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Evaluating farm-scale energy used for broiler production can provide insight into how these facilities use energy and allow for seasonal and managerial influences to be evaluated. This study evaluated farm-scale energy consumption for South Carolina broiler production using energy records from 17 broiler and 4 pullet farms. Monthly electric use showed low to moderate correlation (r ranging from 0.476–0.630) with ambient temperature but had limited predictive usefulness. There was no clear pattern in monthly electrical energy use for broiler barns. However, pullet barns were more consistent and could be grouped into seasons. No significant differences (p < 0.05) in annual electric or gas use were observed between farms with generally better equipment and otherwise similar farms, but production type did influence annual electric use. The average annual electrical use was 23.6 kWh m−2 for farms producing larger birds, 8.7 kWh m−2 for those producing smaller birds, and 17.0 kWh m−2 for pullet farms. Electrical energy use accounted for 37% of total energy in broiler barns and 32% of energy in pullet barns. Combined electric and gas consumption averaged 214 MJ m−2 yr−1 across all farms. These findings help better quantify farm-scale energy used for broiler production and provide benchmark values for energy use.

Abstract Categorical learning is important and often challenging in both specialized domains, such as medical image interpretation, and commonplace ones, such as face recognition. Research has shown that comparing items from different categories can enhance the learning of perceptual classifications, particularly when those categories appear highly similar. Here, we developed and tested novel adaptively triggered comparisons (ATCs), in which errors produced during interactive learning dynamically prompted the presentation of active comparison trials. In a facial identity paradigm, undergraduate participants learned to recognize and name varying views of 22 unknown people. In Experiment 1, single-item classification trials were compared to a condition in which ATC trials were generated whenever a participant repeatedly confused two faces. Comparison trials required discrimination between simultaneously presented exemplars from the confused categories. In Experiment 2, an ATC condition was compared to a non-adaptive comparison condition. Participants learned to accuracy and speed criteria, and completed immediate and delayed posttests. ATCs substantially enhanced learning efficiency in both experiments. These studies, using a novel adaptive procedure guided by each learner’s performance, show that adaptively triggered comparisons improve category learning.

Abstract Background This study explores the use of Unmanned Aerial Vehicles (UAVs) for estimating wheat biomass, focusing on the impact of phenotyping and analytical protocols in the context of late-stage variety selection programs. It emphasizes the importance of variable selection, model specificity, and sampling location within the experimental plot in predicting biomass, aiming to refine UAV-based estimation techniques for enhanced selection accuracy and throughput in variety testing programs. Results The research uncovered that integrating geometric and spectral traits led to an increase in prediction accuracy, whilst a recursive feature elimination (RFE) based variable selection workflowled to slight reductions in accuracy with the benefit of increased interpretability. Models, tailored to specific experiments were more accurate than those modelling all experiments together, while models trained for broad-growth stages did not significantly increase accuracy. The comparison between a permanent and a precise region of interest (ROI) within the plot showed negligible differences in biomass prediction accuracy, indicating the robustness of the approach across different sampling locations within the plot. Significant differences in the within-season repeatability (w2) of biomass predictions across different experiments highlighted the need for further investigation into the optimal timing of measurement for prediction. Conclusions The study highlights the promising potential of UAV technology in biomass prediction for wheat at a small plot scale. It suggests that the accuracy of biomass predictions can be significantly improved through optimizing analytical and modelling protocols (i.e., variable selection, algorithm selection, stage-specific model development). Future work should focus on exploring the applicability of these findings under a wider variety of conditions and from a more diverse set of genotypes.

