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Abstract Age-related decline in mobility and cognition are associated with cellular senescence and NAD + depletion in dogs and people. A combination of a novel NAD + precursor and senolytic, LY-D6/2, was examined in this randomized controlled trial. Seventy dogs with mild to moderate cognitive impairment were enrolled and allocated into placebo, low or full dose groups. Primary outcomes were change in cognitive impairment measured with the owner-reported Canine Cognitive Dysfunction Rating (CCDR) scale and change in activity measured with physical activity monitors. Fifty-nine dogs completed evaluations at the 3-month primary endpoint, and 51 reached the 6-month secondary endpoint. There was a significant difference in CCDR score across treatment groups from baseline to the primary endpoint (p = 0.02) with the largest decrease in the full dose group. No difference was detected between groups using in house cognitive testing. There were no significant differences between groups in changes in measured activity. The proportion of dogs that improved in frailty and owner-reported activity levels and happiness was higher in the full dose group than other groups, however this difference was not significant. Adverse events occurred equally across groups. All groups showed improvement in cognition, frailty, and activity suggesting placebo effect and benefits of trial participation. We conclude that LY-D6/2 improves owner-assessed cognitive function over a 3-month period and may have broader, but more subtle effects on frailty, activity and happiness as reported by owners.

Background:. To effectively counsel patients prior to shoulder arthroplasty, surgeons should understand the overall life trajectory and life expectancy of patients in the context of the patient’s shoulder pathology and medical comorbidities. Such an understanding can influence both operative and nonoperative decision-making and implant choices. This study evaluated 5-year mortality following shoulder arthroplasty in patients ≥65 years old and identified associated risk factors. Methods:. We utilized Centers for Medicare & Medicaid Services Fee-for-Service inpatient and outpatient claims data to investigate the 5-year mortality rate following shoulder arthroplasty procedures performed from 2014 to 2016. The impact of patient demographics, including fracture diagnosis, year fixed effects, and state fixed effects; patient comorbidities; and hospital-level characteristics on 5-year mortality rates were assessed with use of a Cox proportional hazards regression model. A p value of

Abstract Changes in health insurance coverage may disrupt access to and continuity of care, even for those who remain insured. Continuity of care is especially important in schizophrenia, which requires ongoing medical and pharmaceutical treatment. However, little is known about continuity of insurance coverage among those with schizophrenia. The objective was to examine the probability of insurance transitions for individuals with schizophrenia who were continuously insured and whether this varied across insurance types. The Massachusetts All-Payer Claims Database identified individuals with schizophrenia aged 18–64 who were continuously insured during a two-year period between 2014 and 2018. A logistic regression estimated the association of having an insurance transition – defined as having a change in insurance type – with insurance type at the start of the period, adjusting for age, sex, ZIP code in the lowest quartile of median income, and ZIP code with concentrated poverty. Overall, 15.1% had at least one insurance transition across a 24-month period. Insurance transitions were most frequent among those with plans from the Marketplace. In regression adjusted results, individuals covered by the traditional Medicaid program were 20.2 percentage points [pp] (95% confidence interval [CI]: 24.6 pp, 15.9 pp) less likely to have an insurance transition than those who were insured by a Marketplace plan. Insurance transitions among individuals with schizophrenia were common, with more than one in six people having at least one transition in insurance type during a two-year period. Given that even continuously insured individuals with schizophrenia commonly experience insurance transitions, attention to insurance transitions as a barrier to care access and continuity is warranted.

Background Medications for opioid use disorder (MOUD) are the gold standard. However, significant barriers limit their use in the primary care setting, including limited knowledge of the medications and stigmatizing attitudes. In this study, we assess knowledge levels among primary care-aligned professionals (PCPs) currently in practice, and whether knowledge of MOUD is associated with stigma and treatment attitudes.Participants and methods Using rosters from the state of Ohio licensing boards, we surveyed 403 physicians, nurse practitioners, and physician associates in 2022, on the mechanism of different MOUD, as well as stigma and treatment attitudes. To assess MOUD knowledge, we employed descriptive and bivariate statistics. We fit four linear regression models, which controlled for empathy towards patients with OUD and provider demographics to assess the relationship between MOUD knowledge and four endpoints: stigma, perceived controllability of opioid use, perceived vulnerability to opioid use disorder, and support for abstinence-only treatment.Results 43% of participants correctly identified the mechanism of all 3 medications whereas 13% of participants did not identify the mechanism of any MOUD correctly. MOUD knowledge was higher among physicians as compared to nurse practitioners and physician associates. Lower MOUD knowledge was associated with more negative attitudes towards patients with OUD and MOUD treatment.Conclusion Expanding access to MOUD treatment requires a trained and willing health-care professional (HCP) workforce. Our findings highlight considerable variation in clinician knowledge of MOUD and suggest that knowledge levels are also related to negative attitudes towards patients with OUD and MOUD. Training interventions that increase knowledge, as well as focus on stigma reduction, are critical for reducing the longstanding treatment gap for opioid use disorder.

Abstract Background Buprenorphine is a highly effective medication for opioid use disorder that is underused by health care professionals (HCPs). Medications for opioid use disorder (MOUD) misinformation may be an important barrier to buprenorphine access, but most implementation strategies have aimed to reduce negative attitudes towards patients with opioid use disorder (OUD) rather than misinformation specific to buprenorphine use. In this study, we assessed the degree to which HCPs endorsed misinformation related to buprenorphine, and whether this is associated with willingness to provide care to patients with OUD. Methods In September-December of 2022, we surveyed HCPs practicing in Ohio (n = 409). Our primary outcomes included a previously validated 5-item measure of HCP willingness to treat patients with OUD, and three other measures of willingness. Our key independent variable was a study-developed 5-item measure of endorsement of misinformation related to buprenorphine, which assessed beliefs in buprenorphine’s efficacy in managing withdrawal symptoms and reducing overdose deaths as well as beliefs about the role of buprenorphine in achieving remission. We computed descriptive and bivariable statistics and fit regression models predicting each outcome of interest. Results On average, HCPs scored 2.34 out of 5.00 (SD = 0.80) on the composite measure of buprenorphine misinformation. 48.41% of participants endorsed at least one piece of misinformation. The most endorsed items were that buprenorphine is ineffective at reducing overdose deaths (M = 2.75, SD =0 .98), and that its use substitutes one drug for another (M = 2.41, SD = 1.25). HCP endorsement of buprenorphine misinformation significantly and negatively predicted willingness to work with patients with OUD (b = − 0.34; 95% CI − 0.46, − 0.21); intentions to increase time spent with this patient population (b = − 0.36; 95% CI − 5.86, − 1.28); receipt of an X-waiver (OR = 0.54, 95% CI 0.38, 0.77); and intention to get an X-waiver (OR: 0.56; 95% CI: 0.33−0.94). Conclusions Misinformation is common among HCPs and associated with lower willingness to treat patients with OUD. Implementation strategies to increase MOUD use among HCPs should specifically counter misinformation related to buprenorphine. Clinical Trial Registration: Clinicaltrials.gov, NCT05505227. Registered 17 August 2022, https://clinicaltrials.gov/ct2/show/NCT05505227

