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Salinity stress represents a key factor for global agriculture. Plants can respond to salinity stress by adapting their physiology in different ways with the aim of limiting reductions in growth and development. Importantly, moisture retention capacity, permeability and nutrient availability of substrates represent critical variables for plants as they may further influence the effect of osmotic stress. Here, a multidisciplinary approach was applied to evaluate the role of two different substrates, peat and perlite, on 2-year-old potted cuttings of Olea europaea (cultivar Arbequina) under different salinity stress conditions (0, 100 and 200 mM NaCl). Biometric and physiological data indicate that plants potted in perlite (AP) generally present lower growth and photosynthetic rates when compared with peat (AS) in combination with salinity stress. Ion measurements indicate a rise in Na+ accumulation with increasing stress severity, which alters the ion ratio in both substrates. In addition, differences occurred in polyphenol contents, with a general increase in quinic acid and rutin contents in AS and AP samples, respectively. Metabolomic and biometric data were also coupled with metabarcoding analysis, which indicates that the moderate salinity treatment (100 mM NaCl, T100) reshaped the endophytic community of plants grown on both substrates. Taken together, the data suggest that the strategy used by a glycophytic species such as the olive tree to cope with salinity stress seems to be highly related to availability of water and nutrients. The lack of both may be simulated by perlite, enhancing the effect of salinity stress response in woody plants. Lastly, applying the beneficial endophytic bacterial taxa identified here could represent a step forward in increasing plant defence and nutrient uptake and reducing inputs for modern and more sustainable agriculture.

Digitalization is often claimed by agri-food actors interested in using technology and corporations to provide many socio-economic benefits for farmers. This article reports on the results of a survey of Canadian farmers (n = 852) to explore producer perceptions of whether new digital technologies 1) improve the quality of work, 2) enhance productivity, 3) increase profitability, 4) offer a reliable return on investment, and 5) are as reliable as earlier tools and technologies. Farmer respondents generally agreed that digital farm tools have certain relative advantages, but considerable skepticism and varying views persist for certain benefits. Farmers with experience using digital tools were more likely to agree to improved quality of work and reliable return on investments. Meanwhile, farmer socio-demographics (region, level of education, farm ownership ratio) partly and to varying degrees explain perceptions of some relative advantages (e.g. productivity and reliability) but not others (e.g. profitability). In the context of the findings, we note with caution that farmers’ optimism for the relative advantages of digitalization could lay the foundation for acceptance of and receptivity for these innovations. However, if the goal is to encourage producers to embrace digital innovations widely, targeted programming to increase farmers’ first-hand experiences and research-backed informational programs on the potential benefits of digitalization would be needed.

Abstract Opioid use disorder (OUD) has emerged as a significant public health crisis affecting individuals across all age groups. However, there remains a critical gap in understanding the specific nuances and challenges associated with OUD in pediatric populations. This article provides a comprehensive review of the epidemiology, definition of OUD, screening recommendations for OUD, and evidence‐based management strategies for OUD in pediatric patients.

Abstract Acute agitation in youth is a challenging presentation to the emergency department. In many cases, however, youth can be behaviorally de‐escalated using a combination of environmental modification and verbal de‐escalation. In cases where additional strategies such as pharmacologic de‐escalation or physical restraint are needed, using the least restrictive means possible, including the youth in the decision‐making process, and providing options are important. This paper reviews specific considerations on the approach to a youth with acute agitation and strategies and techniques to successfully de‐escalate agitated youth who pose a danger to themselves and/or others.

Introduction: Seizures are a common presenting complaint and account for approximately 1% of total emergency department (ED) visits. Seizures are especially common in children less than five years old as they have a lower seizure threshold as compared to adults. One potentially dangerous etiology that is far less common, especially in children, is thyroid storm, the extreme manifestation of hyperthyroidism. Case Report: We describe the case of a 3-year-old girl who presented to the ED with an afebrile seizure but was found to be in thyroid storm. This case should serve as a reminder for emergency physicians to consider thyroid disease when evaluating patients presenting with seizures. Conclusion: Although most pediatric seizures are self-limited and frequently benign, it is imperative that the emergency physician evaluate for and rule out any potentially associated dangerous conditions such as thyroid storm.

Objectives: To examine drug overdose records in Brazil from 2000 to 2020, analyzing trends over time in overdoses and overall sociodemographic characteristics of the deceased. Methods: Using data from the Brazilian Mortality Information System (Sistema de Informações sobre Mortalidade), we identified records from 2000-2020 in which the underlying cause-of-death was one of the following codes: X40-X45 (accidental poisoning), X60-X65 (intentional poisoning), or Y10-Y15 (undetermined intentionality poisoning). The Brazilian dataset included 21,410 deaths. We used joinpoint regression analysis to assess changes in trends over time. Results: People who died of drug overdoses in Brazil between 2000 and 2020 had a mean age of 38.91 years; 38.45% were women, and 44.01% were identified as White. Of the overdose deaths, 44.70% were classified as intentional and 32.12% were classified as unintentional. Among the identified drugs, stimulants were the most common class. However, most records did not report which drug was responsible for death. Conclusion: Sociodemographic trends in overdose deaths in Brazil must guide country-specific policies. Nevertheless, data collection protocols must be improved, particularly regarding the drug used in overdoses.

