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The purpose of this hermeneutic phenomenological study was to understand how Black undergraduate music education students make meaning of their lived experiences in predominantly White schools of music (PWSOM). The study was guided by the overall research questions: (1) What makes the lived experience of Black undergraduate music education students unique? and (2) What meaning(s) and understanding(s) do Black undergraduate music education students ascribe to their experiences in PWSOM? Data were collected primarily through open-ended interviews with nine Black undergraduate music education students in PWSOM in the United States. Data analysis revealed seven emergent themes, including (a) navigating the negative perceptions of White people; (b) making White people comfortable; (c) working harder to prove myself; (d) "Do I belong here?"; (e) a climate of racial and cultural insensitivity; (f) distrust of White faculty; and (g) sacrifice and survival. Findings were interpreted using Du Bois's theory of double consciousness and van Manen's four existentials of lived experience. Interpretation revealed the essence of the phenomenon to be living a dissonant existence.

RationaleTreatments with the serotonergic psychedelic psilocybin are being investigated for multiple neuropsychiatric disorders. Because many patients with these disorders use selective serotonin reuptake inhibitors (SSRIs), understanding interactions between psilocybin and SSRIs is critical for evaluating the safety, efficacy, and scalability of psilocybin-based treatments. Current knowledge about these interactions is limited, as most clinical psilocybin research has prohibited concomittant SSRI use.ObjectivesWe aimed to explore potential interactions between psilocybin and SSRIs by characterizing peoples' real-world experiences using psilocybin mushrooms and SSRIs together.MethodsWe conducted a systematic search of Reddit for posts describing psilocybin mushroom and SSRI coadministration. We identified 443 eligible posts and applied qualitative content analysis to each.Results8% of posts reported negative physical or psychological effects resulting from coadministration. These included 13 reports that may reflect serotonin toxicity, and 1 concerning for a psychotic/manic episode. 54% of posts described reduced intensity of the acute psilocybin experience, but 39% reported unchanged intensity with SSRI coadministration.ConclusionsPsilocybin's interactions with SSRIs are likely complex and may depend on multiple factors. Prospective studies are needed to evaluate whether psilocybin treatments are reliably safe and effective in the setting of SSRI use.

Objective: As the number of individuals diagnosed with dementia increases, so does the need to understand the preferences of persons living with dementia (PLWD) and caregivers for how clinicians can deliver a dementia diagnosis effectively, which can be a difficult process. This study describes the diagnostic communication preferences of PLWD and caregivers. Methods: We conducted semi-structured individual phone interviews with two groups: PLWD who were diagnosed in the past two years (n = 11) and family caregivers of PLWD (n = 19) living in Florida. PLWD and caregivers were not recruited/enrolled as dyads. Results: The groups' communication preferences were largely similar. Data were analyzed thematically into five themes: communicate the diagnosis clearly, meet information needs, discuss PLWD/caregiver resources, prepare for continued care, and communicate to establish and maintain relationships. Conclusion: Participants wanted clear communication, information, and support, but differed in some details (e.g. the language used to describe the diagnosis and the amount/type of desired information). Clinicians can apply general principles but will need to tailor them to individual preferences of PLWD and caregivers. Innovation: Limited research has elicited PLWD and caregivers' communication preferences for receiving dementia diagnoses, particularly through an individualized data collection method allowing for richer descriptions and deeper understanding.

Abstract Reintroductions are often needed to recover carnivore populations and restore ecological processes. Felids are common subjects of reintroduction efforts, but published population models informing felid reintroduction plans are uncommon, and poor planning has sometimes caused issues in felid reintroduction programs. In the United States, ocelots (Leopardus pardalis pardalis) are classified as endangered, and recovery requires population expansion into historic habitat. A multi‐organization effort is underway to establish a new ocelot population in Texas by releasing ocelots into an area of 478 km2 of suitable habitat in ocelots' historic but now unoccupied range. In this study, we used population viability analyses to compare different ocelot reintroduction strategies for the identified reintroduction area. Based on a potential ocelot breeding program's limitations, we modeled reintroduction using a founding population of no more than six ocelots and no more than four ocelots released per year for no more than 15 subsequent years. Within these limitations, we assessed projected population abundances and extinction risks after 30 years for 20 different reintroduction strategies. We found that long‐term releases are necessary to establish a viable population; under conservative model assumptions, releasing six ocelots in the initial year and then releasing four individuals annually for an additional 10–15 years is necessary for attaining a projected population greater than 36.62 ocelots (baseline) with

Neutron interferometry has played a distinctive role in fundamental science and characterization of materials. Moiré neutron interferometers are candidate next-generation instruments: they offer microscopy-like magnification of the signal, enabling direct camera recording of interference patterns across the full neutron wavelength spectrum. Here we demonstrate the extension of phase-grating moiré interferometry to two-dimensional geometries. Our fork-dislocation phase gratings reveal phase singularities in the moiré pattern, and we explore orthogonal moiré patterns with two-dimensional phase gratings. Our measurements of phase topologies and gravitationally induced phase shifts are in good agreement with theory. These techniques can be implemented in existing neutron instruments to advance interferometric analyses of emerging materials and precision measurements of fundamental constants.

SLC4A11 is the most abundant membrane transport protein in corneal endothelial cells. Its functional presence is necessary to support the endothelial fluid pump that draws fluid from the corneal stroma, preventing corneal edema. Several molecular actions have been proposed for SLC4A11 including H2O transport and cell adhesion. One of the most reproduced actions that SLC4A11 mediates is a H+ (or OH−) conductance that is enhanced in the presence of NH4Cl. The mechanism by which this occurs is controversial with some providing evidence in favor of NH3-H+ cotransport and others providing evidence for uncoupled H+ transport that is indirectly stimulated by the effects of NH4Cl upon intracellular pH and membrane potential. In the present study we provide new evidence and revisit previous studies, to support a model in which NH4Cl causes direct allosteric activation of SLC4A11 by means of an acidic shift in the intracellular pK (pKi) that governs the relationship between intracellular pH (pHi) and SLC4A11 H+-conductance. These findings have important implications for the assignment of a physiological role for SLC4A11.

Objectives Only 5–8% of adults with cancer participate in cancer clinical trials (CCTs), with even lower rates among underrepresented groups. Improving oncologists’ communication skills may enhance the frequency and quality of their discussions with patients about CCTs, consequently increasing participation. However, little is known about interest in or presence of CCT-related communication training during Hematology-Oncology (Hem-Onc) fellowships. This study aimed to describe, from the perspective of Hem-Onc fellowship program directors (PDs): (1) the current landscape of CCT education for Hem-Onc fellows; (2) the acceptability and feasibility of implementing a CCT communication skills workshop for Hem-Onc fellows. Methods We used an explanatory sequential mixed-methods approach. PDs were surveyed and interviewed about their graduate medical education (GME) programs’ current CCT curriculum, training challenges, fellows’ CCT knowledge and CCT communication skills, and preferences for a CCT communication workshop. Results PDs were surveyed (n = 40) and interviewed (n = 12). PDs reported that their institutions prioritize CCT accrual (M = 4.58, SD = .78; 1-5 scale, 5 = “Strongly Agree”) and clinical research training (M = 4.20, SD = .85). CCT skills that programs least often addressed were how to (1) discuss CCTs with newly diagnosed patients, (2) talk to patients about CCTs when none are available, and (3) help patients find CCTs at other institutions. PDs were interested in a CCT communication workshop for fellows (“yes” = 67.5%, “maybe” = 32.5%) and said training would be feasible (M = 4.28, SD = .78) and useful (M = 4.47, SD = .78). Qualitative results described programs’ current approaches to CCT education and insights about developing and implementing CCT communication training. Conclusions There is a clear need to improve CCT communication skills training in Hem-Onc fellowship programs and to implement and scale such training to increase CCT participation, especially among diverse patient populations. Furthermore, Hem-Onc GME PDs view such training as feasible and useful.

