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College students' mental health concerns have dramatically increased in prevalence and severity over the past decade, overwhelming the capacity of counseling centers to meet demand for services. In response, institutions of higher education (IHEs) increasingly emphasize prevention, education, and outreach efforts aimed at improving well-being. Although this focus has prompted an increase in research on student well-being, few studies have investigated the unique contributions of malleable psychosocial factors on student outcomes. This study aims to address this gap in the literature by examining the relative impact of an array of psychosocial factors--adaptive and maladaptive perfectionism, coping self-efficacy, social connectedness, perceived burdensomeness, grit, resilience, and meaning in life--on academic performance and distress and suicidality in a sample of 7505 students from 15 U.S. IHEs. Controlling for institutional selectivity and non-malleable aspects of students' identities and pre-college experiences, facets of perfectionism, grit, and emotion-focused coping self-efficacy were the psychosocial factors most strongly associated with GPA, and perceived burdensomeness, social connectedness, emotion-focused coping self-efficacy, and resilience were most strongly associated with distress and suicidality. Among non-malleable factors, race/ethnicity explained the most variance in GPA and gender identity explained the most variance in distress and suicidality. Results are discussed in light of persistent, identity-based disparities in academic achievement and suicide risk and the potential of psychosocial factors as intervention targets to improve academic performance and reduce suicide risk.

August Wilson's Century Cycle is as much a theatrical experiment of black cultural history and sociology as it is one of storytelling. Though often considered a realist playwright, Wilson walks beyond the realist landscape into speculative and imagined ones in Gem of the Ocean. His investment in cultural critique and history enhances the possibility of an enriching analysis of his work as speculative fiction. This research project locates the ties between Wilson’s affinity with history and the creation of a dystopian Pittsburgh in the play. In Wilson’s work, set in 1904, the antebellum past is so close to the post-Emancipation present, temporally and socio-politically, that there is almost no difference at all. The flattening of time Wilson insinuates through the milieu, a capitalist-police state, is articulated through characters’ relationship with it. Wilson is welcomed in conclusion into black speculative traditions of re-imagining time and using cultural histories to critique cultural realities.

Stramenopile algae contribute significantly to global primary productivity, and one class, Eustigmatophyceae, is increasingly studied for applications in high-value lipid production. Yet much about their basic biology remains unknown, including the nature of an enigmatic, pigmented globule found in vegetative cells. Here, we present an in-depth examination of this "red body," focusing on Nannochloropsis oceanica. During the cell cycle, the red body forms adjacent to the plastid, but unexpectedly it is secreted and released with the autosporangial wall following cell division. Shed red bodies contain antioxidant ketocarotenoids, and overexpression of a beta-carotene ketolase results in enlarged red bodies. Infrared spectroscopy indicates long-chain, aliphatic lipids in shed red bodies and cell walls, and UHPLC-HRMS detects a C32 alkyl diol, a potential precursor of algaenan, a recalcitrant cell wall polymer. We propose that the red body transports algaenan precursors from plastid to apoplast to be incorporated into daughter cell walls.

