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OBJECTIVE: Upper extremity function reflects disease progression in multiple sclerosis (MS). This study evaluated the feasibility, validity, and sensitivity to change of remote dexterity assessments applying human pose estimation to patient-uploaded videos. METHODS: A discovery cohort of 50 adults with MS recorded selfie videos of self-care tasks at home: buttoning, brushing teeth, and eating. Kinematic data were extracted using MediaPipe Hand pose estimation software. Clinical comparison tests were grip and pinch strength, 9 hole peg test (9HPT), and vibration, and patient-reported dexterity assessments (ABILHAND). Feasibility and acceptability were evaluated (Health-ITUES framework). A validation cohort (N = 35) completed 9HPT and videos. RESULTS: The modality was feasible: 88% of the 50 enrolled participants uploaded ≥3 videos, and 74% completed the study. It was also usable: assessments easy to access (95%), platform easy to use (97%), and tasks representative of daily activities (86%). The buttoning task revealed four metrics with strong correlations with 9HPT (nondominant: r = 0.60-0.69, dominant: r = 0.51-0.57, P  0.8). Cross-sectional correlations between video metrics and 9HPT were similar at 6 months, and in the validation cohort (nondominant: r = 0.46, dominant: r = 0.45, P

BACKGROUND: Opportunities for residents to develop laparoscopic skills have decreased with the rise in robotic operations and the development of complex, subspecialized laparoscopic operations. Given the changing training landscape, this study aimed to identify laparoscopic surgeons perceptions of gaps in current laparoscopic skills in general surgery, obstetrics-gynecology, and urology residency programs. METHODS: Laparoscopic surgeons who operate with residents participated in semi-structured interviews. Questions addressed expectations for resident proficiency, deficits in laparoscopic surgical skills, and barriers to learning and teaching. Two authors independently coded de-identified transcripts followed by a conventional content analysis. RESULTS: Fourteen faculty members from thirteen subspecialties participated. Faculty identified three main areas to improve laparoscopic training across specialties: foundational knowledge, technical skills, and cognitive skills. They also recognized an overarching opportunity to address faculty development. CONCLUSIONS: This qualitative study highlighted key deficiencies in laparoscopic training that have emerged in the current, changing era of minimally invasive surgery. KEY MESSAGE: This qualitative study identified laparoscopic educators perceptions of deficiencies in laparoscopic training. Findings emphasized the importance of incorporating high quality educational practices to optimize training in the current changing landscape of laparoscopic surgery.

Carbon dioxide and methane emissions are the two primary anthropogenic climate-forcing agents and an important source of uncertainty in the global carbon budget. Uncertainties are further magnified when emissions occur at fine spatial scales (

Process-based land surface models are important tools for estimating global wetland methane (CH4) emissions and projecting their behavior across space and time. So far there are no performance assessments of model responses to drivers at multiple time scales. In this study, we apply wavelet analysis to identify the dominant time scales contributing to model uncertainty in the frequency domain. We evaluate seven wetland models at 23 eddy covariance tower sites. Our study first characterizes site-level patterns of freshwater wetland CH4 fluxes (FCH4) at different time scales. A Monte Carlo approach was developed to incorporate flux observation error to avoid misidentification of the time scales that dominate model error. Our results suggest that (a) significant model-observation disagreements are mainly at multi-day time scales (32 days) for the boreal and Arctic tundra wetland sites but have significant bias in variability at seasonal time scales for temperate and tropical/subtropical sites; (c) model errors exhibit increasing power spectrum as time scale increases, indicating that biases at time scales

BACKGROUND: Poor sleep quality occurs in patients with psoriasis at rates nearly twice that of the general population. Chronic sleep impairment is an independent risk factor for the development of cardiovascular disease. Here, we examine the association between sleep quantity and history of myocardial infarction in patients with psoriasis. METHODS: This observational, cross-sectional study utilized data from the 2020 National Psoriasis Foundation Annual Survey. Effect estimates were obtained using a multivariate logistic regression model, which controlled for prespecified covariates. RESULTS: Based on data from 1405 individuals with psoriasis, our analysis demonstrated a significant association between sleep quantity and history of myocardial infarction: odds ratio (OR) 0.67 [95% confidence interval (CI) 0.49-0.92], p = 0.012. The association was not significantly influenced by psoriasis severity (OR 1.01, [95% CI 0.99-1.03], p = 0.38), comorbid psoriatic arthritis (OR 1.06, [95% CI 0.48-2.38], p = 0.88), sleep apnea, or other traditional risk factors for myocardial infarction. CONCLUSION: Our analyses indicate an association between sleep quantity and history of myocardial infarction in patients with psoriasis. For each hour increase in average nightly sleep, patients with psoriasis have a 33% decrease in the odds of having a history of myocardial infarction. The chief limitation of this study is its cross-sectional design limiting ascertainment of causality.

BackgroundStudents with Intellectual Disability undergo frequent cognitive testing. Testing with this population is limited by insensitivity to relative strengths and weaknesses due to floor effects.AimThe study explored the utility of deviation scores via four case studies as a supplement to educational decision-making.MethodsFour students with Intellectual Disability completed cognitive testing. Deviation scores were calculated using age dependent raw z-score transformations to determine deviation from the standardization sample norms.ResultsThe application of deviation scores highlighted true relative strengths and weaknesses for students with Intellectual Disability rather than documenting previously known deficits. The four cases studies illustrated where deviation scores could, or could not, add value above and beyond traditional scoring.DiscussionDeviation scores can supplement placement and service decisions for students. Practical and psychometric considerations are reviewed.ConclusionThe findings highlight the usefulness of deviation scores in providing meaningful information to school- and clinic-based practitioners.

Abstract Background Current acute healthcare service metrics are not meaningful for older people living with frailty. Healthcare knowledge, situational security, and physical and psychosocial function are important outcomes typically not collected. The use of patient-reported outcome measures (PROMs) could support these assessments. Existing instruments are not comprehensive as they typically consider function, while older people with frailty also value enablement (self-determination and security in health and healthcare). This study field-tested and validated a PROM for older people with frailty receiving acute care (PROM-OPAC) to measure enablement. Methods People aged 65+ with Clinical Frailty Scale 5–8 were recruited within seventy-two hours of an emergency attendance. Iterations of the novel instrument were administered over three stages: (1) preliminary field-testing for reliability (response distribution and internal consistency) and structure (exploratory factor analysis, EFA); (2) intermediate field-testing of an improved instrument for reliability and structure; (3) final draft validation assessing reliability, structure (confirmatory factor analysis, CFA), and construct validity based on a priori hypotheses. Feasibility was appraised throughout using data completeness and response rates and times. Results 241 people participated. Three items of a preliminary seven-item measure had poor response distribution or loading and were accordingly improved. The intermediate instrument had interpretability issues and three items required further improvement. The final eight-item draft had acceptable reliability (Cronbach’s alpha: 0.71), structure (two factors for self-determination and security; RMSEA: 0.065; TLI: 0.917; CFI: 0.944), and construct validity (lower scores from respondents waiting longer and requiring admission). Feasibility was promising (response rate 39%; 98% responses complete; median completion time 11 (IQR: 12) minutes). Conclusions Administration of the PROM-OPAC appeared feasible and the instrument had acceptable psychometric properties. Further evaluation is required to assess generalisability.

