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Abstract Purpose Uncontrolled severe asthma constitutes a major economic burden to society. Add-ons to standard inhaled treatments include inexpensive oral corticosteroids and expensive biologics. Nocturnal treatment with Temperature-controlled Laminar Airflow (TLA; Airsonett®) could be an effective, safe and cheaper alternative. The potential of TLA in reducing severe asthma exacerbations was addressed in a recent randomised placebo-controlled trial (RCT) in patients with severe asthma (Global Initiative for Asthma (GINA) step 4/5), but the results were inconclusive. We re-analysed the RCT with severe exacerbations stratified by the level of baseline asthma symptoms and Quality of Life. Methods More uncontrolled patients, defined by Asthma Control Questionnaire 7 (ACQ7) > 3, EuroQoL 5-Dimension Questionnaire Visual Analogue Scale (EQ5D-VAS) ≤ 65 and Asthma Quality of Life Questionnaire (AQLQ) ≤ 4 were selected for re-analysis. The rates of severe asthma exacerbations, changes in QoL and health-economics were analysed and compared between TLA and placebo. Results The study population included 226 patients (113 TLA / 113 placebo.) The rates of severe asthma exacerbations were reduced by 33, 31 and 25% (p = 0.083, 0.073, 0.180) for TLA compared to placebo, dependent on selected control measures (ACQ7, EQ5D-VAS, AQLQ, respectively). For patients with less control defined by AQLQ≤4, the difference in mean AQLQ0-12M between TLA and placebo was 0.31, 0.33, 0.26 (p = 0.085, 0.034, 0.150), dependent on selected covariate (AQLQ, EQ5D-VAS, ACQ7, respectively). For patients with poor control defined by ACQ7 > 3, the difference in EQ5D-5 L utility scores between TLA and placebo was significant at 9 and 12 months with a cost-effective ICER. The results from the original study did not demonstrate these differences. Conclusion This post hoc analysis demonstrated an effect of TLA over placebo on severe exacerbations, asthma control and health economics in a subgroup of patients with more symptomatic severe allergic asthma. The results are consistent with the present recommendations for TLA. However, these differences were not demonstrated in the full study. Several explanations for the different outcomes have been outlined, which should be addressed in future studies. Funding NIHR Health Technology Assessment Programme and Portsmouth Hospitals NHS Trust.

The approach to stabilizing a quantum state by coupling to engineered reservoirs is limited by a trade-off between state fidelity and stabilization rate. Here the authors implement a protocol based on parametric system-bath coupling to achieve fast and high-fidelity Bell state stabilization in a qutrit-qubit system.

Introduction: Restart a Heart (RSAH) is an annual CPR mass training initiative delivered predominantly by ambulance services in the UK. The aim of this study was to identify to what extent voluntary participation in the 2019 initiative delivered training to the population with the highest need. Methods: A cross-sectional observational study of location characteristics for RSAH training events conducted by UK ambulance services. Descriptive statistics were used to analyse event and area characteristics. National cardiac arrest registry data were used to establish proportions of training coverage in “hot spot” areas with above national median incidence of cardiac arrest and below median bystander CPR rates. The significance of observed differences were tested using chi-square for proportions and t-test for means. Results: Twelve of 14 UK ambulance services participated, training 236,318 people. Most of the events (82%) were held in schools, and schoolchildren comprised most participants (81%). RSAH events were held in areas that were less densely populated (p

Teacher education is at a critical crossroads as colleges and schools of education contend with decreased student enrollment, legislative strategizing to limit what is taught, and general pushback regarding what teachers should learn about teaching and their students. As such, the field of teacher education must examine how to collectively rebuff the current movement by policy makers and elected officials who have formalized their desire to maintain the status quo in education. They continue to lobby against social justice in education, critical race theory, multicultural perspectives in teaching, and culturally responsive and relevant pedagogical approaches to classroom instruction, among others. This paper examines the current moment in educational history and highlights opportunities that may transform teacher education policy to become more justice centered.

Family practitioners come from many walks of life and may include students, provided they are sufficiently prepared or supported through hands-on learning experiences. In this study, we report the outcomes of community different-sex couples who participated in a free, six-week, student-facilitated Marriage Enrichment Workshop between 2015 and 2018, offered over distance via Interactive Video Conferencing. Data from n = 39 individuals (25 couples) indicated positive change during workshop participation regarding negative interaction, commitment, and sexual and emotional intimacy. At six months post-workshop, only change in negative interaction retained significance. No significant results were reported for overall marital satisfaction, and no effects of booster sessions were detected. This workshop showed slight positive gains for couples, a favorable outcome for an experience with dual goals of providing student practice and strengthening couple relationships in the community.

