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Abstract Background The Oakland Score predicts risk of 30-day adverse events among hospitalized patients with lower gastrointestinal bleeding (LGIB) possibly identifying patients who may be safe for discharge. The Oakland Score has not been studied among emergency department (ED) patients with LGIB. The Oakland Score composite outcome includes re-bleeding, defined as additional blood transfusion requirements and/or a further decrease in hematocrit (Hct) >/= 20% after 24 h in clinical stability; red blood cell transfusion; therapeutic intervention to control bleeding, including surgery, mesenteric embolization, or endoscopic hemostasis; in-hospital death, all cause; and re-admission with further LGIB within 28 days. Prediction variables include age, sex, previous LGIB admission, systolic blood pressure, heart rate, and hemoglobin concentration, and scores range from 0 to 35 points, with higher scores indicating greater risk. Methods Retrospective cohort study of adult (≥ 18 years old) patients with a primary ED diagnosis of LGIB across 21 EDs from March 1st, 2018, through March 1st, 2020. We excluded patients who were more likely to have upper gastrointestinal bleeding (esophago-gastroduodenoscopy without LGIB evaluation), patients who left against medical advice or prior to ED provider evaluation, ED patients without active health plan membership, and patients with incomplete Oakland Score variables. We assessed predictive accuracy by reporting the area under the receiver operator curve (AUROC) and sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios at multiple clinically relevant thresholds. Results We identified 8,283 patients with LGIB, 52% were female, mean age was 68, 49% were non-White, and 27% had an adverse event. The AUROC for predicting an adverse event was 0.85 (95% CI 0.84–0.86). There were 1,358 patients with an Oakland Score of

A 25-week preterm neonate was born with complete left-sided partial anomalous pulmonary venous drainage with a confluence draining into a vertical vein to the innominate vein. The ostium was stenotic, resulting in pulmonary hypertension requiring palliation by serial stent placement because of prematurity and comorbidities. The patient subsequently underwent successful surgical left anomalous pulmonary venous confluence reimplantation to the left atrium with vertical vein ligation at 12 months of age. This report highlights the unique multidisciplinary management strategy required for the rarely encountered obstructed complete left-sided anomalous pulmonary venous return in a preterm neonate.

Abstract Aims Emergency department (ED) providers play an important role in the management of patients with acute heart failure (AHF). We present findings from a pilot study of an electronic decision support that includes personalized risk estimates using the STRIDE‐HF risk tool and tailored recommendations for initiating guideline directed medical therapy (GDMT) among appropriate patients. Methods Among ED patients treated for AHF who were discharged from the ED or the ED‐based observation unit in two EDs from 1 January 2023 to 31 July 2023, we assess prescriptions to the four classes of GDMT at two intervals: (1) ED arrival and (2) ED discharge. Specifically, we report active prescriptions for beta‐blockers (BBs), renin–angiotensin receptor system inhibitors (RASis), sodium‐glucose transport protein 2 inhibitors (SGLT2is) and mineralocorticoid receptor antagonists (MRA) among patients with reduced ejection fraction (HFrEF) and mildly reduced (HFmrEF). Second, we describe rates of 30‐day serious adverse events (SAE) (death, cardiopulmonary resuscitation, balloon‐pump insertion, intubation, new dialysis, myocardial infarction or coronary revascularization) among patients predicted to be very low risk by STRIDE‐HF and discharged home. Results Among 234 discharged patients, 55% were female and 76% were non‐White. We found 51 (21.8%), 21 (9.0%) and 126 (53.8%) had HFrEF, HFmEF and HFpEF, respectively, while 36 (15.4%) were missing EF, and 51 (22%) were very low risk, 82 (35%) were low risk, 60 (26%) were medium risk and 41 (18%) were high risk. Among HFrEF patients, 68.6%, 66.7%, 25.5% and 19.6% were on a RASi, BB, SGLT2i and MRA, respectively, at ED arrival, while 42.9%, 66.7%, 14.3% and 4.8% of HFmrEF patients were on a RASi, BB, SGLT2i and MRA, respectively. Among patients with HFpEF, only 6 (4.8%) were on an SGLT2i at ED arrival. The most prescribed new medication at ED discharge was an SGLT2i, with a nearly 10% increase in the proportion of patients with an active prescription for SGLT2i at ED discharge among HFrEF and HFmEF patients. We observed no 30‐day SAE among the 51 patients predicted to be very low risk and discharged home. Conclusions Ongoing treatment with GDMT at ED arrival was sub‐optimal. Initiation among appropriate patients at discharge may be feasible and safe.

Background: While clinical practice habits vary by patient, physician and clinic factors in primary care, limited research has examined whether differences exist in obesity medicine. Our objective was to compare practice habits by such factors among obesity medicine physicians certified by the American Board of Obesity Medicine (ABOM). Methods: We conducted secondary analyses of cross-sectional data from the 2023 ABOM Practice Analysis Validation Survey. We included three obesity medicine practice habits – prescribing anti-obesity medications (AOMs), off-label prescribing of medications for weight reduction, and obesity medicine clinical practice hours (4–20 h/week versus >20 h/week). We included patient (patient population), physician (primary medical specialty, years of obesity medicine experience) and clinic factors (practice setting, geographic catchment, accepts insurance for obesity care). We conducted bivariate analyses using Χ2 tests. Results: Among 565 ABOM-certified physicians, 71.5 % had primary medical specialties within primary care and 9.2 % predominantly treated children/adolescents with obesity. Overall, 97.5 % prescribed AOMs and 85.1 % prescribed off-label medications for weight reduction. Fewer physicians who predominantly treated children/adolescents prescribed AOMs compared to physicians with no or limited treatment of children (88.5 % versus 98.4 % and 98.5 %, respectively; p 20 h/week, which was more likely to occur as years of obesity medicine experience increased (i.e., 21.9 ​% among physicians with 1–2 years of experience versus 58.5 ​% with 10+ years; p ​

Political elites express their ideological positions on contentious issues across various arenas in the public sphere. Social science research often relies on data extracted from various media or political and administrative sources, as well as surveys that are administered directly with the political actor. Although some studies compare ideology across different sources, few systematically analyze how political actors adjust their ideological messaging to the audiences in the respective communication arenas and how such changes are associated with systematic bias in data sources. This paper uses a unique dataset combining climate policy belief observations from three arenas—social media, Congressional testimony, and surveys—on identical ideological variables and during the same time period. We apply item response theory to understand how responses differ by arena and find that ideological communication on Twitter is most left-leaning, Congressional testimony is most right-leaning, and surveys, the data source with the smallest potential arena effect, is in the middle. We also find that actors with strong ideological leaning moderate their positions on social media and in Congress. These findings enhance our understanding of strategic communication depending on audience context and inform social research on biases when analyzing specific data sources.

Background: Preterm inductions may be necessary for maternal comorbidities or fetal abnormalities. Previous studies have identified risk factors for undergoing a cesarean delivery (CD). Our study examined the insertion-to-expulsion time (IET) of cervical ripening balloons (CRB) in preterm inductions that achieved vaginal delivery (VD) compared to CD. Methods: This was a retrospective cohort study of preterm inductions with CRB between 2010 and 2021. Primary outcome was IET of CRB. IRB approval was obtained. Results: The study included 82 women. IET for cesarean patients was significantly greater, and required more removal of CRB at the allotted 12 h. Dilation before and after CRB was significantly greater in the vaginal cohort. There was no significant difference in maternal comorbidities, indication for induction or neonatal complications. Conclusions: Maternal comorbidities, induction indication and neonatal complications were similar between cohorts, making trial of induction with CRB in preterm women a reasonable option. Spontaneous expulsion of CRB and greater dilation may be predictors of vaginal delivery.