Abstract The Melillo et al. article: Reliability and validity of the Veterans Administration Mobility Screening and Solutions Tool (MSST) (Melillo et al, BMC Health Serv Res 22:1323, 2022) introduces the MSST, a derivative flowchart tool in which the Banner Bedside Mobility Assessment Tool (BMAT) is embedded. The authors identify similar goals for the MSST as those for the BMAT, i.e. determine real-time mobility status and choose safe patient handling and mobility (SPHM) equipment to complete transfer and mobility tasks. Further Melillo et al. indicate that goals included “revising and enhancing” and addressing “gaps” in the BMAT, as well as creating instructions for the four BMAT levels (sit and shake, stretch and point, stand, step: march-in-place, advance step and return) that are clear, understandable and comfortable to use. The authors indicate that another goal of the VA MSST is it “enables any healthcare worker at any time to accurately measure and communicate patient mobility and transfer equipment needs.” The present article addresses inaccuracies observed in the Melillo et al. article and confusing elements found in the VA MSST flowchart. The present article is based on the author’s involvement in developing the BMAT starting in 2003 along with teams from Banner Health and Liko/Hill-Rom which incorporated use of the BMAT by unlicensed assistive personnel (UAP) as a recheck or verification of earlier testing. The 2020 BMAT 2.0 clarified confusing elements identified in BMAT 1.0, i.e. items that needed to be revised or enhanced. BMAT 2.0 covered use of SPHM when testing, when completing care tasks and when progressing patients. The BMAT is primarily a nurse-driven mobility assessment tool created to not be overly prescriptive. BMAT was validated and determined to be reliable based on years of clinical utility studies and research in various settings across the continuum of care. It continues to be supported by a large medical equipment manufacturer who maintains the copyright license. Although the VA MSST flowchart has the four BMAT assessment levels embedded within it, for reasons outlined in this article, it is not feasible to use the VA MSST flowchart alongside or in conjunction with the BMAT 2.0.

Abstract The field of cortical sight restoration prostheses is making rapid progress with three clinical trials of visual cortical prostheses underway. However, as yet, we have only limited insight into the perceptual experiences produced by these implants. Here we describe a computational model or ‘virtual patient’, based on the neurophysiological architecture of V1, which successfully predicts the perceptual experience of participants across a wide range of previously published human cortical stimulation studies describing the location, size, brightness and spatiotemporal shape of electrically induced percepts in humans. Our simulations suggest that, in the foreseeable future the perceptual quality of cortical prosthetic devices is likely to be limited by the neurophysiological organization of visual cortex, rather than engineering constraints.

Abstract Stramenopile algae contribute significantly to global primary productivity, and one class, Eustigmatophyceae, is increasingly studied for applications in high-value lipid production. Yet much about their basic biology remains unknown, including the nature of an enigmatic, pigmented globule found in vegetative cells. Here, we present an in-depth examination of this “red body,” focusing on Nannochloropsis oceanica. During the cell cycle, the red body forms adjacent to the plastid, but unexpectedly it is secreted and released with the autosporangial wall following cell division. Shed red bodies contain antioxidant ketocarotenoids, and overexpression of a beta-carotene ketolase results in enlarged red bodies. Infrared spectroscopy indicates long-chain, aliphatic lipids in shed red bodies and cell walls, and UHPLC-HRMS detects a C32 alkyl diol, a potential precursor of algaenan, a recalcitrant cell wall polymer. We propose that the red body transports algaenan precursors from plastid to apoplast to be incorporated into daughter cell walls.

BackgroundOpinion leadership, educational outreach visiting, and innovation championing are commonly used strategies to address barriers to implementing innovations and evidence-based practices in healthcare settings. Despite voluminous research, ambiguities persist in how these strategies work and under what conditions they work well, work poorly, or work at all. The current paper develops middle-range theories to address this gap.MethodsConceptual articles, systematic reviews, and empirical studies informed the development of causal pathway diagrams (CPDs). CPDs are visualization tools for depicting and theorizing about the causal process through which strategies operate, including the mechanisms they activate, the barriers they address, and the proximal and distal outcomes they produce. CPDs also clarify the contextual conditions (i.e., preconditions and moderators) that influence whether, and to what extent, the strategy's causal process unfolds successfully. Expert panels of implementation scientists and health professionals rated the plausibility of these preliminary CPDs and offered comments and suggestions on them.FindingsTheoretically, opinion leadership addresses potential adopters' uncertainty about likely consequences of innovation use (determinant) by promoting positive attitude formation about the innovation (mechanism), which results in an adoption decision (proximal outcome), which leads to innovation use (intermediate outcome). As this causal process repeats, penetration, or spread of innovation use, occurs (distal outcome). Educational outreach visiting addresses knowledge barriers, attitudinal barriers, and behavioral barriers (determinants) by promoting critical thinking and reflection about evidence and practice (mechanism), which results in behavioral intention (proximal outcome), behavior change (intermediate outcome), and fidelity, or guideline adherence (distal outcome). Innovation championing addresses organizational inertia, indifference, and resistance (determinants) by promoting buy-in to the vision, fostering a positive implementation climate, and increasing collective efficacy (mechanisms), which leads to participation in implementation activities (proximal outcome), initial use of the innovation with increasing skill (intermediate outcome) and, ultimately, greater penetration and fidelity (distal outcomes). Experts found the preliminary CPDs plausible or highly plausible and suggested additional mechanisms, moderators, and preconditions, which were used to amend the initial CPD.DiscussionThe middle-range theories depicted in the CPDs furnish testable propositions for implementation research and offer guidance for selecting, designing, and evaluating these social influence implementation strategies in both research studies and practice settings.

