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Time-honoured university policies, such as the credit-hour and academic freedom, present challenges for professional education programs tasked with operationalizing entry-to-practice competence frameworks for professional accreditation. A single embedded case study was used to explore how professional programs from one mid-sized Canadian university are approaching and perhaps problematizing the development and assessment of competence. Semi-structured interviews were conducted with educational leaders (faculty and staff, n=21) from a sample of nine programs. Following a grounded theory approach to qualitative analysis, the constant comparative method was used to inductively discern similarities and differences across programs, and to begin building theory about approaches to operationalization. While limited in scope given the use of a single university, our findings highlight: (a) diversity in approaches to operationalization across programs, (b) common attributes which can be used to classify the manner in which these programs operationalize competence, and (c) challenges with supporting faculty to buy in to competency-informed pedagogy and assessment. Given these findings, it is recommended that professional accrediting bodies and education programs spend time to consider the role university-based programs play in determining competence for entry-to-practice, as well their intents for implementing a competence framework, to ensure sufficiency in the approaches being used. Les politiques universitaires qui ont fait leurs preuves, telles que les crédits-heures et la liberté académique, présentent des défis dans le cas des programmes d’enseignement professionnel dont la tâche est de rendre opérationnels les cadres de compétence de l’entrée à la pratique pour l’obtention d’une accréditation professionnelle. Une étude de cas intégrée unique a été utilisée pour explorer comment les programmes professionnels d’une université canadienne de taille moyenne répondent et peut-être rendent problématique le développement et l’évaluation des compétences. Des entrevues semi-structurées ont été menées avec des leaders en éducation (enseignants et personnel, n=21) d’un échantillon de neuf programmes. En suivant une approche théorique fondée à l’analyse qualitative, la méthode comparative constante a été utilisée pour discerner inductivement les similarités et les différences entre les programmes, et pour commencer à échafauder une théorie sur les approches à l’opérationalisation. Nos résultats, bien que limités dans leur portée du fait que nous n’avons fait cette recherche que dans une seule université, illustrent ce qui suit : (a) la diversité dans les approches à l’opérationalisation dans divers programmes, (b) les attributs communs qui peuvent être utilisés pour classifier la manière dont ces programmes opérationalisent la compétence, et (c) les défis pour encourager les enseignants à accepter une pédagogie fondée sur les compétences et l’évaluation. Vus ces résultats, il est recommandé que les organismes d’accréditation et les programmes d’enseignement prennent le temps de considérer le rôle que les programmes universitaires jouent pour déterminer la compétence de l’entrée à la pratique, ainsi que leur intention de mettre en pratique un cadre de compétence, afin d’assurer la suffisance dans les approches utilisées.

Competency frameworks are developed for a variety of purposes, including describing professional practice and informing education and assessment frameworks. Despite the volume of competency frameworks developed in the healthcare professions, guidance remains unclear and is inconsistently adhered to (perhaps in part due to a lack of organizing frameworks), there is variability in methodological choices, inconsistently reported outputs, and a lack of evaluation of frameworks. As such, we proposed the need for improved guidance. In this paper, we outline a six-step model for developing competency frameworks that is designed to address some of these shortcomings. The six-steps comprise [1] identifying purpose, intended uses, scope, and stakeholders; [2] theoretically informed ways of identifying the contexts of complex, “real-world” professional practice, which includes [3] aligned methods and means by which practice can be explored; [4] the identification and specification of competencies required for professional practice, [5] how to report the process and outputs of identifying such competencies, and [6] built-in strategies to continuously evaluate, update and maintain competency framework development processes and outputs. The model synthesizes and organizes existing guidance and literature, and furthers this existing guidance by highlighting the need for a theoretically-informed approach to describing and exploring practice that is appropriate, as well as offering guidance for developers on reporting the development process and outputs, and planning for the ongoing maintenance of frameworks.