Background: Given the evolving nature of obesity medicine, periodic evaluation of its clinical practice is needed to ensure that certification requirements address real-world experience. Practice analysis is a systematic approach to define a field's body of knowledge, and its results can inform the content outline and examination blueprint for a certification examination. This study describes the 2023 practice analysis conducted by the American Board of Obesity Medicine (ABOM). Methods: Initially, 14 obesity medicine physicians participated in a practice analysis panel, resulting in 3 duties and 30 tasks required for competent practice of obesity medicine physicians. Each task included steps, knowledge, skills, and abilities needed to perform the task. ABOM then recruited 645 certified obesity medicine physicians from its database to participate in a validation survey to rate the frequency [scale: never (0) to very frequently (5)] and importance [scale: not important (0) to very important (3)] of each task. Survey participants could also provide open-ended comments. Results: Among validation survey participants (n = 645), the most common primary medical specialties reported were internal medicine (46.0 %), family medicine (33.8 %), and pediatrics (11.2 %). Years practicing obesity medicine varied with 45.3 % reporting 1–4 years, 26.0 % 5–9 years, and 28.7 % ≥ 10 years in practice. Most tasks were performed frequently (mean score ≥4.0) and rated as important (mean score ≥2.0). All tasks were retained based on the frequency and importance ratings. Survey results informed the weighting in the examination blueprint. Conclusion: There was consensus among practicing ABOM-certified physicians who participated in the validation survey in the tasks required for competent obesity medicine practice. Our practice analysis approach was a structured process that engaged obesity medicine physicians and captured the breadth and depth of knowledge required for obesity medicine. The new content outline and examination blueprint developed will be implemented with the 2025 ABOM certification exam administration.

The present study examined university students’ perceptions of a campus sexual violence scenario, and specifically determined whether the presence of known risk factors for sexual perpetration would influence their views of an individual who caused harm. Two hundred and seventy-five student participants read a vignette that either included the present or absence of the following three risk factors: Frequent alcohol use, attitudes supportive of rape, and negative peer influence. The findings indicated that the risk factors did not have a significant relationship with students' risk perceptions, indicating that students’ perceptions of risk may not be influenced by the presence of known risk factors. The results suggest that students may use intuition or other non-scientific approaches when assessing instances of interpersonal violence, at least in campus settings. Implications for students, post-secondary institutional safety, and prevention of campus sexual violence are discussed.

Abstract Weeds are attractive models for basic and applied research due to their impacts on agricultural systems and capacity to swiftly adapt in response to anthropogenic selection pressures. Currently, a lack of genomic information precludes research to elucidate the genetic basis of rapid adaptation for important traits like herbicide resistance and stress tolerance and the effect of evolutionary mechanisms on wild populations. The International Weed Genomics Consortium is a collaborative group of scientists focused on developing genomic resources to impact research into sustainable, effective weed control methods and to provide insights about stress tolerance and adaptation to assist crop breeding.

Data4HumanRights’ training materials have been developed as open-source and tailored to limited-resource settings, where community data collectors often live and work. Access to training on data collection, analysis, and visualisation to support the advocacy of vulnerable groups is essential, particularly in the context of increasing human rights challenges such as land rights, adequate housing, conflicts, and climate justice. This paper provides an overview of how the training materials were co-developed with community data collectors in Nigeria and Kenya, offering insights into the fundamental principles (i.e., inclusiveness, adaptive, limited resources, and being gender- and incentive-sensitive) and the structure of the open-access training materials. The development process resulted in 28 modules, each designed to be delivered in a face-to-face format in less than one day by a local trainer. To maximize adaptivity, the training modules can be mixed and matched (e.g., as individual modules or a learning path of several modules around a specific training need). The individual modules cover a range of methods and tools that are useful to human rights work and community advocacy, e.g., documenting evictions, performing rapid needs assessments after acute crises, community profiling, and monitoring community development indicators. The training materials contain instructions for the training facilitator(s) and all necessary training materials. To ensure inclusivity, the training covers both basic and advanced topics, with most modules designed to address basic needs that can be followed using a mobile phone, thereby avoiding the need for computers or printed handouts. The training results in Nigeria and Kenya showcase applications, including mapping waste problems and addressing forced evictions. Trained community groups produced maps of waste piles to prioritize community actions, such as finding space for urban agriculture, and conducted rapid needs assessments during a massive eviction. This approach helps reduce power imbalances and empowers community groups to effectively manage and utilise their own data.

Water has proven to be ubiquitously detected in near-infrared (NIR) transmission spectroscopy observations of hot Jupiter atmospheres, including WASP-17b. However, previous analyses of WASP-17b’s atmosphere based upon Hubble Space Telescope (HST) and Spitzer data could not constrain the water abundance, finding that subsolar, supersolar, and bimodal posterior distributions were all statistically valid. In this work, we observe one transit of the hot Jupiter WASP-17b using JWST’s Near Infrared Imager and Slitless Spectrograph (NIRISS) Single Object Slitless Spectroscopy (SOSS) mode. We analyze our data using three independent data analysis pipelines, finding excellent agreement between results. Our transmission spectrum shows multiple H _2 O absorption features and a flatter slope towards the optical than seen in previous HST observations. We analyze our spectrum using both PICASO + Virga forward models and free retrievals. POSEIDON retrievals provide a well-constrained supersolar log(H _2 O) abundance (−2.96 ${}_{-0.24}^{+0.31}$ ), breaking the degeneracy from the previous HST + Spitzer analysis. We verify our POSEIDON results with petitRADTRANS retrievals. Additionally, we constrain the abundance of log(H ^− ), −10.19 ${}_{-0.23}^{+0.30}$ , finding that our model including H ^− is preferred over our model without H ^− to 5.1 σ . Furthermore, we constrain the log(K) abundance (−8.07 ${}_{-0.52}^{+0.58}$ ) in WASP-17b’s atmosphere for the first time using space-based observations. Our abundance constraints demonstrate the power of NIRISS SOSS’s increased resolution, precision, and wavelength range to improve upon previous NIR space-based results. This work is part of a series of studies by our JWST Telescope Scientist Team (JWST-TST), in which we use Guaranteed Time Observations to perform Deep Reconnaissance of Exoplanet Atmospheres through Multi-instrument Spectroscopy (DREAMS).

We present the first emission spectrum of the hot Jupiter WASP-17 b using one eclipse observation from the JWST Near Infrared Imager and Slitless Spectrograph (NIRISS) Single Object Slitless Spectroscopy (SOSS) mode. Covering a wavelength range of 0.6–2.8 μ m, our retrieval analysis reveals a strong detection of H _2 O in WASP-17 b’s dayside atmosphere (6.4 σ ). Our retrievals consistently favor a supersolar dayside H _2 O abundance and a noninverted temperature–pressure profile over a large pressure range. Additionally, our examination of the brightness temperature reveals excess emission below 1 μ m, suggesting the possibility of a high internal temperature (600–700 K) and/or contributions from reflected light. We highlight that JWST emission spectroscopy retrieval results can be sensitive to whether negative eclipse depths are allowed at optical wavelengths during light-curve fitting. Our findings deepen our understanding of WASP-17 b’s atmospheric composition while also highlighting the sensitivity of our results to pressure–temperature profile parameterizations. This work is part of a series of studies by our JWST Telescope Scientist Team (TST), in which we will use Guaranteed Time Observations to perform Deep Reconnaissance of Exoplanet Atmospheres through Multi-instrument Spectroscopy (DREAMS).

