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University-based centers and institutes can play an important role in facilitating community-based, inter- and transdisciplinary research, and providing the capacity and expertise to address pressing issues. However, many centers and institutes face challenges related to long-term stability and resili­ence. In this paper we share recommendations on how to support centers and institutes that focus on food systems transformation. We drew these rec­ommendations from insights and stories shared by leaders of nine diverse centers and institutes that participate in the Inter-Institutional Network for Food, Agriculture, and Sustainability (INFAS). We discuss how they are structured, the work they have done, and the benefits of that work, as well as the challenges they have faced and what they rec­ommend for addressing those challenges. Their primary challenges include cultivating the support of university administrators and faculty, hiring and retaining supportive faculty, and securing sustaina­ble funding. We provide a diverse range of recom­mendations to address each of these challenges, with the hope that other centers and institutes can find some that will be relevant to their particular institutional, social, and political contexts. Note: Lauren Gwin, Michelle Miller, and Erin B. Lowe are co–first authors

Purpose: Our purpose was to report complications requiring surgical intervention among patients treated with postmastectomy proton radiation therapy (PMPRT) for breast cancer in the setting of breast reconstruction (BR). Methods and Materials: Patients enrolled on a prospective proton registry who underwent BR with immediate autologous flap, tissue expander (TE), or implant in place during PMPRT (50/50.4 Gy +/- chest wall boost) were eligible. Major reconstruction complication (MRC) was defined as a complication requiring surgical intervention. Absolute reconstruction failure was an MRC requiring surgical removal of BR. A routine revision (RR) was a plastic surgery refining cosmesis of the BR. Kaplan-Meier method was used to assess disease outcomes and MRC. Cox regression was used to assess predictors of MRC. Results: Seventy-three courses of PMPRT were delivered to 68 women with BR between 2013 and 2021. Median follow-up was 42.1 months. Median age was 47 years. Fifty-six (76.7%) courses used pencil beam scanning PMPRT. Of 73 BR, 29 were flaps (39.7%), 30 implants (41.1%), and 14 TE (19.2%) at time of irradiation. There were 20 (27.4%) RR. There were 9 (12.3%) MRC among 5 implants, 2 flaps, and 2 TE, occurring a median of 29 months from PMPRT start. Three-year freedom from MRC was 86.9%. Three (4.1%) of the MRC were absolute reconstruction failure. Complications leading to MRC included capsular contracture in 5, fat necrosis in 2, and infection in 2. On univariable analysis, BR type, boost, proton technique, age, and smoking status were not associated with MRC, whereas higher body mass index trended toward significance (hazard ratio, 1.07; 95% CI, 0.99-1.16; P = .10). Conclusions: Patients undergoing PMPRT to BR had a 12.3% incidence of major complications leading to surgical intervention, and total loss of BR was rare. MRC rates were similar among reconstruction types. Minor surgery for RR is common in our practice.

Healthcare has long struggled to improve services through technology without further widening health disparities. With the significant expansion of digital health, a group of healthcare professionals and scholars from across the globe are proposing the official usage of the term "Digital Determinants of Health" (DDOH) to explicitly call out the relationship between technology, healthcare, and equity. This is the final paper in a series published in PLOS Digital Health that seeks to understand and summarize current knowledge of the strategies and solutions that help to mitigate the negative effects of DDOH for underinvested communities. Through a search of English-language Medline, Scopus, and Google Scholar articles published since 2010, 345 articles were identified that discussed the application of digital health technology among underinvested communities. A group of 8 reviewers assessed 132 articles selected at random for the mention of solutions that minimize differences in DDOH. Solutions were then organized by categories of policy; design and development; implementation and adoption; and evaluation and ongoing monitoring. The data were then assessed by category and the findings summarized. The reviewers also looked for common themes across the solutions and evidence of effectiveness. From this limited scoping review, the authors found numerous solutions mentioned across the papers for addressing DDOH and many common themes emerged regardless of the specific community or digital health technology under review. There was notably less information on solutions regarding ongoing evaluation and monitoring which corresponded with a lack of research evidence regarding effectiveness. The findings directionally suggest that universal strategies and solutions can be developed to address DDOH independent of the specific community under focus. With the need for the further development of DDOH measures, we also provide a framework for DDOH assessment.

