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Abstract Background The extensive use of antibiotics in the global livestock industry in recent decades has accelerated the accumulation and dissemination of antibiotic-resistance genes (ARGs) within terrestrial ecosystems. This occurs due to the limited absorption of most antibiotics, leading to their release into the environment through feces and urine. This poses a significant threat to both the environment and human health. However, the response of antibiotic-resistant microorganisms and their ARGs in grasslands to prolonged grazing, as well as the primary microbial taxa driving the ARG distribution, remain poorly understood, especially within various microhabitats. In this study, we characterized ARGs in the phyllosphere, litter, and soil after decades of livestock grazing in a meadow steppe. We particularly focused on identifying the major members of the microbial community influencing ARGs and the distinction between microbial generalists and specialists. Results Our findings indicate that a core set of ARGs accounted for 90% of the abundance in this plant-soil ecosystem. While the soil exhibited the highest ARG abundance, the phyllosphere, and litter displayed higher ARG diversity and diverse distribution patterns after overgrazing. Grazing increased ARG abundance by elevating the proportion of core ARGs and suppressing stochastic ARGs in the phyllosphere and litter, while it had little effect on the ARGs in the soil. Additionally, microbial generalist abundance increased, but specialist abundance decreased in the phyllosphere and litter, with no effect in the soil, under grazed conditions. Ultimately, microbial microhabitats and grazing influenced ARG community characteristics through direct (i.e., feces and other exogenous ARG input) and indirect (i.e., trampling and selective feeding) effects on nutrient availability, microbial community composition, and mobile genetic elements. The generalist community, with its broad ecological niches and phylogenetic composition, made the most significant contribution to the ARG characteristics. Conclusions This study underscores the impact of environmental disturbances on the distributional patterns of ARGs in ecosystems, mediated by the regulation of microbial generalized species. These insights enhance our understanding of microbial control over ARGs and facilitate predictions regarding the dynamics and risk of ARGs in diverse ecological niches subjected to anthropogenic disturbances. Video Abstract

Category: Other Introduction/Purpose: Popliteal nerve blocks are often used to aid intraoperative general anesthesia and provide post-operative pain control for many foot and ankle surgeries. Unfortunately, there is conflicting data regarding complication rates from popliteal nerve blocks, specifically when comparing studies from (the) orthopedic and anesthesia literature. Orthopedic literature notes long term effects (foot drop/sensation deficits) whereas anesthesia literature focuses on immediate post-operative pain control. An approach to block more distal nerves and avoid the popliteal fossa altogether may provide equal anesthetic and pain relief with fewer motor and sensory complications. Our study seeks to address such complications by utilizing an alternative anesthetic approach that targets sensory distributions of nerves that may be affected during the procedure while avoiding major motor neve contributions within the popliteal fossa. Methods: We conducted a retrospective chart review between 2019 and 2023, analyzing complications associated with regional anesthesia achieved via a distal ankle block rather than a popliteal nerve block. Two hundred thirty-seven patients who underwent a variety of foot and ankle procedures (e.g., ankle arthroscopy, ankle fracture repair, cavovarus foot reconstruction, hallux valgus arthrodesis, lateral ankle stabilization, calf tendon revision, midfoot fusion, metatarsal arthrodesis) were included in this study. Results: Out of 237 patients who received a distal ankle block, only three patients were found to have superficial peroneal neuropathy confirmed with EMG, yielding a complication rate of 1.3%. Additionally, six patients required post-operative rescue block for pain control. The remaining 234 patients recovered without complications caused by the distal nerve block approach. Conclusion: The low rate of complications, specifically motor complications, from the distal nerve blocks demonstrate a beneficial alternative to the popliteal nerve blocks for various foot and ankle orthopedic surgeries. This finding is important to consider when choosing an appropriate approach to augment intraoperative general anesthesia accompanying foot and ankle surgeries in the outpatient setting.

Abstract The TTG2 transcription factor of Arabidopsis regulates a set of epidermal traits, including the differentiation of leaf trichomes, flavonoid pigment production in cells of the inner testa (or seed coat) layer and mucilage production in specialized cells of the outer testa layer. Despite the fact that TTG2 has been known for over twenty years as an important regulator of multiple developmental pathways, little has been discovered about the downstream mechanisms by which TTG2 co-regulates these epidermal features. In this study, we present evidence of phosphoinositide lipid signaling as a mechanism for the regulation of TTG2-dependent epidermal pathways. Overexpression of the AtPLC1 gene rescues the trichome and seed coat phenotypes of the ttg2-1 mutant plant. Moreover, in the case of seed coat color rescue, AtPLC1 overexpression restored expression of the TTG2 flavonoid pathway target genes, TT12 and TT13/AHA10. Consistent with these observations, a dominant AtPLC1 T-DNA insertion allele (plc1-1D) promotes trichome development in both wild-type and ttg2-3 plants. Also, AtPLC1 promoter:GUS analysis shows expression in trichomes and this expression appears dependent on TTG2. Taken together, the discovery of a genetic interaction between TTG2 and AtPLC1 suggests a role for phosphoinositide signaling in the regulation of trichome development, flavonoid pigment biosynthesis and the differentiation of mucilage-producing cells of the seed coat. This finding provides new avenues for future research at the intersection of the TTG2-dependent developmental pathways and the numerous molecular and cellular phenomena influenced by phospholipid signaling.