ImportanceGlioblastoma is the most lethal primary brain cancer. Clinical outcomes for glioblastoma remain poor, and new treatments are needed.ObjectiveTo investigate whether adding autologous tumor lysate-loaded dendritic cell vaccine (DCVax-L) to standard of care (SOC) extends survival among patients with glioblastoma.Design, setting, and participantsThis phase 3, prospective, externally controlled nonrandomized trial compared overall survival (OS) in patients with newly diagnosed glioblastoma (nGBM) and recurrent glioblastoma (rGBM) treated with DCVax-L plus SOC vs contemporaneous matched external control patients treated with SOC. This international, multicenter trial was conducted at 94 sites in 4 countries from August 2007 to November 2015. Data analysis was conducted from October 2020 to September 2021.InterventionsThe active treatment was DCVax-L plus SOC temozolomide. The nGBM external control patients received SOC temozolomide and placebo; the rGBM external controls received approved rGBM therapies.Main outcomes and measuresThe primary and secondary end points compared overall survival (OS) in nGBM and rGBM, respectively, with contemporaneous matched external control populations from the control groups of other formal randomized clinical trials.ResultsA total of 331 patients were enrolled in the trial, with 232 randomized to the DCVax-L group and 99 to the placebo group. Median OS (mOS) for the 232 patients with nGBM receiving DCVax-L was 19.3 (95% CI, 17.5-21.3) months from randomization (22.4 months from surgery) vs 16.5 (95% CI, 16.0-17.5) months from randomization in control patients (HR = 0.80; 98% CI, 0.00-0.94; P = .002). Survival at 48 months from randomization was 15.7% vs 9.9%, and at 60 months, it was 13.0% vs 5.7%. For 64 patients with rGBM receiving DCVax-L, mOS was 13.2 (95% CI, 9.7-16.8) months from relapse vs 7.8 (95% CI, 7.2-8.2) months among control patients (HR, 0.58; 98% CI, 0.00-0.76; P