Abstract Nutrient‐rich waters along the Pacific coast of North America support diverse fish communities that have helped sustain coastal peoples for millennia. Five Nuu‐chah‐nulth First Nations on the west coast of what is now known as Vancouver Island, Canada, hold constitutional Indigenous rights to conduct a multispecies community fishery, which includes Pacific Halibut (Hippoglossus stenolepis). A 2009 court decision defined the extent of these Indigenous rights to be within 9 nm of the coast, thereby not fully recognizing the knowledge and authority of the traditional leadership and raising concerns about the potential for an increase in rockfish bycatch. Yelloweye Rockfish (Sebastes ruberrimus) are a potential ‘choke’ species for this fishery because the two species occupy similar depth ranges. A choke species is one that is caught incidentally while targeting other species and, if caught in excess of its quota limits, can trigger a halt to fishing on the target species. Guided by the insights of local Indigenous peoples and using both fishery‐independent survey and commercial longline catch data, we investigated the effects of fishing depth and spatial restriction on the relative catch weights of these two species using spatiotemporal models. We find evidence that a confined fishing area can limit opportunities for avoiding choke species. Specifically, fishing at depths deeper than 175 m, which occur outside the court defined area (CDA), would provide more opportunities for catching halibut while avoiding Yelloweye Rockfish than are currently available within the CDA. This Indigenous‐informed, analytical approach to a management problem is just one example of how Western scientists can engage in coproduction of knowledge with Indigenous peoples to transition from the ‘status quo’ towards a practice of ‘Two‐Eyed Seeing’ that more effectively balances Indigenous rights and species conservation. Policy implications: Our study highlights (1) the importance of considering choke species distributions and opportunities for their avoidance when implementing spatial harvest restrictions and (2) how related analytical and management decisions can benefit from being guided by the advice of Indigenous knowledge holders. Read the free Plain Language Summary for this article on the Journal blog.

Research question: The aim of this paper is to examine the financial success of projects in game development industry in comparison with to projects in other industries hosted on crowdfunding platform Kickstarter.com. Motivation: We live in the world of technology where companies arise and disappear on daily basis. The traditional way of financing was expanded with alternative online platforms. Our goal was to conduct an empirical analysis of one crowdfunding platform (Kickstarter.com) in order to understand if technology projects are doing better than other projects. If they do, what are the key factors for their success? Idea: Our goal was to better understand how crowdfunding model supports small indie development projects and projects in other industries. Data: We used the data of 148.510 companies applied for crowdfunding financing between 2015 and 2020, published on the web crawler platform Web Robots. Tools: All statistical analyses were performed using statistical software IBM® SPSS® Statistics v.21. The data were presented using standard methods of non-parametric descriptive statistics (absolute and relative frequencies for medians and interquartile ranges for numeric outcomes). For testing of statistical significance of difference between two groups we used the Pearson´s Chi-Quadrat test and Mann-Whitney test, where appropriate. The effect size for the 2x2 analyses was estimated using Odds ratios. Findings: The paper analyses the financial success of gaming and not gaming projects and tries to identify key factors for successful funding. We found a statistically significant higher prevalence of successful financing in game development projects, with 2.3 times higher odds of successful funding compared to not-gaming industry. Our analysis of quantitative indicators such as the number of backers, goal amount, pledged amount, pledged amount per backer and pledged to goal ratio also showed that projects in game development statistically outperformed projects in other categories. Promising game projects were supported by three times more backers on average and attained almost as double funds as other projects, while still sporting more modest pledged amounts per backer. These findings support the notion of crowdfunding being a viable modality of financing independent game development in emerging economies. Contribution: This paper expands the existing research related to the crowdfunding platforms and indie development companies and formulates key factors for successful financing for technology startup firms.

Background: Diastasis recti abdominis (DRA) is a condition in pregnant and postpartum women. Proposed risk factors include age, sex, multiparity, cesarean delivery, diabetes, gestational weight gain, and high birth weight. This study aims to estimate the prevalence of DRA using medical claims data among U.S. active duty service women (ADSW) and determine associated risk factors. Materials and Methods: We conducted a cross-sectional study of ADSW aged 18 years and older in the U.S. Army, Air Force, Navy, and Marine Corps during fiscal years (FYs) 2016 to 2019. Utilizing claims data, we identified ADSW with a diagnosis of DRA during the study period. Risk factors, including age, race, socioeconomic status, branch of service, military occupation, delivery type, and parity, were evaluated through descriptive statistics, chi-square tests, and logistic regression analysis. Results: A total of 340,748 ADSW were identified during FYs 2016 to 2019, of whom 2,768 (0.81%) had a medical claim for DRA. Of those with deliveries during the study period, 1.41% were multiparous and 84.53% had a cesarean delivery. Increased risk of DRA was found in ages 30 to 39 years, Black women, ranks representing a higher socioeconomic status, and women with overweight and obese body mass indices. Conclusions: Although the prevalence of DRA, defined as a medical claim for DRA, in the study population is low, subpopulations may be disproportionately affected by the condition. Further research could potentially detail the impact of DRA on the functional impairment and operational readiness of ADSW in the U.S. military and any possible means of prevention.

Abstract Background Worldwide observations point to a two-stage theory of disease called Toxicant-Induced Loss of Tolerance (TILT): Stage I, Initiation by an acute high-level or repeated lower-level chemical exposures, followed by Stage II, Triggering of multisystem symptoms by previously tolerated, structurally diverse chemical inhalants, foods/food additives and drugs. Until recently, there was no known biological mechanism that could explain these observations. In 2021, we published a plausible and researchable two-stage biomechanism for TILT involving mast cells: Stage I, Initiation via mast cell sensitization; Stage II, Triggering of mast cell degranulation by previously tolerated exposures, resulting in the release of thousands of mediators, including histamine and a host of inflammatory molecules. The objective of this study was to identify common TILT initiators. Methods A randomized, population-based sample of 10,981 U.S. adults responded to a survey which included items concerning medical diagnoses, personal exposures, antibiotic use, and several possible initiators of Chemical Intolerance (CI). CI was assessed using the internationally validated Quick Environmental Exposure and Sensitivity Inventory (QEESI). Participants identified as chemically intolerant were asked to recall when their intolerances began and what they felt had initiated their condition. Results Twenty percent met QEESI criteria for TILT, approximately half of whom identified one or more initiating exposures. Initiators in order of frequency were mold (15.6%), pesticides (11.5%), remodeling/new construction (10.7%), medical/surgical procedures (11.3%), fires/combustion products (6.4%), and implants (1.6%). Protracted antibiotic use for infections involving the prostate, skin, tonsils, gastrointestinal tract, and sinuses were strongly associated with TILT/CI (OR > 2). Discussion Participants identified two broad classes of TILT initiators: 1) fossil fuel-derived toxicants (i.e., from coal, oil, natural gas), their combustion products, and/or synthetic organic chemical derivatives, e.g., pesticides, implants, drugs/antibiotics, volatile organic compounds (VOCs); and 2) biogenic toxicants, e.g., particles and VOCs from mold or algal blooms. One in four primary care patients suffers from Medically Unexplained Symptoms (MUS). Doctors in primary care, neurology, psychiatry, psychology, occupational medicine, and allergy/immunology would be well-advised to include TILT in their differential diagnosis of patients with so-called MUS. Because 20% of U.S. adults meet QEESI criteria for CI, the role of contemporary exposures in initiating and exacerbating these conditions via mast cells needs our immediate attention. There is a concomitant need for policies and practices that reduce initiating exposures as well as ubiquitous and often unavoidable triggers such as fragranced personal care, cleaning, and laundry products in multi-occupant housing, workplaces, medical settings, schools, places of worship, and all public buildings—literally anywhere air is shared. Fossil fuels are assaulting humans and other animal species both from within via mast cell sensitization, and from without via climate change.