In 2015, the 62nd session of the Regional Committee [RC] of the Eastern Mediterranean Region [EMR] endorsed the Eastern Mediterranean Vaccine Action Plan 2016–2020 (EMVAP) that included postponement of the measles elimination target to before 2020. However, the EMR does not have a regional rubella control or elimination goal. We reviewed the progress of measles and rubella surveillance in context of measles elimination in the Eastern Mediterranean Region during 2019–2022. We compiled data on coverage, reported cases, surveillance indicators, incidence, and genotypes. We conducted an age-cohort analysis to estimate the size of the susceptible population using coverage and SIAs coverage data. We reviewed the dossiers of countries that applied to the Regional Verification Commission [RVC] for the verification of measles and rubella elimination. Between 2019 and 2022, the regional coverage of the vaccine against measles and rubella was stable at 83% for the first dose [MCV1] and increased from 75% to 78% for the second dose [MCV2] after a dip during COVID-19. In the EMRO, eighteen countries are using MR (measles–rubella) and/or measles–mumps–rubella (MMR) vaccines and four are using measles vaccines. The reported regional measles incidence per 1,000,000 was 23.3 in 2019, decreased to 7.4 in 2020, and re-increased to 50 in 2022, with two main genotypes–D8 and B3–in circulation. Both genotypes are considered to be actively circulating in eighteen countries, with different circulating variants of each genotype. There were no genotyping data available from four countries. Measles and rubella surveillance indicators deteriorated in the region. The number of susceptible individuals exceeded one birth cohort in nine of the 22 countries. In 2019–2022, Bahrain, Egypt, Iran, and Oman were verified to have eliminated measles and rubella. While four countries eliminated measles and rubella and another five progressed toward measles and rubella elimination, however, immunity gaps and reported incidence increased in eleven countries. Countries approaching elimination need to prepare verification dossiers, while others need to increase their routine coverage, conduct follow-up campaigns, and improve surveillance. Submission of progress reports to the RVC will measure progress toward the goal.

Abstract Magnetic resonance imaging (MRI) is being integrated into routine radiation therapy (RT) planning workflows. To reap the benefits of this imaging modality, patient positioning, image acquisition parameters and a quality assurance programme must be considered for accurate use. This paper will report on the implementation of a retrofit MRI Simulator for RT planning, demonstrating an economical, resource efficient solution to improve the accuracy of MRI in this setting.

Ecological restoration policies and their implementation are influenced by ecological and socioeconomic drivers. Top-down approach-based spatial planning, emphasizing hierarchical control within government structures, and without a comprehensive consideration of social–ecological interactions may result in implementation failure and low efficiency. Although many researchers have indicated the necessity to engage social–ecological interactions between stakeholders in effective planning processes, socioeconomic drivers of ecological restoration on a large scale are difficult to quantify because of data scarcity and knowledge limitations. Here, we established a new ecological restoration planning approach linking a social–ecological system framework to large-scale ecological restoration planning. The new spatial planning approach integrates bottom-up approaches targeting stakeholder interests and provides social considerations for stakeholder behavior analysis. Based on this approach, a meta-analysis is introduced to recognize key socioeconomic and social–ecological factors influencing large-scale ecological restoration implementation, and a stochastic model is constructed to analyze the impact of socioeconomic drivers on the behavior of authorities and participants on a large scale. We used the Yangtze River Basin-based Conversion of Cropland to Forest Program (CCFP), one of the largest payments for ecosystem service programs worldwide, to quantify the socioeconomic impacts of large-scale ecological restoration programs. Current CCFP planning without socioeconomic considerations failed to achieve large-scale program goals and showed low investment efficiency, with 19.71% of the implemented area reconverting to cropland after contract expiry. In contrast, spatial matching between planned and actual restoration increased from 61.55% to 81.86% when socioeconomic drivers were included. In addition, compared to that with the current CCFP implementation, the cost effectiveness of spatial planning with social considerations improved by 46.94%. Thus, spatial optimization planning that integrates both top-down and bottom-up approaches can result in more practical and effective ecological restoration than top-down approaches alone. Our new approach incorporates socioeconomic factors into large-scale ecological restoration planning with high practicality and efficiency.

Since the World Health Assembly (WHA) in 2012 endorsed the Global Vaccine Action Plan (GVAP), which included regional measles and rubella elimination goals by 2020, global progress towards verification of measles and rubella elimination has been incremental. Even though the 2020 elimination goals were not achieved, commitment towards achieving measles and rubella elimination has been firmly established in the Immunization Agenda 2030 (IA2030) and the Measles and Rubella Strategic Framework (MRSF) 2021–2030. In 2023, the six Regional Verification Commissions for measles and rubella elimination (RVCs) reviewed data as of 31 December 2022 and confirmed that 82 (42%) Member States have been verified for measles elimination, and 98 (51%) Member States have been verified for rubella elimination. The six RVCs are composed of independent public health and immunization experts who are well-placed to support accelerating measles and rubella elimination. RVCs should be leveraged not only to review elimination documents but also to advocate for and champion public health programming that supports measles and rubella activities. The verification of elimination process is one of many tools that should be deployed to reinforce and accelerate efforts towards achieving a world free of measles and rubella.