BackgroundCare for children with special health care needs relies on a network of providers who work to address the medical, behavioral, developmental, educational, social, and economic needs of the child and their family. Family-directed, manually created visual depictions of care team composition (ie, care mapping) and detailed note-taking curated by caregivers (eg, care binders) have been shown to enhance care coordination for families of these children, but they are difficult to implement in clinical settings owing to a lack of integration with electronic health records and limited visibility of family-generated insights for care providers. Caremap is an electronic health record–integrated digital personal health record mobile app designed to integrate the benefits of care mapping and care binders. Currently, there is sparse literature describing end-user participation in the co-design of digital health tools. In this paper, we describe a project that evaluated the usability and proof of concept of the Caremap app through end-user simulation. ObjectiveThis study aimed to conduct proof-of-concept testing of the Caremap app to coordinate care for children with special health care needs and explore early end-user engagement in simulation testing. The specific aims included engaging end users in app co-design via app simulation, evaluating the usability of the app using validated measures, and exploring user perspectives on how to make further improvements to the app. MethodsCaregivers of children with special health care needs were recruited to participate in a simulation exercise using Caremap to coordinate care for a simulated case of a child with complex medical and behavioral needs. Participants completed a postsimulation questionnaire adapted from 2 validated surveys: the Pediatric Integrated Care Survey (PICS) and the user version of the Mobile Application Rating Scale (uMARS). A key informant interview was also conducted with a liaison to Spanish-speaking families regarding app accessibility for non–English-speaking users. ResultsA Caremap simulation was successfully developed in partnership with families of children with special health care needs. Overall, 38 families recruited from 19 different US states participated in the simulation exercise and completed the survey. The average rating for the survey adapted from the PICS was 4.1 (SD 0.82) out of 5, and the average rating for the adapted uMARS survey was 4 (SD 0.83) out of 5. The highest-rated app feature was the ability to track progress toward short-term, patient- and family-defined care goals. ConclusionsInternet-based simulation successfully facilitated end-user engagement and feedback for a digital health care coordination app for families of children with special health care needs. The families who completed simulation with Caremap rated it highly across several domains related to care coordination. The simulation study results elucidated key areas for improvement that translated into actionable next steps in app development.

IntroductionMath achievement for economically disadvantaged students remains low, despite positive developments in research, pedagogy, and funding. In the current paper, we focused on the research-to-practice divide as possible culprit. Our argument is that urban-poverty schools lack the stability that is necessary to deploy the trusted methodology of hypothesis-testing. Thus, a type of efficacy methodology is needed that could accommodate instability.MethodWe explore the details of such a methodology, building on already existing emancipatory methodologies. Central to the proposed solution-based research (SBR) is a commitment to the learning of participating students. This commitment is supplemented with a strength-and-weaknesses analysis to curtail researcher bias. And it is supplemented with an analysis of idiosyncratic factors to determine generalizability. As proof of concept, we tried out SBR to test the efficacy of an afterschool math program.ResultsWe found the SBR produced insights about learning opportunities and barrier that would not be known otherwise. At the same time, we found that hypothesis-testing remains superior in establishing generalizability.DiscussionOur findings call for further work on how to establish generalizability in inherently unstable settings.

This article explores how ARL libraries affiliated with institutions of higher education receive funding, or not, through library related fees collected as part of tuition and fees payments. The authors from the University of XXXX (XXXX) wanted to examine how their library fee funding compared with their peers. They were motivated to research this topic due to the combined impacts of COVID-19, the serials crisis, and recent budget reductions. Data was collected from publicly available tuition and fees data on university websites. Analysis revealed that student library fees at XXXX are significantly lower than other ARL libraries, and that there is a lack of transparency in how libraries are funded through tuition related library fees.

