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INTRODUCTION: Expanding access to doula care is a key strategy for improving the perinatal experiences and health outcomes of birthing people of color in the U.S. This study investigates the future of maternal healthcare in the U.S. from the perspective of doulas and highlights emerging technology and other opportunities related to strengthening the doula workforce. METHODS: The study recruited community doulas from 12 unique U.S. states, ensuring at least half of the doulas predominantly served communities of color. Doulas (N = 26) participated in semi-structured, futures-oriented interviews that explored their experiences providing care during the COVID-19 pandemic and utilization of technology. A subset of doulas (n = 8) were engaged in interactive workshops where they envisioned alternative futures for doula care and childbirth. Interviews and workshops were analyzed using the Framework Method. RESULTS: The COVID-19 pandemic heightened technology use among doulas and increased client accessibility. Social media serves as a unique space for critical community building and client outreach. Doulas reported opportunities to strengthen and mobilize the future workforce: recognizing doula care as a reimbursable service by health insurers, utilizing doula collectives for community practice to decrease burnout, increasing emotional support for doulas, and instilling a chain of learning through mentorship. DISCUSSION: Futures thinking served as a valuable approach for doulas to illuminate the implications of present-day challenges and empowered doulas to design roadmaps toward better futures for doulas and maternal health. Doulas should be engaged as partners to hold a meaningful decision-making role when discussing policies, employment structures, emerging technology, and other aspects of doulas positioning within the healthcare system.

Serious concerns about the way research is organized collectively are increasingly being raised. They include the escalating costs of research and lower research productivity, low public trust in researchers to report the truth, lack of diversity, poor community engagement, ethical concerns over research practices, and irreproducibility. Open science (OS) collaborations comprise of a subset of open practices including open access publication, open data sharing and the absence of restrictive intellectual property rights with which institutions, firms, governments and communities are experimenting in order to overcome these concerns. We gathered two groups of international representatives from a large variety of stakeholders to construct a toolkit to guide and facilitate data collection about OS and non-OS collaborations. Ultimately, the toolkit will be used to assess and study the impact of OS collaborations on research and innovation. The toolkit contains the following four elements: 1) an annual report form of quantitative data to be completed by OS partnership administrators; 2) a series of semi-structured interview guides of stakeholders; 3) a survey form of participants in OS collaborations; and 4) a set of other quantitative measures best collected by other organizations, such as research foundations and governmental or intergovernmental agencies. We opened our toolkit to community comment and input. We present the resulting toolkit for use by government and philanthropic grantors, institutions, researchers and community organizations with the aim of measuring the implementation and impact of OS partnership across these organizations. We invite these and other stakeholders to not only measure, but to share the resulting data so that social scientists and policy makers can analyse the data across projects.

Background and Context: More data are needed about how young learners identify and fix errors while programming in pairs. Objective: The study will identify discernible patterns in the intersection between debugging processes and the type of regulation used during debugging while children engage in coding to drive further theory and model development. Method: Two experiments were conducted in sequential order. First, second-grade students (N = 12) programmed a Code-a-pillar using physical programming blocks. Two coding schemes were used to identify both debugging processes and types of regulation used. Second, using a similar approach, eighth-grade students (N = 30) programmed a Tobbie2 robot using Microsoft MakeCode. Finding: Integrated and sequential use of all four debugging processes is related to successful coding. We see similar patterns in the overlap between debugging processes and regulation types for both ages. Implications: The study highlights the dynamic nature of coding and debugging processes and the importance of including metacognitive and regulatory elements in debugging models.

A teacher's ability to read effectively is critical to that individual's ability to teach reading skills. Correspondingly, most state departments of education require that prospective teachers earn a passing score on a standardized reading comprehension test before they can enter university-based teacher education programs or otherwise get a professional teaching license. Having witnessed quality candidates get pushed away from teaching due to poor performance on the our state's reading comprehension measure and given that previous studies have shed doubt on the construct validity of major standardized assessments (e.g., the SAT and ACT), we examined the validity of our state's standardized reading assessment for teachers. Using data generated by 115 college-aged participants in a prerequisite course for our teacher education programs, we found that our state's assessment did little to measure reading comprehension. Instead, it measured students' test-taking skills. This is exceptionally problematic because tests like this one keep significant numbers of qualified and motivated individuals from entering the teaching profession. Worse, due to the oft-researched relationship between test-taking skills to the socioeconomic background of the test-taker, these impacts may be exponentially worse for individuals from minority and lower socioeconomic backgrounds, thereby further reducing their opportunities to teach.

