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As SARS-CoV-2 continues to spread and mutate, tracking the viral evolutionary trajectory and understanding the functional consequences of its mutations remain crucial. Here, we characterized the antibody evasion, ACE2 receptor engagement, and viral infectivity of the highly mutated SARS-CoV-2 Omicron subvariant BA.2.87.1. Compared with other Omicron subvariants, including EG.5.1 and the current predominant JN.1, BA.2.87.1 exhibits less immune evasion, reduced viral receptor engagement, and comparable infectivity in Calu-3 lung cells. Intriguingly, two large deletions (Δ15-26 and Δ136-146) in the N-terminal domain (NTD) of the spike protein facilitate subtly increased antibody evasion but significantly diminish viral infectivity. Collectively, our data support the announcement by the USA CDC that the public health risk posed by BA.2.87.1 appears to be low.

AbstractObjective The onset of the COVID-19 pandemic engendered a host of different behavioral responses in key areas such as resource purchasing and compliance with COVID regulations. This study explores why participation in these behaviors may have varied by examining the role of perseverative cognition (i.e., worry, rumination).Method A representative sample of U.S. adults (N = 230, Mage = 45.4, 50% female) was recruited online early in the COVID-19 pandemic (June 2020), approximately three months into safety-related school and business shutdowns. Participants completed a series of questionnaires on COVID-19-related worry, non-specific rumination, and a range of behaviors observed during the early stages of the pandemic (e.g., excessive shopping, purchasing guns, following isolation guidelines). Exploratory principal axis factoring and reliability studies of the newly created COVID-19 worry and behavior scales were performed, followed by an examination of the associations between worrying, ruminating and COVID-19-related early behaviors.Results COVID-related worry and reflective rumination were positively associated with purchasing behavior (i.e., purchasing household items, items for security, and items for entertainment). COVID-related worry was also positively associated with compliance behavior (i.e., watching the news, following government directives strictly, and staying home but contacting family and friends remotely). Brooding rumination was not significantly associated with either type of behavior.Conclusions Perseverative cognition can help explain patterns in COVID-related behaviors, what motivated differences in these behaviors and, thereby, help explain how people coped during this trying time.

Abstract Plant biomass is a fundamental ecosystem attribute that is sensitive to rapid climatic changes occurring in the Arctic. Nevertheless, measuring plant biomass in the Arctic is logistically challenging and resource intensive. Lack of accessible field data hinders efforts to understand the amount, composition, distribution, and changes in plant biomass in these northern ecosystems. Here, we present The Arctic plant aboveground biomass synthesis dataset, which includes field measurements of lichen, bryophyte, herb, shrub, and/or tree aboveground biomass (g m−2) on 2,327 sample plots from 636 field sites in seven countries. We created the synthesis dataset by assembling and harmonizing 32 individual datasets. Aboveground biomass was primarily quantified by harvesting sample plots during mid- to late-summer, though tree and often tall shrub biomass were quantified using surveys and allometric models. Each biomass measurement is associated with metadata including sample date, location, method, data source, and other information. This unique dataset can be leveraged to monitor, map, and model plant biomass across the rapidly warming Arctic.

In October 2020, a new population of invasive brown treesnakes (Boiga irregularis) was discovered on the 33-ha Cocos Island, 2.5 km off the south coast of Guam. Cocos Island is a unique conservation resource, providing refuge for many lizards and birds, including endangered species, which were extirpated from mainland Guam by invasive predators including brown treesnakes. We sought to evaluate the usefulness of toxic baiting with acetaminophen-treated carrion baits and cage trapping, common tools for the control of brown treesnakes on mainland Guam, as potential eradication tools on Cocos Island. We evaluated multiple bait types and bait presentations: on the ground, suspended in the canopy emulating aerial bait applications and in four plastic-tube bait station configurations intended to exclude non-target species. We monitored all baits with time-lapse cameras. Despite improved exclusion of non-targets by bait station design, most baits were quickly removed by non-target species, particularly coconut crabs (Birgus latro) and Mariana monitors (Varanus tsukamotoi). Monitoring of 1,250 baits available for 2,427 bait nights resulted in no observations of brown treesnakes taking any bait. Subsequently, we tested two trap types commonly used on Guam and compared trapping success with live versus dead mouse lures. In 10,553 trap nights using live and dead mouse lures, we only captured one brown treesnake, in a trap with a live mouse lure. These baiting and trapping rates are so low as to be ineffectual for all practical purposes. Concurrent visual searching and hand capture of brown treesnakes during initial rapid response efforts demonstrates that these low baiting and trapping success rates are not a result of low snake density. We make a case for our assumption that the ineffectiveness of these tools on Cocos Island is due to the context of extremely high abundance of preferred live prey, primarily large geckos and birds. Our results have profound conservation ramifications, because any future island invasions by brown treesnakes are likely to occur within similarly prey-rich environments where these baiting and trapping methods might be similarly ineffective.

Abstract Introduction As health reforms move Ireland from a mixed public-private system toward universal healthcare, it is important to understand variations in prescribing practice for patients with differing health cover and socioeconomic status. This study aims to determine how prescribing patterns for patients aged ≥ 65 years in primary care in Ireland differ between patients with public and private health cover. Methods This was an observational study using anonymised data collected as part of a larger study from 44 general practices in Ireland (2011–2018). Data were extracted from electronic records relating to demographics and prescribing for patients aged ≥ 65 years. The cohort was divided between those with public health cover (via the General Medical Services (GMS) scheme) and those without. Standardised rates of prescribing were calculated for pre-specified drug classes. We also analysed the number of medications, polypharmacy, and trends over time between groups, using multilevel linear regression adjusting for age and sex, and hospitalisations. Results Overall, 42,456 individuals were included (56% female). Most were covered by the GMS scheme (62%, n = 26,490). The rate of prescribing in all drug classes was higher for GMS patients compared to non-GMS patients, with the greatest difference in benzodiazepine anxiolytics. The mean number of unique medications prescribed to GMS patients was 10.9 (SD 5.9), and 8.1 (SD 5.8) for non-GMS patients. The number of unique medications prescribed to both GMS and non-GMS cohorts increased over time. The increase was steeper in the GMS group where the mean number of medications prescribed increased by 0.67 medications/year. The rate of increase was 0.13 (95%CI 0.13, 0.14) medications/year lower for non-GMS patients, a statistically significant difference. Conclusion Our study found a significantly larger number of medications were prescribed to patients with public health cover, compared to those without. Increasing medication burden and polypharmacy among older adults may be accelerated for those of lower socioeconomic status. These findings may inform planning for moves towards universal health care, and this would provide an opportunity to evaluate the effect of expanding entitlement on prescribing and medications use.

Abstract Background Bipolar spectrum disorders (BSDs) are associated with a heightened sensitivity to rewards and elevated reward-related brain function in cortico-striatal circuitry. A separate literature documents social and circadian rhythm disruption in BSDs. Recently, integrated reward-circadian models of BSDs have been proposed. These models draw on work indicating that the two systems influence each other and interact to affect mood functioning. When dysregulated, reward and circadian system signaling may combine to form a positive feedback loop, whereby dysregulation in one system exacerbates dysregulation in the other. Project CREST (Circadian, Reward, and Emotion Systems in Teens) provides a first systematic test of reward-circadian dysregulation as a synergistic and dynamic vulnerability for first onset of BSD and increases in bipolar symptoms during adolescence. Methods This NIMH-funded R01 study is a 3-year prospective, longitudinal investigation of approximately 320 community adolescents from the broader Philadelphia area, United States of America. Eligible participants must be 13–16 years old, fluent in English, and without a prior BSD or hypomanic episode. They are being selected along the entire dimension of self-reported reward responsiveness, with oversampling at the high tail of the dimension in order to increase the likelihood of BSD onsets. At Times 1–6, every 6 months, participants will complete assessments of reward-relevant and social rhythm disruption life events and self-report and diagnostic assessments of bipolar symptoms and episodes. Yearly, at Times 1, 3, and 5, participants also will complete self-report measures of circadian chronotype (morningness-eveningness) and social rhythm regularity, a salivary dim light melatonin onset (DLMO) procedure to assess circadian phase, self-report, behavioral, and neural (fMRI) assessments of monetary and social reward responsiveness, and a 7-day ecological momentary assessment (EMA) period. During each EMA period, participants will complete continuous measures of sleep/wake and activity (actigraphy), a daily sleep diary, and three within-day (morning, afternoon, evening) measures of life events coded for reward-relevance and social rhythm disruption, monetary and social reward responsiveness, positive and negative affect, and hypo/manic and depressive symptoms. The fMRI scan will occur on the day before and the DLMO procedure will occur on the first evening of the 7-day EMA period. Discussion This study is an innovative integration of research on multi-organ systems involved in reward and circadian signaling in understanding first onset of BSD in adolescence. It has the potential to facilitate novel pharmacological, neural, and behavioral interventions to treat, and ideally prevent, bipolar conditions.