Abstract Background Approximately one in ten men experience mental health difficulties during the early years of fatherhood, and these can have negative impacts on children and families. However, few evidence-based interventions targeting fathers’ mental health are available. The aim of the trial is to evaluate the effectiveness and cost-effectiveness of Working Out Dads (WOD) – a facilitated peer support group intervention for fathers of young children, in reducing psychological distress and other mental health symptoms. Methods This trial will employ a parallel-arm randomised controlled trial (RCT) to evaluate the effectiveness and cost effectiveness of WOD peer support group intervention compared to usual care (a 30-min mental health and service focused phone consultation with a health professional). A total of 280 fathers of young children (aged 0-4 years) who are experiencing mental health difficulties and/or are at risk of poor mental health will be recruited. Randomisation and analyses will be at the level of the individual participant. The primary outcome is psychological distress symptoms, measured by the Kessler Psychological Distress Scale (K10) from baseline to 24 weeks post randomisation. A range of secondary outcomes will be assessed including suicidal ideation; mental health disorders, specific symptoms of depression, anxiety, and stress; social support, quality of life, health service use, and health care costs. Data will be collected at baseline, 10- and 24 weeks post-randomisation. Discussion This trial will examine the effectiveness of a novel group-based peer support intervention in reducing the psychological distress and other mental health symptoms of fathers compared to usual care. The economic and process evaluation will guide policy decision making along with informing the future implementation of WOD on a larger scale if effectiveness is demonstrated. Trial registration The current trial has been registered with ClinicalTrials.gov (Registration ID - NCT04813042 ). Date of Registration: March 22nd, 2021.

Protein aggregates are a common feature of diseased and aged cells. Membrane proteins comprise a quarter of the proteome, and yet, it is not well understood how aggregation of membrane proteins is regulated and what effects these aggregates can have on cellular health. We have determined in yeast that the derlin Dfm1 has a chaperone-like activity that influences misfolded membrane protein aggregation. We establish that this function of Dfm1 does not require recruitment of the ATPase Cdc48 and it is distinct from Dfm1's previously identified function in dislocating misfolded membrane proteins from the endoplasmic reticulum (ER) to the cytosol for degradation. Additionally, we assess the cellular impacts of misfolded membrane proteins in the absence of Dfm1 and determine that misfolded membrane proteins are toxic to cells in the absence of Dfm1 and cause disruptions to proteasomal and ubiquitin homeostasis.

National planning and health organizations agree that to achieve healthy and sustainable food systems, planners must balance goals across a spectrum of sustainability issues that include economic vitality, public health, ecological sustainability, social equity, and cultural diversity. This research is an assessment of government-adopted food system plans in the U.S. that examines which topics, across the three dimensions of sustainability (social, environmental, and economic), are included in local food system plans and conducts an exploratory analysis that asks whether the community capitals (built, cultural, social, financial, human, and natural) available in a community are associated with the content of food system plans. The research team first developed a Sustainable Food System Policy Index made up of 26 policy areas across the three dimensions that, in aggregate, define and operationalize sustainable food systems. With this index we evaluated a sample of 28 food system plans for inclusion of these policy impact areas. We then performed an exploratory regression analysis to examine whether the availability of community capitals was associated with the content of food system plans. Findings indicated that jurisdictions integrated a broad range of issues into their food system plans; however, there are certain issues across every dimension of sustainability that are much less frequently included in plans, such as strategies related to participation in decision-making, financial infrastructure, and the stewardship of natural resources. Regression analysis identified statistically significant linear relationships between particular capitals and the proportion of policy areas included in plans. In particular, higher metrics associated with poverty were associated with the inclusion of fewer policy areas and with a potentially narrower policy agenda. This study adds to the plan evaluation literature as one of the first attempts to document the content of a sample of U.S. food system plans through a sustainability lens, contributing to the knowledge of what types of issues are advanced by local food system plans and the policy implications of current gaps in planning agendas.