Abstract Background Simulation is increasingly being used in postgraduate medical education as an opportunity for competency assessment. However, there is limited direct evidence that supports performance in the simulation lab as a surrogate of workplace-based clinical performance for non-procedural tasks such as resuscitation in the emergency department (ED). We sought to directly compare entrustment scoring of resident performance in the simulation environment to clinical performance in the ED. Methods The resuscitation assessment tool (RAT) was derived from the previously implemented and studied Queen’s simulation assessment tool (QSAT) via a modified expert review process. The RAT uses an anchored global assessment scale to generate an entrustment score and narrative comments. Emergency medicine (EM) residents were assessed using the RAT on cases in simulation-based examinations and in the ED during resuscitation cases from July 2016 to June 2017. Resident mean entrustment scores were compared using Pearson’s correlation coefficient to determine the relationship between entrustment in simulation cases and in the ED. Inductive thematic analysis of written commentary was conducted to compare workplace-based with simulation-based feedback. Results There was a moderate, positive correlation found between mean entrustment scores in the simulated and workplace-based settings, which was statistically significant (r = 0.630, n = 17, p

Professional accrediting and regulating bodies are increasingly trying to delineate the knowledge and skills needed for entry-to-practice for quality assurance and international labor mobility. The purpose of this study was to com-pare how professions describe and represent competence. Current, publicly accessible Canadian entry-to-practice competence frameworks for ten professions (Medicine, Nursing, Occupational Therapy, Pharmacy, Psychology, Social Work, Teaching, Engineering, Law, and Planning) were analyzed through content and inductive thematic analysis. Findings revealed that although professions describe similar core competencies across technical and intrinsic domains, systematic differences exist in the architectures of the frameworks. Professions with ‘meta-competencies’ describe competence as being more integrated/holistic. Whereas professions without meta-competencies describe competence as either behavioral-/performance-like lists of ‘attributes’ or groups of knowledge, skills, and ethical/professional values. How competence is represented within frameworks has implications for how professional education programs conceptualize competence and subsequently design and enact curricula, teaching and learning opportunities, and systems of assessment.

Abstract Discerning whether certain timber species were harvested from natural forests versus often less restricted planted forests can help ascertain the legality of wood products that enter the global market. However, readily available global planted forest data to the species level have been scarce. We confronted the need for such data by developing a two-pronged dataset, consisting of ‘polygon’ and ‘non-polygon’ location-based data, collectively, Planted Forest Timber Data. We obtained the polygon data from the World Resources Institute’s Spatial Database of Planted Trees v2.0, extracting data specific to traded timber species. We derived the non-polygon data from peer-reviewed literature and government documents. The polygon dataset encompasses 27 countries and 253 species and the non-polygon dataset spans 91 countries and 447 species. We envision that the more these two living datasets grow, the more they will mutually benefit from one another for data cross-validation. This assembled information is meant to equip global leaders in forest governance, policy, enforcement, and research with vetted data for promoting legal timber trade and protecting biodiversity.

Abstract Aboveground biomass density (AGBD) estimates from Earth Observation (EO) can be presented with the consistency standards mandated by United Nations Framework Convention on Climate Change (UNFCCC). This article delivers AGBD estimates, in the format of Intergovernmental Panel on Climate Change (IPCC) Tier 1 values for natural forests, sourced from National Aeronautics and Space Administration’s (NASA’s) Global Ecosystem Dynamics Investigation (GEDI) and Ice, Cloud and land Elevation Satellite (ICESat-2), and European Space Agency’s (ESA’s) Climate Change Initiative (CCI). It also provides the underlying classification used by the IPCC as geospatial layers, delineating global forests by ecozones, continents and status (primary, young (≤20 years) and old secondary (>20 years)). The approaches leverage complementary strengths of various EO-derived datasets that are compiled in an open-science framework through the Multi-mission Algorithm and Analysis Platform (MAAP). This transparency and flexibility enables the adoption of any new incoming datasets in the framework in the future. The EO-based AGBD estimates are expected to be an independent contribution to the IPCC Emission Factors Database in support of UNFCCC processes, and the forest classification expected to support the generation of other policy-relevant datasets while reflecting ongoing shifts in global forests with climate change.