Abstract The Nominal Group Technique (NGT) has been used to establish clinical priorities and generate guidelines within healthcare since its creation over fifty years ago. It is characterised by its five distinct stages; introduction, silent idea generation, ‘round robin’, clarifications and rating or ranking. A key element traditionally has been the inclusion of face-to-face discussion, however in the context of COVID-19 innovations were required. This article provides a case study illustrating an adaptation of the NGT to a virtual format (vNGT) and outlines the processes involved in a virtual NGT (vNGT), using an illustrative study exploring the rehabilitation of stroke survivors. The vNGT offers opportunities for global collaborations without the constraints of geography or incurred costs. Future studies should evaluate it’s acceptability for stroke survivors to enable their participation within research. Summary statement 1. This study provides a guide for the use of virtual nominal group technique (vNGT), using a freely available video-conferencing platform 2. vNGT increases opportunities for global collaborations whilst incurring minimal costs. 3. It remains unclear how feasible this procedure is with patient populations who have potentially less digital confidence and access. This work was supported by NIHR ARC-East Midlands, Grant number NIHR200171.

Abstract In this review, we discuss current research on forest carbon risk from natural disturbance under climate change for the United States, with emphasis on advancements in analytical mapping and modeling tools that have potential to drive research for managing future long-term stability of forest carbon. As a natural mechanism for carbon storage, forests are a critical component of meeting climate mitigation strategies designed to combat anthropogenic emissions. Forests consist of long-lived organisms (trees) that can store carbon for centuries or more. However, trees have finite lifespans, and disturbances such as wildfire, insect and disease outbreaks, and drought can hasten tree mortality or reduce tree growth, thereby slowing carbon sequestration, driving carbon emissions, and reducing forest carbon storage in stable pools, particularly the live and standing dead portions that are counted in many carbon offset programs. Many forests have natural disturbance regimes, but climate change and human activities disrupt the frequency and severity of disturbances in ways that are likely to have consequences for the long-term stability of forest carbon. To minimize negative effects and maximize resilience of forest carbon, disturbance risks must be accounted for in carbon offset protocols, carbon management practices, and carbon mapping and modeling techniques. This requires detailed mapping and modeling of the quantities and distribution of forest carbon across the United States and hopefully one day globally; the frequency, severity, and timing of disturbances; the mechanisms by which disturbances affect carbon storage; and how climate change may alter each of these elements. Several tools (e.g. fire spread models, imputed forest inventory models, and forest growth simulators) exist to address one or more of the aforementioned items and can help inform management strategies that reduce forest carbon risk, maintain long-term stability of forest carbon, and further explore challenges, uncertainties, and opportunities for evaluating the continued potential of, and threats to, forests as viable mechanisms for forest carbon storage, including carbon offsets. A growing collective body of research and technological improvements have advanced the science, but we highlight and discuss key limitations, uncertainties, and gaps that remain.

Abstract Background Nuts consumption is related to cardioprotective effects on primary cardiovascular prevention, but studies conducted in secondary prevention are small, scarce and controversial. The objective of this trial was to evaluate the effects of a regional and sustainable cardioprotective diet added or not with an affordable mixed nuts on cardiometabolic features in patients with previous myocardial infarction. Methods DICA-NUTS study is a national, multi-center, and superiority-parallel randomized clinical trial. Males and females over 40 years old diagnosed with previous myocardial infarction in the last 2 to 6 months were included. Patients were allocated into two groups: the Brazilian Cardioprotective diet (DICA Br) supplemented with 30 g/day of mixed nuts (10 g of peanuts; 10 g of cashew; 10 g of Brazil nuts) (intervention group, n = 193); or only DICA Br prescription (control group, n = 195). The primary outcome was low-density lipoprotein cholesterol means (in mg/dL) after 16 weeks. Secondary outcomes were other lipid biomarkers, glycemic and anthropometric data and diet quality. Results After adjustment for baseline values, participating study site, time since myocardial infarction and statin treatment regimen (high potency, moderate and low potency/no statins), no significant difference was found between the groups in low-density lipoprotein cholesterol concentrations (intervention-control difference: 3.48 mg/dL [-3.45 to 10.41], P = 0.32). Both groups improved their overall diet quality at the end of the study without differences between them after 16 weeks (intervention-control difference: 1.05 (-0.9 to 2.99); P = 0.29). Other lipids, glycemic profile and anthropometrics were also not different between study groups at the end of the study. Conclusion Adding 30 g/day of mixed nuts to the DICA Br for 16 weeks did not change lipid, glycemic and anthropometric features in the post-myocardial infarction setting. Trial registration This study is registered on ClinicalTrials.gov website under number NCT03728127 and its World Health Organization Universal Trial Number (WHO-UTN) is U1111-1259–8105.

Abstract We describe the geographical variation in tree species composition across Amazonian forests and show how environmental conditions are associated with species turnover. Our analyses are based on 2023 forest inventory plots (1 ha) that provide abundance data for a total of 5188 tree species. Within-plot species composition reflected both local environmental conditions (especially soil nutrients and hydrology) and geographical regions. A broader-scale view of species turnover was obtained by interpolating the relative tree species abundances over Amazonia into 47,441 0.1-degree grid cells. Two main dimensions of spatial change in tree species composition were identified. The first was a gradient between western Amazonia at the Andean forelands (with young geology and relatively nutrient-rich soils) and central–eastern Amazonia associated with the Guiana and Brazilian Shields (with more ancient geology and poor soils). The second gradient was between the wet forests of the northwest and the drier forests in southern Amazonia. Isolines linking cells of similar composition crossed major Amazonian rivers, suggesting that tree species distributions are not limited by rivers. Even though some areas of relatively sharp species turnover were identified, mostly the tree species composition changed gradually over large extents, which does not support delimiting clear discrete biogeographic regions within Amazonia.