Engineered aeration is one solution for increasing oxygen concentrations in highly eutrophic estuaries that undergo seasonal hypoxia. Although there are various designs for engineered aeration, all approaches involve either destratification of the water column or direct injection of oxygen or air through fine bubble diffusion. To date, the effect of either approach on estuarine methane dynamics remains unknown. Here we tested the hypotheses that 1) bubble aeration will strip the water of methane and enhance the air-water methane flux to the atmosphere and 2) the addition of oxygen to the water column will enhance aerobic methane oxidation in the water column and potentially offset the air-water methane flux. These hypotheses were tested in Rock Creek, Maryland, a shallow-water sub-estuary to the Chesapeake Bay, using controlled, ecosystem-scale deoxygenation experiments where the water column and sediments were sampled in mid-summer, when aerators were ON, and then 1, 3, 7, and 13 days after the aerators were turned OFF. Experiments were performed under two system designs, large bubble and fine bubble approaches, using the same observational approach that combined discrete water sampling, long term water samplers (OsmoSamplers) and sediment porewater profiles. Regardless of aeration status, methane concentrations reached as high as 1,500 nmol L−1 in the water column during the experiments and remained near 1,000 nmol L−1 through the summer and into the fall. Since these concentrations are above atmospheric equilibrium of 3 nmol L−1, these data establish the sub-estuary as a source of methane to the atmosphere, with a maximum atmospheric flux as high as 1,500 µmol m−2 d−1, which is comparable to fluxes estimated for other estuaries. Air-water methane fluxes were higher when the aerators were ON, over short time frames, supporting the hypothesis that aeration enhanced the atmospheric methane flux. The fine-bubble approach showed lower air-water methane fluxes compared to the larger bubble, destratification system. We found that the primary source of the methane was the sediments, however, in situ methane production or an upstream methane source could not be ruled out. Overall, our measurements of methane concentrations were consistently high in all times and locations, supporting consistent methane flux to the atmosphere.

In the United States, students are increasingly diverse in their academic and linguistic abilities. The specialization of teaching professionals has been the primary method used in order to respond to this increase. Programs for these professionals have largely been siloed along the dichotomous groupings of students identified in law, namely, disabled/nondisabled or English proficient/nonproficient. However, the reality of students is much more complex and interdisciplinary approaches present an opportunity for meeting the realistic needs of all students. This study used a one-time, open-ended survey to gather the perceptions of four preservice special education teachers who worked collaboratively with students identified as English-Language Learners (ELL) and their teacher. These perceptions were analyzed in light of recent literature calling for increased collaboration among professionals in special and bilingual education.

The researchers conducted a qualitative case study to describe the experiences (over the course of a semester) of an interdisciplinary team of three special education and three psychology undergraduates who participated in a relational learning community and a graduate student who designed and facilitated this learning community. An Associate Professor and special education researcher oversaw and co-facilitated the project. The design of the learning community promoted the building of rapport and trust among the group members and the progress of the group toward a common goal of incorporating principles from psychology to develop teaching strategies for students who are struggling in math and experiencing severe math anxiety. Gathering more frequent and individualized feedback would have helped the learning community facilitator make some key adjustments earlier in the project, but the incorporation of rapport building activities that supported trust and collaboration among the group was supportive of group progress toward a common goal. We learned key lessons about how to design and implement a learning community that can be applied to the field of education, interdisciplinary collaboration, and other contexts.

Multifaceted causes and consequences of food insecurity require collaborative work across multiple academic disciplines and with various community partners in order to build sustainable solutions. Interdisciplinary teams require thoughtful considerations of time devoted to team-building exercises, paying particular attention to understanding members’ values. Teams must find points of convergence, develop mutually agreed upon common language, and openly discuss needs and expectations. This paper describes the process of building a community-university Food Mapping Team to address food security. The FMT initiative allows for a well-coordinated exploration of data collection methods that capitalize on the diverse interdisciplinary expertise and resources of university researchers and extensive knowledge of community partners, whose work can inform, and be impacted by, these efforts. We provide a set of processes used to form our partnership and describe our decision-making process in the development of a community food security research project. We also include a self-assessment of the research planning and implementation process that our team used and describe areas of improvement for other community-university groups to consider.