Abstract Background Medications for opioid use disorder (OUD) are effective at preventing overdose and infectious disease but are vastly under-prescribed in the US. For decades, prescribers faced additional training and regulation to prescribe buprenorphine which stigmatized the medication and lessened support for a harm reduction approach to treating opioid use disorder. The Drug Enforcement Administration removed the X-waiver requirement for prescribing buprenorphine in late 2022, which removed stigma and lessened important barriers to prescribing but also left training at the discretion of individual organizations. Our study aimed to assess differences in knowledge, confidence, and stigma regarding buprenorphine between those who went through the X-waiver training and those who did not, among practicing primary care providers (PCPs). Methods We assessed buprenorphine prescribing readiness among primary care aligned outpatient providers in Ohio, USA. Using survey data, we conducted bivariate and regression analyses predicting primary prescribing outcomes. Primary outcomes measured knowledge of and confidence in buprenorphine, as well as perceived adequacy of one’s training. Secondary outcomes were attitudes toward patients with OUD, including bias toward OUD patients, stress when working with them, and empathy toward them. Participants (n = 403) included physicians, nurse practitioners, and physician assistants practicing in primary care aligned disciplines. Results Survey data showed that PCPs who received X-waiver training were more likely to understand and have confidence in the mechanism of buprenorphine, and consider their training on treating OUD to be adequate. PCPs with an X-waiver showed more empathy, less negative bias, and experienced less stress when working with patients with OUD. Conclusion Removing restrictive policies for prescribing buprenorphine is an important step to expanding access and reducing the stigma associated with opioid use disorder treatment. Yet, our findings suggest that the training received alongside regulation may be important for improving prescribing confidence and reducing stigma. Strategies to increase buprenorphine prescribing are unlikely to be effective without also expanding access to prescribing support for primary care providers across the career course.

The Antarctic Ice Sheet represents the largest source of uncertainty in future sea level rise projections, with a contribution to sea level by 2100 ranging from −5 to 43 cm of sea level equivalent under high carbon emission scenarios estimated by the recent Ice Sheet Model Intercomparison for CMIP6 (ISMIP6). ISMIP6 highlighted the different behaviors of the East and West Antarctic ice sheets, as well as the possible role of increased surface mass balance in offsetting the dynamic ice loss in response to changing oceanic conditions in ice shelf cavities. However, the detailed contribution of individual glaciers, as well as the partitioning of uncertainty associated with this ensemble, have not yet been investigated. Here, we analyze the ISMIP6 results for high carbon emission scenarios, focusing on key glaciers around the Antarctic Ice Sheet, and we quantify their projected dynamic mass loss, defined here as mass loss through increased ice discharge into the ocean in response to changing oceanic conditions. We highlight glaciers contributing the most to sea level rise, as well as their vulnerability to changes in oceanic conditions. We then investigate the different sources of uncertainty and their relative role in projections, for the entire continent and for key individual glaciers. We show that, in addition to Thwaites and Pine Island glaciers in West Antarctica, Totten and Moscow University glaciers in East Antarctica present comparable future dynamic mass loss and high sensitivity to ice shelf basal melt. The overall uncertainty in additional dynamic mass loss in response to changing oceanic conditions, compared to a scenario with constant oceanic conditions, is dominated by the choice of ice sheet model, accounting for 52 % of the total uncertainty of the Antarctic dynamic mass loss in 2100. Its relative role for the most dynamic glaciers varies between 14 % for MacAyeal and Whillans ice streams and 56 % for Pine Island Glacier at the end of the century. The uncertainty associated with the choice of climate model increases over time and reaches 13 % of the uncertainty by 2100 for the Antarctic Ice Sheet but varies between 4 % for Thwaites Glacier and 53 % for Whillans Ice Stream. The uncertainty associated with the ice–climate interaction, which captures different treatments of oceanic forcings such as the choice of melt parameterization, its calibration, and simulated ice shelf geometries, accounts for 22 % of the uncertainty at the ice sheet scale but reaches 36 % and 39 % for Institute Ice Stream and Thwaites Glacier, respectively, by 2100. Overall, this study helps inform future research by highlighting the sectors of the ice sheet most vulnerable to oceanic warming over the 21st century and by quantifying the main sources of uncertainty.

The signature feature of all plant viruses is the encoding of movement proteins (MPs) that supports the movement of the viral genome into adjacent cells and through the vascular system. The recent discovery of umbravirus-like viruses (ULVs), some of which only encode replication-associated proteins, suggested that they, as with umbraviruses that lack encoded capsid proteins (CPs) and silencing suppressors, would require association with a helper virus to complete an infection cycle. We examined the infection properties of 2 ULVs: citrus yellow vein associated virus 1 (CY1), which only encodes replication proteins, and closely related CY2 from hemp, which encodes an additional protein (ORF5CY2) that was assumed to be an MP. We report that both CY1 and CY2 can independently infect the model plant Nicotiana benthamiana in a phloem-limited fashion when delivered by agroinfiltration. Unlike encoded MPs, ORF5CY2 was dispensable for infection of CY2, but was associated with faster symptom development. Examination of ORF5CY2 revealed features more similar to luteoviruses/poleroviruses/sobemovirus CPs than to 30K class MPs, which all share a similar single jelly-roll domain. In addition, only CY2-infected plants contained virus-like particles (VLPs) associated with CY2 RNA and ORF5CY2. CY1 RNA and a defective (D)-RNA that arises during infection interacted with host protein phloem protein 2 (PP2) in vitro and in vivo, and formed a high molecular weight complex with sap proteins in vitro that was partially resistant to RNase treatment. When CY1 was used as a virus-induced gene silencing (VIGS) vector to target PP2 transcripts, CY1 accumulation was reduced in systemic leaves, supporting the usage of PP2 for systemic movement. ULVs are therefore the first plant viruses encoding replication and CPs but no MPs, and whose systemic movement relies on a host MP. This explains the lack of discernable helper viruses in many ULV-infected plants and evokes comparisons with the initial viruses transferred into plants that must have similarly required host proteins for movement.

Abstract Background“Lock to Live” (L2L) is a novel web-based decision aid for helping people at risk of suicide reduce access to firearms. Researchers have demonstrated that L2L is feasible to use and acceptable to patients, but little is known about how to implement L2L during web-based mental health care and in-person contact with clinicians. ObjectiveThe goal of this project was to support the implementation and evaluation of L2L during routine primary care and mental health specialty web-based and in-person encounters. MethodsThe L2L implementation and evaluation took place at Kaiser Permanente Washington (KPWA)—a large, regional, nonprofit health care system. Three dimensions from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) model—ReachAdoptionImplementation ResultsThe initial implementation consisted of updates for clinicians to add a URL and QR code referencing L2L to the safety planning EHR templates. Recommendations about introducing L2L were subsequently derived from the thematic analysis of semistructured interviews with patients (n=36), which included (1) “have an open conversation,” (2) “validate their situation,” (3) “share what to expect,” (4) “make it accessible and memorable,” and (5) “walk through the tool.” Clinicians’ interviews (n=30) showed a strong preference to have L2L included by default in the EHR-based safety planning template (in contrast to adding it manually). During the 2-year observation period, 2739 patients reported prior-month suicide attempt planning or intent and had a documented safety plan during the study period, including 745 (27.2%) who also received L2L. Over four 6-month subperiods of the observation period, L2L adoption rates increased substantially from 2% to 29% among primary care clinicians and from