ABSTRACT Histoplasma capsulatum is a dimorphic fungal pathogen acquired via inhalation of soil-resident spores. Upon exposure to mammalian body temperatures, these fungal elements transform into yeasts that reside primarily within phagocytes. Macrophages (MΦ) provide a permissive environment for fungal replication until T cell-dependent immunity is engaged. MΦ activated by granulocyte macrophage colony stimulating factor (GM-CSF) induces metallothioneins (MTs) that bind zinc (Zn) and deprive yeast cells of labile Zn, thereby disabling fungal growth. Prior work demonstrated that the zinc transporter, ZRT2, was important for fungal survival in vivo. Hence, we constructed a yeast cell reporter strain that expresses green fluorescent protein (GFP) under control of the ZRT2 zinc-regulated promoter. This reporter accurately responds to a medium devoid of Zn. ZRT2 expression increased in GM-CSF, but not interferon-γ, stimulated MΦ. To examine the in vivo response, we infected mice with a reporter yeast strain and assessed ZRT2 expression at 0, 3, 7, and 14 days post-infection (dpi). ZRT2 expression minimally increased at 3 dpi and peaked at 7 dpi, corresponding with the onset of adaptive immunity. We discovered that the major MΦ populations that restrict Zn from the fungus are interstitial MΦ and exudate MΦ. Neutralizing GM-CSF blunted the control of infection but unexpectedly increased ZRT2 expression. This increase was dependent on another cytokine that activates MΦ to control H. capsulatum replication, M-CSF. These findings illustrate the reporter’s ability to sense Zn in vitro and in vivo and correlate ZRT2 expression with GM-CSF and M-CSF activation of MΦ.IMPORTANCEPhagocytes use an arsenal of defenses to control the replication of Histoplasma yeasts, one of which is the limitation of trace metals. On the other hand, H. capsulatum combats metal restriction by upregulating metal importers such as the Zn importer ZRT2. This transporter contributes to H. capsulatum pathogenesis upon activation of adaptive immunity. We constructed a fluorescent ZRT2 transcriptional reporter to probe H. capsulatum Zn sensing during infection and exposed the role for M-CSF activation of macrophages when GM-CSF is absent. These data highlight the ways in which fungal pathogens sense metal deprivation in vivo and reveal the potential of metal-sensing reporters. The work adds a new dimension to study how intracellular pathogens sense and respond to the changing environments of the host.

Abstract High strength and ductility are highly desired in fiber‐reinforced composites, yet achieving both simultaneously remains elusive. A hierarchical architecture is developed utilizing high aspect ratio chemically transformable thermoplastic nanofibers that form covalent bonding with the matrix to toughen the fiber‐matrix interphase. The nanoscale fibers are electrospun on the micrometer‐scale reinforcing carbon fiber, creating a physically intertwined, randomly oriented scaffold. Unlike conventional covalent bonding of matrix molecules with reinforcing fibers, here, the nanofiber scaffold is utilized ‒ interacting non‐covalently with core fiber but bridging covalently with polymer matrix ‒ to create a high volume fraction of immobilized matrix or interphase around core reinforcing elements. This mechanism enables efficient fiber‐matrix stress transfer and enhances composite toughness. Molecular dynamics simulation reveals enhancement of the fiber‐matrix adhesion facilitated by nanofiber‐aided hierarchical bonding with the matrix. The elastic modulus contours of interphase regions obtained from atomic force microscopy clearly indicate the formation of stiffer interphase. These nanoengineered composites exhibit a ≈60% and ≈100% improved in‐plane shear strength and toughness, respectively. This approach opens a new avenue for manufacturing toughened high‐performance composites.

The decidual immunome is dynamic, dramatically changing its composition across gestation. Early pregnancy is dominated by decidual NK cells, with a shift towards T cells later in pregnancy. However, the degree, timing, and subset-specific nature of leukocyte traffic between the decidua and systemic circulation during gestation remains poorly understood. Herein, we employed intravascular staining in pregnant C57BL/6J mice and cynomolgus macaques (Macaca fascicularis) to examine leukocyte traffic into the decidual basalis during pregnancy. Timed-mated or virgin mice were tail-vein injected with labelled αCD45 antibodies 24 hours and 5 minutes before sacrifice. Pregnant cynomolgus macaques (GD155) were infused with labelled αCD45 at 2 hours or 5 mins before necropsy. Decidual cells were isolated and resulting suspensions analyzed by flow cytometry. We found that the proportion of intravascular (IVAs)-negative leukocytes (cells labeled by the 24h infusion of αCD45 or unlabeled) decreased across murine gestation while recent immigrants (24h label only) increased in mid- to late-gestation. In the cynomolgus model our data confirmed differential labeling of decidual leukocytes by the infused antibody, with the 5 min infused animal having a higher proportion of IVAs+ cells compared to the 2hr infused animal. Decidual tissue sections from both macaques showed the presence of intravascularly labeled cells, either in proximity to blood vessels (5min infused animal) or deeper into decidual stroma (2hr infused animal). These results demonstrate the value of serial intravascular staining as a sensitive tool for defining decidual leukocyte traffic during pregnancy.

Patient self-reported satisfaction is commonly used as an assessment of service experience and quality for community pharmacy services. This commentary discusses alternative foundational approaches to evaluating service experience and quality in patient-centered care. It describes historical and recent literature pertaining to the development and use of satisfaction measures for service design and patient experience assessment. It then highlights potential limitations of patient satisfaction as an assessment tool for patient-centeredness and patient experience identified in the pharmacy literature, which include criticisms that use of patient satisfaction may compromise accuracy in measuring quality due to factors such as patients having poor knowledge of and low expectations for quality and having a predisposition toward rating satisfaction highly when experiencing no-cost and/or unfamiliar services. Moreover, satisfaction measurements may change based on service exposure, with patient preferences for service offerings changing with increased service exposure and variation in patient-specific and environmental factors. After discussing limitations and criticism of patient self-reported satisfaction, we introduce alternative assessments methods which may facilitate more accurate assessments of patient experience and patient-centered pharmacy services such as patient-reported outcomes measures (PROMs), patient-reported experience measures (PREMs), and human-centered design techniques such as journey mapping, prototyping, and user testing to design and assess patient-centered pharmacy services. These alternative assessments are rooted in, or related to preferred implementation science approaches to establishing, evaluating, and sustaining pharmacy services.