Purpose – In this study, we question: how do the social costs of failure interact with gendered institutions to affect the early stage entrepreneurship activity? We address this question by employing the institutional theory and a unique dataset of 286,989 entrepreneurs across 35 countries. Design/methodology/approach – To test our hypotheses, we use a multilevel modeling analysis that nests individual entrepreneurs within the countries. To capture individual and country-level variables, we constructed a unique dataset that combines data from the Global Entrepreneurship Monitor (GEM), European Flash Barometer (EUFB), World Bank Development Indicator (WDI), World Bank Doing Business Report (WBDB) and World Economic Forum (WEF). Findings – Our analysis confirms that higher levels of the country-level gender equality positively correlate with the early-stage entrepreneurship activity of women. Moreover, we find that this positive relationship is amplified in institutional environments with high social costs of failure, suggesting that societal intolerance for failure can exacerbate the negative effect of gender inequality on the participation of women in entrepreneurship. Research limitations/implications – Our research contributes to academic interest on the role of legitimacy in women entrepreneurship and is of particular interest to international business scholars, seeking a better understanding of multidimensional construction of institutional frameworks across countries. In this study, we set out to address an important research question: how do the social costs of failure interact with gendered institutions to affect entrepreneurship activity? Our study provides a comprehensive portrait of gendered institutions by including the framework conditions of education, healthcare and political power. We found that in societies with gender equality, the likelihood of individuals engaging in the early-stage entrepreneurship activity is higher and that the positive relationship is strengthened in national environments with high social costs of failure. Practical implications – Our study findings underscore the need for government policies addressing global gender gaps in economic empowerment. In particular, policies assisting women in obtaining education in high-growth industries like information technology or providing funding to women-dominated industries may foster activity for women seeking to do business in such industries. Such policies connect the early-stage entrepreneurship activities with gender equality concerns and initiatives. Social implications – Regarding the social costs of failure construct, specifically, prior studies generally focus narrowly on the context of failed entrepreneurs. We cast a wider net on men and women entrepreneurs’ entry decisions (irrespective of prior experience with business failure) and provide new views on the effects of social costs of failure on entrepreneurial ecosystems. We also extend the research on the legitimacy of women as entrepreneurs with the gender equality construct. Originality/value – Unlike previous studies, which often focus on the “3Ms” of market, money and management, our research adopts a more holistic perspective. We recognize that the opportunities and challenges faced by entrepreneurs are shaped not only by individual skills and resources but also by the broader macroenvironment. By incorporating the framework conditions of education, healthcare and political power, alongside the intricate interplay of social costs and norms, our study paints a comprehensive picture of the landscape of female entrepreneurship.

Abstract Background The RNLI “Float to Live” campaign is based on research conducted in indoor pools with experienced open water swimmers. Study 1 investigated whether the RNLI “Float to Live” guidance would enable less experienced individuals to float in realistic open water conditions. Study 2 examined the separate effects of practice and coaching on floating competence. Methods Study 1: Inexperienced water users conducted floats in either still, open fresh (n = 22) or open sea water (n = 13), followed by moving sea (n = 6) or fresh water (n = 5). Participants undertook three 2-min floats in still water wearing swimwear and one clothed float: 1) naïve; 2) following RNLI “Float to live” messaging; 3) individual float coaching; 4) simulated fall wearing summer clothing. In moving sea water, participants undertook two floats equivalent to Floats 3 and 4. In moving fresh water, participants undertook 3 floats: 1) naïve; 2) following “defensive floating” coaching; 3) simulated fall wearing summer clothing. Study 2: Two groups matched for skinfold thickness undertook three 2-min floats in a flume wearing swimwear. PRAC group (n = 12): 1) naïve; 2) following float practice; 3) float coaching; COACH group (n = 11) coaching followed by practice. Floating difficulty, confidence, competence, “efficiency” and perceived exertion were analysed using either a Friedman test or mixed model ANOVA. Results In both fresh water and sea water, participants’ floating competence and confidence increased after viewing the RNLI messaging, it was further improved with individualised float coaching. The additional helpful instructions included: 1) “head back with ears submerged”; 2) “relax”; 3) “breathe normally”; 4) “it is OK if your legs sink”; 5) an accurate description of sculling for “active” floaters that needed it; 6) spread arms and legs for stability. The simulated fall with clothing did not impair floating competence. No difference in floating competence was seen between PRAC and COACH, though confidence may be increased sooner in COACH. Conclusions The RNLI float advice can be applied in realistic open water settings by less experienced water users. Additional content could be included to make the messaging even more effective.

