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Little is known about how to mitigate moral distress within occupational therapy, but ethics education may reduce its impact by providing practitioners with tools for managing ethical problems. This study aimed to explore the impact of ethics education on managing ethical problems among occupational therapy practitioners within the first five years of practice using a pre-existing survey dataset collected in the spring of 2020. The investigators examined the formats and types of ethics education practitioners reported they received and how helpful they found that education. Investigators analyzed correlations between education and confidence with ethical problem-solving using Spearman's rho. Results included significant but weak correlations between ethical problem-solving confidence and classroom discussions, case studies, fieldwork mentorship, continuing education, and informal discussions with colleagues. This study adds to the current literature by identifying which types of ethics education new practitioners reported as most helpful, and which types correlated with ethical problem-solving confidence. The results of this study provide educational strategies to address ethical problems and mitigate moral distress. Future research is needed to provide further evidence for interventions to reduce moral distress.

PURPOSE OF REVIEW: Machine learning (ML), a subset of artificial intelligence (AI), has been vital in advancing tasks such as image classification and speech recognition. Its integration into clinical medicine, particularly dermatology, offers a significant leap in healthcare delivery. RECENT FINDINGS: This review examines the impact of ML on psoriasis-a condition heavily reliant on visual assessments for diagnosis and treatment. The review highlights five areas where ML is reshaping psoriasis care: diagnosis of psoriasis through clinical and dermoscopic images, skin severity quantification, psoriasis biomarker identification, precision medicine enhancement, and AI-driven education strategies. These advancements promise to improve patient outcomes, especially in regions lacking specialist care. However, the success of AI in dermatology hinges on dermatologists oversight to ensure that MLs potential is fully realized in patient care, preserving the essential human element in medicine. SUMMARY: This collaboration between AI and human expertise could define the future of dermatological treatments, making personalized care more accessible and precise.

Black women remain severely underrepresented in computing despite ongoing efforts to diversify the field. Given that Black women exist at the intersection of both racial and gendered identities, tailored approaches are necessary to address the unique barriers Black women face in computing. However, it is difficult to quantitatively evaluate the efficacy of interventions designed to retain Black women in computing, since samples of computing students typically contain too few Black women for robust statistical analysis. Using about a decade of student survey responses from an National Science Foundation--funded Broadening Participation in Computing alliance, we use regression analyses to quantitatively examine the connection between different types of interventions and Black women's intentions to persist in computing and how this compares to other students (specifically, Black men, white women, and white men). This comparison allows us to quantitatively explore how Black women's needs are both distinct from--and similar to--other students. We find that career awareness and faculty mentorship are the two interventions that have a statistically significant, positive correlation with Black women's computing persistence intentions. No evidence was found that increasing confidence or developing skills/knowledge was correlated with Black women's computing persistence intentions, which we posit is because Black women must be highly committed and confident to pursue computing in college. Last, our results suggest that many efforts to increase the number of women in computing are focused on meeting the needs of white women. While further analyses are needed to fully understand the impact of complex intersectional identities in computing, this large-scale quantitative analysis contributes to our understanding of the nuances of Black women's needs in computing.

Several studies have reported the positive benefits of informal Computer Science learning programs for Black girls, which include staff, mentors, and peers reflective of the girls in the program; however, we do not know enough about what motivates Black women to sign up to teach in such programs, or how representation in mentoring affects future CS learning for Black girls. Here we report the intersectional experiences of 11 Black women who served as instructors and mentors for the virtual INTech Summer Camp. The women in this study confirm that it is imperative to consider the intersectional experiences of Black women in CS as a whole, without explicating their identities. We found that Black women in CS feel that it is their responsibility to give back to Black girls to pay it forward from their own mentorship experiences. The Black women in our study describe seeking to fill a gap in mentorship that they experienced themselves, to share their knowledge and experiences to support the development of others who can relate to that intersection of identifying as Black and a girl or woman. Providing positive representation to encourage young Black girls to pursue tech careers is imperative to diversifying the tech workforce.

