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Background Long COVID (LC) is a novel multisystem clinical syndrome affecting millions of individuals worldwide. The modified COVID-19 Yorkshire Rehabilitation Scale (C19-YRSm) is a condition-specific patient-reported outcome measure designed for assessment and monitoring of people with LC.Objectives To evaluate the psychometric properties of the C19-YRSm in a prospective sample of people with LC.Methods 1314 patients attending 10 UK specialist LC clinics completed C19-YRSm and EuroQol 5D-5L (EQ-5D-5L) longitudinally. Scale characteristics were derived for C19-YRSm subscales (Symptom Severity (SS), Functional Disability (FD) and Overall Health (OH)) and internal consistency (Cronbach’s alpha). Convergent validity was assessed using the Functional Assessment of Chronic Illness Therapy (FACIT)—Fatigue Scale. Known groups validity was assessed for the Other Symptoms subscale as tertiles, as well as by hospitalisation and intensive care admission. Responsiveness and test–retest reliability was evaluated for C19-YRSm subscales and EQ-5D-5L. The minimal important difference (MID) and minimal clinically important difference (MCID) were estimated. Confirmatory factor analysis was applied to determine the instrument’s two-factor structure.Results C19-YRSm demonstrated good scale characteristic properties. Item-total correlations were between 0.37 and 0.65 (for SS and FD), with good internal reliability (Cronbach’s alphas>0.8). Item correlations between subscales ranged between 0.46 and 0.72. Convergent validity with FACIT was good (−0.46 to −0.62). The three subscales discriminated between different levels of symptom burden (p

Abstract Global disease registries are critical to capturing common patient related information on rare illnesses, allowing patients and their families to provide information about their condition in a safe, accessible, and engaging manner that enables researchers to undertake critical research aimed at improving outcomes. Typically, English is the default language of choice for these global digital health platforms. Unfortunately, language barriers can significantly inhibit participation from non-English speaking participants. In addition, there is potential for compromises in data quality and completeness. In contrast, multinational commercial entities provide access to their websites in the local language of the country they are operating in, and often provide multiple options reflecting ethnic diversity. This paper presents a case study of how the Global Angelman Syndrome Registry (GASR) has used a novel approach to enable multiple language translations for its website. Using a “semi-automated language translation” approach, the GASR, which was originally launched in English in September 2016, is now available in several other languages. In 2020, the GASR adopted a novel approach using crowd-sourcing and machine translation tools leading to the availability of the GASR in Spanish, Traditional Chinese, Italian, and Hindi. As a result, enrolments increased by 124% percent for Spain, 67% percent for Latin America, 46% percent for Asia, 24% for Italy, and 43% for India. We describe our approach here, which we believe presents an opportunity for cost-effective and timely translations responsive to changes to the registry and helps build and maintain engagement with global disease communities.

Nucleic acid-based gene interference and editing strategies, such as antisense oligonucleotides, ribozymes, RNA interference (RNAi), and CRISPR/Cas9 coupled with guide RNAs, are exciting research tools and show great promise for clinical applications in treating various illnesses. RNase P ribozymes have been engineered for therapeutic applications against human viruses such as human cytomegalovirus (HCMV). M1 ribozyme, the catalytic RNA subunit of RNase P from Escherichia coli, can be converted into a sequence-specific endonuclease, M1GS ribozyme, which is capable of hydrolyzing an mRNA target base-pairing with the guide sequence. M1GS RNAs have been shown to hydrolyze essential HCMV mRNAs and block viral progeny production in virus-infected cell cultures. Furthermore, RNase P ribozyme variants with enhanced hydrolyzing activity can be generated by employing in vitro selection procedures and exhibit better ability in suppressing HCMV gene expression and replication in cultured cells. Additional studies have also examined the antiviral activity of RNase P ribozymes in mice in vivo. Using cytomegalovirus infection as an example, this review summarizes the principles underlying RNase P ribozyme-mediated gene inactivation, presents recent progress in engineering RNase P ribozymes for applications in vitro and in mice, and discusses the prospects of using M1GS technology for therapeutic applications against HCMV as well as other pathogenic viruses.

