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In the Nintendo game Animal Crossing: New Horizons, players move to an uninhabited island and quickly become instrumental to the naming, aesthetic development, and biodiversity of the island. In some ways, the game can foster a love for and curiosity about nature. In other ways, the game reinforces harmful colonialist values and attitudes that are ultimately an obstacle to conservation in the real world. Here I critique the game values relevant to conservation, both the values that benefit and the values that hinder conservation. I discuss possibilities for a future version of the game that reinforces values better aligned with conservation.

Introduction. Medical Students experience high levels of stress throughout their four years. When the COVID-19 pandemic exacerbated this, there was a need for programming and this created an opportunity to provide a whole person, lifestyle medicine approach to enhance medical student wellbeing. Methods. Two student leaders and one faculty member created a 12-week program that addressed the 6 pillars of lifestyle medicine as well as positive psychology. The program was offered to all first year students, and within 12 hours the roster was full with 15 students. The program was held weekly by Zoom for 1-2 hours. Results. Attendance was high each week with full participation from everyone present. In the post program evaluation form, conducted one year after completion of the program, 100% of respondents reported they would recommend this group to another medical student, 71% reported they used tools learned from the group at least weekly. Participants noted that growth mindset, gratitude, mindfulness, priorities, and relationship building were the most used well-being strategies learned in the program. Conclusion. An intervention that is based on the 6 pillars of lifestyle medicine and positive psychology and presented by Zoom is feasible in medical school and well accepted by medical students.

The current article will highlight recent trends and novel approaches to behavior change strategies in nutrition. Physicians, nurses, and other healthcare professionals play key roles in counseling patients on lifestyle change, which is critical for patients with chronic conditions. Nutrition science continues to advance, and new approaches to behavior change are needed for successful implementation at the individual and population level.The solutions to obstacles around healthful eating patterns are varied, population-dependent, and require a multipronged approach. One area of focus is the language around behavior change, ensuring it is clear and emphasizes its multifactorial nature. For young adults, the careful use of video games and social media may be essential. For older adults, altering food consistency and ensuring proper nutrient intake are crucial factors. Vulnerable populations remain susceptible to malnutrition and need special attention. Despite significant advances in managing and treating diseases, there are still gaps in nutrition counseling and behavior change efforts.Every age and stage of life needs a focus on healthful foods, and nutrition counseling at each stage has its unique nuances. Careful attention to the language of change and the phrasing used in counseling is vital for educating, connecting with, and empowering patients to change. Changing healthcare operations and provider behavior around nutrition counseling is a part of the solution to the worldwide problem of unhealthy eating patterns and practices.

Background Firearm-related injury (FRI) became the leading cause of death among children/adolescents in 2019. Purpose This study sought to determine changes over time in the population of adolescents affected by FRI in Atlanta, Georgia, such that high risk cohorts could be identified. Research Design City-wide retrospective cohort review. Study Sample Adolescent victims (age 11-21 years of age) of FRI, defined by ICD9/10 codes, in Atlanta, Georgia. Data Analysis Descriptive, multivariate and time series analysis. Results There were 1,453 adolescent FRI victims in this time period, predominantly Black (86%) and male (86.6%). Unintentional injury was higher among ages 11-14 years (43.1%) compared to 15-17 years (10.2%) and 18-21 years (9.3%) (P < .01). FRI affecting females increased at a rate of 8.1 injuries/year (P < .01), and unintentional injuries increased at by 7.6/year (P < .01). Mortality declined from 16% in 2016 to 7.7% in 2021. Conclusion Our data provides evidence for firearm policy reform. Interventions should target prevention of intentional injury among AQ4 females and seek to reverse the trend in unintentional injuries.

We report a case of a patient that presented with typical angina pain and associated risk factors for coronary artery disease (CAD). Subsequent cardiac catheterisation led to the discovery of an isolated R-IIP modified Lipton classification coronary artery anomaly with follow-up coronary computed tomography angiography (CCTA) confirmation. This case report includes images of the CCTA and left heart catheterisation results, along with a discussion of the potential for increased risk of atherosclerosis in our patient, and a proposed explanation of his presentation with prototypical angina pain, despite lack of apparent atherosclerosis.