BRIDGES is a software framework for creating engaging assignments for required courses such as data structures and algorithms. It provides students with a simplified API that populates their own data structure implementations with live and real-world data, and provides the ability for students to easily visualize the data structures they create as part of routine classroom exercises. The objective is to use the infrastructure to promote a better understanding of the data structure and its underlying algorithms. This report describes the BRIDGES infrastructure and provides evaluation data collected over the first five years of the project. In the first 2 years, as we were developing the BRIDGES projects, our focus was on gathering data to assess whether the addition of the BRIDGES exercises had an effect on student retention of core concepts in data structures; and throughout the 5-year duration of the project, student interest and faculty feedback were collected online and anonymously. A mixed method design was used to evaluate the project impact. A quasiexperimental design compared student cohorts who were enrolled in comparable course sections that used BRIDGES with those that did not. Qualitative and quantitative measures were developed and used together with course grades and grade point averages. Interest and relevance in BRIDGES programming assignments was assessed with additional survey data from students and instructors. Results showed that students involved in BRIDGES projects demonstrated larger gains in knowledge of data structures compared to students enrolled in comparable course sections, as well as long-term benefits in their performance in four follow-on required courses. Survey responses indicated that some investment of time was needed to use BRIDGES, but the extra efforts were associated with several notable outcomes. Students and instructors had positive perceptions of the value of engaging in BRIDGES projects. BRIDGES can become a tool to get students more engaged in critical foundational courses, demonstrating relevance and context to today's computational challenges.

INTRODUCTION: Psoriasis, a chronic inflammatory skin condition, affects approximately 3.0% of the US population, with patients often experiencing significant sleep disturbances. These disturbances include a higher prevalence of conditions such as obstructive sleep apnea, restless leg syndrome, and insomnia. Given the additional risks for cardiovascular disease, metabolic disorders, and depression linked to both poor sleep and psoriasis, addressing sleep issues in this patient group is critical. METHODS: The study utilized National Health and Nutrition Examination Survey (NHANES) data, focusing on individuals aged ≥ 20 years who provided information on psoriasis status and sleep. Multistage stratified survey methodology was applied, with multivariable logistic regression models used to examine the association between psoriasis and sleep issues, adjusting for factors such as age, gender, and health history. RESULTS: Psoriasis diagnosis was significantly associated with trouble sleeping (adjusted odds ratio [aOR] 1.88; 95% confidence interval [CI] 1.44-2.45). There was no significant association between psoriasis and sleep quantity. Older age, female gender, and a history of sleep disorders were predictors of trouble sleeping among psoriasis patients. CONCLUSIONS: Psoriasis is significantly associated with sleep disturbances, independent of sleep duration. This underscores the need for clinical screening focusing on sleep quality rather than quantity in psoriasis patients to effectively identify and treat sleep-related comorbidities. Further research using objective sleep measures is warranted to guide clinical management and improve patient quality of life.

Periods of social mobility, such as attending college, can challenge ones status-based identity, leading to uncertainty around ones status in society. Status uncertainty is associated with poorer well-being and academic outcomes. Little is known, however, about what experiences lead to status uncertainty. The current longitudinal study investigated discrimination experiences and cultural mismatch as predictors of status uncertainty. We propose that discrimination indirectly predicts increased status uncertainty by increasing perceived cultural mismatch with the university. Participants were Latinx college students, all of whom were low-income and/or first generation to college. Discrimination experiences were measured at the end of participants first year. Cultural mismatch and status uncertainty were measured at the end of Year 2. Status uncertainty was measured again at the end of Year 3. Results indicated that students who experienced more frequent discrimination felt more cultural mismatch 1 year later, and, in turn, reported increased status uncertainty over the following year.

