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Tropical tropospheric ozone (TTO) is important for the global radiation budget because the longwave radiative effect of tropospheric ozone is higher in the tropics than midlatitudes. In recent decades the TTO burden has increased, partly due to the ongoing shift of ozone precursor emissions from midlatitude regions toward the Equator. In this study, we assess the distribution and trends of TTO using ozone profiles measured by high-quality in situ instruments from the IAGOS (In-Service Aircraft for a Global Observing System) commercial aircraft, the SHADOZ (Southern Hemisphere ADditional OZonesondes) network, and the ATom (Atmospheric Tomographic Mission) aircraft campaign, as well as six satellite records reporting tropical tropospheric column ozone (TTCO): TROPOspheric Monitoring Instrument (TROPOMI), Ozone Monitoring Instrument (OMI), OMI/Microwave Limb Sounder (MLS), Ozone Mapping Profiler Suite (OMPS)/Modern-Era Retrospective analysis for Research and Applications version 2 (MERRA-2), Cross-track Infrared Sounder (CrIS), and Infrared Atmospheric Sounding Interferometer (IASI)/Global Ozone Monitoring Experiment 2 (GOME2). With greater availability of ozone profiles across the tropics we can now demonstrate that tropical India is among the most polluted regions (e.g., western Africa, tropical South Atlantic, Southeast Asia, Malaysia and Indonesia), with present-day 95th percentile ozone values reaching 80 nmol mol−1 in the lower free troposphere, comparable to midlatitude regions such as northeastern China and Korea. In situ observations show that TTO increased between 1994 and 2019, with the largest mid- and upper-tropospheric increases above India, Southeast Asia, and Malaysia and Indonesia (from 3.4 ± 0.8 to 6.8 ± 1.8 nmol mol−1 decade−1), reaching 11 ± 2.4 and 8 ± 0.8 nmol mol−1 decade−1 close to the surface (India and Malaysia–Indonesia, respectively). The longest continuous satellite records only span 2004–2019 but also show increasing ozone across the tropics when their full sampling is considered, with maximum trends over Southeast Asia of 2.31 ± 1.34 nmol mol−1 decade−1 (OMI) and 1.69 ± 0.89 nmol mol−1 decade−1 (OMI/MLS). In general, the sparsely sampled aircraft and ozonesonde records do not detect the 2004–2019 ozone increase, which could be due to the genuine trends on this timescale being masked by the additional uncertainty resulting from sparse sampling. The fact that the sign of the trends detected with satellite records changes above three IAGOS regions, when their sampling frequency is limited to that of the in situ observations, demonstrates the limitations of sparse in situ sampling strategies. This study exposes the need to maintain and develop high-frequency continuous observations (in situ and remote sensing) above the tropical Pacific Ocean, the Indian Ocean, western Africa, and South Asia in order to estimate accurate and precise ozone trends for these regions. In contrast, Southeast Asia and Malaysia–Indonesia are regions with such strong increases in ozone that the current in situ sampling frequency is adequate to detect the trends on a relatively short 15-year timescale.

In his multi-volume Historiarum Britanniae libri xi (1597–1607), the English Catholic scholar Richard White of Basingstoke promotes an anachronistic vision of the founding and history of Britain that challenges the analytical and source critical Anglicae historiae libri xxvi (1534ff.) of Polydore Vergil (1534ff.). White, seeking support for his historiographical enterprise, adopts two brief accounts of the life and achievements of King Arthur by the notorious abbot Trithemius (d. 1516), then makes editorial interventions, including repositioning and textual glosses. Veritas is White’s leading historiographical principle, as expressed, for example, when he claims to be able to distinguish between truth and the fabulous in these Arthurian texts by Trithemius. The difficulty—and the irony—are that White, as editor, imposes an unverifiable ethos of veracity upon Trithemius’ Arthuriana. White and Trithemius do concur, in general, on the historicity of King Arthur and the credibility of both the Historia regum Britanniae (circa 1136) of Geoffrey of Monmouth and the Trojan foundational myth promoted therein.

The rapid increase in telehealth has the potential to bring informed decision-making for prostate cancer screening (PCS) at the population level to high-risk individuals. We utilized a global technology platform of electronic health records data repositories (TriNetX) to determine its utility for Navigator-guided decision-making aid for PCS in Black men ages 45–79 years with no history of prostate cancer and PSA testing. Patients from Pennsylvania were invited to participate in a telehealth-delivered informed decision-making session for PCS. Focus groups, social learning theory, visual diagrams, and quantitative data on PCS risks and benefits were used to develop the content of the sessions, which included numerical discussions of risks vs. benefits in Black men. Participants completed several surveys, including baseline demographic and numeracy questionnaires, a one-on-one telehealth session with a trained Navigator, post-Navigation surveys, and an optional follow-up session with a urologist. Eighty-seven participants were consented and recruited. Although the mean numeracy score was only 1.9 out of 6, more than 90% rated as good or excellent that the sessions aided their PCS decision-making skills. This study indicates that Navigation by telehealth offers the ability to assist in informed decision-making for PCS at the population level.

High-quality long-term observational records are essential to ensure appropriate and reliable trend detection of tropospheric ozone. However, the necessity of maintaining high sampling frequency, in addition to continuity, is often under-appreciated. A common assumption is that, so long as long-term records (e.g., a span of a few decades) are available, (1) the estimated trends are accurate and precise, and (2) the impact of small-scale variability (e.g., weather) can be eliminated. In this study, we show that the undercoverage bias (e.g., a type of sampling error resulting from statistical inference based on sparse or insufficient samples, such as once-per-week sampling frequency) can persistently reduce the trend accuracy of free tropospheric ozone, even if multi-decadal time series are considered. We use over 40 years of nighttime ozone observations measured at Mauna Loa, Hawaii (representative of the lower free troposphere), to make this demonstration and quantify the bias in monthly means and trends under different sampling strategies. We also show that short-term meteorological variability remains a cause of an inflated long-term trend uncertainty. To improve the trend precision and accuracy due to sampling bias, two remedies are proposed: (1) a data variability attribution of colocated meteorological influence can efficiently reduce estimation uncertainty and moderately reduce the impact of sparse sampling, and (2) an adaptive sampling strategy based on anomaly detection enables us to greatly reduce the sampling bias and produce more accurate trends using fewer samples compared to an intense regular sampling strategy.