Background and study aims A reliable outcome measure is needed for bowel preparation quality during capsule endoscopy. Currently, no scales are adequately validated. Our objective was to update an existing small bowel preparation score, create a standardized training module, then determine its inter-rater and intra-rater reliability. Patients and methods Modification to produce standardized scoring of an existing small bowel preparation score was performed followed by development of a training module and validation to create the new Korea-Canada (KODA) score. Twenty readers from a range of backgrounds, including capsule endoscopists, gastroenterology fellows, residents, medical students, and nurses rated bowel cleanliness in 25 capsule videos consisting of 1,233 images, in duplicate 4 weeks apart, after completing the training module. Sequential images selected in 5-minute intervals during small bowel transit were rated on a scale between 0–3 based on the amount of visualized mucosa and the degree of obstruction. Reliability was assessed using estimates of intraclass correlation coefficients (ICCs). Results Intraclass correlation coefficients for inter-rater (ICC 0.81, 95 % CI 0.70–0.87) and intra-rater (ICC 0.92, 95 % CI 0.87–0.94) reliability were almost perfect among the 20 readers. Inter-rater reliability ranged between 0.72 (95 % CI 0.57–0.81) and 0.89 (95 % CI 0.79–0.93) for nurses and residents, respectively. Intra-rater reliability was greater than 0.90 for all groups except for nurses, which was still almost perfect (ICC 0.86, 95 % CI 0.79–0.90). Conclusions Almost perfect inter-rater and intra-rater reliability was observed for the KODA score. This simple score could be used for future clinical trials after completion of the training module.

OBJECTIVES: To determine the face validity of the survey instrument, Düsseldorf Orthorexie Scale (DOS), in adolescents aged 14–17 years. The DOS has been validated for use in adults to identify individuals at-risk for symptoms and behaviors consistent with the condition of Orthorexia Nervosa (ON). This condition is characterized by a pathological obsession with healthy or “clean” eating which leads to psychological and physical impairment. METHODS: Researchers conducted seven focus groups with male and female students currently enrolled in a high school health class (n = 40; 11 males, 29 females aged 14–17). Participants first completed the DOS scale and then were asked to participate in a group discussion regarding their understanding of the meaning of the questions in the DOS survey. Focus groups were audio recorded, transcribed, and coded to identify recurring themes. Codes for each of the 10 questions in the DOS scale were analyzed to determine group understanding of key words identified for each question. RESULTS: Key words in the original DOS survey questions were in agreement with the codes identified from the transcript of the focus groups for eight of the 10 DOS survey questions. The key words in the other two questions (indulgence in question one and colleague in question seven) were either not understood by focus group population or would need to be altered due to incorrect or inadequate understanding by focus group participants. 38 participants completed the DOS (M = 18.5, SD = 4.88). 7.9% of participants DOS responses indicated they were at moderate (n = 2) or high (n = 1) risk of practicing orthorexic behavior. CONCLUSIONS: The DOS scale demonstrated good face validity in an adolescent population and the modification of two questions may improve its face validity. Though our sample was small, results indicate that a sizeable proportion of adolescents may already be practicing orthorexic behaviors. This demonstrates a need for further research to be conducted on effective prevention and intervention strategies for this age group. FUNDING SOURCES: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Cadherins are calcium-dependent, transmembrane adhesion molecules that assemble through direct noncovalent association of their N-terminal extracellular modular domains. As the transmembrane component of adherens junctions, they indirectly link adherent cells' actin cytoskeletons. Here, we investigate the most distal extracellular domain of neural cadherin (N-cadherin), a protein required at excitatory synapses, the site of long-term potentiation. This domain is the site of the adhesive interface, and it forms a dimer spontaneously without binding calcium, a surprising finding given that calcium binding is required for proper physiological function. A critical tryptophan at position 2, W2, provides a spectroscopic probe for the "closed" monomer and strand-swapped dimer. Spectroscopic studies show that W2 remains docked in the two forms but has a different apparent interaction with the hydrophobic pocket. Size-exclusion chromatography was used to measure the levels of the monomer and dimer over time to study the kinetics and equilibria of the unexpected spontaneous dimer formation ( K

