Search

The challenges observed in health-service-psychology (HSP) training during COVID-19 revealed systemic and philosophical issues that preexisted the pandemic but became more visible during the global health crisis. In a position article written by 23 trainees across different sites and training specializations, we use lessons learned from COVID-19 as a touchstone for a call to action in HSP training. Historically, trainee voices have been conspicuously absent from literature about clinical training. We describe long-standing dilemmas in HSP training that were exacerbated by the pandemic and will continue to require resolution after the pandemic has subsided. We make recommendations for systems-level changes that would advance equity and sustainability in HSP training. This article advances the conversation about HSP training by including the perspective of trainees as essential stakeholders.

Context The incidence of extreme heat events (prolonged temperatures above 35°C) is increasing in the northern Victorian dairying region in Australia. This increase is having a significant effect on the performance of perennial ryegrass, which has traditionally been the major perennial species in these pastures. Aim During seven extreme heat events, forage sampling was conducted on commercial farms to evaluate the effects of high temperatures on the nutritive characteristics of perennial ryegrass, tall fescue and lucerne. Our hypothesis was that reductions in nutritive characteristics with an increasing external temperature would vary among species. Methods Before, during and after heat events, replicated samples of the three forage species were collected and analysed for in vitro dry matter digestibility (IVDMD), neutral detergent fibre (NDF), acid detergent fibre (ADF), water soluble carbohydrates (WSC) and crude protein (CP). Several anti-nutritive compounds (alkaloids in perennial ryegrass, and saponins and coumestrols in lucerne) were also measured. Key results None of the temperate forage species evaluated maintained nutritive quality under high temperatures. Linear mixed model (LMM) analyses showed that for each degree rise between 23°C and 40°C, IVDMD and WSC concentrations decreased by 0.2% while NDF and ADF concentrations increased by 0.2% and 0.15% respectively. Concentrations of the alkaloid, ergovaline, in the base of the perennial ryegrass tiller were close to, or above, the recommended threshold level for animal health and welfare in three of the six samples taken during heat events. Conclusions These results suggest that extreme heat events have a detrimental effect on the nutritive characteristics of the evaluated forage species. Implications Heat-induced decreases in nutritive characteristics will potentially have serious implications for milk production and farm productivity. Further research, undertaken under controlled conditions of temperature, humidity and plant growth stage, is recommended to determine the full effect of these extreme summer conditions on forage nutritive characteristics.

In a recent call to action, we described pressing issues in the health-service-psychology (HSP) internship from the perspective of interns. In our article, we sought to initiate a dialogue that would include trainees and bring about concrete changes. The commentaries on our article are a testament to the readiness of the field to engage in such a dialogue, and we applaud the actionable recommendations that they make. In our response to these commentaries, we seek to move the conversation further forward. We observe two themes that cut across these responses: the impetus to gather novel data on training (the “need to know”) and the importance of taking action (the “need to act”). We emphasize that in new efforts to gather data and take policy-level action, the inclusion of trainee stakeholders (as well as others involved in and affected by HSP training) is a crucial ingredient for sustainable and equitable change.

Background: Prior studies demonstrate a higher prevalence of pulmonary hypertension (PH) and more severe hemodynamics in patients with higher body mass index (BMI). However, this association was only described in post-capillary PH. To better understand the relationship between pre-capillary PH and BMI, we compared various PH parameters stratified by BMI class. Methods: Data from right heart catheterization (RHC), 6-minute walk (6MW), and functional class (FC) were collected from the University of Michigan Pulmonary Hypertension Patient Registry from 2016-2020 at baseline and 3-month follow-up. Group 1 pulmonary arterial hypertension (PAH) patients were grouped into 4 BMI weight classes: under/normal weight (BMI < 25), overweight (25 < BMI < 30), obesity class 1 (30 < BMI < 35), obesity class 2/3 (BMI > 35). Results: Among 175 PAH patients, obese patients exhibited higher right atrial and pulmonary capillary wedge pressures. There were no major differences in mean pulmonary artery (PA) pressures, pulmonary vascular resistance (PVR), cardiac index Fick, 6MW distance walked, or peak Borg Dyspnea score among BMI groups. Despite having similar mean PA pressure and PVR (major determinants of functional capacity in PAH), patients in higher weight classes had higher dyspnea symptom burden by WHO FC. Specifically, a greater prevalence of normal/overweight patients were in FC 1 while more obese patients were in FC 3. Conclusions: Overall, in patients with PAH, higher BMI classes presented with worse FC for dyspnea, higher RA and PCW pressures, with similar PA pressures and 6MW results. Our data suggests that BMI may be an important factor that influences PAH symptoms. The impact of BMI in PAH outcomes is yet to be determined. It is possible that patients with higher BMI may exhibit more frequent comorbid conditions contributing to multifactorial symptoms of dyspnea; further study is warranted.