Introduction: We present six adenovirus cases that emerged from a cluster of respiratory illnesses within a college population. Two patients required intensive care with complicated hospital courses and experienced residual symptoms. Four additional patients were evaluated in the emergency department (ED) with two additional diagnoses of neuroinvasive disease. These cases represent the first known occurrences of neuroinvasive adenovirus infections in healthy adults.Case Series: An individual presented to the ED with fever, altered mental status, and seizures after being found unresponsive in his apartment. His presentation was concerning for significant central nervous system pathology. Shortly after his arrival, a second individual presented with similar symptoms. Both required intubation and admission to a critical care setting. Over a 24-hour period, four additional individuals presented to the ED with moderate severity symptoms. All six individuals tested positive for adenovirus in their respiratory secretions. A provisional diagnosis of neuroinvasive adenovirus was made after consultation with infectious diseases. Conclusion: This cluster of cases appears to represent the first known reported diagnosis of neuroinvasive adenovirus in healthy young individuals. Our cases were also unique in demonstrating a significant spectrum of disease severity. Over 80 individuals in the broader college community ultimately tested positive for adenovirus in respiratory samples. As respiratory viruses continue to challenge our healthcare systems, new spectrums of disease are being discovered. We believe clinicians should be aware of the potential severity of neuroinvasive adenovirus disease.

Abstract Introduction Accidental extubation during prone position can be a life-threatening emergency requiring rapid establishment of the airway. However, there is limited evidence of the best airway rescue method for this potentially catastrophic emergency. The aim of this study was to determine the most effective method to recover the airway in case of accidental extubation during prone positioning by comparing three techniques (supraglottic airway, video laryngoscopy, and fiber-optic bronchoscopy) in a simulated environment. Methods Eleven anesthesiologists and 12 anesthesia fellows performed the simulated airway management using 3 different techniques on a mannequin positioned prone in head pins. Time required for definitive airway management and the success rates were measured. Results The success rates of airway rescue were 100% with the supraglottic airway device (SAD), 69.6% with the video laryngoscope (CMAC), and 91.3% with the FOB. The mean (SD) time to insertion was 18.1 (4.8) s for the supraglottic airway, 78.3 (32.0) s for the CMAC, and 57.3 (24.6) s for the FOB. There were significant differences in the time required for definitive airway management between the SAD and FOB (t = 5.79, p

Abstract Medical datasets inherently contain errors from subjective or inaccurate test results, or from confounding biological complexities. It is difficult for medical experts to detect these elusive errors manually, due to lack of contextual information, limiting data privacy regulations, and the sheer scale of data to be reviewed. Current methods for training robust artificial intelligence (AI) models on data containing mislabeled examples generally fall into one of several categories—attempting to improve the robustness of the model architecture, the regularization techniques used, the loss function used during training, or selecting a subset of data that contains cleaner labels. This last category requires the ability to efficiently detect errors either prior to or during training, either relabeling them or removing them completely. More recent progress in error detection has focused on using multi-network learning to minimize deleterious effects of errors on training, however, using many neural networks to reach a consensus on which data should be removed can be computationally intensive and inefficient. In this work, a deep-learning based algorithm was used in conjunction with a label-clustering approach to automate error detection. For dataset with synthetic label flips added, these errors were identified with an accuracy of up to 85%, while requiring up to 93% less computing resources to complete compared to a previous model consensus approach developed previously. The resulting trained AI models exhibited greater training stability and up to a 45% improvement in accuracy, from 69 to over 99% compared to the consensus approach, at least 10% improvement on using noise-robust loss functions in a binary classification problem, and a 51% improvement for multi-class classification. These results indicate that practical, automated a priori detection of errors in medical data is possible, without human oversight.

Abstract Our GWAS of hematuria in the UK Biobank identified 6 loci, some of which overlap with loci for albuminuria suggesting pleiotropy. Since clinical syndromes are often defined by combinations of traits, generating a combined phenotype can improve power to detect loci influencing multiple characteristics. Thus the composite trait of hematuria and albuminuria was chosen to enrich for glomerular pathologies. Cases had both hematuria defined by ICD codes and albuminuria defined as uACR > 3 mg/mmol. Controls had neither an ICD code for hematuria nor an uACR > 3 mg/mmol. 2429 cases and 343,509 controls from the UK Biobank were included. eGFR was lower in cases compared to controls, with the exception of the comparison in females using CKD-EPI after age adjustment. Variants at 4 loci met genome-wide significance with the following nearest genes: COL4A4, TRIM27, ETV1 and CUBN. TRIM27 is part of the extended MHC locus. All loci with the exception of ETV1 were replicated in the Geisinger MyCode cohort. The previous GWAS of hematuria reported COL4A3-COL4A4 variants and HLA-B*0801 within MHC, which is in linkage disequilibrium with the TRIM27 variant (D′ = 0.59). TRIM27 is highly expressed in the tubules. Additional loci included a coding sequence variant in CUBN (p.Ala2914Val, MAF = 0.014 (A), p = 3.29E−8, OR = 2.09, 95% CI = 1.61–2.72). Overall, GWAS for the composite trait of hematuria and albuminuria identified 4 loci, 2 of which were not previously identified in a GWAS of hematuria.