Drugs of abuse (DOA) are widely used in the United States and are ubiquitous at outdoor music festivals. Attendees at music festivals are at high-risk for novel psychoactive substance (NPS) use, which is becoming more prevalent worldwide. No U.S. studies have employed an qualitative approach to investigate the etiologies of both traditional DOA and NPS use amongst music festival attendees.The objective of this study was to improve understanding of the knowledge, attitudes, beliefs, and practices of festival attendees using NPS and DOA.We conducted semi-structured interviews of 171 attendees during the Sonic Bloom and Arise music festivals in Colorado in 2015 and 2016. Discrete variables were summarized with descriptive statistics. The anonymous, multi-domain interview documented the knowledge, attitudes beliefs, and practices underlying DOA use, which were analyzed with qualitative methods.We enrolled 171 participants that endorsed DOA use at the festivals. Most were experienced DOA users, who perceived minimal risks associated with DOA and NPS use. Nearly all unanimously reported normalization of DOA at music festivals. Participants popularly cited empathogenic, entactogenic, and entheogenic effects of DOA as their primary motivations for use. NPS use was endorsed by 39.8% (n = 68) of respondents, all of whom identified as being experienced DOA users.This population of novel psychoactive substance users is primarily composed of experienced drug users that endorsed use because of low cost, minimal perceived risk, accessibility, and normalization of drug use at music festivals.

Cancer, in part, is driven, by alterations in cellular metabolism that promote cell survival and cell proliferation. Identifying factors that influence this shift in cellular metabolism in cancer cells is important. Interleukin-1β (IL-1β) is a pro-inflammatory cytokine that has been reported to be elevated in colorectal cancer patients. While much is known toward the effect of dietary nutrients on regulating inflammation and the inflammatory response, which includes cytokines such as IL-1β, far less is understood how cytokines impact nutrient fate to alter cancer cell metabolism. Butyrate, a nutrient derived from the fermentation of dietary fiber in the colon, is the preferential exogenous energetic substrate used by non-cancerous colonocytes, but is used less efficiently by colorectal cancer cells. To test whether IL-1β alters colonocyte energy metabolism, we measured butyrate oxidation in HCT116 colorectal cancer cells with and without IL-1β. We hypothesize that IL-1β will push cancerous colonocytes away from the utilization and oxidation of butyrate. In this study, we demonstrate that pretreatment of colorectal cancer cells with IL-1β diminished butyrate oxidation and NADH levels. This effect was blocked with the interleukin receptor antagonist A (IL-1RA). Moreover, IL-1β suppressed basal mitochondrial respiration and lowered the mitochondrial spare capacity. By using inhibitors to block downstream targets of the interleukin-1 receptor pathway, we show that p38 is required for the IL-1β-mediated decrease in butyrate oxidation. These data provide insight into the metabolic effects induced by IL-1β in colorectal cancer, and identify relevant targets that may be exploited to block the effects of this cytokine. J. Cell. Biochem. 118: 1614-1621, 2017. © 2016 Wiley Periodicals, Inc.

Aims The distinction between benign and malignant thyroid nodules has important therapeutic implications. Our objective was to develop an assay that could classify indeterminate thyroid nodules as benign or suspicious, using routinely prepared fine needle aspirate (FNA) cytology smears. Methods A training set of 375 FNA smears was used to develop the microRNA-based assay, which was validated using a blinded, multicentre, retrospective cohort of 201 smears. Final diagnosis of the validation samples was determined based on corresponding surgical specimens, reviewed by the contributing institute pathologist and two independent pathologists. Validation samples were from adult patients (≥18 years) with nodule size >0.5 cm, and a final diagnosis confirmed by at least one of the two blinded, independent pathologists. The developed assay, RosettaGX Reveal, differentiates benign from malignant thyroid nodules, using quantitative RT-PCR. Results Test performance on the 189 samples that passed quality control: negative predictive value: 91% (95% CI 84% to 96%); sensitivity: 85% (CI 74% to 93%); specificity: 72% (CI 63% to 79%). Performance for cases in which all three reviewing pathologists were in agreement regarding the final diagnosis (n=150): negative predictive value: 99% (CI 94% to 100%); sensitivity: 98% (CI 87% to 100%); specificity: 78% (CI 69% to 85%). Conclusions A novel assay utilising microRNA expression in cytology smears was developed. The assay distinguishes benign from malignant thyroid nodules using a single FNA stained smear, and does not require fresh tissue or special collection and shipment conditions. This assay offers a valuable tool for the preoperative classification of thyroid samples with indeterminate cytology.

