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Teaching and learning undergraduate statistics has been a most challenging task for undergraduate psychology majors (Salkind, 2017). A seasoned statistics instructor consulted with a seasoned instructional designer on a method to improve a particularly demanding course using a performance improvement approach to address learning difficulties she had noted in previous semesters. The Decoding the Disciplines methodology identified the most challenging concepts and provided a methodology to improve student learning performance. The methodology focused on five core concepts in psychological statistics: probability, variability, central limit theorem, independent/dependent variables, and degrees of freedom. The Decoding the Disciplines curriculum was used for three semesters. In these three semesters, performance was compared pre and post on these concepts within the semester. Repeated measures t-tests found a significant change in the percentage of correct answers between the pretest and the final exam on the five core concepts.

Abstract Background Degeneration of both intervertebral discs (IVDs) and facet joints in the lumbar spine has been associated with low back pain, but whether and how IVD/joint degeneration contributes to pain remains an open question. Joint degeneration can be identified by pairing T1 and T2 magnetic resonance imaging (MRI) with analysis techniques such as Pfirrmann grades (IVD degeneration) and Fujiwara scores (facet degeneration). However, these grades are subjective, prompting the need to develop an automated technique to enhance inter‐rater reliability. This study introduces an automated convolutional neural network (CNN) technique trained on clinical MRI images of IVD and facet joints obtained from public‐access Lumbar Spine MRI Dataset. The primary goal of the automated system is to classify health of lumbar discs and facet joints according to Pfirrmann and Fujiwara grading systems and to enhance inter‐rater reliability associated with these grading systems. Methods Performance of the CNN on both the Pfirrmann and Fujiwara scales was measured by comparing the percent agreement, Pearson's correlation and Fleiss kappa value for results from the classifier to the grades assigned by an expert grader. Results The CNN demonstrates comparable performance to human graders for both Pfirrmann and Fujiwara grading systems, but with larger errors in Fujiwara grading. The CNN improves the reliability of the Pfirrmann system, aligning with previous findings for IVD assessment. Conclusion The study highlights the potential of using deep learning in classifying the IVD and facet joint health, and due to the high variability in the Fujiwara scoring system, highlights the need for improved imaging and scoring techniques to evaluate facet joint health. All codes required to use the automatic grading routines described herein are available in the Data Repository for University of Minnesota (DRUM).

Background: Access to healthcare services is a major barrier to residents of the rural state of South Dakota. As a highly accessible member of the healthcare team, outpatient pharmacists can play a key role in a patient's healthcare journey. There is a need to identify the unique barriers and facilitators pharmacists in both rural and urban areas face to maximize the impact of their role. Objective: The objective of this work was to compare perceptions of rural and urban pharmacists regarding the facilitators and barriers to providing patient care in South Dakota. Methods: This qualitative project highlights results from interviews and focus group sessions with a convenience sample of South Dakota pharmacists. Participants were recruited using a referral word-of-mouth system, contracts with healthcare market research agencies, newspaper advertisements, and posters displayed in public locations in South Dakota. Practice location was characterized as rural or urban based on United States Department of Agriculture definitions. Findings from interviews and focus group sessions were coded and analyzed using content analysis by two student researchers. Results: Participants included 12 rural-practicing and 21 urban-practicing pharmacists in South Dakota. In both rural and urban areas, key barriers included communication with providers (50% rural; 50% urban), lack of electronic health record access (25% rural; 14% urban), not enough staff (22% rural; 20% urban), and patient misunderstanding the scope of pharmacy (22% rural; 40% urban). Barriers specific to rural areas included time to provide services (22%), having smaller facilities (27%) and provider hesitation regarding collaborative practice agreements (29%). There were no urban-specific barriers. Facilitators specific to urban areas included frequent communication with patients (6.1%) and good quality support staff (9.1%). There were no rural-specific facilitators. Conclusions: Next steps include increasing awareness of pharmacy-based patient care services, researching further to identify the extent to which facilitators and barriers influence the ability to initiate and sustain pharmacy services in rural and urban areas, and providing support to pharmacies to overcome barriers and leverage facilitators.