All cells produce extracellular vesicles (EVs). These biological packages contain complex mixtures of molecular cargo and have a variety of functions, including interkingdom communication. Recent discoveries highlight the roles microbial EVs may play in the environment with respect to interactions with plants as well as nutrient cycling. These studies have also identified molecules present within EVs and associated with EV surfaces that contribute to these functions. In parallel, studies of engineered nanomaterials have developed methods to track and model small particle behavior in complex systems and measure the relative importance of various surface features on transport and function. While studies of EV behavior in complex environmental conditions have not yet employed transdisciplinary approaches, it is increasingly clear that expertise from disparate fields will be critical to understand the role of EVs in these systems. Here, we outline how the convergence of biology, soil geochemistry, and colloid science can both develop and address questions surrounding the basic principles governing EV-mediated interkingdom interactions.

In northern Victoria, Australia, perennial pastures for the dairy industry have historically been based on perennial ryegrass. However, perennial ryegrass does not perform well under high summer temperatures and water stress. We investigated irrigation, renovation and grazing management strategies for improving the resilience and survival of perennial ryegrass over summer on two farms in northern Victoria over 2.5 years. At each farm, two irrigation bays were sown in March 2015. During summer (late December–mid-March), one bay was not irrigated and the other bay received a single mid-summer irrigation. Each bay was sown to 12 ryegrass cultures: five cultivars of perennial ryegrass either oversown or not oversown, and two oversown cultivars of short-lived ryegrass (SLRG). A mid-summer grazing treatment was applied to one-half of each of these plots. All plots at both sites received the same irrigation and grazing management at other times of the year. There were significant variations in dry matter (DM) production, nutritive characteristics and plant frequencies across sites and seasons, and across renovation, irrigation and grazing management strategies. Cumulative DM yields were higher in the perennial ryegrass than the SLRG cultivars. Summer DM removal was very low at both sites; the ungrazed plots recovered and produced more DM in the following cooler period than the grazed plots in the first year but not the second. Metabolisable energy concentration was higher for perennial ryegrass than SLRG cultivars and was also higher in plots that had been grazed over the summer. There were large differences in plant frequency between species, and there were some differences among perennial ryegrass cultivars. The effect of summer grazing on plant frequency varied at each site and was not significant within an irrigation treatment. This research confirms that perennial ryegrass is not well suited to the hot, dry summers of northern Victoria and suggests that, under conditions of limited summer irrigation, farmers should focus on plant survival rather than summer yield if they are to maximise annual DM production.

Beginning medical students have a very early idea of what their physician identity will be. Providing a brief structured opportunity to reflect on the end of their career can be an important first step in identity formation. A reflective exercise was used in the summer prior to beginning medical school as each class of students at a regional rural medical school began a summer prematriculation program from 2015-2019. Students wrote what they wished to be said about them at the end of their career using a “Career Eulogy.” Identifiers were removed and narratives were coded into recurring text clusters by the authors. The students, on an anonymous evaluation, strongly agreed that the exercise facilitated the accomplishment of the program goals. Reflections from 42 entering medical students indicated a preference to be remembered for compassion, passion, quality, and patient relationships. Men more frequently mentioned family and enjoying life, and women more frequently mentioned patient relationships. Rural students included quality and being a teacher of medical students more frequently, and those with a physician parent included passion and community more frequently. Those who later chose family medicine as a specialty more often included references to enjoying life and family. This reflective exercise provided useful insight into early professional identity formation among these medical students and served to encourage group discussion. It could be used with larger, more diverse groups to determine its value and clarify true differences among the demographic and specialty choice patterns. This exercise could also be used annually for each student, providing a longitudinal view of identity formation.