The declining trend in vehicle emissions has underscored the growing significance of volatile organic compound (VOC) emissions from volatile chemical products (VCPs). However, accurately representing VOC chemistry in simplified chemical mechanisms remains challenging due to its chemical complexity including speciation and reactivity. Previous studies have predominantly focused on VOCs from fossil fuel sources, leading to an underrepresentation of VOC chemistry from VCP sources. We developed an integrated chemical mechanism, RACM2B-VCP, that is compatible with WRF-Chem and is aimed at enhancing the representation of VOC chemistry, particularly from VCP sources, within the present urban environment. Evaluation against the Air Quality System (AQS) network data demonstrates that our model configured with RACM2B-VCP reproduces both the magnitude and spatial variability of O3 and PM2.5 in Los Angeles. Furthermore, evaluation against comprehensive measurements of O3 and PM2.5 precursors from the Reevaluating the Chemistry of Air Pollutants in California (RECAP-CA) airborne campaign and the Southwest Urban NOx and VOC Experiment (SUNVEx) ground site and mobile laboratory campaign confirm the model's accuracy in representing NOx and many VOCs and highlight remaining biases. Although there exists an underprediction in the total VOC reactivity of observed VOC species, our model with RACM2B-VCP exhibits good agreement for VOC markers emitted from different sectors, including biogenic, fossil fuel, and VCP sources. Through sensitivity analyses, we probe the contributions of VCP and fossil fuel emissions to total VOC reactivity and O3. Our results reveal that 52 % of the VOC reactivity and 35 % of the local enhancement of MDA8 O3 arise from anthropogenic VOC emissions in Los Angeles. Significantly, over 50 % of this anthropogenic fraction of either VOC reactivity or O3 is attributed to VCP emissions. The RACM2B-VCP mechanism created, described, and evaluated in this work is ideally suited for accurately representing ozone for the right reasons in the present urban environment where mobile, biogenic, and VCP VOCs are all important contributors to ozone formation.

Abstract Background Wheat is one of the world’s most important cereal crops. However, the fungal pathogen Zymoseptoria tritici can cause disease epidemics, leading to reduced yields. With climate change and development of new agricultural areas with suitable environments, Z. tritici may advance into geographical areas previously unaffected by this pathogen. It is currently unknown how Egyptian wheat will perform in the face of this incoming threat. This project aimed to assess the resistance of Egyptian wheat germplasm to Z. tritici, to identify cultivars with high levels of resistance and characterise the mechanism(s) of resistance present in these cultivars. Results Eighteen Egyptian wheat cultivars were screened against two Z. tritici model isolates and exhibited a wide spectrum of responses. This ranged from resistance to complete susceptibility to one or both isolates tested. The most highly resistant cultivars from the initial screen were then tested under two environmental conditions against modern UK field isolates. Disease levels under UK-like conditions were higher, however, symptom development on the cultivar Gemmeiza-12 was noticeably slower than on other Egyptian wheats. The robustness of the resistance shown by Gemmeiza-12 was confirmed in experiments mimicking Egyptian environmental conditions, where degree of Z. tritici infection was lower. The Kompetitive allele-specific PCR (KASP) diagnostic assay suggested the presence of an Stb6 resistant allele in several Egyptian wheats including Gemmeiza-12. Infection assays using the IPO323 WT and IPO323ΔAvrStb6 mutant confirmed the presence of Stb6 in several Egyptian cultivars including Gemmeiza-12. Confocal fluorescence microscopy demonstrated that growth of the IPO323 strain is blocked at the point of stomatal penetration on Gemmeiza-12, consistent with previous reports of Stb gene mediated resistance. In addition to this R-gene mediated resistance, IPO323 spores showed lower adherence to leaves of Gemmeiza-12 compared to UK wheat varieties, suggesting other aspects of leaf physiology may also contribute to the resistance phenotype of this cultivar. Conclusion These results indicate that Gemmeiza-12 will be useful in future breeding programs where improved resistance to Z. tritici is a priority.

The MIXv2 Asian emission inventory is developed under the framework of the Model Inter-Comparison Study for Asia (MICS-Asia) Phase IV and produced from a mosaic of up-to-date regional emission inventories. We estimated the emissions for anthropogenic and biomass burning sources covering 23 countries and regions in East, Southeast and South Asia and aggregated emissions to a uniform spatial and temporal resolution for seven sectors: power, industry, residential, transportation, agriculture, open biomass burning and shipping. Compared to MIXv1, we extended the dataset to 2010–2017, included emissions of open biomass burning and shipping, and provided model-ready emissions of SAPRC99, SAPRC07, and CB05. A series of unit-based point source information was incorporated covering power plants in China and India. A consistent speciation framework for non-methane volatile organic compounds (NMVOCs) was applied to develop emissions by three chemical mechanisms. The total Asian emissions for anthropogenic/open biomass sectors in 2017 are estimated as follows: 41.6/1.1 Tg NOx, 33.2/0.1 Tg SO2, 258.2/20.6 Tg CO, 61.8/8.2 Tg NMVOC, 28.3/0.3 Tg NH3, 24.0/2.6 Tg PM10, 16.7/2.0 Tg PM2.5, 2.7/0.1 Tg BC (black carbon), 5.3/0.9 Tg OC (organic carbon), and 18.0/0.4 Pg CO2. The contributions of India and Southeast Asia were emerging in Asia during 2010–2017, especially for SO2, NH3 and particulate matter. Gridded emissions at a spatial resolution of 0.1° with monthly variations are now publicly available. This updated long-term emission mosaic inventory is ready to facilitate air quality and climate model simulations, as well as policymaking and associated analyses.

This study assessed the accuracy of a smartphone telematics algorithm that classifies car trips as driver or non-driver. Participants’ trips were measured for 4 weeks by Way to Drive, a research telematics application that uses the same data algorithms as leading auto-insurance companies. At the end of each week, participants completed a survey prompting them to review trips within the app and report time and nature of any misclassified trips. Overall accuracy of driver vs. non-driver classification was high (96.5 %, SD = 5.1 %). Sensitivity, the percentage of actual driver trips classified as such, was also high (97.5 %, SD = 4.6 %). Specificity, the percentage of non-driver trips classified as such, was slightly lower and more variable (91.2 %, SD = 14.8 %). The algorithm’s accuracy was generally robust to a variety of phone characteristics, vehicle features, and driving habits.