Abstract Background BMI variability has been associated with increased cardiovascular disease risk in individuals with type 2 diabetes, however comparison between clinical studies and real-world observational evidence has been lacking. Furthermore, it is not known whether BMI variability has an effect independent of HbA1c variability. Methods We investigated the association between BMI variability and 3P-MACE risk in the Harmony Outcomes trial (n = 9198), and further analysed placebo arms of REWIND (n = 4440) and EMPA-REG OUTCOME (n = 2333) trials, followed by real-world data from the Tayside Bioresource (n = 6980) using Cox regression modelling. BMI variability was determined using average successive variability (ASV), with first major adverse cardiovascular event of non-fatal stroke, non-fatal myocardial infarction, and cardiovascular death (3P-MACE) as the primary outcome. Results After adjusting for cardiovascular risk factors, a + 1 SD increase in BMI variability was associated with increased 3P-MACE risk in Harmony Outcomes (HR 1.12, 95% CI 1.08–1.17, P

Abstract Background Ethnicity is known to be an important correlate of health outcomes, particularly during the COVID-19 pandemic, where some ethnic groups were shown to be at higher risk of infection and adverse outcomes. The recording of patients’ ethnic groups in primary care can support research and efforts to achieve equity in service provision and outcomes; however, the coding of ethnicity is known to present complex challenges. We therefore set out to describe ethnicity coding in detail with a view to supporting the use of this data in a wide range of settings, as part of wider efforts to robustly describe and define methods of using administrative data. Methods We describe the completeness and consistency of primary care ethnicity recording in the OpenSAFELY-TPP database, containing linked primary care and hospital records in > 25 million patients in England. We also compared the ethnic breakdown in OpenSAFELY-TPP with that of the 2021 UK census. Results 78.2% of patients registered in OpenSAFELY-TPP on 1 January 2022 had their ethnicity recorded in primary care records, rising to 92.5% when supplemented with hospital data. The completeness of ethnicity recording was higher for women than for men. The rate of primary care ethnicity recording ranged from 77% in the South East of England to 82.2% in the West Midlands. Ethnicity recording rates were higher in patients with chronic or other serious health conditions. For each of the five broad ethnicity groups, primary care recorded ethnicity was within 2.9 percentage points of the population rate as recorded in the 2021 Census for England as a whole. For patients with multiple ethnicity records, 98.7% of the latest recorded ethnicities matched the most frequently coded ethnicity. Patients whose latest recorded ethnicity was categorised as Other were most likely to have a discordant ethnicity recording (32.2%). Conclusions Primary care ethnicity data in OpenSAFELY is present for over three quarters of all patients, and combined with data from other sources can achieve a high level of completeness. The overall distribution of ethnicities across all English OpenSAFELY-TPP practices was similar to the 2021 Census, with some regional variation. This report identifies the best available codelist for use in OpenSAFELY and similar electronic health record data.

Objective The objective of this study was to describe the real‐world characteristics and clinical status of patients with psoriatic arthritis (PsA) currently prescribed ixekizumab. Methods Data were drawn from the Adelphi PsA Plus Disease Specific Programme (DSP), a cross‐sectional survey conducted in the United States between September 2021 and March 2022. Rheumatologists provided data for their next five consulting patients currently receiving ixekizumab, including demographic and clinical characteristics, disease severity, treatment history, reasons for treatment choice, satisfaction with current treatment, and current and historic symptom burden. Patients voluntarily completed questionnaires, providing perceptional data on symptom burden and satisfaction with current treatment. Results Overall, 68 rheumatologists provided data on 275 patients with PsA, 90 of whom completed the voluntary questionnaire. Patients had been prescribed ixekizumab for a mean of 11.7 (SD 10.6) months. Clinical characteristics, disease severity, and symptom burden of patients with PsA improved significantly from ixekizumab initiation to the most recent consultation, including symptom burden, tender and swollen joint counts, and body surface area affected by psoriasis (all P < 0.001). Both rheumatologists and patients were satisfied with ixekizumab treatment and reported improvements in pain and fatigue. Improvements were noted after more than three months of ixekizumab treatment duration and regardless of whether the patients had prior exposure to an advanced therapy or were treatment naïve. Conclusion Our results indicate that ixekizumab was efficacious in the treatment of PsA in real‐world clinical practice, complementing efficacy data from randomized controlled clinical trials. The results of this study may assist rheumatologists and their patients in making informed treatment choices.