Study Design A retrospective cohort study. Purpose To determine whether the 11-item modified frailty index (mFI) is associated with readmission rates, complication rates, revision rates, or differences in patient-reported outcome measures (PROMs) for patients undergoing posterior cervical decompression and fusion (PCDF). Overview of Literature mFI incorporates preexisting medical comorbidities and dependency status to determine physiological reserve. Based on previous literature, it may be used as a predictive tool for identifying postoperative clinical and surgical outcomes. Methods Patients undergoing elective PCDF at our urban academic medical center from 2014 to 2020 were included. Patients were categorized by mFI scores (0–0.08, 0.09–0.17, 0.18–0.26, and ≥0.27). Univariate statistics compared demographics, comorbidities, and clinical/surgical outcomes. Multiple linear regression analysis evaluated the magnitude of improvement in PROMs at 1 year. Results A total of 165 patients were included and grouped by mFI scores: 0 (n=36), 0.09 (n=62), 0.18 (n=42), and ≥0.27 (n=30). The severe frailty group (mFI ≥0.27) was significantly more likely to be diabetic (p

Background: Few studies regarding ossification of the posterior longitudinal ligament (OPLL) outside of Asia currently exist in the literature. A set of patients with multilevel cervical OPLL causing symptomatic myelopathy or radiculopathy from a North American sample is analyzed. Objective: The objective of this study was to describe the demographics, radiographic findings, and surgical outcomes of a cohort of North American patients with degenerative spondylosis presenting for operative management of multilevel (>3 segments) cervical OPLL. Materials and Methods: Forty-three patients diagnosed with multilevel cervical OPLL and degenerative spondylosis presenting with symptomatic cervical myelopathy or radiculopathy were surgically treated over a 9-year period at a single tertiary care academic medical center. Radiographic measurements were performed on preoperative computed tomography and magnetic resonance imaging images of the cervical spine. Clinical outcomes included pre- and postoperative Nurick scores, 90-day readmission, complication, and revision surgery rates. Results: The mean age was 66.1 ± 10.9 years with a mean latest follow-up time of 32.7 ± 16.4 months. Most patients had previous diagnoses of obesity (70.7%) and hypertension (55.8%). At least one-quarter of patients were diagnosed with type 2 diabetes (34.9%), hyperlipidemia (41.9%), cardiovascular disease (25.6%), or chronic kidney disease (25.3%). The most common OPLL subtype was segmental (39.5%) and spanned a mean of 3.54 ± 1.48 segments. Myelopathic symptoms were present in 88.4% of patients. All patients experienced significant neurologic improvement at 3-week and latest follow-up (P < 0.001 for both). Conclusions: Obesity, diabetes, and other metabolic derangements in patients with existing cervical spondylosis may be risk factors for a particularly aggressive form of multilevel OPLL. Various operative approaches may be employed to achieve adequate neurologic recovery. Further workup for OPLL in patients with these risk factors may prove beneficial to ensure appropriate operative management.

Purpose: This study is a secondary analysis of data from a mixed methods exploration of fatigue in people with multiple sclerosis (MS), a chronic autoimmune disease affecting the central nervous system. During initial analysis, worry emerged during discussions of the fatigue experience. The purpose of this study is to explore worry in relationship to exercise and physical activity behavior.Methods: Mixed methods were used to address the research question. 55 people with MS provided demographic and survey data (habitual physical activity, body perception, functioning). 35 participated in semi-structured interviews on the topics of fatigue, body sensations, emotions, and their effects on physical activity. Qualitative data were analyzed utilizing constructivist grounded theory. Quantitative data were analyzed utilizing multiple regression.Results: Qualitative theory described participants’ thoughts and experiences regarding the consequences of fatigue during activity, and how they appear to influence subsequent actions. Worry played a critical role in thought processes regarding physical activity. Aspects of body perception were weak quantitative predictors of physical activity behavior after control of physical functionality.Conclusions: The most significant finding of this study was the description and dialogue about worry as a factor that shapes perceptions of the benefits and value of exercise and physical activity. Physical activity practitioners could benefit from seeking to understand physical-activity-related worry when examining physical activity behavior and designing programming.

There is growing evidence of mitochondrial dysfunction and prefrontal cortex (PFC) hypometabolism in bipolar disorder (BD). Older adults with BD exhibit greater decline in PFC-related neurocognitive functions than is expected for age-matched controls, and clinical interventions intended for mood stabilization are not targeted to prevent or ameliorate mitochondrial deficits and neurocognitive decline in this population. Transcranial infrared laser stimulation (TILS) is a non-invasive form of photobiomodulation, in which photons delivered to the PFC photo-oxidize the mitochondrial respiratory enzyme, cytochrome-c-oxidase (CCO), a major intracellular photon acceptor in photobiomodulation. TILS at 1064-nm can significantly upregulate oxidized CCO concentrations to promote differential levels of oxygenated vs. deoxygenated hemoglobin (HbD), an index of cerebral oxygenation. The objective of this controlled study was to use non-invasive broadband near-infrared spectroscopy to assess if TILS to bilateral PFC (Brodmann area 10) produces beneficial effects on mitochondrial oxidative energy metabolism (oxidized CCO) and cerebral oxygenation (HbD) in older (≥50 years old) euthymic adults with BD (N = 15). As compared to sham, TILS to the PFC in adults with BD increased oxidized CCO both during and after TILS, and increased HbD concentrations after TILS. By significantly increasing oxidized CCO and HbD concentrations above sham levels, TILS has the potential ability to stabilize mitochondrial oxidative energy production and prevent oxidative damage in the PFC of adults with BD. In conclusion, TILS was both safe and effective in enhancing metabolic function and subsequent hemodynamic responses in the PFC, which might help alleviate the accelerated neurocognitive decline and dysfunctional mitochondria present in BD.