Abstract BackgroundA concussion is a common adolescent injury that can result in a constellation of symptoms, negatively affecting academic performance, neurobiological development, and quality of life. Mobile health (mHealth) technologies, such as apps for patients to report symptoms or wearables to measure physiological metrics like heart rate, have been shown to be promising in health maintenance. However, there is limited evidence about mHealth engagement in adolescents with a concussion during their recovery course. ObjectiveThis study aims to determine the response rate and response rate patterns in concussed adolescents reporting their daily symptoms through mHealth technology. It will also examine the effect of time-, demographic-, and injury-related characteristics on response rate patterns. MethodsParticipants aged between 11-18 years (median days since injury at enrollment: 11 days) were recruited from the concussion program of a tertiary care academic medical center and a suburban school’s athletic teams. They were asked to report their daily symptoms using a mobile app. Participants were prompted to complete the Post-Concussion Symptom Inventory (PCSI) 3 times (ie, morning, afternoon, and evening) per day for 4 weeks following enrollment. The primary outcome was the response rate pattern over time (by day since initial app use and the day since injury). Time-, demographic-, and injury-related differences in reporting behaviors were compared using Mann Whitney U ResultsA total of 56 participants were enrolled (mean age 15.3, SD 1.9 years; n=32, 57% female). The median response rate across all days of app use in the evening was 37.0% (IQR 27.2%-46.4%), which was significantly higher than the morning (21.2%, IQR 15.6%-30.5%) or afternoon (26.4%, IQR 21.1%-31.5%; PPPPPP ConclusionsEvening may be the optimal time to prompt for daily concussion symptom assessment among concussed adolescents compared with morning or afternoon. Multiple demographic- and injury-related characteristics were associated with higher daily response rates, including for female participants, those with more than 1 week from injury to beginning mHealth monitoring, and those with a history of at least one previous concussion. Future studies may consider incentive strategies or adaptive digital concussion assessments to increase response rates in populations with low engagement.

Introduction The use of smart technology in supporting older adults is a growing field of research. However, there is little qualitative research on the experiences of patients utilizing this technology, particularly those attending psychiatry services. Objectives To explore the experiences of staff and patients utilizing smart-hubs implemented during the Covid-19 pandemic to provide remote audio/visual communication and smart AI personal assistant technology for the management of patients in a rural Psychiatry of Old Age service. Methods Smart hubs were installed in patient homes and in the Psychiatry of Old Age base during the Covid-19 pandemic when lockdown restrictions limited in-person service provision. Patients and staff utilized the smart hubs for its assistive technology and to engage with each other. Semi-structured qualitative interviews were conducted of 10 staff and 15 patients at 6-12 months following the introduction of the smart hubs and thematic analysis was conducted to generate themes. Results Three themes were generated from the thematic analysis: 1) Openness to SMART hub technology, 2) Getting set-up and 3) Keeping SMART. The majority of participants did not have much experience using smart technology prior to the intervention. However, many participants reported that they would be comfortable using technology. The Covid-19 pandemic contributed to the rapid adoption of this intervention within the service with mixed views regarding the smart hub prior to implementation. The role of key individuals such as staff and family was highlighted in supporting older persons with setting-up the smart hub. Technical needs included the need for a strong internet connection and technical limitations were driven by privacy, cost and regional considerations. Many patients were able to utilize the smart hub independently to access interests, therapeutic activities and as a memory aid. The smart hub offered a novel way to connect to services and families and was also seen as a companion by some patients and staff to help address loneliness and isolation. The majority of participants found the use of smart hubs acceptable and were willing to utilize the smart hub in the future as an adjunct to face to face psychiatric interventions. However, suggestions for future use included the need for additional training as users felt that there was more they could do with the smart hub, continued support to manage any challenges and improved information leaflets to better engage users. Conclusions Smart hub technology offers an alternate means of providing remote and inclusive psychiatric care to older patients unable to access services in person and at risk of deterioration without intervention in the community. Disclosure of Interest None Declared

Abstract Background White matter (WM) microstructural changes in the hippocampal cingulum bundle (CBH) in Alzheimer’s disease (AD) have been described in cohorts of largely European ancestry but are lacking in other populations. Methods We assessed the relationship between CBH WM integrity and cognition or amyloid burden in 505 Korean older adults aged ≥ 55 years, including 276 cognitively normal older adults (CN), 142 with mild cognitive impairment (MCI), and 87 AD patients, recruited as part of the Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer’s disease (KBASE) at Seoul National University. Results Compared to CN, AD and MCI subjects showed significantly higher RD, MD, and AxD values (all p-values

Abstract Background The impact of young drivers’ motor vehicle crashes (MVC) is substantial, with young drivers constituting only 14% of the US population, but contributing to 30% of all fatal and nonfatal injuries due to MVCs and 35% ($25 billion) of the all medical and lost productivity costs. The current best-practice policy approach, Graduated Driver Licensing (GDL) programs, are effective primarily by delaying licensure and restricting crash opportunity. There is a critical need for interventions that target families to complement GDL. Consequently, we will determine if a comprehensive parent-teen intervention, the Drivingly Program, reduces teens’ risk for a police-reported MVC in the first 12 months of licensure. Drivingly is based on strong preliminary data and targets multiple risk and protective factors by delivering intervention content to teens, and their parents, at the learner and early independent licensing phases. Methods Eligible participants are aged 16-17.33 years of age, have a learner’s permit in Pennsylvania, have practiced no more than 10 h, and have at least one parent/caregiver supervising. Participants are recruited from the general community and through the Children’s Hospital of Philadelphia’s Recruitment Enhancement Core. Teen-parent dyads are randomized 1:1 to Drivingly or usual practice control group. Drivingly participants receive access to an online curriculum which has 16 lessons for parents and 13 for teens and an online logbook; website usage is tracked. Parents receive two, brief, psychoeducational sessions with a trained health coach and teens receive an on-road driving intervention and feedback session after 4.5 months in the study and access to DriverZed, the AAA Foundation’s online hazard training program. Teens complete surveys at baseline, 3 months post-baseline, at licensure, 3months post-licensure, 6 months post-licensure, and 12 months post-licensure. Parents complete surveys at baseline, 3 months post-baseline, and at teen licensure. The primary end-point is police-reported MVCs within the first 12 months of licensure; crash data are provided by the Pennsylvania Department of Transportation. Discussion Most evaluations of teen driver safety programs have significant methodological limitations including lack of random assignment, insufficient statistical power, and reliance on self-reported MVCs instead of police reports. Results will identify pragmatic and sustainable solutions for MVC prevention in adolescence. Trial Registration ClinicalTrials.gov # NCT03639753.