The sweetpotato whitefly, Bemisia tabaci MEAM1, is a pest known to significantly impact tomato development and yields through direct damage and virus transmission. To manage this pest, the current study compared the effectiveness of various insecticide rotations. Field trials included rotations involving synthetic insecticides, biochemicals, and microbial agents, applied according to their highest labeled concentrations. The results indicated that while standard synthetic insecticides consistently reduced whitefly egg and nymph counts significantly, microbial biopesticide rotations also achieved reductions, although less consistently. This study demonstrated that while traditional chemical treatments remain highly effective, microbial biopesticides containing Beauveria bassiana and Cordyceps javanica present a viable alternative to manage MEAM1 in tomato fields. The data generated in this study provided baseline information for further investigations to determine the potential for optimizing integrated pest management (IPM) and insecticide resistance management (IRM) strategies by incorporating microbial biopesticides in rotations with a variety of modes of action to sustainably manage B. tabaci MEAM1 populations in agricultural settings.

Abstract Background Colorectal cancer (CRC) is a heterogeneous disease, with subtypes that have different clinical behaviours and subsequent prognoses. There is a growing body of evidence suggesting that right-sided colorectal cancer (RCC) and left-sided colorectal cancer (LCC) also differ in treatment success and patient outcomes. Biomarkers that differentiate between RCC and LCC are not well-established. Here, we apply random forest (RF) machine learning methods to identify genomic or microbial biomarkers that differentiate RCC and LCC. Methods RNA-seq expression data for 58,677 coding and non-coding human genes and count data for 28,557 human unmapped reads were obtained from 308 patient CRC tumour samples. We created three RF models for datasets of human genes-only, microbes-only, and genes-and-microbes combined. We used a permutation test to identify features of significant importance. Finally, we used differential expression (DE) and paired Wilcoxon-rank sum tests to associate features with a particular side. Results RF model accuracy scores were 90%, 70%, and 87% with area under curve (AUC) of 0.9, 0.76, and 0.89 for the human genomic, microbial, and combined feature sets, respectively. 15 features were identified as significant in the model of genes-only, 54 microbes in the model of microbes-only, and 28 genes and 18 microbes in the model with genes-and-microbes combined. PRAC1 expression was the most important feature for differentiating RCC and LCC in the genes-only model, with HOXB13, SPAG16, HOXC4, and RNLS also playing a role. Ruminococcus gnavus and Clostridium acetireducens were the most important in the microbial-only model. MYOM3, HOXC4, Coprococcus eutactus, PRAC1, lncRNA AC012531.25, Ruminococcus gnavus, RNLS, HOXC6, SPAG16 and Fusobacterium nucleatum were most important in the combined model. Conclusions Many of the identified genes and microbes among all models have previously established associations with CRC. However, the ability of RF models to account for inter-feature relationships within the underlying decision trees may yield a more sensitive and biologically interconnected set of genomic and microbial biomarkers.

Background Proximal radial artery (pRA) access for cardiac catheterization is safe but can jeopardize subsequent use of the artery because of occlusion. Distal radial artery (dRA) access in the anatomical snuffbox preserves the radial artery, but safety and potential detrimental effects on hand function are unknown. Methods and Results In the DIPRA (Distal Versus Proximal Radial Artery Access for Cardiac Catheterization and Intervention) study, a single‐center trial, 300 patients were randomized 1:1 to cardiac catheterization through dRA or pRA. The primary end point of change in hand function from baseline to 30 days was a composite of the QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand) questionnaire, hand‐grip test, and thumb forefinger pinch test. Secondary end points included access feasibility and complications; 254 of 300 patients completed follow‐up at 30 days; of these, 128 were randomized to dRA and 126 to pRA with balanced demographic and procedural characteristics. Both groups had similar rates of access site bleeding (dRA 0% versus pRA 1.4%; P=0.25). Six patients with dRA failed access compared with 2 patients with pRA. Radial artery occlusion occurred in 2 pRA versus none in dRA. There were no significant differences in change in hand function, median hand‐grip (dRA 0 [−3.2, 3.3] versus pRA 0.7 [−2.3, 3.3] kg; P=0.21), pinch‐grip (dRA −0.3 [−1.2, 0.5] versus pRA 0 [−0.9, 0.9] kg; P=0.09), and QuickDASH (dRA 0 [−4.6, 2.3] versus pRA 0 [−4.6, 2.3] points, P=0.96). There was no significant difference in the composite of hand function between pRA and dRA. Conclusions dRA is a safe strategy for cardiac catheterization with a low complication rate. Compared with pRA, there is no increased risk of hand dysfunction at 30 days. Registration URL: https://www.ClinicalTrials.gov. Unique identifier: NCT04318990.