Abstract Background With the global challenge of antimicrobial resistance intensified during the COVID-19 pandemic, evaluating adverse events (AEs) post-antibiotic treatment for common infections is crucial. This study aims to examines the changes in incidence rates of AEs during the COVID-19 pandemic and predict AE risk following antibiotic prescriptions for common infections, considering their previous antibiotic exposure and other long-term clinical conditions. Methods With the approval of NHS England, we used OpenSAFELY platform and analysed electronic health records from patients aged 18–110, prescribed antibiotics for urinary tract infection (UTI), lower respiratory tract infections (LRTI), upper respiratory tract infections (URTI), sinusitis, otitis externa, and otitis media between January 2019 and June 2023. We evaluated the temporal trends in the incidence rate of AEs for each infection, analysing monthly changes over time. The survival probability of emergency AE hospitalisation was estimated in each COVID-19 period (period 1: 1 January 2019 to 25 March 2020, period 2: 26 March 2020 to 8 March 2021, period 3: 9 March 2021 to 30 June 2023) using the Kaplan–Meier approach. Prognostic models, using Cox proportional hazards regression, were developed and validated to predict AE risk within 30 days post-prescription using the records in Period 1. Results Out of 9.4 million patients who received antibiotics, 0.6% of UTI, 0.3% of URTI, and 0.5% of LRTI patients experienced AEs. UTI and LRTI patients demonstrated a higher risk of AEs, with a noted increase in AE incidence during the COVID-19 pandemic. Higher comorbidity and recent antibiotic use emerged as significant AE predictors. The developed models exhibited good calibration and discrimination, especially for UTIs and LRTIs, with a C-statistic above 0.70. Conclusions The study reveals a variable incidence of AEs post-antibiotic treatment for common infections, with UTI and LRTI patients facing higher risks. AE risks varied between infections and COVID-19 periods. These findings underscore the necessity for cautious antibiotic prescribing and call for further exploration into the intricate dynamics between antibiotic use, AEs, and the pandemic.

Abstract ANKRD11 (Ankyrin Repeat Domain 11) is a chromatin regulator and a causative gene for KBG syndrome, a rare developmental disorder characterized by multiple organ abnormalities, including cardiac defects. However, the role of ANKRD11 in heart development is unknown. The neural crest plays a leading role in embryonic heart development, and its dysfunction is implicated in congenital heart defects. We demonstrate that conditional knockout of Ankrd11 in the murine embryonic neural crest results in persistent truncus arteriosus, ventricular dilation, and impaired ventricular contractility. We further show these defects occur due to aberrant cardiac neural crest cell organization leading to outflow tract septation failure. Lastly, knockout of Ankrd11 in the neural crest leads to impaired expression of various transcription factors, chromatin remodelers and signaling pathways, including mTOR, BMP and TGF-β in the cardiac neural crest cells. In this work, we identify Ankrd11 as a regulator of neural crest-mediated heart development and function.

The application of extracellular vesicles, particularly exosomes (EXs), is rapidly expanding in the field of medicine, owing to their remarkable properties as natural carriers of biological cargo. This study investigates utilization of exosomes derived from stromal cells of tumor adjacent normal tissues (NAF-EXs) for personalized medicine, which can be derived at the time of diagnosis by endoscopic ultrasound. Herein, we show that exosomes (EXs) derived from NAFs demonstrate differential bio-physical characteristics, efficient cellular internalization, drug loading efficiency, pancreatic tumor targeting and delivery of payloads. NAF-derived EXs (NAF-EXs) were used for loading ormeloxifene (ORM), a potent anti-cancer and desmoplasia inhibitor as a model drug. We found that ORM maintains normal fibroblast cell phenotype and renders them incompatible to be triggered for a CAF-like phenotype, which may be due to regulation of Ca2+ influx in fibroblast cells. NAF-EXs-ORM effectively blocked oncogenic signaling pathways involved in desmoplasia and epithelial mesenchymal transition (EMT) and repressed tumor growth in xenograft mouse model. In conclusion, our data suggests preferential tropism of NAF-EXs for PDAC tumors, thus imply feasibility of developing a novel personalized medicine for PDAC patients using autologous NAF-EXs for improved therapeutic outcome of anti-cancer drugs. Additionally, it provides the opportunity of utilizing this biological scaffold for effective therapeutics in combination with standard therapeutic regimen.

