Aspects of acceptance: building a shared conceptual understanding.

Many contemplatives, scientists, and clinicians have pointed to the value of responding to life's difficulties by accepting experiences as they are. A growing body of research also suggests that acceptance contributes to effective coping with adversity, reduced stress, and improved emotional well-being. Yet within the scientific literature, there is little consensus on what acceptance means or how it should be measured. This makes it nearly impossible to synthesize empirical work on acceptance into a cohesive scientific understanding. Our goal in this paper is to clarify four facets of acceptance that are commonly referenced in research: acknowledging, allowing, non-judging, and non-attachment. We do not propose a specific definition of acceptance or even a set of privileged facets that must be included in future frameworks. We instead offer a vocabulary to facilitate productive communication among researchers that will, in turn, enable a more definitive scientific understanding of this important construct to emerge. After defining and explaining these aspects of acceptance, we further clarify these constructs in two ways. First, we illustrate how the four aspects are dissociable from one another. Second, we analyze their correspondence to related constructs from Acceptance and Commitment Therapy (ACT). Finally, we provide a concept worksheet that scholars can utilize to precisely operationalize acceptance in their own work.

Sex-dependent niche responses modulate steady-state and regenerative hematopoiesis.

Hematopoietic stem cells (HSCs) adapt to organismal blood production needs by balancing self-renewal and differentiation, adjusting to physiological demands and external stimuli. Although sex differences have been implicated in differential hematopoietic function in males versus females, the mediators responsible for these effects require further study. Here, we characterized hematopoiesis at a steady state and during regeneration following hematopoietic stem cell transplantation (HST). RNA sequencing of lineage(-) bone marrow cells from C57/Bl6 mice revealed a broad transcriptional similarity between the sexes. However, we identified distinct sex differences in key biological pathways, with female cells showing reduced expression of signatures involved in inflammation and enrichment of genes related to glycolysis, hypoxia, and cell cycle regulation, suggesting a more quiescent and less inflammatory profile compared with male cells. To determine the functional impacts of the observed transcriptomic differences, we performed sex-matched and mismatched transplantation studies of lineage(-) donor cells. During short-term 56-day HST recovery, we found a male donor cell proliferative advantage, coinciding with elevated serum TNF-α, and a male recipient engraftment advantage, coinciding with increased serum CXCL12. Together, we show that sex-specific cell responses, marked by differing expression of pathways regulating metabolism, hypoxia, and inflammation, shape normal and regenerative hematopoiesis, with implications for the clinical understanding of hematopoietic function.

Default mode network electrophysiological dynamics and causal role in creative thinking.

The default mode network (DMN) is a widely distributed, intrinsic brain network thought to play a crucial role in internally-directed cognition. The present study employs stereo-electroencephalography in 13 human patients, obtaining high resolution neural recordings across multiple canonical DMN regions during two processes that have been associated with creative thinking: spontaneous and divergent thought. We probe these two DMN-associated higher cognitive functions through mind wandering and alternate uses tasks, respectively. Our results reveal DMN recruitment during both tasks, as well as a task-specific dissociation in spatiotemporal response dynamics. When compared to the fronto-parietal network, DMN activity was characterized by a stronger increase in gamma band power (30-70 Hz) coupled with lower theta band power (4-8 Hz). The difference in activity between the two networks was especially strong during the mind wandering task. Within the DMN, we found that the tasks showed different dynamics, with the alternate uses task engaging the DMN more during the initial stage of the task, and mind wandering in the later stage. Gamma power changes were mainly driven by lateral DMN sites, while theta power displayed task-specific effects. During alternate uses task, theta changes did not show spatial differences within the DMN, while mind wandering was associated to an early lateral and late dorsomedial DMN engagement. Furthermore, causal manipulations of DMN regions using direct cortical stimulation preferentially decreased the originality of responses in the alternative uses task, without affecting fluency or mind wandering. Our results suggest that DMN activity is flexibly modulated as a function of specific cognitive processes and supports its causal role in divergent thinking. These findings shed light on the neural constructs supporting different forms of cognition and provide causal evidence for the role of DMN in the generation of original connections among concepts.

Gender and cultural differences in the development of reciprocity in young children.