Abstract Recent increases in pediatric and adolescent opioid fatalities mandate an urgent need for early consideration of possible opioid exposure and specific diagnostic and management strategies and interventions tailored to these unique populations. In contrast to adults, pediatric methods of exposure include accidental ingestions, prescription misuse, and household exposure. Early recognition, appropriate diagnostic evaluation, along with specialized treatment for opioid toxicity in this demographic are discussed. A key focus is on Naloxone, an essential medication for opioid intoxication, addressing its unique challenges in pediatric use. Unique pediatric considerations include recognition of accidental ingestions in our youngest population, critical social aspects including home safety and intentional exposure, and harm reduction strategies, mainly through Naloxone distribution and education on safe medication practices. It calls for a multifaceted approach, including creating pediatric‐specific guidelines, to combat the opioid crisis among children and to work to lower morbidity and mortality from opioid overdoses.

BackgroundThe Ehlers-Danlos syndromes (EDS) are a group of inherited connective tissue disorders characterized by disruptions in collagen synthesis and processing. These disorders lead to various symptoms, including hypermobility, musculoskeletal conditions, and chronic pain that can significantly limit patients' daily living. In the absence of a curative treatment, an EDS specific disability index that tracks changes in patient-reported outcomes can facilitate the investigation of new treatment options and enhance the quality of life for EDS patients.MethodsAn EDS-specific disability index was created using survey data and input from clinicians. A total of 222 EDS patients in a multidisciplinary clinical program completed the index during their initial visit. Exploratory and confirmatory factor analyses were conducted to determine the index's factor solution and assess its goodness-of-fit. Paired t-tests were performed with follow-up visit data collected over the course of one year.ResultsThe exploratory and confirmatory factor analyses indicated a two-factor solution, accounting for 42.40% of the variance. The index demonstrated adequate fit to the data, supported by Tucker and Lewis's index (0.85) and root mean square error of approximation (0.1). Data from follow-up visits showed significant improvement in three symptom related variables and one function related variable in addition to the total score and the symptom subscale score when compared to the initial visit.ConclusionThe development of an EDS-specific disability index is a crucial step in creating a clinical tool that enables healthcare professionals to gain a deeper understanding of the impact EDS has on patients’ lives and potentially identify new therapeutic interventions.

BackgroundA chatbot is a computer program that is designed to simulate conversation with humans. Chatbots may offer rapid, responsive, and private contraceptive information; counseling; and linkages to products and services, which could improve contraceptive knowledge, attitudes, and behaviors. ObjectiveThis review aimed to systematically collate and interpret evidence to determine whether and how chatbots improve contraceptive knowledge, attitudes, and behaviors. Contraceptive knowledge, attitudes, and behaviors include access to contraceptive information, understanding of contraceptive information, access to contraceptive services, contraceptive uptake, contraceptive continuation, and contraceptive communication or negotiation skills. A secondary aim of the review is to identify and summarize best practice recommendations for chatbot development to improve contraceptive outcomes, including the cost-effectiveness of chatbots where evidence is available. MethodsWe systematically searched peer-reviewed and gray literature (2010-2022) for papers that evaluated chatbots offering contraceptive information and services. Sources were included if they featured a chatbot and addressed an element of contraception, for example, uptake of hormonal contraceptives. Literature was assessed for methodological quality using appropriate quality assessment tools. Data were extracted from the included sources using a data extraction framework. A narrative synthesis approach was used to collate qualitative evidence as quantitative evidence was too sparse for a quantitative synthesis to be carried out. ResultsWe identified 15 sources, including 8 original research papers and 7 gray literature papers. These sources included 16 unique chatbots. This review found the following evidence on the impact and efficacy of chatbots: a large, robust randomized controlled trial suggests that chatbots have no effect on intention to use contraception; a small, uncontrolled cohort study suggests increased uptake of contraception among adolescent girls; and a development report, using poor-quality methods, suggests no impact on improved access to services. There is also poor-quality evidence to suggest increased contraceptive knowledge from interacting with chatbot content. User engagement was mixed, with some chatbots reaching wide audiences and others reaching very small audiences. User feedback suggests that chatbots may be experienced as acceptable, convenient, anonymous, and private, but also as incompetent, inconvenient, and unsympathetic. The best practice guidance on the development of chatbots to improve contraceptive knowledge, attitudes, and behaviors is consistent with that in the literature on chatbots in other health care fields. ConclusionsWe found limited and conflicting evidence on chatbots to improve contraceptive knowledge, attitudes, and behaviors. Further research that examines the impact of chatbot interventions in comparison with alternative technologies, acknowledges the varied and changing nature of chatbot interventions, and seeks to identify key features associated with improved contraceptive outcomes is needed. The limitations of this review include the limited evidence available on this topic, the lack of formal evaluation of chatbots in this field, and the lack of standardized definition of what a chatbot is.

Breast milk from people with overweight/obesity may differ in composition compared with that from normal-weight people. Exercise training can modify breast milk composition in rodent models, with a beneficial impact demonstrated on the offspring’s metabolism, but whether these findings translate to humans is unclear. This trial aims to determine the effect of an exercise intervention on breast milk composition and whether an exercise-induced modification of breast milk impacts the infants’ growth and body composition. Effect of Exercise Training on Breastmilk Composition is a randomised, controlled trial with two parallel groups, one exercise group and one control group, with a 1:1 allocation. We will include a minimum of 62 exclusively breastfeeding participants, 6 weeks postpartum. The exercise intervention lasts 8 weeks and comprises 25 supervised endurance exercise sessions with moderate or high intensity. The primary outcome measure is the change in the relative concentration of the human milk oligosaccharide 3′sialyllactose in breast milk from baseline at 6 weeks postpartum to the end of the intervention period. Secondary outcomes include breast milk concentrations of other metabolites, cytokines, hormones and microRNA, maternal health outcomes, infant growth, infant gut microbiome and infant circulating microRNA. Maternal and infant outcomes will be measured before, during and after the intervention period, with a follow-up of the infants until they are 24 months old. Trial registration number NCT05488964.