The resting membrane potential enables neurons to rapidly initiate and conduct electrical signals. K2p channels are key in maintaining this membrane potential and electrical excitability. They direct the resting membrane potential toward the K+ equilibrium potential. Doxapram is a known blocker for a subset of K2p channels that are pH sensitive. We assessed the effects of 0.1 and 5 mM doxapram on the neural activity within the propodite-dactylopodite (PD) proprioceptive sensory organ in the walking legs of blue crabs (Callinectes sapidus). Results indicate that 0.1 mM doxapram enhances excitation, while the higher concentration 5 mM may over-excite the neurons and promote a sustained absolute refractory period until the compound is removed. The effect of 5 mM doxapram mimics the effect of 40 mM K+ exposure. Verapamil, another known K2p channel blocker as well as an L-type Ca2+ channel blocker, reduces neural activity at both 0.1 and 5 mM. Verapamil may block stretch activated channels in sensory endings, in addition to reducing the amplitude of the compound action potential with whole nerve preparations. These findings are notable as they demonstrate that doxapram has acute effects on neurons of crustaceans, suggesting a targeted K2p channel. The actions of verapamil are complex due to the potential of affecting multiple ion channels in this preparation. Crustacean neurons can aid in understanding the mechanisms of action of various pharmacological agents as more information is gained.

Abstract Protecting the climate system requires urgently reducing carbon emissions to the atmosphere and increasing cumulative carbon stocks in natural systems. Recent studies confirm that large trees accumulate and store a disproportionate share of aboveground forest carbon. In the temperate forests of the western United States, a century of intensive logging drastically reduced large‐trees and older forest, but some large trees remain. However, recent changes to large tree management policy on National Forest lands east of the Cascade Mountains crest in Oregon and southeastern Washington allows increased harvesting of large‐diameter trees (≥53 cm or 21 inches) that account for just 3% of all stems, but hold 42% of total aboveground carbon. In this article, we describe synergies with protecting large trees for climate mitigation, biodiversity, and forest resilience goals to shift species composition, reduce fuel loads and stem density, and adapt to climatically driven increases in fire activity in eastern Oregon.

Introduction: The role of community pharmacists has evolved in recent years with expansion in pharmacy services offered. The extent to which patients utilise such services in community pharmacies in Ireland is unclear. Objective: To assess pharmacy services use among adults aged ≥56 years in Ireland, and determine the demographic and clinical factors associated with pharmacy services use. Methods: This cross-sectional study included community-dwelling participants in wave 4 of The Irish Longitudinal Study on Ageing (TILDA), aged ≥56 years who were self-respondents. TILDA is a nationally representative cohort study, with wave 4 data collected during 2016. TILDA collects participant demographics and health data, in addition to information on the use of several services when visiting the pharmacy in the last 12 months. Characteristics and pharmacy services use were summarised. Multivariate logistic regression was used to examine the association of demographic and health factors with reporting (i) any pharmacy service use and (ii) requesting medicines advice. Results: Among 5782 participants (55.5% female, mean age 68 years), 96.6% (5587) reported visiting a pharmacy in the previous 12 months, and almost one fifth of these (1094) utilised at least one non-dispensing pharmacy service. The most common non-dispensing services reported were requesting advice about medications (786, 13.6%), blood pressure monitoring (184, 3.2%), and vaccination (166, 2.9%). Controlling for other factors, female sex (odds ratio (OR) 1.32, 95% CI 1.14–1.52), third-level education (OR 1.85, 95% CI 1.51–2.27), higher rates of GP visits, private health insurance (OR 1.29, 95% CI 1.07–1.56), higher number of medications, loneliness, and respiratory condition diagnosis (OR 1.42, 95% CI 1.14–1.74) were associated with higher likelihood of utilising pharmacy services. The relationship between these factors and requesting medicines advice was similar. Conclusion: A high proportion of middle-aged and older adults visit community pharmacy and a fifth utilise specified pharmacy services. Despite advances in the services offered in pharmacies, medicines advice remains at the core of pharmacists' practice.

As the neuroimaging field moves towards detecting smaller effects at higher spatial resolutions, and faster sampling rates, there is increased attention given to the deleterious contribution of unstructured, thermal noise. Here, we critically evaluate the performance of a recently developed reconstruction method, termed NORDIC, for suppressing thermal noise using datasets acquired with various field strengths, voxel sizes, sampling rates, and task designs.Following minimal preprocessing, statistical activation (t-values) of NORDIC processed data was compared to the results obtained with alternative denoising methods. Additionally, we examined the consistency of the estimates of task responses at the single-voxel, single run level, using a finite impulse response (FIR) model. To examine the potential impact on effective image resolution, the overall smoothness of the data processed with different methods was estimated. Finally, to determine if NORDIC alters or removes temporal information important for modeling responses, we employed an exhaustive leave-p-out cross validation approach, using FIR task responses to predict held out timeseries, quantified using R2.After NORDIC, the t-values are increased, an improvement comparable to what could be achieved by 1.5 voxels smoothing, and task events are clearly visible and have less cross-run error. These advantages are achieved with smoothness estimates increasing by less than 4%, while 1.5 voxel smoothing is associated with increases of over 140%. Cross-validated R2s based on the FIR models show that NORDIC is not measurably distorting the temporal structure of the data under this approach and is the best predictor of non-denoised time courses. The results demonstrate that analyzing 1 run of data after NORDIC produces results equivalent to using 2 to 3 original runs and that NORDIC performs equally well across a diverse array of functional imaging protocols.Significance Statement: For functional neuroimaging, the increasing availability of higher field strengths and ever higher spatiotemporal resolutions has led to concomitant increase in concerns about the deleterious effects of thermal noise. Historically this noise source was suppressed using methods that reduce spatial precision such as image blurring or averaging over a large number of trials or sessions, which necessitates large data collection efforts. Here, we critically evaluate the performance of a recently developed reconstruction method, termed NORDIC, which suppresses thermal noise. Across datasets varying in field strength, voxel sizes, sampling rates, and task designs, NORDIC produces substantial gains in data quality. Both conventional t-statistics derived from general linear models and coefficients of determination for predicting unseen data are improved. These gains match or even exceed those associated with 1 voxel Full Width Half Max image smoothing, however, even such small amounts of smoothing are associated with a 52% reduction in estimates of spatial precision, whereas the measurable difference in spatial precision is less than 4% following NORDIC.

Abstract Introduction Older adults face several challenges when transitioning from acute hospitals to community-based care. The PHARMacist Discharge Care (PHARM-DC) intervention is a pharmacist-led Transitions of Care (TOC) program intended to reduce 30-day hospital readmissions and emergency department visits at two large hospitals. This study used the Consolidated Framework for Implementation Research (CFIR) framework to evaluate pharmacist perceptions of the PHARM-DC intervention. Methods Intervention pharmacists and pharmacy administrators were purposively recruited by study team members located within each participating institution. Study team members located within each institution coordinated with two study authors unaffiliated with the institutions implementing the intervention to conduct interviews and focus groups remotely via telecommunication software. Interviews were recorded and transcribed, with transcriptions imported into NVivo for qualitative analysis. Qualitative analysis was performed using an iterative process to identify “a priori” constructs based on CFIR domains (intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation) and to create overarching themes as identified during coding. Results In total, ten semi-structured interviews and one focus group were completed across both hospitals. At Site A, six interviews were conducted with intervention pharmacists and pharmacists in administrative roles. Also at Site A, one focus group comprised of five intervention pharmacists was conducted. At Site B, interviews were conducted with four intervention pharmacists and pharmacists in administrative roles. Three overarching themes were identified: PHARM-DC and Institutional Context, Importance of PHARM-DC Adaptability, and Recommendations for PHARM-DC Improvement and Sustainability. Increasing pharmacist support for technical tasks and navigating pharmacist-patient language barriers were important to intervention implementation and delivery. Identifying cost-savings and quantifying outcomes as a result of the intervention were particularly important when considering how to sustain and expand the PHARM-DC intervention. Conclusion The PHARM-DC intervention can successfully be implemented at two institutions with considerable variations in TOC initiatives, resources, and staffing. Future implementation of PHARM-DC interventions should consider the themes identified, including an examination of institution-specific contextual factors such as the roles that pharmacy technicians may play in TOC interventions, the importance of intervention adaptability to account for patient needs and institutional resources, and pharmacist recommendations for intervention improvement and sustainability. Trial registration NCT04071951 .