Abstract Pathogenic changes in gut microbial composition precede the onset of HIV-1 infection in men who have sex with men (MSM). This process is associated with increased levels of systemic inflammatory biomarkers and risk for AIDS development. Using mediation analysis framework, in this report we link the effects of unprotected receptive intercourse among MSM prior to primary HIV-1 infection to higher levels of proinflammatory cytokines sCD14 and sCD163 in plasma and a significant decrease in the abundance of A. muciniphila, B. caccae, B. fragilis, B. uniformis, Bacteroides spp., Butyricimonas spp., and Odoribacter spp., and a potential increase in the abundance of Dehalobacterium spp. and Methanobrevibacter spp. in stools of MSM with the highest number of sexual partners. These differences in microbiota, together with a reduction in the pairwise correlations among commensal and short-chain fatty acid-producing bacteria with a number of sexual partners, support an increase in gut dysbiosis with the number of sexual partners. These results demonstrate the interconnectedness of sexual behavior, immune response, and microbiota composition, notably among MSM participating in high-risk sexual behaviors.

Abstract Background An increased risk of diabetes mellitus (DM) after COVID-19 has been reported in the United States, Europe, and Asia. The burden of COVID-related DM has yet to be described in Africa, where the overall risk of DM has been increasing rapidly. Our objective was to compare the prevalence of pre-DM and DM in Nigerian individuals with a history of COVID-19 to individuals without known COVID-19 infection. Methods We undertook a retrospective cohort study with 256 individuals with a past medical history of COVID-19 with no history of pre-DM or DM and 256 individuals without a history of COVID-19 or pre-DM/DM. Participants were categorized as pre-DM (fasting capillary glucose 100–125 mg/dL) or DM (fasting capillary glucose ≥ 126 mg/dL). We employed univariate and multivariable logistic regression to identify key predictors and adjust for confounders related to hyperglycaemia risk factors. Additionally, we used multinomial logistic regression to analyze the relationship between COVID-19 history and diabetes status, distinguishing between normal, pre-diabetic, and diabetic glucose levels. All models were adjusted for age, gender, hypertension, physical activity, central adiposity, and family history of DM. Results Compared to the control group, those with a history of COVID-19 had a similar median age (38 vs. 40 years, p = 0.84), had a higher proportion of men (63% vs. 49%), and had a lower prevalence of central adiposity (waist: hip ratio ≥ 0.90 for males and WHR ≥ 0.85 for females) (48% vs. 56.3%, p = 0.06). Of the 256 with a history of COVID-19, 44 (17%) required in-patient care. The median (interquartile range) time interval between COVID-19 diagnosis and the glycaemic assessment was 19 (IQR: 14, 24) months. Pre-DM prevalence was 27% in the post-COVID-19 group and 4% in the control group, whereas the prevalence of DM was 7% in the post-COVID-19 group and 2% in the control group. After multivariable adjustment, the odds of pre-DM were 8.12 (95% confidence interval (CI): 3.98, 16.58; p

Phenology is the study of periodic biological occurrences and can provide important insights into the influence of climatic variability and change on ecosystems. Understanding Australia's vegetation phenology is a challenge due to its diverse range of ecosystems, from savannas and tropical rainforests to temperate eucalypt woodlands, semi-arid scrublands, and alpine grasslands. These ecosystems exhibit marked differences in seasonal patterns of canopy development and plant life-cycle events, much of which deviates from the predictable seasonal phenological pulse of temperate deciduous and boreal biomes. Many Australian ecosystems are subject to irregular events (i.e. drought, flooding, cyclones, and fire) that can alter ecosystem composition, structure, and functioning just as much as seasonal change. We show how satellite remote sensing and ground-based digital repeat photography (i.e. phenocams) can be used to improve understanding of phenology in Australian ecosystems. First, we examine temporal variation in phenology on the continental scale using the enhanced vegetation index (EVI), calculated from MODerate resolution Imaging Spectroradiometer (MODIS) data. Spatial gradients are revealed, ranging from regions with pronounced seasonality in canopy development (i.e. tropical savannas) to regions where seasonal variation is minimal (i.e. tropical rainforests) or high but irregular (i.e. arid ecosystems). Next, we use time series colour information extracted from phenocam imagery to illustrate a range of phenological signals in four contrasting Australian ecosystems. These include greening and senescing events in tropical savannas and temperate eucalypt understorey, as well as strong seasonal dynamics of individual trees in a seemingly static evergreen rainforest. We also demonstrate how phenology links with ecosystem gross primary productivity (from eddy covariance) and discuss why these processes are linked in some ecosystems but not others. We conclude that phenocams have the potential to greatly improve the current understanding of Australian ecosystems. To facilitate the sharing of this information, we have formed the Australian Phenocam Network (http://phenocam.org.au/).

Pretend play is one of the most beneficial and complex forms of play that promotes a myriad of children's development. Children's engagement in pretend play can be influenced by their genders, age, material or toys available, and adults' support. Pretend play has been long studied globally, however, there is still a dearth of available information about it in the Malaysian context. This study explored 85 young children's engagement in pretend play at home from the perspectives of parents, the differences in engagement based on children's age and gender; and the perceived benefits of pretend play for young children. Children mostly engage in pretend play at home alone, with siblings and their parents. Children as young as 2 years old engaged in from the simplest to the complex form of pretend play. However, no statistical differences were found in pretend play engagement across age and gender groups. Most parents perceive that pretend play is beneficial for children's development especially creativity, imagination, social and communication skills. Results are from a single source and are to be interpreted with caution which can be improved with multiple sources of data collected in future research.