BackgroundDigital technologies may improve sexual and reproductive health (SRH) across diverse settings. Chatbots are computer programs designed to simulate human conversation, and there is a growing interest in the potential for chatbots to provide responsive and accurate information, counseling, linkages to products and services, or a companion on an SRH journey. ObjectiveThis review aimed to identify assumptions about the value of chatbots for SRH and collate the evidence to support them. MethodsWe used a realist approach that starts with an initial program theory and generates causal explanations in the form of context, mechanism, and outcome configurations to test and develop that theory. We generated our program theory, drawing on the expertise of the research team, and then searched the literature to add depth and develop this theory with evidence. ResultsThe evidence supports our program theory, which suggests that chatbots are a promising intervention for SRH information and service delivery. This is because chatbots offer anonymous and nonjudgmental interactions that encourage disclosure of personal information, provide complex information in a responsive and conversational tone that increases understanding, link to SRH conversations within web-based and offline social networks, provide immediate support or service provision 24/7 by automating some tasks, and provide the potential to develop long-term relationships with users who return over time. However, chatbots may be less valuable where people find any conversation about SRH (even with a chatbot) stigmatizing, for those who lack confidential access to digital devices, where conversations do not feel natural, and where chatbots are developed as stand-alone interventions without reference to service contexts. ConclusionsChatbots in SRH could be developed further to automate simple tasks and support service delivery. They should prioritize achieving an authentic conversational tone, which could be developed to facilitate content sharing in social networks, should support long-term relationship building with their users, and should be integrated into wider service networks.

Endocrine disruptors have devastating impacts on the reproductive physiology of aquatic organisms. The Gulf pipefish, Syngnathus scovelli, is a sexually dimorphic species, which demonstrates predictable morphological, physiological, behavioral, and genetic responses to synthetic estrogen exposure. It has a broad geographic range, spanning freshwater and marine environments, making it a potential sentinel species across a wide range of habitats. In this study, we investigated the effects of ecologically relevant levels of 17α-ethinylestradiol (EE2) exposure on gene expression patterns in the male pipefish’s brood pouch. We also characterized the extent to which EE2-exposed males developed coloration patterns that are normally restricted to females. We identified differentially expressed genes in the brood pouches of pregnant and non-pregnant males when males were exposed to 5ng/L EE2 from the second to eighth day of pregnancy (which normally lasts about 2 weeks). Our result revealed several potential candidate genes that have a role in the brood pouch’s response to environmental estrogens. We also identified genes that were differentially expressed between mid-gestation pregnant males and non-pregnant males. We found an overall greater effect of EE2 exposure in the transcriptomes of non-pregnant males, which may explain why estrogen-exposed males exhibited difficulty receiving eggs in previous studies. The offspring developed similarly in the control and estrogen treatments, highlighting a potential link between the timing of EE2 exposure and its effects on male pregnancy. These results provide insight into how breeding pipefish populations may still exist even though they are found in freshwater and coastal locations where they are periodically exposed to potentially high concentrations of endocrine-disrupting compounds. We also present examples of female-typical coloration development on males due to EE2 exposure and identify candidate brood pouch genes that can be utilized as biomarkers, contributing to the development of the Gulf pipefish as a sentinel model for ecotoxicology.

Reliably quantifying the strength of visual sexual signals, such as iridescence, has been challenging across the field of evolutionary biology, but is critically important for studying biologically relevant trait variation. To address this issue, we present the Iridescence Detection and Isolation Algorithm (IDIA), which was designed to isolate the iridescent signal from photographs for quantification of ornamentation. The Gulf pipefish, Syngnathus scovelli, served as a model system for testing the limits of the algorithm, and was an ideal test case due to their female-specific iridescent bands on their abdomens with a large degree of among-individual variation. Specifically, we tested the repeatability of iridescence estimates in a variety of settings, including manual versus automated measurements, a gradient of lighting intensities, observational data from multiple populations, and in detecting exposure to synthetic estrogen. Using the IDIA, female iridescence was quantified in two ways with results indicating a manual measurement of each individual band may be more reliable than the automated measurement taken by drawing a polygon around all bands. However, the intensity of the lighting the photographs were taken in did not significantly affect repeatability of the measurement of iridescence no matter how it was taken. The IDIA was able to detect geographical variation in female ornamentation of S. scovelli, demonstrating that our automated approach can potentially replicate previously-described population-level variation. Differences in the iridescent signal were significant when comparing female pipefish from the Florida coast to females collected from the Texas coast, indicating the possibility that external factors, such as differing environmental conditions, could affect the strength of female visual signals. Lastly, the IDIA was applied in an ecotoxicology application to detect the development of iridescence in male pipefish exposed to synthetic estrogen. Exposed males began expressing banding patterns with iridescence levels within the range of females. The results from this study confirm the feasibility of using the IDIA for measuring iridescence in fish across a variety of applications.