Background: Rural US regions experience lower naloxone dispensing rates compared to urban counterparts, particularly in Alabama. In light of this, strategies to enhance opioid counseling and naloxone services (OCN) in rural community pharmacies are critical. However, organizational readiness to implement OCN in rural versus urban contexts where resource networks may differ is not well understood. Objectives: The purpose of this study was to explore organizational readiness and identify factors associated with implementation of OCN in rural versus urban Alabama community pharmacies. Methods: Alabama community pharmacists and technicians were recruited to participate in an anonymous online cross-sectional survey via email. The survey instrument was adapted from the Organizational Readiness to Change Assessment (ORCA). Primary outcome measures included 3 overarching ORCA domains (Evidence, Context, and Facilitation) with 19 subscales regarding OCN implementation readiness, measured via 5-point Likert-type scales (1 = strongly disagree, 5 = strongly agree). Secondarily, pharmacy OCN implementation status (implementer, non-implementer, or in-development) was measured via multiple-choice (1-item). Differences in mean domain and subscale scores between rural and urban pharmacies were evaluated using Mann-Whitney U tests and influential factors affecting OCN implementation status were assessed via logistic regression (alpha = 0.05). Results: Of 171 respondents, the majority were pharmacists (78.6 %) in urban locations (57.1 %). Mean[SD] clinical experience evidence (Evidence) (3.98[0.69] vs 3.74[0.71]; p = 0.029), staff culture (Context) (4.04[0.66] vs 3.85[0.76]; p = 0.047), service measurement goals (Context) (3.92[0.77] vs 3.66[0.79]; p = 0.034), and senior management characteristics (Facilitation) (3.87[0.72] vs 3.71[0.66]; p = 0.045) subscales were higher in urban versus rural pharmacies. Notably, 66.7 % of pharmacies were current OCN implementers, and pharmacies with higher ORCA context domain scores had 3.230 greater odds of implementing or being in the process of developing OCN (95 % CI = 1.116–9.350; p = 0.031). Conclusion: Organizational readiness to implement OCN was higher among urban versus rural pharmacies in terms of perceived strength of clinical evidence, staff culture, service measurement goals, and senior management characteristics. Future research may leverage key contextual factors to enhance OCN implementation.

Abstract Background Healthcare workers (HCWs) are commonly not prepared to properly communicate with D/deaf and hard of hearing (HoH) patients. The resulting communication challenges reinforce the existing barriers to accessing and benefiting from quality of care in these populations. In response, this study aimed to develop and evaluate a capacity-building intervention for HCWs to raise their awareness of D/deaf and HoH individuals’ experiences in healthcare and improve their capacity to communicate with these populations. Methods This study featured a participatory action research design using qualitative and quantitative methods. The intervention was developed and tested through 4 iterative phases. Reactions (i.e., satisfaction and perception of the intervention content, quality, appropriateness and usefulness) were assessed quantitatively and qualitatively after the intervention, whereas perceived knowledge and self-efficacy in communicating with D/deaf and HoH patients and organizational payoffs (use frequency of basic rules and tools improving communication) were quantitatively assessed before, after and 6-month post-intervention. Results Main qualitative and quantitative findings showed that the final version of the intervention reached high levels of satisfaction among participants. Next, perceived knowledge and self-efficacy scores obtained after receiving the intervention and 6 months later were significantly higher than those yielded in the initial assessment, although both scores significantly decreased at 6 months (compared to the scores obtained just after the intervention). Finally, findings showed no significant changes in organizational payoffs after receiving the intervention. Echoing these results, main qualitative findings documented that after receiving the intervention, participants felt more confident yet not more equipped to communicate with D/deaf and HoH patients. Conclusions Findings suggest that the capacity-building intervention is a promising means to sustainably increase HCWs’ perceived knowledge and self-efficacy on how communicating with D/deaf and HoH patients, although complementary approaches and follow-up intervention reminders may be necessary to enable practice changes in the working environment.

Abstract Estuaries provide essential ecosystem services and economic value but are facing widespread degradation due to changing anthropogenic and climatic factors. In North Carolina, coastal structures, like bulkheads and riprap, are widely used by property owners throughout the Albemarle-Pamlico estuary to stop erosion and reclaim lost land following storm events. While coastal development is tightly governed, limited historical and no up-to-date data report on the spatial distribution of coastal structures throughout the Albemarle-Pamlico estuary. Here we describe the development of a dataset that classifies and catalogues 67 km of shoreline type along the Neuse River Estuary (NRE), a large tributary of the Albemarle-Pamlico. We used available LiDAR digital elevation models (DEMs), aerial imagery, and a ground truthing field campaign to determine shoreline type present along the NRE as of 2020. We validated these results using an intensive manual editing procedure that comparatively examines DEMs, LiDAR derived slope, aerial imagery, and ground truth photography of the shoreline. This dataset is available for public download.