Research Findings: Early elementary school is a crucial time for the development of executive functions, but less is known about the impact of parent-child narratives on executive function development in children of this age group. This study aims to investigate the influence of parental scaffolding styles in parent-child co-constructed narratives in the development of transitional kindergartners' executive function. The sample comprised 35 Hispanic and non-Hispanic parent-child dyads, who were video recorded discussing a past experience at home. Video recordings were transcribed and coded for parental scaffolding strategies. Through principal component analysis, three scaffolding styles were identified: elaborative, eliciting, and echoing. Children's executive function was measured using the pencil tap task. Hierarchical linear regression analysis revealed that parents' echoing scaffolding style was positively and significantly associated with children's executive function outcomes, after controlling for child expressive language, maternal education, and parent dominant narrative languages. Practice or Policy: These findings highlight that the way parents scaffold their children's narratives can have a positive impact on their development of executive function. It also emphasizes the need for educators and practitioners to recognize the role of parent-child language interactions in supporting children's cognitive development, and to collaborate with families to promote positive developmental outcomes.

Abstract Increasing evidence suggests that alternative splicing plays an important role in Alzheimer’s disease (AD) pathology. We used long-read sequencing in combination with a novel bioinformatics tool (FICLE) to profile transcript diversity in the entorhinal cortex of female transgenic (TG) mice harboring a mutant form of human tau. Our analyses revealed hundreds of novel isoforms and identified differentially expressed transcripts – including specific isoforms of Apoe, App, Cd33, Clu, Fyn and Trem2 – associated with the development of tau pathology in TG mice. Subsequent profiling of the human cortex from AD individuals and controls revealed similar patterns of transcript diversity, including the upregulation of the dominant TREM2 isoform in AD paralleling the increased expression of the homologous transcript in TG mice. Our results highlight the importance of differential transcript usage, even in the absence of gene-level expression alterations, as a mechanism underpinning gene regulation in the development of AD neuropathology.

Abstract Background Radiography is commonly used in the assessment of spinal disorders, despite a lack of high-quality evidence demonstrating improved clinical outcomes or additional benefit to the patient. There is disagreement amongst chiropractors regarding the appropriate use of radiography for clinical management. This study aims to qualitatively explore chiropractors’ perceptions on the use of spinal radiographs in clinical practice with respect to how they determine when to order radiographs; and how they use radiographs to inform clinical management. Methods Online qualitative semi-structured interviews were conducted with 17 Australian chiropractors who currently manage patients with spinal disorders. Convienence, snowball, and purposive sampling strategies were used to ensure an appropriate breadth and depth of participant characterisitcs and beliefs. Interview data were recorded, transcribed and analysed using framework analysis. Results Three themes were developed to describe how chiropractors determined when to order radiographs. These themes included specific findings from the clinical encounter that may inform clinical management, their perceptions of radiation risk, and the influence of clinical experience/intuition. Three themes and four subthemes were developed for how chiropractors use radiographs to inform their management. These themes explored the use of radiography for the application of chiropractic technique, as well as the role of radiographs in predicting patient prognosis, and as an educational tool to provide reassurance. Conclusion Australian chiropractors’ decision-making around spinal radiography is diverse and can be influenced by a number of clinical and external factors. Previously unexplored uses of spinal radiography in clinical practice were highlighted. Some chiropractors reported potential benefits of radiography that are currently not supported by research evidence. Future research should address how radiographic findings are reported to patients with spinal disorders and how this could be optimised to improve patient outcomes.

Abstract Tauopathies are characterised by the pathological accumulation of misfolded tau. The emerging view is that toxic tau species drive synaptic dysfunction and potentially tau propagation before measurable neurodegeneration is evident, but the underlying molecular events are not well defined. Human non-mutated 0N4R tau (tauWT) and P301L mutant 0N4R tau (tauP301L) were expressed in mouse primary cortical neurons using adeno-associated viruses to monitor early molecular changes and synaptic function before the onset of neuronal loss. In this model tauP301L was differentially phosphorylated relative to tauwt with a notable increase in phosphorylation at ser262. Affinity purification - mass spectrometry combined with tandem mass tagging was used to quantitatively compare the tauWT and tauP301L interactomes. This revealed an enrichment of tauP301L with ribosomal proteins but a decreased interaction with the proteasome core complex and reduced tauP301L degradation. Differences in the interaction of tauP301L with members of a key synaptic calcium-calmodulin signalling pathway were also identified, most notably, increased association with CaMKII but reduced association with calcineurin and the candidate AD biomarker neurogranin. Decreased association of neurogranin to tauP301L corresponded with the appearance of enhanced levels of extracellular neurogranin suggestive of potential release or leakage from synapses. Finally, analysis of neuronal network activity using micro-electrode arrays showed that overexpression of tauP301L promoted basal hyperexcitability coincident with these changes in the tau interactome and implicating tau in specific early alterations in synaptic function.