Industry 4 (I4) was a revolutionary new stage for technological progress in manufacturing which promised a new level of interconnectedness between a diverse range of technologies. Sensors, as a point technology, play an important role in these developments, facilitating human–machine interaction and enabling data collection for system-level technologies. Concerns for human labour working in I4 environments (e.g., health and safety, data generation and extraction) are acknowledged by Industry 5 (I5), an update of I4 which promises greater attention to human–machine relations through a values-driven approach to collaboration and co-design. This article explores how engineering experts integrate values promoted by policy-makers into both their thinking about the human in their work and in their writing. This paper demonstrates a novel interdisciplinary approach in which an awareness of different disciplinary epistemic values associated with humans and work guides a systematic literature review and interpretive coding of practice-focussed engineering papers. Findings demonstrate evidence of an I5 human-centric approach: a high value for employees as “end-users” of innovative systems in manufacturing; and an increase in output addressing human activity in modelling and the technologies available to address this concern. However, epistemic publishing practices show that efforts to increase the effectiveness of manufacturing systems often neglect worker voice.

Abstract Cannabis is the most used recreational drug in the United States, and its use is increasing among children and adolescents. With the increase in legalized use, there have been increases in intentional and accidental cannabis exposure in the pediatric population. There is also minimized perceived risk. We review the current use of cannabis and its derivatives, the drug effects and clinical presentation, common misconceptions, pharmacology, and epidemiology. Finally, we review some long‐term consequences of cannabis use.

Abstract Pediatric pain is challenging to assess and manage. Frequently underestimated in children, untreated pain may have consequences including increased fear, anxiety, and psychological issues. With the current opioid crisis, emergency physicians must be knowledgeable in both pharmacologic and non‐pharmacologic approaches to address pain and anxiety in children that lead to enhanced patient cooperation and family satisfaction. This document focuses pain management and distress mitigation strategies for the brief diagnostic and therapeutic procedures commonly performed.

A growing body of literature highlights the increasing demand on college graduates to possess the problem finding, problem framing, and problem-solving skills necessary to address complex real-world challenges. Design thinking (DT) is an iterative, human-centered approach to problem solving that synthesizes what is desirable, equitable, technologically feasible, and sustainable. As universities expand efforts to train students with DT mindsets and skills, we must assess faculty and student DT practices and outcomes to better understand DT course experiences. Understanding how DT is taught and experienced within higher education can help schools promote student learning and align their training programs with professional, personal, and civic needs. In this study, surveys were completed by 19 faculty and 196 students from 23 courses at four universities. DT teaching and learning was characterized by three DT practices and five outcomes. Statistically significant differences were found by discipline of study and student type (i.e., graduate vs undergraduate), but not by gender or race/ethnicity. These results can be used to inform the development of classroom-based DT teaching and learning strategies across higher education institutions and disciplines.

Background: Our instructional team at the The University of North Carolina at Chapel Hill led an innovative project that used IDEO.org's design thinking process to create a brand-new interdisciplinary graduate course, housed in the school of public health, titled Design Thinking for the Public Good. We offer our course design process as a case study of the use of design thinking for course design.Methods: We collected data and generated insights through a variety of inspiration, ideation, and implementation design thinking methods alongside members of our three stakeholder groups: (1) faculty who teach or have taught courses related to design thinking at our higher education institution; (2) design thinking experts at ours and other institutions and outside of higher education; and (3) graduate students at our institution.Results: We learned that interdisciplinary design thinking courses should include growth-oriented reflection, explicit group work skills, and content with a real-world application.Conclusions: Our course design process and findings can be replicated to design courses regardless of area of study, level, or format.

Objective The mandible is the most common fractured craniofacial bone of all craniofacial fractures in the Philippines, with the mandibular body as the most involved segment of all mandibular fractures. To the best of our knowledge, there are no existing guidelines for the diagnosis and management of mandibular body fractures in particular. General guidelines include the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAOHNSF) Resident Manual of Trauma to the Face, Head, and Neck chapter on Mandibular Trauma, the American Association of Oral and Maxillofacial Surgeons (AAOMS) Clinical Practice Guidelines for Oral and Maxillofacial Surgery section on the Mandibular Angle, Body, and Ramus, and a 2013 Cochrane Systematic Review on interventions for the management of mandibular fractures. On the other hand, a very specific Clinical Practice Guideline on the Management of Unilateral Condylar Fracture of the Mandible was published by the Ministry of Health Malaysia in 2005. Addressing the prevalence of mandibular body fractures, and dearth of specific guidelines for its diagnosis and management, this clinical practice guideline focuses on the management of isolated mandibular body fractures in adults. Purpose This guideline is meant for all clinicians (otolaryngologists – head and neck surgeons, as well as primary care and specialist physicians, nurses and nurse practitioners, midwives and community health workers, dentists, and emergency first-responders) who may provide care to adults aged 18 years and above that may present with an acute history and physical and/ or laboratory examination findings that may lead to a diagnosis of isolated mandibular body fracture and its subsequent medical and surgical management, including health promotion and disease prevention. It is applicable in any setting (including urban and rural primary-care, community centers, treatment units, hospital emergency rooms, operating rooms) in which adults with isolated mandibular body fractures would be identified, diagnosed, or managed. Outcomes are functional resolution of isolated mandibular body fractures; achieving premorbid form; avoiding use of context-inappropriate diagnostics and therapeutics; minimizing use of ineffective interventions; avoiding co-morbid infections, conditions, complications and adverse events; minimizing cost; maximizing health-related quality of life of individuals with isolated mandibular body fracture; increasing patient satisfaction; and preventing recurrence in patients and occurrence in others.