As part of the spine, the vertebral canal represents a central structure protecting the spinal cord running within it. Since alterations to the spinal canal and adjacent structures can have a significant impact on the spinal cord, knowledge of the physiological vertebral canal dimensions is essential. Compression of spinal nerves at the lumbosacral junction is the primary cause of cauda equina syndrome (CES). Although CES is common in dogs, it is rarely documented in cats. Given the lack of information on normal vertebral canal dimensions in cats, it is necessary to collect data and verify currently used measurements, to determine if and to what extent comparisons with dogs are valid. In 50 cats, interpedicular (ID) and midsagittal (SD) diameters were examined from the first thoracic (Th1) to the first sacral vertebra (S1). In 28 of these animals, the intervertebral disc width (IVDW) was measured. All data were gathered through gross anatomical dissection of the cats. Significant lumen reduction was evident in all cats from L6 to S1 with the narrowest point at S1. Narrowings were also found in the thoracic spine. The widest points coincide with the spinal cord enlargements. IVDW shows relatively constant values up to Th10–Th11 and peaks at L7–S1 in 95.65% of cats. While distinct similarities to dogs were observed, differences exist. The findings allow conclusions as to whether relations between the parameters and resulting predispositions to pathological changes can be derived. This could help the understanding of the pathogenesis of feline spinal diseases, particularly compressive myelopathies. Further studies are necessary to investigate the impact of age, sex and breed.

Context: In recent years, cities across the world have seen widespread growth in unsheltered homelessness, in which a person sleeps in a place not meant for human habitation such as cars, parks, sidewalks, and abandoned buildings. It is widely understood that people experiencing homelessness have poorer health outcomes than the general population. Less is known about the health of people who are unsheltered, yet they may be exposed to greater health risks than their sheltered counterparts. The purpose of this literature review is to evaluate and summarize the evidence on unsheltered homelessness and health. Evidence Acquisition: A literature search was conducted using PubMed to identify publications on unsheltered homelessness and health. A total of 42 studies were included for review. Evidence Synthesis: Unsheltered populations experience higher rates of chronic disease, serious mental illness, and substance abuse than sheltered populations. Unsheltered homelessness is strongly associated with chronic homelessness that exacerbates serious mental illness and substance use, which is often co-occurring. Despite having large unmet health needs, unsheltered populations have lower healthcare utilization and often lack health insurance. Conclusions: Evaluating the impact of shelter status on health outcomes has important implications for the allocation of housing and health services. Longitudinal studies are needed to examine the relationship between the duration of sheltered and unsheltered homelessness and health outcomes and explore the mediating mechanisms that lead to poor health among unsheltered populations. Despite these limitations, our results also suggest an urgent need to address the unique and severe challenges facing unsheltered populations and the need for intervention approaches that are sensitive to these unique disease burdens.

Jahrzehntelangen feministischen Kämpfen, Analysen und Errungenschaften zum Trotz sind Männer und Frauen in Arbeitsmarkt, Beschäftigung oder Sozialversicherung keineswegs gleichgestellt. Der Gender Pay Gap oder die Tatsache, dass insbesondere Frauen von (Alters-)Armut betroffen sind, sind nur einige merkliche Auswirkungen der Geschlechterungleichheit, die auch im 21. Jahrhundert nicht an Wirkmächtigkeit verloren hat. Dieser Band macht sich die Geschichte von Geschlechterhierarchien in Arbeitskontexten zum Gegenstand und stellt sich damit in die lange Tradition frauen- und geschlechterhistorischer Forschungen. Die Beiträge untersuchen, wie Ungleichheit zwischen Männern und Frauen historisch immer wieder neu hergestellt, ausgestaltet und abgesichert wurde. Sie zeigen die vielfältigen Wechselbezüge von Arbeit und Geschlecht auf und analysieren die Verschränkungen mit anderen Differenz- und Ungleichheitskategorien, insbesondere mit Stand/Klasse. Dabei stellen die Autor*innen Akteur*innen in den Mittelpunkt ihres Interesses, die an der Durchsetzung von Hierarchien oder an stillen oder lautstarken Protesten um deren Beseitigung beteiligt waren. Die Protagonistinnen der Beiträge sind meist weibliche Arbeitskräfte, die sich ihren Lebensunterhalt vielfach unter äußerst prekären Umständen organisierten. Damit schreiben die Aufsätze die Geschlechtergeschichte von Ungleichheit, Diskriminierung und Prekarität, aber auch von Handlungsmacht und Eigensinn in Arbeitsverhältnissen fort.