Background: Patient-centered care is at the center of the Pharmacists' Patient Care Process; however, little is known about patient-centered care preferences and expectations for pharmacist care. Objective: To develop and test items exploring the applicability of a proposed three-archetype heuristic for patient-centered care preferences and expectations in pharmacist care in a population of older adults using community pharmacies that provided enhanced and integrated services. Methods: This was an exploratory analysis of a cross-sectional survey developed and distributed by postal mail to 17 Medicare-eligible patients at five Community Pharmacy Enhanced Service Network (CPESN) pharmacies in Iowa between November 2021 and January 2022. A total of 15 Likert-type archetype survey items were developed with an item developed for each of five constructs (Nature of Relationship and Locus of Control, Care Customization, Care Longevity, Intent of Communication, and Source of Value) for three archetypes (“Partner,” “Client,” and “Customer”).Items were grouped by archetype to yield three, five-item scales, intended to reflect each archetype. Cronbach alphas (α) were calculated for each scale, measuring internal consistency. K-means clustering with silhouette analysis was performed using a group of archetype items with high internal consistency to identify clusters. Kruskal Wallis and Fisher's exact tests used to determine statistical significance for response means and frequencies between clusters, when appropriate. Results: In total, 17 participants completed the survey (100% response rate). Cronbach alphas for the five-item scales reflecting “Partner,” “Client,” and “Customer” archetypes were 0.66, 0.33, and − 0.03, respectively. K-means clustering identified two clusters, labeled: “Independent Partner” and “Collaborative Partner.” There were significant (p-value

Background: A variety of services exit to assist eligible beneficiaries select Medicare Part D insurance plans; however, selecting an optimal plan remains a challenge. While patients would benefit from evaluating and switching their Medicare Part D plan on a yearly basis, few choose to do so. Objective: The objective of this study was to describe the Medicare Part D plan selection experience across all US states. Methods: This was a qualitative analysis using data from a cross-sectional Qualtrics panel survey administered in January 2022. Descriptive statistics were generated for demographic and patient-specific items for individuals who provided open-ended survey item responses. Open-coding and content analysis were used to analyze responses to the open-ended survey item. Results: Overall, 540 responses were received, with the largest number of responses from Florida (11%, 61). A total of 101 respondents (18.7%) of survey respondents provided open-ended comments. Qualitative analysis identified four response categories: Benefit design, Plan information and selection assistance, Plan Switching, and Plan-selection experience. Conclusions: Overall, participants expressed frustrations with high costs and plan restrictions. Many participants needed plan-selection assistance, with some individuals switching plans each year. Recent legislation may address difficulties related to medication costs; however, additional focus on resources and educational interventions may improve the Medicare Part D experience.

Objectives Geriatric guidelines strongly recommend avoiding benzodiazepines and non-benzodiazepine sedative hypnotics in older adults. Hospitalisation may provide an important opportunity to begin the process of deprescribing these medications, particularly as new contraindications arise. We used implementation science models and qualitative interviews to describe barriers and facilitators to deprescribing benzodiazepines and non-benzodiazepine sedative hypnotics in the hospital and develop potential interventions to address identified barriers.Design We used two implementation science models, the Capability, Opportunity and Behaviour Model (COM-B) and the Theoretical Domains Framework, to code interviews with hospital staff, and an implementation process, the Behaviour Change Wheel (BCW), to codevelop potential interventions with stakeholders from each clinician group.Setting Interviews took place in a tertiary, 886-bed hospital located in Los Angeles, California.Participants Interview participants included physicians, pharmacists, pharmacist technicians, and nurses.Results We interviewed 14 clinicians. We found barriers and facilitators across all COM-B model domains. Barriers included lack of knowledge about how to engage in complex conversations about deprescribing (capability), competing tasks in the inpatient setting (opportunity), high levels of resistance/anxiety among patients to deprescribe (motivation), concerns about lack of postdischarge follow-up (motivation). Facilitators included high levels of knowledge about the risks of these medications (capability), regular rounds and huddles to identify inappropriate medications (opportunity) and beliefs that patients may be more receptive to deprescribing if the medication is related to the reason for hospitalisation (motivation). Potential modes of delivery included a seminar aimed at addressing capability and motivation barriers in nurses, a pharmacist-led deprescribing initiative using risk stratification to identify and target patients at highest need for deprescribing, and the use of evidence-based deprescribing education materials provided to patients at discharge.Conclusions While we identified numerous barriers and facilitators to initiating deprescribing conversations in the hospital, nurse- and pharmacist-led interventions may be an appropriate opportunity to initiate deprescribing.

Prior research has questioned the appropriateness of internal focus instructions or the juxtaposition to external and control conditions. Moreover, there has been a lack of research conducted to test a variety of internal conditions on motor performance. The purpose of the present study was to address those critiques and add to the attentional focus literature by varying the location of an internal focus while performing a standing long jump. Participants performed a standing long jump during five separate conditions (internal focus: toes, knees, hips, arms; and control). The analysis revealed that all internal focus conditions performed worse than the control condition. Furthermore, the only difference between internal conditions was found between arms and knees, where the knee condition resulted in a significantly shorter jump distance relative to the arms. Regardless of the location specified, all internal focus conditions led to detriments in jump performance when compared to the control condition. These findings add to a large body of work demonstrating the importance of instructional content on motor performance.

The evolution of virtual reality (VR) has created the opportunity for a relatively low-cost and accessible method to practice motor skills. Previous studies have demonstrated how motor skill practice in non-immersive virtual environments transfers to physical environments. Though minimal research has investigated motor learning and transfer within immersive VR, multiple experiments provide empirical evidence of positive transfer effects. Most studies have used software engines and modified hardware to enhance the similarities between virtual and physical environments. However, many learners and practitioners currently use commercially available VR intending to enhance real-world performance, though there is very little evidence to support the notion of positive transfer for these systems. Therefore, this experiment aimed to investigate how motor skill practice using a commercially available VR system improved real-world performance and how that compared to physical practice. Participants (n = 68) were randomly selected into one of two groups: virtual reality (VR) practice (n = 33) or real-world (RW) practice (n = 35). The experiment occurred over two consecutive days, with a pretest, posttest, and practice phase occurring each day. The pre- and post-testing phases were identical for both groups and consisted of putting a golf ball 10 times on a carpeted surface towards the center of a target. The practice phases consisted of 60 total putts per day in the respective environment (VR or RW). Participants continuously alternated golf putting holes from three different distances until they accrued 60 total putts. Participants in the RW group performed golf putts to three targets. Participants in the VR group also performed golf putts on three different miniature golf putting holes, using the commercially available Oculus Rift and the Cloudlands VR Minigolf game. The VR putting targets were designed to replicate the putting holes in the physical environment. Separate 2 (group) x 4 (test) repeated measures ANOVAs were used to assess accuracy and club head kinematics. The results revealed a significant main effect for test, but not for group. Post hoc analyses revealed that both groups significantly improved their putting accuracy and club head kinematics at similar rates. The results from this study indicate that the transfer of learning that occurred as a result of practicing in a commercially available VR environment was similarly effective when compared to RW practice.