Civil unrest is a call for realignment of values in all aspects of society, including medical education. Systematic difference in the treatment of groups of individuals concerning educational curricula has previously been highlighted in South Africa during student-led campaigns to decolonialize and diversify medical curricula1. Institutional resistance that results in a failure to account for the politics of identity or for pluralistic thinking,1 implies that the academic ‘fence of unambiguous knowledge’ not only creates an ivory tower but it may simultaneously insulate itself from community input and access. Confronting the tension between communal meaning (which sanctions a culturally relevant curriculum) and privileged meaning (which derives from a monolithic mindset) demands that educators recognize that the scientific method is only one ‘way of knowing.’ In this manuscript we ask: Who possesses authoritative medical meaning-making? And, Who confers authoritativeness to academia?

Introduction As childhood mortality from infectious diseases falls across sub-Saharan Africa (SSA), the burden of disease attributed to surgical conditions is increasing. However, limited data exist on paediatric surgical outcomes in SSA. We compared the outcomes of five common paediatric surgical conditions in SSA with published benchmark data from high-income countries (HICs).Methods A multicentre, international, prospective cohort study was undertaken in hospitals providing paediatric surgical care across SSA. Data were collected on consecutive children (birth to 16 years), presenting with gastroschisis, anorectal malformation, intussusception, appendicitis or inguinal hernia, over a minimum of 1 month, between October 2016 and April 2017. Participating hospitals completed a survey on their resources available for paediatric surgery.The primary outcome was all-cause in-hospital mortality. Mortality in SSA was compared with published benchmark mortality in HICs using χ2 analysis. Generalised linear mixed models were used to identify patient-level and hospital-level factors affecting mortality. A p

Reforming instruction is challenging. In this comparative case study of 12 school districts, we investigated the dilemmas that emerged for system leaders as they engaged in system building for elementary science and the approaches leaders took in managing them. We found that system leaders' efforts to manage their environments contributed to the preferential treatment of literacy and mathematics relative to science. Leaders managed this dilemma using three strategies: (a) integration of science with other subjects, (b) specialization of teachers, and (c) adopting curriculum materials. This study contributes to literature on dilemma management by showing that dilemmas in education system building are school-subject sensitive, emerge in relation to system building for other subjects, and are embedded in school and education systems' structural/organizational arrangements.

Abstract The prevalence of urinary stone disease (USD) is rapidly rising. However, the factors driving this increase are unknown. Recent microbiome studies suggest that dysbiosis may in part contribute to the increasing prevalence. The objective of the current study was to determine the nature and location of dysbiosis associated with USD. We conducted microbiome analysis from the gastrointestinal and urinary tracts, along with a metabolomic analysis of the urinary metabolome, from subjects with an active episode of USD or no history of the disease. Higher rates of antibiotic use among USD patients along with integrated microbiome and metabolomic results support the hypothesis that USD is associated with an antibiotic-driven shift in the microbiome from one that protects against USD to one that promotes the disease. Specifically, our study implicates urinary tract Lactobacillus and Enterobacteriaceae in protective and pathogenic roles for USD, respectively, which conventional, culture-based methods of bacterial analysis from urine and kidney stones would not necessarily detect. Results suggest that antibiotics produce a long-term shift in the microbiome that may increase the risk for USD, with the urinary tract microbiome holding more relevance for USD than the gut microbiome.

Solid dose vaccine formulation and delivery systems offer potential advantages over traditional liquid vaccine formulations. In addition to enhanced thermostability, needle-free delivery of unit solid dose injectable (USDI) vaccines offers safe, rapid, and error-free administration, with applicability to both human and animal health. Solid dose formulation technologies can be adapted for delivery of different vaccine formats including live attenuated vaccines, which remain the ‘gold standard’ for many disease targets. Porcine reproductive and respiratory syndrome viruses (PRRSV) cause one of the most economically important diseases affecting the global pig industry. Despite several shortcomings, live attenuated vaccines are widely used to control PRRSV. We optimised a freeze-dried USDI formulation of live attenuated PRRSV-1, which fully retained infectious titre, and evaluated its immunogenicity in comparison to virus delivered in liquid suspension via intramuscular and subcutaneous needle inoculation. Pigs vaccinated with the USDI formulation displayed vaccine viraemia, and PRRSV-specific antibody and T cell responses comparable to animals immunised with the liquid vaccine. The USDI vaccine formulation was stable for at least 6 months when stored refrigerated. These data demonstrate the potential for a solid dose vaccine delivery system as an alternative to conventional needle-syringe delivery of live attenuated PRRSV vaccines.

Abstract The opioid crisis has greatly affected not only adults but also children as well. As clinicians develop effective approaches to minimize pain and distress in children, the risks and benefits of opioids must be carefully considered. Children of parents with opioid use disorder are also at risk of living in unstable environments, performing poorly academically, engaging in future drug use, and having increased stress, which affects their development before entering adulthood. This statement focuses on the effects of the opioid crisis on children and adolescents and is intended to inform institutional policies, improve education, advocate for evidence‐informed guidelines, and improve the care of children affected by the opioid epidemic who are seen in the emergency department.