Introduction: Fibromuscular dysplasia (FMD) is a non-inflammatory vasculopathy associated with arterial stenosis, aneurysm, dissection, and tortuosity. We investigated racial differences in clinical manifestations and events of multifocal FMD. Methods: Demographics, medical history, presenting signs and symptoms, and major vascular events were queried from the US Registry for FMD and stratified into White or Black based on self-identified race. Results: Of the 1897 female patients (pts) with multifocal FMD and race reported from 14 sites as of 12/23/2020, there were 1697 (89.5 %) White, 123 (6.5 %) Black, 52 (2.7%) Hispanic, and 25 (1.3%) pts of other races. Given a small number of pts in other groups, analysis was only performed between White and Black pts. Age at diagnosis and at first sign/symptom was similar between the two groups. Black pts were more likely to have a history of hypertension (p=0.009), stroke (p=0.002), and subarachnoid hemorrhage (p Conclusion: We noted a low number of Black patients enrolled in the US Registry for FMD at FMD specialty centers. There were differences in clinical manifestations, events, and pattern of vascular involvement among Black and White patients enrolled in US Registry, the mechanisms for which require additional study.

Introduction: Anticoagulation (AC) with warfarin or direct oral anticoagulants (DOAC) is the core of VTE treatment. Due to lower risk of VTE recurrence, American College of Chest Physicians (ACCP) recommends three months AC in patients with provoked VTE and without other indication for long-term AC. We aimed to assess how closely “real world” practice followed guideline recommendations. Hypothesis: We hypothesize most patients taking warfarin or DOAC for provoked VTE receive no more than three months AC. Patients who get prolonged AC are more likely to be taking DOAC than warfarin. Methods: We identified patients who initiated warfarin or DOAC from a six center AC clinic registry between 2008-20. Provoked VTE was defined as VTE after a transient risk factor: surgery, lower extremity cast/immobilization, childbirth, or OCPs. AC duration was categorized as 120 days. Appropriate treatment window was defined as 80-120 days to adjust for variability in clinic scheduling. Median AC length for DOAC vs. warfarin was compared with a two-sample test. Prevalence of extended AC was compared using chi-square test. Variables increasing risk of extended AC were analyzed with logistic regression, adjusted for baseline demographic and clinical characteristics. Results: At six centers, we identified 488 patients with provoked VTE on warfarin and 302 on DOAC. Average AC length was 137 days for warfarin and 180 days for DOAC (p120 days of AC (p120 days AC include recurrent VTE (OR 2.11; CI 1.34,3.32), prior MI (OR 4.09; CI 1.37,12.2), and DOAC use (OR 2.34; CI 1.69, 3.23) (Figure 1). Conclusions: In this multi-center analysis, most patients receive AC longer than guideline-recommended. DOAC use, recurrent VTE, and prior MI are associated with prolonged AC. Understanding the relationship between prior MI and AC duration in provoked VTE warrants future investigation.

Silver nanoparticles (AgNPs) are well-proven antimicrobial nanomaterials, yet little is elucidated regarding the mechanism underlying cytotoxicity induced by these nanoparticles. Here, we tested the hypothesis that mitochondria are primary intracellular targets of two AgNPs and silver ions, in mouse hepatocytes (AML12) cultured in glucose and galactose-based media. AML12 cells were more sensitive to mitochondrial uncoupling when grown with galactose rather than glucose. However, 24 hour-treatments with 15 nm AgNPs and 6 nm GA-AgNPs (5 and 10 μg/mL), and AgNO(3) (1 and 3 μg/mL), concentrations that resulted in either 10 or 30% cytotoxicity, failed to cause more toxicity to AML12 cells grown on galactose than glucose. Furthermore, colocalization analysis and subcellular Ag quantification did not show any enrichment of silver content in mitochondria in either medium. Finally, the effects of the same exposures on mitochondrial respiration were mild or undetectable, a result inconsistent with mitochondrial toxicity causing cell death. Our results suggest that neither ionic Ag nor the AgNPs that we tested specifically target mitochondria, and are inconsistent with mitochondrial dysfunction being the primary cause of cell death after Ag exposure under these conditions.