Purpose/Objective: Magnetic resonance-guided radiation therapy (MRgRT) utilization is rapidly expanding worldwide, driven by advanced capabilities including continuous intrafraction visualization, automatic triggered beam delivery, and on-table adaptive replanning (oART). Our objective was to describe patterns of 0.35Tesla(T)-MRgRT (MRIdian) utilization in the United States (US) among early adopters of this novel technology. Materials/Methods: Anonymized administrative data from all US MRIdian treatment systems were extracted for patients completing treatment from 2014 to 2020. Detailed treatment information was available for all MRIdian linear accelerator (linac) systems and some cobalt systems. Results: Seventeen systems at 16 centers delivered 5736 courses and 36,389 fractions (fraction details unavailable for 1223 cobalt courses), of which 21.1% were adapted. Ultra-hypofractionation (UHfx) (1–5 fractions) was used in 70.3% of all courses. At least one adaptive fraction was used for 38.5% of courses (average 1.7 adapted fractions/course), with higher oART use in UHfx dose schedules (47.7% of courses, average 1.9 adapted fractions per course). The most commonly treated organ sites were pancreas (20.7%), liver (16.5%), prostate (12.5%), breast (11.5%), and lung (9.4%). Temporal trends show a compounded annual growth rate (CAGR) of 59.6% in treatment courses delivered, with a dramatic increase in use of UHfx to 84.9% of courses in 2020 and similar increase in use of oART to 51.0% of courses. Conclusions: This is the first comprehensive study reporting patterns of utilization among early adopters of MRIdian in the US. Intrafraction MR image-guidance, advanced motion management, and increasing adoption of adaptive radiation therapy has led to a substantial transition to ultra-hypofractionated regimens. 0.35 T-MRgRT has been predominantly used to treat abdominal and pelvic tumors with increasing use of on-table adaptive replanning, which represents a paradigm shift in radiation therapy.

AbstractThis is a case of a 23-year-old female who presented to the emergency department (ED) comatose after ingesting 7.8 g of propafenone and 11.7 g of valsartan. Upon arrival to the ED, the patient had seizures and required intubation. Several boluses of sodium bicarbonate were given as well as a continuous infusion to normalize QRS intervals. Norepinephrine and intravenous lipid emulsion (ILE) therapy were initiated. In the intensive care unit (ICU), the patient experienced persistent seizures and a 5-minute period of pulseless ventricular tachycardia. Subsequently, hyperinsulinemic-euglycemic therapy (HIET) was initiated. The patient received a 1 unit/kg intravenous bolus of regular insulin followed by a continuous infusion starting at 1 unit/kg/hr. Norepinephrine infusion was weaned off after 27 h of HIET. Within 48 h of presentation, the patient was transferred out of the ICU. This case exhibits the successful management of a mixed overdose with propafenone and valsartan utilizing a multimodal approach. In addition to supportive care, the patient received sodium bicarbonate, HIET, ILE and vasopressors to manage the cardiovascular collapse associated with these toxicities.