The term “listening niche” refers to the contexts in which people listen to music including what music they are listening to, with whom, when, where, and with what media. The first experiment investigates undergraduate students’ music listening niches in the initial COVID-19 lockdown period, 4 weeks immediately after the campus shut down abruptly. The second experiment explores how returning to a hybrid semester, the “new normal,” further affected these listening habits. In both experiments, the participants provided a list of their most frequently listened-to songs during the respective period of time. From these, they identified one song that seemed most associated with this period, their “signature song,” and stated why this song seemed relevant. These reasons were coded on nine underlying themes. Three clusters were found to underlie the themes: (1) emotional responses (2) memory associations, and (3) discovery of new music. We identified songs and reasons for selecting them that represented the three clusters and related these to the lyrical content. Compared to before the pandemic, participants in both experiments report listening more in general and on Spotify, but there were no differences in listening between lockdown and the new normal. Whom they were listening with shifted overtime from family members to significant others and finally to other friends and roommates. These results demonstrate how students listen to and find new music that is meaningful to them during this unprecedented pandemic.

Future space-based geodesy missions such as the Mass Change Mission and the Next Generation Gravity Mission are expected to rely on laser ranging as their primary instrument. Short-term laser frequency stability has previously been achieved on the GRACE Follow On mission by stabilizing the lasers to an optical cavity. The development of a technique to provide long-term laser frequency stability is expected to be required. We have previously demonstrated a technique to track long-term frequency changes by using measurements of the optical cavity’s free spectral range. In this paper, we calibrate this technique to absolute frequency by using an atomic reference. We have also validated an approach for on-ground calibration to allow the absolute frequency to be determined whilst in orbit.

Abstract Tick-borne rickettsial pathogens (TBRP) are important causes of infections in both dogs and humans. Dogs play an important role as a biological host for several tick species and can serve as sentinels for rickettsial infections. Our aim was to determine the presence of TBRP in dogs and in dog-associated ticks and their potential risk to human diseases in Medellin, Colombia. DNA for E. canis (16S rRNA and dsb) and A. platys (groEl) was detected in 17.6% (53/300) and 2.6% (8/300) of dogs, respectively. Antibodies against Ehrlichia spp. 82 (27.3%) and Anaplasma spp. 8 (2.6%) were detected in dogs. Antibody reactivity against both agents were found in 16 dogs (5.3%). Eight dogs showed antibody for Rickettsia spp. with titers that suggest 3 of them had a probable exposure to R. parkeri. Rhipicephalus sanguineus s.l. (178/193) was the main tick in dogs, followed by R. microplus (15/193). The minimum infection rates (MIR) in R. sanguineus were 11.8% for E. canis and 3.4% for A. platys. E. canis and A. platys are the main TBRP infecting dogs and ticks and R. sanguineus s.l. is likely involved in the transmission of both agents. Interestingly, we found serological evidence of exposure in dogs for spotted fever group rickettsiae.

Background and significance Blast injuries arising from high explosive weaponry is common in conflict areas. While blast injury characteristics are well recognised in the adults, there is a lack of consensus as to whether these characteristics translate to the paediatric population. Understanding blast injury patterns in this cohort is essential for providing appropriate provision of services and care for this vulnerable cohort.Methods In this mixed-methods review, original papers were screened for data pertaining to paediatric injuries following blasts. Information on demographics, morbidity and mortality, and service requirements were evaluated. The papers were written and published in English from a range of international specialists in the field.Results Children affected by blast injuries are predominantly male and their injuries arise from explosive remnants of war, particularly unexploded ordinance. Blasts show increased morbidity and mortality in younger children, while older children have injury patterns similar to adults. Head and burn injuries represent a significant cause of mortality in young children, while lower limb morbidity is reduced compared with adults. Children have a disproportionate requirement for both operative and non-operative service resources, and provisions for this burden are essential.Conclusions Certain characteristics of paediatric injuries arising from blasts are distinct from that of the adult cohort, while the intensive demands on services highlight the importance of understanding the diverse injury patterns in order to optimise future service provisions in caring for this child blast survivor.

PURPOSE: To describe positive mental health, or flourishing, and self-reported health trajectories among transition-aged young adults (TAYA) with developmental/learning and physical disabilities over a 12-year period, utilizing a population-based sample. METHODS: This study features a secondary analysis of national data from the Panel Study of Income Dynamics Transition to Adulthood Supplement. The analytic sample included all TAYA with (n = 487) and without (n = 810) disabilities, including developmental/learning disabilities (DD/LD), attention deficit hyperactivity disorder (ADHD), and speech, hearing, and vision impairments who participated in 2017 Transition to Adulthood Supplement data collection (n = 1,297; M age = 24.5, standard deviation = 2.40). We utilized linear mixed modeling to retrospectively describe flourishing and self-reported health trajectories across 12 years among TAYA with and without disabilities between ages 18 to 28, adjusting for demographic and developmental characteristics. RESULTS: Relative to TAYA without disabilities, TAYA with speech [0.10, 0.85] and vision impairments [0.10, 0.92], DD/LD [0.38, 1.11], and ADHD [0.27, 0.97] demonstrated lower flourishing. TAYA with speech [0.07, 0.36] and vision impairments [0.08, 0.38], DD/LD [0.15, 0.411], and ADHD [0.14, 0.93] reported lower health. Relative to TAYA with other disabilities, TAYA with ADHD [0.14, 0.93] and DD/LD [0.01, 0.29] reported lower flourishing and health, respectively. Interaction effects and descriptive analyses revealed distinct patterns of change for TAYA with ADHD. DISCUSSION: TAYA with disabilities report lower flourishing and health, relative to TAYA without disabilities. TAYA with specific disabilities differ in their flourishing and health trajectories. Findings can inform the development of interventions for TAYA with disabilities.