Access, discovery, and preservation have historically been concerns for artists’ file collections. To address these issues, the author outlines a systematic digitization plan developed during an internship at the National Gallery of Art Library in Washington, DC, during the summer of 2013. Discovery, execution on limited funds, a realistic workflow, and standards are just a few of the areas any digitization project must consider. This study is an example of how institutions of any size can approach digitization of ephemera and better serve their constituents.

This study was supported by Cancer Research UK, AstraZeneca and Pfizer UK. Introduction: Phase I of the Cancer Research UK Stratified Medicine Programme (SMP1) was designed to roll out molecular pathology testing nationwide at the point of cancer diagnosis, as well as facilitate an infrastructure where surplus cancer tissue could be used for research. It offered a non-trial setting to examine common UK cancer genetics in a real-world context. Methods: A total of 26 sites in England, Wales and Scotland, recruited samples from 7814 patients for genetic examination between 2011 and 2013. Tumour types involved were breast, colorectal, lung, prostate, ovarian cancer and malignant melanoma. Centralised molecular testing of surplus material from resections or biopsies of primary/metastatic tissue was performed, with samples examined for 3-5 genetic alterations deemed to be of key interest in site-specific cancers by the National Cancer Research Institute Clinical Study groups. Results: 10 754 patients (98% of those approached) consented to participate, from which 7814 tumour samples were genetically analysed. In total, 53% had at least one genetic aberration detected. From 1885 patients with lung cancer, KRAS mutation was noted to be highly prevalent in adenocarcinoma (37%). In breast cancer (1873 patients), there was a striking contrast in TP53 mutation incidence between patients with ductal cancer (27.3%) and lobular cancer (3.4%). Vast inter-tumour heterogeneity of colorectal cancer (1550 patients) was observed, including myriad double and triple combinations of genetic aberrations. Significant losses of important clinical information included smoking status in lung cancer and loss of distinction between low-grade and high-grade serous ovarian cancers. Conclusion: Nationwide molecular pathology testing in a non-trial setting is feasible. The experience with SMP1 has been used to inform ongoing CRUK flagship programmes such as the CRUK National Lung MATRIX trial and TRACERx. Publisher PDF

Guidelines for nonoperative management (NOM) of high-grade pancreatic injuries in children have not been established, and wide practice variability exists. The purpose of this study was to evaluate common clinical strategies across multiple pediatric trauma centers to develop a consensus-based standard clinical pathway.A multicenter, retrospective review was conducted of children with high-grade (American Association of Surgeons for Trauma grade III-V) pancreatic injuries treated with NOM between 2010 and 2015. Data were collected on demographics, clinical management, and outcomes.Eighty-six patients were treated at 20 pediatric trauma centers. Median age was 9 years (range, 1-18 years). The majority (73%) of injuries were American Association of Surgeons for Trauma grade III, 24% were grade IV, and 3% were grade V. Median time from injury to presentation was 12 hours and median ISS was 16 (range, 4-66). All patients had computed tomography scan and serum pancreatic enzyme levels at presentation, but serial enzyme level monitoring was variable. Pancreatic enzyme levels did not correlate with injury grade or pseudocyst development. Parenteral nutrition was used in 68% and jejunal feeds in 31%. 3Endoscopic retrograde cholangiopancreatogram was obtained in 25%. An organized peripancreatic fluid collection present for at least 7 days after injury was identified in 59% (42 of 71). Initial management of these included: observation 64%, percutaneous drain 24%, and endoscopic drainage 10% and needle aspiration 2%. Clear liquids were started at a median of 6 days (IQR, 3-13 days) and regular diet at a median of 8 days (IQR 4-20 days). Median hospitalization length was 13 days (IQR, 7-24 days). Injury grade did not account for prolonged time to initiating oral diet or hospital length; indicating that the variability in these outcomes was largely due to different surgeon preferences.High-grade pancreatic injuries in children are rare and significant variability exists in NOM strategies, which may affect outcomes and effective resource utilization. A standard clinical pathway is proposed.Therapeutic/care management, level V (case series).