Abstract Mother plants play an important role in the control of dormancy and dispersal characters of their progeny. In Arabidopsis seed dormancy is imposed by the embryo-surrounding tissues of the endosperm and seed coat. Here we show that VERNALIZATION5/VIN3-LIKE 3 (VEL3) maintains maternal control over progeny seed dormancy by establishing an epigenetic state in the central cell that primes the depth of primary seed dormancy later established during seed maturation. VEL3 colocalises with MSI1 in the nucleolus and associates with a histone deacetylase complex. Furthermore, VEL3 preferentially associates with pericentromeric chromatin and is required for deacetylation and H3K27me3 deposition established in the central cell. The epigenetic state established by maternal VEL3 is retained in mature seeds, and controls seed dormancy in part through repression of programmed cell death-associated gene ORE1. Our data demonstrates a mechanism by which maternal control of progeny seed physiology persists post-shedding, maintaining parental control of seed behaviour.

Abstract Background Management of adults with atrial fibrillation (AF) or atrial flutter in the emergency department (ED) includes rate reduction, cardioversion, and stroke prevention. Different approaches to these components of care may lead to variation in frequency of hospitalization and stroke prevention actions, with significant implications for patient experience, cost of care, and risk of complications. Standardization using evidence-based recommendations could reduce variation in management, preventable hospitalizations, and stroke risk. Methods We describe the rationale for our ED-based AF treatment recommendations. We also describe the development of an electronic clinical decision support system (CDSS) to deliver these recommendations to emergency physicians at the point of care. We implemented the CDSS at three pilot sites to assess feasibility and solicit user feedback. We will evaluate the impact of the CDSS on hospitalization and stroke prevention actions using a stepped-wedge cluster randomized pragmatic clinical trial across 13 community EDs in Northern California. Discussion We hypothesize that the CDSS intervention will reduce hospitalization of adults with isolated AF or atrial flutter presenting to the ED and increase anticoagulation prescription in eligible patients at the time of ED discharge and within 30 days. If our hypotheses are confirmed, the treatment protocol and CDSS could be recommended to other EDs to improve management of adults with AF or atrial flutter. Trial registration ClinicalTrials.gov NCT05009225 . Registered on 17 August 2021.

Goal: Current Space Medicine operations depend on terrestrial support to manage medical events. As astronauts travel to destinations such as the Moon, Mars, and beyond, distance will substantially limit this support and require increasing medical autonomy from the crew. This paper defines Earth Independent Medical Operations (EIMO) and identifies key elements of a conceptual EIMO system. Methods: The NASA Human Research Program Exploration Medical Capability Element held a 2-day conference at Johnson Space Center in Houston, TX with NASA experts representing all aspects of Space Medicine. Results: EIMO will be a process enabling progressively resilient deep space exploration systems and crews to reduce risk and increase mission success. Terrestrial assets will continue to provide pre-mission screening, planning, health maintenance, and prevention, while onboard medical care will increasingly be the purview of the crew. Conclusions: This paper defines and describes the key components of EIMO.

People who travel on ice-covered rivers to access traditional lands and resources can be profoundly impacted by effects of climate change on river ice seasonality. We used remote sensing, bolstered by citizen science, to assess trends and geospatial patterns of the ice cover in the Copper River Basin of Southcentral Alaska. Our analysis of Landsat imagery from water years (WYs) 1973 to 2021 suggests a severely diminishing season of river ice travel (delayed or incomplete freezeup, early breakup) due to increasing air temperatures. The weekly probability of an adequate ice cover for river crossings declined by an average of 53 percentage points. Ice extent was closely related to accumulated freezing degree days (AFDD). AFDDOct-Apr decreased by 15% since WY 1943, a significant warming trend. We mapped the spatiotemporal variation of ice and open water extent with multispectral and synthetic aperture radar (SAR) imagery (Sentinel-2, Sentinel-1). We identified reaches with more reliable opportunities for winter access and others susceptible to extensive open water, differences related to flow energy and channel form. The results of this study can support local decision making and adaptation in response to rapidly changing river ice conditions, and our approach can be applied elsewhere to document change and improve travel safety.

Systematic surveys of the distribution of epibenthic megafaunal species relative to one another and to environmental variables in the deep sea can lead to inferences and testable hypotheses regarding factors that influence their distributions. Here we use a seascape approach to provide insight into the character and spatial extent of the influence of a chemosynthetic seep on the distribution of epibenthic megafauna and the nature of transition zones (ecotones). Faunal distributions were determined from georeferenced images of the seabed collected during a systematic survey (~ 400 m x 400 m) by the Autonomous Underwater Vehicle Sentry in the vicinity of a newly discovered methane bubble plume on the Blake Ridge Diapir. The survey area was found to include both seep and non-seep habitats. The sphere of influence of seep productivity on the surrounding benthic megafaunal assemblage was limited—on the order of 10’s of meters—based on ecotone analysis. Small but detectable redox anomalies in the water column (5 m above bottom) in the study area occurred on a similar horizontal scale. Distributions of background megafaunal taxa were non-random for many morphotypes and included both positive and negative associations between morphotypes and the seep habitat. Subtle variations in depth (

Two primary ovarian hormones that fluctuate across the female menstrual cycle—estradiol and progesterone—have been independently linked in separate literatures to nicotine reinforcement and anxiety psychopathology. We identify existing methodological limitations in these literatures, describe an example protocol that was developed to address such limitations, highlight case examples, and offer insights on the resulting advantages and challenges. This protocol was an observational, prospective, within-subjects study of female cigarette smokers who were followed over the course of a complete menstrual cycle. Non-treatment seeking, female cigarette smokers (N = 50), between the ages of 18–40 who have a normal menstrual cycle (25–35 days in length) were recruited from the community. Females with anxiety or mood psychopathology represented 38.0% of the sample. Salivary progesterone and estradiol were assessed each morning via at-home saliva collection methods. Self-reported within-day momentary ratings of anxiety and nicotine reinforcement were collected using ecological momentary assessment (EMA) via a mobile app. Protocol compliance was >85%. Within- and between-subjects heterogeneity was observed in the progesterone and estradiol, anxiety, and nicotine craving measures, especially in the context of anxiety psychopathology. We aimed to integrate the anxiety and nicotine dependence literatures and advance the empirical study of the role of ovarian hormones. This protocol reflects an intensive, yet feasible approach to collecting daily-level naturalistic data related to estradiol, progesterone, anxiety, and nicotine reinforcement.