Team collaboration is an essential for success both within academics and the clinical environment. Often, team collaboration is not explicitly taught during medical school or even residency, and must be learned during one’s early career. In this article, we aim to summarize five key papers about team collaboration for early career clinician educators. We conducted a consensus-building process among the writing team to generate a list of key papers that describe the importance or significance of team collaboration, seeking input from social media sources. The authors then used a three-round voting methodology akin to a Delphi study to determine the most important papers from the initially generated list. The five most important papers on the topic of team collaboration, as determined by this mixed group of junior faculty members and faculty developers, are presented in this paper. For each included publication, a summary was provided along with its relevance to junior faculty members and faculty developers. Five key papers about team collaboration are presented in this publication. These papers provide a foundational background to help junior faculty members with collaborating in teams both clinically and academically. This list may also inform senior faculty and faculty developers about the needs of junior faculty members. [West J Emerg Med. 2017;18(2)303-310.]

Abstract Introduction We aimed to evaluate the safety, efficacy and surgical outcomes of combined laparoscopic/vaginal prolapse repair by two surgeons. Material and Methods A retrospective chart review of all patients (n =135) who underwent apical prolapse repair from February 2009 to December 2012 performed in a collaborative manner by a Minimally Invasive Gynecologic Surgeon and a Urogynecologist. Demographic data (age, body mass index [BMI], race, gravidity, parity) and surgical information (estimated blood loss, operative time, intraoperative complications, readmission and reoperation rates, presence of postoperative infection) were collected. Results The majority of patients were postmenopausal (58.91%), multiparous (mean parity =2.49) and overweight (mean BMI =27.71). Nearly 20% had previous prolapse surgery. The most common surgical procedure was laparoscopic supracervical hysterectomy (LSH) with sacrocervicopexy (59.26%), and the most common vaginal repair was of the posterior compartment (78.68%). The median operative time was 149 minutes (82-302), and the estimated blood loss was 100 mL (10-530). Five intraoperative complications, five readmissions and four reoperations were noted. Performance of a concomitant hysterectomy did not affect surgical or anatomical outcomes. Conclusion Combination laparoscopic/vaginal prolapse repair by two separate surgeons seems to be an efficient option for operative management.

Seahorses are considered one of the most iconic examples of a monogamous species in the animal kingdom. This study investigates the relationship between stocking density and mating and competitive behavior from the context of the field biology of the dwarf seahorse, Hippocampus zosterae (Jordan & Gilbert). Animals were housed in 38 liter tanks at a range of densities and sex ratios (from 2-8 animals per tank), and their reproductive and other social behaviors were monitored from tank introduction through copulation. At low tank densities and even sex ratios but comparatively high field densities, frequency of both mating and competitive behaviors was low in trials. A higher level of males in tanks across all densities increased competition, activity levels, and aggression leading to egg transfer errors and brood expulsion, resulting in lower reproductive success. Across seahorse species, mean and maximum wild densities were consistently lower than those used in ex situ breeding, with adult sex ratios that were significantly female biased. However, significant variation exists in wild seahorse densities across species, with higher densities detected in focal/mark recapture studies and on artificial habitat structures than reported with belt transect sampling techniques. Interchange of knowledge gained in both aquarium and wild contexts will allow us to better understand the biology of this genus, and improve reproduction in captivity. Interpreting ex situ reproductive behaviors of seahorses within various densities reported from natural populations will help us predict the impact of conservation efforts and increase the likelihood of long-term persistence of populations for this threatened genus.

[This corrects the article DOI: 10.1371/journal.pone.0219436.].

RAS is the founding member of a superfamily of GTPases and regulates signaling pathways involved in cellular growth control. While recent studies have shown that the activation state of RAS can be controlled by lysine ubiquitylation and acetylation, the existence of lysine methylation of the RAS superfamily GTPases remains unexplored. In contrast to acetylation, methylation does not alter the side chain charge and it has been challenging to deduce its impact on protein structure by conventional amino acid substitutions. Herein, we investigate lysine methylation on RAS and RAS-related GTPases. We developed GoMADScan (Go language-based Modification Associated Database Scanner), a new user-friendly application that scans and extracts posttranslationally modified peptides from databases. The GoMADScan search on PhosphoSitePlus databases identified methylation of conserved lysine residues in the core GTPase domain of RAS superfamily GTPases, including residues corresponding to RAS Lys-5, Lys-16, and Lys-117. To follow up on these observations, we immunoprecipitated endogenous RAS from HEK293T cells, conducted mass spectrometric analysis and found that RAS residues, Lys-5 and Lys-147, undergo dimethylation and monomethylation, respectively. Since mutations of Lys-5 have been found in cancers and RASopathies, we set up molecular dynamics (MD) simulations to assess the putative impact of Lys-5 dimethylation on RAS structure. Results from our MD analyses predict that dimethylation of Lys-5 does not significantly alter RAS conformation, suggesting that Lys-5 methylation may alter existing protein interactions or create a docking site to foster new interactions. Taken together, our findings uncover the existence of lysine methylation as a novel posttranslational modification associated with RAS and the RAS superfamily GTPases, and putative impact of Lys-5 dimethylation on RAS structure.