Abstract: Atmospheric rivers (ARs) deliver significant and essential precipitation to the western United States (US) with consequential interannual variability. The intensity and frequency of ARs strongly influence reservoir levels, mountain snowpack, and groundwater recharge, which are key drivers of water‐resource availability and natural hazards. Between October 2022 and April 2023, western states experienced exceptionally heavy precipitation from several families of powerful ARs. Using observations of surface‐loading deformation from Global Navigation Satellite Systems, we find that terrestrial water‐storage gains exceeded 100% of normal within vital California watersheds. Independent water‐storage solutions derived from different data‐analysis and inversion methods provide an important measure of precision. The sustained storage increases, which we show are closely associated with ARs at daily‐to‐weekly timescales, alleviated both meteorological and hydrological drought conditions in the region, with a lag in hydrological‐drought improvements. Quantifying water‐storage recovery associated with extreme precipitation after drought advances understanding of an increasingly variable hydrologic cycle.

Chronic pruritis, characterized by persistent itchiness lasting more than six weeks, affects up to 15% of the population, significantly impairing quality of life. Despite its prevalence and impact, there is an absence of FDA-approved medications specifically for the treatment of chronic pruritus, highlighting a significant unmet need in dermatology. Advancements in dermatologic medications, however, including the development of biologics and Janus kinase (JAK) inhibitors, signal potential breakthroughs in pruritus management through a radically different mechanism of action that focuses on their effect on the nervous system. Currently, the most commonly utilized treatments for pruritis are sedating antihistamines, which have been largely ineffective for non-histamine-induced itch, underscoring the necessity for novel approaches. This editorial reviews key studies and clinical trials with a particular focus on cases of prurigo nodularis, where itch serves as the primary pathology rather than just a symptom. The effectiveness of dupilumab in phase III trials for treating prurigo nodularis, independent of its effects on dermatitis or atopic background, alongside the success of JAK inhibitors in managing chronic idiopathic pruritus, indicates a shift towards therapies that directly and specifically target itch nerve pathways instead of indirectly via immune system modulation or sedation. These developments suggest that significant progress may be on the horizon for treating chronic itch, providing hope for those suffering from pruritis, the number one cause of misery in dermatology.

OBJECTIVE: There is widespread overuse of antibiotics in neonatal intensive care units (NICUs). The objective of this study was to safely reduce antibiotic use in participating NICUs by targeting early-onset sepsis (EOS) management. STUDY DESIGN: Twenty-eight NICUs participated in this statewide multicenter antibiotic stewardship quality improvement collaborative. The primary aim was to reduce the total monthly mean antibiotic utilization rate (AUR) by 25% in participant NICUs. RESULT: Aggregate AUR was reduced by 15.3% (p

Geologic features (e.g., fractures and alluvial fans) can play an important role in the locations and volumes of groundwater discharge and degree of groundwater-surface water (GW-SW) interactions. However, the role of these features in controlling GW-SW dynamics and streamflow generation processes are not well constrained. GW-SW interactions and streamflow generation processes are further complicated by variability in precipitation inputs from summer and fall monsoon rains, as well as declines in snowpack and changing melt dynamics driven by warming temperatures. Using high spatial and temporal resolution radon and water stable isotope sampling and a 1D groundwater flux model, we evaluated how groundwater contributions and GW-SW interactions varied along a stream reach impacted by fractures (fractured-zone) and downstream of the fractured hillslope (non-fractured zone) in Coal Creek, a Colorado River headwater stream affected by summer monsoons. During early summer, groundwater contributions from the fractured zone were high, but declined throughout the summer. Groundwater contributions from the non-fractured zone were constant throughout the summer and became proportionally more important later in the summer. We hypothesize that groundwater in the non-fractured zone is dominantly sourced from a high-storage alluvial fan at the base of a tributary that is connected to Coal Creek throughout the summer and provides consistent groundwater influx. Water isotope data revealed that Coal Creek responds quickly to incoming precipitation early in the summer, and summer precipitation becomes more important for streamflow generation later in the summer. We quantified the change in catchment dynamic storage and found it negatively related to stream water isotope values, and positively related to modeled groundwater discharge and the ratio of fractured zone to non-fractured zone groundwater. We interpret these relationships as declining hydrologic connectivity throughout the summer leading to late summer streamflow supported predominantly by shallow flow paths, with variable response to drying from geologic features based on their storage. As groundwater becomes more important for sustaining summer flows, quantifying local geologic controls on groundwater inputs and their response to variable moisture conditions may become critical for accurate predictions of streamflow.