Abstract: As human development continues to expand, wildlife must relocate or adapt to survive. Many mammalian mesopredators, such as the Virginia opossum (Didelphis virginiana), have adapted to living alongside human development. Furthermore, top‐down predation pressure may be altered in nuanced ways within the human environment. Species such as opossums may be shielded from predation by human development or behavioral changes in predators. Understanding how dominant and subordinate mesopredators co‐exist across natural and developed areas will provide insight into how wildlife communities are structured. Our objective was to evaluate how opossum occupancy, abundance, and activity were associated with human development and the relative abundance of their predators. We used data from a nationwide camera trapping study, Snapshot USA, to estimate opossum occupancy, abundance, and activity. We related these measures to the surrounding landscape and urbanization variables. We found that opossum occupancy was positively associated with anthropogenic sound (a surrogate for human activity). Furthermore, opossums in heavily forested areas were more likely to be detected in locations with higher predicted anthropogenic sounds. In areas with a high density of human housing, opossum relative abundance increased when predator abundance increased. We also found opossums were strictly nocturnal and shifted their activity to earlier in the evening in the presence of high predator abundance. Our results suggest that humans and their urban development can have multidimensional impacts on opossum behavior and occurrence, and could facilitate changes in predator–prey dynamics. Future research should evaluate if the association of opossums with urban areas is due to human‐subsidized resources or caused by reduced mortality from altered predator–prey dynamics.

OBJECTIVE: Among neonates with acute symptomatic seizures, we evaluated whether inability to take full feeds at time of hospital discharge from neonatal seizure admission is associated with worse neurodevelopmental outcomes, after adjusting for relevant clinical variables. METHODS: This prospective, 9-center study of the Neonatal Seizure Registry (NSR) assessed characteristics of infants with seizures including: evidence of brainstem injury on MRI, mode of feeding upon discharge, and developmental outcomes at 12, 18, and 24 months. Inability to take oral feeds was identified through review of medical records. Brainstem injury was identified through central review of neonatal MRIs. Developmental outcomes were assessed with the Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA-FS) at 12, 18, and 24 months corrected age. RESULTS: Among 276 infants, inability to achieve full oral feeds was associated with lower total WIDEA-FS scores (160.2±25.5 for full oral feeds vs. 121.8±42.9 for some/no oral feeds at 24 months, p

Abstract: We present the survey design, implementation, and outlook for COSMOS-Web, a 255 hr treasury program conducted by the James Webb Space Telescope in its first cycle of observations. COSMOS-Web is a contiguous 0.54 deg2 NIRCam imaging survey in four filters (F115W, F150W, F277W, and F444W) that will reach 5σ point-source depths ranging ∼27.5–28.2 mag. In parallel, we will obtain 0.19 deg2 of MIRI imaging in one filter (F770W) reaching 5σ point-source depths of ∼25.3–26.0 mag. COSMOS-Web will build on the rich heritage of multiwavelength observations and data products available in the COSMOS field. The design of COSMOS-Web is motivated by three primary science goals: (1) to discover thousands of galaxies in the Epoch of Reionization (6 ≲ z ≲ 11) and map reionization’s spatial distribution, environments, and drivers on scales sufficiently large to mitigate cosmic variance, (2) to identify hundreds of rare quiescent galaxies at z > 4 and place constraints on the formation of the universe’s most-massive galaxies (M ⋆ > 1010 M ⊙), and (3) directly measure the evolution of the stellar-mass-to-halo-mass relation using weak gravitational lensing out to z ∼ 2.5 and measure its variance with galaxies’ star formation histories and morphologies. In addition, we anticipate COSMOS-Web’s legacy value to reach far beyond these scientific goals, touching many other areas of astrophysics, such as the identification of the first direct collapse black hole candidates, ultracool subdwarf stars in the Galactic halo, and possibly the identification of z > 10 pair-instability supernovae. In this paper we provide an overview of the survey’s key measurements, specifications, goals, and prospects for new discovery.