ObjectiveTools that quantify tissue perfusion of the foot are deficient, contributing to the uncertainty in predicting ulcer healing potential. This pilot study aims to quantify peri-wound foot perfusion at various tissue depths using a novel application of pseudo-continuous arterial spin labeling magnetic resonance imaging.MethodsTen diabetic patients with neuropathic wounds and 20 healthy volunteers without wounds were recruited. Wounds were graded according to the Wound, Ischemia, Foot Infection (WIfI) system. All subjects underwent a noncontrasted ASL MRI of the foot for perfusion measurements. For healthy volunteers, perfusion was compared at rest and during sustained toe flexion between four regions: lateral plantar, medial plantar, lateral calcaneal, and medial calcaneal. Evaluations of diabetic volunteers compared perfusion between four zones: wound, near border, far border, and remote. Remote zone perfusion in diabetics was compared with perfusion in the plantar foot of healthy volunteers.ResultsThere were 11 wounds, which were located over the metatarsal heads in five, the stump of a transmetatarsal amputation in three, the heel in two, and the mid foot in one. The median WIfI stage was 2. One patient had a WIfI ischemia grade of 1; the remaining patients' grades were 0. The mean ankle-brachial index was 1.0 ± 0.3. There were two patients with a WIfI foot infection grade of 1; the remaining patients' grades were 0. In healthy volunteers, plantar foot perfusion with sustained toe flexion was 43.9 ± 1.7 mL/100g/min and significantly higher than perfusion at rest (27.3 ± 2.7 mL/100g/min; P < .001). In diabetic patients, perfusion at the wound, near border, far border, and remote regions was 96.1 ± 10.7, 92.7 ± 9.4, 73.4 ± 8.2, and 62.8 ± 2.7 mL/100g/min. Although this perfusion pattern persisted throughout the depth of the wound, perfusion decreased with tissue depth. In the near border, perfusion at 20% of the wound depth was 124.0 ± 35.6 mL/100g/min and 69.9 ± 10.1 mL/100g/min at 100% (P = .006). Lastly, remote perfusion in diabetics was 2.3 times the plantar perfusion in healthy volunteers (27.3 ± 2.7 mL/100g/min; P < .001).ConclusionsThe pattern of resting tissue perfusion around nonischemic diabetic foot ulcers was successfully quantified with arterial spin labeling magnetic resonance imaging. Diabetic patients with wounds were hyperemic compared with healthy volunteers. There was a 1.5-fold increase in peri-wound tissue perfusion relative to the rest of the foot. This study is the first step in developing a tool to assess the perfusion deficit in ischemic wounds.

Despite Canada’s strengths and widespread acknowledgment of the importance of children and youth, this country recently ranked 30th among 38 high-income countries on indicators of their well-being (UNICEF Innocenti 2020). While there are limited data readily available for monitoring within and across jurisdictions, Alberta compares worse than Canadian averages on indicators of early development vulnerability and child abuse (PHAC 2023a). The Alberta government convened a Child and Youth Well-being Review (GOA 2021) and Action Plan (GOA 2022a) to understand and address the pandemic’s adverse impacts. Indigenous and racialized children and youth, children in low-income families and children with disabilities were highlighted as being disproportionately impacted. In addition, the review found significant gaps in mental health, education, social data and evidence along with fragmentation of data within ministries and service systems (GOA 2021). Influences on child and youth health, well-being and health inequity have social, environmental and economic origins that extend beyond health policy boundaries (Lopez et al. 2021; Vargas-Barón, Diehl and Small 2022; Clark et al. 2020; Patton et al. 2016). Yet, public policy can be a powerful intermediary between children’s conditions and outcomes (UNICEF 2020). Cross-sectoral, whole-of-society approaches are required to improve child and youth health and well-being and government ministries have important roles to play (Akseer et al. 2020; De Montigny, Desjardins and Bouchard 2019; Leppo et al. 2013). Meaningful and accessible measurement and monitoring information is required to support co-ordinated, cross-sectoral decision-making and policy strategies to improve health outcomes and reduce health inequities (OECD 2021). Information is required about child and youth material living standards, physical and mental health, social lives and learning and education (OECD 2021). While definitions of child and youth well-being vary depending on diverse perspectives and cultural, social and local contexts, many established indicators and frameworks can be tailored to local community needs and priorities (OECD 2021).

Research Findings: We examined the association between neighborhood median income, child race/ethnicity, and parental perspectives and practical considerations regarding preschool program location. We conducted a cross-sectional survey of parents in Boston, Massachusetts planning to enroll in preschool (N = 1171). Questions measured parental preferences regarding program location, number of care transitions, safety, and transportation. We used adjusted logistic regression models to calculate the association between these factors and race/ethnicity and zip code median household income. Compared to the second quartile, parents living in zip codes within the two highest quartiles of median neighborhood income were more likely to prefer preschool near home. Parents living in zip codes within the highest quartile were less likely to be willing to use school transportation. Compared to parents identifying their child's race as white, parents of Asian, Black, and Hispanic children were more likely to prefer preschool near work and parents of Black children were less likely to prefer preschool near home. Practice or Policy: Neighborhood median income had a graded association with preference for preschool near home. Transportation and location preferences varied by neighborhood context and socio-demographic factors. These findings can inform efforts to address disparities in preschool enrollment, preschool program design, and family engagement.