Somalia is a complex and fragile setting with a demonstrated potential for disruptive, high-burden measles outbreaks. In response, since 2018, Somalian authorities have partnered with UNICEF and the WHO to implement measles vaccination campaigns across the country. In this paper, we create a Somalia-specific model of measles transmission based on a comprehensive epidemiological dataset including case-based surveillance, vaccine registries, and serological surveys. We use this model to assess the impact of these campaign interventions on Somalian’s measles susceptibility, showing, for example, that across the roughly 10 million doses delivered, 1 of every 5 immunized a susceptible child. Finally, we use the model to explore a counter-factual epidemiology without the 2019–2020 campaigns, and we estimate that those interventions prevented over 10,000 deaths.

Abstract The Qinghai-Tibet Plateau (QTP) supplies many ecosystem services (ESs) that maintain local and global pan-Asian populations and ecosystems. The effects of climate change on ES provision in the QTP will have far-reaching impacts on the region and the many downstream ecosystems and countries that depend on ESs from the "Third Pole". This study undertook a systematic assessment of ES provision, trade-offs and synergies between four ESs (raw material provision, water yield, soil retention, and carbon storage) under future climate scenarios (representative concentration pathway). The results show that: (1) the total amount of the four ESs on the QTP is predicted to increase from 1980 to 2100 for three climate change scenarios. (2) The spatial pattern of ESs on the QTP will not change significantly in the future, and the grassland and forest ESs in the central and southern regions are predicted to increase significantly. (3) The synergistic interactions among ESs were generally consistent at three spatial scales (10 km (pixel), county and watershed scales), but with more significant synergistic effects at the watershed scale. This demonstrates the necessity for the examination of scale-dependent ES dynamics and interactions. This study will supply a reference for further research on long-term ES assessments, especially the dynamic ES changes and the spatial scale dependency of the ES interactions, and provide evidence-based strategies for formulating ecosystem management on the QTP under climate change.

Study Design: The study design used was a retrospective cohort. Objective: The objective of this study is to determine if intraoperative improvements in sagittal alignment on the operating table persisted on postoperative standing radiographs. Summary of Background Data: Cervical sagittal alignment may be correlated to postoperative outcomes. Since anterior cervical discectomy and fusions (ACDFs) can restore some cervical lordosis through intervertebral grafts/cages, it is important to understand if intraoperative radiographic measurements correlate with persistent postoperative radiographic changes. Materials and Methods: Patients undergoing elective primary ACDF were screened for the presence of lateral cervical radiographs preoperatively, intraoperatively, and postoperatively. Patients were excluded if their first postoperative radiograph was more than 3 months following the procedure or if cervical lordosis was not able to be measured at each time point. Paired t-tests were utilized to compare differences in measurements between time points. Statistical significance was set at P < 0.05. Results: Of 46 included patients, 26 (56.5%) were female, and the mean age was 55.2 ± 11.6 years. C0-C2 lordosis significantly increased from the preoperative to intraoperative time point (delta [Δ] = 4.49, P = 0.029) and significantly decreased from the intraoperative to postoperative time period (Δ = −6.57, P < 0.001), but this resulted in no significant preoperative to postoperative change (Δ = −2.08, P = 0.096). C2 slope decreased from the preoperative to the intraoperative time point (Δ = −3.84, P = 0.043) and significantly increased from the intraoperative to the postoperative time point (Δ = 3.68, P = 0.047), which also resulted in no net change in alignment between the preoperative and postoperative periods (Δ = −0.16, P = 0.848). There was no significant difference in the C2-C7 SVA from the preoperative to intraoperative (Δ = 0.85, P = 0.724) or intraoperative to postoperative periods (Δ = 2.04, P = 0.401); however, the C2-C7 SVA significantly increased from the preoperative to postoperative period (Δ = 2.88, P = 0.006). Conclusions: Intraoperative positioning predominantly affects the mobile upper cervical spine, particularly C0-C2 lordosis and C2 slope, but these changes do not persist postoperatively.

Understanding the embodied carbon transfer in inter-provincial trade and its employment-economic spillover effects is of crucial value in achieving carbon equity management. Surprisingly, few studies have focused on the intrinsic relationship between embodied carbon, embodied GDP, and embodied employment in iinter-provincial trade and its equity implications. Based on the 2012 and 2017 multi-regional input-output tables, our study of inter-provincial trade in 30 Chinese provinces shows that: 1) net outflows of embodied carbon were concentrated in the Beijing-Tianjin region and the eastern and southern coastal regions, while net inflows were in the central and northwestern regions; 2) embodied carbon, GDP, and employment were characterized by nearby transfer, complementary energy economy, and asymmetric transfers in and out; and 3) western provinces, which relied heavily on traditional energy and heavy chemical industries, gained a competitive disadvantage implying by the internal relationship between net transfers of embodied carbon, GDP, and employment. To mitigate the inequity of inter-provincial carbon trade, top-down climate goals must be aligned with bottom-up socio-economic incentives to achieve balanced regional development and improved public welfare.