The US drone strike programme has prompted debate between pro- and anti-drone lawyers over interpretations of self-defence and the laws of war. The debate frequently neglects the effects of drone technology on interpreting these laws. This article argues that drone strikes are best understood as techno-legal assemblages that combine technoscience and law to make killing lawful. The argument proceeds in three parts. Part one analyses the formal legal debate concerning drone strikes. The seeds of the debate are in the US’s response to terrorism in the 1980s, when it developed legal strategies to overcome the obstacles of territorial sovereignty and the ban on assassination. The contemporary debate on the law of self-defence divides into supporters and critics of the US’s legal position. However, the debate neglects what critical drone scholars have argued is an essential link between drone technology and legal ambiguity. Part two analyses the technoscientific practices of drone strikes and how they interpret and implement the laws of war. Armed drones are part of a widespread surveillance system that converts people into information, which the US uses to target individuals. The thresholds that distinguish between military and civilian objects, and that delineate the spaces, temporal order, and legal subjects of conflict, are all interpreted through the lens of the surveillance system. These techno-legal practices become a legal justification for drone killing that goes beyond positive law. Part three argues that drone strikes are techno-legal assemblages that are part of a general collective of assemblages of control. The enmeshing of law and technology in drone strikes reflects the expansion of the law to cover more subjects and more areas. Drone strikes, then, are not a radical break from the law, but a techno-legal continuation of patterns of colonial warfare.

Penelitian ini bertujuan untuk mengetahui apakah model pembelajaran artikulasi berpengaruh penggunaanya terhadap hasil belajar siswa pada mata pelajaran IPA terpadu. Metode penelitian ini menggunakan metode penelitian kuantitatif dan jenis penelitian adalah quasi eksperimen. Populasi dalam penelitian adalah seluruh siswa kelas IX SMP Negeri 1 Toma yang berjumlah 116 orang. Sampel penelitian adalah kelas IX-B sebagai kelas eksperimen dengan jumlah 29 orang dan kelas IX-C sebagai kelas kontrol berjumlah 27 orang. Instrumen yang digunakan adalah tes hasil belajar siswa yaitu tes awal dan tes akhir. Berdasarkan pengolahan data yang telah dilaksanakan, maka ada beberapa yang menjadi kesimpulan yaitu (1) berdasarkan perhitungan nilai rata-rata tes awal pada kelas eksperimen diperoleh sebesar 42.93 sedangkan kelas kontrol sebesar 54.26. (2) berdasarkan perhitungan nilai rata-rata tes akhir pada kelas eksperimen diperoleh sebesar 66.04 sedangkan pada kelas kontrol sebesar 45.66. (3) berdasarkan perhitungan uji hipotesis thitung = 8,228 dan ttabel = 1.671, sehingga thitung > ttabel yaitu 8,228 > 1.671. Maka Ha diterima dan Ho ditolak. Dapat disimpulkan bahwa ada pengaruh model pembelajaran artikulasi terhadap hasil belajar siswa pada mata pelajaran IPA Terpadu di SMP Negeri 1 Toma.

We experimentally assess the suitability of transmon qubits with fixed frequencies and fixed interactions for the realization of analogue quantum simulations of spin systems. We test a set of necessary criteria for this goal on a commercial quantum processor using full quantum process tomography and more efficient Hamiltonian tomography. Significant single qubit errors at low amplitudes are identified as a limiting factor preventing the realization of analogue simulations on currently available devices. We additionally find spurious dynamics in the absence of drive pulses, which we identify with coherent coupling between the qubit and a low dimensional environment. With moderate improvements, analogue simulation of a rich family of time-dependent many-body spin Hamiltonians may be possible.