Decades of work exploring the development of children's analogical reasoning illustrates that 3- and 4-year-old children struggle with reasoning by analogy (i.e. glove:hand::sock:___), almost always preferring superficially related “object matches” (:shoe) over “relational matches” (:foot). However, one recent study demonstrated preschoolers' ability to choose relational matches when a traditional relational-match-to-sample task is embedded in causal scaffolding, framing the target abstract relation as one between beginning and ending states of a causal transformation. Current work aims to discover which factors of causal framing facilitate this boost in early abstract reasoning. In Study 1, we replicate this effect while adapting the transformation to involve two objects, showing that preservation of identity is not necessary for analogical reasoning in a causal context. In Study 2, we explore the replicated effect in a case of non-agentive causation, finding that the causal boost, while still present, is significantly weaker when scaffolding involves a machine vs. an agent. These findings demonstrate that causal framing can be a powerful tool in bolstering children's early abstract reasoning capabilities and show that this enhancing effect is even stronger when an agent holds causal power.

Introduction The emergency medicine (EM) clerkship curriculum at Los Angeles County + University of Southern California Medical Center includes monthly lectures on pediatric fever and shortness of breath (SOB). This educational innovation evaluated if learning could be enhanced by “priming” the students with educational online videos prior to an in-class session. Factors that impacted completion rates were also evaluated (planned specialty and time given for video viewing). Methods Twenty-minute videos were to be viewed prior to the didactic session. Students were assigned to either the fever or SOB group and received links to those respective videos. All participating students took a pre-test prior to viewing the online lectures. For analysis, test scores were placed into concordant groups (test results on fever questions in the group assigned the fever video and test results on SOB questions in the group assigned the SOB video) and discordant groups (crossover between video assigned and topic tested). Each subject contributed one set of concordant results and one set of discordant results. Descriptive statistics were performed with the Mann-Whitney U test. Lecture links were distributed to students two weeks prior to the in-class session for seven months and three days prior to the in-class session for eight months (in which both groups included both EM-bound and non-EM bound students). Results In the fifteen-month study period, 64% of students rotating through the EM elective prepared for the in class session by watching the videos. During ten months where exclusively EM-bound students were rotating (n=144), 71.5% of students viewed the lectures. In four months where students were not EM-bound (n=54), 55.6% of students viewed the lectures (p=0.033). Participation was 60.2% when lecture links were given three days in advance and 68.7% when links were given two weeks in advance (p=0.197). In the analysis of concordant scores, the pre-test averaged 56.7% correct, the immediate post-test averaged 78.1% correct, and the delayed post-test was 67.2%. In the discordant groups, the pretest averaged 51.9%, the immediate posttest was 67.1% and the delayed by 68.8%. In the concordant groups, the immediate post-test scores improved by 21.4%, compared with 15.2% in the discordant groups (p = 0.655). In the delayed post-test the concordant scores improved by 10.5% and discordant scores by 16.9 percent (p=0.609). Sixty-two percent of students surveyed preferred the format of online videos with in-class case discussion to a traditional lecture format. Conclusion Immediate post-tests and delayed post-tests improved but priming was not demonstrated to be a statistically superior educational method in this study. Medical student completion of the preparatory materials for the EM rotation session increased when the students were EM-bound. Participation rates were not significantly different when given at two weeks versus three days.

Introduction: Peer review, a cornerstone of academia, promotes rigor and relevance in scientific publishing. As educators are encouraged to adopt a more scholarly approach to medical education, peer review is becoming increasingly important. Junior educators both receive the reviews of their peers, and are also asked to participate as reviewers themselves. As such, it is imperative for junior clinician educators to be well-versed in the art of peer reviewing their colleagues’ work. In this article, our goal was to identify and summarize key papers that may be helpful for faculty members interested in learning more about the peer-review process and how to improve their reviewing skills. Methods: The online discussions of the 2016–17 Academic Life in Emergency Medicine (ALiEM) Faculty Incubator program included a robust discussion about peer review, which highlighted a number of papers on that topic. We sought to augment this list with further suggestions by guest experts and by an open call on Twitter for other important papers. Via this process, we created a list of 24 total papers on the topic of peer review. After gathering these papers, our authorship group engaged in a consensus-building process incorporating Delphi methods to identify the papers that best described peer review, and also highlighted important tips for new reviewers. Results: We found and reviewed 24 papers. In our results section, we present our authorship group’s top five most highly rated papers on the topic of peer review. We also summarize these papers with respect to their relevance to junior faculty members and to faculty developers. Conclusion: We present five key papers on peer review that can be used for faculty development for novice writers and reviewers. These papers represent a mix of foundational and explanatory papers that may provide some basis from which junior faculty members might build upon as they both undergo the peer-review process and act as reviewers in turn.

Diphenhydramine toxicity commonly manifests with antimuscarinic features, including dry mucous membranes, tachycardia, urinary retention, mydriasis, tachycardia, and encephalopathy. Severe toxicity can include seizures and intraventricular conduction delay. We present here a case of a 23-year-old male presenting with recurrent seizures, hypotension and wide complex tachycardia who had worsening toxicity despite treatment with sodium bicarbonate. The patient was ultimately treated with intravenous lipid emulsion therapy that was temporally associated with improvement in the QRS duration. We also review the current literature that supports lipid use in refractory diphenhydramine toxicity. [West J Emerg Med. 2014;15(7):–0.]

This paper examines multicultural issues that currently exist within the field of music therapy. Music therapists often find themselves working with clients who come from very different cultural backgrounds than themselves. Before music therapists can understand and work with clients from other cultures, they must first have an understanding of their own background and culture, and how their values and beliefs have shaped them as therapists. This paper highlights the value of multicultural awareness, and explores issues of disability, gender/sexuality, feminism, and race, as they relate to music therapy.