Abstract Introduction Intrafraction imaging is an Elekta feature that enables cone beam computed tomography (CBCT) acquisition simultaneously with treatment arc delivery. It has facilitated the introduction of breath‐hold (BH) gated stereotactic body radiation therapy (SBRT) by enabling visualisation of tumour and organs at risk during treatment. The aims of this study were to assess BH reproducibility and use intrafraction CBCT (IF‐CBCT) to quantify any variation in diaphragm position (diaphragmatic feathering) during the multiple BHs performed during each arc. Methods IF‐CBCTs for consecutive liver SBRT patients where BH was achieved using the Elekta Active Breathing Control (ABC) system were retrospectively evaluated. Average intrafraction couch shifts for deep‐inspiration BH (DIBH) or end‐expiration BH (EEBH) were recorded as an indication of reproducibility. Diaphragmatic feathering was quantified by measuring the difference between the most superior and inferior visible edges of the diaphragm on IF‐CBCTs. Results A total of 212 images from 30 patients were reviewed. Twenty‐two (73.3%) patients were treated in EEBH. The mean intrafraction shift was similar between DIBH and EEBH groups with the largest mean shift of 0.22cm occurring in the superior–inferior direction. Mean diaphragmatic feathering was similar between the DIBH and EEBH groups, 0.09cm (0‐0.44cm) and 0.14cm (0–1.89cm) respectively. A higher percentage of EEBH patients demonstrated no diaphragmatic feathering throughout treatment compared with DIBH patients (31.8% vs 25%). Conclusion The results of this study indicate that BH is reproducible in both DIBH and EEBH for liver SBRT treatment using the ABC system. Appropriate patient selection and BH coaching prior to CT simulation are critical to its success.

The positive roles of earthworms on soil functionality has been extensively documented. The capacity of the earthworm gut microbiota on decomposition and nutrient cycling under long-term fertilization in field conditions has rarely been studied. Here, we report the structural, taxonomic, and functional responses of Eisenia foetida and Pheretima guillelmi gut microbiota to different fertilization regimes and durations using 16S rRNA gene-based Illumina sequencing and high-throughput quantitative PCR techniques. Our results revealed that the core gut microbiota, especially the fermentative bacteria were mainly sourced from the soil, but strongly stimulated with species-specificity, potential benefits for the host and soil health. The functional compositions of gut microbiota were altered by fertilization with fertilization duration being more influential than fertilization regimes. Moreover, the combination of organic and inorganic fertilization with the longer duration resulted in a higher richness and connectivity in the gut microbiota, and also their functional potential related to carbon (C), nitrogen, and phosphorus cycling, particularly the labile C decomposition, denitrification, and phosphate mobilization. We also found that long-term inorganic fertilization increased the abundance of pathogenic bacteria in the P. guillelmi gut. This study demonstrates that understanding earthworm gut microbiota can provide insights into how agricultural practices can potentially alter soil ecosystem functions through the interactions between soil and earthworm gut microbiotas.

The mammal gut is a rich reservoir of antibiotic resistance genes (ARGs), and the relationship between bacterial communities and ARGs has been widely studied. Despite ecological significance of microeukaryotes (fungi and protists), our understanding of their roles in the mammal gut microbiome and antibiotic resistome is still limited. Here, we used amplicon sequencing, metagenomic sequencing and high-throughput quantitative PCR to examine microbiomes and antibiotic resistomes of 41 giant panda fecal samples from individuals with different genders, ages, sampling sites and diet. Our results show that diverse protists inhabit in the giant panda gut ecosystem, dominated by consumers. Higher abundance of protistan consumers was detected in the elder compared to sub-adult and adult giant pandas. Diet is the main driving factor of variation in ARGs in the giant panda gut microbiome. Weighted correlation network analysis identified two key microbial modules from multitrophic communities, which all contributed to the variation in ARGs in the giant panda gut. Protists occupied an important position in the two modules which were dominated by fungal taxa. Deterministic processes made a more important contribution to microbial community assembly of the two modules than to bacterial, fungal and protistan communities. This study sheds new light on how key microbial modules contribute to the variation in ARGs, which is crucial in understanding dynamics of antibiotic resistome in the mammal gut, particularly endangered species.

The ability to accurately and reliably estimate body mass of extinct taxa is a vital tool for interpreting the physiology and even behavior of long-dead animals. For this reason, paleontologists have developed many possible methods of estimating the body mass of extinct animals, with varying degrees of success. These methods can be divided into two main categories: volumetric mass estimation and extant scaling methods. Each has advantages and disadvantages, which is why, when possible, it is best to perform both, and compare the results to determine what is most plausible within reason. Here we employ volumetric mass estimation (VME) to calculate an approximate body mass for previously described specimens of Anzu wyliei from the Carnegie Museum of Natural History. We also use extant scaling methods to try to obtain a reliable mass estimate for this taxon. In addition, we present the first digital life restoration and convex hull of the dinosaur Anzu wyliei used for mass estimation purposes. We found that the volumetric mass estimation using our digital model was 216-280kg, which falls within the range predicted by extant scaling techniques, while the mass estimate using minimum convex hulls was below the predicted range, between 159-199 kg . The VME method for Anzu wyliei strongly affirms the predictive utility of extant-based scaling. However, volumetric mass estimates are likely more precise because the models are based on comprehensive specimen anatomy rather than regressions of a phylogenetically comprehensive but disparate sample.