The current study examines /s/ variation in the southern-central city of Concepción, Chile and its relation to a variety of linguistic and social factors. A proportional-odds mixed effects model, with the random factor of “speaker”, was used to treat the categorically coded data on a continuum of acoustical variation ([s] > [h] > ∅). The results presented show that contrary to the previous assertions, heavy sibilant reduction, especially elision, in Concepción, Chile is the rule, rather than the exception, to the extent that it is no longer a marker of certain social demographics as has been reported previously. Furthermore, based on the trends reported, it is likely that this has been the case for several decades. Finally, the overall observed trends are indicative that the rates of /s/ elision will continue to increase across social demographics and different phonetic and phonological contexts in Concepción, Chile.

While the public can play a vital role in saving lives during emergencies, intervention is only effective if people have the skills, confidence, and willingness to help. This review employs a five-stage framework to systematically analyse first aid and emergency helping literature from 22 countries (predominately in Asia, Australia, Europe, and the United States). The review covers 54 articles that investigate public first-aid knowledge and uptake of first-aid training (40); public confidence in first-aid skills and willingness to help during an emergency (21); and barriers to or enablers of learning first aid and delivering first aid in an emergency (25). The findings identify high levels of perceived knowledge, confidence, and willingness to help, supporting the contention that the public can play a vital role during an emergency. However, the findings also point to low uptake levels, low tested skill-specific knowledge, and barriers to learning first aid and helping, indicating that the first-aid training landscape is in need of improvement.

Objectives: Pegfilgrastim is a granulocyte colony-stimulating factor (G-CSF) used as primary prophylaxis in patients receiving myelosuppressive chemotherapy regimens that have greater than 20% risk of developing febrile neutropenia (FN). Historically, pegfilgrastim has been administered 24 to 72 hours after chemotherapy, necessitating a return to clinic to receive the provider-administered injection. An alternative option is the pegfilgrastim on-body injector (OBI). With the OBI device, patients have their pegfilgrastim administered 27 hours after receiving chemotherapy while remaining at home, avoiding an additional clinic appointment. Concerns with pegfilgrastim OBI include lack of experience with the device in both the patient and provider, device-related failures, and the success of delivery. This study evaluates pegfilgrastim OBI failure rates through associated patient outcomes among cancer patients receiving chemotherapy requiring G-CSF. Methods: A retrospective electronic chart review was conducted of adult patients with cancer who received chemotherapy and pegfilgrastim OBI from July 1, 2016, to July 31, 2018. The primary objective of this study was the incidence of FN in patients receiving pegfilgrastim OBI. Results: There were no reported cases of hospitalization due to FN in patients who received pegfilgrastim OBI. Dose delays and dosage modifications were not observed in our review. The OBI device failure rate was found to be low (1.92%). Conclusion: The low device failure rate from this study suggests that the OBI is a viable option for administration of pegfilgrastim in patients receiving chemotherapy requiring G-CSF.

G protein–coupled receptor (GPCR) signaling is regulated by members of the protein kinase C (PKC) and GPCR kinase (GRK) families, although the relative contribution of each to GPCR function varies among specific GPCRs. The CXC motif receptor 4 (CXCR4) is a member of the GPCR superfamily that binds the CXC motif chemokine ligand 12 (CXCL12), initiating signaling that is subsequently terminated in part by internalization and lysosomal degradation of CXCR4. The purpose of this study is to define the relative contribution of PKC and GRK to CXCR4 signaling attenuation by studying their effects on CXCR4 lysosomal trafficking and degradation. Our results demonstrate that direct activation of PKC via the phorbol ester phorbol 12-myristate 13-acetate (PMA) mimics CXCL12-mediated desensitization, internalization, ubiquitination, and lysosomal trafficking of CXCR4. In agreement, heterologous activation of PKC by stimulating the chemokine receptor CXCR5 with its ligand, CXCL13, also mimics CXCL12-mediated desensitization, internalization, ubiquitination, and lysosomal degradation of CXCR4. Similar to CXCL12, PMA promotes PKC-dependent phosphorylation of serine residues within CXCR4 C-tail that are required for binding and ubiquitination by the E3 ubiquitin ligase AIP4 (atrophin-interacting protein 4). However, inhibition of PKC activity does not alter CXCL12-mediated ubiquitination and degradation of CXCR4, suggesting that other kinases are also required. Accordingly, siRNA-mediated depletion of GRK6 results in decreased degradation and ubiquitination of CXCR4. Overall, these results suggest that PKC and GRK6 contribute to unique aspects of CXCR4 phosphorylation and lysosomal degradation to ensure proper signal propagation and termination.