Abstract Plant diversity effects on community productivity often increase over time. Whether the strengthening of diversity effects is caused by temporal shifts in species-level overyielding (i.e., higher species-level productivity in diverse communities compared with monocultures) remains unclear. Here, using data from 65 grassland and forest biodiversity experiments, we show that the temporal strength of diversity effects at the community scale is underpinned by temporal changes in the species that yield. These temporal trends of species-level overyielding are shaped by plant ecological strategies, which can be quantitatively delimited by functional traits. In grasslands, the temporal strengthening of biodiversity effects on community productivity was associated with increasing biomass overyielding of resource-conservative species increasing over time, and with overyielding of species characterized by fast resource acquisition either decreasing or increasing. In forests, temporal trends in species overyielding differ when considering above- versus belowground resource acquisition strategies. Overyielding in stem growth decreased for species with high light capture capacity but increased for those with high soil resource acquisition capacity. Our results imply that a diversity of species with different, and potentially complementary, ecological strategies is beneficial for maintaining community productivity over time in both grassland and forest ecosystems.

This paper proposes a linear algebra-based supervised machine learning algorithm for the symbolic representation of arbitrarily non-linear and recursive systems. It introduces multiple extensions to the algorithmic class of “Forward Orthogonal Least Squares Regressions” (FOrLSR), which performs dictionary-based sparse symbolic regressions. The regression, being only provided with the system’s input and output, performs variable combinations and non-linear transformations from a given dictionary of analytic expressions and selects the optimal ones to represent the unknown system. This yields a “symbolic” system representation, having the minimum number of terms to enforce sparsity ( $L_{0}$ -norm), while keeping the highest possible precision. The first proposed algorithm (rFOrLSR) restructures the FOrLSR to be in matrix form (for large scale GPU and BLAS-like optimizations), recursive (to reduce the computational complexity from quadratic in model length to linear) and allows regressors to be imposed (to include user expertise and perform tree-searches). Furthermore, the dictionary search is restructured into a breadth-first arborescence traversal kept sparse by five proposed theorems, four corollaries and one pruning mechanism, while adding a validation procedure for the final model selection. The proposed arborescence (AOrLSR) scans large search-space segments, significantly increasing the probability of finding an optimal system representation, while only computing a marginal fraction of the search-space. The regression and arborescence are solvers for arbitrarily-determined linear equation systems which maximize sparsity in the solution vectors.

This paper investigates the phenomena of overclaiming -- the propensity for individuals to claim more knowledge about an issue or topic than they really (or could possibly) do. Using Programme for International Student Assessment (PISA) data from nine Anglophone countries and over 40,000 young people, we examine teenagers' propensity to claim knowledge of three mathematics constructs that do not really exist. We find substantial differences in young people's tendency to overclaim across countries, genders, and socio-economic groups. Those who are most likely to overclaim are also found to exhibit high levels of overconfidence and believe they work hard, persevere at tasks, and are popular amongst their peers. Together this provides important new insight into overclaiming, how this differs across groups, and how it relates to other psychological constructs.

Our study is among the first to provide a comprehensive review of cross-national patterns of gender differences in various STEM-related constructs--achievement, beliefs, attitudes, aspirations, and participation, concerning country-level gender equality. We complement our review with empirical analyses utilizing rigorous methodologies and richer datasets from individual and country levels. Specifically, we examine gender differences in relative strength measures (e.g., strength in science relative to math and reading) and STEM aspirations and graduation, using PISA 2015 and PISA 2018 data from 78 countries/regions (N = 941,475). Our analysis corroborates our literature review, indicating that support for both the gender stratification hypothesis and the gender equality paradox (i.e., whether gender gaps favoring male students are smaller or larger in more gender-equal countries) is generally inconsistent and weak. Various factors contribute to this inconsistency, including specific outlier countries, different years of data collection, diverse data sources, a range of composite and domain-specific measures of gender equality, and statistical models. Our study also introduces a robust statistical model to compare performances in three subjects and evaluate the predictive power of relative strength measures for STEM aspirations at the student level. Our analyses reveal that general academic achievement and math achievement relative to reading are key predictors of STEM aspirations, compared with science achievement relative to math and reading. By juxtaposing both levels of analysis, our findings offer a more nuanced understanding of gender differences in decision-making processes that lead to careers in STEM-related fields.

Introduction Although limited, recent research suggests that contact sport participation might have an adverse long-term effect on brain health. Further work is required to determine whether this includes an increased risk of neurodegenerative disease and/or subsequent changes in cognition and behaviour. The Advanced BiomaRker, Advanced Imaging and Neurocognitive Health Study will prospectively examine the neurological, psychiatric, psychological and general health of retired elite-level rugby union and association football/soccer players.Methods and analysis 400 retired athletes will be recruited (200 rugby union and 200 association football players, male and female). Athletes will undergo a detailed clinical assessment, advanced neuroimaging, blood testing for a range of brain health outcomes and neuropsychological assessment longitudinally. Follow-up assessments will be completed at 2 and 4 years after baseline visit. 60 healthy volunteers will be recruited and undergo an aligned assessment protocol including advanced neuroimaging, blood testing and neuropsychological assessment. We will describe the previous exposure to head injuries across the cohort and investigate relationships between biomarkers of brain injury and clinical outcomes including cognitive performance, clinical diagnoses and psychiatric symptom burden.Ethics and dissemination Relevant ethical approvals have been granted by the Camberwell St Giles Research Ethics Committee (Ref: 17/LO/2066). The study findings will be disseminated through manuscripts in clinical/academic journals, presentations at professional conferences and through participant and stakeholder communications.

The Crested-tailed deer mouse, Habromys lophurus, is one of seven arboreal species within the genus Habromys. Species of this genus are monotypic, relatively rare, and occur in low densities. Their geographical distribution is highly fragmented due to being restricted to montane cloud forest in Mesoamerica and they are of conservation concern. All Habromys species are endemic to Mexico, except H. lophurus, which is also distributed in Guatemala and El Salvador. In this study, we obtained and characterized the first mitogenome and several thousand nuclear ultraconserved elements (UCEs) of H. lophurus to determine its phylogenetic position within neotomine–peromyscine mice. Its mitogenome sequence (16,509 bp) is only the second complete mitogenome obtained for this poorly known genus. We also obtained the first nuclear genomic data for H. lophurus, including 3,654 UCE loci, as well as a partial mitogenome of H. simulatus (6,349 bp), and 2,186 UCE for the outgroup Holochilus sciureus. Phylogenetic analyses that included our newly generated genomic data coupled with previously published data from other neotomine–peromyscine mice confirm the placement of H. lophurus, H. simulatus, and H. ixtlani within a highly supported clade. The Habromys clade was nested within a clade that also contains members of the genus Peromyscus and provides further support for the hypothesis of the paraphyly of Peromyscus. These genomic resources will contribute to future phylogenomic studies that aim to further elucidate the evolutionary history of this rare and critically endangered genus of rodents.