OBJECTIVE: Increased social risk data collection in health care settings presents new opportunities to apply this information to improve patient outcomes. Clinical decision support (CDS) tools can support these applications. We conducted a participatory engagement process to develop electronic health record (EHR)-based CDS tools to facilitate social risk-informed care plan adjustments in community health centers (CHCs). MATERIALS AND METHODS: We identified potential care plan adaptations through systematic reviews of hypertension and diabetes clinical guidelines. The results were used to inform an engagement process in which CHC staff and patients provided feedback on potential adjustments identified in the guideline reviews and on tool form and functions that could help CHC teams implement these suggested adjustments for patients with social risks. RESULTS: Partners universally prioritized tools for social risk screening and documentation. Additional high-priority content included adjusting medication costs and changing follow-up plans based on reported social risks. Most content recommendations reflected partners interests in encouraging provider-patient dialogue about care plan adaptations specific to patients social needs. Partners recommended CDS tool functions such as alerts and shortcuts to facilitate and efficiently document social risk-informed care plan adjustments. DISCUSSION AND CONCLUSION: CDS tools were designed to support CHC providers and staff to more consistently tailor care based on information about patients social context and thereby enhance patients ability to adhere to care plans. While such adjustments occur on an ad hoc basis in many care settings, these are among the first tools designed both to systematize and document these activities.

Abstract The main protease (Mpro) of SARS-CoV-2 is critical for viral function and a key drug target. Mpro is only active when reduced; turnover ceases upon oxidation but is restored by re-reduction. This suggests the system has evolved to survive periods in an oxidative environment, but the mechanism of this protection has not been confirmed. Here, we report a crystal structure of oxidized Mpro showing a disulfide bond between the active site cysteine, C145, and a distal cysteine, C117. Previous work proposed this disulfide provides the mechanism of protection from irreversible oxidation. Mpro forms an obligate homodimer, and the C117-C145 structure shows disruption of interactions bridging the dimer interface, implying a correlation between oxidation and dimerization. We confirm dimer stability is weakened in solution upon oxidation. Finally, we observe the protein’s crystallization behavior is linked to its redox state. Oxidized Mpro spontaneously forms a distinct, more loosely packed lattice. Seeding with crystals of this lattice yields a structure with an oxidation pattern incorporating one cysteine-lysine-cysteine (SONOS) and two lysine-cysteine (NOS) bridges. These structures further our understanding of the oxidative regulation of Mpro and the crystallization conditions necessary to study this structurally.

Engaging the private sector in extension services and their direct interaction with farmers contributes to conservation agriculture production systems (CAPS) promotion. This study was conducted to assess influencing factors and mechanisms to engage private sector actors and to rank them to perform their engagement with farmers in an agricultural extension model designed to promote CAPS in Cambodia. The sample size for the survey instrument consisted of 481 randomly selected households, including both CAPS and non-CAPS farmers. For focus group discussions, a purposive sample of 28 participants was used. The positive factors influencing CAPS farmers' engagement with the private sector included gender, number of fields, off-farm income, farm experience, familiarity with the private sector in a commune and government subsidies. In contrast, total land size of main crops, and farmers' perceptions of utilization of private services including a distance of service and increase in profit had a negative impact. Subsidy and incentive programs from the government emerged as highly effective mechanisms for encouraging private sector engagement with farmers. Access to financial institutions was a key priority when engaging the private sector with CAPS farmers. Providing subsidies and incentives is a short-term economic benefit for smallholder farmers that could impact the long-term adoption.

Background: Community pharmacists are often the most accessible member of the healthcare team to many patients and play a key role in managing their chronic conditions, such as diabetes or heart disease, through expanded pharmacy services like Medication Therapy Management. Despite their accessibility, pharmacy services are often underutilized due, in part, to a lack of adequate reimbursement models for pharmacy services. There is a need for qualitative data to be collected to indicate the full impact of those services and why they are so important in a patient’s healthcare journey. Methods: An online Patient Stories Reporting Tool (PRST) was developed to allow outpatient pharmacists to document their perspectives of select direct patient care encounters that they felt showcased their value. In a pilot test, the PSRT was distributed to pharmacists from a partnering pharmacy organization. Qualitative data was collected, assessed by project team members, and organized by intervention types. For select stories, the otherwise undocumented nuances of delivered services and their impact were considered. Results: Forty-seven stories were reported by 17 pharmacists across 13 practice sites from August 2021 to March 2023. Three types of key interventions delivered were identified including General Patient Education (7 stories), Medication Optimization (20 stories), and Cost Reduction (20 stories). Given the nature and scope of this initial pilot, one story for each of the three most prevalent intervention types was identified as exemplifying the types of stories the tool can collect. Conclusions: The three selected stories help to characterize the services pharmacists provide, the important nuances of pharmacist-patient interactions, and the value of sharing these stories through tools like the PSRT. Through these stories, the PSRT also begins to record the nuances of pharmacist interventions and the impact they can make in a patient’s healthcare journey. Potential applications of the tool are multivarious including leading to improvements in the perception of pharmacists’ roles on the healthcare team and justifying reimbursement models.