Background There is a need to develop electronic health record–based predictive models for worsening heart failure (WHF) events across clinical settings and across the spectrum of left ventricular ejection fraction (LVEF). Methods and Results We studied adults with heart failure (HF) from 2011 to 2019 within an integrated health care delivery system. WHF encounters were ascertained using natural language processing and structured data. We conducted boosted decision tree ensemble models to predict 1‐year hospitalizations, emergency department visits/observation stays, and outpatient encounters for WHF and all‐cause death within each LVEF category: HF with reduced ejection fraction (EF) (LVEF

OBJECTIVES/GOALS: Our aim is to establish soluble salivary biomarkers indicative of increased risk of oral premalignancy to be used in a point-of-service technology. Our goal is to non-invasively assess risk level for premalignancy by characterizing a molecular signature pattern that can be applied to such a diagnostic tool at routine dental or medical visits. METHODS/STUDY POPULATION: Adult patients 18 years of age and older who are non-smokers and patients of the University of Maryland School of Dentistry Oral Medicine Clinic and have been diagnosed with oral premalignancy (proliferative verrucous leukoplakia) are eligible. Exclusion criteria include history of immunosuppression or immune compromise; use of antifungal, antibiotic, and/or antiviral medications within the past three months; and gross dental disease. Serial unstimulated saliva samples will be collected at baseline or diagnosis of oral premalignancy, 6 months and 12 months. Solubility testing will be completed to determine whether malignant markers such as EGFR/mTOR/PI3K/p53 are soluble in saliva, and patient samples will be analyzed by ELISA and compared to appropriate controls. RESULTS/ANTICIPATED RESULTS: We anticipate demonstrating increased activity of molecular pathways known to be involved in malignant transformation, such as EGFR/mTOR/PI3K/p53, or increased burden of select microbial pathogens to be associated with increased risk of oral premalignancy in the form of proliferative verrucous leukoplakia. Preliminary sensitivity and specificity testing of the identified markers will provide additional insight to the utility of a diagnostic tool with salivary specimen. Therefore, the microbiome and/or molecular profile proposed from these results will serve as a translational application to development of future point-of-service test devices to be used in the prevention and detection of oral premalignant lesions. DISCUSSION/SIGNIFICANCE: Oral cancer is the sixth most common cancer worldwide, and presents challenges in its diagnosis and clinical management. Later diagnosis is associated with poorer patient outcomes—therefore, a molecular and microbiome profile that may be used in a noninvasive diagnostic test technology would prove beneficial to providers and patients.

This study introduces a new automated system that blends multi-satellite information and citizen science data for reliable and timely observations of lake and river ice in under-observed northern regions. The system leverages the Google Earth Engine resources to facilitate the analysis and visualization of ice conditions. The adopted approach utilizes a combination of moderate and high-resolution optical data, along with radar observations. The results demonstrate the system’s capability to accurately detect and monitor river ice, particularly during key periods, such as the freeze-up and the breakup. The integration citizen science data showed added values in the validation of remote sensing products, as well as filling gaps whenever satellite observations cannot be collected due to cloud obstruction. Moreover, it was shown that citizen science data can be converted to valuable quantitative information, such as the case of ice thickness, which is very useful when combined with ice extent derived from remote sensing. In this study, citizen science data were employed for the quantitative assessment of the remote sensing product. Obtained results showed a good agreement between the product and observed river status, with a Critical Success Index of 0.82. Notably, the system has shown effectiveness in capturing the spatial and temporal evolution of snow and ice conditions, as evidenced by its application in analyzing specific ice jam events in 2023. The study concludes that the developed system marks a significant advancement in river ice monitoring, combining technological innovation with community engagement.

El Centro Cultural Polinesio (PCC) es un lugar de turismo cultural dirigido por la Iglesia de Jesucristo de los Santos de los Últimos Días (LDS) como empresa para ganar dinero para apoyar a los estudiantes y programas de la Universidad Brigham Young-Hawai'i (BYU-H). Las actuaciones de música y danza polinesia son la pieza central definitiva de la experiencia del PCC, y los visitantes tienen repetidamente entretenimiento en directo en el parque. Estas presentaciones se pueden leer como textos performativos y aquí se someten a análisis semiótico y discursivo. La naturaleza inmersiva y repetitiva de los elementos de estas actuaciones (por ejemplo, vestuario, estilos musicales, cinésica, descripciones narrativas) están diseñadas para crear identidades musicales fáciles de entender para que los turistas lo asocien con cada cultura polinesia que se encuentren. Las identidades presentadas participan en estereotipos culturales bien conocidos derivados de los imaginarios coloniales y turísticos existentes para producir una experiencia que se comercializa a los turistas como oportunidad para conocer la Polinesia en un día. En este artículo, analizamos los cambios significativos que se han realizado recientemente en su espectáculo musical, basado en la canoa, de larga duración y muy popular, a través de un análisis comparativo de los imaginarios musicales plasmados en cada versión. Los cambios deliberados en los mensajes de identidad cultural documentados se consideran en el contexto de los cambios en curso en la formación de identidades étnicas de la diáspora polinesia, así como la historia de la LDS en el Pacífico. Defendemos que, en definitiva, el concurso de canoa revisado puede entenderse como una narrativa musical que empaqueta la relación colonial-misionera de la LDS con los polinesios en un imaginario musical no sólo para el consumo de los turistas, sino también de los propios intérpretes (miembros indígenas de la LDS).

Abstract As we contemplate the future of forest landscapes under changing climate conditions and land‐use demands, there is increasing value in studying historic forest conditions and how these landscapes have changed following past disturbances. Historic landscape paintings are a potential source of data on preindustrial forests with highly detailed, full‐color depictions of overstory and understory environments. They display key details about forest community composition, microhabitat features, and structural complexity from a time well before the advent of color photography. Despite these paintings' potential, their scientific applications have been impeded by questions of validity. How truly accurate are the images portrayed in these paintings? How much of an image is an artist's manipulation of a scene to best illustrate an allegory or romanticized view of nature? Following an established assessment model from historical ecology for evaluating resource validity, we demonstrate how scholarship on art history can be integrated with ecological understanding of forest landscapes to follow this model and address these questions of image veracity in 19th century American art. Further, to illustrate the potential use of these historic images in ecological studies, we present in a case study assessing microhabitat features of 10 different paintings. While this paper explores 19th century landscape art broadly, we focus our art historical review in particular on Asher Durand, a prolific and influential artist associated with the so‐called “Hudson River School” in the mid‐1800s. Durand left clear records about his perspectives on accurately depicting nature, and from a review of images and writings of Durand, we find support for the potential use of many of his paintings and sketches in historic forest ecology research. However, we also identify important caveats regarding potential ecological interpretations from these images. More broadly, because 19th century landscape paintings are not always directly transcriptive, and because regional art cultures differed in the 1800s, we cannot within this paper speak about landscape image veracity across all 19th century landscape art. However, in following established methods in historical ecology and integrating tools from art history research, we show that one can identify accurate historic landscape paintings for application in scientific studies.

Abstract Low‐efficacy mu‐opioid receptor (MOR) agonists represent promising therapeutics, but existing compounds (e.g., buprenorphine, nalbuphine) span a limited range of low MOR efficacies and have poor MOR selectivity. Accordingly, new and selective low‐efficacy MOR agonists are of interest. A novel set of chiral C9‐substituted phenylmorphans has been reported to display improved MOR selectivity and a range of high‐to‐low MOR efficacies under other conditions; however, a full opioid receptor binding profile for these drugs has not been described. Additionally, studies in mice will be useful for preclinical characterization of these novel compounds, but the pharmacology of these drugs in mice has also not been examined. Accordingly, the present study characterized the binding selectivity and in vitro efficacy of these compounds using assays of opioid receptor binding and ligand‐stimulated [35S]GTPɣS binding. Additionally, locomotor effects were evaluated as a first step for in vivo behavioral assessment in mice. The high‐efficacy MOR agonist and clinically effective antidepressant tianeptine was included as a comparator. In binding studies, all phenylmorphans showed improved MOR selectivity relative to existing lower‐efficacy MOR agonists. In the ligand‐stimulated [35S]GTPɣS binding assay, seven phenylmorphans had graded levels of sub‐buprenorphine MOR efficacy. In locomotor studies, the compounds again showed graded efficacy with a rapid onset and ≥1 h duration of effects, evidence for MOR mediation, and minor sex differences. Tianeptine functioned as a high‐efficacy MOR agonist. Overall, these in vitro and in vivo studies support the characterization of these compounds as MOR‐selective ligands with graded MOR efficacy and utility for further behavioral studies in mice.