Background: Timed chair rise tests are frequently used as a substitute for assessing leg muscle strength or power. To determine if timed chair rise tests are an indicator of lower extremity muscle power, we examined the relationship between the repetitions completed in a 30-s chair rise test and the power generated during the test.Methods: Seventy-five individuals participated in this study (n = 30 < 65 years and 45 ≥ 65 years). Participants underwent a 30-s chair rise test while instrumented with a power analyzer. Handgrip strength was also evaluated.Results: The relationship between chair rise repetitions and average chair rise power was R2 = 0.32 (p < 0.001). Chair rise repetitions when regressed on a total (i.e., summed) chair rise power, it yielded R2 = 0.70 with data from all participants combined (p < 0.001). A mediation analysis indicated that anthropometrics partially mediates the relationship between chair rise repetitions and total chair rise power accounting for 2.8%–6.9% of the variance.Conclusion: Our findings indicate that in older adults, the overall performance of chair rises offers limited information about the average power per rise but is more indicative of the cumulative power exerted. Thus, the total number of chair rises in a 30-s test is likely a more comprehensive metric of overall muscular power, reflecting endurance aspects as well. Additionally, we found that personal physical attributes, such as height and weight, partially influence the link between chair rise count and total power, highlighting the importance of factoring in individual body metrics in assessments of muscular performance.

Abstract Disturbances in the sleep–wake cycle are a debilitating, yet rather common condition not only in humans, but also in family dogs. While there is an emerging need for easy-to-use tools to document sleep alterations (in order to ultimately treat and/or prevent them), the veterinary tools which yield objective data (e.g. polysomnography, activity monitors) are both labor intensive and expensive. In this study, we developed a modified version of a previously used sleep questionnaire (SNoRE) and determined criterion validity in companion dogs against polysomnography and physical activity monitors (PAMs). Since a negative correlation between sleep time and cognitive performance in senior dogs has been demonstrated, we evaluated the correlation between the SNoRE scores and the Canine Dementia Scale (CADES, which includes a factor concerning sleep). There was a significant correlation between SNoRE 3.0 questionnaire scores and polysomnography data (latency to NREM sleep, ρ = 0.507, p

Taiwan, home to over 580,000 Indigenous people in 16 state‐recognized groups, is one of three Asian countries to recognize the existence of Indigenous peoples in its jurisdiction. Taiwan’s Indigenous peoples remember their pre‐colonial lives as autonomous nations living according to their own laws and political institutions, asserting that they have never ceded territory or sovereignty to any state. As Taiwan democratized, the state dealt with resurgent Indigenous demands for political autonomy through legal indigeneity, including inclusion in the Constitution since 1997 and subsequent legislation. Yet, in an examination of two court rulings, we find that liberal indigeneity protects individuals, while consistently undermining Indigenous sovereignty. In 2021, the Constitutional Court upheld restrictive laws against hunting, seeking to balance wildlife conservation and cultural rights for Indigenous hunters, but ignoring Indigenous demands to create autonomous hunting regimes. In 2022, the Constitutional Court struck down part of the Indigenous Status Act, which stipulated that any child with one Indigenous parent and one Han Taiwanese parent must use an Indigenous name to obtain Indigenous status and benefit from anti‐discrimination measures. Both rulings deepen state control over Indigenous lives while denying Indigenous peoples the sovereign power to regulate these issues according to their own laws. Critical race theory (CRT) is useful in understanding how legislation designed with good intentions to promote anti‐discrimination can undermine Indigenous sovereignty. Simultaneously, studies of Indigenous resurgence highlight an often‐neglected dimension of CRT—the importance of affirming the nation in the face of systemic racism.

Abstract The Niobrara Formation of north‐east Colorado, USA, has anomalously negative δ18O values compared to all other Cretaceous chalks. These unique δ18O values have been attributed to elevated heat flow and/or freshening of the Cretaceous Western Interior Seaway. This work utilises clumped isotopes of calcite (Δ47), peak burial temperatures estimated from pyrolysis data, and strontium and neodymium isotopes of carbonate to re‐evaluate the origin of the calcite's 18O‐depletion. Peak temperatures indicate lateral variability in geothermal gradients of ca 20°C/km at the tens of kilometre scale, and corroborate prior studies proposing locally elevated palaeotemperatures. Greater insight is provided by numerical models of calcite recrystallisation and oxygen isotope evolution that are constrained by measured Δ47‐derived temperatures, calcite δ18O values and inferences from the 87Sr/86Sr and εNd values. The models indicate that (1) sea water in the seaway had normal marine δ18O values of −1 (VSMOW) except on the eastern margin of the basin where some freshwater dilution yielded −2 to −3‰ (VSMOW) water, and (2) the main driver of the anonymously negative calcite δ18O values was a semi‐open hydrologic system that provided a few percent by pore volume of meteoric groundwater derived from post‐Laramide recharge into the basin. Minor contributions were a Laramide‐aged heat pulse related to the underlying Colorado Mineral Belt, the thermal insulating effects of now eroded coals, and a small flux of compaction‐driven Cretaceous sea water evolved by smectite dehydration. However, those three factors alone were insufficient drivers of the calcites' 18O depletion. High burial temperatures are interpreted to have caused clumped isotope reordering in at least one well, but those temperatures cannot yield the observed calcite δ18O values. The study illustrates the unique attributes of the Niobrara's diagenetic system that results in its anomalous δ18O values, and reaffirms the value of clumped isotopes in unravelling the diagenetic history of chalk systems.

Abstract Prolonged treatment resistant quadriceps weakness after anterior cruciate ligament reconstruction (ACL-R) contributes to re-injury risk, poor patient outcomes, and earlier development of osteoarthritis. The origin of post-injury weakness is in part neurological in nature, but it is unknown whether regional brain activity is related to clinical metrics of quadriceps weakness. Thus, the purpose of this investigation was to better understand the neural contributions to quadriceps weakness after injury by evaluating the relationship between brain activity for a quadriceps-dominated knee task (repeated cycles of unilateral knee flexion/extension from 45° to 0°), , and strength asymmetry in individuals returned to activity after ACL-R. Forty-four participants were recruited (22 with unilateral ACL reconstruction; 22 controls) and peak isokinetic knee extensor torque was assessed at 60°/s to calculate quadriceps limb symmetry index (Q-LSI, ratio of involved/uninvolved limb). Correlations were used to determine the relationship of mean % signal change within key sensorimotor brain regions and Q-LSI. Brain activity was also evaluated group wise based on clinical recommendations for strength (Q-LSI

Advancements in veterinary medicine have resulted in increased life spans for dogs, necessitating a better understanding of quality of life for older dogs. This study aimed to evaluate quality of life (QoL) progression and its potential association with mortality in senior and geriatric dogs. The Canine Owner-Reported Quality of Life Questionnaire (CORQ), consisting of 17 questions across four domains (vitality, companionship, pain, and mobility) was employed. Higher scores indicated better quality of life, with 7 as the highest potential score for each question. In a cross-sectional analysis including 92 dogs, we found an inverse correlation between overall CORQ (and all domain scores) and fractional lifespan. The domain of vitality demonstrated the lowest scores, while companionship exhibited the highest. A longitudinal analysis, including 34 dogs, revealed that when dogs reach the geriatric stage (100% of their calculated lifespan), their expected overall CORQ is 5.95 out of 7, and dogs are expected to have a monthly decline of 0.05 units in the score. Cox proportional hazard analysis demonstrated a significant association between overall CORQ scores and mortality, with dogs scoring below 5.35 being at a higher risk of mortality. This study underscores the association between aging, declining quality of life, and increased mortality risk in aging dogs.

