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Abstract In order to improve conservation outcomes translocation or reintroduction of individuals may be necessary. When song learning birds are translocated, changes in the cultural diversity of song repertoires, or abnormal vocalizations, in the new population can be a problem. We monitored song production over 8 years in a reintroduced population of the cirl bunting (Emberiza cirlus). Chicks were removed from nests in Devon, UK, between 2006 and 2011, translocated at 6 days old to be hand‐reared and released in Cornwall, UK. Recordings at the release site in 2011 showed a significantly reduced population repertoire and individuals sang abnormal song types compared to the source populations in Devon. However, recordings in 2019, showed population song repertoire had reached the level of source populations of similar size, and song types were species typical. Our study shows that species can recover from a cultural bottleneck and suggests that, for some song learning birds, if translocation of nestlings is necessary it may not lead to long‐term problems for communication and thus population persistence. For future translocations of nestlings, we recommend that efforts are made to provide tutoring to enable song learning. This may be achieved by providing recordings, but may also include providing adult song tutors. In addition, playback of “normal” songs to translocated populations may aid in development of species typical song repertoires, although care must be taken that this is not disturbing the reintroduced birds.

Abstract Background Thirty million small and sick newborns worldwide require inpatient care each year. Many receive antibiotics for clinically diagnosed infections without blood cultures, the current ‘gold standard’ for neonatal infection detection. Low neonatal blood culture use hampers appropriate antibiotic use, fuelling antimicrobial resistance (AMR) which threatens newborn survival. This study analysed the gap between blood culture use and antibiotic prescribing in hospitals implementing with Newborn Essential Solutions and Technologies (NEST360) in Kenya, Malawi, Nigeria, and Tanzania. Methods Inpatient data from every newborn admission record (July 2019–August 2022) were included to describe hospital-level blood culture use and antibiotic prescription. Health Facility Assessment data informed performance categorisation of hospitals into four tiers: (Tier 1) no laboratory, (Tier 2) laboratory but no microbiology, (Tier 3) neonatal blood culture use 50%. Results A total of 144,146 newborn records from 61 hospitals were analysed. Mean hospital antibiotic prescription was 70% (range = 25–100%), with 6% mean blood culture use (range = 0–56%). Of the 10,575 blood cultures performed, only 24% (95%CI 23–25) had results, with 10% (10–11) positivity. Overall, 40% (24/61) of hospitals performed no blood cultures for newborns. No hospitals were categorised as Tier 1 because all had laboratories. Of Tier 2 hospitals, 87% (20/23) were District hospitals. Most hospitals could do blood cultures (38/61), yet the majority were categorised as Tier 3 (36/61). Only two hospitals performed > 50% blood cultures for newborns on antibiotics (Tier 4). Conclusions The two Tier 4 hospitals, with higher use of blood cultures for newborns, underline potential for higher blood culture coverage in other similar hospitals. Understanding why these hospitals are positive outliers requires more research into local barriers and enablers to performing blood cultures. Tier 3 facilities are missing opportunities for infection detection, and quality improvement strategies in neonatal units could increase coverage rapidly. Tier 2 facilities could close coverage gaps, but further laboratory strengthening is required. Closing this culture gap is doable and a priority for advancing locally-driven antibiotic stewardship programmes, preventing AMR, and reducing infection-related newborn deaths.