Abstract Objectives Efficient and accurate emergency department (ED) triage is critical to prioritize the sickest patients and manage department flow. We explored the use of electronic health record data and advanced predictive analytics to improve triage performance. Methods Using a data set of over 5 million ED encounters of patients 18 years and older across 21 EDs from 2016 to 2020, we derived triage models using deep learning to predict 2 outcomes: hospitalization (primary outcome) and fast‐track eligibility (exploratory outcome), defined as ED discharge with

The Polynesian Cultural Center (PCC) is a cultural tourism site run by the Church of Jesus Christ of Latter-day Saints (LDS) as a money-making enterprise to support students and programs at Brigham Young University-Hawai’i (BYU-H). Polynesian music and dance performances are the definitive centerpiece of the PCC experience, and visitors are treated to live entertainment repeatedly throughout the park. These presentations can be read as performative texts and are here subjected to semiotic and discursive analysis. The immersive and repetitive nature of the elements of these performances (e.g., costumes, musical styles, kinesics, narrative descriptions) are designed to create easily understood musical identities for tourists to associate with each Polynesian culture encountered. The identities presented engage in well-worn cultural stereotypes derived from existing colonial and tourist imaginaries to produce an experience that is marketed to tourists as an opportunity to get to know Polynesia in one day. In this article, we analyze the significant changes recently made to their long-standing and highly popular canoe-based musical show through a comparative analysis of the musical imaginaries embodied in each version. The deliberate changes in cultural identity messaging documented are considered in the context of on-going shifts in Polynesian diasporic ethnic identity formation, as well as the history of the LDS in the Pacific. We argue that, ultimately, the revised canoe pageant can be understood as a musical narrative that packages the LDS’ colonial-missionizing relationship to Polynesians into a musical imaginary not just for consumption by tourists, but also by the performers (indigenous LDS members) themselves.

This case report describes a pharmacist’s intervention with a 58-year-old female who presented with recurrent rhinosinusitis symptoms and limited treatment options due to a complicated allergy history. Using guidelines for treatment of acute bacterial rhinosinusitis coupled with a thorough antibiotic allergy assessment, the pharmacist developed a treatment plan that was acceptable to both the patient and the provider. Pharmacists can play an essential role in verification of allergies to both medications and non-pharmaceutical products, which further ensures patient safety as well as optimization of appropriate treatment methods.

The JWST NIRSpec integral field unit (IFU) presents a unique opportunity to observe directly imaged exoplanets from 3 to 5 μ m at moderate spectral resolution ( R ∼ 2700) and thereby better constrain the composition, disequilibrium chemistry, and cloud properties of their atmospheres. In this work, we present the first NIRSpec IFU high-contrast observations of a substellar companion that requires starlight suppression techniques. We develop specific data-reduction strategies to study faint companions around bright stars and assess the performance of NIRSpec at high contrast. First, we demonstrate an approach to forward model the companion signal and the starlight directly in the detector images, which mitigates the effects of NIRSpec’s spatial undersampling. We demonstrate a sensitivity to planets that are 3 × 10 ^−6 fainter than their stars at 1″, or 3 × 10 ^−5 at 0.″3. Then, we implement a reference star point-spread function subtraction and a spectral extraction that does not require spatially and spectrally regularly sampled spectral cubes. This allows us to extract a moderate resolution ( R ∼ 2,700) spectrum of the faint T dwarf companion HD 19467 B from 2.9 to 5.2 μ m with a signal-to-noise ratio of ∼10 per resolution element. Across this wavelength range, HD 19467 B has a flux ratio varying between 10 ^−5 and 10 ^−4 and a separation relative to its star of 1.″6. A companion paper by Hoch et al. more deeply analyzes the atmospheric properties of this companion based on the extracted spectrum. Using the methods developed here, NIRSpec’s sensitivity may enable direct detection and spectral characterization of relatively old (∼1 Gyr), cool (∼250 K), and closely separated (∼3–5 au) exoplanets that are less massive than Jupiter.

We present the first spectroscopic characterization of the dayside atmosphere of WASP-17b in the mid-infrared using a single JWST MIRI/LRS eclipse observation. From forward-model fits to the 5–12 μ m emission spectrum, we tightly constrain the heat redistribution factor of WASP-17b to be 0.92 ± 0.02 at the pressures probed by this data, indicative of inefficient global heat redistribution. We also marginally detect a supersolar abundance of water, consistent with previous findings for WASP-17b, but note our weak constraints on this parameter. These results reflect the thermodynamically rich but chemically poor information content of MIRI/LRS emission data for high-temperature hot Jupiters. Using the eclipse mapping method, which utilizes the signals that the spatial emission profile of an exoplanet imprints on the eclipse light curve during ingress/egress due to its partial occultation by the host star, we also construct the first eclipse map of WASP-17b, allowing us to diagnose its multidimensional atmospheric dynamics for the first time. We find a day–night temperature contrast of order 1000 K at the pressures probed by this data, consistent with our derived heat redistribution factor, along with an eastward longitudinal hotspot offset of ${18.7}_{-3.8}^{+11.1\circ }$ , indicative of the presence of an equatorial jet induced by day–night thermal forcing being the dominant redistributor of heat from the substellar point. These dynamics are consistent with general circulation model predictions for WASP-17b. This work is part of a series of studies by the JWST Telescope Scientist Team, in which we use Guaranteed Time Observations to perform Deep Reconnaissance of Exoplanet Atmospheres through Multi-instrument Spectroscopy.

Introduction and aimsDietary Rational Gene Targeting (DRGT) is a therapeutic dietary strategy that uses healthy dietary agents to modulate the expression of disease-causing genes back toward the normal. Here we use the DRGT approach to (1) identify human studies assessing gene expression after ingestion of healthy dietary agents with an emphasis on whole foods, and (2) use this data to construct an online dietary guide app prototype toward eventually aiding patients, healthcare providers, community and researchers in treating and preventing numerous health conditions.MethodsWe used the keywords “human”, “gene expression” and separately, 51 different dietary agents with reported health benefits to search GEO, PubMed, Google Scholar, Clinical trials, Cochrane library, and EMBL-EBI databases for related studies. Studies meeting qualifying criteria were assessed for gene modulations. The R-Shiny platform was utilized to construct an interactive app called “Eat4Genes”.ResultsFifty-one human ingestion studies (37 whole food related) and 96 key risk genes were identified. Human gene expression studies were found for 18 of 41 searched whole foods or extracts. App construction included the option to select either specific conditions/diseases or genes followed by food guide suggestions, key target genes, data sources and links, dietary suggestion rankings, bar chart or bubble chart visualization, optional full report, and nutrient categories. We also present user scenarios from physician and researcher perspectives.ConclusionIn conclusion, an interactive dietary guide app prototype has been constructed as a first step towards eventually translating our DRGT strategy into an innovative, low-cost, healthy, and readily translatable public resource to improve health.