Background: Dyspnea and exercise intolerance are commonly reported post-acute sequelae of SARS-CoV-2 infection (PASC), but routine diagnostic testing is often normal. Cardiopulmonary exercise testing (CPET) offers comprehensive assessment of dyspnea to characterize pulmonary PASC. Methods: We performed a retrospective cohort study of CPET performed on patients reporting dyspnea and/or exercise intolerance following confirmed Covid-19 between August 1, 2020 and March 1, 2021, and compared them to age- and sex-matched patients with unexplained dyspnea referred for CPET at the same center in the pre-Covid-19 era. Findings: Compared to matched unexplained dyspnea comparators, PASC patients shared similar medical comorbidities and subjective dyspnea at referral (mMRC score 1.6 ± 0.9 vs. 1.4 ± 0.9, P = 0.5). Fifteen (83.3%) PASC patients underwent high resolution computed tomography of the chest, of which half (46.7%) were normal, and 17 (94.4%) patients had pulmonary function testing, of which the majority (76.5%) were normal. All patients underwent CPET, and 12 (67%) had normal findings. Compared to matched comparators, PASC patients had similar peak oxygen consumption, oxygen consumption at ventilatory anaerobic threshold, and ventilatory efficiency measured by the minute ventilation to carbon dioxide production (VE/VCO2) slope. Interpretation: Despite prominent dyspnea, physiological abnormalities on CPET were mild across a range of initial Covid-19 severity and similar to matched comparators referred for dyspnea without antecedent SARS-CoV-2. Funding: The project was supported by the NHLBI (R01HL131029, R01HL151841, U10HL110337, T32HL116275) and a KL2 award (5KL2TR002542–02) from Harvard Catalyst.

Since the onset of the COVID-19 pandemic, telehealth technologies have become critical to providing family and patient-centered care. Little is known about the impact of these technologies on parent stress levels in the Neonatal Intensive Care Unit (NICU). We sought to determine the impact of bedside web cameras on stress levels of parents in the NICU in order to work toward interventions that might improve family-centered care. A validated survey, the Parental Stress Scale NICU, was administered to parents of babies admitted to the Children’s Hospital of Philadelphia Neonatal/Infant Intensive Care Unit on days 7 to 10 of hospitalization. Parents were also asked if they used the available AngelEye Camera while their baby was hospitalized. Stress levels were analyzed for associations with the use of the bedside cameras. Parents who reported using the bedside camera also reported lower levels of stress relating to being separated from their babies. Bedside web camera interventions may hold potential for reducing parent stress related to separation from their babies, especially in the setting of a global pandemic.

Mycobacterium chelonae is a rapidly growing nontuberculous mycobacterium that is a common cause of nosocomial infections. Here we describe investigation of a possible nosocomial transmission of M. chelonae at the Hospital of the University of Pennsylvania (HUP). M. chelonae strains with similar high-level antibiotic resistance patterns were isolated from two patients who developed post-operative infections at HUP in 2017, suggesting a possible point source infection. The isolates, along with other clinical isolates from other patients, were sequenced using the Illumina and Oxford Nanopore technologies. The resulting short and long reads were hybrid assembled into draft genomes. The genomes were compared by quantifying single nucleotide variants in the core genome and assessed using a control dataset to quantify error rates in comparisons of identical genomes. We show that all M. chelonae isolates tested were highly dissimilar, as indicated by high pairwise SNV values, consistent with environmental acquisition and not a nosocomial point source. Our control dataset determined a threshold for evaluating identity between strains while controlling for sequencing error. Finally, antibiotic resistance genes were predicted for our isolates, and several single nucleotide variants were identified that have the potential to modulated drug resistance.

On March 24 and 25, 2017 researchers and clinicians from around the world met at Temple University in Philadelphia to discuss the current knowledge of Mycobacterium avium ssp. paratuberculosis (MAP) and its relationship to human disease. The conference was held because of shared concern that MAP is a zoonotic bacterium that poses a threat not only to animal health but also human health. In order to further study this problem, the conferees discussed ways to improve MAP diagnostic tests and discussed potential future anti-MAP clinical trials. The conference proceedings may be viewed on the www.Humanpara.org website. A summary of the salient work in this field is followed by recommendations from a majority of the conferees.

We present a synthesis of findings from constructivist teaching experiments regarding six schemes children construct for reasoning multiplicatively and tasks to promote them. We provide a task-generating platform game, depictions of each scheme, and supporting tasks. Tasks must be distinguished from children’s thinking, and learning situations must be organized to (a) build on children’s available schemes, (b) promote the next scheme in the sequence, and (c) link to intended mathematical concepts. Presentamos una síntesis de hallazgos de experimentos de enseñanzaconstructivistas en relación con seis esquemas que los niños construyen para razonar multiplicativamente y tareas para promoverlos. Proveemos una plataforma de juego generadora de tareas, descripciones de cada esquema y tareas para apoyarlos. Las tareas deben distinguirse del pensamiento de los niños, y las situaciones de aprendizaje deben organizarse para que (a) se basen en los esquemas que los niños tienen disponibles, (b) promuevan el siguiente esquema en la secuencia y (c) se relacionen con los conceptos matemáticos pretendidos.