Abstract Background High-quality neonatal care requires sufficient functional medical devices, furniture, fixtures, and use by trained healthcare workers, however there is lack of publicly available tools for quantification and costing. This paper describes development and use of a planning and costing tool regarding furniture, fixtures and devices to support scale-up of WHO level-2 neonatal care, for national and global newborn survival targets. Methods We followed a systematic process. First, we reviewed planning and costing tools of relevance. Second, we co-designed a new tool to estimate furniture and device set-up costs for a default 40-bed level-2 neonatal unit, incorporating input from multi-disciplinary experts and newborn care guidelines. Furniture and device lists were based off WHO guidelines/norms, UNICEF and national manuals/guides. Due to lack of evidence-based quantification, ratios were based on operational manuals, multi-country facility assessment data, and expert opinion. Default unit costs were from government procurement agency costs in Kenya, Nigeria, and Tanzania. Third, we refined the tool by national use in Tanzania. Results The tool adapts activity-based costing (ABC) to estimate quantities and costs to equip a level-2 neonatal unit based on three components: (1) furniture/fixtures (18 default but editable items); (2) neonatal medical devices (16 product categories with minimum specifications for use in low-resource settings); (3) user training at device installation. The tool was used in Tanzania to generate procurement lists and cost estimates for level-2 scale-up in 171 hospitals (146 District and 25 Regional Referral). Total incremental cost of all new furniture and equipment acquisition, installation, and user training were US$93,000 per District hospital (level-2 care) and US$346,000 per Regional Referral hospital. Estimated cost per capita for whole-country district coverage was US$0.23, representing 0.57% increase in government health expenditure per capita and additional 0.35% for all Regional Referral hospitals. Conclusion Given 2.3 million neonatal deaths and potential impact of level-2 newborn care, rational and efficient planning of devices linked to systems change is foundational. In future iterations, we aim to include consumables, spare parts, and maintenance cost options. More rigorous implementation research data are crucial to formulating evidence-based ratios for devices numbers per baby. Use of this tool could help overcome gaps in devices numbers, advance efficiency and quality of neonatal care.

IntroductionCentral to public health practice is mindfulness and intentionality toward achieving social justice and health equity. However, there is limited literature published on how educators are integrating these concepts into their curricular, pedagogical and instructional efforts. The goal of this study was to leverage the pluralistic views, social identities, and demographics within the classroom to explore the effects of introducing a Global Health Book Club (GHBC) assignment focused on identity of culture, equity, and power. We also sought to explore the use of first-account narratives illustrating the human experience as an instructional strategy to cultivate an empathic understanding of global health threats, while fostering critical consciousness toward one’s positionality within macro-level contexts. Finally, students were encouraged to reflect on their lived cultural experiences and engage in open and authentic dialogue with their peers.MethodsWe implemented a four-week GHBC assignment within an undergraduate global public health course. At the conclusion of the GHBC, students engaged in a reflective Individual Analysis Paper, which captured students’ perspectives on their cultural values and traditions, how these views shaped their understanding of their book, and evaluate whether their global perspective had changed as a result of the assignment. Thirty-one students consented to have their Individual Analysis Paper downloaded and de-identified for analysis. Student responses were analyzed using inductive thematic analysis procedures.ResultsThrough our analysis, six themes, with several coinciding categories, were identified as salient. The themes include Demonstrated Empathy, Personal Reflection and Growth, Personally Inspired, Immersive Learning Experience, Broadened Perspective, and Provoked Emotion.DiscussionOur findings support that a GHBC assignment is a viable and effective mechanism for engaging students in critical reflection, critical motivation and critical action. In cultivating a learning environment that promotes student-centered learning and active participation, students exemplified agency in their own learning. This work can serve as an exemplary model for other public health educators to engage students in reflective-based assignments regarding their positionality and critical consciousness. By utilizing frameworks conceived out of antiracism, diversity, equity, and inclusion, our work presents an innovative activity in engaging students in decolonization efforts within global public health practice.

Abstract In the United Kingdom, woodland planting and soil and crop management are being promoted as approaches to tackling flooding. Although evidence is limited, it is thought tree planting and regenerative agriculture practices such as crop–herbal ley pasture rotations increase infiltration, soil water storage and evapotranspiration, potentially reducing flooding. A process‐based soil–water–vegetation model was coupled with a semi‐distributed groundwater model to explore the impact of these interventions on peak and low flows in a large, groundwater‐dominated catchment. Land use change and management were found to have limited potential to reduce flooding in this setting. Herbal ley–crop rotations produced a 2 years, and levels of woodland planting judged to be the realistic maximum produced reductions of 0.2%–2.6%, depending on tree species. Broadscale spruce planting was the only scenario to produce significant reductions in peak flow (16.0%–24.7% at return periods 1–15 years); however, the level of spruce planting required to achieve these reductions was estimated to reduce Q95 flow by ~39%, which would likely have negative implications for water security and ecological river flows. The impact of land‐based natural flood management interventions for flood prevention in large, permeable catchments should not be overstated.