BACKGROUND: An ancillary study of the High-Dose Erythropoietin for Asphyxia and Encephalopathy (HEAL) trial for neonates with hypoxic-ischemic encephalopathy (HIE) and treated with therapeutic hypothermia examined the hypothesis that neonates randomized to receive erythropoietin (Epo) would have a lower seizure risk and burden compared with neonates who received placebo. METHODS: Electroencephalograms (EEGs) from 7/17 HEAL trial centers were reviewed. Seizure presence was compared across treatment groups using a logistic regression model adjusting for treatment, HIE severity, center, and seizure burden prior to the first dose. Among neonates with seizures, differences across treatment groups in median maximal hourly seizure burden were assessed using adjusted quantile regression models. RESULTS: Forty-six of 150 (31%) neonates had EEG seizures (31% in Epo vs 30% in placebo, p = 0.96). Maximal hourly seizure burden after the study drug was not significantly different between groups (median 11.4 for Epo, IQR: 5.6, 18.1 vs median 9.7, IQR: 4.9, 21.0 min/h for placebo). CONCLUSION: In neonates with HIE treated with hypothermia who were randomized to Epo or placebo, we found no meaningful between-group difference in seizure risk or burden. These findings are consistent with overall trial results, which do not support Epo use for neonates with HIE undergoing therapeutic hypothermia. IMPACT: In the HEAL trial of erythropoietin (Epo) vs placebo for neonates with encephalopathy presumed due to hypoxic-ischemic encephalopathy (HIE) who were also treated with therapeutic hypothermia, electrographic seizures were detected in 31%, which is lower than most prior studies. Epo did not reduce the proportion of neonates with acute provoked seizures (31% in Epo vs 30% in placebo) or maximal hourly seizure burden after the study drug (median 11.4, IQR 5.6, 18.1 for Epo vs median 9.7, IQR 4.9, 21.0 min/h for placebo). There was no anti- or pro-convulsant effect of Epo when combined with therapeutic hypothermia for HIE.

During their studies, musicians transition to work-readiness, develop a professional persona and graduate from skills acquisition in a traditional master-mentor relationship towards heterarchical collaboration in ensembles. Over the final year of an undergraduate program in performance, students, faculty/industry mentors and course coordinators worked collaboratively to implement a music work integrated learning (WIL) project, culminating in public performance as a capstone experience. This phenomenological case report outlines how a student group with diverse skills formed a complex adaptive system through inclusion, connection, support, and collaboration culminating in a final public performance and this practice report. Through this process, students obtained a broad range of graduate skills as well as professional musical competencies within a functioning heterarchy. In creative and performing arts, WIL can positively produce professional outcomes that appear indistinguishable from professional practice in the industry at large. This can be a model for transformative WIL in other disciplines. In addition, this research and practice report was prepared primarily by students with a faculty mentor, providing yet another set of graduate skills for musicians seeking portfolio careers in the arts.

This study analyzes the flipped instruction model used in three special education educator preparation courses to examine which components preservice teachers perceived most contributed to their content knowledge, motivation, and engagement (n=50). Weekly pre-class asynchronous assignments included the use of educational technology tools such as an interactive e-textbook site, Perusall, and online academic activities such as Khan Academy to strengthen their content knowledge. This allowed more time for a student-centered approach during synchronous instruction to incorporate tools such as Nearpod, Pear Deck, Flipgrid and digital badges to strengthen their motivation and engagement. Data were collected through a post-course survey; results indicate that preservice teachers perceived this model was motivating, engaging, and contributed significantly to their content knowledge. They also identified hands-on activities during class as a significant component of their learning. This article discusses the project, limitations, and implications for future flipped instruction research in special education educator preparation programs.