We present the Fire Inventory from National Center for Atmospheric Research (NCAR) version 2.5 (FINNv2.5), a fire emissions inventory that provides publicly available emissions of trace gases and aerosols for various applications, including use in global and regional atmospheric chemistry modeling. FINNv2.5 includes numerous updates to the FINN version 1 framework to better represent burned area, vegetation burned, and chemicals emitted. Major changes include the use of active fire detections from the Visible Infrared Imaging Radiometer Suite (VIIRS) at 375 m spatial resolution, which allows smaller fires to be included in the emissions processing. The calculation of burned area has been updated such that a more rigorous approach is used to aggregate fire detections, which better accounts for larger fires and enables using multiple satellite products simultaneously for emissions estimates. Fuel characterization and emissions factors have also been updated in FINNv2.5. Daily fire emissions for many trace gases and aerosols are determined for 2002–2019 (Moderate Resolution Imaging Spectroradiometer (MODIS)-only fire detections) and 2012–2019 (MODIS + VIIRS fire detections). The non-methane organic gas emissions are allocated to the species of several commonly used chemical mechanisms. We compare FINNv2.5 emissions against other widely used fire emissions inventories. The performance of FINNv2.5 emissions as inputs to a chemical transport model is assessed with satellite observations. Uncertainties in the emissions estimates remain, particularly in Africa and South America during August–October and in southeast and equatorial Asia in March and April. Recommendations for future evaluation and use are given.

The tumour-associated carbonic anhydrases (CA) IX and XII are upregulated by cancer cells to combat cellular and metabolic stress imparted by hypoxia and acidosis in solid tumours. Owing to its tumour-specific expression and function, CAIX is an attractive therapeutic target and this has driven intense efforts to develop pharmacologic agents to target its activity, including small molecule inhibitors. Many studies in multiple solid tumour models have demonstrated that targeting CAIX activity with the selective CAIX/XII inhibitor, SLC-0111, results in anti-tumour efficacy, particularly when used in combination with chemotherapy or immune checkpoint blockade, and has now advanced to the clinic. However, it has been observed that sustainability and durability of CAIX inhibition, even in combination with chemotherapy agents, is limited by the occurrence of adaptive resistance, resulting in tumour recurrence. Importantly, the data from these models demonstrates that CAIX inhibition may sensitize tumour cells to cytotoxic drugs and evidence now points to ferroptosis, an iron-dependent form of regulated cell death (RCD) that results from accumulation of toxic levels of phospholipid peroxidation as a major mechanism involved in CAIX-mediated sensitization to cancer therapy. In this mini-review, we discuss recent advances demonstrating the mechanistic role CAIX plays in sensitizing cancer cells to ferroptosis.

The opportunity for sexual selection is a key evolutionary parameter but we know little about its temporal dynamics. Using data from multiple animal species the authors show that this metric varies rapidly through time and that simulations should be used to avoid substantial misinterpretation.

Zymoseptoria tritici is an important fungal pathogen of wheat which has spread globally. Here, the authors perform genomic analyses on a collection of ~1100 Z. tritici samples from 42 countries to describe its global spread and elucidate mechanisms of adaptation to different environmental conditions.

Introduction: Understanding spatial and temporal trends in travel for COVID-19 vaccinations by key demographic characteristics (i.e., gender, race, and age) is important for ensuring equitable access to and increasing the distribution efficiency of vaccines and other health services. The aim of this study is to examine trends in distances traveled for COVID-19 vaccinations over the course of the vaccination rollout in North Carolina. Methods: Data were collected using electronic medical records of individuals who had either first- or single-dose COVID-19 vaccination appointments through UNC Health between December 15, 2020, and August 31, 2021 (N=204,718). Travel distances to appointments were calculated using the Euclidean distance from individuals’ home ZIP code centroids to clinic addresses. Descriptive statistics and multivariable regression models with individuals’ home ZIP codes incorporated as fixed effects were used to examine the differences in travel distances by gender, race, and age. Results: Males and White individuals traveled significantly farther for vaccination appointments throughout the vaccination rollout. On average, females traveled 14.4 miles, a 3.5% shorter distance than that of males; Black individuals traveled 13.6 miles, a 10.0% shorter distance than that of White individuals; and people aged ≥65 years traveled 14.5 miles, a 2.6% longer distance than that of younger people living in the same ZIP code. Conclusions: Controlling for SES and spatial proximity to vaccination clinics at the ZIP code level, males and White individuals traveled longer distances for vaccination appointments, demonstrating more ability to travel for vaccinations. Results indicate a need to consider differential ability to travel for vaccinations by key demographic characteristics in COVID-19 vaccination programs and future mass health service delivery efforts.

Volatile chemical products (VCPs) and other non-combustion-related sources have become important for urban air quality, and bottom-up calculations report emissions of a variety of functionalized compounds that remain understudied and uncertain in emissions estimates. Using a new instrumental configuration, we present online measurements of oxygenated organic compounds in a US megacity over a 10 d wintertime sampling period, when biogenic sources and photochemistry were less active. Measurements were conducted at a rooftop observatory in upper Manhattan, New York City, USA using a Vocus chemical ionization time-of-flight mass spectrometer, with ammonium (NH4+) as the reagent ion operating at 1 Hz. The range of observations spanned volatile, intermediate-volatility, and semi-volatile organic compounds, with targeted analyses of ∼150 ions, whose likely assignments included a range of functionalized compound classes such as glycols, glycol ethers, acetates, acids, alcohols, acrylates, esters, ethanolamines, and ketones that are found in various consumer, commercial, and industrial products. Their concentrations varied as a function of wind direction, with enhancements over the highly populated areas of the Bronx, Manhattan, and parts of New Jersey, and included abundant concentrations of acetates, acrylates, ethylene glycol, and other commonly used oxygenated compounds. The results provide top-down constraints on wintertime emissions of these oxygenated and functionalized compounds, with ratios to common anthropogenic marker compounds and comparisons of their relative abundances to two regionally resolved emissions inventories used in urban air quality models.