IntroductionPublic health has declared a commitment toward diversity as a whole, with a commitment toward addressing and dismantling racism being at the forefront. Although public health has admirably taken on this mission, and the foundational principles of public health align with social justice and health equity, public health as a discipline is vastly behind other fields in integrating and utilizing critical race theorizations. Of particular concern is the lack of critical race theorization within public health education materials. Public health education serves as a precursor to public health practice and situates topics and competencies that are essential to one’s foundational public health knowledge and skillset, thus the use of strong theoretical groundings is critical in public health education.ObjectivesTherefore, to explore the current landscape of public health educational research that employs critical race theories, this study sought to conduct a scoping review investigating the current literature of public health pedagogical, instructional, and curricular efforts that utilize race and antiracist theorization principles as a means to administer public health education. More specifically, we sought to investigate how have faculty and instructors published their integration of race theorization in public health curriculum/instruction within the United States since 2011.ResultsWe found 18 examples from peer-reviewed literature of curricular, pedagogical, or instructional practices and strategies that integrate critical theories of race, including contemplative pedagogy (n = 1), antiracism (n = 3), Public Health Critical Race praxis (n = 4), Critical Race (n = 5), critical service-learning/community engagement (n = 2), ethnic studies (n = 1), and intersectionality (n = 2).ConclusionThese articles present a wide breadth of innovative approaches to infusing critical race studies within public health higher education, ranging from individual assignments to course design and implementation to institutional culture change, thus demonstrating the multifaceted nature of critical race studies within micro-learning communities and macro-discipline practices. Identifying theoretically grounded, exemplary models and scholarly recommendations of pedagogical, instructional, and curricular practices provides readers the opportunity to borrow from successful practices and implement concepts of race, racism, antiracism, intersectionality, and more into their classrooms.

The contribution and regulation of various CD4+ T cell lineages that occur with remitting vs progressive courses in sarcoidosis are poorly understood. We developed a multiparameter flow cytometry panel to sort these CD4+ T cell lineages followed by measurement of their functional potential using RNA-sequencing analysis at six-month intervals across multiple study sites. To obtain good quality RNA for sequencing, we relied on chemokine receptor expression to identify and sort lineages. To minimize gene expression changes induced by perturbations of T cells and avoid protein denaturation caused by freeze/thaw cycles, we optimized our protocols using freshly isolated samples at each study site. To accomplish this study, we had to overcome significant standardization challenges across multiple sites. Here, we detail standardization considerations for cell processing, flow staining, data acquisition, sorting parameters, and RNA quality control analysis that were performed as part of the NIH-sponsored, multi-center study, BRonchoscopy at Initial sarcoidosis diagnosis Targeting longitudinal Endpoints (BRITE). After several rounds of iterative optimization, we identified the following aspects as critical for successful standardization: 1) alignment of PMT voltages across sites using CS&T/rainbow bead technology; 2) a single template created in the cytometer program that was used by all sites to gate cell populations during data acquisition and cell sorting; 3) use of standardized lyophilized flow cytometry staining cocktails to reduce technical error during processing; 4) development and implementation of a standardized Manual of Procedures. After standardization of cell sorting, we were able to determine the minimum number of sorted cells necessary for next generation sequencing through analysis of RNA quality and quantity from sorted T cell populations. Overall, we found that implementing a multi-parameter cell sorting with RNA-seq analysis clinical study across multiple study sites requires iteratively tested standardized procedures to ensure comparable and high-quality results.