Abstract Background Although older adults with heart failure (HF) and multiple chronic conditions (MCC) frequently rely on caregivers for health management, digital health systems, such as patient portals and mobile apps, are designed for individual patients and often exclude caregivers. There is a need to develop approaches that integrate caregivers into care. This study tested the feasibility of the Social Convoy Palliative Care intervention (Convoy-Pal), a 12-week digital self-management program that includes assessment tools and resources for clinical palliative care, designed for both patients and their caregivers. Methods A randomized waitlist control feasibility trial involving patients over 65 years old with MCC who had been hospitalized two or more times for HF in the past 12 months and their caregivers. Descriptive statistics were used to evaluate recruitment, retention, missing data, self-reported social functioning, positive aspects of caregiving, and the acceptability of the intervention. Results Of 126 potentially eligible patients, 11 were ineligible and 69 were deceased. Of the 46 eligible patients, 31 enrolled in the trial. Although 48 caregivers were identified, only 15 enrolled. The average age was 76.3 years for patients and 71.6 years for caregivers, with most participants being non-Hispanic White. Notably, 4% did not have access to a personal mobile device or computer. Retention rates were 79% for intervention patients, 57% for intervention caregivers, and 60% for control participants. Only 4.6% of survey subscales were missing, aided by robust technical support. Intervention patients reported improved social functioning (SF-36: 64.6 ± 25.8 to 73.2 ± 31.3) compared to controls (64.6 ± 27.1 to 67.5 ± 24.4). Intervention caregivers also reported increased positive perceptions of caregiving (29.5 ± 5.28 to 35.0 ± 5.35) versus control caregivers (29.4 ± 8.7 to 28.0 ± 4.4). Waitlist control participants who later joined the Convoy-Pal program showed similar improvements. The intervention was well-rated for acceptability, especially regarding the information provided (3.96 ± .57 out of 5). Conclusions Recruiting informal caregivers proved challenging. Nonetheless, Convoy-Pal retained patients and collected meaningful self-reported outcomes, showing potential benefits for both patients and caregivers. Given the importance of a patient and caregiver approach in palliative care, further research is needed to design digital tools that cater to multiple simultaneous users. Trial registration ClinicalTrials.gov Identifier NCT04779931. Date of registration: March 3, 2021.

Patients with limited English proficiency (LEP) experience reduced pain assessment and treatment, less comprehensive physical exams, and fewer explanations of the next steps in care. These disparities persist in hospitals with staffed professional interpreters, raising questions about interpreter access and the impact on outcomes. A retrospective review of 1133 trauma activations at a single center Level 1 Trauma Center in 2021–2022 was conducted. Demographic, injury, and outcome data were drawn from the institutional trauma registry, and patient-preferred language was pulled from EMR data. Early interpreter use was defined as documentation of professional interpreter use within 24 h of arrival. LOS and ICU LOS were compared between language groups using Cox regression, and mortality was compared using Fischer's exact test. 1114 patients had data available on initial injury severity and preferred language. Of the 70 LEP patients, 62 (88.6 %) required an interpreter, and 41 of those (66.1 %) had evidence of professional interpreter use within 24 h of arrival. LEP patients who lacked early interpreter use had longer hospital stays than both English proficient (EP) patients (HR 0.59, p

Abstract Gene drives are genetic modifications designed to propagate efficiently through a population. Most applications rely on homologous recombination during sexual reproduction in diploid organisms such as insects, but we recently developed a gene drive in herpesviruses that relies on co-infection of cells by wild-type and engineered viruses. Here, we report on a viral gene drive against human herpes simplex virus 1 (HSV-1) and show that it propagates efficiently in cell culture and during HSV-1 infection in mice. We describe high levels of co-infection and gene drive-mediated recombination in neuronal tissues during herpes encephalitis as the infection progresses from the site of inoculation to the peripheral and central nervous systems. In addition, we show evidence that a superinfecting gene drive virus could recombine with wild-type viruses during latent infection. These findings indicate that HSV-1 achieves high rates of co-infection and recombination during viral infection, a phenomenon that is currently underappreciated. Overall, this study shows that a viral gene drive could spread in vivo during HSV-1 infection, paving the way toward therapeutic applications.

Abstract Proteins can be targeted for degradation by engineering biomolecules that direct them to the eukaryotic ubiquitination machinery. For instance, the fusion of an E3 ubiquitin ligase to a suitable target binding domain creates a ‘biological Proteolysis-Targeting Chimera’ (bioPROTAC). Here we employ an analogous approach where the target protein is recruited directly to a human E2 ubiquitin-conjugating enzyme via an attached target binding domain. Through rational design and screening we develop E2 bioPROTACs that induce the degradation of the human intracellular proteins SHP2 and KRAS. Using global proteomics, we characterise the target-specific and wider effects of E2 vs. VHL-based fusions. Taking SHP2 as a model target, we also employ a route to bioPROTAC discovery based on protein display libraries, yielding a degrader with comparatively weak affinity capable of suppressing SHP2-mediated signalling.

Abstract The role of genomic research and medicine in improving health continues to grow significantly, highlighting the need for increased equitable inclusion of diverse populations in genomics. Native Hawaiian and Pacific Islander (NHPI) communities are often missing from these efforts to ensure that the benefits of genomics are accessible to all individuals. In this article, we analyze the qualities of NHPI populations relevant to their inclusion in genomic research and investigate their current representation using data from the genome-wide association studies (GWAS) catalog. A discussion of the barriers NHPI experience regarding participating in research and recommendations to improve NHPI representation in genomic research are also included.

Abstract We present the Manually Annotated GONG Filaments in H-alpha Observations (MAGFiLO v1.0) dataset. This dataset contains 10,244 annotated filaments from 1,593 observations captured by the Global Oscillation Network Group (GONG), spanning the years 2011 through 2022. Each annotation details one filament’s segmentation, minimum bounding box, spine, and magnetic field chirality. With a total of over one thousand person-hours of annotation, and a double-blind review process, we ensured high-quality ground-truth data. Our inter-annotator agreement reaches a Kappa score of 0.66. We also verified that the hemispheric preference of filaments as annotated in MAGFiLO aligns with the findings from similar datasets of much smaller sample sizes. MAGFiLO is the first dataset of its size, enabling advanced deep learning models to identify filaments and their features with unprecedented precision. It also provides a testbed for solar physicists interested in large-scale analysis of filaments. In this report, we document the details of the annotation and the post-processing phases that were applied.