A foundational mechanism underlying human cooperation is reciprocity. In the context of repeated interactions with others, it is not always clear the degree to which in-kind responses reflect responsiveness to partners' prior behaviors ("reactive" responses), an interest unrelated to the partner ("nonreactive" responses), or any combination of the two. To disentangle these two types of responses, we presented children with sequential, one-shot, and costly interactions between themselves and either egalitarian or selfish peers. Study 1 tested direct, generalized, and normative reciprocal scenarios (N = 144 seven-year-old German children; 50% girls and 50% boys), finding that "nonreactive" responses were dominant for boys and manifested in the form of "selfish" resource distribution. Among girls, "reactive" responses were dominant and manifested in the form of in-kind resource distribution. Study 2 addressed even younger German children (N = 144; 4- to 8-year-old German children; 50% girls and 50% boys), exposing the same phenomenon among 4-year-olds, but not among 5.5-year-olds. Study 3 addressed 7-year-old Israeli children (N = 95; 49% girls and 51% boys), and replicated the basic phenomenon, with an additional cultural variation. The early emergence of gender differences in reciprocity and implications are discussed in cultural, socio-developmental, and evolutionary accounts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Order and timing of infection with different parasite life stages impacts host and parasite life histories.

Co-exposure to multiple parasites can alter parasite success and host life history when compared to single infections. These infection outcomes can be affected by the order of parasite arrival, the host immune response, and the interspecific interactions among co-infecting parasites. In this study, we examined how the arrival order of two trematode parasites, Schistosoma mansoni and Echinostoma caproni, influenced parasite ecology and the life history of their snail host, Biomphalaria glabrata. Snail hosts were exposed to E. caproni cercariae before, with, and after their exposure to S. mansoni miracidia. We then measured the effects of this timing on infection prevalence, infection intensity of E. caproni metacercariae, and cercarial output of S. mansoni, as well as on snail reproduction and survival. Snails infected only with S. mansoni and snails exposed to E. caproni after S. mansoni both shed more cercariae than simultaneously exposed snails. Additionally, S. mansoni prevalence was lower in snails that were first exposed to E. caproni compared to snails that were exposed to E. caproni after S. mansoni. Moreover, snails exposed to E. caproni before S. mansoni did not differ in their survival compared to control snails, whereas simultaneously exposed snails and snails exposed to E. caproni after S. mansoni had lower survival than control snails. Combined, this prevalence and survival data suggest a potential protective role of early E. caproni exposure. The timing of E. caproni exposure impacts S. mansoni establishment and reproduction, but host survival patterns are likely driven by S. mansoni prevalence alone.

Mechanistic Investigation, Wavelength-Dependent Reactivity, and Expanded Reactivity of N-Aryl Azacycle Photomediated Ring Contractions.

Under mild blue-light irradiation, α-acylated saturated heterocycles undergo a photomediated one-atom ring contraction that extrudes a heteroatom from the cyclic core. However, for nitrogenous heterocycles, this powerful skeletal edit has been limited to substrates bearing electron-withdrawing substituents on nitrogen. Moreover, the mechanism and wavelength-dependent efficiency of this transformation have remained unclear. In this work, we increased the electron richness of nitrogen in saturated azacycles to improve light absorption and strengthen critical intramolecular hydrogen bonding while enabling the direct installation of the photoreactive handle. As a result, a broadly expanded substrate scope, including underexplored electron-rich substrates and previously unsuccessful heterocycles, has now been achieved. The significantly improved yields and diastereoselectivities have facilitated reaction rate, kinetic isotope effect (KIE), and quenching studies, in addition to the determination of quantum yields. Guided by these studies, we propose a revised ET/PT mechanism for the ring contraction, which is additionally corroborated by computational characterization of the lowest-energy excited states of α-acylated substrates through time-dependent DFT. The efficiency of the ring contraction at wavelengths longer than those strongly absorbed by the substrates was investigated through wavelength-dependent rate measurements, which revealed a red shift of the photochemical action plot relative to substrate absorbance. The elucidated mechanistic and photophysical details effectively rationalize empirical observations, including additive effects, that were previously poorly understood. Our findings not only demonstrate enhanced synthetic utility of the photomediated ring contraction and shed light on mechanistic details but may also offer valuable guidance for understanding wavelength-dependent reactivity for related photochemical systems.