BACKGROUND: Adherence to a Mediterranean Diet (MeD) has been associated with lower disease severity in patients with psoriasis. However, the mechanism behind how this diet may lead to disease modification remain understudied. Recent studies have revealed dysbiosis of the gut microbiome in patients with psoriasis suggestive of inflammation and altered immune regulation. Diet affects the gut microbiome and this review aims to evaluate whether correcting this dysbiosis may be one theoretical mechanism by which the MeD may be associated with lower psoriasis severity. METHODS: A literature search of the PubMed database was conducted for the terms 1) psoriasis and microbiome or microbiota, and 2) Mediterranean diet and microbiome or microbiota with manual screening for relevant articles. In total, we identified 9 relevant primary research studies investigating the gut microbiome in patients with psoriasis and 16 relevant primary research studies investigating changes in the microbiota for those consuming a MeD. RESULTS: Though varying in exact levels of certain bacteria, studies analyzing the microbiome in psoriasis revealed dysbiosis. Those analyzing the effect of the Mediterranean diet on the microbiome revealed beneficial changes, including alleviating some of the same alterations seen in the microbiome of those with psoriasis. CONCLUSION: Microbiota change is a possible mechanism why the MeD has previously been associated with lower psoriasis severity.

The accumulation of microplastics in various ecosystems has now been well documented and recent evidence suggests detrimental effects on various biological processes due to this pollution. Accumulation of microplastics in the natural environment is ultimately due to the chemical nature of widely used petroleum-based plastic polymers, which typically are inaccessible to biological processing. One way to mitigate this crisis is adoption of plastics that biodegrade if released into natural environments. In this work, we generated microplastic particles from a bio-based, biodegradable thermoplastic polyurethane (TPU-FC1) and demonstrated their rapid biodegradation via direct visualization and respirometry. Furthermore, we isolated multiple bacterial strains capable of using TPU-FC1 as a sole carbon source and characterized their depolymerization products. To visualize biodegradation of TPU materials as real-world products, we generated TPU-coated cotton fabric and an injection molded phone case and documented biodegradation by direct visualization and scanning electron microscopy (SEM), both of which indicated clear structural degradation of these materials and significant biofilm formation.

Malaria remains a major threat to global health with [approximately equal to]247 million cases reported in 2021 (2). An invasive malaria vector, Anopheles stephensi mosquito, has emerged in Africa; the [...]

Personal stories serve learning and socioemotional functions in teaching. Instructors share personal stories with students to promote engagement, foster learning, and create a sense of community. Students may also share personal stories with each other for similar reasons. Thus, the current study explored how often, and why, students (N = 79) shared personal stories as well as responded to other students' stories in online discussion forums (ODFs) that were part of a remotely taught adult development and aging class. The students ODF posts (f = 1,354) were content-coded for: (i) whether they contained a personal story, (ii) were a direct response to another students' personal story, and (iii) whether they served a teach and inform, empathic, or social-bonding function. Twenty-two percent of the posts made in the ODFs were personal stories, and almost half served a teach and inform function. Ten percent of students' posts were responses to other students' personal stories, and primarily served empathic and social-bonding functions. Results highlight the possibility that students can engage with one another to foster the pedagogical benefits of personal stories and provide insights into how personal stories can be infused into teaching and learning. [Note: The page range (101-112) shown on the PDF is incorrect. The correct page range is 101-114.]