Abstract We performed a preliminary study of neutron resonance absorption imaging to investigate the spatial distribution of constituent elements in borosilicate glasses containing simulated high-level radioactive waste, in which elemental inhomogeneities affect the physical and chemical stabilities of the glass. Dips generated by the resonance absorptions of Rh, Pd, Na, Gd, Cs, and Sm were observed in the neutron transmission spectra of the glass samples. The spatial distributions of these elements were obtained from the neutron transmission images at the resonance energies. The distributions of Rh and Pd visualized the sedimentation of these platinum group elements. In contrast, the lanthanides (Gd and Sm) and Cs were uniformly dispersed. These results show that neutron resonance absorption imaging is a promising tool for characterizing borosilicate glasses and investigating the vitrification mechanism of high-level radioactive waste.

Abstract Efforts to catalog global biodiversity have often focused on aboveground taxonomic diversity, with limited consideration of belowground communities. However, diversity aboveground may influence the diversity of belowground communities and vice versa. In addition to taxonomic diversity, the structural diversity of plant communities may be related to the diversity of soil bacterial and fungal communities, which drive important ecosystem processes but are difficult to characterize across broad spatial scales. In forests, canopy structural diversity may influence soil microorganisms through its effects on ecosystem productivity and root architecture, and via associations between canopy structure, stand age, and species richness. Given that structural diversity is one of the few types of diversity that can be readily measured remotely (e.g., using light detection and ranging—LiDAR), establishing links between structural and microbial diversity could facilitate the detection of belowground biodiversity hotspots. We investigated the potential for using remotely sensed information about forest structural diversity as a predictor of soil microbial community richness and composition. We calculated LiDAR‐derived metrics of structural diversity as well as a suite of stand and soil properties from 38 forested plots across the central hardwoods region of Indiana, USA, to test whether forest canopy structure is linked with the community richness and diversity of four key soil microbial groups: bacteria, fungi, arbuscular mycorrhizal (AM) fungi, and ectomycorrhizal (EM) fungi. We found that the density of canopy vegetation is positively associated with the taxonomic richness (alpha diversity) of EM fungi, independent of changes in plant taxonomic richness. Further, structural diversity metrics were significantly correlated with the overall community composition of bacteria, EM, and total fungal communities. However, soil properties were the strongest predictors of variation in the taxonomic richness and community composition of microbial communities in comparison with structural diversity and tree species diversity. As remote sensing tools and algorithms are rapidly advancing, these results may have important implications for the use of remote sensing of vegetation structural diversity for management and restoration practices aimed at preserving belowground biodiversity.

Biodiversity within ecological communities has been shown to influence plant resistance and tolerance to herbivory, and may strongly interact with climate change. However, the effects of diversity within microbial symbionts on their plant hosts’ responses to herbivores is less well documented, particularly within the context of agricultural systems. Here we examine the interactive effects of rhizobial diversity and drought in promoting soybean resistance and tolerance to insect and mammalian herbivores in an outdoor pot experiment. We demonstrate that soybean plants provided with a diverse mixture of rhizobial strains experience 30% less damage by chewing insect herbivores under both drought (reduced watering and increased temperature) and ambient weather conditions, as well as half as much colonization by aphids under drought conditions. This effect was not due to the presence of any particularly beneficial rhizobial strain (i.e., not a selection effect), but rather due to an enhanced benefit provided by the rhizobial strains in combination (i.e., a complementarity effect). No effects of rhizobial diversity were observed on the rate of defoliation by rabbits. While rhizobial diversity did affect soybean resistance to insect herbivores, these differences in insect damage did not carry through to affect soybean growth or final yield. Thus, soybean plants exhibited high tolerance to herbivory regardless of our experimentally imposed rhizobial diversity or drought treatments. With future projections for increased pest outbreaks and drought, understanding the factors that can sustainably enhance agricultural yield is critical. Our results suggest that promoting rhizobial diversity within soybean agriculture may be one nature-based solution to promote the resistance of this critical crop to insect pests.

Abstract Background Identifying blood-based signatures of brain health and preclinical pathology may offer insights into early disease mechanisms and highlight avenues for intervention. Here, we systematically profiled associations between blood metabolites and whole-brain volume, hippocampal volume, and amyloid-β status among participants of Insight 46—the neuroscience sub-study of the National Survey of Health and Development (NSHD). We additionally explored whether key metabolites were associated with polygenic risk for Alzheimer’s disease (AD). Methods Following quality control, levels of 1019 metabolites—detected with liquid chromatography-mass spectrometry—were available for 1740 participants at age 60–64. Metabolite data were subsequently clustered into modules of co-expressed metabolites using weighted coexpression network analysis. Accompanying MRI and amyloid-PET imaging data were present for 437 participants (age 69–71). Regression analyses tested relationships between metabolite measures—modules and hub metabolites—and imaging outcomes. Hub metabolites were defined as metabolites that were highly connected within significant (p FDR

A scarcity of studies of the dynamics of wild bee populations hampers conservation efforts by bee ecologists and conservationists. Present limited information suggests that bee populations are highly unpredictable from year-to-year. Here we present an historical data set from nine sites replicated in 1984 and 1985 that demonstrates extreme between-year variability in numbers for 19 xylophilous bee species. Sixteen of those species produced far fewer nests in 1985, and 13 species in 1985 produced less than a third the number of nests produced in 1984. We argue that the 1985 collapse was not due to semivoltinism, i.e., the absence of morphs that require two years to mature, or to excessive sampling in 1984, but to a record cold period from January to March 1985 which likely killed most diapausing bees. Such events illustrate the dynamism of wild bee populations and thereby the large number of years needed to establish statistically significant population trends. We suggest that the current emphasis by bee conservationists to promote widespread surveillance monitoring programs is misguided and that funds are more effectively spent on hypothesis-driven targeted monitoring and on actions to actually reclaim degraded wild bee habitat.

Abstract Bats are important pest control agents in agriculture. Yet, the underlying fine‐scale biotic and abiotic mechanisms that drive their foraging behaviors and responses to insect outbreaks are unclear. Herbivore‐induced plant volatiles (HIPVs) can attract both invertebrate and vertebrate natural enemies that use the chemical plant cues to locate insect prey. The ability of HIPVs to attract multiple species raises the question of whether they may also be a biotic factor influencing insectivorous bat activity. Additionally, abiotic factors, such as weather conditions, can affect bat activity in agricultural settings, but little is known about how bats respond to shifting environmental conditions on short timescales in this landscape context. Using a model crop system, soybean (Glycine max), our study asked three questions: (1) Which bat species are active in eastern Maryland soybean fields? (2) Is insectivorous bat activity affected by naturally occurring soybean HIPVs and/or synthetic soybean HIPVs (indole or farnesene)? (3) How is insectivorous bat activity affected by hourly weather conditions in this landscape? In soybean fields in eastern Maryland, we created paired treatment plots: HIPV plots (damaged plants or synthetic HIPV dispensers) and control plots (undamaged plants or empty dispensers). We measured bat activity using ultrasonic recorders, summarizing hourly and nightly activity, and detected 10 total species. The most abundant species were big brown/silver‐haired bats (Eptesicus fuscus/Lasionycteris noctivagans). Bat activity did not significantly differ between control and HIPV plots in any of the three experiments. Thus, our results do not support our expectation that bats in eastern Maryland use soybean HIPVs to locate insect prey. However, bat activity did increase with increasing average hourly temperature and wind speed. This initial study of bats and HIPVs, as well as the fine‐scale examination of weather conditions on bat activity, may serve as a guide for future research on bat–plant interactions that can support the development of new strategies for sustainable pest management.

Matthew Parker et al. use the ARTIC network tiled amplicon PCR and Oxford Nanopore sequencing of thousands of SARS-CoV-2 samples to detect subgenomic RNA changes in the B.1.1.7 lineage endemic in the UK in late 2020/early 2021. They discovered higher subgenomic RNA in B.1.1.7 compared to previous lineages, and find a noncanonical subgenomic RNA that could encode ORF9b.