Abstract Background Cystoid macular edema (CME) can develop following silicone oil placement in complex vitreoretinal surgeries, contributing to poor visual outcomes. In this study, we investigated the clinical and surgical characteristics associated with the development of CME following the use of silicone oil (SO) in pars plana vitrectomy (PPV) surgeries. Methods We conducted a retrospective chart review of patients who underwent implantation of SO during PPV from 2010 to 2020 by a single surgeon. Patient demographics, type of oil, duration of oil tamponade, retinectomy size, diabetic status, lens status, prior panretinal photocoagulation, visual acuity, and incidence of CME were reviewed. Results This study included 43 eyes from 40 patients who underwent SO tamponade for retinal detachment (RD) surgery. The mean duration of SO tamponade was 15.7 ± 12.7 months (range: 1–58 months). The most common indication for surgery was diabetic tractional RD (32.7%), followed by traumatic RD (16.3%) and rhegmatogenous RD with proliferative vitreoretinopathy (11.6%). Of the 43 eyes, 18 (41.9%) developed CME for the first time after PPV with SO placement, with 8 (44%) resolving within a year of oil removal. The mean duration for the development of CME was 9 months. A logistic regression model showed that a scleral buckle procedure and poor initial vision were statistically significant factors for predicting the development of CME (ORs: 11.65 and 16.06, respectively). Overall, 91% of the patients had stable or improved vision after surgery. Conclusions The use of a scleral buckle procedure and poor initial vision are significant factors for predicting CME following silicone oil tamponade in PPV surgeries, with 41.9% of patients developing CME with an average duration of 9 months. Recognizing such factors can lead to early monitoring and prompt management of CME. Meeting presentation Partial analyses were presented at the ASRS 2020 conference. Clinical trial number Not applicable.

Abstract Thermophily is a trait scattered across the fungal tree of life, with its highest prevalence within three fungal families (Chaetomiaceae, Thermoascaceae, and Trichocomaceae), as well as some members of the phylum Mucoromycota. We examined 37 thermophilic and thermotolerant species and 42 mesophilic species for this study and identified thermophily as the ancestral state of all three prominent families of thermophilic fungi. Thermophilic fungal genomes were found to encode various thermostable enzymes, including carbohydrate-active enzymes such as endoxylanases, which are useful for many industrial applications. At the same time, the overall gene counts, especially in gene families responsible for microbial defense such as secondary metabolism, are reduced in thermophiles compared to mesophiles. We also found a reduction in the core genome size of thermophiles in both the Chaetomiaceae family and the Eurotiomycetes class. The Gene Ontology terms lost in thermophilic fungi include primary metabolism, transporters, UV response, and O-methyltransferases. Comparative genomics analysis also revealed higher GC content in the third base of codons (GC3) and a lower effective number of codons in fungal thermophiles than in both thermotolerant and mesophilic fungi. Furthermore, using the Support Vector Machine classifier, we identified several Pfam domains capable of discriminating between genomes of thermophiles and mesophiles with 94% accuracy. Using AlphaFold2 to predict protein structures of endoxylanases (GH10), we built a similarity network based on the structures. We found that the number of disulfide bonds appears important for protein structure, and the network clusters based on protein structures correlate with the optimal activity temperature. Thus, comparative genomics offers new insights into the biology, adaptation, and evolutionary history of thermophilic fungi while providing a parts list for bioengineering applications.

Abstract The North Temperate Lakes Long-Term Ecological Research (NTL-LTER) program has been extensively used to improve understanding of how aquatic ecosystems respond to environmental stressors, climate fluctuations, and human activities. Here, we report on the metagenomes of samples collected between 2000 and 2019 from Lake Mendota, a freshwater eutrophic lake within the NTL-LTER site. We utilized the distributed metagenome assembler MetaHipMer to coassemble over 10 terabases (Tbp) of data from 471 individual Illumina-sequenced metagenomes. A total of 95,523,664 contigs were assembled and binned to generate 1,894 non-redundant metagenome-assembled genomes (MAGs) with ≥50% completeness and ≤10% contamination. Phylogenomic analysis revealed that the MAGs were nearly exclusively bacterial, dominated by Pseudomonadota (Proteobacteria, N = 623) and Bacteroidota (N = 321). Nine eukaryotic MAGs were identified by eukCC with six assigned to the phylum Chlorophyta. Additionally, 6,350 high-quality viral sequences were identified by geNomad with the majority classified in the phylum Uroviricota. This expansive coassembled metagenomic dataset provides an unprecedented foundation to advance understanding of microbial communities in freshwater ecosystems and explore temporal ecosystem dynamics.

As photovoltaic (PV) deployment increases worldwide, PV systems are being installed more frequently in locations that experience snow cover. The higher albedo of snow, relative to the ground, increases the performance of PV systems in northern and high-altitude locations by reflecting more light onto the PV modules. Accurate modeling of the snow’s albedo can improve estimates of PV system production. Typical modeling of snow albedo uses a simple two-value model that sets the albedo high when snow is present, and low when snow is not present. However, snow albedo changes over time as snow settles and melts and a binary model does not account for transitional changes, which can be significant. Here, we present and validate a model for estimating snow albedo as it changes over time. The model is simple enough to only require daily snow depth and hourly average temperature data, but can be improved through the addition of site-specific factors, when available. We validate this model to quantify its ability to more accurately predict snow albedo and compare the model’s performance against satellite imagery-based methods for obtaining historical albedo data. In addition, we perform modeling using the System Advisor Model (SAM) to show the impact of changes in albedo on energy modeling for PV systems. Overall, our albedo model has a significantly improved ability to predict the solar insolation on PV modules in real time, especially on bifacial PV modules where reflected irradiance plays a larger role in energy production.

Aims: Complete ruptures of the ulnar collateral ligament (UCL) of the thumb are a common injury, yet little is known about their current management in the UK. The objective of this study was to assess the way complete UCL ruptures are managed in the UK. Methods: We carried out a multicentre, survey-based cross-sectional study in 37 UK centres over a 16-month period from June 2022 to September 2023. The survey results were analyzed descriptively. Results: A total of 37 centres participated, of which nine were tertiary referral hand centres and 28 were district general hospitals. There was a total of 112 respondents (69 surgeons and 43 hand therapists). The strongest influence on the decision to offer surgery was the lack of a firm ‘endpoint’ to stressing the metacarpophalangeal joint (MCPJ) in either full extension or with the MCPJ in 30° of flexion. There was variability in whether additional imaging was used in managing acute UCL injuries, with 46% routinely using additional imaging while 54% did not. The use of a bone anchor was by far the most common surgical option for reconstructing an acute ligament avulsion (97%, n = 67) with a transosseous suture used by 3% (n = 2). The most common duration of immobilization for those managed conservatively was six weeks (58%, n = 65) and four weeks (30%, n = 34). Most surgeons (87%, n = 60) and hand therapists (95%, n = 41) would consider randomizing patients with complete UCL ruptures in a future clinical trial. Conclusion: The management of complete UCL ruptures in the UK is highly variable in certain areas, and there is a willingness for clinical trials on this subject. Cite this article: Bone Jt Open 2024;5(8):708–714.