Abstract Background All clinical trial investigators have ethical and regulatory obligations to monitor participant safety and trial integrity. Specific procedures for meeting these obligations, however, may differ substantially between pragmatic trials and traditional explanatory clinical trials. Methods/Results Appropriate monitoring of clinical trials typically includes assessing rate of recruitment or enrollment; monitoring safe and effective delivery of study treatments; assuring that study staff act to minimize risks; monitoring quality and timeliness of study data; and considering interim analyses for early detection of benefit, harm, or futility. Each of these responsibilities applies to pragmatic clinical trials. Just as design of pragmatic trials typically involves specific and necessary departures from methods of explanatory clinical trials, appropriate monitoring of pragmatic trials typically requires specific departures from monitoring procedures used in explanatory clinical trials. We discuss how specific aspects of pragmatic trial design and operations influence selection of monitoring procedures and illustrate those choices using examples from three ongoing pragmatic trials conducted by the Mental Health Research Network. Conclusions Pragmatic trial investigators should not routinely adopt monitoring procedures used in explanatory clinical trials. Instead, investigators should consider core principles of trial monitoring and design monitoring procedures appropriate for each pragmatic trial.

Dynamic monitoring of forest ecosystem quality is necessary for restoration program evaluation but remains challenging for very large-scale programs. Current evaluation methods employ regional forest quality indicators that compare the quality status of targeted forests with benchmarks from remnant old-growth forest communities, however data availability usually limits the application of available methods to small scales. We constructed an improved framework, integrating forest site classification selection and local remnant old-growth forest community delimitation, to quantify and map forest quality using environmental data and remote sensing (RS) based approaches. A classification strength model was introduced to improve the accuracy of forest site classification. The remote-sensing-based method integrates species composition and forest biological productivity characteristics recognition to develop a practical tool for large-scale remnant old-growth forest community delimitation. The new assessment framework was tested across the entire spatially heterogeneous Yangtze River Basin, the largest watershed in China and showed high accuracy in forest quality assessment based on observed field data validation. The forest site classification was selected by considering spatial heterogeneities in climate, topography and soil type, with 37 forest sites classified. The native forest community groups with less human disturbance in each forest site used for forest quality baseline estimation were also selected as forests with top 10% of biomass in protected areas. The case study demonstrated that forest areas of low and poor quality accounted for 34.46% of the total forest area in 2015. Between 2000 and 2015, 55.72% of forest areas experienced increases in quality level, and 7.07% experienced decreases. The improved forest quality assessment framework enhances the scope and accuracy of forest restoration information and can be applied as an evaluation tool for forest restoration management.

Ecological benefits provided by ecosystem assets play an important role in improving human wellbeing. However, there are few feasible methods to combine data on the quantity and quality of ecosystem assets to describe their state and trend. Here, we developed a new remote-sensing-based indicator by synthesizing ecosystem asset quantity and quality data for effective assessment at a regional or national scale. The new indicator includes a typological ecosystem asset index (TEAI) (e.g., forest ecosystem asset index) and an integrated ecosystem asset index (IEAI). The TEAI and IEAI can be used to assess the state and trend of a specific ecosystem or set of regional ecosystems, respectively. We applied the new indicator in the context of ecological protection policy in the Three-Rivers Source Region (TRSR), a region known as the ‘Chinese water tower’. From 2000 to 2015, the IEAI increased by 4.02% due to an increase in the ecosystem asset area (0.2%) and the ecosystem asset quality (0.66% and 0.02% increases in excellent and good level ecosystem assets, respectively). The implementation of ecological protection and ecological restoration programs was the main direct driver of regional ecological asset improvement. Our results suggest the new indicator is feasible for quickly and accurately evaluating the state and trend of ecosystem assets and can be used to guide ecosystem management at a large regional scale.

Abstract Background Smokers usually abstain from tobacco while hospitalized but relapse after discharge. Inpatient interventions may encourage sustained quitting. We previously demonstrated that a decision support tool embedded in an electronic health record (EHR) improved physicians’ treatment of hospitalized smokers. This report describes the effect on quit rates of this decision support tool and order set for hospitalized smokers. Methods In a single hospital system, 254 physicians were randomized 1:1 to receive a decision support tool and order set, embedded in the EHR. When an adult patient was admitted to a medical service, an electronic alert appeared if current smoking was recorded in the EHR. For physicians receiving the intervention, the alert linked to an order set for tobacco treatment medications and electronic referral to the state tobacco quitline. Additionally, “Tobacco Use Disorder” was added to the patient’s problem list, and a secure message was sent to the patient’s primary care provider (PCP). In the control arm, no alert appeared. Patients were contacted by phone at 1, 6, and 12 months; those reporting tobacco abstinence at 12 months were asked to return to measure exhaled carbon monoxide. Generalized estimating equations were used to model the data. Results From 2013 to 2016, the alert fired for 10,939 patients (5391 intervention, 5548 control). Compared to control physicians, intervention physicians were more likely to order tobacco treatment medication, populate the problem list with tobacco use disorder, refer to the quitline, and notify the patient’s PCP. In a subset of 1044 patients recruited for intensive follow-up, one-year quit rates for intervention and control patients were, respectively, 11.5% and 11.6%, (p = 0.94), after controlling for age, sex, race, ethnicity, and insurance. Similarly, there were no differences in 1- and 6-month quit rates. Conclusions Although we were able to improve processes of care, long-term tobacco quit rates were unchanged. This likely reflects, in part, the need for sustained quitting interventions, and higher-than-expected quit rates in controls. Future enhancements should improve prescription of medications for smoking cessation at discharge, engagement of primary care providers, and perhaps direct engagement of patients in a more longitudinal approach. Trial registration ClinicalTrials.gov, NCT01691105. Registered on September 12, 2012