Repeated projective measurements in unitary circuits can lead to an entanglement phase transition as the measurement rate is tuned. In this work, we consider a different setting in which the projective measurements are replaced by dynamically chosen unitary gates that minimize the entanglement. This can be seen as a one-dimensional unitary circuit game in which two players get to place unitary gates on randomly assigned bonds at different rates: the “entangler” applies a random local unitary gate with the aim of generating extensive (volume-law) entanglement. The “disentangler,” based on limited knowledge about the state, chooses a unitary gate to reduce the entanglement entropy on the assigned bond with the goal of limiting to only finite (area-law) entanglement. In order to elucidate the resulting entanglement dynamics, we consider three different scenarios: (i) a classical discrete height model, (ii) a Clifford circuit, and (iii) a general U(4) unitary circuit. We find that both the classical and Clifford circuit models exhibit phase transitions as a function of the rate that the disentangler places a gate, which have similar properties that can be understood through a connection to the stochastic Fredkin chain. In contrast, the entangler always wins when using Haar random unitary gates and we observe extensive, volume-law entanglement for all nonzero rates of entangling.

Abstract Background Small intestinal bacterial overgrowth (SIBO) is a condition of unknown prevalence characterized by an excessive amount of bacteria in the small bowel, typically resulting in vague gastrointestinal symptoms with bloating being most commonly reported. Here we describe a severe case of SIBO leading to small bowel necrosis requiring surgical intervention. Case presentation A 55-year-old Hispanic female with gastric outlet obstruction secondary to a newly diagnosed gastric adenocarcinoma, receiving neoadjuvant chemotherapy, developed bloody gastrostomy output and rapidly progressing nausea and abdominal distention 3 days after jejunostomy tube placement and initiation of jejunal enteral nutrition. Imaging revealed diffuse pneumatosis and portal venous gas. Surgical exploration confirmed segmental bowel necrosis requiring resection. Histologic findings were consistent with SIBO. Conclusions Presentation of severe SIBO in the setting of intestinal stasis secondary to gastric outlet after initiation of enteral feeds is a rare phenomenon. Early recognition and diagnosis of SIBO is critical in minimizing patient morbidity and mortality.

Background Effective development and retention of talented early-career researchers (ECRs) is essential to the continued success of biomedical science research fields. To this end, formal mentorship programmes (where researchers are paired with one or more mentors beyond their direct manager) have proven to be successful in providing support and expanding career development opportunities. However, many programmes are limited to pools of mentors and mentees within one institute or geographical area, highlighting that cross-regional connections may be a missed opportunity in many mentorship schemes. Methods Here, we aimed to address this limitation through our pilot cross-regional mentorship scheme, creating reciprocal mentor-mentee pairings between two pre-established networks of Alzheimer’s Research UK (ARUK) Network-associated researchers. We carefully created 21 mentor-mentee pairings between the Scotland and University College London (UCL) networks in 2021, with surveys conducted to assess mentor/mentee satisfaction with the programme. Results Participants reported very high satisfaction with the nature of the pairings and the mentors’ contribution to the career development of mentees; a majority also reported that the mentorship scheme increased their connections outside of their home network. Our assessment of this pilot programme is that it supports the utility of cross-regional mentorship schemes for ECR development. At the same time, we highlight the limitations of our programme and recommend areas for improvement in future programmes, including greater consideration of support for minoritized groups and the need for additional training for mentors. Conclusions In conclusion, our pilot scheme generated successful and novel mentor-mentee pairings across pre-existing networks; both of which reported high satisfaction with pairings, ECR career and personal development, and the formation of new cross-network connections. This pilot may serve as a model for other networks of biomedical researchers, where existing networks within medical research charities can act as a scaffold to build new cross-regional career development opportunities for researchers.

Simulating time evolution of generic quantum many-body systems using classical numerical approaches has an exponentially growing cost either with evolution time or with the system size. In this work we present a polynomially scaling hybrid quantum-classical algorithm for time evolving a one-dimensional uniform system in the thermodynamic limit. This algorithm uses a layered uniform sequential quantum circuit as a variational Ansatz to represent infinite translation-invariant quantum states. We show numerically that this Ansatz requires a number of parameters polynomial in the simulation time for a given accuracy. Furthermore, this favorable scaling of the Ansatz is maintained during our variational evolution algorithm. All steps of the hybrid optimization are designed with near-term digital quantum computers in mind. After benchmarking the evolution algorithm on a classical computer, we demonstrate the measurement of observables of this uniform state using a finite number of qubits on a cloud-based quantum processing unit. With more efficient tensor contraction schemes, this algorithm may also offer improvements as a classical numerical algorithm.