BackgroundCongenital Zika virus (ZIKV) infection can result in birth defects, including malformations in the fetal brain and visual system. There are two distinct genetic lineages of ZIKV: African and Asian. Asian-lineage ZIKVs have been associated with adverse pregnancy outcomes in humans; however, recent evidence from experimental models suggests that African-lineage viruses can also be vertically transmitted and cause fetal harm.Methodology/principal findingsTo evaluate the pathway of vertical transmission of African-lineage ZIKV, we inoculated nine pregnant rhesus macaques (Macaca mulatta) subcutaneously with 44 plaque-forming units of a ZIKV strain from Senegal, (ZIKV-DAK). Dams were inoculated either at gestational day 30 or 45. Following maternal inoculation, pregnancies were surgically terminated seven or 14 days later and fetal and maternal-fetal interface tissues were collected and evaluated. Infection in the dams was evaluated via plasma viremia and neutralizing antibody titers pre- and post- ZIKV inoculation. All dams became productively infected and developed strong neutralizing antibody responses. ZIKV RNA was detected in maternal-fetal interface tissues (placenta, decidua, and fetal membranes) by RT-qPCR and in situ hybridization. In situ hybridization detected ZIKV predominantly in the decidua and revealed that the fetal membranes may play a role in ZIKV vertical transmission. Infectious ZIKV was detected in the amniotic fluid of three pregnancies and one fetus had ZIKV RNA detected in multiple tissues. No significant pathology was observed in any fetus; and ZIKV did not have a substantial effect on the placenta.Conclusions/significanceThis study demonstrates that a very low dose of African-lineage ZIKV can be vertically transmitted to the macaque fetus during pregnancy. The low inoculating dose used in this study suggests a low minimal infectious dose for rhesus macaques. Vertical transmission with a low dose in macaques further supports the high epidemic potential of African ZIKV strains.

Strategic forest reserves based on biodiversity and carbon storage can help to protect animal and tree species habitat, surface drinking water and carbon stocks and accumulation in the western US, suggests an assessment of current forest preservation.

¿Cómo reacciona la ciudadanía en un sistema político polarizado ante una emergencia como la pandemia de la COVID-19?, ¿cómo procesa la ciudadanía las narrativas polarizadas que están en conflicto?, y ¿qué imagen se forman de la gestión política de la amenaza de la pandemia? En EE. UU, hay que retrotraerse a la epidemia de la polio de hace 70 años para encontrar una emergencia sanitaria como la pandemia de la COVID-19. No obstante, hay importantes diferencias; en la década de 1950, el clima político de los EE.UU. era mucho más uniforme y consensuado que el actual, profundamente dividido y polarizado. Este trabajo utiliza datos de un estudio longitudinal realizado durante 35 años en personas jóvenes de la Generación X (ahora ya en la cuarentena) y datos provenientes de encuestas realizadas en Estados Unidos durante tres décadas, con el propósito de examinar los patrones de adquisición de la información en la comprensión de una nueva amenaza. Nuestro análisis de los últimos 35 años de la Generación X muestra que, en las elecciones de 2020, el factor predictivo del voto individual que tuvo más fuerza fue una ideología política polarizada, pero, aquellas personas que contaban con una mejor comprensión del coronavirus fueron más críticas con la gestión de la pandemia de la COVID-19 que realizó la administración de Donald Trump y estuvieron más predispuestas a votar por Joe Biden que a votar por Trump. Un análisis paralelo de una muestra probabilística representativa de personas adultas estadounidenses en 2020 reveló el mismo patrón de influencia del partidismo ideológico, la comprensión del coronavirus y la evaluación de la administración de Trump. Los resultados muestran que el conocimiento y la comprensión pueden proporcionar un efecto moderador crítico en un sistema político polarizado y dividido.

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

As healthcare continues to embrace the concept of person- and patient-centered care, pharmacogenomics, patient experience, and medication experience will continue to play an increasingly important role in care delivery. This review highlights the intersection between these concepts and provides considerations for patient-centered medication and pharmacogenomic experiences. Elements at the patient, provider, and system level can be considered in the discussion, supporting the use of pharmacogenomics, with components of the patient and medication experience contributing to the mitigation of barriers surrounding patient use and the valuation of pharmacogenomic testing.

This study assessed the myocarditis and pericarditis reporting rate of the first dose of mRNA COVID-19 vaccines in Europe. Myocarditis and pericarditis data pertinent to mRNA COVID-19 vaccines (1 January 2021–11 February 2022) from EudraVigilance database were combined with European Centre for Disease Prevention and Control (ECDC)’s vaccination tracker data. The reporting rate was expressed as events (occurring within 28 days of the first dose) per 1 million individuals vaccinated. An observed-to-expected (OE) analysis quantified excess risk for myocarditis or pericarditis following the first mRNA COVID-19 vaccination. The reporting rate of myocarditis per 1 million individuals vaccinated was 17.27 (95% CI, 16.34–18.26) for CX-024414 and 8.44 (95% CI, 8.18–8.70) for TOZINAMERAN; and of pericarditis, 9.76 (95% CI, 9.06–10.51) for CX-024414 and 5.79 (95% CI, 5.56–6.01) for TOZINAMERAN. Both vaccines produced a myocarditis standardized morbidity ratio (SMR) > 1, with the CX-024414 vaccine having a greater SMR than TOZINAMERAN. Regarding TOZINAMERAN, SMR for pericarditis was >1 when considering the lowest background incidence, but

Background: Transcranial focused ultrasound (tFUS) is a noninvasive brain stimulation method that may modulate deep brain structures. This study investigates whether sonication of the right anterior thalamus would modulate thermal pain thresholds in healthy individuals. Methods: We enrolled 19 healthy individuals in this three-visit, double-blind, sham-controlled, crossover trial. Participants first underwent a structural MRI scan used solely for tFUS targeting. They then attended two identical experimental tFUS visits (counterbalanced by condition) at least one week apart. Within the MRI scanner, participants received two, 10-min sessions of either active or sham tFUS spread 10 min apart targeting the right anterior thalamus [fundamental frequency: 650 kHz, Pulse repetition frequency: 10 Hz, Pulse Width: 5 ms, Duty Cycle: 5%, Sonication Duration: 30s, Inter-Sonication Interval: 30 s, Number of Sonications: 10, ISPTA.0 995 mW/cm2, ISPTA.3 719 mW/cm2, Peak rarefactional pressure 0.72 MPa]. The primary outcome measure was quantitative sensory thresholding (QST), measuring sensory, pain, and tolerance thresholds to a thermal stimulus applied to the left forearm before and after right anterior thalamic tFUS. Results: The right anterior thalamus was accurately sonicated in 17 of the 19 subjects. Thermal pain sensitivity was significantly attenuated after active tFUS. The pre-post x active-sham interaction was significant (F(1,245.95) = 4.03, p = .046). This interaction indicates that in the sham stimulation condition, thermal pain thresholds decreased 1.08 °C (SE = 0.28) pre-post session, but only decreased .51 °C (SE = 0.30) pre-post session in the active stimulation group. Conclusions: Two 10-min sessions of anterior thalamic tFUS induces antinociceptive effects in healthy individuals. Future studies should optimize the parameter space, dose and duration of this effect which may lead to multi-session tFUS interventions for pain disorders.

Satellites provide clear evidence of greening trends in the Arctic, but high-resolution pan-Arctic quantification of these trends is lacking. Here the authors analyse high-resolution Landsat data to show widespread greening in the Arctic, and find that greening trends are linked to summer warming overall but not always locally.