Introduction: Despite an increase in the number of undergraduate training positions, Australia faces a critical shortage of medical practitioners in regional, rural and remote communities. Extended rural clinical placements have shown great utility in undergraduate medical curricula, increasing training capacity and providing comparable educational outcomes while promoting rural medicine as a career. The Prevocational Integrated Extended Rural Clinical Experience (PIERCE) was developed to increase the training capacity of the Queensland Rural Generalist Pathway (QRGP) and strengthen trainee commitment to rural practice by offering an authentic, extended 15-week rural term that provided an integrated experience in anaesthetics, obstetrics and gynaecology, and paediatrics, while meeting the requirements for satisfactory completion of prevocational rural generalist training. This study sought to evaluate whether trainees believed PIERCE and/or traditional regional hospital specialty placements achieved their learning objectives and to identify elements of the placements that contributed to, or were a barrier to, their realisation. Methods: This translational qualitative study explored the experiences and perceptions of QRGP trainees who undertook a PIERCE placement in three Queensland rural hospitals (Mareeba, Proserpine and Stanthorpe) in 2015, with a matched cohort of trainees who undertook regional hospital placements in anaesthetics, obstetrics and gynaecology, and paediatrics at a regional referral hospital (Cairns, Mackay and Toowoomba base hospitals). The study used a realist evaluation framework that investigates What works, for whom, in what circumstances, in what respects and why? Results: PIERCE provided an enjoyable and valued rural training experience that promoted trainee engagement with, and contribution to, a rural community of practice, reinforcing their commitment to a career in rural medicine. However, QRGP trainees did not accept that PIERCE could be a substitute for regional hospital experience in anaesthetics, obstetrics and gynaecology, and paediatrics. Rather, trainees thought PIERCE and regional hospital placements offered complementary experiences. PIERCE offered integrated, hands-on rural clinical experience in which trainees had more autonomy and responsibility. Regional hospital placements offered more traditional caseload learning experiences based on observation and the handing down of knowledge and skills by hospital-based supervisors. Conclusion: Both PIERCE and regional hospital placements provided opportunities and threats to the attainment of the curriculum objectives of the Australian Curriculum Framework for Junior Doctors, the Australian College of Rural and Remote Medicine and the Royal Australian College of General Practitioners Fellowship in Advanced Rural General Practice curricula. PIERCE trainees enjoyed the opportunity to experience rural medicine in a community setting, a broad caseload, hands-on proficiency, continuity of care and an authentic role as a valued member of the clinical team. This was reinforced by closer and more consistent clinical and educational interactions with their supervisors, and learning experiences that address key weaknesses identified in current hospital-based prevocational training. Successful achievement of prevocational curriculum objectives is contingent on strategic alignment of the curricula with supportive learning mechanisms focused by the learning context on the desired outcome, rural practice. This study adds weight to the growing consensus that rural community-based placements such as PIERCE are desirable components of prevocational training.

Transcranial infrared laser stimulation (TILS) is a novel, safe, non-invasive method of brain photobiomodulation. Laser stimulation of the human prefrontal cortex causes cognitive enhancement. To investigate the hemodynamic effects in prefrontal cortex by which this cognitive enhancement occurs, we used functional near-infrared spectroscopy (fNIRS), which is a safe, non-invasive method of monitoring hemodynamics. We measured concentration changes in oxygenated and deoxygenated hemoglobin, total hemoglobin and differential effects in 18 healthy adults during sustained attention and working memory performance, before and after laser of the right prefrontal cortex. We also measured 16 sham controls without photobiomodulation. fNIRS revealed large effects on prefrontal oxygenation during cognitive enhancement post-laser and provided the first demonstration that cognitive enhancement by transcranial photobiomodulation is associated with cerebrovascular oxygenation of the prefrontal cortex. Sham control data served to rule out that the laser effects were due to pre-post task repetition or other non-specific effects. A laser-fNIRS combination may be useful to stimulate and monitor cerebrovascular oxygenation associated with neurocognitive enhancement in healthy individuals and in those with prefrontal hypometabolism, such as in cognitive aging, dementia and many neuropsychiatric disorders.