Abstract An exceptionally large coral Porites sp. has been identified and measured at Goolboodi (Orpheus Island), Great Barrier Reef (GBR). This coral was measured in March 2021 during citizen science research of coral reefs in the Palm Islands group. We conducted a literature review and consulted scientists to compare the size, age and health of the Porites with others in the GBR and internationally. This is the largest diameter Porites coral measured by scientists and the sixth highest coral measured in the GBR. The health of the Porites was assessed as very good with over 70% live coral cover and minor percentages of sponge, live coral rock and macroalgae. An estimated age of 421–438 years was calculated based on linear growth models. Manbarra Traditional Owners were consulted and suggested that the Porites be named Muga dhambi (big coral) to communicate traditional knowledge, language and culture to indigenous, tourists, scientists and students.

Healthy agroecosystems are dependent on a complex web of factors and inter-species interactions. Flowers are hubs for pathogen transmission, including the horizontal or vertical transmission of plant-viruses and the horizontal transmission of bee-viruses. Pollination by the European honey bee (Apis mellifera) is critical for industrial fruit production, but bees can also vector viruses and other pathogens between individuals. Here, we utilized commercial honey bee pollination services in blueberry (Vaccinium corymbosum) farms for a metagenomics-based bee and plant virus monitoring system. Following RNA sequencing, viruses were identified by mapping reads to a reference sequence database through the bioinformatics portal Virtool. In total, 29 unique plant viral species were found at two blueberry farms in British Columbia (BC). Nine viruses were identified at one site in Ontario (ON), five of which were not identified in BC. Ilarviruses blueberry shock virus (BlShV) and prune dwarf virus (PDV) were the most frequently detected viruses in BC but absent in ON, while nepoviruses tomato ringspot virus and tobacco ringspot virus were common in ON but absent in BC. BlShV coat protein (CP) nucleotide sequences were nearly identical in all samples, while PDV CP sequences were more diverse, suggesting multiple strains of PDV circulating at this site. Ten bee-infecting viruses were identified, with black queen cell virus frequently detected in ON and BC. Area-wide bee-mediated pathogen monitoring can provide new insights into the diversity of viruses present in, and the health of, bee-pollination ecosystems. This approach can be limited by a short sampling season, biased towards pollen-transmitted viruses, and the plant material collected by bees can be very diverse. This can obscure the origin of some viruses, but bee-mediated virus monitoring can be an effective preliminary monitoring approach.

Quantum computers promise to perform computations beyond the reach of modern computers with profound implications for scientific research. Due to remarkable technological advances, small scale devices are now becoming available for use. One of the most apparent applications for such a device is the study of complex many-body quantum systems, where classical computers are unable to deal with the generic exponential complexity of quantum states. Even zero-temperature equilibrium phases of matter and the transitions between them have yet to be fully classified, with topologically protected phases presenting major difficulties. We construct and measure a continuously parametrized family of states crossing a symmetry protected topological phase transition on the IBM Q quantum computers. We present two complementary methods for measuring string order parameters that reveal the transition, and additionally analyze the effects of noise in the device using simple error models. The simulation that we perform is easily scalable and is a practical demonstration of the utility of near-term quantum computers for the study of quantum phases of matter and their transitions.

Gynandromorphy is an anomaly that results in an organism phenotypically expressing both male and female characteristics. Here we describe the first gynandromorph of the bee species Megalopta amoena (Spinola, 1853) (Halictidae, Augochlorini) and the second record of this anomaly within the genus Megalopta. Additionally, we analyzed the bee’s circadian rhythm, which has never before been quantified for a gynandromorph. The gynandromorph showed a deviant activity pattern; it was intermediate between that of the male and female M. amoena. Our results imply that the brains of bilateral gynandromorphs may have mixed sex-specific signaling. Based on four days of recording, the gynandromorph circadian rhythm was shifted earlier in the day relative to the male and female M. amoena, and it exhibited intensity similar to the female.