IntroductionAs public health expands its role in global settings, the need to develop intercultural competency for public health students also grows. One initiative being applied to promote global awareness is the use of virtual exchange (VE) programs. VE programs promote collaborative online international learning (COIL) and allow students from different countries to connect and work together on projects related to their field of study; however, there is little research around the long-term impacts of these programs.MethodsUndergraduate pre-health students from the United States who participated in a VE program a year prior were interviewed about their experiences engaging with undergraduate medical students in Egypt. They were asked if the experience impacted their current behaviors, skills, or knowledge, and what improvements could be made to the program. Mezirow's Transformative Learning Theory (TLT) served as the theoretical framework, grounding interview instrument development and directed content analysis procedures. Researchers also engaged in inductive analysis to capture other salient themes.ResultsTen students were interviewed with a majority engaging in either of the two final stages of Mezirow's TLT: “building of self-confidence and self-competence” (60%) and “reintegration” (50%). Other salient themes found were intercultural interactions, VE appreciation, and VE improvements. When describing their experience in one word, students overwhelmingly provided words with positive connotations (80%), with the negative responses being explained by the structure and presentation of the VE.DiscussionStudents were able to apply lessons they learned during the VE within a 1-year follow-up period. This is beneficial, as health professionals require intercultural competency to promote and provide improved health outcomes. Results from this study indicate the need for structure when conducting a VE, addressing the need to increase the number of direct interactions and thereby promoting more intercultural exchanges. Likewise, the interviews demonstrated that changes in course instruction need to be implemented gradually to allow for students to adjust to unfamiliar teaching methods.

With more classrooms within higher education mobilizing strategies for internationalization, collaborative online international learning (COIL), also referred to as virtual exchange, is an effective approach at offering intercultural competence through experiential learning. This strategy provides students who face barriers to international travel the opportunity to engage with students from other countries in meaningful ways, while enhancing and reinforcing course content. Grounded in the transformative learning theory, this study evaluates the effectiveness of a virtual exchange that was implemented within an undergraduate global public health course. The virtual exchange connected students from the University of Florida (within the US) with medical students in a microbiology course at Ain Shams University in Cairo, Egypt. Using adapted reflection prompts, we assessed the students' knowledge and learning before, during, and after the virtual exchange. This was coupled with a final paper to capture how personal backgrounds and experiences may contribute to their perception of the virtual exchange, as well as if they felt their global perspective had changed or shifted during the experience. Using directed content analysis for each of the measurements, two researchers coded the data independently to then present agreed upon salient themes to the larger group. Of the 28 randomly sampled students who participated in the virtual exchange, seven major themes emerged from the data: Connectedness; Openness; Acquisition of Knowledge and Skills; Communication; Cultural Identity; Anticipation of Options for New Roles, Relationships, and Actions; and Absence of Change. Through this evaluation it was clear there was a variance of different perspectives with many sampled students having diverse lived experiences that influenced their worldview prior to the virtual exchange. Despite course-related barriers, students acknowledged several facilitating factors that improved their intercultural competence and knowledge of course content. The integration of a virtual exchange within the classroom, with careful design and implementation, can provide a unique experience for students and an inclusive approach to learning.

Though community-based scientific approaches are becoming more common, many scientific efforts are conducted by small groups of researchers that together develop a concept, analyze data, and interpret results that ultimately translate into a publication. Here, we present a community effort that breaks these traditional boundaries of the publication process by engaging the scientific community from initial hypothesis generation to final publication. We leverage community-generated data from the Worldwide Hydrobiogeochemistry Observation Network for Dynamic River Systems (WHONDRS) consortium to study organic matter composition through the lens of ecological theory. This community endeavor will use a suite of paired physical and chemical datasets collected from 97 river corridors across the globe. With our first step aimed at ideation, we engaged a community of scientists from over 20 countries and 60 institutions, spanning disciplines and career stages by holding a virtual workshop (April 2021). In the workshop, participants generated content for questions, hypotheses, and proposed analyses based on the WHONDRS dataset. These ideation efforts resulted in several narratives investigating different questions led by different teams, which will be the basis for research articles in a Frontiers in Water collection. Currently, the community is collectively analyzing, interpreting, and synthesizing these data that will result in six crowdsourced articles using a single, existing WHONDRS dataset. The use of a shared dataset across articles not only lowers barriers for broad participation by not requiring generation of new data, but also provides unique opportunities for emergent learning by connecting outcomes across studies. Here we will explain methods used to enable this community endeavor aimed to promote a greater diversity of thinking on river corridor biogeochemistry through crowdsourced science.