We present a comparative study of the thermal emission of the transiting exoplanets WASP-1b and WASP-2b using the Spitzer Space Telescope. The two planets have very similar masses but suffer different levels of irradiation and are predicted to fall either side of a sharp transition between planets with and without hot stratospheres. WASP-1b is one of the most highly irradiated planets studied to date. We measure planet/star contrast ratios in all four of the IRAC bands for both planets (3.6-8.0um), and our results indicate the presence of a strong temperature inversion in the atmosphere of WASP-1b, particularly apparent at 8um, and no inversion in WASP-2b. In both cases the measured eclipse depths favor models in which incident energy is not redistributed efficiently from the day side to the night side of the planet. We fit the Spitzer light curves simultaneously with the best available radial velocity curves and transit photometry in order to provide updated measurements of system parameters. We do not find significant eccentricity in the orbit of either planet, suggesting that the inflated radius of WASP-1b is unlikely to be the result of tidal heating. Finally, by plotting ratios of secondary eclipse depths at 8um and 4.5um against irradiation for all available planets, we find evidence for a sharp transition in the emission spectra of hot Jupiters at an irradiation level of 2 x 10^9 erg/s/cm^2. We suggest this transition may be due to the presence of TiO in the upper atmospheres of the most strongly irradiated hot Jupiters., Comment: 10 pages, submitted to ApJ

We live in a politically polarizing climate and at a time when there is great economic and social unrest in the United States. Our current moment brings to my mind other periods in our nation’s history. First, the 1857 Dred Scott decision, when the Supreme Court decided that slaves were not U.S. citizens and could not sue for their freedom. So that even if a slave escaped to the North, he or she was still considered the property of the slave owner and must be returned.1 The second is in the 1960s, when the antiwar and civil rights movements occurred.2,3

The purpose of this document is to outline the Advanced Light Source (ALS) approach for preventing a radiation accident scenario on the ALS experimental floor due to top-off operation. The document will describe the potential risks, the analysis, and the resulting specifications for the controls.

This study explored the use of a problem-based learning (PBL) approach for teaching information and communication technology (ICT) skills to first-year students. Two questions were posed. The first addressed the ICT skill needs of 20 students enrolled in a first-year composition course. The second focused on the use of PBL to facilitate ICT skill acquisition. Both qualitative and quantitative data were collected and analyzed. Results indicate that ICT instruction was most useful when: (1) students defined/interpreted information needs by recalling prior knowledge and experiences; (2) those interpretations were tested, refined, rejected, or revised for a specific purpose; (3) access to resources and tools (artifacts, symbols, and language) were readily available; and (4) formative feedback supported critical thinking about the information retrieval process. These findings provided important insights into using PBL to facilitate and reinforce learning.

Using data from 68 organizations embedded within 14 nations, we examined hypotheses concerning the moderating roles of national culture and organizational climate on the transfer of training to the work context. A dimension of national culture, uncertainty avoidance, moderated the transfer of safety training with regard to reducing accidents and injuries; and organizational safety climate moderated the transfer of safety training with respect to both engaging in safe work behaviour and reducing accidents and injuries. Along with discussing the implications of a positive safety climate, we discuss how the tendency within a culture to avoid uncertainty may paradoxically lead to greater uncertainty and negative consequences in relation to the transfer of safety training.

Although the Advanced Light Source (ALS) was initially conceived primarily as a low-energy (1.9-GeV) third-generation source of vacuum ultraviolet (VUV) and soft X-ray radiation, it was realized very early in the development of the facility that a multipole wiggler source coupled with high-quality (brightness-preserving) optics would result in a beamline whose performance across the optimal energy range (5–15 keV) for macromolecular crystallography (MX) would be comparable to, or even exceed, that of many existing crystallography beamlines at higher-energy facilities. Hence, starting in 1996, a suite of three beamlines, branching off a single wiggler source, was constructed, which together formed the ALS Macromolecular Crystallography Facility [1]. From the outset, this facility was designed to cater equally to the needs of both academic and industrial users, with a heavy emphasis placed on the development and introduction of high-throughput crystallographic tools, techniques, and facilities, including la...