One of the purposes of the Cold Regions Hydrological Modelling platform (CRHM) is to diagnose inadequacies in the understanding of the hydrological cycle and its simulation. A physically based hydrological model including a full suite of snow and cold regions hydrology processes as well as warm season, hillslope and groundwater hydrology was developed in CRHM for application in the Marmot Creek Research Basin (~ 9.4 km2), located in the Front Ranges of the Canadian Rocky Mountains. Parameters were selected from digital elevation model, forest, soil, and geological maps, and from the results of many cold regions hydrology studies in the region and elsewhere. Non-calibrated simulations were conducted for six hydrological years during the period 2005–2011 and were compared with detailed field observations of several hydrological cycle components. The results showed good model performance for snow accumulation and snowmelt compared to the field observations for four seasons during the period 2007–2011, with a small bias and normalised root mean square difference (NRMSD) ranging from 40 to 42% for the subalpine conifer forests and from 31 to 67% for the alpine tundra and treeline larch forest environments. Overestimation or underestimation of the peak SWE ranged from 1.6 to 29%. Simulations matched well with the observed unfrozen moisture fluctuation in the top soil layer at a lodgepole pine site during the period 2006–2011, with a NRMSD ranging from 17 to 39%, but with consistent overestimation of 7 to 34%. Evaluations of seasonal streamflow during the period 2006–2011 revealed that the model generally predicted well compared to observations at the basin scale, with a NRMSD of 60% and small model bias (1%), while at the sub-basin scale NRMSDs were larger, ranging from 72 to 76%, though overestimation or underestimation for the cumulative seasonal discharge was within 29%. Timing of discharge was better predicted at the Marmot Creek basin outlet, having a Nash–Sutcliffe efficiency (NSE) of 0.58 compared to the outlets of the sub-basins where NSE ranged from 0.2 to 0.28. The Pearson product-moment correlation coefficient of 0.15 and 0.17 for comparisons between the simulated groundwater storage and observed groundwater level fluctuation at two wells indicate weak but positive correlations. The model results are encouraging for uncalibrated prediction and indicate research priorities to improve simulations of snow accumulation at treeline, groundwater dynamics, and small-scale runoff generation processes in this environment. The study shows that improved hydrological cycle model prediction can be derived from improved hydrological understanding and therefore is a model that can be applied for prediction in ungauged basins.

The Cold Regions Hydrological Modelling platform (CRHM) was used to create a prairie hydrological model for Smith Creek Research Basin (~400 km2), east-central Saskatchewan, Canada. Physically based modules were sequentially linked in CRHM to simulate snow processes, frozen soils, variable contributing area and wetland storage and runoff generation. Five "representative basins" (RBs) were defined and each was divided into seven hydrological response units (HRUs): fallow, stubble, grassland, river channel, open water, woodland, and wetland. Model parameters were estimated using field survey data, LiDAR digital elevation model (DEM), SPOT 5 satellite imageries, stream network and wetland inventory GIS data. Model simulations were conducted for 2007/2008 and 2008/2009. No calibration was performed. The model performance in predicting snowpack, soil moisture and streamflow was evaluated against field observations. Root mean square differences (RMSD) between simulation and observations ranged from 1.7 to 25.2 mm and from 4.3 to 22.4 mm for the simulated snow accumulation in 2007/2008 and 2008/2009, respectively, with higher RMSD in grassland, river channel, and open water HRUs. Spring volumetric soil moisture was reasonably predicted compared to a point observation in a grassland area, with RMSD of 0.011 and 0.009 for 2008 and 2009 simulations, respectively. The model was able to capture the timing and magnitude of peak spring basin discharge, but it underestimated the cumulative volume of basin discharge by 32% and 56% in spring 2008 and 2009, respectively. The results suggest prediction of Canadian Prairie basin snow hydrology is possible with no calibration if physically based models are used with physically meaningful model parameters that are derived from high resolution geospatial data.

Drawing upon numerous field studies and modelling exercises of snow processes, the Cold Regions Hydrological Model (CRHM) was developed to simulate the four season hydrological cycle in cold regions. CRHM includes modules describing radiative, turbulent and conductive energy exchanges to snow in open and forest environments, as well as account for losses from canopy snow sublimation and rain evaporation. Due to the physical-basis and rigorous testing of each module, there is a minimal need for model calibration. To evaluate CRHM, simulations of snow accumulation and melt were compared to observations collected at paired forest and clearing sites of varying latitude, elevation, forest cover density, and climate. Overall, results show that CRHM is capable of characterising the variation in snow accumulation between forest and clearing sites, achieving a model efficiency of 0.51 for simulations at individual sites. Simulations of canopy sublimation losses slightly overestimated observed losses from a weighed cut tree, having a model efficiency of 0.41 for daily losses. Good model performance was demonstrated in simulating energy fluxes to snow at the clearings, but results were degraded from this under forest cover due to errors in simulating sub-canopy net longwave radiation. However, expressed as cumulative energy to snow over the winter, simulated values were 96% and 98% of that observed at the forest and clearing sites, respectively. Overall, the good representation of the substantial variations in mass and energy between forest and clearing sites suggests that CRHM may be useful as an analytical or predictive tool for snow processes in needleleaf forest environments.