A solid-state high harmonic generation spectrometer with cryogenic cooling.

Solid-state high harmonic generation (sHHG) spectroscopy is a promising technique for studying electronic structure, symmetry, and dynamics in condensed matter systems. Here, we report on the implementation of an advanced sHHG spectrometer based on a vacuum chamber and closed-cycle helium cryostat. Using an in situ temperature probe, it is demonstrated that the sample interaction region retains cryogenic temperature during the application of high-intensity femtosecond laser pulses that generate high harmonics. The presented implementation opens the door for temperature-dependent sHHG measurements down to a few Kelvin, which makes sHHG spectroscopy a new tool for studying phases of matter that emerge at low temperatures, which is particularly interesting for highly correlated materials.

Comparison of firocoxib and meloxicam for pain mitigation in goats undergoing surgical castration.

OBJECTIVE: This study sought to determine whether firocoxib (FIRO) or meloxicam (MEL) was effective at providing analgesia after surgical castration in goats. ANIMALS: 18 intact male crossbred goats (6 to 8 months old) were enrolled with a mean weight of 32.6 (± 2.9) kg. METHODS: Surgical castration was done under injectable anesthesia by a licensed veterinarian. Twelve bucks were surgically castrated and given either FIRO (n = 6) or MEL (n = 6). Six bucks served as controls (CNTLs) and were not castrated. Outcome measurements included visual analogue scale, infrared thermography, plasma cortisol, plasma substance P, and kinetic gait analysis. All outcome measurements were obtained at -24, 4, 8, 24, 48, and 72 hours. RESULTS: All 3 treatments were significantly different from each other at the 24- and 48-hour time points, with MEL animals having lower visual analogue scale scores when compared to FIRO animals; CNTL animals exhibited the lowest plasma cortisol levels (3.19 ng/mL; 95% CI, -1.21 to 7.59 ng/mL) followed by FIRO (7.45 ng/mL; 95% CI, 3.10 to 11.80 ng/mL) and MEL (10.24 ng/mL; 95% CI, 5.87 to 14.60 ng/mL). FIRO had an average mean decrease in gait velocity change (-54.17 cm/s; 95% CI, -92.99 to -15.35 cm/s), while MEL had an increase in gait velocity when compared to baseline values (14.54 cm/s; 95% CI, -24.27 to 53.36 cm/s). Control animals had an average mean of -3.06 cm/s (95% CI, -41.88 to 35.75 cm/s). CLINICAL RELEVANCE: Results from this study showed that there were some analgesic effects from administering MEL when compared to bucks that received a placebo treatment (CNTL).

A novel conjugative transposon carrying an autonomously amplified plasmid.

Tetracyclines serve as broad-spectrum antibiotics to treat bacterial infections. The discovery of new tetracycline resistance genes has led to new questions about the underlying mechanisms of resistance, gene transfer, and their relevance to human health. We tracked changes in the abundance of a 55-kbp conjugative transposon (CTn214) carrying tetQ, a tetracycline resistance gene, within a Bacteroides fragilis metagenome-assembled genome derived from shotgun sequencing of microbial DNA extracted from the ileal pouch of a patient with ulcerative colitis. The mapping of metagenomic reads to CTn214 revealed the multi-copy nature of a 17,044-nt region containing tetQ in samples collected during inflammation and uninflamed visits. B. fragilis cultivars isolated from the same patient during periods of inflammation harbored CTn214 integrated into the chromosome or both a circular, multi-copy, extrachromosomal region of the CTn214 containing tetQ and the corresponding integrated form. The tetracycline-dependent mechanism for the transmission of CTn214 is nearly identical to a common conjugative transposon found in the genome of B. fragilis (CTnDOT), but the autonomously amplified nature of a circular 17,044-nt region of CTn214 that codes for tetQ and the integration of the same sequence in the linear chromosome within the same cell is a novel observation. Genome and transcriptome sequencing of B. fragilis cultivars grown under different concentrations of tetracycline and ciprofloxacin indicates that tetQ in strains containing the circular form remains actively expressed regardless of treatment, while the expression of tetQ in strains containing the linear form increases only in the presence of tetracycline.IMPORTANCEThe exchange of antibiotic production and resistance genes between microorganisms can lead to the emergence of new pathogens. In this study, short-read mapping of metagenomic samples taken over time from the illeal pouch of a patient with ulcerative colitis to a Bacteroides fragilis metagenome-assembled genome revealed two distinct genomic arrangements of a novel conjugative transposon, CTn214, that encodes tetracycline resistance. The autonomous amplification of a plasmid-like circular form from CTn214 that includes tetQ potentially provides consistent ribosome protection against tetracycline. This mode of antibiotic resistance offers a novel mechanism for understanding the emergence of pathobionts like B. fragilis and their persistence for extended periods of time in patients with inflammatory bowel disease.