Abstract Background Transportation problems are known barriers to health care and can result in late arrivals and delayed or missed care. Groups already prone to greater social and economic disadvantage, including low-income individuals and people with chronic conditions, encounter more transportation barriers and experience greater negative health care consequences. Addressing transportation barriers is important not only for mitigating adverse health care outcomes among patients, but also for avoiding additional costs to the health care system. In this study, we investigate transportation barriers to accessing health care services during the COVID-19 pandemic among high-frequency health care users. Methods A web-based survey was administered to North Carolina residents aged 18 and older in the UNC Health system who were enrolled in Medicaid or Medicare and had at least six outpatient medical appointments in the past year. 323 complete responses were analyzed to investigate the prevalence of reporting transportation barriers that resulted in having arrived late to, delayed, or missed care, as well as relationships between demographic and other independent variables and transportation barriers. Qualitative analyses were performed on text response data to explain transportation barriers. Results Approximately 1 in 3 respondents experienced transportation barriers to health care between June 2020 and June 2021. Multivariate logistic regressions indicate individuals aged 18–64, people with disabilities, and people without a household vehicle were significantly more likely to encounter transportation barriers. Costs of traveling for medical appointments and a lack of driver or car availability emerged as major transportation barriers; however, respondents explained that barriers were often complex, involving circumstantial problems related to one’s ability to access and pay for transportation as well as to personal health. Conclusions To address transportation barriers, we recommend more coordination between transportation and health professionals and the implementation of programs that expand access to and improve patient awareness of health care mobility services. We also recommend transportation and health entities direct resources to address transportation barriers equitably, as barriers disproportionately burden younger adults under age 65 enrolled in public insurance programs.

Abstract Purpose Several studies have reported sleep disturbances during the COVID‐19 virus pandemic. Little data exist about the impact of the pandemic on sleep and mental health among older women with breast cancer. We sought to examine whether women with and without breast cancer who experienced new sleep problems during the pandemic had worsening depression and anxiety. Methods Breast cancer survivors aged ≥60 years with a history of nonmetastatic breast cancer (n = 242) and frequency‐matched noncancer controls (n = 158) active in a longitudinal cohort study completed a COVID‐19 virus pandemic survey from May to September 2020 (response rate 83%). Incident sleep disturbance was measured using the restless sleep item from the Center for Epidemiological Studies‐Depression Scale (CES‐D). CES‐D score (minus the sleep item) captured depressive symptoms; the State‐Anxiety subscale of the State Trait Anxiety Inventory measured anxiety symptoms. Multivariable linear regression models examined how the development of sleep disturbance affected changes in depressive or anxiety symptoms from the most recent prepandemic survey to the pandemic survey, controlling for covariates. Results The prevalence of sleep disturbance during the pandemic was 22.3%, with incident sleep disturbance in 10% and 13.5% of survivors and controls, respectively. Depressive and anxiety symptoms significantly increased during the pandemic among women with incident sleep disturbance (vs. no disturbance) (β = 8.16, p

Abstract Background Frogeye leaf spot is a disease of soybean, and there are limited sources of crop genetic resistance. Accurate quantification of resistance is necessary for the discovery of novel resistance sources, which can be accelerated by using a low-cost and easy-to-use image analysis system to phenotype the disease. The objective herein was to develop an automated image analysis phenotyping pipeline to measure and count frogeye leaf spot lesions on soybean leaves with high precision and resolution while ensuring data integrity. Results The image analysis program developed measures two traits: the percent of diseased leaf area and the number of lesions on a leaf. Percent of diseased leaf area is calculated by dividing the number of diseased pixels by the total number of leaf pixels, which are segmented through a series of color space transformations and pixel value thresholding. Lesion number is determined by counting the number of objects remaining in the image when the lesions are segmented. Automated measurement of the percent of diseased leaf area deviates from the manually measured value by less than 0.05% on average. Automatic lesion counting deviates by an average of 1.6 lesions from the manually counted value. The proposed method is highly correlated with a conventional method using a 1–5 ordinal scale based on a standard area diagram. Input image compression was optimal at a resolution of 1500 × 1000 pixels. At this resolution, the image analysis method proposed can process an image in less than 10 s and is highly concordant with uncompressed images. Conclusion Image analysis provides improved resolution over conventional methods of frogeye leaf spot disease phenotyping. This method can improve the precision and resolution of phenotyping frogeye leaf spot, which can be used in genetic mapping to identify QTLs for crop genetic resistance and in breeding efforts for resistance to the disease.

Abstract Sexual selection is a key evolutionary force but varies widely between populations. Two key factors that influence sexual selection are the extent to which females copulate with multiple males (polyandry) and variation in the social environment. Increasing research demonstrates populations are structured by complex socio‐sexual networks, and the structure of these networks can influence sexual selection by shaping the relationship between male precopulatory mating success and the intensity of postcopulatory competition. However, comparatively less attention has been dedicated to the influence of group structure on sexual selection and how differences in the size of groups may impact on the relative force of pre‐ and postcopulatory sexual selection in polyandrous populations. The presence of groups (i.e., group structure) and the size of groups varies widely in nature and forms an implicit part of much experimental sexual selection research under laboratory conditions. Here I use simulations of mating competition within populations that vary in the size of groups they contain, to show that variation in group size, and in particular small groups, can influence sexual selection. Specifically, I show that null expectations for the operation of pre‐ and postcopulatory sexual selection is governed by the size of groups within populations because smaller group sizes constrain the structure of sexual networks leading to reinforcing episodes of pre‐ and postcopulatory sexual selection. Given broad variation in group structure in nature and the tendency for experimental sexual selection research to study replicate small groups, these effects have implications for our understanding of the operation of sexual selection in polyandrous populations.

Abstract Background Psychosis, even in its early stages, is associated with significant disability, causing it to be ranked ahead of paraplegia and blindness in those aged 18–35 in terms of years lived with disability. Current pharmacological and psychological interventions intervention have focused primarily on the reduction of positive symptoms (hallucinations and delusions), with little benefit to domains of psychosis such as cognitive difficulties and social and occupational functioning. Methods/design The CReSt-R intervention trial is a single center, pilot randomised controlled study based at the National University of Ireland (NUI), Galway. The trial will recruit participants from four clinical sites with assessment and intervention completed by the primary NUI Galway team. The trial will explore the feasibility, acceptability, and effectiveness of a novel psychosocial intervention for early psychosis based on a combined cognitive remediation training and cognitive behavioural therapy approach focused on social recovery. Participants, aged 16–35 within the first 5 years of a diagnosed psychotic disorder, will be recruited from the Children and Adolescent Mental Health Service and the Adult Mental Health Services in the region. Discussion Cognitive remediation training (for improving cognition) and social recovery focused cognitive behavioural therapy, have both separately demonstrated effectiveness. This trial will evaluate the feasibility, acceptability, and explore the efficacy of a treatment approach that combines both approaches as part of an integrated, multicomponent intervention. Trial registration Cognitive Remediation & Social Recovery in Early Psychosis (CReSt-R): ClincialTrials.gov Identifier NCT04273685. Trial registered Feb 18th, 2020. Last updated April 14th, 2021.