Abstract Scope of practice has been defined as the activities that an individual health care practitioner is allowed to undertake within a specific profession. The chiropractic profession in Australia does not currently have a documented scope of practice. Informed discussions around scope of practice are hampered by a paucity of literature in this area. Acknowledging this void in the literature, we chose to investigate the factors that influence scope of practice of the chiropractic profession. A knowledge of the factors will facilitate discussion on the topic and help the profession to work towards establishing a scope of practice. Aim The aim of this study was to identify the factors that influence scope of practice of chiropractic in Australia from the perspective of 4 stakeholder groups within the profession. Methods This study employed semi-structured, online-interviews. Open-ended questions, guided by a flexible interview protocol, and augmented by supplemental questions, probes and comments, were used to gather data on the research question. Data were analysed using reflexive thematic analysis. Results Six factors that influenced scope of practice of chiropractic were identified in this study: education, evidence (research-derived and practice-based), political influence, community expectations, entrepreneurial business models, and geographical location. Conclusion Knowledge of the factors that influence scope of practice of chiropractic in Australia is important for establishing a scope of practice for the profession. This knowledge is also of value to a range of stakeholders including patients, health care providers (within and outside the profession), professional associations, and policymakers.

Abstract Background To assess the outcome of previously untreated patients with perihilar cholangiocarcinoma who present to a cancer referral center with or without pre-existing trans-papillary biliary drainage. Methods Consecutive patients with a diagnosis of perihilar cholangiocarcinoma presenting between January 1, 2013, and December 31, 2017, were identified from a prospective surgical database and by a query of the institutional database. Of 237 patients identified, 106 met inclusion criteria and were reviewed. Clinical information was obtained from the Electronic Medical Record and imaging studies were reviewed in the Picture Archiving and Communication System. Results 73 of 106 patients (69%) presenting with a new diagnosis of perihilar cholangiocarcinoma underwent trans-papillary biliary drainage (65 endoscopic and 8 percutaneous) prior to presentation at our institution. 8 of the 73 patients with trans-papillary biliary drainage (11%) presented with and 5 developed cholangitis; all 13 (18%) required subsequent intervention; none of the patients without trans-papillary biliary drainage presented with or required drainage for cholangitis (p = 0.008). Requiring drainage for cholangitis was more likely to delay treatment (p = 0.012) and portended a poorer median overall survival (13.6 months, 95%CI [4.08, not reached)] vs. 20.6 months, 95%CI [18.34, 37.51] p = 0.043). Conclusion Trans-papillary biliary drainage for perihilar cholangiocarcinoma carries a risk of cholangitis and should be avoided when possible. Clinical and imaging findings of perihilar cholangiocarcinoma should prompt evaluation at a cancer referral center before any intervention. This would mitigate development of cholangitis necessitating additional drainage procedures, delaying treatment and potentially compromising survival.

Abstract Background To illustrate how (standardised) effect sizes (ES) vary based on calculation method and to provide considerations for improved reporting. Methods Data from three trials of tanezumab in subjects with osteoarthritis were analyzed. ES of tanezumab versus comparator for WOMAC Pain (outcome) was defined as least squares difference between means (mixed model for repeated measures analysis) divided by a pooled standard deviation (SD) of outcome scores. Three approaches to computing the SD were evaluated: Baseline (the pooled SD of WOMAC Pain values at baseline [pooled across treatments]); Endpoint (the pooled SD of these values at the time primary endpoints were assessed); and Median (the median pooled SD of these values based on the pooled SDs across available timepoints). Bootstrap analyses were used to compute 95% confidence intervals (CI). Results ES (95% CI) of tanezumab 2.5 mg based on Baseline, Endpoint, and Median SDs in one study were − 0.416 (− 0.796, − 0.060), − 0.195 (− 0.371, − 0.028), and − 0.196 (− 0.373, − 0.028), respectively; negative values indicate pain improvement. This pattern of ES differences (largest with Baseline SD, smallest with Endpoint SD, Median SD similar to Endpoint SD) was consistent across all studies and doses of tanezumab. Conclusion Differences in ES affect interpretation of treatment effect. Therefore, we advocate clearly reporting individual elements of ES in addition to its overall calculation. This is particularly important when ES estimates are used to determine sample sizes for clinical trials, as larger ES will lead to smaller sample sizes and potentially underpowered studies. Trial Registration Clinicaltrials.gov NCT02697773, NCT02709486, and NCT02528188.