Most Campylobacter jejuni isolates carry the fucose utilization cluster (Cj0480c-Cj0489) that supports the metabolism of l-fucose and d-arabinose. In this study we quantified l-fucose and d-arabinose metabolism and metabolite production, and the impact on Caco-2 cell interaction and binding to fibronectin, using C. jejuni NCTC11168 and the closely related human isolate C. jejuni strain 286. When cultured with l-fucose and d-arabinose, both isolates showed increased survival and production of acetate, pyruvate and succinate, and the respective signature metabolites lactate and glycolic acid, in line with an overall upregulation of l-fucose cluster proteins. In vitro Caco-2 cell studies and fibronectin-binding experiments showed a trend towards higher invasion and a significantly higher fibronectin binding efficacy of C. jejuni NCTC11168 cells grown with l-fucose and d-arabinose, while no significant differences were found with C. jejuni 286. Both fibronectin binding proteins, CadF and FlpA, were detected in the two isolates, but were not significantly differentially expressed in l-fucose or d-arabinose grown cells. Comparative proteomics analysis linked the C. jejuni NCTC11168 phenotypes uniquely to the more than 135-fold upregulated protein Cj0608, putative TolC-like component MacC, which, together with the detected Cj0606 and Cj0607 proteins, forms the tripartite secretion system MacABC with putative functions in antibiotic resistance, cell envelope stress response and virulence in Gram negative pathogenic bacteria. Further studies are required to elucidate the role of the MacABC system in C. jejuni cell surface structure modulation and virulence.

IntroductionCommunity Supported Agriculture (CSA) is an emerging model within alternative food networks (AFNs). It shapes close relationships between food producers and consumers, thereby contributing to food sovereignty and agri-food system transformations. Despite rapid growth from about 10 to over 500 CSAs in just over a decade, the model in Germany still remains niche. We argue that further and faster scaling up requires better understanding of its diversity, yet a comprehensive conceptualization of CSA types is lacking, with insufficient differentiation in research and practice.MethodsThis study employs a transdisciplinary mixed-methods approach (literature, qualitative, and quantitative data) in cooperation with the German CSA Network. By integrating organizational perspectives, we found that CSAs are highly complex and diverse organizations. Therefore, we firstly aimed at identifying characteristics that we summarized in a CSA framework. In a second stage, we used this framework as guiding structure for co-developing a survey with the Network covering 70 participating CSAs.ResultsAs the defining characteristic within the CSA framework, community financing (domain A) clarifies the uniqueness of the CSA model, thus enables delimitation from other AFN forms. Then differentiation characteristics (domain B) encompass the diversity of CSA configurations. CSA governance (domain B1), regarding the predominant characteristic of organizational governance, distinguish between Producer-led, Consumer-led, and Integrated (all-in-one) CSA types. Varying characteristics (domain B2) specify CSA configurations and enable additional distinction between CSAs. Based on the developed CSA framework, the survey results verify the applicability of governance types in particular, while confirming a high level of diversity of differentiating characteristics in general.DiscussionThis study can be used to reveal existing generalizations about CSAs, providing a starting point for more nuanced and critical views in research and practice. When seen against the background of AFN and food sovereignty discourses in particular, CSA is an alternative production-distribution model, but not every CSA is governed or structured in alternative ways. CSAs can simultaneously contain both more conventional, traditional elements, as well as more alternative elements. Moreover, the framework provides easy-to-access differentiation criteria for matching members with their most suitable CSAs and vice versa. Overall, this study illustrates that CSA cannot be considered as homogeneous AFN type but be rather marked as a diverse field of its own.

A new approach to an automatable fiber impregnation and consolidation process for the manufacturing of fiber-reinforced composite parts is presented in this article. Therefore, a vacuum chamber sealing machine classically used in food packaging is modified for this approach—Vacuum Chamber Infusion (VCI). Dry fiber placement (DFP) preforms, made from 30 k carbon fiber tape, with different layer amounts and fiber orientations, are infused with the VCI and with the state-of-the-art process—Vacuum Assisted Process (VAP)—as the reference. VCI uses a closed system that is evacuated once, while VAP uses a permanently evacuated open system. Since process management greatly influences material properties, the mechanical properties, void content, and fiber volume fraction (FVF) are analyzed. In addition, the study aims to identify how the complexity of a resin infusion process can be reduced, the automation potential can be increased, and the number of consumables can be reduced. Comparable material characteristics and a reduction in consumables, setup complexity, and manufacturing time by a factor of four could be approved for VCI. A void content of less than 2% is measured for both processes and an FVF of 39% for VCI and 45% for VAP is achieved.