The sodium-bicarbonate cotransporter (NBCe1) has three primary variants: NBCe1-A, -B and -C. NBCe1-A is expressed in renal proximal tubules in the cortical labyrinth, where it is essential for reclaiming filtered bicarbonate, such that NBCe1-A knockout mice are congenitally acidemic. NBCe1-B and -C variants are expressed in chemosensitive regions of the brainstem, while NBCe1-B is also expressed in renal proximal tubules located in the outer medulla. Although mice lacking NBCe1-B/C (KOb/c) exhibit a normal plasma pH at baseline, the distribution of NBCe1-B/C indicates that these variants could play a role in both the rapid respiratory and slower renal responses to metabolic acidosis (MAc). Therefore, in this study we used an integrative physiologic approach to investigate the response of KOb/c mice to MAc. By means of unanesthetized whole-body plethysmography and blood-gas analysis, we demonstrate that the respiratory response to MAc (increase in minute volume, decrease in pCO2) is impaired in KOb/c mice leading to a greater severity of acidemia after 1 day of MAc. Despite this respiratory impairment, the recovery of plasma pH after 3-days of MAc remained intact in KOb/c mice. Using data gathered from mice housed in metabolic cages we demonstrate a greater elevation of renal ammonium excretion and greater downregulation of the ammonia recycling enzyme glutamine synthetase in KOb/c mice on day 2 of MAc, consistent with greater renal acid-excretion. We conclude that KOb/c mice are ultimately able to defend plasma pH during MAc, but that the integrated response is disturbed such that the burden of work shifts from the respiratory system to the kidneys, delaying the recovery of pH.

Abstract INTRODUCTION The Centiloid scale aims to harmonize amyloid beta (Aβ) positron emission tomography (PET) measures across different analysis methods. As Centiloids were created using PET/computerized tomography (CT) data and are influenced by scanner differences, we investigated the Centiloid transformation with data from Insight 46 acquired with PET/magnetic resonanceimaging (MRI). METHODS We transformed standardized uptake value ratios (SUVRs) from 432 florbetapir PET/MRI scans processed using whole cerebellum (WC) and white matter (WM) references, with and without partial volume correction. Gaussian‐mixture‐modelling–derived cutpoints for Aβ PET positivity were converted. RESULTS The Centiloid cutpoint was 14.2 for WC SUVRs. The relationship between WM and WC uptake differed between the calibration and testing datasets, producing implausibly low WM‐based Centiloids. Linear adjustment produced a WM‐based cutpoint of 18.1. DISCUSSION Transformation of PET/MRI florbetapir data to Centiloids is valid. However, further understanding of the effects of acquisition or biological factors on the transformation using a WM reference is needed. HIGHLIGHTS Centiloid conversion of amyloid beta positron emission tomography (PET) data aims to standardize results. Centiloid values can be influenced by differences in acquisition. We converted florbetapir PET/magnetic resonance imaging data from a large birth cohort. Whole cerebellum referenced values could be reliably transformed to Centiloids. White matter referenced values may be less generalizable between datasets.

Young women (18-45 years of age) with breast cancer often view the end of active treatment as a significant milestone. While completing treatment is largely celebrated, little is known about the immediate time after completing active treatment. The purpose of this qualitative, descriptive study was to explore the needs of young women survivors transitioning out of active breast cancer treatment and into survivorship. We used a qualitative design with convenience sampling of young women who completed active breast cancer treatment within the last 5 years to participate in semi-structured online focus groups from November 2020 to May 2021. Thematic analysis was used to reveal the needs as women transitioned out of active treatment and into survivorship. Thirty-three young women breast cancer survivors (75.8% White, 12.1% Black, 12.1% other) participated in 7 online focus groups each lasting approximately 90 min. Three dominant themes with accompanying subthemes emerged from the data: (1) “feeling like a different kind of woman” (physical [cognitive, weight, sexual] changes, emotional changes [defining normal, loss of purpose]); (2) lingering emotional trauma (active treatment, survivorship); and (3) recommendations (services needed, content needed). Participants in this study did not feel prepared for the physical and emotional changes associated with the transition from active treatment and into survivorship as identified in our 2 main themes of “feeling like a different kind of woman” and lingering emotional trauma. Participants recommended more thorough communication about expectations in survivorship focusing on physical aspects like cognitive, weight, and sexual changes as well emotional challenges like loss of identity in survivorship. More communication specific to young women could assist in the transition to survivorship.

Abstract Background Equal-tailed confidence intervals that maintain nominal coverage (0.95 or greater probability that a 95% confidence interval covers the true value) are useful in interval-based statistical reliability standards, because they remain conservative. For age-adjusted death rates, while the Fay–Feuer gamma method remains the gold standard, modifications have been proposed to streamline implementation and/or obtain more efficient intervals (shorter intervals that retain nominal coverage). Methods This paper evaluates three such modifications for use in interval-based statistical reliability standards, the Anderson–Rosenberg, Tiwari, and Fay–Kim intervals, when data are sparse and sample size-based standards alone are overly coarse. Initial simulations were anchored around small populations (P = 2400 or 1200), the median crude all-cause US mortality rate in 2010–2019 (833.8 per 100,000), and the corresponding age-specific probabilities of death. To allow for greater variation in the age-adjustment weights and age-specific probabilities, a second set of simulations draws those at random, while holding the mean number of deaths at 20 or 10. Finally, county-level mortality data by race/ethnicity from four causes are selected to capture even greater variation: all causes, external causes, congenital malformations, and Alzheimer disease. Results The three modifications had comparable performance when the number of deaths was large relative to the denominator and the age distribution was as in the standard population. However, for sparse county-level data by race/ethnicity for rarer causes of death, and for which the age distribution differed sharply from the standard population, coverage probability in all but the Fay–Feuer method sometimes fell below 0.95. More efficient intervals than the Fay–Feuer interval were identified under specific circumstances. When the coefficient of variation of the age-adjustment weights was below 0.5, the Anderson–Rosenberg and Tiwari intervals appeared to be more efficient, whereas when it was above 0.5, the Fay–Kim interval appeared to be more efficient. Conclusions As national and international agencies reassess prevailing data presentation standards to release age-adjusted estimates for smaller areas or population subgroups than previously presented, the Fay–Feuer interval can be used to develop interval-based statistical reliability standards with appropriate thresholds that are generally applicable. For data that meet certain statistical conditions, more efficient intervals could be considered.

SARS-CoV-2 has resulted in multiple outbreaks in hospitals, but identifying transmission events is challenging. Here, the authors combine whole genome sequencing and epidemiological data from the first two waves of the pandemic at a UK hospital trust and characterise transmission chains.

Summary: Mitochondria are vital organelles that require sophisticated homeostatic mechanisms for maintenance. Intercellular transfer of damaged mitochondria is a recently identified strategy broadly used to improve cellular health and viability. Here, we investigate mitochondrial homeostasis in the vertebrate cone photoreceptor, the specialized neuron that initiates our daytime and color vision. We find a generalizable response to mitochondrial stress that leads to loss of cristae, displacement of damaged mitochondria from their normal cellular location, initiation of degradation, and transfer to Müller glia cells, a key non-neuronal support cell in the retina. Our findings show transmitophagy from cones to Müller glia as a response to mitochondrial damage. Intercellular transfer of damaged mitochondria represents an outsourcing mechanism that photoreceptors use to support their specialized function.

