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Patellar ligament desmopathy in horses is regarded as an uncommon condition with unclear aetiology. Of the three patellar ligaments in the horse, the intermediate is the one most often diagnosed with desmopathy in horses presenting with chronic lameness. This structure corresponds to the patellar tendon in humans. As diagnostic imaging modalities continuously improve, changes in echogenicity of the patellar ligaments are identified ultrasonographically with increasing frequency. However, disruption of the normal fibre pattern may be present also in patellar ligaments in horses that show no signs of lameness. Similarly, there is a poor correlation between pain and diagnostic imaging findings in human patellar tendinopathy. Consequently, there appears to be a knowledge gap pertaining to normal ultrasonographic variation and diagnostic criteria for disease of the patellar ligaments in horses. Furthermore, local anaesthetic techniques to verify the diagnosis are poorly described, and due to the low number of treated cases, no specific treatment modality can be recommended on a scientific basis. The aim of this paper is to review the current knowledge regarding the pathogenesis, diagnosis and management of patellar ligament desmopathy in horses, compare this condition with patellar tendinopathy in humans, and identify areas for further research to increase the diagnostic accuracy in horses. We conclude that there is a profound need for better descriptions of ultrasonographic variation and pathological changes of the equine patellar ligaments. Identification of areas of maximal ligament strain and descriptions of early histopathological changes could render more information on the possible aetiology, preventive measurements and treatment options of desmopathy. Description of regional innervation could aid in development of methods for diagnostic anaesthesia to verify pain originating from the ligaments.

Purpose To critically synthesise qualitative research to understand experiences of supportive care in people affected by brain cancer and their informal caregivers. Methods A qualitative systematic review was conducted according to the Joanna Briggs methodology and has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines. Electronic databases were searched by an expert systematic review librarian for all qualitative studies irrespective of research design. All publications were double screened by two reviewers using a pre-determined exclusion and inclusion criteria. The review was managed using Covidence systematic review software. Methodological quality assessment and data extraction were performed. Qualitative findings accompanied by illustrative quotes from included studies were extracted and grouped into categories, which created the overall synthesised findings. Results A total of 33 studies were included which represented a total sample of 671 participants inclusive of 303 patients and 368 informal caregivers. There was a total of 220 individual findings included in this review, which were synthesised into two findings (1) caregivers and patients perceived supports which would have been helpful and (2) caregiver and patient experiences of unmet supportive care needs. Conclusion This review highlighted the suffering and distress caused by brain cancer and associated treatments. Both patients and their informal caregivers experienced disconnect from themselves in renegotiating roles, and a profound sense of loneliness as the physical deterioration of the disease progressed. Both patients and informal caregivers reported similar unmet needs within the current service provision for brain cancer. However, what is apparent is that current cancer services are provided solely for patients, with little or no consideration to the support needs of both the patient and their informal caregiver. Service re-design is needed to improve care coordination with individualised informational support, implementation of holistic needs assessments for both the patients and their caregivers, better community support provision, improved opportunities for emotional care with early referral for palliative care services. Implications for cancer survivors It is recommended that members of the multidisciplinary brain cancer team reflect on these findings to target holistic needs assessments and develop shared self-management care plans for both the patient and the informal caregiver.

A recently discovered, enhanced Ge diffusion mechanism along the oxidizing interface of Si/SiGe nanostructures has enabled the formation of single-crystal Si nanowires and quantum dots embedded in a defect-free, single-crystal SiGe matrix. Here, we report oxidation studies of Si/SiGe nanofins aimed at gaining a better understanding of this novel diffusion mechanism. A superlattice of alternating Si/Si

Ground source heat pumps (GSHPs) are an environmentally friendly alternative to conventional heating and cooling systems because of their high efficiency and low greenhouse gas emissions. The ground acts as a heat sink/source for the excess/required heat inside a building for cooling and heating modes, respectively. However, imbalance in heating and cooling needs can change ground temperature over the operating duration. This increase/decrease in ground temperature lowers system efficiency and causes the ground to foul—failing to accept or provide more heat. In order to ensure that GSHPs can operate to their designed conditions, thermal modelling is required to simulate the ground temperature during system operation. In addition, the borehole field layout can have a major impact on ground temperature. In this study, four buildings were studied—a hospital, fast-food restaurant, residence, and school, each with varying borehole configurations. Boreholes were modeled in a soil volume using finite-element methods and heating and cooling fluxes were applied to the borehole walls to simulate the GSHP operation. 20 years of operation were modelled for each building for 2x2, 4x4, and 2x8 borehole configurations. Results indicate that the borehole separation distance of 6 m, recommended by ASHRAE, is not always sufficient to prevent borehole thermal interactions. Benefits of using a 2x8 configuration as opposed to a 4x4 configuration, which can be observed because of the larger perimeter it provides for heat to dissipate to surrounding soil were quantified. This study indicates that it is important to carefully consider ground temperature during the operation of a GSHP. Borehole separation distances, layout, and hybridization should be studied to alleviate ground fouling problems.