Objectives The Serious Illness Conversation Guide (SICG) has emerged as a framework for conversations with patients with a serious illness diagnosis. This study reports on narratives generated from open-ended questions of a novel assessment tool, the Serious Illness Conversation-Evaluation Exercise (SIC-Ex), to assess resident-led conversations with patients in oncology outpatient clinics.Design Qualitative study using template analysis.Setting Three academic cancer centres in Canada.Participants 7 resident physicians (trainees), 7 patients from outpatient cancer clinics, 10 preceptors (raters) consisting of medical oncologists, palliative care physicians and radiation oncologists.Interventions Each trainee conducted an SIC with a patient, which was videotaped. The raters watched the videos and evaluated each trainee using the novel SIC-Ex and the reference Calgary-Cambridge Guide (CCG) initially and again 3 months later. Two independent coders used template analysis to code the raters’ narrative comments and identify themes/subthemes.Outcome measures How narrative comments aligned with elements of the CCG and SICG.Results Template analysis yielded four themes: adhering to SICG, engaging patients and family members, conversation management and being mindful of demeanour. Narrative comments identified numerous verbal and non-verbal elements essential to SICG. Some comments addressing general skills in engaging patients/families and managing the conversation (eg, setting agenda, introduction, planning, exploring, non-verbal communication) related to both the CCG and SICG, whereas other comments such as identifying substitute decision maker(s), affirming commitment and introducing Advance Care Planning were specific to the SICG.Conclusions Narrative comments generated by SIC-Ex provided detailed and nuanced insights into trainees’ competence in SIC, beyond the numerical ratings of SIC-Ex and the general communication skills outlined in the CCG, and may contribute to a more fulsome assessment of SIC skills.

We report the use of sodium fluorescein (SF) as an additional visualization tool during resection of a schwannoma of the foot. A 56-year-old woman presented with excruciating left foot pain that was aggravated by standing and associated with paresthesia under her foot. Magnetic resonance imaging (MRI) revealed a contrast-enhancing lesion in the region of the medial plantar nerve. Microsurgical excision of the lesion was performed with intraoperative neurological monitoring and sodium fluorescein (SF) as a visual aid. Following administration of SF intravenously, under the Yellow-560 filter lens of the operating microscope, the schwannoma demonstrated a bright green fluorescence that distinguished it from adjacent normal structures. A complete resection of the tumor was achieved and the patient's symptoms resolved completely. No complications were noted due to the SF administration. The patient remains symptom-free at a 1.5-year follow-up with no evidence of tumor recurrence. SF is a safe and effective tool to assist visualization of schwannomas of the foot.

Introduction: Patients with opioid use disorder (OUD) have a heightened need for quality health care, including access to evidence-based medications to reduce cravings and prevent overdose. However, primary care providers (PCPs) are reluctant to work with patients with OUD and implement medication prescribing into primary care practice. Previous studies have sought to identify potential ways to overcome these barriers, but often utilize interventions that facilitate both positive contact with as well as empathy for patients with OUD. In this study, we jointly assess positive contact and empathy to determine their unique impact on treatment attitudes and behaviors among PCPs, after controlling for other known predictors. Methods: We surveyed 409 PCPs currently practicing in Ohio in 2022. Our primary dependent variables were willingness to work with patients with OUD, receipt of an X-waiver to prescribe buprenorphine, and interest in receiving an X-waiver. Our primary independent variables were positive contact and empathy toward patients with OUD. We computed bivariate correlations and multivariable linear regression (for continuous dependent variables) and logistic regression (for binary dependent variables) to understand the relationship between positive contact, empathy, and our outcome variables while accounting for other known predictors and relevant participant demographics. Results: Positive contact was positively correlated with willingness to work with patients with OUD, receipt of the X-waiver, an interest in receiving the X-waiver, more frequent checking with patients about the need for naloxone, and higher odds of naloxone prescribing. These relationships held after accounting for PCP demographics, explicit bias toward patients with OUD, and overall levels of contact with patients with OUD. Empathy, conversely, was not a significant predictor of any treatment outcomes in the fully adjusted models. Conclusion: Interventions and medical education programs aimed at improving treatment outcomes for patients with OUD should facilitate positive contact between PCPs and patients with OUD.

Brassica vegetables (Brassicaceae) produce a unique class of compounds known as glucosinolates. The breakdown products of glucosinolates, including isothiocyanates, are recognized as the primary sources of bioactivity and characteristic taste, flavor and aroma of these vegetables. An emerging market trend is to harvest leafy greens at the immature stage known as “baby greens”, however, much is still unknown about the phytochemistry at this earlier stage of development. Glucosinolates and their breakdown products were examined in three members of the Brassicaceae family: Eruca vesicaria subsp. sativa ‘Arugula’, Brassica juncea ‘Garnet Giant’ (mustard greens) and Brassica oleracea var. acephala ‘Red Kale’. A total of 16 glucosinolates were tentatively identified using UHPLC-QTOF/MS and seven volatile breakdown products were identified using GC/MS. Nine putative glucosinolates and one isothiocyanate are reported for the first time in these plant species and varieties. Glucobarbarin, glucocheirolin, glucoiberin, gluconapin and neoglucobrassicin were newly identified in Eruca vesicaria subsp. sativa. Glucoalyssin, glucobarbarin, glucobrassicanapin and glucotropaeolin were newly identified in B. oleracea var. acephala, and butane isothiocyanate was newly identified in B. oleracea. Future work will focus on correlating chemistry data with sensory analyses to determine the impact of these specific glucosinolates and breakdown products on taste, flavor and aroma.

IntroductionAnterior cruciate ligament reconstruction (ACLR) is characterized by persistent involved limb functional deficits that persist for years despite rehabilitation. Previous research provides evidence of both peripheral and central nervous system adaptations following ACLR. However, no study has compared functional organization of the brain for involved limb motor control relative to the uninvolved limb and healthy controls. The purpose of this study was to examine sensorimotor cortex and cerebellar functional activity overlap and non-overlap during a knee motor control task between groups (ACLR and control), and to determine cortical organization of involved and uninvolved limb movement between groups.MethodsEighteen participants with left knee ACLR and 18 control participants performed a knee flexion/extension motor control task during functional magnetic resonance imaging (fMRI). A conjunction analysis was conducted to determine the degree of overlap in brain activity for involved and uninvolved limb knee motor control between groups.ResultsThe ACLR group had a statistically higher mean percent signal change in the sensorimotor cortex for the involved > uninvolved contrast compared to the control group. Brain activity between groups statistically overlapped in sensorimotor regions of the cortex and cerebellum for both group contrasts: involved > uninvolved and uninvolved > involved. Relative to the control group, the ACLR group uniquely activated superior parietal regions (precuneus, lateral occipital cortex) for involved limb motor control. Additionally, for involved limb motor control, the ACLR group displayed a medial and superior shift in peak voxel location in frontal regions; for parietal regions, the ACLR group had a more posterior and superior peak voxel location relative to the control group.ConclusionACLR may result in unique activation of the sensorimotor cortex via a cortically driven sensory integration strategy to maintain involved limb motor control. The ACLR group's unique brain activity was independent of strength, self-reported knee function, and time from surgery.