Abstract People living with HIV (PLWH) experience increased vulnerability to premature aging and inflammation-associated comorbidities, even when HIV replication is suppressed by antiretroviral therapy (ART). However, the factors associated with this vulnerability remain uncertain. In the general population, alterations in the N-glycans on IgGs trigger inflammation and precede the onset of aging-associated diseases. Here, we investigate the IgG N-glycans in cross-sectional and longitudinal samples from 1214 women and men, living with and without HIV. PLWH exhibit an accelerated accumulation of pro-aging-associated glycan alterations and heightened expression of senescence-associated glycan-degrading enzymes compared to controls. These alterations correlate with elevated markers of inflammation and the severity of comorbidities, potentially preceding the development of such comorbidities. Mechanistically, HIV-specific antibodies glycoengineered with these alterations exhibit a reduced ability to elicit anti-HIV Fc-mediated immune activities. These findings hold potential for the development of biomarkers and tools to identify and prevent premature aging and comorbidities in PLWH.

Abstract Background The management of low back pain (LBP) is highly variable and patients often receive management that is not recommended and/or miss out on recommended care. Clinician knowledge and behaviours are strongly influenced by entry-level clinical training and are commonly cited as barriers to implementing evidence-based management. Currently there are no internationally recognised curriculum standards for the teaching of LBP content to ensure graduating clinicians have the appropriate knowledge and competencies to assess and manage LBP. We formed an international interdisciplinary working group to develop curriculum content standards for the teaching of LBP in entry-level clinical training programs. Methods The working group included representatives from 11 countries: 18 academics and clinicians from healthcare professions who deal with the management of LBP (medicine, physiotherapy, chiropractic, osteopathy, pharmacology, and psychology), seven professional organisation representatives (medicine, physiotherapy, chiropractic, spine societies), and one healthcare consumer. A literature review was performed, including database and hand searches of guidelines and accreditation, curricula, and other policy documents, to identify gaps in current LBP teaching and recommended entry-level knowledge and competencies. The steering group (authors) drafted the initial LBP Curriculum Content Standards (LBP-CCS), which were discussed and modified through two review rounds with the working group. Results Sixty-two documents informed the draft standards. The final LBP-CCS consisted of four broad topics covering the epidemiology, biopsychosocial contributors, assessment, and management of LBP. For each topic, key knowledge and competencies to be achieved by the end of entry-level clinical training were described. Conclusion We have developed the LBP-CCS in consultation with an interdisciplinary, international working group. These standards can be used to inform or benchmark the content of curricula related to LBP in new or existing entry-level clinical training programs.

We describe an RF-photonic system architecture to measure microwave spectrum over a wide bandwidth with high resolution. The approach relies on the up-conversion of the electronic signal to the optical domain using a high-speed electro-optic modulator, and an arrayed-waveguide grating (AWG) for spectral analysis. The modulator is implemented in lithium niobate whereas the AWG takes the form of a photonic integrated circuit fabricated in a silicon-on-insulator material platform. We present experimental results showing high-frequency response, in excess of 200 GHz, for the modulator, and broadband response of the AWG with the free spectral range of 81 GHz. The system is suitable for the measurement of atmospheric radiation between the oxygen and water vapor absorption lines for the monitoring of the planetary boundary layer to aid in weather prediction and the modeling of climate dynamics.

Objective. This study explores the impact of parental oral health knowledge on children’s oral health, investigating if limited knowledge contributes to poor outcomes. The CAMBRA caries risk assessment and the World Health Organization dmft/DMFT index measure oral health. Methods. Over 23 months, the Knowledge Related to Oral Health Literacy (KROHL) questionnaire assesses parental knowledge in 4 domains and 5 oral health conditions. Pearson Correlation Coefficient analyzes the association between KROHL scores and CAMBRA outcomes. Results. Positive correlation emerges between parental oral health knowledge levels and children’s dental caries risk, indicating the KROHL questionnaire’s utility in identifying knowledge gaps. No standardized method for measuring oral health knowledge exists, although various tools claim to address aspects of the issue. This study pioneers the correlation between oral health knowledge and CAMBRA outcomes. Conclusion. The KROHL questionnaire proves a practical, disease-specific tool for research, emphasizing parental oral health knowledge’s pivotal role in children’s oral health. It serves as a valuable means to identify knowledge gaps and potential areas for intervention and education in oral health.