Abstract Background Virtual activities, hybrid work and virtual mentoring have become part of the ongoing milieu of academic medicine. As the shift to remote mentoring continues to evolve, it is now possible to adapt, refine, and improve tools to support thriving mentoring relationships that take place virtually. This study explores strategies for virtual mentoring as a cornerstone for effective training programs among senior mentors participating in an ongoing mentoring program. Methods We conducted a qualitative study among prior and current participants of an ongoing “Mentoring the Mentors” program about key strategies for optimizing virtual mentoring. Data were coded and analyzed following a thematic analysis approach. Results Respondents were mostly female (62%), white (58%), and associate (39%) or full professors (32%). We found that, with the expansion of hybrid and fully remote work, there are now fewer opportunities for informal but important chance meetings between mentors and mentees; however, virtual mentoring provides opportunities to compensate for reduced interactivity normally experienced in the workplace. The heightened need to plan and be more deliberate in the virtual sphere was woven throughout narratives and was the foundation of most recommendations. Specifically, a central obstacle for respondents was that spontaneous conversations were harder to initiate because virtual conversations are expected to have set agendas. Conclusions Developing new ways to maintain meaningful interpersonal relationships in a virtual training environment, including opportunities for serendipitous and informal engagement, is critical to the success of virtual mentoring programs.

Abstract Background Teachers are recognized as ‘key agents’ for the delivery of physical activity programs and policies in schools. The aim of our study was to develop and evaluate a tool to assess teachers’ capability, opportunity, and motivation to deliver school-based physical activity interventions. Methods The development and evaluation of the Capability, Opportunity, and Motivation to deliver Physical Activity in School Scale (COM-PASS) involved three phases. In Phase 1, we invited academic experts to participate in a Delphi study to rate, provide recommendations, and achieve consensus on questionnaire items that were based on the Capability, Opportunity, and Motivation Behavior (COM-B) model. Each item was ranked on the degree to which it matched the content of the COM-B model, using a 5-point scale ranging from ‘1 = Poor match’ to ‘5 = Excellent match’. In Phase 2, we interviewed primary and secondary school teachers using a ‘think-aloud’ approach to assess their understanding of the items. In Phase 3, teachers (n = 196) completed the COM-PASS to assess structural validity using confirmatory factor analysis (CFA). Results Thirty-eight academic experts from 14 countries completed three rounds of the Delphi study. In the first round, items had an average rating score of 4.04, in the second round 4.51, and in the third (final) round 4.78. The final tool included 14 items, which related to the six constructs of the COM-B model: physical capability, psychological capability, physical opportunity, social opportunity, reflective motivation, and automatic motivation. In Phase 2, ten teachers shared their interpretation of COM-PASS via a 20-min interview, which resulted in minor changes. In Phase 3, CFA of the 3-factor model (i.e., capability, opportunity, and motivation) revealed an adequate fit to the data (χ2 = 122.6, p

Abstract Bistability enables adaptive designs with tunable deflections for applications including morphing wings, robotic grippers, and consumer products. Composite laminates may be designed to exhibit bistability due to pre-strains that develop during the processing of the polymer matrix, enabling fast reconfiguration between two stable shapes. Unfortunately, designing bistable laminates is challenging because of their highly nonlinear behavior. Here, we propose the Switching Tunneling Method to address this challenge by alternating between gradient-based local minimization and tunneling search phases, with the enhancement of objective expression switching to improve numerical conditioning. Results demonstrate high effectiveness compared to existing optimizers; the Switching Tunneling Method achieves a 99% success rate in finding all energy minima across general composite layups. Additionally, our method facilitates the inverse design of variable pre-strain fields, enabling bioinspired, positive Gaussian curvatures, which are not possible with conventional pre-strain laminates. Validations through both finite element analysis and 3D printed samples confirm the optimal designs.

Abstract Background Diet and exercise are important components of treatment for complex chronic conditions, however access to allied health support is limited. When available, support is often siloed and fragmented. Digital health incorporating patient choice may help to align health care services with preferences and goals. This study evaluated the implementation of a ubiquitously accessible patient-centred digital health diet and exercise service. Methods U-DECIDE was a single-centre, 26-week randomised controlled trial set in kidney and liver disease clinics in a tertiary hospital in Brisbane, Australia. Participants were adults with a complex chronic condition referred for dietetic consultation with at least one feature of the metabolic syndrome. All participants received a dietary consultation, an activity monitor and usual care. Intervention participants were offered one text message per week and access to additional digital health options (increased text message frequency, nutrition app, exercise app, group-based diet and/or exercise video consultations). The primary outcome of feasibility was determined by safety (study-related serious adverse events: SRSAEs), recruitment (≥ 50% eligible patients), retention (≥ 70%), exposure uptake (≥ 75% of intervention group had greater access to health professional contact than comparator) and video consultation adherence (≥ 80% attendance). Secondary outcomes included process evaluation metrics and clinical outcomes. Results Of 67 participants (intervention n = 33, comparator n = 34), 37 (55%) were men, median (IQR) age was 51 (41–58) years. The most chosen digital health options were the nutrition app (n = 29, 88%) and exercise video consultations (n = 26, 79%). Only one participant chose no additional digital health options. The intervention group had no SRSAEs. The study exceeded targets for recruitment (52%), retention (81%) and exposure uptake (94%). Video consultation adherence was 42%. Engagement across digital health options was inconsistent. Conclusions Digital health options incorporating patient choice were feasible and can be offered to people with complex chronic disease as a service model option. Trial registration Australia and New Zealand Trials Register: Trial Registration Number: ACTRN12620001282976. Registered 27th November 2020.