The diffusion of cations in organic solvent solutions is important for the performance of metal-ion batteries. In this article, pulsed field gradient nuclear magnetic resonance experiments and fully atomistic molecular dynamic simulations were employed to study the temperature-dependent diffusive behavior of various liquid electrolytes representing 1M propylene carbonate solutions of metal salts with bis(trifluoromethylsulfonyl)imide (TFSI−) or hexafluorophosphate (PF6−) anions commonly used in lithium-ion batteries and beyond. The experimental studies revealed the temperature dependence of the diffusion coefficients for the propylene carbonate (PC) solvent and for the anions following an Arrhenius type of behavior. It was observed that the PC molecules are the faster species. For the monovalent cations (Li+, Na+, K+), the PC solvent diffusion was enhanced as the cation size increased, while for the divalent cations (Mg2+, Ca2+, Sr2+, Ba2+), the opposite trend was observed, i.e., the diffusion coefficients decreased as the cation size increased. The anion diffusion in LiTFSI and NaTFSI solutions was found to be similar, while in electrolytes with divalent cations, a decrease in anion diffusion with increasing cation size was observed. It was shown that non-polarizable charge-scaled force fields could correspond perfectly to the experimental values of the anion and PC solvent diffusion coefficients in salt solutions of both monovalent (Li+, Na+, K+) and divalent (Mg2+, Ca2+, Sr2+, Ba2+) cations at a range of operational temperatures. Finally, after calculating the radial distribution functions between cations, anions, and solvent molecules, the increase in the PC diffusion coefficient established with the increase in cation size for monovalent cations was clearly explained by the large hydration shell of small Li+ cations, due to their strong interaction with the PC solvent. In solutions with larger monovalent cations, such as Na+, and with a smaller solvation shell of PC, the PC diffusion is faster due to more liberated solvent molecules. In the salt solutions with divalent cations, both the anion and the PC diffusion coefficients decreased as the cation size increased due to an enhanced cation–anion coordination, which was accompanied by an increase in the amount of PC in the cation solvation shell due to the presence of anions. [ABSTRACT FROM AUTHOR]

Advances in social norm research indicated the potential benefit of utilizing social referents, who are highly connected to others and have outstanding positions in social networks, and therefore may effectively provide normative cues for other group members. Addressing the need to increase intergroup tolerance among adolescents, we developed an intervention for secondary schools focusing on network-identified social referents, who were encouraged to spread "Equality-Based Respect" norms to increase peer-to-peer tolerant relationships. We examined the feasibility, acceptability, and effectiveness of "Together for Tolerance" in a waitlist-controlled trial (N= 1,339). Implementation was largely as planned, with high acceptability among randomly selected social referents. However, we observed no increase in perceived respect norms or tolerant behaviors, apart from a potential short-term benefit in tolerance among students exposed to peer-led actions. We address conceptual (e.g., the role of norms) and methodological (e.g., positive initial attitudes) limitations, and suggestions for future implementation and evaluation.

Understanding tropical biology is important for solving complex problems such as climate change, biodiversity loss, and zoonotic pandemics, but biology curricula view research mostly via a temperate-zone lens. Integrating tropical research into biology education is urgently needed to tackle these issues.

As the expected cost of conservation agriculture (CA) inputs becomes an issue for farmers, financial institutions (FIs) play an essential role in promoting CA, a set of agricultural management practices with multiple positive effects. This research aimed to determine influencing factors, to rank challenges, and identify mechanisms for farmers to access agricultural credit for adoption of CA management practices in Cambodia. It was administered by conducting a survey of 242 randomly selected households for face-to-face interviews and conducting key informant interviews from purposive samples of 28 participants in Battambang and Preah Vihear provinces. The results indicated that influencing factors, including the family, adult labor and total farm size, had a positive relationship with farmers’ accessibility to agricultural credit, whereas age was negative. However, education year, farm size for main crops, on-farm income and farm experience were not significantly associated. High interest rates were the significant first-order challenge ranked, followed by document process complication, limited agricultural credit information, limited collateral security and a few other challenges. Support and improved process mechanisms to enhance credit accessibility are required to engage with multiple stakeholders, including farmers, FIs, non-government organizations (NGOs) and government officers. There has been a reduction in agricultural credit interest rates and incentives for importing CA inputs by the government, while provision of information support for agribusiness plans by NGOs which have implemented development project activities were considered as the main support mechanism. An improved process mechanism at the farmers’ level needs to include access to credit with low interest rates and a straightforward documentation process, whereas the FI level requires a business plan for lending decisions. It is evident that high lending rates hinder access to agricultural credit and the improvement of support and improved process mechanisms are necessary to better promote CA practices among farmers in Cambodia.