Abstract Background Remote, centralized clinical pharmacist services provided by board-certified clinical pharmacists have been shown to effectively assist in chronic disease management. We assess the feasibility of implementing a pharmacist-led, remote, centralized pharmacy service to improve A1c levels in patient with diabetes in a rural clinic setting. Methods This was a non-randomized pilot and feasibility study. Participants were enrolled in a pharmacist-led telehealth intervention service, with data prior to enrollment used as baseline data for control. To be included, patients needed to have A1c readings of greater than 7% to be considered uncontrolled. A1c changes were reported for two groups based on A1c ranges: between 7 and 10% and ≥ 10%. Clinical pharmacists and clinical pharmacy interns initiated contact with patients via telephone communication and managed the patients remotely. The following outcomes were evaluated: organization perceptions (patients, providers, and clinic staff), changes in A1c, medication discrepancies, impact of an internally operated Patient Assistance Program, and potential return on investment (ROI). Results Fifty-two patients were initially identified and referred to the service with 43 patients consenting to participate in the intervention. Patient and provider survey responses were recorded. In the initial analysis occurring during the first 3 to 5 months of the program, there was considerable improvement in diabetes control as measured by A1c. For patients with uncontrolled diabetes with a baseline A1c > 7% but less than < 10% and ≥ 10%, the intervention resulted in an A1c decrease of 0.57% and 2.55%, respectively. Clinical pharmacists and clinical pharmacy interns identified at least one medication discrepancy in 44% of patients, with number of discrepancies ranging from 1 to 5 per patient. At the conclusion of the study window, 42 potentially billable encounters were documented, which would have generated a net profit of $1140 USD, had they been submitted for reimbursement. Given the potential revenue generation, the service theoretically yields a ROI of 1.4 to 1. Conclusions Initial results suggest that a pharmacist-led telehealth intervention has potential to decrease A1c levels in patients with diabetes, assist in identification of medication discrepancies, provide a positive return on investment for rural clinics, and potentially increase reimbursement for providers and clinics tasked with managing patients with uncontrolled diabetes.

Flare frequency distributions represent a key approach to addressing one of the largest problems in solar and stellar physics: determining the mechanism that counterintuitively heats coronae to temperatures that are orders of magnitude hotter than the corresponding photospheres. It is widely accepted that the magnetic field is responsible for the heating, but there are two competing mechanisms that could explain it: nanoflares or Alfvén waves. To date, neither can be directly observed. Nanoflares are, by definition, extremely small, but their aggregate energy release could represent a substantial heating mechanism, presuming they are sufficiently abundant. One way to test this presumption is via the flare frequency distribution, which describes how often flares of various energies occur. If the slope of the power law fitting the flare frequency distribution is above a critical threshold, α = 2 as established in prior literature, then there should be a sufficient abundance of nanoflares to explain coronal heating. We performed >600 case studies of solar flares, made possible by an unprecedented number of data analysts via three semesters of an undergraduate physics laboratory course. This allowed us to include two crucial, but nontrivial, analysis methods: preflare baseline subtraction and computation of the flare energy, which requires determining flare start and stop times. We aggregated the results of these analyses into a statistical study to determine that α = 1.63 ± 0.03. This is below the critical threshold, suggesting that Alfvén waves are an important driver of coronal heating.

Background: When prescribing antibiotics, infection eradication rates, local resistance rates, and cost should be among the most essential considerations. Helicobacter pylori is among the most common infections worldwide, and it can lead to burdensome sequela for the patient and the healthcare system, without appropriate treatment. Due to constantly fluctuating resistance rates, regimens must be constantly assessed to ensure effectiveness. Methods: This was a narrative review. The sources for this review are as follows: searching on PubMed, Google Scholar, Medline, and ScienceDirect; using keywords: Helicobacter pylori, Treatment Options, Clinical Practice. Results: Multiple antibiotics are prescribed as part of the regimen to thwart high resistance rates. This can lead to unwanted adverse reactions and adherence issues, due to the amount and timing of medication administration, which also may contribute to resistance. Single-capsule combination capsules have reached the market to ease this concern, but brand-only may be problematic for patient affordability. Due to the previously mentioned factors, effectiveness and affordability must be equally considered. Conclusions: This review will utilize guidelines to discuss current treatment options and give cost considerations to elicit the most effective regimen for the patient.

There is an urgent need for accurate, scalable and cost-efficient models of the tumor microenvironment. Here, we detail how to fabricate and use the metabolic microenvironment chamber (MEMIC) – a 3D-printed ex vivo model of intratumoral heterogeneity. A major driver of the cellular and molecular diversity in tumors is accessibility to the blood stream. Whereas perivascular tumor cells have direct access to oxygen and nutrients, cells further from the vasculature must survive under progressively more ischemic environments. The MEMIC simulates this differential access to nutrients, allow co-culturing any number of cell types, and it is optimized for live imaging and other microscopy-based analyses. Owing to a modular design and full experimental control, the MEMIC provides insights into the tumor microenvironment that would be difficult to obtain via other methods. As proof of principle, we show that cells sense gradual changes in metabolite concentration leading to predictable molecular and cellular spatial patterns. We propose the MEMIC as a complement to standard in vitro and in vivo experiments, diversifying the tools available to accurately model, perturb and monitor the tumor microenvironment.

Abstract: —J. Blunden and T. Boyer In 2023, La Niña conditions that generally prevailed in the eastern Pacific Ocean from mid-2020 into early 2023 gave way to a strong El Niño by October. Atmospheric concentrations of Earth’s major greenhouse gases—carbon dioxide, methane, and nitrous oxide—all increased to record-high levels. The annual global average carbon dioxide concentration in the atmosphere rose to 419.3±0.1 ppm, which is 50% greater than the pre-industrial level. The growth from 2022 to 2023 was 2.8 ppm, the fourth highest in the record since the 1960s. The combined short-term effects of El Niño and the long-term effects of increasing levels of heat-trapping gases in the atmosphere contributed to new records for many essential climate variables reported here. The annual global temperature across land and oceans was the highest in records dating as far back as 1850, with the last seven months (June–December) having each been record warm. Over land, the globally averaged temperature was also record high. Dozens of countries reported record or near-record warmth for the year, including China and continental Europe as a whole (warmest on record), India and Russia (second warmest), and Canada (third warmest). Intense and widespread heatwaves were reported around the world. In Vietnam, an all-time national maximum temperature record of 44.2°C was observed at Tuong Duong on 7 May, surpassing the previous record of 43.4°C at Huong Khe on 20 April 2019. In Brazil, the air temperature reached 44.8°C in Araçuaí in Minas Gerais on 20 November, potentially a new national record and 12.8°C above normal. The effect of rising temperatures was apparent in the cryosphere, where snow cover extent by June 2023 was the smallest in the 56-year record for North America and seventh smallest for the Northern Hemisphere overall. Heatwaves contributed to the greatest average mass balance loss for Alpine glaciers around the world since the start of the record in 1970. Due to rapid volume loss beginning in 2021, St. Anna Glacier in Switzerland and Ice Worm Glacier in the United States disappeared completely. In August, as a direct result of glacial thinning over the past 20 years, a glacial lake on a tributary of the Mendenhall Glacier in Alaska burst through its ice dam and caused unprecedented flooding on Mendenhall River near Juneau. Across the Arctic, the annual surface air temperature was the fourth highest in the 124-year record, and summer (July–September) was record warm. Smaller-than-normal snow cover extent in May and June contributed to the third-highest average peak tundra greenness in the 24-year record. In September, Arctic minimum sea ice extent was the fifth smallest in the 45-year satellite record. The 17 lowest September extents have all occurred in the last 17 years. In Antarctica, temperatures for much of the year were up to 6°C above average over the Weddell Sea and along coastal Dronning Maud Land. The Antarctic Peninsula also experienced well-above-average temperatures during the 2022/23 melt season, which contributed to its fourth consecutive summer of above-average surface melt. On 21 February, Antarctic sea ice extent and sea ice area both reached all-time lows, surpassing records set just a year earlier. Over the course of the year, new daily record-low sea ice extents were set on 278 days. In some instances, these daily records were set by a large margin, for example, the extent on 6 July was 1.8 million km2 lower than the previous record low for that day. Across the global oceans, the annual sea surface temperature was the highest in the 170-year record, far surpassing the previous record of 2016 by 0.13°C. Daily and monthly records were set from March onward, including an historic-high daily global mean sea surface temperature of 18.99°C recorded on 22 August. Approximately 94% of the ocean surface experienced at least one marine heatwave in 2023, while 27% experienced at least one cold spell. Globally averaged ocean heat content from the surface to 2000-m depth was record high in 2023, increasing at a rate equivalent to ∼0.7 Watts per square meter of energy applied over Earth’s surface. Global mean sea level was also record high for the 12th consecutive year, reaching 101.4 mm above the 1993 average when satellite measurements began, an increase of 8.1±1.5 mm over 2022 and the third highest year-over-year increase in the record. A total of 82 named tropical storms were observed during the Northern and Southern Hemispheres’ storm seasons, below the 1991–2020 average of 87. Hurricane Otis became the strongest landfalling hurricane on record for the west coast of Mexico at 140 kt (72 m s−1), causing at least 52 fatalities and $12–16 billion U.S. dollars in damage. Freddy became the world’s longest-lived tropical cyclones on record, developing into a tropical cyclone on 6 February and finally dissipating on 12 March. Freddy crossed the full width of the Indian Ocean and made one landfall in Madagascar and two in Mozambique. In the Mediterranean Sea—outside of traditional tropical cyclone basins—heavy rains and flooding from Storm Daniel killed more than 4300 people and left more than 8000 missing in Libya. The record-warm temperatures in 2023 created conditions that helped intensify the hydrological cycle. Measurements of total-column water vapor in the atmosphere were the highest on record, while the fraction of cloud area in the sky was the lowest since records began in 1980. The annual global mean precipitation total over land surfaces for 2023 was among the lowest since 1979, but global one-day maximum totals were close to average, indicating an increase in rainfall intensity. In July, record-high areas of land across the globe (7.9%) experienced extreme drought, breaking the previous record of 6.2% in July 2022. Overall, 29.7% of land experienced moderate or worse categories of drought during the year, also a record. Mexico reported its driest (and hottest) year since the start of its record in 1950. In alignment with hot and prolonged dry conditions, Canada experienced its worst national wildfire season on record. Approximately 15 million hectares burned across the country, which was more than double the previous record from 1989. Smoke from the fires were transported far into the United States and even to western European countries. August to October 2023 was the driest three-month period in Australia in the 104-year record. Millions of hectares of bushfires burned for weeks in the Northern Territory. In South America, extreme drought developed in the latter half of the year through the Amazon basin. By the end of October, the Rio Negro at Manaus, a major tributary of the Amazon River, fell to its lowest water level since records began in 1902. The transition from La Niña to El Niño helped bring relief to the prolonged drought conditions in equatorial eastern Africa. However, El Niño along with positive Indian Ocean dipole conditions also contributed to excessive rainfall that resulted in devastating floods over southeastern Ethiopia, Somalia, and Kenya during October to December that displaced around 1.5 million people. On 5 September, the town of Zagora, Greece, broke a national record for highest daily rainfall (754 mm in 21 hours, after which the station ceased reporting) due to Storm Daniel; this one-day accumulation was close to Zagora’s normal annual total.