Abstract The number of birds or their total live weight in relation to a given area is known as stocking density; higher stocking densities will cause more stress to the birds, which may have an impact on their physiological state, productivity, carcass quality, growth performance, immunity, metabolism, and meat quality. The present study aimed to investigate the potential impact of 2 different stocking densities on growth performance, carcass characteristics, meat quality, serum, and expression of Insulin like growth factor-1 (IGF-1), muscle regulatory genes expression and serum biochemical indicators of broilers supplemented with essential oils (EO). In total, 784-day-old chicks of Ross 308 were randomly assigned into 4 different groups with 7 replicates for each: Normal feed (no essential oils [EO] added) and normal stocking as 9 bird/m2, (NSD). Normal feed (no essential oils [EO] added) and high stocking as 14 bird/m2, (HSD). Feed with essential oils (Digestarom DC® 150 g/Ton of feed) and normal stocking as 9 birds/m2, (NSD + EO). Feed with essential oils (Digestarom DC® 150 g/Ton of feed) and high stocking as 14 birds/m2, (HSD + EO) for 35 days. Bodyweight was recorded at the beginning of the trial and then at the end of each week, feed intake was recorded at the end of each week as well. A total of 28 birds (7 birds per treatment) birds were slaughtered at 35 days of age to evaluate each parameter. The HSD group had the lowest (P

Abstract Learning new skills requires neuroplasticity. Vagus nerve stimulation (VNS) during sensory and motor events can increase neuroplasticity in networks related to these events and might therefore serve to facilitate learning on sensory and motor tasks. We tested if VNS could broadly improve learning on a wide variety of tasks across different skill domains in healthy, female adult rats. VNS was paired with presentation of stimuli or on successful trials during training, strategies known to facilitate plasticity and improve recovery in models of neurological disorders. VNS failed to improve either rate of learning or performance for any of the tested tasks, which included skilled forelimb motor control, speech sound discrimination, and paired-associates learning. These results contrast recent findings from multiple labs which found VNS pairing during training produced learning enhancements across motor, auditory, and cognitive domains. We speculate that these contrasting results may be explained by key differences in task designs, training timelines and animal handling approaches, and that while VNS may be able to facilitate rapid and early learning processes in healthy subjects, it does not broadly enhance learning for difficult tasks.

Abstract There are genetic and environmental risk factors that contribute to the development of cognitive decline in Alzheimer’s disease (AD). Some of these include the genetic predisposition of the apolipoprotein E4 genotype, consuming a high-fat diet (HFD), and the female sex. Brain insulin receptor resistance and deficiency have also been shown to be associated with AD and cognitive impairment. Intranasal (INL) insulin enhances cognition in AD, but the response varies due to genotype, diet, and sex. We investigated here the combination of these risk factors in a humanized mouse model, expressing E3 or E4, following a HFD in males and females on cognitive performance and the brain distribution of insulin following INL delivery. The HFD had a negative effect on survival in male mice only, requiring sex to be collapsed. We found many genotype, diet, and genotype x diet effects in anxiety-related tasks. We further found beneficial effects of INL insulin in our memory tests, with the most important findings showing a beneficial effect of INL insulin in mice on a HFD. We found insulin distribution throughout the brain after INL delivery was largely unaffected by diet and genotype, indicating these susceptible groups can still receive adequate levels of insulin following INL delivery. Our findings support the involvement of brain insulin signaling in cognition and highlight continuing efforts investigating mechanisms resulting from treatment with INL insulin.

Abstract Neural processing of rewarding stimuli involves several distinct regions, including the nucleus accumbens (NAc). The majority of NAc neurons are GABAergic projection neurons known as medium spiny neurons (MSNs). MSNs are broadly defined by dopamine receptor expression, but evidence suggests that a wider array of subtypes exist. To study MSN heterogeneity, we analyzed single-nucleus RNA sequencing data from the largest available rat NAc dataset. Analysis of 48,040 NAc MSN nuclei identified major populations belonging to the striosome and matrix compartments. Integration with mouse and human data indicated consistency across species and disease-relevance scoring using genome-wide association study results revealed potentially differential roles for MSN populations in substance use disorders. Additional high-resolution clustering identified 34 transcriptomically distinct subtypes of MSNs definable by a limited number of marker genes. Together, these data demonstrate the diversity of MSNs in the NAc and provide a basis for more targeted genetic manipulation of specific populations.

Abstract Ecosystem restoration practices are gaining prominence in coping with the crisis of ecosystem degradation. To improve the long‐term effectiveness of restoration activities, community engagement in restoration projects needs to be strengthened. In communities where traditional and local values drive adaptation to environmental changes, a community‐engaged restoration approach requires the integration of restoration techniques and local value systems. In two pastoral communities on the Qinghai‐Tibetan Plateau, we used the Q method to explore pastoralists' attitudes towards grassland degradation and restoration and to understand different levels of community engagement in grassland restoration activities. Through this study, we aim to promote an understanding of the value‐based approach of local communities to enable better community engagement for the long‐term effectiveness of ecosystem restoration projects and contribute to the achievement and synergy of global Sustainable Development Goals (SDGs). The study revealed eight types of pastoralists with different attitudes in two communities, with the type of Active Agents leverages transformative restoration action through creating value‐inclusive narratives of grassland restoration in the community with a higher level of engagement in restoration practices. Alongside this, we explored the pastoralists' perspectives of biodiversity in restoration and the importance of local elites in facilitating multiple‐actor cooperation in restoration projects. We recommend that decision‐makers recognize the significance of local worldviews and values in facilitating environmental adaptations, as well as the irreplaceable role played by local people in developing value‐inclusive narratives that align with the local cultural context. Open dialogues and sufficient communication between multiple stakeholders are needed to build mutual trust and accumulate social capital for driving transformative actions in traditional communities. Such approaches are essential to foster community engagement and gain better momentum in ecosystem management initiatives. Read the free Plain Language Summary for this article on the Journal blog.

Background: Young adults (YA) with cancer often have unmet psychosocial needs. The impact of peer support delivered in an online format to fulfil these needs in the populations of YA with cancer has not been thoroughly examined. Methods: We searched Cochrane Central Register of Controlled Trials, CINAHL, Embase, and Medline databases. We included articles about online peer support interventions for YA cancer survivors between the ages of 18 to 40 years old. Results: Our literature search yielded n = 2,773 articles and we obtained consensus on 12 articles for inclusion. We qualitatively synthesized these articles using data abstraction based on the Template for Intervention and Replication (TIDierR) checklist. Overall, six studies demonstrated correlation between online peer support and improved wellbeing of participants. Thus, online peer support may be useful for young cancer patients. Conclusion: This systematic review summarizes the current state of knowledge regarding the availability and evaluation of online YA peer support programs and reveals the need for further research in this field.

Contexte : Il n’est pas rare que les besoins psychosociaux des jeunes adultes atteints de cancer ne soient pas satisfaits. Peu d’études se sont penchées de manière exhaustive sur l’efficacité des ressources de soutien par les pairs en ligne pour répondre aux besoins de cette population. Méthodologie : Une recherche dans les bases de données Cochrane Central Register of Controlled Trials, CINAHL, Embase et Medline a permis de trouver des articles portant sur les interventions de soutien par les pairs à l’intention des jeunes survivants du cancer âgés entre 18 et 40 ans. Résultats : Cette recherche a fait ressortir 2 773 articles, dont 12 ont été retenus par consensus. Les articles ont fait l’objet d’une synthèse qualitative à partir de données extraites à l’aide de la liste de vérification Template for Intervention Description and Replication (TIDieR; modèle pour la description et la reproduction des interventions). En tout, 6 études ont montré l’existence d’une corrélation entre le soutien par les pairs en ligne et l’amélioration du bien-être. Ce type d’intervention pourrait donc être utile pour les jeunes atteints de cancer. Conclusion : La présente revue systématique résume l’état actuel des connaissances sur la disponibilité et l’évaluation des programmes en ligne de soutien par les pairs à l’intention des jeunes; elle révèle également le besoin d’approfondir la recherche dans ce domaine.