IntroductionCultural factors are constructs that capture important life experiences of Latinx/Hispanic individuals, families, and communities. Despite their importance for Latinx communities, Latinx cultural factors have yet to be fully incorporated into the literature of many social, behavioral science, and health service fields, including implementation science. This significant gap in the literature has limited in-depth assessments and a more complete understanding of the cultural life experiences of diverse Latinx community residents. This gap has also stifled the cultural adaptation, dissemination, and implementation of evidence based interventions (EBIs). Addressing this gap can inform the design, dissemination, adoption, implementation, and sustainability of EBIs developed to serve Latinx and other ethnocultural groups.MethodsBased on a prior Framework Synthesis systematic review of Latinx stress-coping research for the years 2000–2020, our research team conducted a thematic analysis to identify salient Latinx cultural factors in this research field. This thematic analysis examined the Discussion sections of 60 quality empirical journal articles previously included into this prior Framework Synthesis literature review. In Part 1, our team conducted an exploratory analysis of potential Latinx cultural factors mentioned in these Discussion sections. In Part 2 we conducted a confirmatory analysis using NVivo 12 for a rigorous confirmatory thematic analysis.ResultsThis procedure identified 13 salient Latinx cultural factors mentioned frequently in quality empirical research within the field of Latinx stress-coping research during the years 2000–2020.DiscussionWe defined and examined how these salient Latinx cultural factors can be incorporated into intervention implementation strategies and can be expanded to facilitate EBI implementation within diverse Latinx community settings.

BACKGROUND Chronic kidney disease (CKD) is characterized by chronic overactivation of the sympathetic nervous system (SNS), which increases the risk of cardiovascular (CV) disease and mortality. SNS overactivity increases CV risk by multiple mechanisms, including vascular stiffness. We tested the hypothesis that aerobic exercise training would reduce resting SNS activity and vascular stiffness in patients with CKD.METHODS In this randomized controlled trial, sedentary older adults with CKD underwent 12 weeks of exercise (cycling, n = 32) or stretching (an active control group, n = 26). Exercise and stretching interventions were performed 20–45 minutes/session at 3 days/week and were matched for duration. Primary endpoints include resting muscle sympathetic nerve activity (MSNA) via microneurography, arterial stiffness by central pulse wave velocity (PWV), and aortic wave reflection by augmentation index (AIx).RESULTS There was a significant group × time interaction in MSNA and AIx with no change in the exercise group but with an increase in the stretching group after 12 weeks. The magnitude of change in MSNA was inversely associated with baseline MSNA in the exercise group. There was no change in PWV in either group over the study period.CONCLUSION Our data demonstrate that 12 weeks of cycling exercise has beneficial neurovascular effects in patients with CKD. Specifically, exercise training safely and effectively ameliorated the increase in MSNA and AIx observed over time in the control group. This sympathoinhibitory effect of exercise training showed greater magnitude in patients with CKD with higher resting MSNA.TRIAL REGISTRATION ClinicalTrials.gov, NCT02947750.FUNDING NIH R01HL135183; NIH R61AT10457; NIH NCATS KL2TR002381; and NIH T32 DK00756; NIH F32HL147547; and VA Merit I01CX001065.

Amaranthus retroflexus L. and Chenopodium album L. (Amaranthaceae) are weedy plants that cause severe ecological and economic damage. In this study, we collected DNA from three different countries and assessed genetic diversity using inter-simple sequence repeat (ISSR) markers. Our analysis shows both weed species have low genetic diversity within a population and high genetic diversity among populations, as well as a low value of gene flow among the populations. UPGMA clustering and principal coordinate analysis indicate four distinct groups for A. retroflexus L. and C. album L. exist. We detected significant isolation-by-distance for A. retroflexus L. and no significant correlation for C.album L. These conclusions are based data from 13 ISSR primers where the average percentage of polymorphism produced was 98.46% for A. retroflexus L. and 74.81% for C. album L.These data suggest that each population was independently introduced to the location from which it was sampled and these noxious weeds come armed with considerable genetic variability giving them the opportunity to manifest myriad traits that could be used to avoid management practices. Our results, albeit not definitive about this issue, do not support the native status of C. album L. in Iran.

Clouds are prevalent in many of the exoplanet atmospheres that have been observed to date. For transiting exoplanets, we know if clouds are present because they mute spectral features and cause wavelength-dependent scattering. While the exact composition of these clouds is largely unknown, this information is vital to understanding the chemistry and energy budget of planetary atmospheres. In this work, we observe one transit of the hot Jupiter WASP-17b with JWST’s Mid-Infrared Instrument Low Resolution Spectrometer and generate a transmission spectrum from 5 to 12 μ m. These wavelengths allow us to probe absorption due to the vibrational modes of various predicted cloud species. Our transmission spectrum shows additional opacity centered at 8.6 μ m, and detailed atmospheric modeling and retrievals identify this feature as SiO _2 (s) (quartz) clouds. The SiO _2 (s) clouds model is preferred at 3.5–4.2 σ versus a cloud-free model and at 2.6 σ versus a generic aerosol prescription. We find the SiO _2 (s) clouds are composed of small ∼0.01 μ m particles, which extend to high altitudes in the atmosphere. The atmosphere also shows a depletion of H _2 O, a finding consistent with the formation of high-temperature aerosols from oxygen-rich species. This work is part of a series of studies by our JWST Telescope Scientist Team (JWST-TST), in which we will use Guaranteed Time Observations to perform Deep Reconnaissance of Exoplanet Atmospheres through Multi-instrument Spectroscopy (DREAMS).

The development of religious extremism in Indonesia continues to increase every year so that serious attention is needed by the government to deal with religious extremism in Indonesia. Indonesia is an archipelagic country where there are various ethnic groups and religions that coexist. However, the development of religious extremism sometimes becomes a serious problem for the Indonesian people because it can have a negative impact and damage the unity between nations and religions. This research uses literature study. This research method is carried out by reviewing various literatures, both books, newspapers, survey reports, academic journals related to religious extremism in Indonesia. The results show that not all religious extremism has an impact on the emergence of terrorism, but the government still must make the right policies in handling religious extremism that can cause division and affect peoples welfare. The policies that have been made by the government are considered appropriate and based on the laws that have been set by the government so that they can have a positive impact in maintaining the unity and integrity of the Indonesian nation.

Abstract Aims This study aimed to assess short‐term outcomes among emergency department (ED) patients with acute heart failure (AHF) by preserved (≥50%) vs. reduced (

Background: Despite the rising prevalence of infertility, studies have indicated that in the United States fertility awareness remains low. No published study to date, however, has investigated the impact of any racial or ethnic disparities in fertility awareness. Materials and Methods: We conducted a cross-sectional survey of people self-identifying as female, aged 18?45 years, via Amazon Mechanical Turk in August 2020. The study was approved by the institutional review board at the University of Colorado. The survey consisted of demographic questions and a validated questionnaire, the Fertility and Infertility Treatment Knowledge Score (FIT-KS). Participants were classified as non-Hispanic White (NHW) or ?Minority? race/ethnicity. Results: A total of 476 women completed the survey, 405 of which were included in analysis. Of those, 54.6% self-identified as NHW and 45.4% were in the Minority group. The median FIT-KS was 51.7% (16 items answered correctly). The Minority group scored significantly lower than the NHW participants overall (58.6% vs. 48.3%, p?0.001) and in all three subscales (p?