European ash-rich forest ecosystems are transforming rapidly under the influence of ash dieback, putting many associated species at risk. Forest managers face the urgent challenge to deal with the loss of European ash (Fraxinus excelsior L.) as a key tree species to maintain species richness and ecosystem functioning. The project FraDivexp, located in Schleswig-Holstein, Germany, aims at counteracting detrimental effects of progressive ash decline by testing alternative tree species in a Biodiversity-Ecosystem Functioning (BEF) experiment along a hydrological gradient. Here, we provide insight into how a BEF-approach can be combined with silvicultural management practice to meet the needs for both ecological research and reforestation. At the same time, we present first data on the survival of the planted saplings.In winter 2019/2020, FraDivexp was established with autochthonous tree species considered potential substitutes for the functioning of ash. At 12 sites, plantations including Fraxinus excelsior, Acer platanoides L., Carpinus betulus L., Tilia cordata Mill. and Ulmus laevis Pall. were planted directly underneath the remains of collapsing forest canopies involving all monocultures, and all combinations of 2-, 4- and 5-species mixtures. One year after planting of 25,200 trees, total mortality was at 5 % with U. laevis showing lowest mortality while establishment of A. platanoides was least successful. In this early phase of FraDivexp tree mortality was species-specific and driven by initial individual tree size, pH-values in the topsoil and canopy openness, while there was no effect associated with tree diversity. Analysis of further biotic factors showed high mortality of A. platanoides in areas with a high cover of Rubus spp. in the herb layer, indicating species-specific susceptibility to different site conditions. Overall, low mortality (compared to other BEF experiments on arable land) suggests an advantage of establishing a BEF experiment within an existing forest matrix. Simultaneously, this study shows that differences in environmental context dependency among species need to be considered more explicitly, when recommending management strategies. To ensure successful establishment of reforestations with substitute tree species is the first step to efficiently counteract the massive loss of ash trees with the aim of maintaining biodiversity and ecosystem functioning.

Objective: The purpose of this report is to provide insight from pediatric stakeholders with a shared desire to facilitate a revision of the current United States regulatory pathways for the development of pediatric healthcare devices. Methods: On August 5, 2020, a group of innovators, engineers, professors and clinicians met to discuss challenges and opportunities for the development of new medical devices for pediatric health and the importance of creating a regulatory environment that encourages and accelerates the research and development of such devices. On January 6, 2021, this group joined regulatory experts at a follow-up meeting. Results: One of the primary issues identified was the need to present decision-makers with opportunities that change the return-on-investment balance between adult and pediatric devices to promote investment in pediatric devices. Discussion/Conclusion: Several proposed strategies were discussed, and these strategies can be divided into two broad categories: 1. Removal of real and perceived barriers to pediatric device innovation; 2. Increasing incentives for pediatric device innovation.

Background: The directed forgetting paradigm involves individuals encoding a list of words(List 1; L1) and then, prior to encoding a second list of words (List 2; L2), they are given specific instructions to either remember all the words from L1 or to try and forget these words. In this paradigm, after encoding L1, those who are given the directed forgetting (DF) instructions tend tore call more words for L2 when compared to those who were given the remember (R) instructions(DF benefit effect). Similarly, those given the DF instructions tend to recall fewer words from L1(DF cost effect). This DF phenomenon may, in part, occur via attentional inhibitory mechanisms, or mental context-change mechanisms, which may be influenced via acute exercise. Methods: The present experiment investigates if acute exercise can facilitate DF when exercise occurs after L1 forgetting instructions. Participants (N = 97; Mage = 21 years) were randomly assigned into either acute exercise (15-min high-intensity aerobic exercise) plus DF (EX + DF),2) DF (directed forgetting) only (DF) or 3) R (remember) only (R). A standard two list (L1 and L2)DF paradigm was employed. Results: We observed evidence of a DF cost effect, but not a DF benefit effect. For L1, although both EX + DF and DF differed from R, there was no difference between EX + DF and DF. Further, although for L2, EX + DF was different than DF, neither of these groups differed when compared to R. Conclusion: We reserve caution in suggesting that exercise had a DF effect.

Ion channels activated by mechanical inputs are important force sensing molecules in a wide array of mammalian cells and tissues. The transient receptor potential channel, TRPV4, is a polymodal, nonselective cation channel that can be activated by mechanical inputs but only if stimuli are applied directly at the interface between cells and their substrate, making this molecule a context-dependent force sensor. However, it remains unclear how TRPV4 is activated by mechanical inputs at the cell-substrate interface, which cell intrinsic and cell extrinsic parameters might modulate the mechanical activation of the channel and how mechanical activation differs from TRPV4 gating in response to other stimuli. Here we investigated the impact of substrate mechanics and cytoskeletal components on mechanically evoked TRPV4 currents and addressed how point mutations associated with TRPV4 phosphorylation and arthropathy influence mechanical activation of the channel. Our findings reveal distinct regulatory modulation of TRPV4 from the mechanically activated ion channel PIEZO1, suggesting the mechanosensitivity of these two channels is tuned in response to different parameters. Moreover, our data demonstrate that the effect of point mutations in TRPV4 on channel activation are profoundly dependent on the gating stimulus.