Climate change impacts are accelerating and there is an urgent need to address this global issue. Tackling climate change in an effective and socially just manner needs to involve mitigation strategies that address the underlying causes of climate change, but also adaptation strategies that help us prepare for current and future impacts. Historically, mitigation and adaptation strategies have been treated separately, but there is now growing awareness of important synergies between them. We highlight these synergies across six key areas where humans need to make transformative changes in order to reduce the impacts of climate change, including energy, pollutants, nature, food, population and the economy. In doing so, we show the enormous potential for civil society, government, world leaders and the private sector to take advantage of the fact that mitigation strategies can also provide adaptation opportunities to lessen humanity’s suffering as we navigate the uncertainties of the climate crisis.

We report the development of a process/device simulation platform to model superconductor electronics. The process simulator leverages the back-end modeling capabilities of Florida object-oriented process/device/reliability simulator (FLOOXS) and builds on the existing models to simulate processes specific to Josephson junction (JJ) fabrication. The device simulator uses the process generated models and computes the normal-state electrical properties of a Nb/Al-AlO/Nb JJ. It is used to predict key operational figures of merit and how they vary with changes in process models. By integrating the process and device simulation tools, this research aims to offer an environment for the simulation of JJ circuits.

Background This study compared the ergonomics of surgeons during deep inferior epigastric perforator (DIEP) flap surgery using either baseline equipment (loupes, headlights, and an operating microscope) or an exoscope. Plastic surgeons may be at high risk of musculoskeletal problems. Recent studies indicate that adopting an exoscope may significantly improve surgeon postures and ergonomics. Methods Postural exposures, using inertial measurement units at the neck, torso, and shoulders, were calculated in addition to the surgeons' subjective physical and cognitive workload. An ergonomic risk score on a scale of 1 (lowest) to 4 (highest) was calculated for each of the postures observed. Data from 23 bilateral DIEP flap surgeries (10 baseline and 13 exoscope) were collected. Results The neck and torso risk scores decreased significantly during abdominal flap harvest and chest dissection, while right shoulder risk scores increased during the abdominal flap harvest for exoscope DIEP flap procedures compared with. Exoscope anastomoses demonstrated higher neck, right shoulder, and left shoulder risk scores. The results from the survey for the “surgeon at abdomen” showed that the usage of exoscopes was associated with decreased performance and increased mental demand, temporal demand, and effort. However, the results from the “surgeon at chest” showed that the usage of exoscopes was associated with lower physical demand and fatigue, potentially due to differences in surgeon preference. Conclusion Our study revealed some objective evidence for the ergonomic benefits of exoscope; however, this is dependent on the tasks the surgeon is performing. Additionally, personal preferences may be an important factor to be considered in the ergonomic evaluation of the exoscope.

Creating strategic forest reserves is essential for stemming the loss of biodiversity and contributing to climate mitigation and adaptation. Meeting preservation targets of 30% protection by 2030, and 50% by 2050 would lead to greater protection of animal taxa and tree species habitat, carbon stocks and accumulation, and forests that are important sources of drinking water. Here, we develop a regional framework to specifically identify at a fine resolution (30 m) high priority forestlands for preservation in Oregon, USA. We include a resilience metric that represents connectivity and topographic diversity, and identify areas within each ecoregion that are ranked high priority for carbon, biodiversity, resilience and drinking water. Oregon has less than 10% of its forestlands protected at the highest levels, yet its temperate forests are among those with the highest carbon densities in the world. Reserves for surface drinking water sources and forest habitat for birds, mammals, amphibians, and reptiles could increase to 50–70% protection at the highest levels by 2050. Protected aboveground biomass carbon could triple to 635 teragrams of carbon by 2050. The ownership of the high preservation priority lands for carbon and biodiversity is primarily federal (67% by 2050) followed by private (28% by 2050), with much less in the other ownerships. Forest reserves could be established on federal lands through executive action, regulation and rule-making, while private landowners could be incentivized to store more carbon, limit harvest in certain areas and transfer ownership to land trusts. Protecting mature and old forests on federal lands fulfills an urgent need for protection and provides a low-cost way to simultaneously meet national and international goals. This study provides a flexible, dynamic framework for identifying areas that are high priority to protect for climate mitigation and adaptation at regional and sub-regional scales.