The 5-(3-hydroxy)phenylmorphan structural class of compounds are unlike the classical morphinans, 4,5-epoxymorphinans, and 6,7-benzomorphans, in that they have an equatorially oriented aromatic ring rather than the axial orientation of that ring found in the classical opioids. This modified and simplified opioid-like structure has been shown to retain antinociceptive activity, depending on its stereochemistry and substituents, and some of them have been found to be much more potent than morphine. A simple C9-hydroxy-5-(3-hydroxy)phenylmorphan enantiomer was found to be about 500 times more potent than morphine in vivo. We have previously examined C9-alkenyl and hydroxyalkyl substituents in the N-phenethyl-5-(3-hydroxy)phenylmorphan class of compounds. Comparable C9-alkyl (methyl through butyl) substituents, with their sets of diastereomers, have not been explored. All these compounds have now been synthesized to determine the effect chain-length and stereochemistry at the C9 position in the molecule might have on their interaction with opioid receptors. We now report the synthesis and in vitro activity of 16 compounds, the C9-methyl, ethyl, propyl, and butyl diastereomers, using the inhibition of forskolin-induced cAMP accumulation assay. Several potent (sub-nanomolar and nanomolar) MOR compounds were found to be selective agonists with varying efficacy. Of greatest interest, a selective MOR antagonist was discovered; it did not display any DOR or KOR agonist activity in vitro, was three times more potent than naltrexone, and was found to antagonize the EC90 of fentanyl at MOR to a greater extent than naltrexone.

How has the youth climate movement in the US grown since the Climate Strikes began and in what ways did it change as it grew? This article takes advantage of a unique dataset that includes surveys from activists who organized the nationally coordinated climate strikes in the US that began with Fridays for Future in spring 2019. Building on the research on alliance building and strategic coalitions, this article analyzes how the patterns of participation changed over the period of the study. We employ social network analysis to map the affiliation networks among the organizers of these events to assess the coalitions of groups involved and the shifting organizational landscape. Our analysis does not provide evidence that groups spanned the boundaries across movements, nor does it show that identity plays a role in coalition building in this movement. Instead, by mapping out the coalition of organizations within this movement and how connections among them change over time, we see clear evidence that this youth-led movement was reoriented by adult-led organizations. Our article concludes by considering how these findings suggest the future trajectory of the youth climate movement and its role in a ‘new climate politics’ in America.

Abstract Native salmonid fishes—cutthroat trout (Oncorhynchus clarkii) and steelhead/rainbow trout (Oncorhynchus mykiss)—are ecologically, culturally, and economically important species distributed across western North America. These fish are generally considered “cold‐water” adapted species. As such, recent studies have speculated about the potential effects of climate change on these native salmonids if stream temperature thresholds exceed 16–20°C during the summer. However, the magnitude of stream thermal responses to the slow but steady increases in regional temperatures associated with climate change remains uncertain and hard to predict. Comparatively, abrupt disturbances, such as wildfire, may produce almost instantaneous and substantial increases in stream temperatures that may persist for multiple years until near‐stream vegetation becomes re‐established. In the first summer following a severe wildfire in western Oregon, we observed the initial persistence of populations of O. clarkii clarkii (coastal cutthroat trout) and O. mykiss (rainbow/steelhead trout). The fire burned the entire catchment, including the riparian area (~76% of the watershed area burned at moderate or high severity), resulting in stream temperature that regularly exceeded 20°C and represented increases of 6–7°C relative to prefire conditions. However, the mechanisms enabling the persistence of cold‐water fishes despite the dramatic increases in stream temperature remain unclear and require further investigation. Nevertheless, wildfires represent acute natural disturbances that can substantially alter stream thermal regimes and provide unique insights that allow us to better understand how native fishes in natural systems cope with projected increases in stream temperatures.

Reduced fertility associated with normal aging may reflect the over-maturity of oocytes. It is increasingly important to reduce aging-induced infertility since recent trends show people marrying at later ages. 2,3,5,4′-Tetrahydroxystilbene-2-O-β-D-glucoside (THSG), a polyphenol extracted from Polygonum multiflorum, has been reported to have anti-inflammatory and anti-aging properties. To evaluate whether THSG can reduce aging-related ovarian damage in a female mouse model of aging, THSG was administered by gavage at a dose of 10 mg/kg twice weekly, starting at 4 weeks of age in a group of young mice. In addition, the effect of THSG in a group of aged mice was also studied in mice starting at 24 weeks of age. The number of oocytes in the THSG-fed group was higher than in the untreated control group. Although the percentage of secondary polar bodies (PB2) decreased during aging in the THSG-fed group, it decreased much more slowly than in the age-matched control group. THSG administration increased the quality of ovaries in young mice becoming aged. Western blotting analyses also indicated that CYP19, PR-B, and ER-β expressions were significantly increased in 36-week-old mice. THSG also increased oocyte numbers in aged mice compared to mice without THSG fed. Studies of qPCR and immunohistochemistry (IHC) analyses of ovaries in the aged mice groups were conducted. THSG increased gene expression of anti-Müllerian hormone (AMH), a biomarker of oocyte number, and protein accumulation in 40-week-old mice. THSG increased the expression of pgc1α and atp6, mitochondrial biogenesis-related genes, and their protein expression. THSG also attenuated the fading rate of CYP11a and CYP19 associated with sex hormone synthesis. And THSG maintains a high level of ER-β expression, thereby enhancing the sensitivity of estrogen. Our findings indicated that THSG increased or extended gene expression involved in ovarian maintenance and rejuvenation in young and aged mice. On the other hand, THSG treatments significantly maintained oocyte quantity and quality in both groups of young and aged mice compared to each age-matched control group. In conclusion, THSG can delay aging-related menopause, and the antioxidant properties of THSG may make it suitable for preventing aging-induced infertility.

Background: Preterm birth continues to be a major public health challenge that has long term consequences on participation into adulthood. However, little is known about effective interventions to improve the participation of children born preterm. Methods: This study gathered initial evidence on the usefulness of a goal-focused, environmental-based approach (Pathways and Resources for Engagement and Participation (PREP)) in improving the participation of children born preterm, and living in Ireland. Three school-age boys (6–7 years old) with a history of preterm birth participated in the 12-week PREP intervention. A 36-week single-subject AB design was employed and replicated across 3 different participation goals within each child and across 3 children. Activity performance was measured repeatedly, through parental involvement, using the Canadian Occupational Performance Measure (COPM), providing 9 individual outcome trajectories. Visual inspection and mixed-effects segmented regression were used. Results: Goals were selected from various participation domains and settings. Throughout the baseline phase, once goals were set, significant improvements in activity performance were observed for all participants (t = 14.06, p

ObjectiveTo examine rates of postpartum hemorrhagic (PPH) morbidity among patients who did and did not have immediate skin-to-skin contact (SSC).MethodsThis study was a retrospective cohort of all non-anomalous, term singleton vaginal births at a Level IV center over 2 years. Exclusion criteria included COVID-19. Immediate SSC was defined as at least 60 min of direct contact initiated between parturient and neonate within 10 min of birth. The primary outcome was a composite of maternal morbidity related to PPH compared among those with and without immediate SSC. We used multivariable Poisson regression adjusted for possible confounders with robust error variance to determine the strength of the association.ResultsOf 8623 deliveries during the study period, 3520 (40.8%) deliveries were included; of which 2428 (55.5%) had immediate SSC and 1028 (31.0%) did not. Immediate SSC reduced the overall rate of composite morbidity (adjusted relative risk 0.78, 95% confidence interval 0.65-0.92), and rate of blood loss 1000 mL or greater, use of additional uterotonics, and use of mechanical tamponade. Blood loss and third stage of labor duration were significantly less for immediate SSC. Transfusion rate and hematocrit change after delivery, did not differ.ConclusionImmediate SSC among term vaginal deliveries was associated with a significant reduction in PPH. Emphasis on early contact for maternal benefit may increase uptake of SSC and provide an accessible intervention for PPH in high- and low-resource settings.