BackgroundProlapse recurrence after transvaginal surgical repair is common; however, its mechanisms are ill-defined. A thorough understanding of how and why prolapse repairs fail is needed to address their high rate of anatomic recurrence and to develop novel therapies to overcome defined deficiencies.ObjectiveThis study aimed to identify mechanisms and contributors of anatomic recurrence after vaginal hysterectomy with uterosacral ligament suspension (native tissue repair) vs transvaginal mesh (VM) hysteropexy surgery for uterovaginal prolapse.Study designThis multicenter study was conducted in a subset of participants in a randomized clinical trial by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network. Overall, 94 women with uterovaginal prolapse treated via native tissue repair (n=48) or VM hysteropexy (n=46) underwent pelvic magnetic resonance imaging at rest, maximal strain, and poststrain rest (recovery) 30 to 42 months after surgery. Participants who desired reoperation before 30 to 42 months were imaged earlier to assess the impact of the index surgery. Using a novel 3-dimensional pelvic coordinate system, coregistered midsagittal images were obtained to assess study outcomes. Magnetic resonance imaging-based anatomic recurrence (failure) was defined as prolapse beyond the hymen. The primary outcome was the mechanism of failure (apical descent vs anterior vaginal wall elongation), including the frequency and site of failure. Secondary outcomes included displacement of the vaginal apex and perineal body and change in the length of the anterior wall, posterior wall, vaginal perimeter, and introitus of the vagina from rest to strain and rest to recovery. Group differences in the mechanism, frequency, and site of failure were assessed using the Fisher exact tests, and secondary outcomes were compared using Wilcoxon rank-sum tests.ResultsOf the 88 participants analyzed, 37 (42%) had recurrent prolapse (VM hysteropexy, 13 of 45 [29%]; native tissue repair, 24 of 43 [56%]). The most common site of failure was the anterior compartment (VM hysteropexy, 38%; native tissue repair, 92%). The primary mechanism of recurrence was apical descent (VM hysteropexy, 85%; native tissue repair, 67%). From rest to strain, failures (vs successes) had greater inferior displacement of the vaginal apex (difference, -12 mm; 95% confidence interval, -19 to -6) and perineal body (difference, -7 mm; 95% confidence interval, -11 to -4) and elongation of the anterior vaginal wall (difference, 12 mm; 95% confidence interval, 8-16) and vaginal introitus (difference, 11 mm; 95% confidence interval, 7-15).ConclusionThe primary mechanism of prolapse recurrence following vaginal hysterectomy with uterosacral ligament suspension or VM hysteropexy was apical descent. In addition, greater inferior descent of the vaginal apex and perineal body, lengthening of the anterior vaginal wall, and increased size of the vaginal introitus with strain were associated with anatomic failure. Further studies are needed to provide additional insight into the mechanism by which these factors contribute to anatomic failure.

Abstract Background Identifying the locations of gene breakpoints between species of different taxonomic groups can provide useful insights into the underlying evolutionary processes. Given the exact locations of their genes, the breakpoints can be computed without much effort. However, often, existing gene annotations are erroneous, or only nucleotide sequences are available. Especially in mitochondrial genomes, high variations in gene orders are usually accompanied by a high degree of sequence inconsistencies. This makes accurately locating breakpoints in mitogenomic nucleotide sequences a challenging task. Results This contribution presents a novel method for detecting gene breakpoints in the nucleotide sequences of complete mitochondrial genomes, taking into account possible high substitution rates. The method is implemented in the software package DeBBI. DeBBI allows to analyze transposition- and inversion-based breakpoints independently and uses a parallel program design, allowing to make use of modern multi-processor systems. Extensive tests on synthetic data sets, covering a broad range of sequence dissimilarities and different numbers of introduced breakpoints, demonstrate DeBBI ’s ability to produce accurate results. Case studies using species of various taxonomic groups further show DeBBI ’s applicability to real-life data. While (some) multiple sequence alignment tools can also be used for the task at hand, we demonstrate that especially gene breaks between short, poorly conserved tRNA genes can be detected more frequently with the proposed approach. Conclusion The proposed method constructs a position-annotated de-Bruijn graph of the input sequences. Using a heuristic algorithm, this graph is searched for particular structures, called bulges, which may be associated with the breakpoint locations. Despite the large size of these structures, the algorithm only requires a small number of graph traversal steps.