Cancer-related cognitive impairment (CRCI) affects a large proportion of cancer survivors and has significant negative effects on survivor function and quality of life (QOL). Treatments for CRCI are being developed and evaluated. Memory and attention adaptation training (MAAT) is a cognitive-behavioral therapy (CBT) demonstrated to improve CRCI symptoms and QOL in previous research. The aim of this article is to describe a single-case experimental design (SCED) approach to evaluate interventions for CRCI in clinical practice with patient-reported outcome measures (PROs). We illustrate the use of contemporary SCED methods as a means of evaluating MAAT, or any CRCI treatment, once clinically deployed. With the anticipated growth of cancer survivorship and concurrent growth in the number of survivors with CRCI, the treatment implementation and evaluation methods described here can be one way to assess and continually improve CRCI rehabilitative services.

Septoria tritici blotch (STB) has been ranked the third most important wheat disease in the world, threatening a large area of wheat production. Although major genes play an important role in the protection against Zymoseptoria tritici infection, the lifespan of their resistance unfortunately is very short in modern wheat production systems. Combinations of quantitative resistance with minor effects, therefore, are believed to have prolonged and more durable resistance to Z. tritici. In this study, new quantitative trait loci (QTLs) were identified that are responsible for seedling-stage resistance and adult-plant stage resistance (APR). More importantly was the characterisation of a previously unidentified QTL that can provide resistance during different stages of plant growth or multi-stage resistance (MSR). At the seedling stage, we discovered a new isolate-specific QTL, QSt.wai.1A.1. At the adult-plant stage, the new QTL QStb.wai.6A.2 provided stable and consistent APR in multiple sites and years, while the QTL QStb.wai.7A.2 was highlighted to have MSR. The stacking of multiple favourable MSR alleles was found to improve resistance to Z. tritici by up to 40%.

Non-methane volatile organic compounds (NMVOCs) are important precursors of ozone (O3) and secondary organic aerosol (SOA), which play key roles in tropospheric chemistry. A huge amount of NMVOC emissions from solvent use are complicated by a wide spectrum of sources and species. This work presents a long-term NMVOC emission inventory of solvent use during 2000–2017 in China. Based on a mass (material) balance method, NMVOC emissions were estimated for six categories, including coatings, adhesives, inks, pesticides, cleaners, and personal care products. The results show that NMVOC emissions from solvent use in China increased rapidly from 2000 to 2014 then kept stable after 2014. The total emission increased from 1.6 Tg (1.2–2.2 Tg at 95 % confidence interval) in 2000 to 10.6 Tg (7.7–14.9 Tg) in 2017. The substantial growth is driven by the large demand for solvent products in both industrial and residential activities. However, increasing treatment facilities in the solvent-related factories in China restrained the continued growth of solvent NMVOC emissions in recent years. Rapidly developing and heavily industrialized provinces such as Jiangsu, Shandong, and Guangdong contributed significantly to the solvent use emissions. Oxygenated VOCs, alkanes, and aromatics were the main components, accounting for 42 %, 28 %, and 21 % of total NMVOC emissions in 2017, respectively. Our results and previous inventories are generally comparable within the estimation uncertainties (−27 %–52 %). However, there exist significant differences in the estimates of sub-categories. Personal care products were a significant and quickly rising source of NMVOCs, which were probably underestimated in previous inventories. Emissions from solvent use were growing faster compared with transportation and combustion emissions, which were relatively better controlled in China. Environmentally friendly products can reduce the NMVOC emissions from solvent use. Supposing all solvent-based products were substituted with water-based products, it would result in 37 %, 41 %, and 38 % reduction of emissions, ozone formation potential (OFP), and secondary organic aerosol formation potential (SOAP), respectively. These results indicate there is still large potential for NMVOC reduction by reducing the utilization of solvent-based products and implementation of end-of-pipe controls across industrial sectors.

Current observational data on Hindu Kush Himalayas (HKH) glaciers are sparse, and characterizations of seasonal melt dynamics are limited. Time series synthetic aperture radar (SAR) imagery enables detection of reach-scale glacier melt characteristics across continents. We analyze C-band Sentinel-1 A/B SAR time series data, comprised of 32 741 Sentinel-1 A/B SAR images, and determine the duration of seasonal glacier melting for 105 432 mapped glaciers (83 102 km2 glacierized area, defined using optical observations) in the HKH across the calendar years 2017–2019. Melt onset and duration are recorded at 90 m spatial resolution and 12 d temporal repeat. All glacier areas within the HKH exhibit some degree of melt. Melt signals persist for over two-thirds of the year at elevations below 4000 m a.s.l. and for nearly half of the calendar year at elevations exceeding 7000 m a.s.l. Retrievals of seasonal melting span all elevation ranges of glacierized area in the HKH region, extending greater than 1 km above the maximum elevation of an interpolated 0 ∘C summer isotherm and at the top of Mount Everest, where in situ data and surface energy balance models indicate that the Khumbu Glacier is melting at surface air temperatures below −10 ∘C. Sentinel-1 melt retrievals reflect broad-scale trends in glacier mass balance across the region, where the duration of melt retrieved in the Karakoram is on average 16 d less than in the eastern Himalaya sub-region. Furthermore, percolation zones are apparent from meltwater retention indicated by delayed refreeze. Time series SAR datasets are suitable to support operational monitoring of glacier surface melt and the development and assessment of surface energy balance models of melt-driven ablation across the global cryosphere.