In this commentary we very briefly highlight farming- and land-related historical injustices impacting African Americans, and outline useful ways for racially diverse food justice organizations, activists, and academics to collaborate on place-based interventions in an equitable and inclusive way. Place-based strategies to address inequity in the food system must begin with an equitable and inclusive environment within which residents can engage in developing solutions. Equitable and inclusive civic engagement can build capacity, trust, and empowerment in marginalized communities, creating an environment where communities can enact transformative local food system change using their own resources. Transformative change is change that occurs at the very core of ourselves as individuals and in our communities. Such change requires us to reexamine our long-standing customs, assumptions, beliefs, and institutional practices, moving community conversations towards those that build relationships, foster mutual accountability, and strive for respectful understanding among neighbors and neighborhoods. Transformative change doesn't come easily. However, practicing equitable engagement can help build capacity for sustaining change. Alternative food movement scholars and activists can lift up and build on community assets, but to do so requires historical understanding, recognition of individual and community strengths, and work to build long-term relationships of trust.

We present a new method for analyzing spatial variation in the cost of a balanced diet, as an alternative to food desert classification. Our specific hypothesis is that the cost of a balanced diet varies according to where one lives, as a function of travel and food item costs. We collected price data for the USDA Thrifty Food Plan from approximately 30 percent of food retail outlets of various kinds in the three Gulf Coast counties of Mississippi, and these prices were extrapolated to the remaining stores. Transportation costs were calculated for both driving by automobile and the combination of walking and public transportation by bus, accounting for both the shoppers' time and the cost of automobile mileage. We developed a "traveling purchaser problem" algorithm to estimate the lowest-cost combination of travel and food costs for purchasing all items in the Thrifty Food Plan for each residential parcel in the study area, and mapped the resulting costs and examined their variation. Estimated costs varied more because of transportation costs than food prices, and ranged from US$109 to US$215 for automobile travel and from US$111 to US$439 for a combination of walking and public transportation. In general, costs were lowest in the more populated areas near the coast and higher in more rural areas further inland. Results of this analysis demonstrate that the cost of acquiring a balanced diet varies considerably and more or less continuously. Food is not equally cheap for all; it depends on where one lives. For any given location, an estimate of the cost of a balanced diet, including both food price and transportation, is more useful than a classification as food desert or not in understanding access issues and needs. Furthermore, policy alternatives that are intended to influence access should be evaluated based on how much they influence costs, and for whom, depending on where people live.

The purpose of this study was to investigate the effect of wine style and cane sugar addition in the liqueur d’expedition (dosage) solution on volatile aroma compounds (VOCs) in traditional method sparkling wine. There were 24 bottles of each treatment produced. Treatments were sparkling wine zero dosage (ZD); NV sparkling wine + sugar (BS); unoaked still Chardonnay wine + sugar (UC); Pinot noir 2009 sparkling wine + sugar (PN); Niagara produced Brandy + sugar (B) and Icewine (IW). The control treatment in the sensory analysis was an oaked still Chardonnay wine + sugar (OC) because the zero-dosage wine was not suitable for a difference test that compared wines with sugar to one without. Standard wine chemical parameters were analysed before disgorging and after liqueur d’expedition was added and included; pH, titratable acidity (TA g/L), alcohol (v/v %), residual sugar (RS g/L), free and total SO2 and total phenolics (A.U.). Volatile aroma compounds (VOCs) analysed by Headspace Solid- Phase Micro-Extraction Gas Chromatography-Mass Spectrometry (HS-SPME-GC-MS) included two alcohols, and six ethyl esters. ZD wines had the highest foam height and highest dissolved oxygen level. Sugar affected VOC concentrations in all treatments at five weeks post-disgorging, but by 15 weeks after liqueur d’expedition addition, the wine with added sugar had similar VOC concentrations to the ZD wines. The type of wines used in the dosage solutions had more influence on VOC concentrations than sugar addition.