During spermatogenic meiosis, chromatin changes due to transcription, homologous recombination, and chromosome synapsis must be coordinated. Here they show that A-MYC and BRDT regulate release of paused RNA PolII to induce a transcriptional burst during pachytene of prophase I.

Abstract Suicide risk prediction models can identify individuals for targeted intervention. Discussions of transparency, explainability, and transportability in machine learning presume complex prediction models with many variables outperform simpler models. We compared random forest, artificial neural network, and ensemble models with 1500 temporally defined predictors to logistic regression models. Data from 25,800,888 mental health visits made by 3,081,420 individuals in 7 health systems were used to train and evaluate suicidal behavior prediction models. Model performance was compared across several measures. All models performed well (area under the receiver operating curve [AUC]: 0.794–0.858). Ensemble models performed best, but improvements over a regression model with 100 predictors were minimal (AUC improvements: 0.006–0.020). Results are consistent across performance metrics and subgroups defined by race, ethnicity, and sex. Our results suggest simpler parametric models, which are easier to implement as part of routine clinical practice, perform comparably to more complex machine learning methods.

Introduction: The purpose of this study was to assess racial disparities in total shoulder arthroplasty (TSA) in the United States and to determine whether these disparities were affected by the COVID-19 pandemic. Methods: Centers for Medicare and Medicaid Services (CMS) 100% sample was used to examine primary TSA volume from April to December from 2019 to 2020. Utilization was assessed for White, Black, Hispanic, and Asian populations to determine if COVID-19 affected these groups differently. A regression model adjusted for age, sex, CMS-hierarchical condition categories (HCC) score, dual enrollment (proxy for socioeconomic status), time-fixed effects, and core-based statistical area fixed effects was used to study difference across groups. Results: In 2019, the TSA volume per 1000 beneficiaries was 1.51 for White and 0.57 for non-White, with a 2.6-fold difference. In 2020, the rate of TSA in White patients (1.30/1000) was 2.9 times higher than non-White (0.45/1000) during the COVID-19 pandemic (P

Abstract Background Patients with cancer are known to be at increased risk for suicide but little is known about the interaction between cancer and psychiatric diagnoses, another well‐documented risk factor. Methods Electronic medical records from nine healthcare systems participating in the Mental Health Research Network were aggregated to form a retrospective case–control study, with ICD‐9 codes used to identify diagnoses in the 1 year prior to death by suicide for cases (N = 3330) or matching index date for controls (N = 297,034). Conditional logistic regression was used to assess differences in cancer and psychiatric diagnoses between cases and controls, controlling for sex and age. Results Among patients without concurrent psychiatric diagnoses, cancer at disease sites with lower average 5‐year survival rates were associated with significantly greater relative risk, while cancer disease sites with survival rates of >70% conferred no increased risk. Patients with most psychiatric diagnoses were at higher risk, however, there was no additional risk conferred to these patients by a concurrent cancer diagnosis. Conclusion We found no evidence of a synergistic effect between cancer and psychiatric diagnoses. However, cancer patients with a concurrent psychiatric illness remain at the highest relative risk for suicide, regardless of cancer disease site, due to strong independent associations between psychiatric diagnoses and suicide. For patients without a concurrent psychiatric illness, cancer disease sites associated with worse prognoses appeared to confer greater suicide risk.

Catnip (Nepeta cataria L.) plants produce a wide array of specialized metabolites with multiple applications for human health. The productivity of such metabolites, including nepetalactones, and natural insect repellents is influenced by the conditions under which the plants are cultivated. In this study, we assessed how field-grown catnip plants, transplanted after being propagated via either single-node stem cuttings or seeds, varied regarding their phytochemical composition throughout a growing season in two distinct environmental conditions (Pittstown and Upper Deerfield) in the state of New Jersey, United States. Iridoid terpenes were quantified in plant tissues via ultra-high-performance liquid chromatography with triple quadrupole mass spectrometry (UHPLC-QqQ-MS), and phenolic compounds (phenolic acids and flavonoids) were analyzed via UHPLC with diode-array detection (UHPLC-DAD). The highest contents of total nepetalactones in Pittstown were found at 6 weeks after transplanting (WAT) for both seedlings and cuttings (1305.4 and 1223.3 mg/100 g, respectively), while in Upper Deerfield, the highest contents for both propagules were at 11 WAT (1247.7 and 997.1 mg/100 g, respectively) for seed-propagated and stem cuttings). The highest concentration of nepetalactones was associated with floral-bud to partial-flowering stages. Because plants in Pittstown accumulated considerably more biomass than plants grown in Upper Deerfield, the difference in nepetalactone production per plant was striking, with peak productivity reaching only 598.9 mg per plant in Upper Deerfield and 1833.1 mg per plant in Pittstown. Phenolic acids accumulated in higher contents towards the end of the season in both locations, after a period of low precipitation, and flavone glycosides had similar accumulation patterns to nepetalactones. In both locations, rooted stem cuttings reached their maximum nepetalactone productivity, on average, four weeks later than seed-propagated plants, suggesting that seedlings have, overall, better agronomic performance.

Basil (Ocimum basilicum L.) is a popular specialty crop known for its use as a culinary herb and medicinal plant around the world. However, its profitability and availability are limited by a short postharvest shelf life due to poor handling, cold sensitivity and microbial contamination. Here, we comprehensively review the research on pre- and postharvest techniques that extend the shelf life of basil to serve as a practical tool for growers, distributors, retailers and scientists. Modifications to postharvest storage conditions, pre- and postharvest treatments, harvest time and preharvest production methods have been found to directly impact the quality of basil and its shelf life. The most effective strategies for extending the shelf life and improving the quality of basil are discussed and promising strategies that research and industry employ are identified.

Soil tests and Multichannel Analysis of Surface Waves (MASW) data were conducted in Hatsalatladi village, Botswana, to investigate the occurrence of ground fissures within the village and to identify the likely causes of the fissures and their depth extent. The MASW data were collected to gain insights into the variation of shear wave velocity with depth. The dataset shows that the shear wave velocity ranged from 150 m/s – 500 m/s, with Poisson's ratios ranging from 0.02 to 0.25. A low-velocity zone (LVZ) was observed in the upper 5 m of the subsurface with velocities ranging from 200 m/s to 350 m/s.The soil plasticity was measured through the plastic and liquid Atterberg tests. Atterberg limits measurements obtained from the three survey sites show that the plastic index of the soil samples collected from depths of 1 m fall within the 10–20% range. Specifically, the Filled Crack survey site had a plastic index of 16%, while the Abandoned House and Bridge sites had 18.7% and 13.5%, respectively. Soil samples from Filled Crack and Abandoned House site revealed a linear shrinkage of 6.4%, while the Bridge site soil sample had a linear shrinkage of 2.9%. The sieve analysis test results are also presented.