Anthropogenic secondary organic aerosol (ASOA), formed from anthropogenic emissions of organic compounds, constitutes a substantial fraction of the mass of submicron aerosol in populated areas around the world and contributes to poor air quality and premature mortality. However, the precursor sources of ASOA are poorly understood, and there are large uncertainties in the health benefits that might accrue from reducing anthropogenic organic emissions. We show that the production of ASOA in 11 urban areas on three continents is strongly correlated with the reactivity of specific anthropogenic volatile organic compounds. The differences in ASOA production across different cities can be explained by differences in the emissions of aromatics and intermediate- and semi-volatile organic compounds, indicating the importance of controlling these ASOA precursors. With an improved model representation of ASOA driven by the observations, we attribute 340 000 PM2.5-related premature deaths per year to ASOA, which is over an order of magnitude higher than prior studies. A sensitivity case with a more recently proposed model for attributing mortality to PM2.5 (the Global Exposure Mortality Model) results in up to 900 000 deaths. A limitation of this study is the extrapolation from cities with detailed studies and regions where detailed emission inventories are available to other regions where uncertainties in emissions are larger. In addition to further development of institutional air quality management infrastructure, comprehensive air quality campaigns in the countries in South and Central America, Africa, South Asia, and the Middle East are needed for further progress in this area.

Aluminum gallium arsenide-on-insulator (AlGaAsOI) exhibits large χ2 and χ3 optical nonlinearities, a wide tunable bandgap, low waveguide propagation loss, and a large thermo-optic coefficient, making it an exciting platform for integrated quantum photonics. With ultrabright sources of quantum light established in AlGaAsOI, the next step is to develop the critical building blocks for chip-scale quantum photonic circuits. Here we expand the quantum photonic toolbox for AlGaAsOI by demonstrating edge couplers, 3 dB splitters, tunable interferometers, and waveguide crossings with performance comparable to or exceeding silicon and silicon-nitride quantum photonic platforms. As a demonstration, we de-multiplex photonic qubits through an unbalanced interferometer, paving the route toward ultra-efficient and high-rate chip-scale demonstrations of photonic quantum computation and information applications.

Increasing freight traffic has posed greater road safety threats to Vulnerable Road Users (VRUs), including pedestrians and bicyclists, in urban communities. Although there are some disaggregated studies on truck-related crashes, the literature offers limited knowledge of how crash-level factors influence crashes related to urban freight. Our study uses crash data from North Carolina (2007–2019) and Tennessee (2009–2019) to explore the relationship between the crash-level factors and the occurrence and injury severity of crashes involving freight vehicles and VRUs. Crash-level factors include socio-demographics of VRUs and freight vehicle drivers, driving behaviors, temporal and weather effects, and environmental factors. The results indicate that freight-related VRU crashes, compared to nonfreight-related VRU crashes, are more likely to occur at private properties and parking areas and have a higher probability of causing severe injuries or deaths. The results also show that the involvement of larger vehicles and the occurrence at midblock segments are positively associated with more severe injury outcomes. The research results could help community and transport designers to increase attention to the safety impacts of growing freight traffic in urban communities.

This study examines telehealth use during the first year of the COVID-19 pandemic among individuals with high health care-related transportation burdens. Survey results of high-frequency health care users with public insurance were analyzed to investigate differences in telehealth use, care access, and perceived care quality between groups. Open text responses demonstrated whether and how telehealth can address transportation barriers and promote care access. While many respondents tried and preferred telehealth, it could not meet all medical needs. The continued availability of telehealth, coupled with improved transport planning to support in-person care needs, will expand access to care for high-frequency users.

Background: There have been no published genome-wide studies of the genetics of cancer- and treatment-related cognitive decline (CRCD); the purpose of this study is to identify genetic variants associated with CRCD in older female breast cancer survivors. Methods: Analyses included white non-Hispanic women with non-metastatic breast cancer aged 60+ (N = 325) and age-, racial/ethnic group-, and education-matched controls (N = 340) with pre-systemic treatment and one-year follow-up cognitive assessment. CRCD was evaluated using longitudinal domain scores on cognitive tests of attention, processing speed, and executive function (APE), and learning and memory (LM). Linear regression models of one-year cognition included an interaction term for SNP or gene SNP enrichment*cancer case/control status, controlling for demographic variables and baseline cognition. Results: Cancer patients carrying minor alleles for two SNPs, rs76859653 (chromosome 1) in the hemicentin 1 (HMCN1) gene (p = 1.624 × 10−8), and rs78786199 (chromosome 2, p = 1.925 × 10−8) in an intergenic region had lower one-year APE scores than non-carriers and controls. Gene-level analyses showed the POC5 centriolar protein gene was enriched for SNPs associated with differences in longitudinal LM performance between patients and controls. Conclusions: The SNPs associated with cognition in survivors, but not controls, were members of the cyclic nucleotide phosphodiesterase family, that play important roles in cell signaling, cancer risk, and neurodegeneration. These findings provide preliminary evidence that novel genetic loci may contribute to susceptibility to CRCD.

Abstract Background Sexual-size dimorphism (SSD) is replete among animals, but while the selective pressures that drive the evolution of SSD have been well studied, the developmental mechanisms upon which these pressures act are poorly understood. Ours and others’ research has shown that SSD in D. melanogaster reflects elevated levels of nutritional plasticity in females versus males, such that SSD increases with dietary intake and body size, a phenomenon called sex-specific plasticity (SSP). Additional data indicate that while body size in both sexes responds to variation in protein level, only female body size is sensitive to variation in carbohydrate level. Here, we explore whether these difference in sensitivity at the morphological level are reflected by differences in how the insulin/IGF-signaling (IIS) and TOR-signaling pathways respond to changes in carbohydrates and proteins in females versus males, using a nutritional geometry approach. Results The IIS-regulated transcripts of 4E-BP and InR most strongly correlated with body size in females and males, respectively, but neither responded to carbohydrate level and so could not explain the sex-specific response to body size to dietary carbohydrate. Transcripts regulated by TOR-signaling did, however, respond to dietary carbohydrate in a sex-specific manner. In females, expression of dILP5 positively correlated with body size, while expression of dILP2,3 and 8, was elevated on diets with a low concentration of both carbohydrate and protein. In contrast, we detected lower levels of dILP2 and 5 protein in the brains of females fed on low concentration diets. We could not detect any effect of diet on dILP expression in males. Conclusion Although females and males show sex-specific transcriptional responses to changes in protein and carbohydrate, the patterns of expression do not support a simple model of the regulation of body-size SSP by either insulin- or TOR-signaling. The data also indicate a complex relationship between carbohydrate and protein level, dILP expression and dILP peptide levels in the brain. In general, diet quality and sex both affect the transcriptional response to changes in diet quantity, and so should be considered in future studies that explore the effect of nutrition on body size.