OBJECTIVE. Persistence of the embryologic falcine sinus can be a congenital or acquired phenomenon related to a defect of the straight sinus. Previous studies have stated that it is rare for the falcine sinus to persist without an additional abnormality of the brain such as a vein of Galen malformation or venous sinus thrombosis. The purpose of this article is to show that persistent falcine sinus is not an uncommon isolated finding in the pediatric population. MATERIALS AND METHODS. We performed a retrospective review of pediatric brain MRIs to identify patients with a persistent falcine sinus and subsequently recorded whether there were findings in addition to the straight sinus defect. RESULTS. Thirty-one patients were identified as having a persistent falcine sinus, five of whom had no other congenital or acquired abnormality of the brain other than a defect in the straight sinus. CONCLUSION. Our data support the hypothesis that persistent falcine sinus is not an uncommon isolated finding in the pedia...

There is an increasing demand for well-focused beam with high quality imaging of the full field to further explore the potential of novel instruments. For beamlines operating at focal point, mechanical benders have often been used to shape the refocusing mirror into an ideal elliptical cylinder. Unfortunately, the limited number of couplings for these mechanisms requires specific substrate side-shaping, often calculated using beam bending theory [J.H. Underwood, Space Sci. Instrum. 3 (1977) 259; M. Howells et al., Opt. Eng. 39 (2000) 2748; T. Warwick et al., Document available at OSTI website: http://www.osti.gov/energycitations/servlets/purl/842557-JYZCS3/native/], to meet demanding figure requirements. Here, we use finite element analysis (FEA) to validate the side-shaping algorithm and then couple the output with SHADOW to evaluate mirror performance when an ideal ellipse is not achieved.

Pregnant women in labour are generally encouraged by their carers to continue taking plenty of oral fluids. This is sometimes supplemented by intravenous fluids either due to a clinical necessity or in preparation for a caesarean section. It is important that there is clear documentation of the amount of fluids received by pregnant women in the perinatal period as excessive maternal fluid has been associated with low serum sodium in neonates. This often goes under-recognised; therefore it is important to consider this in a neonate presenting with hyponatraemia in the first day of life. Presented here is a case of neonatal hyponatraemia secondary to excessive fluid taken in the perinatal period.

Extramedullary plasmacytomas are plasma cell neoplasms in organs other than the bone marrow. Most are found in the upper respiratory tract. Involvement of the pancreas is rare. We report a case of pancreatic plasmacytoma in association with advanced multiple myeloma.

This study investigates five North American K-12 classroom teachers’ perceptions of ESOL students’ challenges in academic English skills and strategies for improving ESOL students’ academic English skills. Seven distinct areas of interest emerged from the five interviews: 1) ranking of importance of academic listening, speaking, reading, and writing skills; 2) challenges that ESOL students face in the classroom; 3) strategies to help ESOL students in academic listening; 4) strategies to help ESOL students in academic speaking; 5) strategies to help ESOL students in academic reading; 6) strategies to help ESOL students in academic writing; and 7) strategies to assist ESOL students in overcoming challenges in academic English skills. This paper focuses on the implementation of coping strategies for K-12 ESOL students in academic English skills, as perceived by their classroom teachers. Cette étude enquête sur les perceptions de cinq enseignants nord-américains de classes préscolaires à la 12e, des défis de leurs élèves ESOL face aux compétences en Anglais académique et des stratégies pouvant améliorer les compétences en Anglais académique de ces élèves ESOL. Sept domaines d’intérêt distincts ont émergés de ces cinq entretiens:1) degré d’importance académique des compétences en écoute, parler, lecture et écriture; 2) défis auxquels font face les élèves ESOL dans leurs salles de classe; 3) stratégies visant à aider les élèves ESOL avec leur écoute académique; 4) stratégies visant à aider les élèves ESOL avec leur parler académique; 5) stratégies visant à aider les élèves ESOL avec leur lecture académique; 6) stratégies visant à aider les élèves ESOL avec leur écriture académique; et 7) stratégies visant à assister les élèves ESOL à surmonter les défis liés aux compétences en Anglais académique. Cet article porte l’accent sur l’implémentation de stratégies d’adaptation pour les élèves de la maternelle à la 12e concernant les compétences en Anglais académique, telle que perçue par leurs enseignants.