Metastasis of renal cell carcinoma (RCC) to the vaginal wall has rarely been reported in the literature. We present a case of a 48-year-old who was found to have a solitary RCC metastasis at the vaginal wall, five years following radical nephrectomy. This case is noteworthy because this late presentation is unique, with prior reports of synchronous metastasis or metastasis within two years of nephrectomy, highlighting the need to consider metastatic RCC to the vagina a possibility even many years after treatment.

A key function of a highway network is to maintain access during normal and emergency operations. During wildfire evacuations, first-responders and firefighters depend on highways and local roads for transporting heavy equipment to communities in need. The California Department of Transportation (Caltrans) is expanding vegetation management to begin establishing defensible space zones along California’s nearly 16,000 miles of state highways and in about 230,000 acres of highway right-ofway. However, extended drought, a longer fire season, and higher temperatures brought on by climate change, along with the spread of invasive weeds and dense, dry vegetation, have created new challenges.The California Department of Forestry and Fire Protection produced a Community Wildfire Prevention and Mitigation Report in 2019 with a methodology to assess wildfire risk. Caltrans and researchers at the University of California, Davis applied these methods to develop a highway-segment-specific prioritization model for vegetation management within highway rights-of-way. The researchers also interviewed Caltrans staff about opportunities for and obstacles to increasing the pace and scale of vegetation treatments. This policy brief summarizes the findings from that research and provides policy implications.View the NCST Project Webpage

High-resolution historical climate grids are readily available and frequently used as inputs for a wide range of regional management and risk assessments, including water supply, ecological processes, and as baseline for climate change impact studies that compare them to future projected conditions. Because historical gridded climates are produced using various methods, their portrayal of landscape conditions differ, which becomes a source of uncertainty when they are applied to subsequent analyses. Here we tested the range of values from five gridded climate datasets. We compared their values to observations from 1231 weather stations, first using each dataset’s native scale, and then after each was rescaled to 270-m resolution. We inputted the downscaled grids to a mechanistic hydrology model and assessed the spatial results of six hydrological variables across California, in 10 ecoregions and 11 large watersheds in the Sierra Nevada. PRISM was most accurate for precipitation, ClimateNA for maximum temperature, and TopoWx for minimum temperature. The single most accurate dataset overall was PRISM due to the best performance for precipitation and low air temperature errors. Hydrological differences ranged up to 70% of the average monthly streamflow with an average of 35% disagreement for all months derived from different historical climate maps. Large differences in minimum air temperature data produced differences in modeled actual evapotranspiration, snowpack, and streamflow. Areas with the highest variability in climate data, including the Sierra Nevada and Klamath Mountains ecoregions, also had the largest spread for snow water equivalent, recharge, and runoff.

Two of the main obstacles to the development of epiretinal prosthesis technology are electrodes that require current amplitudes above safety limits to reliably elicit percepts, and a failure to consistently elicit pattern vision. Here, we explored the causes of high current amplitude thresholds and poor spatial resolution within the Argus II epiretinal implant. We measured current amplitude thresholds and two-point discrimination (the ability to determine whether one or two electrodes had been stimulated) in 3 blind participants implanted with Argus II devices. Our data and simulations show that axonal stimulation, lift and retinal damage all play a role in reducing performance in the Argus 2, by either limiting sensitivity and/or reducing spatial resolution. Understanding the relative role of these various factors will be critical for developing and surgically implanting devices that can successfully subserve pattern vision.