Highly migratory shorebirds are among the fastest declining avian guilds, so determining causes of mortality is critically important for their conservation. Most of these species depend on a specific geographic arrangement of suitable sites that reliably provide resources needed to fuel physiologically demanding life histories. Long-term mark-resight projects allow researchers to investigate specific potential sources of variation in demographic rates between populations. Red Knots (Calidris canutus) occur in three relatively distinct regions across the northern Gulf of Mexico, and two of these areas have been experiencing episodic harmful algal blooms (red tide) with increased frequency in recent decades. Since knots are mostly molluscivorous during the nonbreeding season in the Gulf, they are potentially exposed to red tide toxins at high concentrations via their filter-feeding prey. We used long-term mark-resight data from Texas, Louisiana, and Florida (USA) to estimate apparent survival, and to assess the effects of red tides on survival of Red Knots. We also assessed effects of tracking devices deployed in conjunction with the projects over the years. While overall apparent annual survival rates were similar across the three locations (0.768 – 0.819), several red tide events were associated with catastrophically low seasonal (fall) survival in Florida (as low as 0.492) and Texas (as low as 0.510). Leg-mounted geolocators, but not temporary glued-on VHF tags, were associated with a reduction in apparent survival (~8%/year). Movement of knots between the three areas was rare and site fidelity is known to be high. Harmful algal blooms are predicted to increase in frequency and severity with climate change and increased anthropogenic degradation of coastal habitats, which may further endanger these as well as other shorebird populations around the world.

BackgroundMultiple chronic conditions (multimorbidity) are becoming more prevalent among aging populations. Digital health technologies have the potential to assist in the self-management of multimorbidity, improving the awareness and monitoring of health and well-being, supporting a better understanding of the disease, and encouraging behavior change. ObjectiveThe aim of this study was to analyze how 60 older adults (mean age 74, SD 6.4; range 65-92 years) with multimorbidity engaged with digital symptom and well-being monitoring when using a digital health platform over a period of approximately 12 months. MethodsPrincipal component analysis and clustering analysis were used to group participants based on their levels of engagement, and the data analysis focused on characteristics (eg, age, sex, and chronic health conditions), engagement outcomes, and symptom outcomes of the different clusters that were discovered. ResultsThree clusters were identified: the typical user group, the least engaged user group, and the highly engaged user group. Our findings show that age, sex, and the types of chronic health conditions do not influence engagement. The 3 primary factors influencing engagement were whether the same device was used to submit different health and well-being parameters, the number of manual operations required to take a reading, and the daily routine of the participants. The findings also indicate that higher levels of engagement may improve the participants’ outcomes (eg, reduce symptom exacerbation and increase physical activity). ConclusionsThe findings indicate potential factors that influence older adult engagement with digital health technologies for home-based multimorbidity self-management. The least engaged user groups showed decreased health and well-being outcomes related to multimorbidity self-management. Addressing the factors highlighted in this study in the design and implementation of home-based digital health technologies may improve symptom management and physical activity outcomes for older adults self-managing multimorbidity.

This study examined the experiences of three new online instructors supported by a multidisciplinary, team-based model of course development and how their experiences may transform their knowledge of teaching and learning. In-depth, individual interviews with instructors during the course development process provided insights into participants' perspectives. Analysis reveals faculty reflected positively on the overall development process and that they intend to incorporate new understandings in future course design, suggesting that the model provides a solid foundation for online course development and faculty support. Based on a cross-case analysis using Cranton's (2002) adaptations to transformative learning theory, findings indicated the importance of critical reflection and discourse during the course development process. Lastly, the need for development teams to acknowledge time-management concerns and to consider instructors as novice learners is recognized as an essential requirement to online course development.