Longevity of species populations depends largely on interactions among animals and plants in an ecosystem. Predation and seed dispersal are among the most important interactions necessary for species conservation and persistence, and diet analysis is a prerequisite tool to evaluate these interactions. Understanding these processes is crucial for identifying conservation targets and for executing efficient reforestation and ecological restoration. In this study, we applied a scat DNA metabarcoding technique using the P6-loop of the trnL (UAA) chloroplastic marker to describe the seasonal plant diet composition of 15 mammal species from a highly biodiverse Lebanese forest in the Eastern Mediterranean. We also recovered plant seeds, when present, from the scats for identification. The mammal species belong to 10 families from 5 different orders. More than 133 plant species from 54 plant families were detected and identified. Species from the Rosaceae, Poaceae, Apiaceae, Fabaceae, Fagaceae and Berberidaceae families were consumed by the majority of the mammals and should be taken into consideration in future reforestation and conservation projects. Our results showed that the DNA metabarcoding approach provides a promising method for tracking the dietary plant components of a wide diversity of mammals, yielding key insights into plant-animal interactions inside Lebanon’s forests.

The parahippocampal cingulum bundle (PHCB) interconnects regions known to be vulnerable to early Alzheimer's disease (AD) pathology, including posteromedial cortex and medial temporal lobe. While AD-related pathology has been robustly associated with alterations in PHCB microstructure, specifically lower fractional anisotropy (FA) and higher mean diffusivity (MD), emerging evidence indicates that the reverse pattern is evident in younger adults at increased risk of AD. In one such study, Hodgetts et al. (2019) reported that healthy young adult carriers of the apolipoprotein-E (APOE) ε4 allele – the strongest common genetic risk factor for AD – showed higher FA and lower MD in the PHCB but not the inferior longitudinal fasciculus (ILF). These results are consistent with proposals claiming that heightened neural activity and intrinsic connectivity play a significant role in increasing posteromedial cortex vulnerability to amyloid-β and tau spread beyond the medial temporal lobe. Given the implications for understanding AD risk, here we sought to replicate Hodgetts et al.‘s finding in a larger sample (N = 128; 40 APOE ε4 carriers, 88 APOE ε4 non-carriers) of young adults (age range = 19–33). Extending this work, we also conducted an exploratory analysis using a more advanced measure of white matter microstructure: hindrance modulated orientational anisotropy (HMOA). Contrary to the original study, we did not observe higher FA or lower MD in the PHCB of APOE ε4 carriers relative to non-carriers. Bayes factors (BFs) further revealed moderate-to-strong evidence in support of these null findings. In addition, we observed no APOE ε4-related differences in PHCB HMOA. Our findings indicate that young adult APOE ε4 carriers and non-carriers do not differ in PHCB microstructure, casting some doubt on the notion that early-life variation in PHCB tract microstructure might enhance vulnerability to amyloid-β accumulation and/or tau spread.

AbstractGrowing orogenic wedges cool rocks during exhumation of thrust hanging walls and heat them during burial of footwalls, leaving behind a resilient thermal record of earlier deformation in fold-thrust belts. In order to investigate early burial of deformed strata within the retroarc Idaho-Montana fold-thrust belt, we use Raman spectroscopy of carbonaceous material to construct a maximum temperature profile that constrains the thicknesses of eroded rocks structurally above the Lemhi arch, a pre-thrusting basement high. In the eastern portion of the study area, a sharp maximum temperature change of ~120°C occurs across the Johnson thrust, signifying that regional burial and heating predated late-stage faulting. West of here, cumulative exhumation is irregular, varying by up to 5 km over large (~75 km) wavelength folds; however, maximum temperatures in this same region are consistently ~200°C higher than correlative stratigraphic units in the adjacent foreland. The pre-thrusting, low-relief unconformity above the Lemhi arch, which served as the early décollement to the fold-thrust belt, was everywhere buried to at least ~6.5 km depth, which is ~1.5-5.0 km deeper than can be explained by stratigraphic burial. We hypothesize that between ~145 and 80 Ma, a combination of Cretaceous deposition and folding and thrusting at higher structural levels buried the décollement of the Medicine Lodge-McKenzie thrust system to this depth. These results suggest that the early orogenic wedge had exceptionally low taper. We propose that thin strata over the low-relief Lemhi arch limited the availability of potential décollements, which restricted the maximum surface slope that could be constructed in a thin-skinned system. Subsequent growth of the orogenic wedge required activation of a much deeper décollement and a switch to a thick-skinned structural style, promoting a shift from burial to exhumation of the former décollement and the underlying Lemhi arch. This suggests that the growth of an orogenic wedge is dependent on the thicknesses of the preexisting strata and the availability of potential décollements, with sedimentation and burial heating potentially playing a key role.

It is estimated that in the human brain, short association fibres (SAF) represent more than half of the total white matter volume and their involvement has been implicated in a range of neurological and psychiatric conditions. This population of fibres, however, remains relatively understudied in the neuroimaging literature. Some of the challenges pertinent to the mapping of SAF include their variable anatomical course and proximity to the cortical mantle, leading to partial volume effects and potentially affecting streamline trajectory estimation. This work considers the impact of seeding and filtering strategies and choice of scanner, acquisition, data resampling to propose a whole-brain, surface-based short (≤30–40 mm) SAF tractography approach. The framework is shown to produce longer streamlines with a predilection for connecting gyri as well as high cortical coverage. We further demonstrate that certain areas of subcortical white matter become disproportionally underrepresented in diffusion-weighted MRI data with lower angular and spatial resolution and weaker diffusion weighting; however, collecting data with stronger gradients than are usually available clinically has minimal impact, making our framework translatable to data collected on commonly available hardware. Finally, the tractograms are examined using voxel- and surface-based measures of consistency, demonstrating moderate reliability, low repeatability and high between-subject variability, urging caution when streamline count-based analyses of SAF are performed.

Plant–microbe interactions are of rising interest in plant sustainability, biomass production, plant biology, and systems biology. These interactions have been a challenge to detect until recent advancements in mass spectrometry imaging. Plants and microbes interact in four main regions within the plant, the rhizosphere, endosphere, phyllosphere, and spermosphere. This mini review covers the challenges within investigations of plant and microbe interactions. We highlight the importance of sample preparation and comparisons among time-of-flight secondary ion mass spectroscopy (ToF-SIMS), matrix-assisted laser desorption/ionization (MALDI), laser desorption ionization (LDI/LDPI), and desorption electrospray ionization (DESI) techniques used for the analysis of these interactions. Using mass spectral imaging (MSI) to study plants and microbes offers advantages in understanding microbe and host interactions at the molecular level with single-cell and community communication information. More research utilizing MSI has emerged in the past several years. We first introduce the principles of major MSI techniques that have been employed in the research of microorganisms. An overview of proper sample preparation methods is offered as a prerequisite for successful MSI analysis. Traditionally, dried or cryogenically prepared, frozen samples have been used; however, they do not provide a true representation of the bacterial biofilms compared to living cell analysis and chemical imaging. New developments such as microfluidic devices that can be used under a vacuum are highly desirable for the application of MSI techniques, such as ToF-SIMS, because they have a subcellular spatial resolution to map and image plant and microbe interactions, including the potential to elucidate metabolic pathways and cell-to-cell interactions. Promising results due to recent MSI advancements in the past five years are selected and highlighted. The latest developments utilizing machine learning are captured as an important outlook for maximal output using MSI to study microorganisms.