Abstract Climate change‐driven droughts and insect outbreaks are becoming more frequent and widespread, increasing forest vulnerability to mortality. By addressing the impacts of climate and insects on tree growth preceding death, we can better understand tree mortality risk under a changing climate. Here, we used tree stature and interannual growth (basal area increment; BAI) to assess processes leading to trembling aspen (Populus tremuloides) survival or mortality during an unprecedented leaf miner (Phyllocnistis populiella) outbreak in boreal North America. We identified eight sites (22 plots) in the longest running forest monitoring network in Alaska, spanning ~350 km of latitude, that experienced ≥0.25 Mg·ha−1·yr−1 aspen mortality during the outbreak. We compared the size and canopy position, growth patterns, and sensitivity to climate and leaf mining of aspen that survived (living; n = 84) vs. died (dying; n = 76) and linked the normalized difference vegetation index (NDVI) to plot‐level aspen growth and stand biomass recruitment, growth, and mortality. Dying aspen were in the subcanopy, smaller in diameter, and after a drought in 1957 had lower growth than living aspen until death. Before the outbreak, growth of all trees was positively influenced by moisture and negatively by temperature, but only living trees maintained this climate response during the outbreak. Leaf mining reduced growth of both groups, exerting at least a twofold greater impact than climate. The NDVI captured plot‐level tree growth and stand biomass growth and mortality, yet it was nearly two times more strongly associated with living than dying tree growth and 12 times more strongly associated with biomass growth than mortality. These differences suggest that NDVI may inadequately detect insect‐driven dieback and dispersed mortality of aspen across the boreal biome. Our findings reveal that a historic drought triggered a multi‐decadal growth decline that predisposed aspen to mortality during the leaf miner outbreak and that while aspen growth is influenced by moisture and temperature, it is more strongly affected by P. populiella. We conclude that as the climate warms and insect outbreaks increase in frequency and magnitude at high latitudes, we should expect to see persistent and greater declines in aspen growth and increases in mortality.

Surface Electromyography (sEMG) is the non-invasive measurement of skeletal muscle contraction bio-potentials. Measuring sEMG of a stimulated muscle can prove particularly difficult due to large scale and long lasting stimulation-induced artefacts: if an sEMG device does not account for such artefacts, its measurements can be swamped and components damaged. sEMG has been used in a wide range of clinical and biomedical fields, providing measures such as muscular fatigue and subject intent. The recording of sEMG can prove difficult due to signal contamination such as movement artefact and mains interference.There are very few commercial sEMG devices that contain protection against large stimulation voltages or measures to reduce artefact transient times. Furthermore, most commercial or research level designs are not open source; these designs are effectively an inflexible black box to researchers and developers.This research presents the design, test and validation of an open source sEMG design, able to record muscle bio-potentials concurrently to electrical stimulation. The open source, low-cost nature of the design provides accessibility to researchers without the time and cost associated with design development. The design has been tested on the forearms of four able-bodied subjects during 25 Hz constant current stimulation, and has been shown to record subject volitional sEMG and M-wave without saturation.

Background: Patient experience with community pharmacy services can be informed by human-centered design principles and approaches. Pharmacy services may benefit from detailed evaluations of consumer experience and patient-centered service design. Objectives: To use an online journey mapping platform to understand the patient experience with selecting a Medicare Part D plan for individuals that did, and did not, use a free, pharmacy-led, Medicare Part D consultation service. Methods: This was a two-group cross-sectional survey study in a single, rural community pharmacy. Surveys consisted of 7 demographic items, 30 Likert-type items, and 7 open-ended response items. The pharmacy used purposeful convenience sampling to distribute a paper survey to individuals 65 years of age and older currently enrolled in Medicare Part D between June and August 2019. Surveys were distributed to 36 patients currently enrolled in a Medicare Part D plan, with 18 surveys distributed to patients who had previously used a pharmacy-led Medicare Part D consultation service and 18 surveys distributed to patients who did not use the service. Surveys were uploaded to an online journey mapping platform, producing data visualizations for each group. Multiple choice survey items were analyzed using descriptive statistics, wth service user and nonuser groups compared using Mann-Whitney U tests. Open-ended survey responses were coded by the research team using an inductive approach. Results: In total, 36 surveys were returned to the community pharmacy for a response rate of 100%. The journey map platform generated Persona, Empathy, and Current Journey outputs, which mapped Good Experiences and Bad Experiences within the Medicare Part D plan selection experience. Personas differed in their median household incomes ($25,000–$39,999 for service users compared to $50,000–$74,999 for nonusers). Empathy and Current Journey outputs showed that service users had a wider variety of emotions compared to non-users. Mann-Whitney U tests yielded 5 items with statistically significant differences (p-values

The brain is organized into distinct, flexible networks. Within these networks, cognitive variables such as attention can modulate sensory representations in accordance with moment-to-moment behavioral requirements. These modulations can be studied by varying task demands; however, the tasks employed are often incongruent with the postulated functions of a sensory system, limiting the characterization of the system in relation to natural behaviors. Here we combine domain-specific task manipulations and ultra-high field fMRI to study the nature of top-down modulations. We exploited faces, a visual category underpinned by a complex cortical network, and instructed participants to perform either a stimulus-relevant/domain-specific or a stimulus-irrelevant task in the scanner. We found that 1. perceptual ambiguity (i.e. difficulty of achieving a stable percept) is encoded in top-down modulations from higher-level cortices; 2. the right inferior-temporal lobe is active under challenging conditions and uniquely encodes trial-by-trial variability in face perception.