Collaborative online international learning programs, such as virtual exchange, that utilize telecollaborative activities have been integrated into more classrooms within the higher education setting. These programs provide students exposure to international cultures, perspectives, and ideas is no longer considered “value added”, but a prerequisite to entering many workforces. These programmatic objectives compliment Mezirow's Transformative Learning Theory, that substantiates two major elements of transformative learning are critical reflection and dialectical discourse. This study presents the second half of a qualitative inquiry into the prominent themes that arose during a virtual exchange that was conducted in March 2021 between students in the United States (US) enrolled in a global public health course and Egyptian microbiology students. This study sought to expand upon the Transformative Learning Theory through inductive analysis procedures to offer a modernized adaptation of the theoretical framework within international learning environments. Student responses enrolled in an undergraduate global public health course were collected and analyzed by two coders using inductive/open coding to identify salient codes. These codes were then summarized into categories and subsequently defined. Resulting themes include Connectedness, Openness, Acquisition of Knowledge and Skills, Communication, Cultural Identity, Anticipation of Options for New Roles, Relationships, and Actions, and Absence of Change. Several themes have corresponding categories and subcategories. Adult learning environments such as the modern college classroom have changed with the introduction and reliance upon online learning domains, as well as the diversification of higher education student demographics, accentuating the need to inductively analyze student learning processes and outcomes. In doing so, our findings provide a modernized adaptation of the Transformative Learning Theory that allows for adult learning theorists, researchers, and scholars to integrate tenets of transformative learning more appropriately. As such, this provides an opportunity for educators to coalesce the identified mechanisms (e.g., openness, cultural background, anticipation of roles and relationships) to bolster student's willingness and ability to engage in transformative critical reflections. By capitalizing on students' innate characteristics, such as open-mindedness predispositions and cultural background, educators are able to augment transformative learning strategies through tailored assignments and course activities.

Summary: Fibrosis-driven solid organ failure is an enormous burden on global health. Spiny mice (Acomys) are terrestrial mammals that can regenerate severe skin wounds without scars to avoid predation. Whether spiny mice also regenerate internal organ injuries is unknown. Here, we show that despite equivalent acute obstructive or ischemic kidney injury, spiny mice fully regenerate nephron structure and organ function without fibrosis, whereas C57Bl/6 or CD1 mice progress to complete organ failure with extensive renal fibrosis. Two mechanisms for vertebrate regeneration have been proposed that emphasize either extrinsic (pro-regenerative macrophages) or intrinsic (surviving cells of the organ itself) controls. Comparative transcriptome analysis revealed that the Acomys genome appears poised at the time of injury to initiate regeneration by surviving kidney cells, whereas macrophage accumulation was not detected until about day 7. Thus, we provide evidence for rapid activation of a gene expression signature for regenerative wound healing in the spiny mouse kidney.