Identification of enteric bacteria species by whole genome sequence (WGS) analysis requires a rapid and an easily standardized approach. We leveraged the principles of average nucleotide identity using MUMmer (ANIm) software, which calculates the percent bases aligned between two bacterial genomes and their corresponding ANI values, to set threshold values for determining species consistent with the conventional identification methods of known species. The performance of species identification was evaluated using two datasets: the Reference Genome Dataset v2 (RGDv2), consisting of 43 enteric genome assemblies representing 32 species, and the Test Genome Dataset (TGDv1), comprising 454 genome assemblies which is designed to represent all species needed to query for identification, as well as rare and closely related species. The RGDv2 contains six Campylobacter spp., three Escherichia/Shigella spp., one Grimontia hollisae, six Listeria spp., one Photobacterium damselae, two Salmonella spp., and thirteen Vibrio spp., while the TGDv1 contains 454 enteric bacterial genomes representing 42 different species. The analysis showed that, when a standard minimum of 70% genome bases alignment existed, the ANI threshold values determined for these species were ≥95 for Escherichia/Shigella and Vibrio species, ≥93% for Salmonella species, and ≥92% for Campylobacter and Listeria species. Using these metrics, the RGDv2 accurately classified all validation strains in TGDv1 at the species level, which is consistent with the classification based on previous gold standard methods.

Objective To identify and synthesize evidence on the barriers and facilitators to older adults’ acceptance of camera-based active and assisted living (AAL) technologies in the home. Introduction Camera-based AAL technologies have been heralded as an important solution to population ageing. By leveraging state-of-the-art computer vision techniques, camera-based AAL technologies can secure greater levels of safety, health, and independence for older adults whilst benefiting their desires to age-in-place. However, these technologies face widespread rejection and are at present scarcely used. A critical first step toward enhancing older adults’ acceptance and uptake of camera-based AAL technologies is to understand the barriers and facilitators to their acceptance of said technology. Inclusion criteria This review will consider primary studies reporting data on the barriers and facilitators to the acceptance of camera-based AAL technologies among community-dwelling older adults aged 60 and above. No date or language restrictions will be applied. Methods Following JBI scoping review methodology, key electronic databases (e.g., MEDLINE, CINAHL, Embase, Web of Science, ACM Digital Library, IEEE Xplore) and the grey literature (e.g., Google Scholar) will be searched to locate both unpublished and published articles of relevance. Retrieved citations will undergo independent screening against pre-defined eligibility criteria. Data will be independently extracted and mapped to the Theoretical Domains Framework with guidance from a pre-piloted coding manual. Results will be presented in tabular form accompanied by a narrative summary of barriers and facilitators.

Discovery of digital items by scholars and the public is highly dependent upon effective metadata to ensure inclusion and prioritization in search engines. Subject descriptions based on controlled vocabulary, such as Library of Congress subject headings (LCSH), are particularly useful to enhance discovery, but they may be expensive to provide. In this case study we compared the results of computer-assisted indexing with manual selection of subject terms as part of an effort to enhance findability of journal information at the issue level. Our results suggest that incorporating both computer and human processes provide the highest impact for discovery of distinctive digital collections.

The Pollard-Yates transect is a widely used method for sampling butterflies. Data from these traditional transects are analyzed to produce density estimates, which are then used to make inferences about population status or trends. A key assumption of the Pollard-Yates transect is that detection probability is 1.0, or constant but unknown, out to a fixed distance (generally 2.5 m on either side of a transect line). However, species-specific estimates of detection probability would allow for sampling at farther distances, resulting in more detections of individuals. Our objectives were to (1) evaluate butterfly density estimates derived from Pollard-Yates line transects and distance sampling, (2) estimate how detection probabilities for butterflies vary across sampling distances and butterfly wing lengths, and (3) offer advice on future butterfly sampling techniques to estimate population density. We conducted Pollard-Yates transects and distance-sampling transects in central Iowa in 2014. For comparison to densities derived from Pollard-Yates transects, we used Program DISTANCE to model detection probability (p) and estimate density (D) for eight butterfly species representing a range of morphological characteristics. We found that detection probability among species varied beyond 2.5 m, with variation apparent even within 5 m of the line. Such variation correlated with wing size, where species with larger wing size generally had higher detection probabilities. Distance sampling estimated higher densities at the 5-m truncation for five of the eight species tested. At this truncation, detection probability was 5 m wide and when smaller species are targeted.

