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Gestational diabetes mellitus (GDM) is associated with adverse health outcomes for the pregnant individual and their baby. Screening approaches for GDM have undergone several iterations, introducing variability in practice among healthcare providers. As such, our study aimed to explore the views of antenatal providers regarding their practices of, and counseling experiences on the topic of, GDM screening in Ontario. We conducted a qualitative, grounded theory study. The study population included antenatal providers (midwives, family physicians, and obstetricians) practicing in Hamilton, Ottawa, or Sudbury, Ontario. Semi-structured telephone interviews were conducted and transcribed verbatim. Transcripts were analyzed using inductive coding upon which codes, categories, and themes were developed to generate a theory grounded in the data. Twenty-two participants were interviewed. Using the social-ecological theory, we created a model outlining four contextual levels that shaped the experiences of GDM counseling and screening: Intrapersonal factors included beliefs, knowledge, and skills; interpersonal factors characterized the patient-provider interactions; organizational strengths and challenges shaped collaboration and health services infrastructure; and finally, guidelines and policies were identified as systemic barriers to health care access and delivery. A focus on patient-centered care was a guiding principle for all care providers and permeated all four levels of the model. Patient-centered care and close attention to barriers and facilitators across intrapersonal, interpersonal, organizational, and policy domains can minimize the impact of variations in GDM screening guidelines. Among care providers, there is a desire for additional skill development related to GDM counseling, and for national consensus on optimal screening guidelines.

Objective To quantify the implementation of the third Joint British Societies’ Consensus Recommendations for the Prevention of Cardiovascular Disease (JBS3) after coronary event.Methods Using a cross-sectional survey design, patients were consecutively identified in 36 specialist and district general hospitals between 6 months and 2 years, after acute coronary syndrome or revascularisation procedure and invited to a research interview. Outcomes included JBS3 lifestyle, risk factor and therapeutic management goals. Data were collected using standardised methods and instruments by trained study nurses. Blood was analysed in a central laboratory and a glucose tolerance test was performed.Results 3926 eligible patients were invited to participate and 1177 (23.3% women) were interviewed (30% response). 12.5% were from black and minority ethnic groups. 45% were persistent smokers, 36% obese, 52.9% centrally obese, 52% inactive; 30% had a blood pressure >140/90 mm Hg, 54% non-high-density lipoprotein ≥2.5 mmol/L and 44.3% had new dysglycaemia. Prescribing was highest for antiplatelets (94%) and statins (85%). 81% were advised to attend cardiac rehabilitation (86%

Objective: This cross-sectional study utilized structural equation modeling to examine effects of COVID-19 stress on food insecurity and fruit and vegetable consumption mediated through personal agency and behavioral intention. Participants: Students (n = 749) enrolled at one federally designated Hispanic-serving public university during the fall 2020 semester. Methods: A 34-item survey was developed and administered. Results: COVID-19 stress had a statistically significant impact on food insecurity (B = 0.341; p < 0.001) and an inverse impact on personal agency to consume fruit and vegetables (B = -0.283; p < 0.001). Personal agency (B = 0.389; p < 0.001) and behavioral intention to consume fruit and vegetables were directly associated while food insecurity inversely impacted behavioral intention (B = -0.076; p = 0.034). Conclusions: Pandemic-related stress impacts nutrition behaviors among the student population already at risk of poor fruit and vegetable intake. During periods of high pandemic-related stress, college students need adequate access to fruits and vegetables and health promotion programs emphasizing stress management and healthy dietary behaviors.

The need to improve diversity, equity, inclusion, and accessibility (DEIA) efforts has reached monumental heights in the past decade as a result of the Black Lives Matter movement and other DEIA efforts. This shift in thought has impacted recruitment and hiring practices in the public, private, and nonprofit sectors. For years, universities have tried a variety of mechanisms to increase the pool of minority applicants in PhD programs as well as the faculty ranks. However, many of these efforts have not been sustainable. In this article, we discuss the results from a survey of graduate-level public affairs programs to discern specific efforts to increase the number of minority students pursuing graduate degrees and subsequently the number of minority faculty. In addition, we completed an extant review of the literature to determine additional practices that have proven fruitful in other graduate programs.