Abstract Epigenetic clocks are age predictors that use machine-learning models trained on DNA CpG methylation values to predict chronological or biological age. Increases in predicted epigenetic age relative to chronological age (epigenetic age acceleration) are connected to aging-associated pathologies, and changes in epigenetic age are linked to canonical aging hallmarks. However, epigenetic clocks rely on training data from bulk tissues whose cellular composition changes with age. Here, we found that human naive CD8+ T cells, which decrease in frequency during aging, exhibit an epigenetic age 15–20 years younger than effector memory CD8+ T cells from the same individual. Importantly, homogenous naive T cells isolated from individuals of different ages show a progressive increase in epigenetic age, indicating that current epigenetic clocks measure two independent variables, aging and immune cell composition. To isolate the age-associated cell intrinsic changes, we created an epigenetic clock, the IntrinClock, that did not change among 10 immune cell types tested. IntrinClock shows a robust predicted epigenetic age increase in a model of replicative senescence in vitro and age reversal during OSKM-mediated reprogramming.

Abstract Targeting brain insulin resistance (BIR) has become an attractive alternative to traditional therapeutic treatments for Alzheimer’s disease (AD). Incretin receptor agonists (IRAs), targeting either or both of the glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptors, have proven to reverse BIR and improve cognition in mouse models of AD. We previously showed that many, but not all, IRAs can cross the blood-brain barrier (BBB) after intravenous (IV) delivery. Here we determined if widespread brain uptake of IRAs could be achieved by circumventing the BBB using intranasal (IN) delivery, which has the added advantage of minimizing adverse gastrointestinal effects of systemically delivered IRAs. Of the 5 radiolabeled IRAs tested (exenatide, dulaglutide, semaglutide, DA4-JC, and DA5-CH) in CD-1 mice, exenatide, dulaglutide, and DA4-JC were successfully distributed throughout the brain following IN delivery. We observed significant sex differences in uptake for DA4-JC. Dulaglutide and DA4-JC exhibited high uptake by the hippocampus and multiple neocortical areas. We further tested and found the presence of AD-associated Aβ pathology minimally affected uptake of dulaglutide and DA4-JC. Of the 5 tested IRAs, dulaglutide and DA4-JC are best capable of accessing brain regions most vulnerable in AD (neocortex and hippocampus) after IN administration. Future studies will need to be performed to determine if IN IRA delivery can reduce BIR in AD or animal models of that disorder.

As Chamoru scholars with experience working at two universities within the University of California (UC) system, the authors write from institutions deeply implicated in interconnected projects of settler colonialism and militarism. Addressing the UC's historical narrative in the authors' pedagogy is an important way to connect with ongoing calls for justice for Indigenous peoples in California and beyond. Located in the US nation-state with the most military bases and installations, these universities are networked within a vast military infrastructure made possible by federal investments from the Department of Defense (DoD). Several UC campuses and institutes have long-standing financial relationships with the DoD, meaning the US military plays a notable role in shaping contemporary institutional priorities and economy. In this essay, the authors interrogate the lack of sustained education on militarism as a communicative practice that functions to maintain ignorance. Thus, the authors utilize place-based communication pedagogy to explicitly address settler colonialism as an interrelated structural issue. Given the authors focus on the US/California and specific characteristics of military power in these places, the authors urge practitioners from other regions to scope these proposed interventions within their own local contexts. According to the authors, they have demonstrated the significance of Communication teaching to provide more robust and life-affirming educational opportunities for students that directly prepare and educate them to simultaneously confront the violent structures of militarism and settler colonialism.

This data-based theoretical paper explores the contrasting tensions of adults being in "solidarity" with youths while not reproducing systems of oppression through adultism. Written by adults who have been engaged side-by-side with youth activism, the purpose of this article is to better understand what adult solidarity and support look like according to youth activists themselves as we grapple with the unintentional mechanisms of reinforcing oppressive power dynamics between young people and adults in activist communities. Extending on the Gaztambide-Fernández's (2012) notion of "relational solidarity," the findings offer four types of actions (modeling, connecting, supporting, and protecting) adults can do to authentically support youths and thereby adds conceptual clarification and nuance for adults seeking to work in solidarity in more authentic youth adult partnerships (YAPs).

Increasing student engagement is a challenge for faculty of all experience levels. This manuscript introduces the Participation Competition as a pathway for faculty to gamify the Marketing classroom and increase student engagement. Through incentivizing group-based in-class participation, faculty can help students practice soft skills, facilitate collaboration, and encourage class attendance and preparation using this semester-long activity. To demonstrate the efficacy of the Participation Competition, data was collected for one academic year at two universities leveraging the Zhoc, Webster, King, Li, and Chungh (2019) Higher Education Student Engagement Scale (HESES) for a total sample size of n = 396. The HESES scale measures student outcomes (i.e. academic learning, cognitive engagement, and peer engagement) and class outcomes (i.e. value-add). General student participation and engagement are also measured for both the control and treatment groups. The results revealed that student and class outcomes were higher when comparing a class in which the participation competition was enacted relative to a class not exposed to the participation competition. Additionally, students reported increased participation within the class and among their peers and higher perceptions of satisfaction and engagement. Evidence suggests that the Participation Competition is an advantageous and pragmatic tool for augmenting the Marketing classroom.

Student engagement is a growing challenge within higher education, especially as technology continues to evolve and competition for attention rises. As a business discipline, many marketing students struggle to connect with the theory presented in the classroom and seek interactive, experiential learning opportunities. The authors created the "Find the Marketing in the Music" playlist matching activity to address this challenge and provide students with an engaging application of marketing concepts. Music is a means of personal expression and broadens listeners' perspectives. Music can help ignite or explain feelings, highlight complexities of social situations, and serve as a vehicle driving understanding and compassion. This featured activity reveals that by pairing songs that illustrate marketing concepts with information discussed in class, students could connect to the material in a new way. This exercise allows students to leverage the creative and grounded aspects of critical thinking by connecting something artistic with concrete marketing concepts. Students note that this activity helps them better relate to the material and that the relevancy of things discussed in the classroom takes on a new level when integrated into their everyday lives.