Introduction: A common neurosurgical condition, chronic subdural haematoma (cSDH) typically affects older people with other underlying health conditions. The care of this potentially vulnerable cohort is often, however, fragmented and suboptimal. In other complex conditions, multidisciplinary guidelines have transformed patient experience and outcomes, but no such framework exists for cSDH. This paper outlines a protocol to develop the first comprehensive multidisciplinary guideline from diagnosis to long-term recovery with cSDH. Methods: The project will be guided by a steering group of key stakeholders and professional organisations and will feature patient and public involvement. Multidisciplinary thematic working groups will examine key aspects of care to formulate appropriate, patient-centered research questions, targeted with evidence review using the GRADE framework. The working groups will then formulate draft clinical recommendations to be used in a modified Delphi process to build consensus on guideline contents. Conclusions: We present a protocol for the development of a multidisciplinary guideline to inform the care of patients with a cSDH, developed by cross-disciplinary working groups and arrived at through a consensus-building process, including a modified online Delphi.

Fat distribution is associated with cardiometabolic disease, although it has been less well studied than overall obesity. In a multiancestry exome-sequencing study, the authors identified predicted loss-of-function mutations in INHBE associated with favorable fat distribution and protection from type 2 diabetes.

Introduction: We present six adenovirus cases that emerged from a cluster of respiratory illnesses within a college population. Two patients required intensive care with complicated hospital courses and experienced residual symptoms. Four additional patients were evaluated in the emergency department (ED) with two additional diagnoses of neuroinvasive disease. These cases represent the first known occurrences of neuroinvasive adenovirus infections in healthy adults. Case Series: An individual presented to the ED with fever, altered mental status, and seizures after being found unresponsive in his apartment. His presentation was concerning for significant central nervous system pathology. Shortly after his arrival, a second individual presented with similar symptoms. Both required intubation and admission to a critical care setting. Over a 24-hour period, four additional individuals presented to the ED with moderate severity symptoms. All six individuals tested positive for adenovirus in their respiratory secretions. A provisional diagnosis of neuroinvasive adenovirus was made after consultation with infectious diseases. Conclusion: This cluster of cases appears to represent the first known reported diagnosis of neuroinvasive adenovirus in healthy young individuals. Our cases were also unique in demonstrating a significant spectrum of disease severity. Over 80 individuals in the broader college community ultimately tested positive for adenovirus in respiratory samples. As respiratory viruses continue to challenge our healthcare systems, new spectrums of disease are being discovered. We believe clinicians should be aware of the potential severity of neuroinvasive adenovirus disease.

We present the first Chandra X-ray Observatory (CXO) catalog of “pulsar X-ray filaments,” or “misaligned outflows.” These are linear, synchrotron-radiating features powered by ultrarelativistic electrons and positrons that escape from bow shock pulsars. The filaments are misaligned with the (large) pulsar velocity, distinguishing them from the pulsar wind nebula (PWN) trail, which is also often visible in CXO ACIS images. Spectral fits and morphological properties are extracted for five secure filaments and three candidates using a uniform method. We present a search of archival CXO data for linear diffuse features; the known examples are recovered and a few additional weak candidates are identified. We also report on a snapshot CXO ACIS survey of pulsars with properties similar to the filament producers, finding no new filaments but some diffuse emission, including one PWN trail. Finally, we provide an updated model for the pulsar properties required to create filaments in light of these new observations.

By measuring photoelectron tracks, the gas pixel detectors of the Imaging X-ray Polarimetry Explorer satellite provide estimates of the photon detection location and its electric vector position angle (EVPA). However, imperfections in reconstructing event positions blur the image, and EVPA-position correlations result in artificial polarized halos around bright sources. We introduce a new model describing this “polarization leakage” and use it to recover the on-orbit telescope point-spread functions, useful for faint-source detection and image reconstruction. These point-spread functions are more accurate than previous approximations or ground-calibrated products (Δ χ ^2 ≈ 3 × 10 ^4 and 4 × 10 ^4 respectively for a bright 10 ^6 -count source). We also define an algorithm for polarization leakage correction substantially more accurate than existing prescriptions (Δ χ ^2 ≈ 1 × 10 ^3 ). These corrections depend on the reconstruction method, and we supply prescriptions for the mission-standard “Moments” methods as well as for “Neural Net” event reconstruction. Finally, we present a method to isolate leakage contributions to polarization observations of extended sources and show that an accurate PSF allows the extraction of sub-PSF-scale polarization patterns.