IntroductionThe World Health Organization recognizes dementia as a public health priority and highlights research as an action to respond to the consequences, with early career dementia researchers (ECDRs) representing the key driving force. Due to the COVID-19 pandemic, however, biomedical and psychosocial dementia research was strained worldwide. The aim of this study was to understand the impact of the pandemic on ECDRs.MethodsIn autumn 2021, the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART) Professional Interest Area to Elevate Early Career Researchers (PEERs) and University College London conducted an online survey querying ECDRs' experiences during the COVID-19 pandemic. The survey was shared through the ISTAART network, social media, podcasts, and emailing lists. Data were analyzed using descriptive and inferential statistics.ResultsSurvey data from n = 321 ECDRs from 34 countries were analyzed (67.6% women; 78.8% working in academia). Overall, 77.8% of ECDRs surveyed indicated research delays, 53.9% made project adjustments, 37.9% required additional or extended funding, and 41.8% reported a negative impact on career progression. Moreover, 19.9% felt unsupported by their institutions and employers (33% felt well supported, 42.7% somewhat supported). ECDR's conference attendance remained the same (26.5%) or increased (More: 28.6%; a lot more: 5.6%) since the start of the pandemic. Continental differences were visible, while the impact of the pandemic did not differ greatly based on ECDRs' sociodemographic characteristics.ConclusionsThe COVID-19 pandemic had a substantial impact on ECDRs worldwide and institutions, employers, and funding bodies are urged to consider the implications and lessons-learned when working with, managing, and promoting ECDRs. Strategies related to the pandemic and general career support to improve ECDRs career progression are discussed, including social media training, digital networking, and benefits of hybrid events. Global resources specific for ECDRs are highlighted.

While coral reefs in Australia have historically been a showcase of conventional management informed by research, recent declines in coral cover have triggered efforts to innovate and integrate intervention and restoration actions into management frameworks. Here we outline the multi-faceted intervention approaches that have developed in Australia since 2017, from newly implemented in-water programs, research to enhance coral resilience and investigations into socio-economic perspectives on restoration goals. We describe in-water projects using coral gardening, substrate stabilisation, coral repositioning, macro-algae removal, and larval-based restoration techniques. Three areas of research focus are also presented to illustrate the breadth of Australian research on coral restoration, (1) the transdisciplinary Reef Restoration and Adaptation Program (RRAP), one of the world's largest research and development programs focused on coral reefs, (2) interventions to enhance coral performance under climate change, and (3) research into socio-cultural perspectives. Together, these projects and the recent research focus reflect an increasing urgency for action to confront the coral reef crisis, develop new and additional tools to manage coral reefs, and the consequent increase in funding opportunities and management appetite for implementation. The rapid progress in trialling and deploying coral restoration in Australia builds on decades of overseas experience, and advances in research and development are showing positive signs that coral restoration can be a valuable tool to improve resilience at local scales (i.e., high early survival rates across a variety of methods and coral species, strong community engagement with local stakeholders). RRAP is focused on creating interventions to help coral reefs at multiple scales, from micro scales (i.e., interventions targeting small areas within a specific reef site) to large scales (i.e., interventions targeting core ecosystem function and social-economic values at multiple select sites across the Great Barrier Reef) to resist, adapt to and recover from the impacts of climate change. None of these interventions aim to single-handedly restore the entirety of the Great Barrier Reef, nor do they negate the importance of urgent climate change mitigation action.

Identified in December 2019, SARS-CoV-2 quickly spread worldwide with a resultant increase in global morbidity, mortality, and economic disruption on a scale not seen since the 1918 Spanish flu. Health officials recommended universal masking to further reduce human-to-human spread of SARS-CoV-2. The state of Hawaii and the Department of Defense (DOD) adopted strict mask policies early in the pandemic and is shown to be effective at reducing transmission. We report a case of Staphylococcus aureus bacteremia in an immunocompetent 21-year-old man attributed to local skin irritation with resultant infection in the setting of continuous reuse of a mask that resulted in bilateral cavernous venous thrombosis and septic pulmonary embolism.