Deviations from normal blood pressure (BP) during general anesthesia have been clearly linked to several adverse outcomes. Measuring BP accurately is therefore critically important for producing excellent outcomes in health care. Normal BP does not necessarily guarantee adequate organ perfusion however and adverse events have occurred even when BP seemed adequate. Invasive blood pressure monitoring has recently evolved beyond merely measuring BP. Arterial line-derived pulse contour analysis is used now to assess both cardiac output and stroke volume variation as indices of adequate intravascular volume. Confirmation of acceptable cardiac output with data derived from invasive intra-arterial catheters has become very important when managing high-risk patients. Newer devices that measure BP continuously and non-invasively in the digital arteries via a finger cuff have also become available. Many clinicians contemplate now if these new devices are ready to replace invasive monitoring with an arterial catheter. Unlike non-invasive devices, intra-arterial catheters allow frequent blood sampling. This makes it possible to assess vital parameters like pH, hemoglobin concentration, ionized calcium, potassium, glucose, and arterial partial pressure of oxygen and carbon dioxide frequently. Non-invasive continuous BP measurement has been found to be unreliable in critically ill patients, the elderly, and patients with calcified arteries. Pulse contour-derived estimates of cardiac output and stroke volume variation have been validated better with data derived from arterial lines than that from the newer finger cuff monitors. Significant advances have been recently made with non-invasive continuous BP monitors. Invasive monitoring with an arterial line however remains the gold standard for measuring BP and assessing pulse contour analysis-derived hemodynamic variables in critically ill patients. In the future, non-invasive continuous BP monitors will likely replace intermittent oscillometers in the operating room and the postoperative period. They will however not eliminate the need for arterial catheterization in critically ill patients.

INTRODUCTION:  Goeckerman therapy, which combines ultraviolet B (UVB) light with crude coal tar (CCT), remains highly effective for moderate-to-severe psoriasis. While it is rarely still used in the USA as effective biotherapeutics have become more readily available, it offers an alternative therapy in developing countries with limited access to newer medications. Moi Teaching & Referral Hospital (MTRH) in Eldoret, Kenya, in collaboration with UCSF, developed a modified Goeckerman regimen suitable for local healthcare needs, condensing the treatment into an intensive two-week program. CASE REPORT:  A 55-year-old female with erythrodermic psoriasis traveled 350 kilometers to MTRH. After the diagnosis was confirmed, she underwent a nine-day inpatient treatment with narrow-band UVB phototherapy and topical medications under occlusion as a modified Goeckerman regimen. RESPONSE TO TREATMENT:  Significant improvement was observed within three days, with full recovery in ten days. Follow-up one month later showed no active lesions, and her psoriasis remained controlled for four months with topical treatments. CONCLUSION:  The modified Goeckerman regimen at MTRH, in collaboration with UCSF, effectively treated severe psoriasis in a challenging healthcare context. This case highlights the potential for adapting established treatments to improve patient outcomes in developing countries with limited access to systemic therapies.

While psoriasis and atopic dermatitis (AD) are two common dermatological conditions, their diagnosis and therapeutic decision-making pathways are often complex. As a result, there has been increased focus on the development of precision medicine approaches for psoriasis and AD. Two companies at the forefront of dermatology precision medicine research are Mindera Health and Castle Biosciences. Here, we review the technologies developed by these two companies using a dermal diagnostic patch and superficial skin scrapings, respectively, their research published to date, and their future research goals. Research from both companies shows promise in predicting the response of inflammatory skin disease to biologics using minimally invasive techniques. However, challenges to adoption include insurance coverage and patient trust in the technologies. While there are several differences between Mindera Health and Castle Biosciences, they have a shared goal of utilizing minimally invasive technologies to sample skin and predict response to biologic treatments using a panel of optimized biomarkers.