The goal of this study was to evaluate residents’ workload and teamwork and the correlation between their workload and teamwork subscales during deep inferior epigastric perforator (DIEP) flap surgery. Ten residents who assisted during DIEP flap procedures completed an electronic survey following each DIEP flap procedure from July 2019 to August 2020. The survey contained items from the NASA-TLX and SURG-TLX and questions to measure teamwork subscales. Across 29 surgical cases, 38 surveys were recorded. Overall, the means of workload subscales were mostly greater than 10 and less than 15 (range=020) and the means of all teamwork subscales were greater than 15 (range=0-20). Good teamwork was correlated with lower distractions (Rs= -0.36 to -0.48) and better performance (Rs=0.35 to 0.52). Also, all the teamwork subscales were highly correlated (Rs= 0.59 to 0.92). Our findings suggest that good teamwork, low distractions, and successful performance are generally observed together; however, a causative relationship could not be established based on these results.

By modeling the propagation of a seed layer with various crystal orientations, this study explores the influence of process variations on grain formation with the help of a physics-based process simulator. Grain boundaries allow easy diffusion of foreign atoms through the lattice, which causes Al to move inside the Nb bottom electrode layer and more interestingly, O to penetrate through the Al layer during oxidation and create a barrier with non-uniform thickness. In addition to thickness variations, the grain structure exhibited by Nb and Al can cause significant suppression of supercurrent at the boundaries depending on the degree of lattice mismatch, impurity deposition, etc. This work details the process simulation of grain boundary formation and aims to provide geometrical models that may be used in the simulation of device performance to account for process-induced variations.

Dopant profiles near the semiconductor–oxide interface are critical for microelectronic device performance. As the incorporation of Si1−xGex into transistors continues to increase, it is necessary to understand the behavior of dopants in Si1−xGex. In this paper, the diffusion and electrical activation of phosphorus within a strained, single-crystal Si0.7Ge0.3 layer on Si during oxidation are reported. Both layers were uniformly doped, in situ, with an average phosphorus concentration of 4 × 1019 atoms/cm3. After high-temperature oxidation, secondary ion mass spectrometry measurements revealed that the bulk of the phosphorus diffuses out of only the SiGe layer and segregates at the oxidizing SiGe–SiO2 interface. Hall effect measurements corroborate the observed phosphorus loss and show that the phosphorus diffusing to the oxidizing interface is electrically inactive. Through density functional theory (DFT) calculations, it is shown that phosphorus interstitials prefer sites near the SiGe–SiO2 interface. Finally, based on a combination of experimental data and DFT calculations, we propose that the phosphorus atoms are displaced from their lattice sites by Ge interstitials that are generated during SiGe oxidation. The phosphorus atoms then migrate toward the SiGe–SiO2 interface through a novel mechanism of hopping between Ge sites as P–Ge split interstitials. Once they reach the interface, they are electrically inactive, potentially in the form of interstitial clusters or as part of the reconstructed interface or oxide.