Despite repeated economic crises and high unemployment, debates on rural flight in Austria continued after WW I. At least until the late 1920s, farmers and administrative authorities bemoaned a lack of agricultural workers, particularly during labour peaks. On the basis of administrative sources, this article deals with state efforts to bring the perceived disequilibrium in the labour market into balance and/or to ensure the availability of farm workers. State measures, however, often pursued contradictory goals: the recruitment of non-Austrian seasonal workers counteracted the labour market administration’s efforts to universally organise and nationalise the labour market. Compounding this, workers and farmers undermined official regulations such as employment restrictions and avoided state attempts to place industrial unemployed in agriculture. This chapter investigates such resistance and shows the complexity of workers’ internal and cross-border migration as well as their occupational mobility.

Abstract Background Hospitalization and antibiotic treatment can put patients at high risk for Clostridium difficile infection, where a disturbance of the gut microbiome allows for Clostridium difficile proliferation and associated symptoms, including mild, moderate, or severe diarrhea. Clostridium difficile infection is challenging to treat, often recurrent, and leads to almost 30,000 annual deaths in the USA alone. Here we present a case where SmartGut™, an at-home, self-administered sequencing-based clinical intestinal screening test, was used to identify the presence of Clostridium difficile in a patient with worsening diarrhea. Identification of this pathogen and subsequent treatment led to a significant improvement in symptoms. Case presentation The patient is a 29-year-old white woman with a history of severe irritable bowel syndrome with diarrhea, hemorrhoidectomy, and anal sphincterotomy complicated by a perianal fistula and perirectal abscesses that required extended courses of broad-spectrum antibiotics. In June 2016, she developed intermittent Clostridium difficile infections, which required continued antibiotic use. Months later she used an at-home, self-administered, intestinal microbial test, the first of which was negative for the presence of Clostridium difficile, but it detected the relative abundance of microbes associated with irritable bowel syndrome outside the healthy reference ranges. In the subsequent 2 months after the negative Clostridium difficile result, her gastrointestinal symptoms worsened dramatically. A second microbiome test resulted in a positive Clostridium difficile finding and continued abnormal microbial parameters, which led the treating physician to refer her to a gastroenterologist. Additional testing confirmed the presence of Clostridium difficile with a toxin-positive strain. She received treatment immediately and her gastrointestinal symptoms improved significantly over the next week. Conclusions This case report suggests that more frequent DNA testing for Clostridium difficile infections may be indicated in patients that are at high-risk for Clostridium difficile infection, especially for patients with irritable bowel syndrome, and those who undergo gastrointestinal surgery and/or an extended antibiotic treatment. This report also shows that such testing could be effectively performed using at-home, self-administered sequencing-based clinical intestinal microbial screening tests. Further research is needed to investigate whether the observations reported here extrapolate to a larger cohort of patients.

The composition of the vaginal microbiome, including both the presence of pathogens involved in sexually transmitted infections (STI) as well as commensal microbiota, has been shown to have important associations for a woman's reproductive and general health. Currently, healthcare providers cannot offer comprehensive vaginal microbiome screening, but are limited to the detection of individual pathogens, such as high-risk human papillomavirus (hrHPV), the predominant cause of cervical cancer. There is no single test on the market that combines HPV, STI, and microbiome screening. Here, we describe a novel inclusive vaginal health assay that combines self-sampling with sequencing-based HPV detection and genotyping, vaginal microbiome analysis, and STI-associated pathogen detection. The assay includes genotyping and detection of 14 hrHPV types, 5 low-risk HPV types (lrHPV), as well as the relative abundance of 31 bacterial taxa of clinical importance, including Lactobacillus, Sneathia, Gardnerella, and 3 pathogens involved in STI, with high sensitivity, specificity, and reproducibility. For each of these taxa, reference ranges were determined in a group of 50 self-reported healthy women. The HPV sequencing portion of the test was evaluated against the digene High-Risk HPV HC2 DNA test. For hrHPV genotyping, agreement was 95.3% with a kappa of 0.804 (601 samples); after removal of samples in which the digene hrHPV probe showed cross-reactivity with lrHPV types, the sensitivity and specificity of the hrHPV genotyping assay were 94.5% and 96.6%, respectively, with a kappa of 0.841. For lrHPV genotyping, agreement was 93.9% with a kappa of 0.788 (148 samples), while sensitivity and specificity were 100% and 92.9%, respectively. This novel assay could be used to complement conventional cervical cancer screening, because its self-sampling format can expand access among women who would otherwise not participate, and because of its additional information about the composition of the vaginal microbiome and the presence of pathogens.