Objectives To evaluate and compare medication adherence and persistence for patients newly initiating single-inhaler triple therapy (SITT) and multiple-inhaler triple therapy (MITT) for chronic obstructive pulmonary disease (COPD) in Japan.Design Retrospective, new-user, active comparator, observational cohort study using inverse probability of treatment weighting.Setting Health insurance claims data from the Medical Data Vision Co., Ltd, hospital claims database.Participants Adults diagnosed with COPD at age ≥40 years newly initiating MITT or SITT (fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) or formoterol fumarate/budesonide/glycopyrronium) from 1 September 2019 to 31 July 2021.Primary and secondary outcome measures The primary outcome was medication adherence compared between patients using SITT and MITT, assessed by the proportion of days covered ≥80%. Secondary outcomes included medication persistence (time from index treatment initiation to discontinuation) compared between patients using SITT and MITT and medication adherence compared before and after the switch in a subgroup of patients switching from MITT to SITT.Results We included 2575 MITT and 2962 SITT users with similar baseline characteristics following weighting. The proportion of adherent patients was significantly greater for SITT versus MITT users at 6 months (19.7% vs 10.2%, p

Introduction: Despite escalating rates of sexually transmitted infections (STIs) in the United States (US), there has been progressive divestment of sexual health services leading to the reliance on emergency departments (EDs) for sexual healthcare, particularly among vulnerable populations. The Sexual Wellness Clinic (SWC), a novel care delivery model operating in collaboration with the ED, offers comprehensive sexual health services. Objectives: This study aims to analyze the demographics, STI positivity, and HIV Pre-Exposure Prophylaxis (PrEP) uptake among patients accessing the SWC. Design: This was a retrospective cohort study of patients attending the SWC between February 20, 2019, and September 30, 2022. Methods: Sociodemographic characteristics, STI testing results, and PrEP initiation data were collected from the electronic health record (EHR). Two multivariable logistic regression models were employed to assess associations between patient factors and STI positivity or PrEP initiation. Results: Among 651 individuals across 785 SWC visits, the majority were Black or African American (94.6%), 18–29 years of age (53.2%), and on Medicaid (65.8%). Of all visits, 27.3% resulted in a syphilis diagnosis, 16.1% tested positive for chlamydia test, and 15.0% tested positive for gonorrhea. Decreased STI positivity was associated with insertive vaginal sex (adjusted odds ratio (aOR): 0.34, p = 0.0079) while using condoms most of the time use was associated with increased STI positivity (aOR: 2.68, p = 0.0038). Eighty SWC patients started PrEP on the same day as their visit, most of which were non-Hispanic Black (96.26%), assigned female at birth (53.75%), and on Medicaid or Medicare (68.75%). Factors associated with PrEP initiation at the SWC included a previous STI (aOR: 3.78, p

Abstract One third of epilepsy patients are resistant to treatment with current anti‐seizure medications. The ketogenic diet is used to treat some forms of refractory epilepsy, but the mechanism of its action has not yet been elucidated. In this study, we aimed to investigate whether the hydroxycarboxylic acid receptor 2 (HCA2), a known immunomodulatory receptor, plays a role in mediating the protective effect of this diet. We demonstrate for the first time that selective agonists at this receptor can directly reduce seizures in animal models. Agonists also reduce network activity in rodent and human brain slices. Ketogenic diet is known to increase circulating levels of endogenous HCA2 agonists, and we show that the effect of ketogenic diet in reducing seizures in the 6 Hz seizure model is negated in HCA2‐deficient mice. Our data support the potential of HCA2 as a target for the treatment of epilepsy and potentially for neurodegenerative diseases.

This article examines the landscape of Science, Technology, and Innovation policies in Central America, focusing on Nicaragua, Guatemala, Honduras, and El Salvador. These nations face significant challenges in leveraging STI for sustainable development, including financial constraints and limited resources. Additionally, Central America struggles with systemic issues such as corruption, violence, and high levels of emigration, further complicating efforts to advance STI. A workshop organized by Georgetown University's Science Technology and International Affairs program brought together scholars to discuss STI policies, resulting in key recommendations. The article highlights critical challenges, including over-reliance on state funding, stagnant researcher numbers, and the pressing need for research diversification. It emphasizes the importance of youth engagement, leadership, and resilience in shaping effective STI policies. Recommendations include investing in science education, establishing governmental scientific advisory bodies, promoting research diversity, and addressing climate change through STI strategies. The findings provide valuable insights for scholars, policymakers, and international organizations working with less developed nations globally.