Interconception care during well-child visits by family physicians in the United States: A cross-sectional study.

Background: Interconception care (ICC) by family physicians during well-child visits (WCVs) has been broadly advocated in principle but has not been widely implemented. We aimed to investigate ICC at WCVs by family physicians at our facility, focusing on four maternal risk factors, including maternal tobacco use, maternal depression, contraception, and folic acid supplementation. Methods: Mothers who visited WCVs with children up to the age of 24 months at our university-affiliated clinic were screened for the four maternal risks. Brief interventions were provided to mothers with positive screening results. We investigated mothers at WCVs from December 1, 2020, to November 30, 2022. We performed descriptive and binary logistic regression analyses to determine the maternal demographic factors associated with positive screenings. Results: Of 1143 WCVs, 205 mothers were evaluated. Screening was positive in the following rates: tobacco use 5.9%, depression 11.5%, contraception 73.6%, and folic acid supplementation 40.5%. Single marital status was associated with positive screening for smoking (odds ratio [OR] 8.689, p = 0.016) and maternal depression (OR 3.470, p = 0.035). Maternal education level lower than a high school diploma was associated with positive screening for folic acid intake (OR 4.975, p = 0.004). Conclusions: ICC conducted during WCVs by family physicians offers valuable opportunities to identify maternal risk factors and address modifiable factors that can influence future birth outcomes. Single marital status and educational level less than a high school diploma were more potent risk factors for maternal behavior in ICC. More research is needed to assess the outcomes of the interventions.

Virtual Interviews During COVID-19 Changed Neurosurgery Match-for Better or Worse.

OBJECTIVE: The COVID-19 pandemic forced neurosurgery residency application processes to adopt a virtual interview model. This study analyzes the trends in program and applicant residency match behavior due to virtual interviews. METHODS: National Resident Matching Program data from Main Residency Match, National Resident Matching Program Director and Applicant Survey, Electronic Residency Application Service, and Charting Outcomes in the Match were collected for neurosurgery residents for all available years, providing information on neurosurgery residency application, interview, and match outcomes. Studied years were dichotomized to account for virtual versus in-person interviews and analyzed for differences. RESULTS: Although the average number of applications received during in-person versus virtual years was not statistically different, 245 versus 290 (P = 0.115), programs interviewed more applicants when interviews were virtual, 37.2 versus 46, (P = 0.008). Similarly, matched U.S. senior applicants did not submit a statistically higher number of applications in person versus virtual, 54 versus 77 (P = 0.055), but they did attend more interviews virtually, 20.5 versus 16.6 (P = 0.013), and ranked more programs, 20 versus 16.2 (P = 0.002). Although White applicants did not have a statistically significant difference in number of applications submitted (55 vs. 68, P = 0.129), Black applicants submitted more applications during virtual match compared with in-person match (52 vs. 74, P = 0.012). The number of applicants that programs needed to rank to fill each position was not statistically different when comparing in-person versus virtually conducted interviews, 4.6 versus 5.4 (P = 0.070). CONCLUSIONS: Despite no change in the overall number of applications submitted per applicant, Black applicants submitted more applications virtually, suggesting potential benefits of virtual format for Black applicants. Interview format was strongly correlated to the use of perceived fitness by applicants in rank decision making. Virtual interviews provide major financial advantages to candidates and could help improve Black representation in neurosurgery. However, they impose limitations on ability access fitness.

Baby food pouches and Baby-Led Weaning: Associations with energy intake, eating behaviour and infant weight status.