Introduction Sarcoidosis is a multiorgan granulomatous disorder thought to be triggered and influenced by gene–environment interactions. Sarcoidosis affects 45–300/100 000 individuals in the USA and has an increasing mortality rate. The greatest gap in knowledge about sarcoidosis pathobiology is a lack of understanding about the underlying immunological mechanisms driving progressive pulmonary disease. The objective of this study is to define the lung-specific and blood-specific longitudinal changes in the adaptive immune response and their relationship to progressive and non-progressive pulmonary outcomes in patients with recently diagnosed sarcoidosis.Methods and analysis The BRonchoscopy at Initial sarcoidosis diagnosis Targeting longitudinal Endpoints study is a US-based, NIH-sponsored longitudinal blood and bronchoscopy study. Enrolment will occur over four centres with a target sample size of 80 eligible participants within 18 months of tissue diagnosis. Participants will undergo six study visits over 18 months. In addition to serial measurement of lung function, symptom surveys and chest X-rays, participants will undergo collection of blood and two bronchoscopies with bronchoalveolar lavage separated by 6 months. Freshly processed samples will be stained and flow-sorted for isolation of CD4 +T helper (Th1, Th17.0 and Th17.1) and T regulatory cell immune populations, followed by next-generation RNA sequencing. We will construct bioinformatic tools using this gene expression to define sarcoidosis endotypes that associate with progressive and non-progressive pulmonary disease outcomes and validate the tools using an independent cohort.Ethics and dissemination The study protocol has been approved by the Institutional Review Boards at National Jewish Hospital (IRB# HS-3118), University of Iowa (IRB# 201801750), Johns Hopkins University (IRB# 00149513) and University of California, San Francisco (IRB# 17-23432). All participants will be required to provide written informed consent. Findings will be disseminated via journal publications, scientific conferences, patient advocacy group online content and social media platforms.

Abstract Multiple studies have reported widespread browning of Northern Hemisphere lakes. Most examples are from boreal lakes that have experienced limited human influence, and browning has alternatively been attributed to changes in atmospheric deposition, climate, and land use. To determine the extent and possible causes of browning across a more geographically diverse region, we examined watercolor and dissolved organic carbon (DOC) time series in hundreds of northeastern U.S. lakes. The majority of lakes have increased in both DOC and color, but there were neither coherent spatial patterns in trends nor relationships with previously reported drivers. Color trends were more variable than DOC trends, and DOC and color trends were not strongly correlated, indicating a cause other than or in addition to increased loading of terrestrial carbon. Browning may be pronounced in regions where climate and atmospheric deposition are dominant drivers but muted in more human‐dominated landscapes with a limited extent of organic soils where other disturbances predominate.

Introduction Relieving gastrointestinal (GI) symptoms was identified as a ‘top ten’ priority by our James Lind Alliance Priority Setting Partnership in cystic fibrosis (CF). We conducted an online survey to find out more about the effect of GI symptoms in CF.Methods We co-produced an online survey distributed to the CF community via web-based platforms. The survey consisted of open and closed questions designed to help us learn more about the effects of GI symptoms for people with CF (pwCF). We analysed the data using descriptive statistics and thematic analysis. We promoted the survey via social media and web-based platforms which allowed respondents from any country to take part. Our participants came from the CF community, including: adults and children with CF, parents and close family of pwCF and healthcare professionals (HCPs) working with pwCF.Results There were 276 respondents: 90 (33%) pwCF, 79 (29%) family, 107 (39%) HCPs. The most commonly reported symptoms by lay respondents were stomach cramps/pain, bloating and a ‘combination of symptoms’. The top three symptoms that HCPs said were reported to them were reduced appetite, bloating and constipation. Almost all (94% (85/90)) HCPs thought medications helped to relieve GI symptoms but only 58% (82/141) of lay respondents agreed.Conclusions Our survey has shown that GI symptoms among our participants are prevalent and intrude on daily lives of pwCF. There is a need for well-designed clinical studies to provide better evidence for management of GI symptoms and complications.

Global change may contribute to ecological changes in high-elevation lakes and reservoirs, but a lack of data makes it difficult to evaluate spatiotemporal patterns. Remote sensing imagery can provide more complete records to evaluate whether consistent changes across a broad geographic region are occurring. We used Landsat surface reflectance data to evaluate spatial patterns of contemporary lake color (2010–2020) in 940 lakes in the U.S. Rocky Mountains, a historically understudied area for lake water quality. Intuitively, we found that most of the lakes in the region are blue (66%) and were found in steep-sided watersheds (>22.5°) or alternatively were relatively deep (>4.5 m) with mean annual air temperature (MAAT)