates that organic chemistry reaction mechanisms are especially challenging for students due to a mixture of underlying conceptual difficulties, the process-oriented thinking inherent to the discipline, and the representations commonly used to depict mechanisms. While student reasoning about many of the reaction types covered in the organic chemistry curriculum has been studied previously, there is minimal research focused specifically on how students think about the mechanisms of addition reactions. Understanding students' conceptions about addition reactions is valuable for both instructors and researchers, as these reactions are among the first for which students must consider different chemical properties to make a decision about alternate reaction pathways. This study provides insight into how students think about these reactions by probing first semester organic chemistry students' thinking using think-aloud interviews as they worked through two addition reactions. To elicit a range of thinking, students worked through the mechanisms using either paper and pencil or an app that dynamically represents the molecules. Generally, students were able to identify the steps of the two addition reactions but did not always successfully apply chemical thinking during the mechanistic steps. Most prominently, both groups of students struggled with the concepts related to carbocation stability, frequently misapplying stabilization via substitution and demonstrating difficulty in identifying the potential for resonance stabilization. Our results suggest that instructors should emphasize the conceptual grounding that directs mechanistic steps, in particular when determining carbocation stability. More generally, our findings suggest that instructors must emphasize the skill of considering and weighing different chemical properties when making decisions about alternative reaction pathways.

An understanding of acid-base reactions is necessary for success in chemistry courses and relevant to careers outside of chemistry, yet research has demonstrated that students often struggle with learning acid-base reaction mechanisms in organic chemistry. One response to this challenge is the development of educational applications to support instruction and learning. The development of these supports also creates an opportunity to probe students' thinking about organic chemistry reaction mechanisms using multiple modalities--i.e., using an app interface or the traditional paper-pencil. This study used think-aloud interviews conducted with undergraduate students in their first semester of organic chemistry to understand how they worked through two acid-base reactions using either paper-pencil or an app. Analysis of the interviews indicates that students from both groups recognize the steps of acid-base reactions, but do not always apply the underlying concepts, such as assessment of pK[subscript a] values or resonance, when determining how a reaction will proceed. The modality seemed to somewhat influence students' thinking, as the app prevented students from making chemically unreasonable mistakes. However, some students relied on the cues it provided, which could potentially be problematic when they are required to respond to assessments that do not provide these cues. Our results suggest that instructors should emphasize the conceptual grounding for the steps that govern acid-base reactions to promote chemical thinking about the relationships between the reaction components and how those influence reaction outcomes, as well as support students to think critically about the chemical information contained within the modalities they are using.

Abstract Introduction: There is an increasing recognition of the benefits of sustained community engagement (CE) that accrue to academic health centers and the communities they serve. However, the success and sustainability of CE projects rely on the efforts of individual faculty, learners, and community members, for whom CE efforts are typically added to their professional and personal priorities and responsibilities. This competition for time and resources between priorities and CE can discourage academic medical faculty from participating in CE activities. The Stacked Community Engagement model is proposed to synergize or “stack” responsibilities and goals onto the scaffolding of CE projects. Methods: We examined the literature and expert CE practitioner opinion to identify the challenges faced by community-engaged academic faculty and the key characteristics of CE projects that successfully align and integrate with the priorities of faculty, learners, and community members. We synthesized this information to develop the conceptual Stacked CE model for developing CE academic medical faculty, then illustrated the model in heterogeneous CE programs to explore its generalizability, validity, and robustness. Results: The Stacked CE model, when applied to a specific nutrition education program (The Food Doctors) and outreach program (StreetLife Communities), provided a practical framework for examining the sustained success of a partnership between Medical College of Wisconsin faculty and medical students and the community. Conclusions: The Stacked CE model is a meaningful framework for developing community-engaged academic medical faculty. By identifying overlap and integrating CE into professional activities with intention, CE practitioners can benefit from the deeper connections and sustainability.

Objective: To assess the impact of standardized pretransplant alcohol abstinence and treatment guidelines on liver transplant outcomes. Methods: This study assessed the posttransplant relapse and survival associated with a pretransplant guideline mandating alcohol abstinence, addiction treatment, and Alcoholics Anonymous (AA) attendance. This retrospective cohort study included liver recipients with alcohol-induced liver disease transplanted between January 1, 2000, and December 31, 2012, at a Midwest transplant center. Cox regression models tested for associations between pretransplant treatment, demographic and clinical characteristics, and outcome measures. Results: Of 236 liver recipients (188 [79.7%] male; 210 [89%] white; mean follow-up, 88.6±55.0 months), 212 (90.2%) completed pretransplant treatment and 135 (57.2%) attended AA weekly. At 5 years, 16.3% and 8.2% had relapsed to any alcohol use and to high-dose drinking, respectively. Smoking during the 6 months before transplant was associated with any relapse (P=.0002) and high-dose relapse (P