Direct land-to-atmosphere carbon exchange has been the primary focus in previous studies of peatland disturbance and subsequent restoration. However, loss of carbon via the fluvial pathway is a significant term in peatland carbon budgets and requires consideration to assess the overall impact of restoration measures. This study aimed to determine the effect of peatland land management regime on aquatic carbon concentrations and fluxes in an area within the UK's largest tract of blanket bog, the Flow Country of northern Scotland. Three sub-catchments were selected to represent peatland land management types: non-drained, drained, and restoration (achieved through drain blocking and tree removal). Water samples were collected on a fortnightly basis from September 2008 to August 2010 at six sampling sites, one located upstream and one downstream within each sub-catchment. Concentrations of dissolved organic carbon (DOC) were significantly lower for the upstream non-drained sub-catchment compared to the drained sub-catchments, and there was considerable variation in the speciation of aquatic carbon (DOC, particulate organic carbon (POC), CO2, and CH4) across the monitoring sites, with dissolved gas concentrations inversely correlated with catchment area and thereby contributing considerably more to total aquatic carbon in the smaller headwater catchments. Significantly higher POC concentrations were observed in the restored sub-catchment most affected by tree removal. Aquatic carbon fluxes were highest from the drained catchments and lowest from the non-drained catchments at 23.5 and 7.9 g C m−2 yr−1, respectively, with variability between the upstream and downstream sites within each catchment being very low. It is clear from both the aquatic carbon concentration and flux data that drainage has had a profound impact on the hydrological and biogeochemical functioning of the peatland. In the restoration catchment, carbon export varied considerably, from 21.1 g C m−2 yr−1 at the upper site to 10.0 g C m−2 yr−1 at the lower site, largely due to differences in runoff generation. As a result of this hydrological variability, it is difficult to make definitive conclusions about the impact of restoration on carbon fluxes, and further monitoring is needed to corroborate the longer-term effects.

Introduction Diagnosing underlying arrhythmia in emergency department (ED) syncope patients is difficult. There is a evidence that diagnostic yield for detecting underlying arrhythmia is highest when cardiac monitoring devices are applied early, ideally at the index visit. This strategy has the potential to change current syncope management from low diagnostic yield Holter to higher yield ambulatory monitoring, reduce episodes of syncope, reduce risk of recurrence and its potential serious consequences, reduce hospital admissions, reduce overall health costs and increase quality of life by allowing earlier diagnosis, treatment and exclusion of clinically important arrhythmias.Methods and analyses This is a UK open prospective parallel group multicentre randomised controlled trial of an immediate 14-day ambulatory patch heart monitor vs standard care in 2234 patients presenting acutely with unexplained syncope. Our patient focused primary endpoint will be number of episodes of syncope at 1 year. Health economic evaluation will estimate the incremental cost per syncope episode avoided and quality-adjusted life year gained.Ethics and dissemination Informed consent for participation will be sought. The ASPIRED trial received a favourable ethical opinion from South East Scotland Research Ethics Committee 01 (21/SS/0073). Results will be disseminated via scientific publication, lay summary and visual abstract.Trial registration number ISRCTN 10278811.

Candida albicans mutants for phosphatidylserine (PS) synthase (cho1ΔΔ) and PS decarboxylase (psd1ΔΔ psd2ΔΔ) are compromised for virulence in mouse models of systemic infection and oropharyngeal candidiasis (OPC). Both of these enzymes are necessary to synthesize phosphatidylethanolamine (PE) by the de novo pathway, but these mutants are still capable of growth in culture media, as they can import ethanolamine from media to synthesize PE through the Kennedy pathway. Given that the host has ethanolamine in its serum, the exact mechanism by which virulence is lost in these mutants is not clear. There are two competing hypotheses to explain their loss of virulence. (i) PE from the Kennedy pathway cannot substitute for de novo-synthesized PE. (ii) The mutants cannot acquire sufficient ethanolamine from the host to support adequate PE synthesis. These hypotheses can be simultaneously tested if ethanolamine availability is increased for Candida while it is inside the host. We accomplish this by transcomplementation of C. albicans with the Arabidopsis thaliana serine decarboxylase gene (AtSDC), which converts cytoplasmic serine to ethanolamine. Expression of AtSDC in either mutant restores PE synthesis, even in the absence of exogenous ethanolamine. AtSDC also restores virulence to cho1ΔΔ and psd1ΔΔ psd2ΔΔ strains in systemic and OPC infections. Thus, in the absence of de novo PE synthesis, C. albicans cannot acquire sufficient ethanolamine from the host to support virulence. In addition, expression of AtSDC restores PS synthesis in the cho1ΔΔ mutant, which may be due to causing PS decarboxylase to run backwards and convert PE to PS.