Oxidative and lipid homeostasis are altered by stress and trauma and post-traumatic stress disorder (PTSD) is associated with alterations to lipid species in plasma. Stress-induced alterations to lipid and oxidative homeostasis may exacerbate PTSD pathology, but few preclinical investigations of stress-induced lipidomic changes in the brain exist. Currently available techniques for the quantification of lipid species in biological samples require tissue extraction and are limited in their ability to retrieve spatial information. Raman imaging can overcome this limitation through the quantification of lipid species in situ in minimally processed tissue slices. Here, we utilized a predator exposure and psychosocial stress (PE/PSS) model of traumatic stress to standardize Raman imaging of lipid species in the hippocampus using LC-MS based lipidomics and these data were confirmed with qRT-PCR measures of mRNA expression of relevant enzymes and transporters. Electron Paramagnetic Resonance Spectroscopy (EPR) was used to measure free radical production and an MDA assay to measure oxidized polyunsaturated fatty acids. We observed that PE/PSS is associated with increased cholesterol, altered lipid concentrations, increased free radical production and reduced oxidized polyunsaturated fats (PUFAs) in the hippocampus (HPC), indicating shifts in lipid and oxidative homeostasis in the HPC after traumatic stress.

Abstract Background Urban areas are often built along large rivers and surrounded by agricultural land. This may lead to small tributary streams that have agricultural headwaters and urbanized lower reaches. Our study objectives assessed are as follows: (1) landscape, geomorphic, and water quality variables that best explained variation in aquatic communities and their integrity in a stream system following this agricultural-to-urban land use gradient; (2) ways this land use gradient caused aquatic communities to differ from what would be expected for an idealized natural stream or other longitudinal gradients; and (3) whether the impacts of this land use gradient on aquatic communities would grow larger in a downstream direction through the agricultural and urban developments. Our study area was an impaired coldwater stream in Michigan, USA. Results Many factors structured the biological communities along the agricultural-to-urban land use gradient. Instream woody debris had the strongest relationship with EPT (Ephemeroptera, Plecoptera, and Trichoptera) abundance and richness and were most common in the lower, urbanized watershed. Fine streambed substrate had the strongest relationship with Diptera taxa and surface air breather macroinvertebrates and was dominant in agricultural headwaters. Fish community assemblage was influenced largely by stream flow and temperature regimes, while poor fish community integrity in lower urban reaches could be impacted by geomorphology and episodic urban pollution events. Scraping macroinvertebrates were most abundant in deforested, first-order agricultural headwaters, while EPT macroinvertebrate richness was the highest downstream of agricultural areas within the urban zone that had extensive forest buffers. Conclusion Environmental variables and aquatic communities would often not conform with what we would expect from an idealized natural stream. EPT richness improved downstream of agricultural areas. This shows promise for the recovery of aquatic systems using well-planned management in watersheds with this agricultural-to-urban land use pattern. Small patches of forest can be the key to conserving aquatic biodiversity in urbanized landscapes. These findings are valuable to an international audience of researchers and water resource managers who study stream systems following this common agricultural-to-urban land use gradient, the ecological communities of which may not conform with what is generally known about land use impacts to streams.

Abstract Background Despite young African American adults (ages 18–24) being among the highest risk groups for HIV infection, little is known about their awareness of HIV pre-exposure prophylaxis (PrEP) – a once daily pill shown to be > 90% effective in preventing HIV. To explore awareness and acceptability of PrEP among college students in this demographic, we conducted a survey of attendees at two large historically Black universities (HBCU) in North Carolina. Methods We administered a 14-item questionnaire to students at two HBCUs in North Carolina between February and April 2018. Questions were formatted in a yes/no or multiple choice format. Questionnaire items specifically addressed PrEP awareness and acceptability. Surveys were administered to students at a campus health fair and while transiting the campus student union via iPad. Response to all questions was optional. We fit a logistic regression model to determine association of key demographic determinants with PrEP acceptability and awareness. Statistical analyses were conducted using SAS 9.4 (SAS, Cary, NC). Results Overall, 210 students participated in the survey, of which 60 completed all survey items as presented. The survey cohort was 75% female, 89% heterosexual and 39% freshmen. The mean age of respondents was 19.8 years (SD: 1.8). Fifty-two percent of survey respondents reported that they were aware of PrEP prior to the time of survey administration. Only 3% of respondents reported that they were on PrEP. The most common sources of information on PrEP were campus health services (24%) and non-social media advertising (15%). Of respondents who were aware of PrEP, 61% reported that they had heard about in the 6 months prior to survey administration, while only 19% say they were aware of it for more than a year. Regarding acceptability of PrEP, 58% of respondents reported that they would take a once a day pill for HIV if they were at risk. Our logistic regression analysis found no statistically significant associations between key demographic factors and PrEP awareness. However, persons who perceived themselves to be at risk for HIV acquisition were more likely to find once daily oral PrEP (relative risk 2.66 (95% CI 1.31–5.42)) as an acceptable prevention strategy than the rest of the survey cohort. Conclusions African American HBCU students are becoming aware of PrEP, and generally perceive the intervention as acceptable and worth consideration.

Abstract Background In view of reported associations between high adiposity, particularly in midlife and late-life dementia risk, we aimed to determine associations between body mass index (BMI), and BMI changes across adulthood and brain structure and pathology at age 69–71 years. Methods Four hundred sixty-five dementia-free participants from Insight 46, a sub-study of the British 1946 birth cohort, who had cross-sectional T1/FLAIR volumetric MRI, and florbetapir amyloid-PET imaging at age 69–71 years, were included in analyses. We quantified white matter hyperintensity volume (WMHV) using T1 and FLAIR 3D-MRI; β-amyloid (Aβ) positivity/negativity using a SUVR approach; and whole brain (WBV) and hippocampal volumes (HV) using 3D T1-MRI. We investigated the influence of BMI, and BMI changes at and between 36, 43, 53, 60–64, 69 and 71 years, on late-life WMHV, Aβ-status, WBV and mean HV. Analyses were repeated using overweight and obese status. Results At no time-point was BMI, change in BMI or overweight/obese status associated with WMHV or WBV at age 69–71 years. Decreasing BMI in the 1–2 years before imaging was associated with an increased odds of being β-amyloid positive (OR 1.45, 95% confidence interval 1.09, 1.92). There were associations between being overweight and larger mean HV at ages 60–64 (β = 0.073 ml, 95% CI 0.009, 0.137), 69 (β = 0.076 ml, 95% CI 0.012, 0.140) and 71 years (β = 0.101 ml, 95% CI 0.037, 0.165). A similar, albeit weaker, trend was seen with obese status. Conclusions Using WMHV, β-amyloid status and brain volumes as indicators of brain health, we do not find evidence to explain reported associations between midlife obesity and late-life dementia risk. Declining BMI in later life may reflect preclinical Alzheimer’s disease.

Abstract Objective To assess associations between head injury (HI) with loss of consciousness (LOC), ageing and markers of later‐life cerebral pathology; and to explore whether those effects may help explain subtle cognitive deficits in dementia‐free individuals. Methods Participants (n = 502, age = 69–71) from the 1946 British Birth Cohort underwent cognitive testing (subtests of Preclinical Alzheimer Cognitive Composite), 18F‐florbetapir Aβ‐PET and MR imaging. Measures include Aβ‐PET status, brain, hippocampal and white matter hyperintensity (WMH) volumes, normal appearing white matter (NAWM) microstructure, Alzheimer’s disease (AD)‐related cortical thickness, and serum neurofilament light chain (NFL). LOC HI metrics include HI occurring: (i) >15 years prior to the scan (ii) anytime up to age 71. Results Compared to those with no evidence of an LOC HI, only those reporting an LOC HI>15 years prior (16%, n = 80) performed worse on cognitive tests at age 69–71, taking into account premorbid cognition, particularly on the digit‐symbol substitution test (DSST). Smaller brain volume (BV) and adverse NAWM microstructural integrity explained 30% and 16% of the relationship between HI and DSST, respectively. We found no evidence that LOC HI was associated with Aβ load, hippocampal volume, WMH volume, AD‐related cortical thickness or NFL (all p > 0.01). Interpretation Having a LOC HI aged 50’s and younger was linked with lower later‐life cognitive function at age ~70 than expected. This may reflect a damaging but small impact of HI; explained in part by smaller BV and different microstructure pathways but not via pathology related to AD (amyloid, hippocampal volume, AD cortical thickness) or ongoing neurodegeneration (serum NFL).