Although concern is frequently expressed regarding the potential impact of baby food pouch use and Baby-Led Weaning (BLW) on infant health, research is scarce. Data on pouch use, BLW, energy intake, eating behaviour and body mass index (BMI) were obtained for 625 infants aged 7-10 months in the First Foods New Zealand study. Frequent pouch use was defined as ≥5 times/week during the past month. Traditional spoon-feeding (TSF), "partial" BLW and "full" BLW referred to the relative proportions of spoon-feeding versus infant self-feeding, assessed at 6 months (retrospectively) and current age. Daily energy intake was determined using two 24-h dietary recalls, and caregivers reported on a variety of eating behaviours. Researchers measured infant length and weight, and BMI z-scores were calculated (World Health Organization Child Growth Standards). In total, 28% of infants consumed food from pouches frequently. Frequent pouch use was not significantly related to BMI z-score (mean difference, 0.09; 95% CI -0.09, 0.27) or energy intake (92 kJ/day; -19, 202), but was associated with greater food responsiveness (standardised mean difference, 0.3; 95% CI 0.1, 0.4), food fussiness (0.3; 0.1, 0.4) and selective/restrictive eating (0.3; 0.2, 0.5). Compared to TSF, full BLW was associated with greater daily energy intake (BLW at 6 months: mean difference 150 kJ/day; 95% CI 4, 297; BLW at current age: 180 kJ/day; 62, 299) and with a range of eating behaviours, including greater satiety responsiveness, but not BMI z-score (6 months: 0.06 (-0.18, 0.30); current age: 0.06 (-0.13, 0.26)). In conclusion, neither feeding approach was associated with weight in infants, despite BLW being associated with greater energy intake compared with TSF. However, infants who consumed pouches frequently displayed higher food fussiness and more selective eating.

Catechin Composition, Phenolic Content, and Antioxidant Properties of Commercially-Available Bagged, Gunpowder, and Matcha Green Teas.

The leaves of the Camellia sinensis plant are used to produce many different types of teas, and green tea is particularly noted for its health promoting properties which are attributed to high concentrations of phenolic compounds known as catechins. Green tea is available in forms such as bagged, gunpowder (rolled leaf), and matcha, a fine powder. This study evaluated the phenolic content, catechin composition, caffeine concentration, and antioxidant properties of fifteen commercially-available green teas with an emphasis on identifying differences between ceremonial and culinary matcha. Gunpowder and bagged green teas had higher total phenolic contents and greater CUPRAC (cupric ion reducing antioxidant capacity) and ORAC (oxygen radical absorbance capacity) antioxidant capacities than matcha teas. Among matcha samples, less expensive culinary teas had greater total phenolic contents and higher antioxidant capacities than ceremonial products. Hierarchical cluster analysis was used to determine similarities and differences in catechin composition and revealed that bagged and gunpowder green teas had the highest levels of the stereoisomers epi/catechin gallate, which correlated with their strong antioxidant properties. Bagged and gunpowder teas were the lowest cost products in this study, indicating that they are an economical choice for consumers who want a green tea beverage with high catechin content, although they generally had lower caffeine levels than matcha.

Exposing the Care Conundrum of Low-Energy Pelvic Ring Fractures in Older Adults: A Review of 322 Patients.

Introduction: A care conundrum for low-energy pelvic ring fracture patients in which they face financial burden after not qualifying for an inpatient stay of 3 days or more has been noted in the literature. The purpose of this study was to identify factors that lead to inpatient length of stay (IP LOS) ≥3 days in older adults with nonoperative pelvic ring fragility fractures and to highlight the challenging financial decision-making of those with IP LOS <3 days in the context of the Medicare 3-day rule. Methods: This was a retrospective review of 322 patients aged ≥65 presenting from March 2016 and February 2019 to either of 2 emergency departments (EDs) after a ground-level fall resulting in a pelvic ring fracture. Patient demographic, IP LOS, and mortality data were extracted. Case management notes were analyzed to summarize financial decision-making for patients with IP LOS <3 days. Multivariate logistic regression analysis was conducted to identify factors that predicted IP LOS ≥3 days and mortality. Results: IP LOS ≥3 days was associated with presentation to level I hospital (OR .30 [.19, 0.50]) and being single (OR 2.50 [1.10, 5.68]). 70.3% required a post-acute skilled nursing facility (SNF) stay. Of patients with LOS <3 days, 25.0% were financially responsible for their SNF stay, while 7.9% elected home care due to financial reasons. Overall 30-day, 90-day, and 1-year mortality were 2.5%, 8.1%, and 20.8%, respectively. For patients with LOS <3 days, returning to assisted living compared to discharging to a SNF increased 90-day mortality risk (HR 8.529, P = .0451). Having Medicare trended towards increased 90-day mortality risk compared to commercial insurance (HR 4.556, P = .0544). Conclusion: The current system is failing older adult patients who sustain nonoperative low-energy pelvic ring fractures in terms of financial coverage of necessary post-acute treatment. This care conundrum has yet to be solved.