Two essential questions for those leading the field of public administration are: What do we teach our students, and how do we train them? As scholars, we pay significant attention to our research, often to the detriment of recognizing the potential for merging our research with teaching through the Scholarship of Teaching and Learning (SoTL). However, given our students' leadership positions, SoTL-related work is vital to their success. In this article, we have come together to reflect on the state of SoTL's work in public administration. Through this reflection, we explore the windows of opportunity for research that we see emerging. Included among these opportunities is the need for research on how we can best serve students in and out of the classroom, as well as research the most effective way of managing our programs. We also see the need for research into faculty development, instructional design, and the return on investment for a public administration degree. Lastly, we argue for improved recognition of the value and contribution of SoTL-related work in tenure and promotion standards.

As K-12 classrooms in the U.S. grow in linguistic diversity, there is a need to develop and evaluate the effects of instructional approaches that build knowledge of academic vocabulary for multilingual learners. While multimedia vocabulary instruction may represent a promising avenue for improving word learning for linguistically diverse classrooms of upper-elementary students, there is a dearth of empirical evidence on this topic, with no research on multimedia vocabulary instruction having been conducted with linguistically diverse populations in rural contexts. This randomized control trial evaluated the effects of a multimedia vocabulary instructional approach (CAP-S), relative to business-as-usual (BAU) vocabulary instruction on researcher-developed and standardized measures of word knowledge for a linguistically diverse sample of Grade 5 students learning in rural schools (n = 418). The intervention took place over 8 weeks; CAP-S and BAU teachers addressed the same target set of academic words. Hierarchical linear modeling indicated statistically significant and meaningful effects on a custom measure of word learning, as well as small but statistically significant effects on a standardized assessment of word knowledge. On the custom vocabulary measure, ELs benefited more than non-ELs from CAP-S instruction, relative to their counterparts in the BAU condition. Findings suggest the potential advantages of employing efficient, feasible multimedia vocabulary approaches to serve diverse, multilingual student groups in rural, upper-elementary classrooms.

Background: A substantial proportion of living kidney donors are women of childbearing age. Some prior studies report a higher risk of gestational hypertension and pre-eclampsia in living kidney donors compared with nondonors. Further research is needed to better quantify the risk of adverse maternal, fetal/infant, and neonatal outcomes attributable to living kidney donation. Objective: To determine the risk of hypertensive disorders of pregnancy, including gestational hypertension, pre-eclampsia, and eclampsia, and other maternal and fetal/infant outcomes in living kidney donors compared with a matched group of nondonors of similar baseline health. Design and Setting: Protocol for a population-based, matched cohort study using Canadian administrative health care databases. The protocol will be run separately in 3 provinces, Ontario, Alberta, and British Columbia, and results will be combined statistically using meta-analysis. Participants: The cohort will include women aged 18 to 48 years who donated a kidney between July 1992 and March 2022 and had at least one postdonation singleton pregnancy of ≥20 weeks gestation between January 1993 and February 2023. We expect to include at least 150 living kidney donors with over 200 postdonation pregnancies from Ontario and a similar number of donors and pregnancies across Alberta and British Columbia combined. Nondonors will include women from the general population with at least one pregnancy of ≥20 weeks gestation between January 1993 and February 2023. Nondonors will be randomly assigned cohort entry dates based on the distribution of nephrectomy dates in donors. The sample of nondonors will be restricted to those aged 18 to 48 years on their cohort entry dates with delivery dates at least 6 months after their assigned entry dates. A concern with donor and nondonor comparisons is that donors are healthier than the general population. To reduce this concern, we will also apply 30+ exclusion criteria to further restrict the nondonor group so that they have similar health measures at cohort entry as the donors. Donor and nondonor pregnancies will then be matched (1:4) on 5 potential confounders: delivery date, maternal age at delivery date, time between cohort entry and delivery date, neighborhood income quintile, and parity at delivery date. Measurements: The primary outcome will be a composite of maternal gestational hypertension, preeclampsia, or eclampsia. Secondary maternal outcomes will include components of the primary outcome, early pre-eclampsia, severe maternal morbidity, cesarean section, postpartum hemorrhage, and gestational diabetes. Fetal/infant/neonatal outcomes will include premature birth/low birth weight, small for gestational age, neonatal intensive care unit admission, stillbirth, and neonatal death. Methods: The primary unit of analysis will be the pregnancy. We will compute the risk ratio of the primary composite outcome in donors versus nondonors using a log-binomial mixed regression model with random effects to account for the correlation within women with multiple pregnancies and within matched sets of donors and nondonors. We will perform the statistical analyses within each province and then combine aggregated results using meta-analytic techniques to produce overall estimates of the study outcomes. Limitations: Due to regulations that prevent individual-level records from being sent to other provinces, we cannot pool individual-level data from all 3 provinces. Conclusion: Compared to prior studies, this study will better estimate the donation-attributable risk of adverse maternal, fetal/infant, and neonatal outcomes. Transplant centers can use the results to counsel female living donor candidates of childbearing age and to inform recommended practices for the follow-up and care of living kidney donors who become pregnant.