Wildfire risk has globally increased during the past few years due to several factors. An efficient and fast response to wildfires is extremely important to reduce the damaging effect on humans and wildlife. This work introduces a methodology for designing an efficient machine learning system to detect wildfires using satellite imagery. A convolutional neural network (CNN) model is optimized to reduce the required computational resources. Due to the limitations of images containing fire and seasonal variations, an image augmentation process is used to develop adequate training samples for the change in the forest’s visual features and the seasonal wind direction at the study area during the fire season. The selected CNN model (MobileNet) was trained to identify key features of various satellite images that contained fire or without fire. Then, the trained system is used to classify new satellite imagery and sort them into fire or no fire classes. A cloud-based development studio from Edge Impulse Inc. is used to create a NN model based on the transferred learning algorithm. The effects of four hyperparameters are assessed: input image resolution, depth multiplier, number of neurons in the dense layer, and dropout rate. The computational cost is evaluated based on the simulation of deploying the neural network model on an Arduino Nano 33 BLE device, including Flash usage, peak random access memory (RAM) usage, and network inference time. Results supported that the dropout rate only affects network prediction performance; however, the number of neurons in the dense layer had limited effects on performance and computational cost. Additionally, hyperparameters such as image size and network depth significantly impact the network model performance and the computational cost. According to the developed benchmark network analysis, the network model MobileNetV2, with 160 × 160 pixels image size and 50% depth reduction, shows a good classification accuracy and is about 70% computationally lighter than a full-depth network. Therefore, the proposed methodology can effectively design an ML application that instantly and efficiently analyses imagery from a spacecraft/weather balloon for the detection of wildfires without the need of an earth control centre.

BackgroundOccurring in up to 40% of all patients with cancer, the incidence of brain tumors has caused limited survival, a high psychosocial burden, and an increase in the loss of decision-making capability for the unique population. Although specific symptoms depend on the type of brain tumor, a clinical team of physicians, nurses, and other individuals commonly assist patients and their caregivers with how to tackle the upcoming challenges of their diagnosis. Despite the support from clinical team members, many patients and caregivers may still seek outside support through social media to process their emotions and seek comfort outside of the clinical setting. Specifically, online resources such as Reddit are used where users are provided with the anonymity they need to show their true behavior without fear of judgment. In this study, we aimed to examine trends from Reddit discussion threads on brain tumors to identify areas of need in patient care. ObjectiveOur primary aims were to determine the type of Reddit user posting, classify the specific brain tumors that were the subject of the posts, and examine the content of the original posts. MethodsWe used a qualitative descriptive design to understand patients’ and caregivers’ unmet and met needs. We selected posts from the top-rated 100 posts from the r/braincancer subreddit from February 2017 to June 2020 to identify common themes using content analysis. ResultsThe qualitative content analysis revealed how Reddit users primarily used the forum as a method to understand and process the emotions surrounding a brain tumor diagnosis. Three major topic areas from content analysis emerged as prominent themes, including (1) harnessing hope, (2) moving through the grief process, and (3) expressing gratitude toward other Reddit users. Most of the authors of the posts were patients with brain tumors (32/88, 36%) who used Reddit as a reflective journaling tool to process the associated emotions of a challenging diagnosis. ConclusionsThis study shows the potential of Reddit to serve as a unique group therapy platform for patients affected by brain tumors. Our results highlight the support provided by the Reddit community members as a unique mechanism to assist cancer survivors and caregivers with the emotional processing of living with brain tumors. Additionally, the results highlight the importance of recommending Reddit as a therapeutic virtual community and the need for implementing online resources as a part of a health care professional’s repertoire to understand the level of support they can give their patients.

Abstract Subsidization of predator populations increases predation pressure on prey species, which is exacerbated when natural resources are scarce. Estimating the frequency of predation by subsidized predators on vulnerable species, especially low‐density, long‐lived species such as the federally threatened Mojave desert tortoise (Gopherus agassizii), allows landscape managers to evaluate the need for actions like reducing subsidies, discouraging predation by taste aversion, or predator removal. Most studies of Mojave desert tortoise predation have relied on morphological analysis to identify hard parts in predator scat. Here, we developed and validated a qPCR assay to test for the presence of Mojave desert tortoise in DNA extracted from scat and pellets. We used the assay to detect tortoise DNA in scat and pellets collected in a conservation easement adjacent to Boulder City, Nevada, from three Mojave desert tortoise predators: coyotes (Canis latrans), desert kit foxes (Vulpes macrotis arsipus), and common ravens (Corvus corax)—all of which consume anthropogenic resources. We compared the results of our qPCR assay to results from morphological analysis of the same samples and found that the qPCR method is much more sensitive at detecting the presence of tortoise remains. Although neither method can determine whether consumption was the result of predation or scavenging, nor how many individual tortoises were consumed, our findings indicate that conservation managers may benefit from focusing efforts on reducing subsidies that attract and support predators and on reducing tortoise mortality from predation.

The ANTHEM-HF, INOVATE-HF, and NECTAR-HF clinical studies of autonomic regulation therapy (ART) using vagus nerve stimulation (VNS) systems have collectively provided dose-ranging information enabling the development of several working hypotheses on how stimulation frequency can be utilized during VNS for tolerability and improving cardiovascular outcomes in patients living with heart failure (HF) and reduced ejection fraction (HFrEF). Changes in heart rate dynamics, comprising reduced heart rate (HR) and increased HR variability, are a biomarker of autonomic nerve system engagement and cardiac control, and appear to be sensitive to VNS that is delivered using a stimulation frequency that is similar to the natural operating frequency of the vagus nerve. Among prior studies, the ANTHEM-HF Pilot Study has provided the clearest evidence of autonomic engagement with VNS that was delivered using a stimulation frequency that was within the operating range of the vagus nerve. Achieving autonomic engagement was accompanied by improvement from baseline in six-minute walk duration (6MWD), health-related quality of life, and left ventricular EF (LVEF), over and above those achieved by concomitant guideline-directed medical therapy (GDMT) administered to counteract harmful neurohormonal activation, with relative freedom from deleterious effects. Autonomic engagement and positive directional changes have persisted over time, and an exploratory analysis suggests that improvement in autonomic tone, symptoms, and physical capacity may be independent of baseline NT-proBNP values. Based upon these encouraging observations, prospective, randomized controlled trials examining the effects on symptoms and cardiac function as well as natural history have been warranted. A multi-national, large-scale, randomized, controlled trial is well underway to determine the outcomes associated with ART using autonomic nervous system engagement as a guide for VNS delivery.