The restoration of ecosystems provides an important opportunity to improve the provision of ecosystem services. Achieving the maximum possible benefits from restoration with a limited budget requires knowing which places if restored would produce the best combination of improved ecosystem services. Using an ecosystem services assessment and optimization algorithm, we find choices that generate maximum benefits from ecosystem restoration. We applied a set of weights to integrate multiple services into a unified approach and find the optimal land restoration option given those weights. We then systematically vary the weights to find a Pareto frontier that shows potentially optimal choices and illustrates trade-offs among services. We applied this process to evaluate optimal restoration on Hainan Island, China, a tropical island characterized by multiple ecosystem service hotspots and conditions of poverty. We analyzed restoration opportunities with the goal of increasing a provisioning service, plantation revenue, and several water-related ecosystem services that contribute to improved water quality and flood mitigation. We found obvious spatial inconsistencies in the optimal location for maximizing separate services and tradeoffs in the provision of these services. Optimized land-use patterns greatly out-performed the non-target restoration scheme. When explicit consideration of the importance of poverty alleviation was taken into account, the location of the prioritized areas shifted and trade-offs among services varied. Our study emphasizes the importance of integrating social concerns into land-use planning to mitigate conflicts and improve equity, especially in the areas where poverty and hotspots of biodiversity and ecosystem services are highly geographically coincident.

Dr Patrick O’Connor is a scientist based in Adelaide, Australia [...]

Objective – This study, which comprises one stage of a larger project (ALIA/HLA Workforce and Education Research Project), aimed to discover employers’ views on how (or whether) health librarians assist in achieving the mission-critical goals of their organizations; how health librarians contribute to the organization now and into the future; and what are the current and future skills requirements of health librarians.Methods – Each member of the project group approached between one and five individuals known to them to generate a convenience sample of 22 employers of health librarians. There were 15 semi-structured interviews conducted between October and November 2010 with employers in the hospital, academic, government, private, consumer health and not-for-profit sectors. The interview schedule was sent to each interviewee prior to the interview so that they had time to consider their responses. The researchers wrote up the interview notes using the interview schedule and submitted them to the principal researcher, who combined the data into one document. Content analysis of the data was used to identify major themes.Results – Employers expressed a clear sense of respect for the roles and responsibilities of library staff in their organizations. Areas of practice such as education and training, scientific research and clinical support were highlighted as critical for the future. Current areas of practice such as using technology and systems to manage information, providing information services to meet user needs and management of health information resources in a range of formats were identified as remaining highly relevant for the future. There was potential for health librarians to play a more active and strategic role in their organizations, and to repackage their traditional skill sets for anticipated future roles. Interpersonal skills and the role of health librarians as the interface between clinicians and information technology were also identified as critical for the future. Conclusions – Interviews with employers provided valuable insights into the current and future roles and skills requirements of health librarians in Australia, enriching the findings of the earlier stages of the research project. The next step is to work with the stakeholder groups in this project and use the research project’s findings as the evidence base on which to develop a structured, modular education framework comprising a postgraduate qualification in health librarianship and a continuing professional development structure supporting a three-year cycle of certification and revalidation.

Objective – This study, which comprises one stage of a larger project (ALIA/HLA Workforce and Education Research Project), aimed to discover employers’ views on how (or whether) health librarians assist in achieving the mission-critical goals of their organizations; how health librarians contribute to the organization now and into the future; and what are the current and future skills requirements of health librarians. Methods – Each member of the project group approached between one and five individuals known to them to generate a convenience sample of 22 employers of health librarians. There were 15 semi-structured interviews conducted between October and November 2010 with employers in the hospital, academic, government, private, consumer health and not-for-profit sectors. The interview schedule was sent to each interviewee prior to the interview so that they had time to consider their responses. The researchers wrote up the interview notes using the interview schedule and submitted them to the principal researcher, who combined the data into one document. Content analysis of the data was used to identify major themes. Results – Employers expressed a clear sense of respect for the roles and responsibilities of library staff in their organizations. Areas of practice such as education and training, scientific research and clinical support were highlighted as critical for the future. Current areas of practice such as using technology and systems to manage information, providing information services to meet user needs and management of health information resources in a range of formats were identified as remaining highly relevant for the future. There was potential for health librarians to play a more active and strategic role in their organizations, and to repackage their traditional skill sets for anticipated future roles. Interpersonal skills and the role of health librarians as the interface between clinicians and information technology were also identified as critical for the future. Conclusions – Interviews with employers provided valuable insights into the current and future roles and skills requirements of health librarians in Australia, enriching the findings of the earlier stages of the research project. The next step is to work with the stakeholder groups in this project and use the research project’s findings as the evidence base on which to develop a structured, modular education framework comprising a postgraduate qualification in health librarianship and a continuing professional development structure supporting a three-year cycle of certification and revalidation.

A decade after the publication of Visible Learning: A Synthesis of Over 800 Meta-Analyses Relating to Achievement, the influence of John Hattie's statistical work continues to grow. This paper critically examines one aspect of Hattie's 'synthesis' of education meta-analyses, his summation of research data for whole language literacy teaching. Of the four meta-analyses reported as being on whole language in Visible Learning, one is in fact a survey of research on language experience. Hattie uncritically accepted another meta-analysis, which reported that whole language triggers dramatic student unlearning, despite ample reasons to question its findings. On the other hand Hattie, revisiting the sole meta-analysis, reported finding a positive effect size for whole language in an unusual manner, with selected research studies removed to produce an effect size of zero. This paper argues that a prior bias on the part of the author of Visible Learning -- against whole language and in favour of synthetic phonics and direct instruction -- likely explains this interpretation of the research data on whole language. Potential implications for basing pedagogical practice and public policy decisions on aggregated effect sizes from meta-analyses are discussed.