Abstract Nonrigid forms of motion are commonplace in everyday life. Given previously documented age-related deteriorations in various tasks involving motion (discriminating speed, identifying motion direction, etc.), an experiment was conducted to evaluate the potential effect of age upon the visual ability to detect rigid and nonrigid object motion. Thirty younger and older observers participated in the experiment (mean ages were 19.9 and 75.8 years, respectively). As has been done multiple times in the past, the individual motions of object vertices were manipulated to simulate either rigid motion (rotation in depth, with or without precession) or two different types of nonrigid motion (also rotation in depth with or without precession, but with added object deformation). In confirmation of previous research, there were large effects of nonrigid motion type and precession upon the ability to differentiate between rigid and nonrigid object motion. There was also a large effect of age, such that the discrimination performance of the younger observers was 49.6% higher than that exhibited by the older observers. In this first ever study of aging and nonrigid object motion perception, we thus find that aging is associated with a substantial impairment in the ability to visually perceive object nonrigidity.

Abstract Macrophages are pivotal innate immune cells which exhibit high phenotypic plasticity and can exist in different polarization states dependent on exposure to external stimuli. Numerous methods have been employed to simulate macrophage polarization states to test their function in vitro. However, limited research has explored whether these polarization methods yield comparable populations beyond key gene, cytokine, and cell surface marker expression. Here, we employ an unbiased comprehensive analysis using data organized through the all RNA-seq and ChIP-seq sample and signature search (ARCHS4) database, which compiles all RNAseq data deposited into the National Center for Biotechnology Information (NCBI) Sequence Read Archive (SRA). In silico analyses were carried out demonstrating that commonly employed macrophage polarization methods generate distinct gene expression profiles in macrophage subsets that remained poorly described until now. Our analyses confirm existing knowledge on broad macrophage polarization, while expanding nuanced differences between M2a and M2c subsets, suggesting non-interchangeable stimuli for M2a polarization. Furthermore, we characterize divergent gene expression patterns in M1 macrophages following standard polarization protocols, indicating significant subset distinctions. Consequently, equivalence cannot be assumed among polarization regimens for in vitro macrophage studies, particularly in simulating diverse pathogen responses.

Abstract Background High grade serous ovarian cancer (HGSOC) is the most lethal gynecologic malignancy in which patients have still yet to respond meaningfully to clinically available immunotherapies. Hence, novel immune targets are urgently needed. Our past work has identified that mast cells are significantly upregulated at the mRNA level in HGSOC patient tumors following neoadjuvant chemotherapy (NACT) exposure. Therefore, in this current investigation we sought to characterize intratumoral mast cell phenotypic changes as a result of NACT exposure and determine how these adaptations are associated with patient clinical outcomes. Methods Hematologic immunohistochemistry was employed to determine mast cell levels in 36 matched pre- and post-NACT HGSOC patient tumors. Fluorescent Immunohistochemistry was utilized to identify Tryptase+(carboxypeptidase A3 (CPA3) + mast cells as well as histamine levels in 29 and 20, respectively, matched pre- and post-NACT HGSOC patient tumors. Finally, human immortalized mast cells, LUVA were stimulated with carboplatin and paclitaxel and genomic changes were analyzed by quantitative PCR. Results Hematologic labeled intratumoral mast cells were significantly upregulated in the intraepithelial and stromal regions of the tumor, post-NACT. Lower levels of pre-NACT mast cells were significantly associated with an improved progression-free survival (PFS). Histamine, a marker of mast cell degranulation was similarly upregulated in post-NACT exposed tumors. Through the characterization of mast cell specific proteases Tryptase and CPA3, it was found that Tryptase+/ CPA3 + mast cells were significantly upregulated both in the intraepithelial and stromal compartments of the tumor, while Tryptase + cells were significantly upregulated in the stromal regions of the tumor. Lower post-NACT treated levels with Tryptase+/ CPA3 + cells were significantly associated with improved overall survival (OS) and PFS while higher Tryptase + mast cells were associated with improved OS. Finally, following chemotherapy exposure mast cell activating factors AREG and CCL2 were significantly upregulated while TGFB1, an inhibitor of mast cell activation was downregulated in LUVA cells. Conclusions Enhanced mast cell numbers, as well as activation and degranulation are a consequence of NACT exposure. Post-NACT mast cells displayed differing associations with survival outcomes that was dependent upon granule classification. Ultimately, mast cells represent a clinically relevant putative HGSOC immune target.