Numerical simulation tools such as large eddy simulations (LESs) have been extensively used in recent years to simulate and analyze turbine–wake interactions within large wind farms. However, to ensure the reliability of the performance and accuracy of such numerical solvers, validation against field measurements is essential. To this end, a measurement campaign is carried out at the Lillgrund offshore wind farm to gather data for the validation of an in-house LES solver. Flow field data are collected from the farm using three long-range WindScanners, along with turbine performance and load measurements from individual turbines. Turbulent inflow conditions are reconstructed from an existing precursor database using a scaling-and-shifting approach in an optimization framework, proposed so that the generated inflow statistics match the measurements. Thus, five different simulation cases are setup, corresponding to five different inflow conditions at the Lillgrund wind farm. Operation of the 48 Siemens 2.3 MW turbines from the Lillgrund wind farm is parameterized in the flow domain using an aeroelastic actuator sector model (AASM). Time-series turbine performance metrics from the simulated cases are compared against field measurements to evaluate the accuracy of the optimization framework, turbine model, and flow solver. In general, results from the numerical solver exhibited a good comparison in terms of the trends in power production, turbine loading, and wake recovery. For four out of the five simulated cases, the total wind farm power error was found to be below 5 %. However, when comparing individual turbine power production, statistical significant errors were observed for 16 % to 84 % of the turbines across the simulated cases, with larger errors being associated with wind directions resulting in configurations with aligned turbines. While the compared flapwise loads in general show a reasonable agreement, errors greater than 100 % were also present in some cases. Larger errors in the wake recovery in the far wake region behind the lidar installed turbines were also observed. An analysis of the observed errors reveals the need for an improved controller implementation, improvement in representing meso-scale effects, and possibly a finer simulation grid for capturing the smaller scales of wake turbulence.

Abstract Recombinant adeno-associated viral (AAV) vectors are a promising gene delivery platform, but ongoing clinical trials continue to highlight a relatively narrow therapeutic window. Effective clinical translation is confounded, at least in part, by differences in AAV biology across animal species. Here, we tackle this challenge by sequentially evolving AAV capsid libraries in mice, pigs and macaques. We discover a highly potent, cross-species compatible variant (AAV.cc47) that shows improved attributes benchmarked against AAV serotype 9 as evidenced by robust reporter and therapeutic gene expression, Cre recombination and CRISPR genome editing in normal and diseased mouse models. Enhanced transduction efficiency of AAV.cc47 vectors is further corroborated in macaques and pigs, providing a strong rationale for potential clinical translation into human gene therapies. We envision that ccAAV vectors may not only improve predictive modeling in preclinical studies, but also clinical translatability by broadening the therapeutic window of AAV based gene therapies.

Abstract Agricultural research institutes in Sub-Sahara Africa have focused on establishing farmer groups that facilitate the commercial production and marketing of African Indigenous Vegetables (AIVs) to address food and nutritional security. With the freedom of selecting the choices of market outlets, we explored the factors such as farmers’ characteristics, farm attributes, selling preferences, social relations, and other primary reasons that influence farmers' decision to choose a particular outlet to sell AIVs. A purposive random survey was conducted among the AIV farmers to understand the preferred market outlets for AIVs in Zambia. The results of the multinomial logit model indicate that male respondents are more likely to choose intermediary options to sell AIVs, particularly brokers and wholesalers. The rainfed farmers and those who receive primary income from farming activities are less likely to choose retailers and wholesalers to market their AIVs. Similarly, those who expect instant payment for their produce indicate that they are less likely to prefer retailers and brokers. Farmers who belong to the farmer's group exhibited a positive coefficient, meaning that they are more likely to choose intermediary options to sell their AIVs compared with the farmer-to-consumer direct sales option. However, good price, a positive momentum of AIVs price in the past, and processing activities were found to be insignificant determinants for market outlet choices when compared with farmer-to-consumer direct outlet option. Our findings could help to better cognize AIVs marketing channels and develop the intervention for new farmers to make an informed decision as to how best to market their AIVs.

Abstract Background Studies have shown that data collection by medical record abstraction (MRA) is a significant source of error in clinical research studies relying on secondary use data. Yet, the quality of data collected using MRA is seldom assessed. We employed a novel, theory-based framework for data quality assurance and quality control of MRA. The objective of this work is to determine the potential impact of formalized MRA training and continuous quality control (QC) processes on data quality over time. Methods We conducted a retrospective analysis of QC data collected during a cross-sectional medical record review of mother-infant dyads with Neonatal Opioid Withdrawal Syndrome. A confidence interval approach was used to calculate crude (Wald’s method) and adjusted (generalized estimating equation) error rates over time. We calculated error rates using the number of errors divided by total fields (“all-field” error rate) and populated fields (“populated-field” error rate) as the denominators, to provide both an optimistic and a conservative measurement, respectively. Results On average, the ACT NOW CE Study maintained an error rate between 1% (optimistic) and 3% (conservative). Additionally, we observed a decrease of 0.51 percentage points with each additional QC Event conducted. Conclusions Formalized MRA training and continuous QC resulted in lower error rates than have been found in previous literature and a decrease in error rates over time. This study newly demonstrates the importance of continuous process controls for MRA within the context of a multi-site clinical research study.

Intro: Recent evidence shows the Greater Mekong Subregion to be a hotspot for Sarbecoviruses in bats, especially insectivorous Horseshoe bats (genus Rhinolophus). However, prevalence, maintenance, and evolution of these viruses in Rhinolophids is still poorly understood. Sampling efforts are still limited and generally only cover cross-sectional surveillance at single points in time. Following the detection of Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2)-related viruses in Rhinolophus shameli from 2010 in Steung Treng, Cambodia, further active longitudinal surveillance in the same area between 2020-2021 continued the detection of these viruses. Methods: Live bat capture and sampling has been implemented in several sites located in Stung Treng province. All rectal swabs of bats were tested for the detection of SARS-CoV-2 or Sarbecoviruses by real time RT-PCR. RNA samples from positive RT-PCR bats were then sequenced using a highly multiplexed PCR amplicon approach using new designed primers set guided by the ARTIC Network multiplex PCR primers set (https://artic.network/ncov-2019), on Oxford Nanopore technology. Findings: The sarbecoviruses were detected in four Rhinolophus shameli bats, a percentage of similarity ranging at the nucleotide level between 98.8% - 99.1% when compared to two other Cambodian bat sarbecoviruses from 2010 and between 92.4% - 94.5% when compared to human SARS-CoV-2 across the whole genome. Discussion: The bat SARS-CoV-2 related virus recently detected in four positive bats in 2020-2021 are genetically homologous with the virus detected in 2010, indicating a geographically/host limited population that is stable over time in the past ten years. Conclusion: Overall, our findings indicate further complexity in the diversity and evolution of sarbecoviruses and add intricacy to the search for the origins of the Coronavirus Disease 2019 (COVID-19) pandemic.