Researchers report the synthesis of a new archaea-inspired tetraether lipid and study the mechanical elastic properties of membranes made from this bolalipid. To access structural diversity in the hydrophobic moiety of the lipids and to tune membrane properties, they have used used Huisgen 1,3-dipolar cycloaddition strategy to design and synthesize a tetraether lipid incorporating phytanyl side chains and polar 1,4 triazole rings known to change lipid packing. The researchers demonstrate the first example of the synthesis of phytanyl side chain incorporated tetraether lipids with 1,4-triazole rings. They also confirm the ability of lipids incorporating 1,4-triazole rings to form stable small and giant vesicles and examined their physical and mechanical properties using a micropipette aspiration technique.

Abstract How animals move across space and time in heterogeneous landscapes has important implications for the conservation of imperiled and dispersal‐limited taxa, such as amphibians. Wetland‐breeding amphibians are thought to exhibit strong site fidelity, but there is growing evidence that many species are more vagile than previously assumed. Few studies have quantified breeding dispersal probabilities or distances while also accounting for observational uncertainty, which means that resultant estimates could be biased or confounded with sampling intensity and other demographic rates (e.g., site‐ and time‐specific detection and survival probabilities). Here, we analyze data from a 6‐year capture–mark–recapture study on adult spotted salamanders (Ambystoma maculatum) conducted at 12 wetlands in central Pennsylvania to estimate population dynamics and population structure at multiple scales. We used a multistate, hidden Markov estimator to quantify sex‐specific site fidelity and breeding dispersal as a function of Euclidean distance between wetlands while accounting for imperfect detection. We estimated short‐timescale movements (i.e., those that occur within a single breeding season) and longer timescale movements (i.e., those that occur among breeding seasons) to determine if dispersal rates and distances differed. We found that interannual site fidelity of males varied among wetlands and was positively associated with population density. Females exhibited higher interannual site fidelity and dispersed further than males between breeding seasons. Within breeding seasons, we found that up to 6% of males dispersed to a new wetland each day. Our study is the first to directly compare amphibian breeding dispersal probabilities and distances at multiple scales and provides a robust framework for improving inference on the spatial and temporal patterns of amphibian movement.

Cerebral edema is a condition where an excess of cerebral water accumulates due to primary neurological or non-neurological causes. Cerebral edema complicates many brain pathologies causing additional injury often in excess of the original neurological insult. Classic descriptions divide cerebral edema into cytotoxic, vasogenic, interstitial, and osmotic subtypes. The interplay of different mechanisms is important in the clinical manifestations. Recent research has advanced our understanding of the molecular pathophysiology of cerebral edema, exposing the central role of aquaporins and specific ion channels. The aim of this review is to provide a comprehensive overview of the molecular pathophysiology of cerebral edema including unique disease specific mechanisms.

Background Achieving patient-centred care necessitates supporting individuals to have more involvement in the self-management of their care. Digital health technologies are widely recognised as a solution to empower more effective self-management. However, given the complexity of multiple chronic condition (multimorbidity) management, coupled with changes that occur as part of the normal ageing process, human support alongside digital self-management is often necessary for older people with multimorbidity (PwM) to sustain successful self-management. Methods The aim of the study was to explore the role played by a clinical, nurse-led telephone triage service in responding to alerts generated by older adults using a digital health platform, ProACT, to self-manage multiple chronic conditions over a period of 1 year. Semi-structured interviews with participants with multimorbidity were carried out across four time points during the trial, while interviews and focus groups were conducted with triage nurses at the end of the trial. Thematic analysis was conducted on the resulting transcripts. Results Themes found in the data include the work of triage nurses; the benefits of triage support; tensions such as anxiety due to patient monitoring; and the relationship between triage nurses and participants. Discussion This work contributes to an understanding of how older adults with multimorbidity and triage nurses collaborate in multiple chronic disease self-management. Findings are discussed within the context of Hudon et al.'s patient-centred care framework and indicate that patient-centred care was achieved, with both PwM and triage participants reporting positive experiences, relationships and several benefits of the triage support alongside digital self-management.