Ongoing targeting of mass transit networks and the challenges associated with policing these large open systems means that encouraging public vigilance and reporting on railways is a counter-terrorism priority. There is, however, surprisingly little research on motivations and barriers to cooperating with the police in this context. This paper contributes to this under-researched field by presenting the findings of a survey experiment which examined (1) the role of uncertainty as a barrier for reporting suspicious behaviour on rail networks, (2) whether drivers for cooperation established in the context of traditional crime hold for reporting suspicious behaviour at train stations, and (3) whether the UK ‘See it. Say it. Sorted’ campaign is effective in encouraging reporting. Data was collected in the UK and Denmark, national contexts with differing baseline attitudes towards the police and experiences of transit terrorist attacks, to assess the extent to which public vigilance campaigns need to be adapted to address local concerns. Results suggest that future public vigilance campaigns should address differences in lay and official definitions of suspicious behaviour to reduce uncertainty as a barrier to reporting. They also demonstrate that the influence of procedural justice on cooperation via its influence on social identification with the police holds beyond the context of community policing and reporting of traditional crime. However, other drivers are likely to be more important for determining reporting suspicious behaviour on rail networks, including perceived benefits of reporting. Theoretical and practical implications of cross-national differences and similarities in responses are discussed.

10 wt% oil-in-water emulsions with varied palm olein and stearin PO:PS ratios stabilized with 0.8 wt% Tween80 and tempered to obtain partially crystalline (CR) droplets (cooled from 80 to 4 °C and held overnight to induce nucleation/crystallization) or undercooled liquid (UC) droplets (cooled from 80 °C to 37 °C) produced emulsions with constant droplet size and polymorphism. However, zeta-potential decreased in undercooled emulsions due to crystallization/orientation of interfacial Tween, increasing alignment and ultimately a greater dipole moment. Significant differences in overall bioaccessibility between PO and PS present for the CR (PO bioaccessible fraction was 91%, whereas PS was 60%) and UC emulsions (PO and PS bioaccessibility were 96% and 77%).When only the solid fat content differs, and all other physical attributes remain constant, lipid digestibility decreases with increasing solid fat content; these findings, along with others, can be employed during food formulation and design more healthful foods.

Resumen: Se ha aseverado que fuera de unos préstamos léxicos, el mapudungun ha tenido poca influencia lingüística en el castellano chileno (p.ej. Alonso 1953). Pese a ello, estudios recientes (p. ej. Sadowsky 2013) indican que el mapudungun puede haber influido en el español chileno de manera más extensa de lo que anteriormente se ha afirmado. La presente investigación analiza un contorno entonativo con forma de meseta anteriormente documentado en Rogers (2013). Se determinó que el mapudungun cuenta con contornos parecidos y que el comportamiento prosódico, sintáctico y pragmático de éstos se asemeja mucho al de los del castellano chileno. Se propone que, en ambas lenguas, estos contornos funcionan como un mecanismo de extensión del foco discursivo y que el mapudungun aportó esta estrategia pragmática a la fonología entonativa del español chileno.

Schools have closed worldwide as part of measures to prevent SARS-CoV-2 transmission but are beginning to reopen in some countries. Various measures are being pursued to minimise transmission but existing guidance has not developed a comprehensive framework or theory of change. We present a framework informed by the occupational health hierarchy of control and a theory of change informed by realist approaches. We present measures focused on elimination, substitution, engineering, administration, education and personal protective equipment. We theorise that such measures offer a means of disrupting SARS-CoV-2 transmission via routes involving fomites, faeco-oral routes, droplets and aerosols., Highlights • Schools have been closed worldwide as part of lock-down measures to prevent SARS-CoV-2 transmission but are beginning to reopen in a number of countries. • Various measures are being pursued to minimise transmission but existing guidance has not aimed to develop a comprehensive framework or theory of change. • We present a framework for measures informed by the occupational health hierarchy of control (elimination, substitution, engineering, administration, education and personal protective equipment) and a theory of change. • We theorise that, together, such measures offer a means of disrupting SARS-CoV-2 transmission via routes involving fomites, faeco-oral routes, droplets and aerosols.