IntroductionNutrition security continues to worsen in sub-Saharan Africa. Current research is limited on how seasonality may influence the impact of nutrition, culinary, and production interventions on food security, diet quality, and consumption of African Indigenous Vegetables (AIV); a culturally accepted source of micro-and-macronutrients that are easily produced due to their adaptation to the local environment. The objective of this study was to evaluate the programmatic impact of AIV interventions on nutrition security among smallholder farmers.MethodsIn a randomized control trial, five target counties in Western Kenya were randomly assigned to one of four treatments: (1) control; (2) production intervention (PI); (3) nutrition and culinary intervention (NCI); and (4) NCI and PI (NCI/PI). After the counties were randomly assigned to a treatment, 503 smallholder farmers (18–65 years) were selected from participatory farmer groups. The PI consisted of five agricultural production modules delivered between 2016 and 2019. The NCI was delivered twice: (1) household nutrition education (2017) and (2) community culinary training (2019). The NCI/PI included communities receiving both interventions at these time periods. Baseline and endline surveys were administered to all participants once in October 2016 (harvest season) and to all available participants (n = 250) once in June to July 2019 (dry season), respectively. The impact evaluation was analyzed by Household Hunger Scale (HHS), Women’s Dietary Diversity Score (WDDS), AIV consumption frequency, and AIV market availability. Statistical tests included descriptive statistics (means and frequencies), paired t-test, McNemar’s test, Wilcoxon Signed-Rank test, ANOVA test with Tukey post hoc, and χ2 test. Open-ended questions were aggregated, and responses were selected based on relevancy and thoroughness of the response to provide context to the quantitative data. A value of p

Abstract Health systems are essential for suicide risk detection. Most efforts target people with mental health (MH) diagnoses, but this only represents half of the people who die by suicide. This study seeks to discover and validate health indicators of suicide death among those with, and without, MH diagnoses. This case-control study used statistical modeling with health record data on diagnoses, procedures, and encounters. The study included 3,195 individuals who died by suicide from 2000 to 2015 and 249,092 randomly selected matched controls, who were age 18+ and affiliated with nine Mental Health Research Network affiliated health systems. Of the 202 indicators studied, 170 (84%) were associated with suicide in the discovery cohort, with 148 (86%) of those in the validation cohort. Malignant cancer diagnoses were risk factors for suicide in those without MH diagnoses, and multiple individual psychiatric-related indicators were unique to the MH subgroup. Protective effects across MH-stratified models included diagnoses of benign neoplasms, respiratory infections, and utilization of reproductive services. MH-stratified latent class models validated five subgroups with distinct patterns of indicators in both those with and without MH. The highest risk groups were characterized via high utilization with multiple healthcare concerns in both groups. The lowest risk groups were characterized as predominantly young, female, and high utilizers of preventive services. Healthcare data include many indicators of suicide risk for those with and without MH diagnoses, which may be used to support the identification and understanding of risk as well as targeting of prevention in health systems.

Plant based natural products have been widely used as antibacterial and insect repellent agents globally. Because of growing resistance in bacterial plant pathogens and urban pests to current methods of control, combined with the long- and short-term negative impact of certain chemical controls in humans, non-target organisms, and the environment, finding alternative methods is necessary to prevent and/or mitigate losses caused by these pathogens and pests. The antibacterial and insect repellent activities of essential oils of novel cultivars of catnip (Nepeta cataria L. cv. CR9) and oregano (Origanum vulgare L. cv. Pierre) rich in the terpenes nepetalactone and carvacrol, respectively, were evaluated using the agar well diffusion assay and petri dish repellency assay. The essential oils exhibit moderate to high antibacterial activity against three plant pathogens, Pseudomonas cichorii, Pseudomonas syringae and Xanthomonas perforans of economic interest and the individual essential oils, their mixtures and carvacrol possess strong insect repellent activity against the common bed bug (Cimex lectularius L.), an urban pest of major significance to public health. In this study, the essential oils of catnip and oregano were determined to be promising candidates for further evaluation and development as antibacterial agents and plant-based insect repellents with applications in agriculture and urban pest management.

IntroductionCatnip (Nepeta cataria L.) produces volatile iridoid terpenes, mainly nepetalactones, with strong repellent activity against species of arthropods with commercial and medical importance. Recently, new catnip cultivars CR3 and CR9 have been developed, both characterized by producing copious amounts of nepetalactones. Due to its perennial nature, multiple harvests can be obtained from this specialty crop and the effects of such practice on the phytochemical profile of the plants are not extensively studied.MethodsIn this study we assessed the productivity of biomass, chemical composition of the essential oil and polyphenol accumulation of new catnip cultivars CR3 and CR9 and their hybrid, CR9×CR3, across four successive harvests. The essential oil was obtained by hydrodistillation and the chemical composition was obtained via gas chromatography-mass spectrometry (GC-MS). Individual polyphenols were quantified by Ultra-High-Performance Liquid Chromatography- diode-array detection (UHPLC-DAD).ResultsAlthough the effects on biomass accumulation were independent of genotypes, the aromatic profile and the accumulation of polyphenols had a genotype-dependent response to successive harvests. While cultivar CR3 had its essential oil dominated by E,Z-nepetalactone in all four harvests, cultivar CR9 showed Z,E-nepetalactone as the main component of its aromatic profile during the 1st, 3rd and 4th harvests. At the second harvest, the essential oil of CR9 was mainly composed of caryophyllene oxide and (E)-β-caryophyllene. The same sesquiterpenes represented the majority of the essential oil of the hybrid CR9×CR3 at the 1st and 2nd successive harvests, while Z,E-nepetalactone was the main component at the 3rd and 4th harvests. For CR9 and CR9×CR3, rosmarinic acid and luteolin diglucuronide were at the highest contents at the 1st and 2nd harvest, while for CR3 the peak occurred at the 3rd successive harvest.DiscussionThe results emphasize that agronomic practices can significantly affect the accumulation of specialized metabolites in N. cataria and the genotype-specific interactions may indicate differential ecological adaptations of each cultivar. This is the first report on the effects of successive harvest on these novel catnip genotypes and highlights their potential for the supply of natural products for the pest control and other industries.

Abstract Background Injury and reconstruction of anterior cruciate ligament (ACL) result in central nervous system alteration to control the muscles around the knee joint. Most individuals with ACL reconstruction (ACLR) experience kinesiophobia which can prevent them from returning to activity and is associated with negative outcomes after ACLR. However, it is unknown if kinesiophobia alters brain activity after ACL injury. Objectives To compare brain activity between an ACLR group and matched uninjured controls during an action‐observation drop vertical jump (AO‐DVJ) paradigm and to explore the association between kinesiophobia and brain activity in the ACLR group. Methods This cross‐sectional study enrolled 26 individuals, 13 with ACLR (5 males and 8 females, 20.62 ± 1.93 years, 1.71 ± 0.1 m, 68.42 ± 14.75 kg) and 13 matched uninjured controls (5 males and 8 females, 22.92 ± 3.17 years, 1.74 ± 0.10 m, 70.48 ± 15.38 kg). Individuals were matched on sex and activity level. Participants completed the Tampa Scale of Kinesiophobia‐11 (TSK‐11) to evaluate the level of movement‐related fear. To assay the brain activity associated with a functional movement, the current study employed an action‐observation/motor imagery paradigm during functional magnetic resonance imaging (fMRI). Results The ACLR group had lower brain activity in the right ventrolateral prefrontal cortex relative to the uninjured control group. Brain activity of the left cerebellum Crus I and Crus II, the right cerebellum lobule IX, amygdala, middle temporal gyrus, and temporal pole were positively correlated with TSK‐11 scores in the ACLR group. Conclusion Brain activity for the AO‐DVJ paradigm was different between the ACLR group and uninjured controls. Secondly, in participants with ACLR, there was a positive relationship between TSK‐11 scores and activity in brain areas engaged in fear and cognitive processes during the AO‐DVJ paradigm.