Optimal lameness induction model development using amphotericin B in meat goats.

Lameness continues to be a critical health and welfare concern associated with goat production. Amphotericin B (amp B) is an antimicrobial successful in inducing transient lameness for research purposes previously in livestock animals. The objectives of this study were to (1) identify which of three varying doses of amp B would be most effective in inducing lameness in meat type goats and (2) develop a facial grimace scale for goats. Lameness was produced by an intra-articular injection of amphotericin B into the left hind lateral claw distal interphalangeal joint with either a 5 mg/0.25 mL (high-low, 5 mg of amphotericin B in a volume of 0.25 mL), 5 mg/0.5 mL (high-high, 5 mg of amphotericin B in a volume of 0.5 mL), or a 2.5 mg/0.25 mL (low-low, 2.5 mg of amphotericin B in a volume of 0.25 mL). A saline treatment of 0.5 mL was used as control (0.9% sterile saline solution). Lameness response was analyzed by infrared thermography (IRT) at the induced joint, mechanical-nociception threshold (MNT), visual lameness scoring (VLS), a visual analogue scale (VAS), kinetic gait analysis (KGA), plasma cortisol (CORT), substance P (Sub P), and behavior scoring. The IRT and MNT values differed by timepoint (P ≤ 0.0001). Results from VLS showed the HL treatment was the most effective at inducing lameness (6/6 goats became lame compared to HH 4/6 and LL 2/6). At 24, 48, and 72 h, VAS scores were significantly higher when comparing HL to all other treatment groups (P = 0.0003). Both behavior observers (1 and 2) reported a significant time effect (P = 0.05), with goats exhibiting more facial grimacing at 24 h post-lameness induction. From these data, an optimal dose for a repeatable lameness induction model in goats was aquired. An effective Goat Grimace Scale (GGS) was also developed to evaluate pain responses in goats.

Neurosurgery Resident Attrition Rates Defy Trends and Decrease During COVID-19 Pandemic.

OBJECTIVE: We sought to determine the effects of the coronavirus disease 2019 (COVID-19) pandemic on U.S. neurosurgery resident attrition. We report the changes in resident attrition due to transfers, withdrawal, or dismissal from program training during the COVID-19 pandemic. METHODS: Neurosurgery resident attrition data reported by the American Council of Graduate Medical Education for the academic year starting in July 2007 to the academic year ending in June 2022 were collected, and the rate of attrition was calculated. Individual postgraduate year program transfer rates were also calculated for the previous 7 consecutive academic years. The attrition rates for the academic years before the pandemic were compared with those during the pandemic. RESULTS: A total of 465 residents did not graduate from neurosurgical training during the past 15 academic years, of which 3 years were at least partially during the COVID-19 pandemic, resulting in a mean attrition rate of 2.5%. The attrition rates during the pandemic were lower than those before the pandemic (1.7% vs. 2.7%; P < 0.001), driven largely by a nearly twofold decrease in the withdrawal rate (0.67% vs. 1.2%; P = 0.003). Bivariate regression between the withdrawal and attrition rates showed a statistically significant correlation (r = 0.809; P < 0.001; r2 = 0.654). The first full year of the COVID-19 pandemic saw the most dramatic changes, with a z score for attrition of -1.9. Linear regression of the effect of training during the COVID-19 pandemic on attrition revealed a statistically significant difference (r = 0.563; P = 0.029; r2 = 0.317). The rate of withdrawal was most affected by training during the pandemic (r = 0.594; P = 0.010; r2 = 0.353). CONCLUSIONS: A statistically significant decline occurred in the rate of neurosurgery resident attrition during the COVID-19 pandemic that was most notable during the first full academic year (2020-2021). These findings were largely driven by a decrease in residents withdrawing from training programs. This contrasts with the overall trend toward resignation among healthcare workers during the pandemic. It is unclear what enduring ramifications this will have on neurosurgery residencies moving forward and whether we will see higher attrition rates as we transition toward a new normal. Future studies should examine trends in the attrition rates after the COVID-19 pandemic and determine the long-term effects of decreased attrition rates of residents during the pandemic.