The emissions of volatile organic compounds (VOCs) from volatile chemical products (VCPs) – specifically personal care products, cleaning agents, coatings, adhesives, and pesticides – are emerging as the largest source of petroleum-derived organic carbon in US cities. Previous work has shown that the ambient concentration of markers for most VCP categories correlates strongly with population density, except for VOCs predominantly originating from solvent- and water-borne coatings (e.g., parachlorobenzotrifluoride (PCBTF) and Texanol®, respectively). Instead, these enhancements were dominated by distinct emission events likely driven by industrial usage patterns, such as construction activity. In this work, the headspace of a variety of coating products was analyzed using a proton-transfer-reaction time-of-flight mass spectrometer (PTR-ToF-MS) and a gas chromatography (GC) preseparation front end to identify composition differences for various coating types (e.g., paints, primers, sealers, and stains). Evaporation experiments of several products showed high initial VOC emission rates, and for the length of these experiments, the majority of the VOC mass was emitted during the first few hours following application. The percentage of mass emitted as measured VOCs (<1 % to 83 %) mirrored the VOC content reported by the manufacturer (<5 to 550 g L−1). Ambient and laboratory measurements, usage trends, and ingredients compiled from architectural coatings surveys show that both PCBTF and Texanol account for ∼10 % of the total VOC ingredient sales and, therefore, can be useful tracers for solvent- and water-borne coatings.

Introduction The COVID-19 pandemic caused significant disruptions in services and necessitated innovation to continue care provision to the vulnerable population of older adults with psychiatric needs. Objectives The objective of this study was to examine the experiences of staff and patients using a hands-free electronic smart-hub (eSMART hub) intervention to keep patients connected with psychiatry of old age following COVID-19 restrictions. Methods A risk stratification register was created of all patients known to the Psychiatry of Old Age service in the North-West of Ireland to identify those at highest risk of relapse. These patients were offered a smart-hub with remote communication and personal assistant technology to be installed into their homes. Smart-hubs were also installed in the team base to facilitate direct device to device communication. Semi-structured qualitative interviews were conducted with 10 staff members and 15 patients at 6-12 months following the installation of the smart-hubs. Results The smart-hubs were utilized by the POA team to offer remote interventions over video including clinician reviews, regular contact with key workers and day-hospital based therapeutic interventions such as anxiety management groups and OT led physical exercises. Patients also used the personal assistant aspect of the hub to attend to personal hobbies such as accessing music and radio. Positive feedback related to companionship during isolation and connectivity to services. Negative feedback was mainly related to technology, particularly internet access and narrow scope of communication abilities. Conclusions Electronic smart-hub devices may offer an acceptable avenue for remote intervention and communication for isolated high-risk older persons. Disclosure The smart hub devices used in this study were donated by Amazon. However, the company was not involved in any other aspect of the study and the researchers have no significant financial interest, consultancy or other relationship with products, manufactur

Care coordinators—which include social workers, nurses, and other professionals who address health-related social needs—have unique perspectives on transportation barriers to health care. They understand both the transportation challenges that individuals may face, and also the facilitators (i.e., solutions) available to help overcome these challenges. We conducted in-depth interviews with care coordinators in North Carolina to expound upon the multiple transportation barriers to accessing health care identified in previous studies, as well as the specific facilitators being employed to alleviate them. Analyzing these interviews using a flexible coding approach, we found that no single facilitator can address all of the various transportation barriers. Instead a multi-pronged approach is required. The findings also provide insights on how care coordinators can broaden their support offered to individuals experiencing transportation barriers to accessing health care.

Abstract We present discrete (2‐h resolution) multi‐year (2008–2017) in situ measurements of seasonal vegetation growth and soil biophysical properties from two sites on Alaska's North Slope, USA, representing dry and wet sedge tundra. We examine measurements of vertical active soil layer temperature and soil moisture profiles (freeze/thaw status), woody shrub vegetation physiological activity, and meteorological site data to assess interrelationships within (and between) these two study sites. Vegetation phenophases (cold de‐hardening start, physiological function start, stem growth start, stem growth end, physiological function end, cold hardening completion) were found to have greater interannual day of year (DOY) occurrence variability at the dry site compared with the wet site. At the dry site, vegetation activity begins on average ~7 days earlier and ends ~11 days earlier. The mean active stem growth window lasts ~54 days for the dry site and ~51 days for the wet site. Vegetation, in both tundra environments, began cold de‐hardening functions (warm season prep) prior to atmospheric temperatures warming above 0°C. Similar results were found related to the critical soil freeze/thaw/transition dates; the dry site had a DOY phenophase occurrence range that was 8 days larger than that of the wet site. A longer continuous summer thaw period was captured at the wet site by ~26 days throughout the active layer. In addition, the dry site was measured to have longer spring and fall soil isothermal conditions than the wet site by ~9 and 5 days throughout the active layer. These results show that the dry site's willow shrub vegetation physiology and soil condition phenology is more variable than the wet site. Alongside the in situ data, a remote sensing product from NASA's MEaSUREs program was utilized; our research indicates that the AMSR‐derived satellite product is more precise over the wet tundra site with critical date alignment between remote sensing observations and in situ measurements ranging from ~4 to 11 days. Furthermore, the AMSR product was shown to preemptively estimate land surface condition change during the spring transition for both tundra types while lagging during the fall transition and freeze‐up periods.

Currently, there are limited data comparing demographic and clinical characteristics of individuals who died by probable suicide and who did and did not previously attend mental health services (MHSs). This study compared demographic and clinical factors for both groups, in a Western region of Ireland over a 13-year period. Postmortem reports between January 1, 2006 and March 31, 2019 were reviewed for 400 individuals who died by probable suicide. Relevant sociodemographic and clinical data were extracted from individuals’ lifetime case notes. One hundred and fifty nine individuals (40%) had attended MHSs at some stage (“attendee”). Hanging was the most common method of suicide (61%), followed by drowning (18%) for both attendees and nonattendees of MHSs, with more violent methods utilized overall by nonattendees (p = 0.028). Sixty-eight percent of individuals who previously attempted hanging subsequently died utilizing this method. A higher proportion of attendees were female compared to nonattendees of MHSs (28.9 vs. 14.5%, p = 0.001). Recurrent depressive disorder (55%) was the most common diagnosed mental health disorder. For individuals with a diagnosis of schizophrenia, 39% had antipsychotic medications detectable in their toxicology reports. In conclusion, the majority of people who died by probable suicide had never had contact with MHSs, and nonattendees overall were more likely to utilize violent methods of suicide. Nonconcordance with psychotropic medications in psychotic patients and previous hanging attempt were highlighted as potential risk factors for death by probable suicide.