Collaborating scientists and storytellers successfully built a university-based science-in-action video storytelling model to test the research question: Can university scientists increase their relatability and public engagement through science-in-action video storytelling? Developed over 14 years, this science storytelling model produced more than a dozen high-visibility narratives that translated science to the public and featured scientists, primarily environmental and climate scientists, who are described in audience surveys as relatable people. This collaborative model, based on long-term trusting partnerships between scientists and video storytellers, documented scientists as they conducted their research and together created narratives intended to humanize scientists as authentic people on journeys of discovery. Unlike traditional documentary filmmaking or journalism, the participatory nature of this translational science model involved scientists in the shared making of narratives to ensure the accuracy of the story's science content. Twelve science and research video story products have reached broad audiences through a variety of venues including television and online streaming platforms such as Public Broadcasting Service (PBS), Netflix, PIVOT TV, iTunes, and Kanopy. With a reach of over 180 million potential public audience viewers, we have demonstrated the effectiveness of this model to produce science and environmental narratives that appeal to the public. Results from post-screening surveys with public, high school, and undergraduate audiences showed perceptions of scientists as relatable. Our data includes feedback from undergraduate and high school students who participated in the video storytelling processes and reported increased relatability to both scientists and science. In 2022, we surveyed undergraduate students using a method that differentiated scientists' potential relatable qualities with scientists' passion for their work, and the scientists' motivation to help others, consistently associated with relatability. The value of this model to scientists is offered throughout this paper as two of our authors are biological scientists who were featured in our original science-in-action videos. Additionally, this model provides a time-saving method for scientists to communicate their research. We propose that translational science stories created using this model may provide audiences with opportunities to vicariously experience scientists' day-to-day choices and challenges and thus may evoke audiences' ability to relate to, and trust in, science.

Abstract Background Anchor institutions, by definition, have a long-term presence within their local communities, but it is uncertain as to whether for-profit hospitals meet this definition; most research on anchor institutions to date has been limited to nonprofit organizations such as hospitals and universities. Accordingly, this study aims to determine whether for-profit hospitals are stable enough to fulfill the role of anchor institutions through a long-term presence in communities which may help to stabilize local economies. Methods This longitudinal study analyzes national, secondary data between 2008 and 2017 compiled from the Dartmouth Atlas of Health Care, the American Hospital Association Annual Survey, and County Health Rankings. We use descriptive statistics to calculate the number of closures and mergers of hospitals of different ownership type, as well as staffing levels. Using logistic regression, we also assessed whether for-profit hospitals had higher odds of closing and merging, controlling for both organization and community factors. Results We found for-profit hospitals to be less stable than their public and nonprofit hospital counterparts, experiencing disproportionately more closures and mergers over time, with a multivariable analysis indicating a statistically significant difference. Furthermore, for-profit hospitals have fewer full-time employees relative to their size than hospitals of other ownership types, as well as lower total payroll expenditures. Conclusions Study findings suggest that for-profit hospitals operate more efficiently in terms of expenses, but this also may translate into a lower level of economic contributions to the surrounding community through employment and purchasing initiatives. For-profit hospitals may also not have the stability required to serve as long-standing anchor institutions. Future studies should consider whether for-profit hospitals make other types of community investments to offset these deficits and whether policy changes can be employed to encourage anchor activities from local businesses such as hospitals.

Abstract Background In 1979, Marvin Zelen proposed a new design for randomized clinical trials intended to facilitate clinicians’ and patients’ participation. The defining innovation of Zelen’s proposal was random assignment of treatment prior to patient or participant consent. Following randomization, a participant would receive information and asked to consent to the assigned treatment. Methods This narrative review examined recent examples of Zelen design trials evaluating clinical and public health interventions. Results Zelen designs have often been applied to questions regarding real-world treatment or intervention effects under conditions of incomplete adherence. Examples include evaluating outreach or engagement interventions (especially for stigmatized conditions), evaluating treatments for which benefit may vary according to participant motivation, and situations when assignment to a control or usual care condition might prompt a disappointment effect. Specific practical considerations determine whether a Zelen design is scientifically appropriate or practicable. Zelen design trials usually depend on identifying participants automatically from existing records rather than by advertising, referral, or active recruitment. Assessments of baseline or prognostic characteristics usually depend on available records data rather than research-specific assessments. Because investigators must consider how exposure to treatments or interventions might bias ascertainment of outcomes, assessment of outcomes from routinely created records is often necessary. A Zelen design requires a waiver of the usual requirement for informed consent prior to random assignment of treatment. The Revised Common Rule includes specific criteria for such a waiver, and those criteria are most often met for evaluation of a low-risk and potentially beneficial intervention added to usual care. Investigators and Institutional Review Boards must also consider whether the scientific or public health benefit of a Zelen design trial outweighs the autonomy interests of potential participants. Analysis of Zelen trials compares outcomes according to original assignment, regardless of any refusal to accept or participate in the assigned treatment. Conclusions A Zelen design trial assesses the real-world consequences of a specific strategy to prompt or promote uptake of a specific treatment. While such trials are poorly suited to address explanatory or efficacy questions, they are often preferred for addressing pragmatic or policy questions.

Background: Palliative care (PC) is an added layer of support provided concurrently with cancer care and serves to improve wellbeing and sustain quality of life. Understanding what is meaningful and a priority to patients, their families, and caregivers with lived experience of cancer and PC is critical in supporting their needs and improving their care provision. However, the impacts of engaging cancer patients within the context of PC research remain unknown. Objective: To examine the impacts of engaging individuals with lived experience of cancer and PC as partners in PC research. Methods: An a priori systematic review protocol was registered with PROSPERO (CRD42021286744). Four databases (APA PsycINFO, CINAHL, EMBASE, and MEDLINE) were searched and only published, peer-reviewed primary English studies aligned with the following criteria were included: (1) patients, their families, and/or caregivers with lived experience of cancer and PC; (2) engaged as partners in PC research; and (3) reported the impacts of engaging cancer PC patient partners in PC research. We appraised the quality of eligible studies using the Critical Appraisal Skills Program (CASP) and GRIPP2 reporting checklists. Results: Three studies that included patient partners with lived experience of cancer and PC engaged at all or several of the research stages were identified. Our thematic meta-synthesis revealed impacts (benefits and opportunities) on patient partners (emotional, psychological, cognitive, and social), the research system (practical and ethical) and health care system (service improvements, bureaucratic attitudes, and inaction). Our findings highlight the paucity of evidence investigating the impacts of engaging patients, their families and caregivers with lived experience of cancer and PC, as partners in PC research. Conclusions: The results of this review and meta-synthesis can inform the more effective design of cancer patient partnerships in PC research and the development of feasible and effective strategies given the cancer and PC context patient partners are coming from.

From the Editor

From the Editor

From the Editor