Purpose: Human papillomavirus (HPV) vaccine uptake is lower in rural areas, particularly for boys. The purpose of the study was to demonstrate how a participatory approach to developing a series of videos about the HPV vaccine better meets the informational needs of rural parents. Methods: We recruited six rural parents to participate on a parent advisory board (PAB). The PAB met monthly spanning five months (n = 5 meetings) from February to May 2023. Each meeting focused on an element of video creation, including: 1) Providing feedback on existing HPV vaccine videos created by federal agencies and developing a tailored plan for local rural parents; 2) Providing feedback on the video plan so the study team could draft scripts; 3) Editing scripts; 4) Finalizing video concepts; and 5) Providing feedback to produced videos. Between meetings, parents completed tasks to facilitate the process, which also served as a way for parent input to be documented. We worked with a local, professional videographer to produce the videos. A local parent and a nurse practitioner were recruited as actors. Results: Six one-minute videos were produced on the following topics: What is HPV?; Does the vaccine prevent cancer?; How does the vaccine work?; Is the vaccine safe?; Who should get the vaccine?; and Where can you go to get the vaccine? The PAB was essential in clarifying source, message, channel and receiver throughout the video creation process. Conclusions: Engaging parents to co-create a series of one-minute videos supports HPV vaccine confidence efforts in rural areas.

Aims: Healthcare professionals are relevant stakeholders because of their gatekeeper role in the clinic. This study aims to explore their perspectives on the potential future clinical implementation of the bio-artificial pancreas (BAP) for people with type 1 diabetes, and suitable target groups. Methods: Semi-structured interviews were conducted with 17 healthcare professionals, including endocrinologists, nurses, and pancreas transplant surgeons. Inclusion was stopped once data saturation was reached. The audiotaped interviews were transcribed verbatim. Qualitative content analysis using an inductive approach was conducted to develop themes within a coding framework. Results: Three main themes emerged: (1) hoped-for benefits, which included improved clinical outcomes, enhanced sense of normality, reduced mental burden for patients and their significant others, greater societal participation, and lower costs; (2) concerns, which included safety and effectiveness, inequitable access, accurate information, control over self-management, and organizational challenges; and (3) allocating the BAP during initial implementation, which included prioritizing people who lack effective treatment options, people with mental health issues, and vulnerable people. Conclusions: The results of this study are important for researchers and practitioners involved in the development of the BAP, so that they can align its design and the process of clinical implementation with healthcare professionals’ perspectives.

ABSTRACTTwo-thirds of small-bowel transplantation (SBT) recipients develop bacteremia, with the majority of infections occurring within 3 months post-transplant. Sepsis-related mortality occurs in 31% of patients and is commonly caused by bacteria of gut origin, which are thought to translocate across the implanted organ. Serial post-transplant surveillance endoscopies provide an opportunity to study whether the composition of the ileal and colonic microbiota can predict the emergence as well as the pathogen of subsequent clinical infections in the SBT patient population. Five participants serially underwent aspiration of ileal and colonic bowel effluents at transplantation and during follow-up endoscopy either until death or for up to 3 months post-SBT. We performed whole-metagenome sequencing (WMS) of 40 bowel effluent samples and compared the results with clinical infection episodes. Microbiome composition was concordant between participants and timepoint-matched ileal and colonic samples. Four out of five (4/5) participants had clinically significant infections thought to be of gut origin. Bacterial translocation from the gut was observed in 3/5 patients with bacterial infectious etiologies. In all three cases, the pathogens had demonstrably colonized the gut between 1–10 days prior to invasive clinical infection. Recipients with better outcomes received donor grafts with higher alpha diversity. There was an increase in the number of antimicrobial resistance genes associated with longer hospital stay for all participants. This metagenomic study provides preliminary evidence to support the pathogen translocation hypothesis of gut-origin sepsis in the SBT cohort. Ileal and colonic microbiome compositions were concordant; therefore, fecal metagenomic analysis could be a useful surveillance tool for impeding infection with specific gut-residing pathogens.