Previous studies indicated that compounds termed Disulfide bond Disrupting Agents (DDAs) exhibit anti-cancer activity that is associated with downregulation of EGFR/HER1, HER2, and HER3, and activation of Death Receptors 4 and 5 (DR4/5). DDA-induced HER1-3 downregulation is preceded by disulfide-mediated oligomerization. In contrast, DDA-mediated DR4/5 oligomerization results in DR5 upregulation, and activation of DR4/5 pro-apoptotic signaling through Caspases 8 and 3. However, the precise mechanisms by which altered disulfide bonding stabilizes and activates DR5 are unknown. A recent report indicated that the extracellular domain of DR5 acts in an auto-inhibitory manner to prevent DR5 oligomerization and pro-apoptotic signaling in the absence of its ligand, TRAIL. A subsequent paper showed that the DR5 auto-inhibitory domain is a positive patch consisting of three basic residues. Importantly, the structure of the auto-inhibitory loop is formed by two disulfide bonds. We hypothesize that DDAs disrupt the disulfide bonds that make up the auto-inhibitory loop, resulting in DR5 oligomerization, and activation of Caspase 8/3-driven apoptosis in a TRAIL-independent manner. Due to their novel mechanisms of action, DDAs may overcome the pharmacological liabilities that have limited the efficacy of TRAIL analogs and DR5 agonist antibodies. Another unanswered question is how precisely DDAs alter DR5 and EGFR disulfide bonding. The direct targets of DDA action were revealed through affinity purification studies with biotinylated-DDA analogs. These studies identified the protein disulfide isomerases AGR2, ERp44, and PDIA1 as DDA target proteins, explaining how DDAs alter DR5 and EGFR disulfide bonding patterns. Consistent with this interpretation, knockdown of AGR2 or ERp44, or expression of catalytically null AGR2 or ERp44 mutants, mimicked DDAs in inducing disulfide-mediated DR5 oligomerization and Caspase 8 activation. Together, these results demonstrate a fundamentally novel, ligand-independent mechanism for activation of DR5 through DDA-mediated inhibition of the PDIs AGR2, ERp44, and PDIA1. Significantly, DDAs are the first identified active site inhibitors of AGR2 and ERp44. Citation Format: Brian K. Law, Mary E. Law, Elham Yaaghubi, Amanda Ghilardi, Brad J. Davis, Renan Ferreira, Samantha Eggleston, Jade Nguyen, Grace Alexandrow, Jin Koh, Sixue Chen, Chi-Wu Chiang, Coy Heldermon, Peter Norgaard, Ronald K. Castallano, Zaafir M. Dulloo. Disulfide isomerases AGR2, ERp44, and PDIA1 maintain death receptor 5 in an auto-inhibited, monomeric form. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6148.

In this study, the response to a heavy-ion strike and the resulting single effect burnout on beta-Ga2O3 Schottky diodes with biased field rings is investigated via TCAD. The model used to simulate the device under high-reverse bias is validated using experimental current-voltage (I-V) curves. A field ring configuration for the device demonstrates an improved charge removal after simulated heavy-ion strikes. If the time scale for charge removal is faster than single event burnout, this can be an effective mechanism for reducing the effect of single ion strikes. This study explores various configurations of the termination structure and shows the impact of different design parameters in terms of a transient response after the ion strike.

Some packaging technologies of electronic devices introduce compressive biaxial stress and variable vertical stress. In unipolar MOS devices, stress variations typically only linearly affect drain current via carrier mobility. Collector currents of bipolar devices are additionally affected by variations in intrinsic carrier concentration. This leads to increased variability of key device parameters in the compressive stress regime. Reducing package-induced compressive stress, or inducing tensile stress, should improve device variability due to local stress variations.

Patient portals are websites or apps where patients can access their health information from their Electronic Health Records (EHR). This study was conducted via an online survey to identify what factors influence an EHR patient portal user to believe that the portal is a valuable part of their health care. In total 395 survey responses were included in a logistic regression model. Our results suggest that only 24.1% of our survey responders consider their EHR portals as a valuable part of their health care. Participants who are more likely to consider EHR portals as valuable were those who found EHR portals useful for information, trusted their portal; believed their portals were important in managing health, those who believed their portals were easy to use, and those who developed a habit of using their portals. This study contributes to the understanding of what factors support the perceived value of EHR portals.

More and more breast cancer patients are turning to autologous options for reconstruction. Deep Inferior Epigastric Perforator (DIEP) flap reconstruction is considered the gold standard flap breast reconstruction procedure; however, it requires a significant number of resources, including two surgeons and microsurgical equipment. A multidisciplinary group was tasked with reducing operative time of DIEP flap procedures by 25% so that complex surgeries can become more routine and accessible to patients. Using participatory ergonomics, members of the operative team were engaged to identify interventions. Following implementation, 22 DIEP flap cases were evaluated using workload surveys and patient outcomes to determine the success of the interventions. DIEP flap surgical durations were reduced by 25% on average (M=12.9 hours, SD=5.7 to M=9.7 hours, SD=1.4). When cases lasted longer than 9 hours, surgeons reported 31% more physical demand and 78% more fatigue than cases that were 9 hours or less. Survey results linked positive team characteristics to reduced frustrations and distractions.