Many forms of artificial sight recovery, such as electronic implants and optogenetic proteins, generally cause simultaneous, rather than complementary firing of on- and off-center retinal cells. Here, using virtual patients-sighted individuals viewing distorted input-we examine whether plasticity might compensate for abnormal neuronal population responses. Five participants were dichoptically presented with a combination of original and contrast-reversed images. Each image (I) and its contrast-reverse (I') was filtered using a radial checkerboard (F) in Fourier space and its inverse (F'). [I * F'] + [I' * F] was presented to one eye, and [I * F] + [I' * F'] was presented to the other, such that regions of the image that produced on-center responses in one eye produced off-center responses in the other eye, and vice versa. Participants continuously improved in a naturalistic object discrimination task over 20 one-hour sessions. Pre-training and post-training tests suggest that performance improvements were due to two learning processes: learning to recognize objects with reduced visual information and learning to suppress contrast-reversed image information in a non-eye-selective manner. These results suggest that, with training, it may be possible to adapt to the unnatural on- and off-cell population responses produced by electronic and optogenetic sight recovery technologies.

Exposure to trauma, grief, and loss (TGL) can elicit spiritual pondering and meaning making, which can manifest as unsettled spiritual rumination or evolve into spiritual growth and transcendence. Incorporating a spiritually informed approach with TGL survivors invites spiritual interaction between the individual and professional helper to move beyond the trauma story and influences toward hope and possibility. This approach benefits survivors and offers the professional helper the potential for personal growth and transcendence. Integrating a spiritually informed approach encourages professionals and clients to engage as co-collaborators, co-creators, and co-authors in the change process. It is proposed that appreciation for spiritual attributes is essential for creating a spiritually interactive and dynamic dialogue. This spiritually informed approach can assist the professional helper in guiding individuals through spiritual processes that evoke hope, elicit meaning, and promote growth, offering spiritual transformation following a traumatic event. While the literature offers valuable information concerning the importance of spiritual intelligence and competence, little has been written about the significance of these spiritual attributes for professional helpers as they pertain to the competencies and development of knowledge, skills, and attitudes required for promoting resilience and posttraumatic growth for clients. This reflective article invites readers to consider the value of professional helpers accessing their spiritual aptitude and competence, emphasizing their integral role in facilitating and nurturing resilience and growth for those exposed to trauma. It offers a conceptual framework, which is structured around three developmental levels: exposure, immersion, and mastery. At each level, the framework incorporates specific knowledge, skills, and attitudes that are essential for the professional helper’s spiritual competency development. This framework integrates literature emphasizing spiritual aptitude and post-trauma growth as critical components of spiritual competency development, further highlighting the importance of the role of spirituality in the helping process.

The many Gondwanic vegetation types found across the extensive latitudes and elevation gradients of South America's southern cone contribute to Chile's global biodiversity hotspot ranking. Species loss in global biodiversity hotspots is an ongoing climate change concern and land managers need spatially explicit climate risk maps to adapt conservation strategies to climate change in these areas. We modeled future climate risk for Chile's terrestrial vegetation using a high-resolution vegetation map and tested the relationship to climate risk for each type's latitudinal and elevation range. We found that 43.6% of all vegetation has high climate risk in Global Circulation Models (GCMs) under a high emissions scenario (RCP8.5). All forest types in the country, including Southern Beech (Nothofagus sp.), Alerce (Fitzroya cupressoides), Araucaria (Araucaria araucana), and Sclerophyllous, as well as the Valdivian rainforest, Altiplanic Steppes, and Salares, face high levels of climate risk. Tests for trends in risk across elevation and latitude showed that exposure for all types increased with elevation based on the MIROC5 GCM, and decreased with latitude based on the Had2GEM-ES GCM. Our results suggest that vegetation types with smaller latitudinal ranges typically have higher levels of climate risk, but a type's elevation range is not significantly correlated with risk of exposure. We identified climatically stable areas which could act as vegetation refugia in Patagonia, the central Andes mountains between latitudes 27.5°S and 32.5°S, and some coastal areas. Conservation strategies in Chile should include the protection of climatically stable areas to safeguard current Gondwanic biodiversity and active habitat restoration in climatically exposed areas to facilitate vegetation shifts.