PURPOSE: To describe and discuss a systematic method for producing a very rapid response (3 days) to a UK government policy question in the context of reducing SARS-CoV-2 transmission. METHODS: A group of behavioural and social scientists advising the UK government on COVID-19 contributed to the analysis and writing of advice through the Government Office for Science. The question was as follows: What are the options for increasing adherence to social distancing (staying at home except for essential journeys and work) and shielding vulnerable people (keeping them at home and away from others)? This was prior to social distancing legislation being implemented. The first two authors produced a draft, based on analysis of the current government guidance and the application of the Behaviour Change Wheel (BCW) framework to identify and evaluate the options. RESULTS: For promoting social distancing, 10 options were identified for improving adherence. They covered improvements in ways of achieving the BCW intervention types of education, persuasion, incentivization, and coercion. For promoting shielding of vulnerable people, four options were identified covering the BCW intervention types of incentivization, coercion, and enablement. CONCLUSIONS: Responding to policymakers very rapidly as has been necessary during the COVID-19 pandemic can be facilitated by using a framework to structure the thinking and reporting of multidisciplinary academics and policymakers.

Following 9/11, Al-Qaeda-orchestrated plots were considered the greatest threat to Western security and sparked the coalition’s war on terror. Close to a decade later, the post-9/11 threat landscape had shifted significantly, leading then CIA-director Leon Panetta to describe “the lone-wolf strategy” as the main threat to the United States. Subsequent lone-actor attacks across the West, including the cities of London, Nice, Berlin, Stockholm, Ottawa and Charleston, further entrenched perspectives of a transformed security landscape in the “after, after-9/11” world. The unique features of lone-actor terrorism, including the challenges of interdiction and potential of copycat attacks, mean that the media is likely to play a particularly important role in shaping the reactions of the public, affected communities and copycat attackers. This article presents findings from a content analysis of British and Danish newspaper reporting of lone-actor terrorism between January 2010 and February 2015. The study highlights that lone-actor terrorism is framed, with national variations, as a significant and increasing problem in both countries; that Islamist lone-actors are often represented as distinct from far-right lone-actors; and that some reporting, despite relatively limited amplification of specific terrorist messages, potentially aids lone-actors by detailing state vulnerabilities to attacks.

This study analyzes the pronunciation of /s/ in the Spanish of young adults in a newer migrant settlement in metropolitan Lima, Peru. The participants have parents and/or grandparents who migrated to Lima primarily from the Andean provinces, where the sibilant pronunciation of /s/ prevails. The study examines a variety of social factors, including migrant generation, family origin, gender, education, occupation, and social networks to determine the factors that correlate with /s/ weakening, which is more prevalent in Classic Limeño Spanish than in Andean Spanish (Caravedo 1990; Hundley 1983; Klee and Caravedo 2006). A proportional-odds mixed effects model was used to treat the repeated measurement categorical data on a continuum of acoustical variation ([s]>[h]>Ø) and the advantages of this model are explained. Results indicate that an important social predictor of /s/ variation is migrant generation: there is a progressive weakening in /s/ with each subsequent migrant generation. In addition to the generational effect, higher levels of education correlate with less /s/ weakening. Two variables were more weakly correlated with /s/ pronunciation: gender and social networks. Overall, the results indicate that young adults in this community, especially those of the third-generation, seem to be assimilating to some degree to coastal norms of /s/ weakening, although there is also a possibility that they may be forming their own norm.

Introduction Cases of neonatal abstinence syndrome (NAS) increased 3-fold in the United States from 2000 to 2009, with some indication that the problem may be worse in rural areas. The purpose of our study was to report the incidence of NAS in a small rural community with a regional referral hospital and describe aspects of these infants’ NICU stay. Methods Using maternal prenatal positive urine drug screens (UDS) as our initial focus, deliveries at 35 weeks or beyond between March 2015 and May 2016 were included. NAS severity score, length of NICU stay, and hospital charges for each infant were obtained from chart review. Results Thirty three of 981 infants developed NAS requiring NICU admission. Most of these were not identified by either a prenatal history or a routine first prenatal visit UDS. For the 7 infants who were identified as at risk by a positive UDS early in pregnancy, the average length of stay in the NICU was 10 days, the average NAS score was 8, and the average NICU charge was $46,000 compared to $3,440 charge for a term normal newborn. Discussion Many studies have shown that neonatal abstinence syndrome is becoming more common, and some suggest that it may be a bigger problem in rural areas. While prenatal UDS may be helpful, many exposed infants will be missed. Even when exposure is proven, without reasonable access to medication assisted treatment during pregnancy, the outcome may still be unfavorable. The precise prevalence and cost in rural hospitals that serve as regional referral centers are needed for adequate health service planning. This planning includes strategies to increase local access to treatment options for pregnant women dependent on opioids.