Background/objectives Surgical populations and particularly injury survivors often present with complex trauma that elevates their risk for prolonged opioid use and misuse. Changes in opioid prescribing guidelines during the past several years have yielded mixed results for pain management after trauma, with a limiting factor being the heterogeneity of clinical populations and treatment needs in individuals receiving opioids. The present analysis illuminates this gap between clinical guidelines and clinical practice through qualitative feedback from hospital trauma providers and unit staff members regarding current opioid prescribing guidelines and practices in the setting of traumatic injury.Methods The parent study aimed to implement a pilot screening tool for opioid misuse in four level I and II trauma hospitals throughout Wisconsin. As part of the parent study, focus groups were conducted at each study site to explore the facilitators and barriers of implementing a novel screening tool, as well as to examine the current opioid prescribing guidelines, trainings, and resources available for trauma and acute care providers. Focus group transcripts were independently coded and analyzed using a modified grounded theory approach to identify themes related to the facilitators and barriers of opioid prescribing guidelines in trauma and acute care.Results Three major themes were identified as impactful to opioid-related prescribing and care provided in the setting of traumatic injury; these include (1) acute treatment strategies; (2) patient interactions surrounding pain management; and (3) the multifactorial nature of trauma on pain management approaches.Conclusion Providers and staff at four Wisconsin trauma centers called for trauma-specific opioid prescribing guidelines in the setting of trauma and acute care. The ubiquitous prescription of opioids and challenges in long-term pain management in these settings necessitate additional community-integrated research to inform development of federal guidelines.Level of evidence Therapeutic/care management, level V.

Background: Disparities in diabetes care quality may have increased for patients with limited English language proficiency (LEP) compared to non-LEP patients during the COVID-19 pandemic. Changes in diabetes care quality for adult LEP and non-LEP patients of community health centers (CHCs) were examined from 2019 to 2020. Methods: Adults with Type 2 diabetes (n = 15 965) of 88 CHC sites in California and with 1+ visit/year in 2019 and 2020 from OCHIN electronic health record data were included. Multivariable regression models estimated the association of LEP status and changes in diabetes care quality from 2019 to 2020, controlling for patient sociodemographic and clinical characteristics. Interaction terms (LEP × 2020) were used to estimate differential over time changes in (1) blood pressure screening, (2) blood pressure control (

Cross-sectional studies have linked differences in white matter tissue properties to reading skills. However, past studies have reported a range of, sometimes conflicting, results. Some studies suggest that white matter properties act as individual-level traits predictive of reading skill, whereas others suggest that reading skill and white matter develop as a function of an individual’s educational experience. In the present study, we tested two hypotheses: a) that diffusion properties of the white matter reflect stable brain characteristics that relate to stable individual differences in reading ability or b) that white matter is a dynamic system, linked with learning over time. To answer these questions, we examined the relationship between white matter and reading in a five-year longitudinal dataset and a series of large-scale, single-observation, cross-sectional datasets (N = 14,249 total participants). We find that gains in reading skill correspond to longitudinal changes in the white matter. However, in the cross-sectional datasets, we find no evidence for the hypothesis that individual differences in white matter predict reading skill. These findings highlight the link between dynamic processes in the white matter and learning.

IntroductionAs people age with HIV (PWH), many comorbid diseases are more common than among age matched comparators without HIV (PWoH). While the Veterans Aging Cohort (VACS) Index 2.0 accurately predicts mortality in PWH using age and clinical biomarkers, the only included comorbidity is hepatitis C. We asked whether adding comorbid disease groupings from the Charlson Comorbidity Index (CCI) improves the accuracy of VACS Index.MethodsTo maximize our ability to model mortality among older age groups, we began with PWoH in Veterans Health Administration (VA) from 2007–2017, divided into development and validation samples. Baseline predictors included age, and components of CCI and VACS Index (excluding CD4 count and HIV RNA). Patients were followed until December 31, 2021. We used Cox models to develop the VACS-CCI score and estimated mortality using a parametric (gamma) survival model. We compared accuracy using C-statistics and calibration curves in validation overall and within subgroups (gender, age

IntroductionThe food-energy-water (FEW) nexus highlights the interdependencies between the systems that people rely on for these essential resources. For example, globally, over two thirds of freshwater withdrawals are used to produce food, and another 10% is used during energy generation. In addition, the food system uses one eighth of global net energy. Seafood is a nutritionally important food, and it is critical to use freshwater and energy resources efficiently throughout seafood supply chains to safeguard future supplies and to reduce environmental impacts. Diverse seafood production methods result in highly variable resource use across supply chains, which may contribute to siloed efforts within supply chains to improve efficiency, instead of larger efforts that involve multiple seafood supply chains. Additionally, efforts to develop and implement efficiency strategies must be informed by fishers, aquaculturists, processors, and other seafood supply chain actors to avoid investing time and resources into strategies that will have low uptake. A significant proportion of seafood is imported into the U.S., so engaging with industry and stakeholders in the U.S. and abroad is critical for understanding and improving the FEW nexus associated with seafood consumed by Americans.MethodsTo understand how resources are being used, current and potential strategies to improve resource use, and relevant motivations and barriers, we conducted 47 semi-structured interviews from 2019 to 2021 with seafood supply chain actors, including producers and processors. Seafood supply chains included were farmed catfish produced in the U.S., farmed pangasius and shrimp produced in Vietnam, farmed Atlantic salmon produced in Norway, and wild-caught sockeye and pink salmon caught in the U.S.ResultsWe provide detailed descriptions of stages within each supply chain regarding resource use and efficiency strategies, and report higher-level findings that apply across supply chains. There was variation across settings regarding how resources are used and opportunities and barriers for improving efficiencies, but we also found commonalities in settings, indicating that resource-saving strategies or innovations could lead to increased efficiency across multiple supply chains. Interviewees shared that cost savings drove past adoption of, and high interest in, energy conservation practices. Generally, direct costs did not motivate reduced use of freshwater, but associated costs like energy to run pumps and supplies to treat contaminated surface water drove interest in reducing water use.DiscussionEfforts to improve resource use in the U.S. seafood supply should focus on identifying and scaling-up strategies that (i) involve improved efficiency of more than one resource and/or (ii) apply across multiple settings. This work should involve partnerships between industry, government agencies, and academic researchers, and should be informed by supply chain actors’ experiences and insights. The qualitative insights from this study encompass rich descriptions of FEW-relevant factors at the level of specific supply chain stages as well as findings across six major seafood supply chains in three countries. The study provides an essential complement to existing quantitative characterizations of resource use, and enables nuanced and informed responses to challenges.