Parenting Stress relates to stressors that are a function of being in and executing the parenting role. It is a construct that relates to both psychological phenomena and to the human body’s physiological state as a parent or caretaker of a child. This article serves as a brief narrative review of the construct.

Large-diameter trees store disproportionally massive amounts of carbon and are a major driver of carbon cycle dynamics in forests worldwide. In the temperate forests of the western United States, proposed changes to Forest Plans would significantly weaken protections for a large portion of trees greater than 53 cm (21 inches) in diameter (herein referred to as “large-diameter trees”) across 11.5 million acres (∼4.7 million ha) of National Forest lands. This study is among the first to report how carbon storage in large trees and forest ecosystems would be affected by a proposed policy. We examined the proportion of large-diameter trees on National Forest lands east of the Cascade Mountains crest in Oregon and Washington, their contribution to overall aboveground carbon (AGC) storage, and the potential reduction in carbon stocks resulting from widespread harvest. We analyzed forest inventory data collected on 3,335 plots and found that large trees play a major role in the accumulated carbon stock of these forests. Tree AGC (kg) increases sharply with tree diameter at breast height (DBH; cm) among five dominant tree species. Large trees accounted for 2.0 to 3.7% of all stems (DBH ≥ 1” or 2.54 cm) among five tree species; but held 33 to 46% of the total AGC stored by each species. Pooled across the five dominant species, large trees accounted for 3% of the 636,520 trees occurring on the inventory plots but stored 42% of the total AGC. A recently proposed large-scale vegetation management project that involved widespread harvest of large trees, mostly grand fir, would have removed ∼44% of the AGC stored in these large-diameter trees, and released a large amount of carbon dioxide to the atmosphere. Given the urgency of keeping additional carbon out of the atmosphere and continuing carbon accumulation from the atmosphere to protect the climate system, it would be prudent to continue protecting ecosystems with large trees for their carbon stores, and also for their co-benefits of habitat for biodiversity, resilience to drought and fire, and microclimate buffering under future climate extremes.

Liquid crystal elastomers (LCE) are soft materials which anisotropically shape morph in response to external stimuli. Herein, a method to produce large‐area carbon nanotube–LCE nanocomposite films with exceptional electrostrictive properties is examined. A methodology to produce telechelic precursor oligomeric composites at scale (>100 g) is presented along with the continuous casting and photocuring process. The carbon nanotubes are well‐aligned and well‐dispersed in the films, which exhibit exceptional anisotropic thermomechanical, optical, and thermal shape change characteristics. When an electric field is applied through the film thickness, the material quickly and reversibly contracts along the alignment direction. As an example, a compliant carbon nanotube–LCE film contracts >4% against a 140 kPa load, roughly comparable to the blocking force of many natural muscular tissues. Furthermore, it is demonstrated that this tunable contraction is dependent upon the electric field strength, and that the contraction mimics the form function of the input electric field (e.g., a sine wave). These compliant actuators are excellent candidates for incorporation into soft and/or biological systems.

Surface electromyography (sEMG) data was captured for three able-body subjects, from their right biceps brachii using the POLE sensor outlined in “Low-cost active electromyography” [1]. Data was captured for 45 seconds per subject, resulting in 12–21 contractions per subject. The raw data files, along with a sinusoidal waveform have been provided. This allows users of the POLE sensor to verify their low-cost sEMG device has been populated and configured correctly. This data also allows researchers/developers to compare their results against this low-cost, low noise sEMG device. The frequency content of the raw sEMG data is also of interest; this is calculated by applying a fast Fourier transform (FFT). The process applied to perform these algorithms is supplied in a MATLAB script. Keywords: sEMG, EMG, Rehabilitation, Right leg driver, Bar electrodes, Bio-sensing, Bio-instrumentation

Whereas recent clinical studies report metastatic melanoma survival rates high as 30-50%, many tumors remain nonresponsive or become resistant to current therapeutic strategies. Analyses of The Cancer Genome Atlas (TCGA) skin cutaneous melanoma (SKCM) data set suggests that a significant fraction of melanomas potentially harbor gain-of-function mutations in the gene that encodes for the ErbB4 receptor tyrosine kinase. In this work, a drug discovery strategy was developed that is based on the observation that the Q43L mutant of the naturally occurring ErbB4 agonist Neuregulin-2beta (NRG2β) functions as a partial agonist at ErbB4. NRG2β/Q43L stimulates tyrosine phosphorylation, fails to stimulate ErbB4-dependent cell proliferation, and inhibits agonist-induced ErbB4-dependent cell proliferation. Compounds that exhibit these characteristics likely function as ErbB4 partial agonists, and as such hold promise as therapies for ErbB4-dependent melanomas. Consequently, three highly sensitive and reproducible (Z' > 0.5) screening assays were developed and deployed for the identification of small-molecule ErbB4 partial agonists. Six compounds were identified that stimulate ErbB4 phosphorylation, fail to stimulate ErbB4-dependent cell proliferation, and appear to selectively inhibit ErbB4-dependent cell proliferation. Whereas further characterization is needed to evaluate the full therapeutic potential of these molecules, this drug discovery platform establishes reliable and scalable approaches for the discovery of ErbB4 inhibitors.

Ecosystems in the North American Arctic-Boreal Zone (ABZ) experience a diverse set of disturbances associated with wildfire, permafrost dynamics, geomorphic processes, insect outbreaks and pathogens, extreme weather events, and human activity. Climate warming in the ABZ is occurring at over twice the rate of the global average, and as a result the extent, frequency, and severity of these disturbances are increasing rapidly. Disturbances in the ABZ span a wide gradient of spatiotemporal scales and have varying impacts on ecosystem properties and function. However, many ABZ disturbances are relatively understudied and have different sensitivities to climate and trajectories of recovery, resulting in considerable uncertainty in the impacts of climate warming and human land use on ABZ vegetation dynamics and in the interactions between disturbance types. Here we review the current knowledge of ABZ disturbances and their precursors, ecosystem impacts, temporal frequencies, spatial extents, and severity. We also summarize current knowledge of interactions and feedbacks among ABZ disturbances and characterize typical trajectories of vegetation loss and recovery in response to ecosystem disturbance using satellite time-series. We conclude with a summary of critical data and knowledge gaps and identify priorities for future study.

Changes in vegetation distribution are underway in Arctic and boreal regions due to climate warming and associated fire disturbance. These changes have wide ranging downstream impacts—affecting wildlife habitat, nutrient cycling, climate feedbacks and fire regimes. It is thus critical to understand where these changes are occurring and what types of vegetation are affected, and to quantify the magnitude of the changes. In this study, we mapped live aboveground biomass for five common plant functional types (PFTs; deciduous shrubs, evergreen shrubs, forbs, graminoids and lichens) within Alaska and northwest Canada, every five years from 1985 to 2020. We employed a multi-scale approach, scaling from field harvest data and unmanned aerial vehicle-based biomass predictions to produce wall-to-wall maps based on climatological, topographic, phenological and Landsat spectral predictors. We found deciduous shrub and graminoid biomass were predicted best among PFTs. Our time-series analyses show increases in deciduous (37%) and evergreen shrub (7%) biomass, and decreases in graminoid (14%) and lichen (13%) biomass over a study area of approximately 500 000 km ^2 . Fire was an important driver of recent changes in the study area, with the largest changes in biomass associated with historic fire perimeters. Decreases in lichen and graminoid biomass often corresponded with increasing shrub biomass. These findings illustrate the driving trends in vegetation change within the Arctic/boreal region. Understanding these changes and the impacts they in turn will have on Arctic and boreal ecosystems will be critical to understanding the trajectory of climate change in the region.