Reported are structure-property-function relationships associated with a class of cyclic thiosulfonate molecules-disulfide-bond disrupting agents (DDAs)-with the ability to downregulate the Epidermal Growth Factor Receptor (HER) family in parallel and selectively induce apoptosis of EGFR+ or HER2+ breast cancer cells. Recent findings have revealed that the DDA mechanism of action involves covalent binding to the thiol(ate) from the active site cysteine residue of members of the protein disulfide isomerase (PDI) family. Reported is how structural modifications to the pharmacophore can alter the anticancer activity of cyclic thiosulfonates by tuning the dynamics of thiol-thiosulfonate exchange reactions, and the studies reveal a correlation between the biological potency and thiol-reactivity. Specificity of the cyclic thiosulfonate ring-opening reaction by a nucleophilic attack can be modulated by substituent addition to a parent scaffold. Lead compound optimization efforts are also reported, and have resulted in a considerable decrease of the IC

Objective Surgeon workload, or human "cost" of performing a procedure, is not well understood in light of emerging surgical technologies. This pilot study quantified surgeon workload for colorectal procedures and identified patient, surgeon, and procedural factors impacting workload. Summary background data Innovative technologies and procedures in surgery have generally been promoted for the advancement of patient care. The resulting surgeon workload is poorly studied with little knowledge of the contributing factors impacting workload. Methods Surgeons completed NASA-Task Load Index (NASA-TLX) questionnaires to self-assess workload following abdominopelvic colon and rectal procedures. Corresponding patient data were retrieved from the medical record. Descriptive statistics, correlations, and ANOVA were performed to compare surgeon and patient factors, procedure type, and surgical approach on workload overall and by subscales. Results Seven attending surgeons rated 238 surgeries, of which 218 (92%) had corresponding patient data. Surgeon experience and patient demographics had inconsistent effects on workload. A statistically significant 3-way interaction was identified among disease process, procedure type, and surgical approach on workload (F(9, 146) = 2.17, P = 0.027), but was limited to open procedures for neoplasia and inflammatory bowel disease patients. Proctectomy and colectomy procedures compared across open, laparoscopic, and robotic approaches showed significant differences in overall workload and subscales, where the robotic procedures required significantly less mental demand, physical demand, and effort, than open or laparoscopic (P Conclusions Patient characteristics, disease process, and surgical experience had inconsistent effects on surgeon workload. Major differences in workload were identified for procedure type and surgical approach, where robotic procedures required less mental demand, physical demand, and effort.

Background Traditional checklist metrics for surgical performance can miss key intraoperative decisions that impact procedural outcomes. Error-based assessments may help identify important metrics for evaluating operative performance and resident readiness for independent practice. Methods This study utilized human factors error analysis and error management theory to investigate a previously collected video database of resident performance during a simulated laparoscopic ventral hernia (LVH) repair on a table-top simulator using standard laparoscopic tools and mesh. Errors were deconstructed and coded using a structured observation tool and video analysis software. Error detection events and error recovery events were categorized for each operative step of the ventral hernia repair. Results Residents made a total of 314 errors (M = 15.7, SD = 4.96). There were more technical errors (63%) than cognitive errors (37%) and more commission errors (69%) than omission errors (30%). Almost half (47%) of all errors went completely undetected by the residents for the entire LVH repair. Of the errors that residents attempted to recover (n = 136), 86.0% were successfully recovered. Technical errors were four times more likely to be successfully recovered than cognitive errors (p = .020). Conclusions Our results revealed specific details regarding residents’ error management strategies and provides validity evidence for the use of human factors error frameworks in surgical performance assessments. Practice in simulation-based learning environments may improve resident decision-making and error management opportunities by providing a structured experience where errors are explicitly characterized and used for training and feedback. Error management training may play a major role in equipping residents and junior faculty with the skills required for independent, high-quality operative performance.

The goal of this study was to quantify and compare prospective self-reported intraoperative workload and teamwork during robot-assisted radical prostatectomy (RARP) for multi-port da Vinci Xi (MP) and single-port da Vinci SP (SP) robots. The self-reported workload (surgeon and surgical team) and teamwork (surgeon) measures were collected and compared between MP and SP RARPs, as well as the learning curve. Results from 25 MP and SP RARPs showed that overall, the NASA-TLX workload subscales were lower, and the teamwork modified NOTECHS subscales were higher for the MP RARPs compared to the SP RARPs. The underlying reason for the significant differences between these two RARP surgical procedures could be other factors (e.g., robot design factors) in addition to the surgeon and surgical team's experience. The results also suggested learning effects through the 25 SP RARPs; however, twenty-five procedures may not be enough to achieve proficiency with the SP system.