Abstract Aims Patients with sleep apnoea (SA) and heart failure (HF) are less sleepy than SA patients without HF. HF and SA both increase sympathetic nervous system activity (SNA). SNA can augment alertness. We previously showed that in HF patients, the degree of daytime sleepiness was not related to the severity of SA but was inversely related to SNA. Elevated SNA is associated with increased mortality in HF. Therefore, we hypothesized that in HF patients with SA, the degree of daytime sleepiness will be inversely related to mortality. Methods and results In a prospective cohort study, 218 consecutive patients with systolic HF had overnight polysomnography. Among them, 80 subjects with SA (apnoea–hypopnoea index ≥15) were followed for a mean of 28 months to determine all‐cause mortality rate. Subjective daytime sleepiness was assessed by the Epworth Sleepiness Scale (ESS). During follow‐up, 20 patients died. The 5 year death rate in patients with ESS less than 6 (i.e. less sleepy) was significantly higher than in patients with an ESS at or above the median of 6 (i.e. sleepier) [21.3 deaths/100 patient‐years vs. 6.2 deaths/100 patient‐years, unadjusted hazard ratio (HR) 2.94, 95% confidence interval (CI) 1.20 to 7.20, P = 0.018]. After adjusting for confounding factors that included sex, history of hypertension, and mean arterial oxyhaemoglobin saturation, compared with the sleepier patients, less sleepy patients had greater risk of mortality (HR 2.56, 95% CI 1.01 to 6.47, P = 0.047). As a continuous variable, ESS scores were inversely related to mortality risk (HR 0.86, 95% CI 0.75 to 0.98, P = 0.022). Conclusions In patients with HF and SA, the degree of subjective daytime sleepiness is inversely related to the mortality risk, suggesting that among HF patients with SA, those with the least daytime sleepiness are at greater risk of death. They may therefore have greater potential for mortality benefit from therapy of SA than those with greater daytime sleepiness.

Abstract Ecological release from herbivory due to chemical novelty is commonly predicted to facilitate biological invasions by plants, but has not been tested on a community scale. We used metabolomics based on mass spectrometry molecular networks to assess the novelty of foliar secondary chemistry of 15 invasive plant species compared to 46 native species at a site in eastern North America. Locally, invasive species were more chemically distinctive than natives. Among the 15 invasive species, the more chemically distinct were less preferred by insect herbivores and less browsed by deer. Finally, an assessment of invasion frequency in 2,505 forest plots in the Atlantic coastal plain revealed that, regionally, invasive species that were less preferred by insect herbivores, less browsed by white‐tailed deer, and chemically distinct relative to the native plant community occurred more frequently in survey plots. Our results suggest that chemically mediated release from herbivores contributes to many successful invasions.

Abstract Background Pulmonary aspiration under anaesthesia is a feared complication. It is likely that the incidence of aspiration occurring during procedural sedation is underreported; although rare, fatalities do occur. The supine position increases the risk of pulmonary aspiration in gastrointestinal endoscopy during procedural sedation. Immediate oral endotracheal intubation has traditionally been the cornerstone of management for aspiration during anaesthesia; however, this may not be always beneficial when aspiration occurs during procedural sedation. To my knowledge, this is the first case report of aspiration pneumonitis resulting from surgical repositioning during colonoscopy under procedural sedation. Case presentation A 72-year-old female underwent elective outpatient diagnostic colonoscopy. Intravenous propofol infusion was commenced for the procedural sedation. A large amount of non-particulate vomitus was expelled from the oropharynx as the patient was repositioned from the left lateral to supine position. Oxygen saturation on pulse oximetry immediately dropped to below 90% during the event. The patient was managed successfully without oral endotracheal intubation. Conclusions Anaesthesiologists need to be mindful of factors that raise the risk of aspiration during procedural sedation. Gastrointestinal endoscopy poses a higher risk of aspiration than other procedures, and positional change may be a precipitant. Aspiration that occurs during procedural sedation may be more safely managed by avoiding immediate oral endotracheal intubation.

Background: The relative influences of baseline risk factors for pediatric nonaccidental burns have not been well described. We evaluated baseline characteristics of pediatric nonaccidental burn patients and their primary caretakers. Methods: A single-center retrospective cohort study was conducted of pediatric (age

Abstract Aims Clinical studies of vagal nerve stimulation (VNS) for heart failure with reduced ejection fraction have had mixed results to date. We sought to compare VNS delivery and associated changes in symptoms and function in autonomic regulation therapy via left or right cervical vagus nerve stimulation in patients with chronic heart failure (ANTHEM‐HF), increase of vagal tone in heart failure (INOVATE‐HF), and neural cardiac therapy for heart failure (NECTAR‐HF) for hypothesis generation. Methods and results Descriptive statistics were used to analyse data from the public domain for differences in proportions using Pearson's chi‐square test, differences in mean values using Student's unpaired t‐test, and differences in changes of mean values using two‐sample t‐tests. Guideline‐directed medical therapy recommendations were similar across studies. Fewer patients were in New York Heart Association 3, and baseline heart rate (HR) was higher in ANTHEM‐HF. In INOVATE‐HF, VNS was aimed at peripheral neural targets, using closed‐loop delivery that required synchronization of VNS to R‐wave sensing by an intracardiac lead. Pulse frequency was low (1–2 Hz) because of a timing schedule allowing ≤3 pulses of VNS following at most 25% of detected R waves. NECTAR‐HF and ANTHEM‐HF used open‐loop VNS delivery (i.e. independent of any external signal) aimed at both central and peripheral targets. In NECTAR‐HF, VNS delivery at 20 Hz caused off‐target effects that limited VNS up‐titration in a majority of patients. In ANTHEM‐HF, VNS delivery at 10 Hz allowed up‐titration until changes in HR dynamics were confirmed. Six months after VNS titration, significant improvements in both HR and HR variability occurred only in ANTHEM‐HF. When ANTHEM‐HF and NECTAR‐HF were compared, greater improvements from baseline were observed in ANTHEM‐HF in standard deviation in normal‐to‐normal R‐R intervals (94 ± 26 to 111 ± 50 vs. 146 ± 48 to 130 ± 52 ms; P < 0.001), left ventricular ejection fraction (32 ± 7 to 37 ± 0.4 vs. 31 ± 6 to 33 ± 6; P < 0.05), and Minnesota Living with Heart Failure mean score (40 ± 14 to 21 ± 10 vs. 44 ± 22 to 36 ± 21; P < 0.002). When compared with INOVATE‐HF, greater improvement in 6‐min walk distance was observed in ANTHEM‐HF (287 ± 66 to 346 ± 78 vs. 304 ± 111 to 334 ± 111 m; P < 0.04). Conclusions In this post‐hoc analysis, differences in patient demographics were seen and may have caused the differential responses in symptoms and function observed in association with VNS. Major differences in technology platforms, neural targets, VNS delivery, and HR and HR variability responses could have also potentially played a very important role. Further study is underway in a randomized controlled trial with these considerations in mind.

BackgroundThe COVID-19 pandemic spurred an increase in online information regarding disease spread and symptomatology. ObjectiveOur purpose is to systematically assess the quality and readability of articles resulting from frequently Google-searched COVID-19 terms in the United States. MethodsWe used Google Trends to determine the 25 most commonly searched health-related phrases between February 29 and April 30, 2020. The first 30 search results for each term were collected, and articles were analyzed using the Quality Evaluation Scoring Tool (QUEST). Three raters scored each article in authorship, attribution, conflict of interest, currency, complementarity, and tone. A readability analysis was conducted. ResultsExactly 709 articles were screened, and 195 fulfilled inclusion criteria. The mean article score was 18.4 (SD 2.6) of 28, with 7% (14/189) scoring in the top quartile. National news outlets published the largest share (70/189, 36%) of articles. Peer-reviewed journals attained the highest average QUEST score compared to national/regional news outlets, national/state government sites, and global health organizations (all P