Abstract Back‐to‐back marine heatwaves in 2016 and 2017 resulted in severe coral bleaching and mortality across the Great Barrier Reef (GBR). Encouragingly, some corals that survived these events exhibit increased bleaching resistance and may represent thermally tolerant populations that can better cope with ocean warming. Using the GBR as a natural laboratory, we investigated whether a history of minimal (Heron Island) or severe (Lizard Island) coral bleaching in 2016 and 2017 equates to stress tolerance in a successive heatwave (2020). We examined the genetic diversity, physiological performance, and trophic plasticity of juvenile (25 cm) corals of two common genera (Pocillopora and Stylophora). Despite enduring greater cumulative heat stress (6.3°C week−1 vs. 5.6°C week−1), corals that experienced the third marine heatwave in 5 years (Lizard) exhibited twice as high survival and visual bleaching thresholds compared to corals that had not experienced significant bleaching in >10 years (Heron). Surprisingly, only one shared host–Symbiodiniaceae association was uncovered between locations (Stylophora pistillata–Cladocopium “C8 group”) and there was no genetic overlap in Pocillopora–Cladocopium partnerships, suggesting turnover in species composition from recent marine heatwaves. Corals within the species complex Pocillopora that survived the 2016 and 2017 marine heatwaves at Lizard Island were the most resilient, exhibiting three times greater calcification rates than conspecifics at Heron Island. Further, surviving corals (Lizard) had distinct isotopic niches, lower host carbon, and greater host protein, while conspecifics that had not experienced recent bleaching (Heron) had two times greater symbiont carbon content, suggesting divergent trophic strategies that influenced survival (i.e., greater reliance on heterotrophy vs. symbiont autotrophy, respectively). Ultimately, while corals may experience less bleaching and survive repeated thermal stress events, species‐specific trade‐offs do occur, leaving open many questions related to the long‐term health and recovery of coral reef ecosystems in the face of intensifying marine heatwaves.

With the emergence of data technologies and algorithms in Aotearoa New Zealand that are used for decision-making and support, there is a need for frameworks to guide how we maximise the opportunities these technologies create and minimise the risks they may impose. For algorithms that use Māori data, these require extra considerations due to the heightened risks Māori endure due to systemic biases inherent within data and the processes that underlie algorithm development. Algorithms can be framed as a particular use of data, therefore data frameworks that currently exist can be extended to include algorithms. Māori data sovereignty principles are well-known and are used by researchers and government agencies to guide the culturally appropriate use of Māori data. Extending these principles to fit the context of algorithms, and re-working the underlying sub-principles to address issues related to responsible algorithms from a Māori perspective leads to the Māori algorithmic sovereignty principles. We define this idea, present the updated principles and sub-principles, and highlight a strategy for the detection and minimisation of bias within the algorithm development process.

The objective of this study is to cross-validate observations over precipitating systems by microwave radiometers on the temporal experiment for storms and tropical systems demonstration (TEMPEST-D) CubeSat mission and the global precipitation measurement microwave imager (GMI). The purpose of this article is twofold: first, to show consistency between TEMPEST-D and GMI observations, and second, to demonstrate the potential to enhance temporal sampling when TEMPEST-D and GMI observations are merged. Two cross-validation methodologies were employed. The first cross-validation methodology is to quantitatively compare TEMPEST-D and GMI brightness temperature (TB) observations over precipitation systems using a priori spatiotemporal constraints. The comparative analysis showed that the two instruments’ TB observations have similar probability distributions, with a mean absolute difference of 2.9 K. The second cross-validation methodology is to quantitatively compare TEMPEST-D and GMI TB observations over tropical cyclone systems. Three storm cases were analyzed in this comparative study. The analysis showed that the structure and intensity of the storms are similar in TEMPEST-D and GMI TB observations, and the overall average correlation coefficient (r) is 0.9. Combining TEMPEST-D and GMI TB observations over the hurricane systems increased the sampling frequency by a factor of 2.5, compared to using the GMI data alone.