[This corrects the article DOI: 10.1371/journal.pone.0176555.].

Abstract: At the beginning of the twentieth century, domestic servants’ frequent changes of position were widely debated and often perceived as an erosion of servants’ loyalty towards employers. For those working in the households of others, however, service was only one of several possibilities for finding a livelihood. In the course of their lives, women in particular alternated between service in private households and on farms, as well as undertaking other kinds of work. In doing so, they frequently changed their place of domicile, sometimes travelling over great distances. On the basis of autobiographical sources of women temporarily working as domestic servants, this contribution investigates representations of mobility and meanings assigned to changes of position.

In most industrialized countries, screening programs for cervical cancer have shifted from cytology (Pap smear or ThinPrep) alone on clinician-obtained samples to the addition of screening for human papillomavirus (HPV), its main causative agent. For HPV testing, self-sampling instead of clinician-sampling has proven to be equally accurate, in particular for assays that use nucleic acid amplification techniques. In addition, HPV testing of self-collected samples in combination with a follow-up Pap smear in case of a positive result is more effective in detecting precancerous lesions than a Pap smear alone. Self-sampling for HPV testing has already been adopted by some countries, while others have started trials to evaluate its incorporation into national cervical cancer screening programs. Self-sampling may result in more individuals willing to participate in cervical cancer screening, because it removes many of the barriers that prevent women, especially those in low socioeconomic and minority populations, from participating in regular screening programs. Several studies have shown that the majority of women who have been underscreened but who tested HPV-positive in a self-obtained sample will visit a clinic for follow-up diagnosis and management. In addition, a self-collected sample can also be used for vaginal microbiome analysis, which can provide additional information about HPV infection persistence as well as vaginal health in general.

The US Air Force Office of Scientific Research convened a meeting of researchers in the fields of neuroscience, psychology, engineering, and medicine to discuss most pressing issues facing ongoing research in the field of transcranial direct current stimulation (tDCS) and related techniques. In this study, we present opinions prepared by participants of the meeting, focusing on the most promising areas of research, immediate and future goals for the field, and the potential for hormesis theory to inform tDCS research. Scientific, medical, and ethical considerations support the ongoing testing of tDCS in healthy and clinical populations, provided best protocols are used to maximize safety. Notwithstanding the need for ongoing research, promising applications include enhancing vigilance/attention in healthy volunteers, which can accelerate training and support learning. Commonly, tDCS is used as an adjunct to training/rehabilitation tasks with the goal of leftward shift in the learning/treatment effect curves. Although trials are encouraging, elucidating the basic mechanisms of tDCS will accelerate validation and adoption. To this end, biomarkers (eg, clinical neuroimaging and findings from animal models) can support hypotheses linking neurobiological mechanisms and behavioral effects. Dosage can be optimized using computational models of current flow and understanding dose–response. Both biomarkers and dosimetry should guide individualized interventions with the goal of reducing variability. Insights from other applied energy domains, including ionizing radiation, transcranial magnetic stimulation, and low-level laser (light) therapy, can be prudently leveraged.

Changes in the relative abundances of many intestinal microorganisms, both those that naturally occur in the human gut microbiome and those that are considered pathogens, have been associated with a range of diseases. To more accurately diagnose health conditions, medical practitioners could benefit from a molecular, culture-independent assay for the quantification of these microorganisms in the context of a healthy reference range. Here we present the targeted sequencing of the microbial 16S rRNA gene of clinically relevant gut microorganisms as a method to provide a gut screening test that could assist in the clinical diagnosis of certain health conditions. We evaluated the possibility of detecting 46 clinical prokaryotic targets in the human gut, 28 of which could be identified with high precision and sensitivity by a bioinformatics pipeline that includes sequence analysis and taxonomic annotation. These targets included 20 commensal, 3 beneficial (probiotic), and 5 pathogenic intestinal microbial taxa. Using stool microbiome samples from a cohort of 897 healthy individuals, we established a reference range defining clinically relevant relative levels for each of the 28 targets. Our assay quantifies 28 targets in the context of a healthy reference range and correctly reflected 38/38 verification samples of real and synthetic stool material containing known gut pathogens. Thus, we have established a method to determine microbiome composition with a focus on clinically relevant taxa, which has the potential to contribute to patient diagnosis, treatment, and monitoring. More broadly, our method can facilitate epidemiological studies of the microbiome as it relates to overall human health and disease.