Sustainable crop production requires nutrient inputs to replace what was removed or lost. Replenishing nutrients using fertilizers and animal wastes is one of the most common input practices. While there is considerable research evaluating the efficacy of fertilizer and manure-based inputs for crop performance, nutrient use efficiency, and the subsequent impact to the environment, the influence of these inputs on soil health properties is less understood. The goals of this review are to summarize the state of literature on the influence of chemical fertilizer and manure-based inputs on soil health and to identify research gaps to refine efforts toward improved soil health, sustainability, and soil carbon storage. Conclusions suggest that chemical fertilizer inputs can increase soil organic matter and soil health provided that additions are not beyond what a plant can utilize. Manure-based inputs contribute to soil organic carbon and associated metrics; however, direct comparison of products is difficult as they are generally applied on a nutrient basis rather than carbon basis, which differentially affects their influence on soil health. Overall, nutrient-containing inputs show beneficial influences on soil health metrics; however, more focused research into their influence on soil health is needed.

Abstract Bulk bismuth has a complex Landau spectrum. The small effective masses and the large g-factors are anisotropic. The chemical potential drifts at high magnetic fields. Moreover, twin boundaries further complexify the interpretation of the data by producing extra anomalies in the extreme quantum limit. Here, we present a study of angle dependence of magnetoresistance up to 65 T in bismuth complemented with Nernst, ultrasound, and magneto-optic data. All observed anomalies can be explained in a single-particle picture of a sample consisting of two twinned crystals tilted by 108° and with two adjacent crystals keeping their own chemical potentials despite a shift between chemical potentials as large as 68 meV at 65 T. This implies an energy barrier between adjacent twinned crystals reminiscent of a metal- semiconductor Schottky barrier or a p-n junction. We argue that this barrier is built by accumulating charge carriers of opposite signs across a twin boundary.

Sn–Bi-based, low-temperature solder alloys are being developed to offer the electronics manufacturing industry a path to lower temperature processes. A critical challenge is the significant microstructural and lattice parameter changes that these alloys undergo at typical service temperatures, largely due to the variable solubility of Bi during the Sn phase. The influence of alloying additions in improving the performance of these alloys is the subject of much research. This study aims to enhance the understanding of how alloying with In influences these properties, which are crucial for improving the alloy’s reliability. Using in situ heating synchrotron powder X-ray diffraction (PXRD), we investigated the Sn–57 wt% Bi–xIn (x = 0, 0.2, 0.5, 1, 3 wt%) alloys during heating and cooling. Our findings reveal that In modifies the microstructure, promoting more homogeneous Bi distribution during thermal cycling. This study not only provides new insights into the dissolution and precipitation behaviour of Bi in Sn–Bi-based alloys, but also demonstrates the potential of In to improve the thermal stability of these alloys. These innovations contribute significantly to advancing the performance and reliability of Sn–Bi-based, low-temperature solder alloys.

Understanding adaptive human driving behavior, in particular how drivers manage uncertainty, is of key importance for developing simulated human driver models that can be used in the evaluation and development of autonomous vehicles. However, existing traffic psychology models of adaptive driving behavior either lack computational rigor or only address specific scenarios and/or behavioral phenomena. While models developed in the fields of machine learning and robotics can effectively learn adaptive driving behavior from data, due to their black box nature, they offer little or no explanation of the mechanisms underlying the adaptive behavior. Thus, generalizable, interpretable, computational models of adaptive human driving behavior are still rare. This paper proposes such a model based on active inference, a behavioral modeling framework originating in computational neuroscience. The model offers a principled solution to how humans trade progress against caution through policy selection based on the single mandate to minimize expected free energy. This casts goal-seeking and information-seeking (uncertainty-resolving) behavior under a single objective function, allowing the model to seamlessly resolve uncertainty as a means to obtain its goals. We apply the model in two apparently disparate driving scenarios that require managing uncertainty, (1) driving past an occluding object and (2) visual time-sharing between driving and a secondary task, and show how human-like adaptive driving behavior emerges from the single principle of expected free energy minimization.