Numerous studies have examined the different effects of English on the Miami-Cuban Spanish lexicon and morphosyntax. However, the studies regarding contact-induced change on Miami-Cuban Spanish and English phonology are noticeably few. The current study acoustically examines Miami-Cuban Spanish and English /l/. Ten Miami Cubans from three immigrant groups were recorded in both Spanish and English. Tokens of /l/ from both Spanish and English were then extracted and measured for “lightness” or “darkness” by subtracting the F1 measurements from their corresponding F2 measurements. Results indicate that Miami-Cuban English /l/ is less resistant to contact-induced change than its Spanish counterpart is.

Leishmania rely heavily on glycans to complete their digenetic life cycle in both mammalian and phlebotomine sand fly hosts. Leishmania promastigotes secrete a proteophosphoglycan-rich gel (Promastigote Secretory Gel, PSG) that is regurgitated during transmission and can exacerbate infection in the skin. Here we explored the role of PSG from natural Leishmania-sand fly vector combinations by obtaining PSG from Leishmania (L.) major-infected Phlebotomus (P.) papatasi and P. duboscqi and L. tropica-infected P. arabicus. We found that, in addition to the vector's saliva, the PSG from L. major and L. tropica potently exacerbated cutaneous infection in BALB/c mice, improved the probability of developing a patent cutaneous lesion, parasite growth and the evolution of the lesion. Of note, the presence of PSG in the inoculum more than halved the prepatent period of cutaneous L. tropica infection from an average of 32 weeks to 13 weeks. In addition, L. major and L. tropica PSG extracted from the permissive experimental vector, Lutzomyia (Lu.) longipalpis, also exacerbated infections in mice. These results reinforce and extend the hypothesis that PSG is an important and evolutionarily conserved component of Leishmania infection that can be used to facilitate experimental infection for drug and vaccine screening.

Effective risk communication is an integral part of responding to terrorism, but until recently, there has been very little pre-event communication in a European context to provide advice to the public on how to protect themselves during an attack. Following terrorist attacks involving mass shootings in Paris, France, in November 2015, the U.K. National Police Chiefs' Council released a Stay Safe film and leaflet that advises the public to "run," "hide," and "tell" in the event of a firearms or weapons attack. However, other countries, including Denmark, do not provide preparedness information of this kind, in large part because of concern about scaring the public. In this survey experiment, 3,003 U.K. and Danish participants were randomly assigned to one of three conditions: no information, a leaflet intervention, and a film intervention to examine the impact of "Run, Hide, Tell" advice on perceptions about terrorism, the security services, and intended responses to a hypothetical terrorist firearms attack. Results demonstrate important benefits of pre-event communication in relation to enhancing trust, encouraging protective health behaviors, and discouraging potentially dangerous actions. However, these findings also suggest that future communications should address perceived response costs and target specific problem behaviors. Cross-national similarities in response suggest this advice is suitable for adaptation in other countries.

Widespread electrical power outages pose a serious risk to modern societies. During an outage, the behavioural and psychological responses of members of the public will influence the overall health, economic and social impacts. In this review, we identified 47 studies containing data relating to public reactions after a major loss of electricity. These highlighted eight key messages: 1) Preparing the public should reduce the impact of an outage; 2) Specific vulnerable groups including older adults and those with psychiatric or medical conditions will require targeted help to prepare; 3) Clear public health communications will be needed to reduce, for example, carbon monoxide or food poisoning; 4) The loss of communication infrastructure is likely to be an important stressor among the public; 5) Panic is unlikely; 6) Acts of altruism will, probably, outweigh acts of criminality; 7) The public's information needs will focus on ‘what has happened’ and ‘when will power be restored’