Offensive behaviour towards school employees is widespread and involves a number of potentially harmful acts. There is evidence that school employees' experiences of offensive behaviour are shaped by demographic, role and school-based factors that mediate the likelihood of victimisation. However, very few studies have investigated the prevalence and correlates of offensive behaviour against school leaders. This study analysed 13,028 survey responses from the Australia Principal Occupational Health, Safety and Wellbeing survey that were completed between the years 2011 and 2019. The analysis determined the prevalence of bullying, threats of violence and physical violence against government school leaders, the main perpetrators of these offenses and the moderating effects of key socio-demographic factors. Results from the study demonstrated that considerable proportions of Australian government school leaders were subjected to offensive behaviour with an average (pooled) prevalence of 36.2% for bullying, 48.6% for threats of violence and 38.7% for physical violence. School leaders report that students and parents are responsible for most offensive behaviours, but that colleagues also contribute considerably to incidents of bullying. Our findings illustrate that offensive behaviours against Australian school leaders are very high and that particular groups of school leaders are at elevated risk of victimization, especially female school leaders and to a lesser extent assistant principals and those inner or outer regional areas.

Purpose: It is now considered commonplace to teach in a multigenerational higher education classroom that is made up of Baby Boomers, Generation X, Y and Z students. To ensure that all students, regardless of their generational identity, are successful in the classroom, educators must teach purposefully, with an understanding of the variables that affect student learning. Educators must ensure instruction is delivered according to varying student strengths and needs. This paper will provide guidance for higher education faculty teaching in multigenerational classrooms by reviewing the strengths and weaknesses across student generations. The most effective instructional practices for teaching will be discussed. Design/methodology/approach: This article is a literature review focused on meeting the needs of multigenerational learners in synchronous and asynchronous online learning classrooms. Findings: To ensure that all students, regardless of generational identity, are successful in the classroom, educators must teach purposefully, with an understanding of the variables that affect student learning. A summary of these generational strengths and needs are discussed within this paper. Practical implications: This paper will provide guidance for higher education faculty teaching in multigenerational classrooms by reviewing the strengths and weaknesses across student generations. Originality/value: This paper will provide guidance for higher education faculty teaching in multigenerational classrooms by reviewing the strengths and weaknesses across student generations. The most effective instructional practices for teaching will be discussed.

Despite growing discussions of antiracist practices and policies in PK-20 schools, education tends to critique racist structures without providing solutions that bring into the conversation the lived experiences of Black students, families, and communities. While these critiques may be helpful, we suggest these critiques omit practices and policies that attend to how education could become a homeplace that affirms Black Joy. In order to realize the affirmative possibilities of homeplace, we argue that more attention is needed toward practitioner preparation programs as training sites for building out education as a location for Black Joy. We discuss the current context of preservice teacher and counselor education training and provide tenets of Black Joy and homeplace that can serve as guideposts for more complete critical accounts of antiracism.

The purpose of our study was to assess the test-retest reliability and concurrent validity of the 30 sec Sit to Stand test in a sample of adolescents. We recruited 30 male (58%) and 22 female (42%) participants (mean age = 15.77 years ± 0.46). Participants completed the 30-sec Sit to Stand and standing long jump tests on two occasions separated by 1 week. The rank order repeatability of the Sit to Stand test for the entire group was good (ICC = 0.84, 95% CI's [0.71 to 0.91]), systematic error was low (1.7 repetitions ± 2.9), and the typical error between tests was 2.1 repetitions (95% CI's 1.73 to 2.55). Sit to Stand results were significantly associated with lower body power (r = 0.55, p < 0.001). Our study demonstrated that the 30-sec Sit to Stand test has moderate-to-high test--retest reliability and acceptable concurrent validity in a population of adolescents.

Through a gerontological lens, using grounded theory methods and both qualitative and quantitative data, we investigated the "off-time" enrollment of mid- and later-life (MLL) community college students (age 40+) to explore how their enrollment decisions and academic goals are situated in the timing and intersection of life events and transitions, such as the responsibilities of work and family. We conducted twelve focus group interviews with MLL community college students (n = 68) in Ohio and conducted a quantitative analysis of the distribution of academic goals by age group in Ohio's 23 community colleges. We conclude that the foremost characteristic of MLL students as a group is its within-group heterogeneity and argue that the greatest barrier to serving MLL students is in how we have been thinking -- or failing to think -- about them. We take a first slice at disaggregating "adult" students and turn away from deficit narratives to identify opportunities and assets among MLLs. Finally, we offer a theory to explain how especially wide within-group diversity of MLL academic goals is produced by cohort divergence of life events, transitions and trajectories; diverse enrollment precipitants; and individual point-of-time appraisals of lifetime elapsed and lifetime remaining. We suggest that community colleges, already leaders in adult education, are in a unique position to effectively serve MLL students by recognizing and accommodating their diversity. We present implications and strategies for colleges, policymakers and researchers based on our findings.

This article aims to enhance the pedagogy of drawing by integrating relevant aspects of art history and aesthetics with perception and communication theories. "Visualcy" is defined as an articulacy with visual languages, from which the more familiar "3Rs" ("R"eading, w"R"iting, and a"R"ithmetic), alluding to literacy and numeracy, evolved. It embraces not only the more familiar definition of "visual literacy" in the sense of how people perceive, interpret, and learn from existing visual imagery, but also the "semogenic" facility for producing the means to understanding through the articulation of visual elements (line, shape, tone, texture, colour) in the construction of new images. After reviewing the role of drawing in cultural evolution, the article discusses drawing in relation to aesthetics, before outlining a pedagogy of drawing designed to nurture visualcy, of central importance to human culture.

The U.S. education system often functions as an adverse developmental context for Black students. Discriminatory policies and racist ideologies contribute to a series of cascading inequities in students' learning experiences. For example, years of data indicate an overrepresentation of Black students suspended and/or expelled from school. Moreover, Black Americans' experiences and contributions to U.S. society are often left out of curricula, compounding the physical exclusion of Black students from classrooms with the exclusion of their experiences. While such contexts inhibit learning and growth at critical developmental stages, the out-of-school time (OST) context can amplify the voices of Black students and support their learning and development in ways that address these exclusionary practices. Specifically, youth participatory action research (YPAR) during OST is an important critical pedagogical approach that provides a safe context for Black students to engage in challenging oppressive policies and practices within schools. The current study engages four Black/African American youth (aged 15--18 years old) in YPAR and positions youth as active learners and experts in their learning and developmental growth. Findings suggest an equitable OST context can contribute to our understanding of Black students' experiences in school and the co-creation of solutions for a more just learning environment.