Breast cancer mortality remains unacceptably high, indicating a need for safer and more effective therapeutic agents. Disulfide bond Disrupting Agents (DDAs) were previously identified as a novel class of anticancer compounds that selectively kill cancers that overexpress the Epidermal Growth Factor Receptor (EGFR) or its family member HER2. DDAs kill EGFR+ and HER2+ cancer cells via the parallel downregulation of EGFR, HER2, and HER3 and activation/oligomerization of Death Receptors 4 and 5 (DR4/5). However, the mechanisms by which DDAs mediate these effects are unknown. Affinity purification analyses employing biotinylated-DDAs reveal that the Protein Disulfide Isomerase (PDI) family members AGR2, PDIA1, and ERp44 are DDA target proteins. Further analyses demonstrate that shRNA-mediated knockdown of AGR2 and ERp44, or expression of ERp44 mutants, enhance basal and DDA-induced DR5 oligomerization. DDA treatment of breast cancer cells disrupts PDIA1 and ERp44 mixed disulfide bonds with their client proteins. Together, the results herein reveal DDAs as the first small molecule, active site inhibitors of AGR2 and ERp44, and demonstrate roles for AGR2 and ERp44 in regulating the activity, stability, and localization of DR4 and DR5, and activation of Caspase 8.

Disulfide bond-disrupting agents (DDAs) are a new chemical class of agents recently shown to have activity against breast tumors in animal models. Blockade of tumor growth is associated with downregulation of EGFR, HER2, and HER3 and reduced Akt phosphorylation, as well as the induction of endoplasmic reticulum stress. However, it is not known how DDAs trigger cancer cell death without affecting nontransformed cells. As demonstrated here, DDAs are the first compounds identified that upregulate the TRAIL receptor DR5 through transcriptional and post-transcriptional mechanisms to activate the extrinsic cell death pathway. At the protein level, DDAs alter DR5 disulfide bonding to increase steady-state DR5 levels and oligomerization, leading to downstream caspase 8 and 3 activation. DDAs and TRAIL synergize to kill cancer cells and are cytotoxic to HER2+ cancer cells with acquired resistance to the EGFR/HER2 tyrosine kinase inhibitor Lapatinib. Investigation of the mechanisms responsible for DDA selectivity for cancer cells reveals that DDA-induced upregulation of DR5 is enhanced in the context of EGFR overexpression. DDA-induced cytotoxicity is strongly amplified by MYC overexpression. This is consistent with the known potentiation of TRAIL-mediated cell death by MYC. Together, the results demonstrate selective DDA lethality against oncogene-transformed cells, DDA-mediated DR5 upregulation, and protein stabilization, and that DDAs have activity against drug-resistant cancer cells. Our results indicate that DDAs are unique in causing DR5 accumulation and oligomerization and inducing downstream caspase activation and cancer cell death through mechanisms involving altered DR5 disulfide bonding. DDAs thus represent a new therapeutic approach to cancer therapy.

Studies utilizing a systems perspective show that individual work system elements impact surgeon workload. However, limited work has shown how multiple elements together can affect perceived workload in the healthcare domain. Using NASA-Task Load Index (NASA-TLX), this study aimed to compare operating room workload across two work system factors (surgical specialty and case number of the day) using a large set of self-reported surgeon workload data. Thirty-two surgeons completed 545 workload surveys across a three month period. Surgeons reported significant differences in composite workload scores across the surgical specialties (F(7,544)=3.622, p=0.001). Significant interactions were identified between surgical specialty and case number for composite workload, F(20,534)=1.72, p=0.027. While such findings are promising, future work is needed across multiple institutions to establish baseline workload values across specialties with different patient characteristics and work systems.

Forest preservation is crucial for protecting biodiversity and mitigating climate change. Here we assess current forest preservation in the western United States using spatial data and find that beyond the 18.9% (17.5 Mha) currently protected, an additional 11.1% (10.3 Mha) is needed to achieve 30% preservation by 2030 (30 × 30). To help meet this regional preservation target, we developed a framework that prioritizes forestlands for preservation using spatial metrics of biodiversity and/or carbon within each ecoregion. We show that meeting this preservation target would lead to greater protection of animal and tree species habitat, current carbon stocks, future carbon accumulation, and forests that are important for surface drinking water. The highest priority forestlands are primarily owned by the federal government, though substantial areas are also owned by private entities and state and tribal governments. Establishing Strategic Forest Reserves would help protect biodiversity and carbon for climate adaptation and mitigation.