Background Ageing populations are resulting in higher prevalence of people with multiple chronic conditions (multimorbidity). Digital health platforms have great potential to support self-management of multimorbidity, increasing a person's awareness of their health and well-being, supporting a better understanding of diseases and encouraging behaviour change. However, little research has explored the long-term engagement of older adults with such digital interventions. Methods The aim of this study is to analyse how 60 older adults with multimorbidity engaged with digital symptom and well-being monitoring through a digital health platform over a period of approximately 12 months. Data analysis focused on user retention, frequency of monitoring, intervals in monitoring and patterns of daily engagement. Results Our findings show that the overall engagement with the digital health platform was high, with more than 80% of participants using the technology devices for over 200 days. The submission frequency for symptom parameters (e.g. blood glucose (BG), blood pressure (BP), etc.) was between three and four times per week which was higher than that of self-report (2.24) and weight (2.84). Submissions of exercise (6.12) and sleep (5.67) were more frequent. The majority of interactions happened in the morning time. The most common time of submission for symptom parameters was 10 am, whereas 8 am was the most common time for weight measurements. Conclusions The findings indicate the patterns of engagement of older adults with complex chronic diseases with digital home-based self-management systems.

Prior knowledge activation is a crucial component of reading comprehension. Previous studies have examined students' prompted (or solicited) purposeful knowledge activation, which occurs when the explicit goal is to activate knowledge, as well as ancillary knowledge activation, which is when students indirectly use their prior knowledge to fill in gaps in the text, form an opinion, or question the author. However, little is known regarding elementary students' unprompted (or unsolicited) purposeful and ancillary activation of prior knowledge while reading grade-level texts. The purpose of the current study was to (a) examine differences between third- and fifth-grade students on their use of purposeful and ancillary prior knowledge activation when reading grade-level social studies and science texts and (b) determine how students' prior knowledge activation relates to their reading outcomes and reader profiles. Participants were 25 third-grade and 27 fifth-grade students from an urban school system in the southeastern United States. Participants were asked to think aloud as they read grade-level texts. Utterances were transcribed and coded according to the type of knowledge activation. Although repeated measures ANOVA revealed no significant differences in purposeful or ancillary activation across texts or between grade levels, the way in which students utilized these two types of prior knowledge activation (i.e., purposeful and ancillary) differed as a function of their reader profile. To uncover these differences, we took a case study approach to further explicate the complex relations between prior knowledge activation, other reading behaviors, and reading outcomes.

Multimorbidity, defined as the concurrent experience of more than one chronic health condition in an individual, affects ∼65% of people over 65 and 85% of those over 85 years old with 30% of those also experiencing mental health concerns. This can lead to reduced quality of life and functioning as well as poorer outcomes in terms of condition management, adherence to treatment, and ultimately disease prognosis and progression. Digital health interventions offer a viable means of condition self-management, as well as psychological support, particularly for those who may have difficulty accessing in-person services. To best meet the needs of older adults with multimorbidity, deeper insights are needed into their specific concerns and issues around condition management, particularly with regard to distress in relation to managing one's condition. The present study aimed to explore this using one-to-one qualitative interviews and focus groups with people with chronic health conditions and healthcare professionals. Participants were 11 older adults with multimorbidity (4 males; mean age: M = 72.7 years) and 14 healthcare professionals including five clinical nurse specialists, four pharmacists, two general practitioners, one occupational therapist, one speech and language therapist and one dietician. Thematic analysis was used to identify key themes, which included: patient feelings of anxiety or worry leading to an unwillingness to access essential information; the various mental health challenges faced by those with multimorbidity; the importance of personal values in providing motivation; and the importance of social support. Findings are discussed in relation to the potential development of transdiagnostically applicable digital interventions for the management of distress in those with multimorbidity.

Introduction: Clinical reasoning (CR) is a core clinical skill that has been directly linked with patient outcomes. Therefore, developing sound clinical reasoning skills in students should be a concern for physical therapy (PT) professional education programs. Purpose: To develop an understanding of PT student perceptions of CR and how they best learn it to inform future educational practice and research needs. Method: A systematic review of the literature was conducted using the databases PubMed, CINAHL, ERIC, and Cochrane database of systematic reviews to develop an understanding of how students perceive CR throughout their professional education programs and how they best learn it. Results: Fifteen articles met inclusion criteria. Three major themes were identified from the systematic review. First, student perceptions of CR do change throughout their professional education programs. Second, students prefer educational experiences that allow them to act in a PT role, for instance case-method teaching. Lastly, that educational experiences designed to enhance CR capability enhances student professional formation and identity. Discussion: Recent calls for reform across all levels of physical therapy education has been made. In part, these reform efforts emphasize the need for PT education programs to provide learner-centered education through practice-based learning experiences and developing adaptive learners. The results of the systematic review support these aims. More research is needed regarding the impact of educational experiences on student CR skill development as well as more valid and reliable tools for assessing CR capability in PT students.