Objectives: Standard molecular testing for patients with stage IV non-small cell lung cancer (NSCLC) in the Canadian publicly funded health system includes single gene testing for EGFR, ALK, and ROS-1. Comprehensive genomic profiling (CGP) may broaden treatment options for patients. This study examined the impact of CGP in a publicly funded health system. Methods: Consenting patients with stage IV NSCLC without known targetable alterations underwent CGP on diagnostic samples. Patients that had progressed on targeted therapy were also eligible. The CGP assay was a hybrid capture next generation sequencing (NGS) panel (Oncomine Comprehensive Assay Version 3, ThermoFisher). The number of actionable alterations, changes in treatment, clinical trial eligibility and costs as a result of CGP were evaluated and patient willingness-to-pay. Results: Of 182 screened patients,134 (74%) had successful CGP testing. Twenty percent had received prior targeted therapy. Incremental actionable alterations were identified in 31% of patients. The most common novel targets identified were mutations in ERBB2 (exon 20 insertions), MET (exon 14 skipping) and KRAS (G12C). At data cut off (31/12/2020), 16% of patients had a change in treatment as a result of CGP. Additional clinical trial options were identified for 75% of patients. The incremental direct laboratory cost for CGP beyond public reimbursement for single gene tests was $747 CAD/case. Conclusion: CGP identifies additional actionable targets beyond single gene tests with a direct impact on patient treatment and increased clinical trial eligibility. These benefits highlight the value of CGP in patients with NSCLC in public health systems.

OBJECTIVES:. To summarize selected meta-analyses and trials related to critical care pharmacotherapy published in 2020. DATA SOURCES:. The Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update group screened 36 journals monthly for impactful publications. STUDY SELECTION:. The group reviewed a total of 119 articles during 2020 according to relevance for practice. DATA EXTRACTION:. Articles were selected with consensus and importance to clinical practice from those included in the monthly Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update. The group reviewed articles according to Grading of Recommendations, Assessment, Development, and Evaluations criteria. Articles with a 1A grade were selected. DATA SYNTHESIS:. Several trials were summarized, including two meta-analyses and five original research trials. Original research trials evaluating vitamin C, hydrocortisone, and thiamine versus hydrocortisone in sepsis, the use of nonsedation strategies, dexmedetomidine in cardiac surgery, remdesivir for severe acute respiratory syndrome coronavirus 2, and thrombectomy in acute ischemic stroke. Two meta-analyses determining the impact of norepinephrine initiation in patients with septic shock and the use of corticosteroids in severe acute respiratory syndrome coronavirus 2 was included. CONCLUSIONS:. This clinical review provides summary and perspectives of clinical practice impact on influential critical care pharmacotherapy publications in 2020.

Purpose: The Lean methodology was applied to clinical metrics by a critical care pharmacy team. The experiences associated with the development and implementation of clinical metrics and their impact on daily workflow are described. Summary: The Lean methodology has been introduced into the healthcare system as a means of process improvement, which can eliminate waste through appropriate medication utilization. At OhioHealth Riverside Methodist Hospital, the department of pharmacy was tasked with the development of clinical metrics after a health system wide Gemba walk was initiated. The pharmacy department's critical care team developed a strategy identifying and evaluating clinical metrics pertaining to their everyday workflow. Each clinical metric was evaluated in accordance with a pre-defined goal. Metrics requiring heavy documentation and those in which the pharmacist does not have autonomous authority to manage were often challenging to implement and were less successful. Throughout this process, the lessons learned focused on generating ideas that were easily documented, evidence-based, and department specific. The critical care team discovered that the outcome of the most successful metrics highlighted clinical pharmacist value and data generated could be used to support funding for additional resources. Conclusion: The critical care pharmacy team developed a streamlined process to implement clinical metrics as means of identifying areas for improvement using the Lean methodology.