We expanded second-line tuberculosis (TB) drug susceptibility testing for extensively drug-resistant Mycobacterium tuberculosis isolates from South Africa. Of 19 patients with extensively drug-resistant TB identified during February 2008–April 2009, 13 (68%) had isolates resistant to all 8 drugs tested. This resistance leaves no effective treatment with available drugs in South Africa.

Insight into how environmental change determines the production and distribution of cyanobacterial toxins is necessary for risk assessment. Management guidelines currently focus on hepatotoxins (microcystins). Increasing attention is given to other classes, such as neurotoxins (e.g., anatoxin-a) and cytotoxins (e.g., cylindrospermopsin) due to their potency. Most studies examine the relationship between individual toxin variants and environmental factors, such as nutrients, temperature and light. In summer 2015, we collected samples across Europe to investigate the effect of nutrient and temperature gradients on the variability of toxin production at a continental scale. Direct and indirect effects of temperature were the main drivers of the spatial distribution in the toxins produced by the cyanobacterial community, the toxin concentrations and toxin quota. Generalized linear models showed that a Toxin Diversity Index (TDI) increased with latitude, while it decreased with water stability. Increases in TDI were explained through a significant increase in toxin variants such as MC-YR, anatoxin and cylindrospermopsin, accompanied by a decreasing presence of MC-LR. While global warming continues, the direct and indirect effects of increased lake temperatures will drive changes in the distribution of cyanobacterial toxins in Europe, potentially promoting selection of a few highly toxic species or strains.

The transdermal contraceptive patch, Ortho Evra™, was approved in December 2001 and released on the market in June 2002. In this study, we reviewed clinical data of young women who started the patch between June 2002 and December 2003 in the adolescent medicine clinic at a university-based outpatient center. A total of 62 patients started the patch in that period and two of them were lost to follow-up. Mean age of patients was 17.9 years and mean length of use was 10 cycles. Only 10 patients (16.7%) discontinued use. Reasons for discontinuation were moderate to severe skin irritation (3 patients, 5%), complete detachment (3 patients, 5%), and economic reasons (4 patients, 6.7%). Compliance was excellent overall and the side-effects profile was good. No pregnancies occurred during this period. These results confirmed that the transdermal contraceptive patch is easy to use and an effective method of birth control that may be better tolerated by young women. It also seemed to improve contraceptive compliance in this population.

The syndrome of hyperandrogenism, insulin resistance, and acanthosis nigricans (HAIR-AN) is a subphenotype of the polycystic ovary syndrome. It is one of the most common causes of menstrual problems, hyperandrogenic symptoms, and insulin resistance among young women. Review of clinical data in an outpatient adolescent clinic showed that of the 1,002 young women (ages 10—21 years) attending the clinic over a 2-year period, 50 (5%) were diagnosed with HAIR-AN syndrome. Mean age of the patients was 15.5, initial mean weight at diagnosis was 94.5 kg, and the mean BMI was 33.33 kg/m2. Patients were treated with a weight-stabilization and -reduction program, oral contraceptive pills, and in most cases metformin. Of the patients, 80% were compliant with the follow-up and treatment regimen, 60% maintained or reduced their weight, 95% had regular menstrual cycles, and in most patients, the acne and/or hirsutism were the same or better than at the start of treatment. We conclude that HAIR-AN syndrome is a common disease in young women and multifaceted, aggressive treatment appears to be effective in reducing the severity of symptoms and preventing further consequences.

While the poor and the uninsured are at increased risk for tobacco use, up to two thirds of these patients express interest in near-term quitting. Nonetheless, tobacco counseling rates remain low in clinics serving these patients. As part of a larger tobacco intervention project in North Carolina free clinics, we gathered baseline data on patient characteristics in six randomly selected facilities affiliated with the North Carolina Association of Free Clinics. An exit interview was completed by 231 patients; 126 (54%) were tobacco users. Among all patients, 71% had been asked by a clinician about tobacco use in the past 3 months. Among tobacco users, 68% had received at least one other counseling step (assessment; advice; or assistance). Patients with asthma and current tobacco users had a two-fold increase in being asked about tobacco use. Patients' diagnoses–-in particular asthma–-can remind clinicians of tobacco intervention.