Infraclavicular de novo placement of a responsive neurostimulator for a patient with eloquent glioma-associated epilepsy: illustrative case.

BACKGROUND: The authors present a 50-year-old female with high-grade glioma involving the motor cortex as the cause of her drug-resistant epilepsy (DRE). Responsive neurostimulation (RNS) was chosen for epilepsy treatment. Due to concerns regarding the generator impeding the regular imaging surveillance required for treatment and monitoring of her glioma, surgeons placed the internal pulse generator (IPG) within an infraclavicular chest pocket. OBSERVATIONS: Implantation of the RNS device and IPG within the infraclavicular pocket was uneventful. However, both subdural and depth electrodes were used and connected to the IPG, and subdural electrodes are considerably shorter than depth electrodes (37 vs 44 cm). The shorter strip leads presumably generated significant tension, leading to fracture of the leads. Therefore, surgery was repeated using only depth electrodes for more length and less tension. The device has good-quality electrocorticography signals that continue to be used for device programming. The seizure burden was reduced, and quality of life improved for the patient. LESSONS: The RNS system with infraclavicular IPG placement reduced the seizure burden and improved the quality of life of a patient with glioma-associated epilepsy. Surgeons may consider the infraclavicular location as an alternative site for implantation for RNS candidates who require recurrent intracranial magnetic resonance imaging.

New diagnostics for the spectrum of asymptomatic TB: from infection to subclinical disease.

TB remains a leading cause of morbidity and mortality worldwide. However, most infected immunocompetent individuals are asymptomatic and only 5-10% of these will eventually develop active TB during their lifetime (typically within 2 years after exposure). Therefore, rapid diagnosis and efficient management of asymptomatic infected individuals who are at the highest risk of progression and transmission remain major clinical and public health challenges. In recent years, there has been important scientific progress in our understanding of the spectrum of asymptomatic Mycobacterium tuberculosis (Mtb) infections that not only includes the dynamic state of latent TB infection (LTBI), but also the preclinical state of incipient and subclinical TB. The latter is possibly as prevalent as symptomatically active TB and potentially contributes to global Mtb transmission in various settings. We summarize the latest developments and current challenges of the existing testing tools for LTBI and describe promising biomarkers and diagnostics for the spectrum of asymptomatic TB. Following the negative results of a recent clinical trial for a biomarker-guided preventive therapy approach, we also suggest some treatment options for incipient TB.

Apes reciprocate food positively and negatively.

Reciprocal food exchange is widespread in human societies but not among great apes, who may view food mainly as a target for competition. Understanding the similarities and differences between great apes' and humans' willingness to exchange food is important for our models regarding the origins of uniquely human forms of cooperation. Here, we demonstrate in-kind food exchanges in experimental settings with great apes for the first time. The initial sample consisted of 13 chimpanzees and 5 bonobos in the control phases, and the test phases included 10 chimpanzees and 2 bonobos, compared with a sample of 48 human children aged 4 years. First, we replicated prior findings showing no spontaneous food exchanges in great apes. Second, we discovered that when apes believe that conspecifics have 'intentionally' transferred food to them, positive reciprocal food exchanges (food-for-food) are not only possible but reach the same levels as in young children (approx. 75-80%). Third, we found that great apes engage in negative reciprocal food exchanges (no-food for no-food) but to a lower extent than children. This provides evidence for reciprocal food exchange in great apes in experimental settings and suggests that while a potential mechanism of fostering cooperation (via positive reciprocal exchanges) may be shared across species, a stabilizing mechanism (via negative reciprocity) is not.