The In–Bi–Sn low-temperature solder alloys are regarded as potential candidates for cryogenic and space exploration applications. This study investigates the variations in the mechanical properties and microstructures of two different compositions: In15wt%Bi35wt%Sn and In30wt%Bi20wt%Sn, after exposure to a low-temperature environment (−20 °C) for 10 months. An increase in the ultimate tensile strength was observed across all the tested samples and a decrease in elongation to failure was observed in In30wt%Bi20wt%Sn. Changes in the microstructure were identified through scanning electron microscopy (SEM) and electron backscatter diffraction (EBSD). The impact of this low-temperature environment is described, considering the varying proportions and compositions of the three phases (BiIn2(Sn), γ-InSn4(Bi), and β-In3Sn(Bi)) present within the alloys and their contribution to the mechanical properties.

Non-islet cell tumor hypoglycemia (NICTH) is a rare clinical entity associated with large mesenchymal tumors. Its pathogenesis is most commonly mediated by tumor overproduction of “big” insulin-like growth factor-2. Here, we present a 54-year-old male who presented with noninsulin-mediated hypoglycemia and a 20 cm intra-abdominal leiomyoma. His hypoglycemic episodes resolved after the resection of his tumor. To our knowledge, this is the only documented case in the English literature of NICTH associated with leiomyoma in a male patient. NICTH due to a benign leiomyoma should be in the differential diagnosis for any patient with hypoglycemia and an abdominal mass.

As a regulator of alveolo-capillary barrier integrity, Transient Receptor Potential Vanilloid 4 (TRPV4) antagonism represents a promising strategy for reducing pulmonary edema secondary to chemical inhalation. In an experimental model of acute lung injury induced by exposure of anesthetized swine to chlorine gas by mechanical ventilation, the dose-dependent effects of TRPV4 inhibitor GSK2798745 were evaluated. Pulmonary function and oxygenation were measured hourly; airway responsiveness, wet-to-dry lung weight ratios, airway inflammation, and histopathology were assessed 24 h post-exposure. Exposure to 240 parts per million (ppm) chlorine gas for ≥50 min resulted in acute lung injury characterized by sustained changes in the ratio of partial pressure of oxygen in arterial blood to the fraction of inspiratory oxygen concentration (PaO2/FiO2), oxygenation index, peak inspiratory pressure, dynamic lung compliance, and respiratory system resistance over 24 h. Chlorine exposure also heightened airway response to methacholine and increased wet-to-dry lung weight ratios at 24 h. Following 55-min chlorine gas exposure, GSK2798745 marginally improved PaO2/FiO2, but did not impact lung function, airway responsiveness, wet-to-dry lung weight ratios, airway inflammation, or histopathology. In summary, in this swine model of chlorine gas-induced acute lung injury, GSK2798745 did not demonstrate a clinically relevant improvement of key disease endpoints.

Efficient engineering of enzymes for expanded substrate scope is currently challenging. Here, the authors develop simple principles of how to design and interpret Substrate Multiplexed Screening assays to guide protein engineering to enable activity improvements with simultaneously with multiple substrates.

JET, the world’s largest operating tokamak with unique Be/W wall and tritium handling capability, completed a Deuterium-Tritium (D-T) campaign in 2021 (Maggi et al 29th Fusion Energy Conf. ) following a decade of preparatory experiments, dedicated enhancements, technical rehearsals and training (Horton et al 2016 Fusion Eng. Des. 109–111 925). Operation with tritium raises significant technical, safety and scientific challenges not encountered in standard protium or deuterium operation. This contribution describes the tritium operational requirements, pulses and technical preparations, new operating procedures, lessons learned and details on the achieved operational availability and performance. The preparation and execution of the recent JET tritium experiments benefitted from the previous experience in 1991 (Preliminary Tritium Experiment), 1997 (DTE1 campaign) and 2003 (Trace Tritium Campaigns) and consisted of the following five phases: technical rehearsals and scenario preparation, tritium commissioning, 100% tritium campaign, D-T campaign (DTE2), tritium clean-up. Following the clean-up JET resumed normal operation and is currently undertaking a further D-T campaign (DTE3).