Primary Care Providers' Experiences Recommending and Performing Cervical Cancer Screening for Women with Intellectual Disabilities: A Qualitative Study.

Women with intellectual and developmental disabilities (I/DD) are less likely to receive cervical cancer screening (CCS) relative to women without disabilities. Primary care providers (PCPs) play key roles in recommending CCS. The purpose of this study was to identify factors PCPs consider when recommending and performing CCS for women with I/DD. Using a qualitative approach, in-depth semi-structured interviews (N = 13) were conducted with majority family medicine-trained PCPs. Through inductive data analysis, it was found that most PCPs reported recommending CCS; however, follow-through for performing CCS varied. PCPs attempted to align their CCS recommendations with national guidelines and provided counseling and education to families and patients about CCS while taking an individualized risk-benefit approach. Despite most PCPs reporting a lack of knowledge or training related to providing I/DD-specific care, PCPs attempted to draw upon experiences with similar populations to recommend and perform CCS. There is an opportunity to improve knowledge of PCPs related to performing CCS for women with I/DD.

The dispersant Corexit 9500 and (dispersed) oil are lethal to coral endosymbionts.

Endosymbionts (Symbiodiniaceae) play a vital role in the health of corals. Seawater pollution can harm these endosymbionts and dispersants used during oil spill cleanup can be extremely toxic to these organisms. Here, we examined the impact of oil and a specific dispersant, Corexit-9500, on two representative endosymbionts - Symbiodinium and Cladocopium - from the Southwestern endemic coral Mussismilia braziliensis. The survival and photosynthetic potential of the endosymbionts decreased dramatically after exposure to the dispersant and oil by ~25 % after 2 h and ~50 % after 7 days. Low concentrations of dispersant (0.005 ml/l) and dispersed oil (Polycyclic Aromatic Hydrocarbons, 1132 µg/l; Total Petroleum Hydrocarbons, 595 µg/l) proved highly toxic to both Symbiodinium and Cladocopium. These levels triggered a reduction in growth rate, cell size, and cell wall thickness. After a few hours of exposure, cellular organelles were damaged or destroyed. These acute toxic effects underline the fragile nature of coral endosymbionts.

Reading tea leaves worldwide: Decoupled drivers of initial litter decomposition mass-loss rate and stabilization.

The breakdown of plant material fuels soil functioning and biodiversity. Currently, process understanding of global decomposition patterns and the drivers of such patterns are hampered by the lack of coherent large-scale datasets. We buried 36,000 individual litterbags (tea bags) worldwide and found an overall negative correlation between initial mass-loss rates and stabilization factors of plant-derived carbon, using the Tea Bag Index (TBI). The stabilization factor quantifies the degree to which easy-to-degrade components accumulate during early-stage decomposition (e.g. by environmental limitations). However, agriculture and an interaction between moisture and temperature led to a decoupling between initial mass-loss rates and stabilization, notably in colder locations. Using TBI improved mass-loss estimates of natural litter compared to models that ignored stabilization. Ignoring the transformation of dead plant material to more recalcitrant substances during early-stage decomposition, and the environmental control of this transformation, could overestimate carbon losses during early decomposition in carbon cycle models.

Detection of Podosphaera macularis in Air Samples by Quantitative PCR.

Detection and quantification of pathogen propagules in the air or other environmental samples is facilitated by culture-independent assays. We developed a quantitative PCR assay for the hop powdery mildew fungus, Podosphaera macularis, for detection of the organism from air samples. The assay utilizes primers and a TaqMan probe designed to target species-specific sequences in the 28S large subunit (LSU) of the nuclear ribosomal rDNA. Analytical sensitivity was not affected by the presence of an exogenous internal control or potential PCR inhibitors associated with DNA extracted from soil. The level of quantification of the assay was between 200 and 350 conidia when DNA was extracted from a fixed number of conidia. The assay amplified all isolates of P. macularis tested and had minimal cross-reactivity with other Podosphaera species when assayed with biologically relevant quantities of DNA. Standard curves generated independently in two other laboratories indicated that assay sensitivity was qualitatively similar and reproducible. All laboratories successfully detected eight unknown isolates of P. macularis and correctly discriminated Pseudoperonospora humuli and a water control. The usefulness of the assay for air sampling for late-season inoculum of P. macularis was demonstrated in field studies in 2019 and 2020. In both years, airborne populations of P. macularis in hop yards were detected consistently and increased during bloom and cone development.

In silico analysis of non-structural protein 12 sequences from SARS-COV-2 found in Manaus, Amazonas, Brazil, reveals mutations linked to higher transmissibility.

The disease coronavirus COVID-19 has been the cause of millions of deaths worldwide. Among the proteins of SARS-CoV-2, non-structural protein 12 (NSP12) plays a key role during COVID infection and is part of the RNA-dependent RNA polymerase complex. The monitoring of NSP12 polymorphisms is extremely important for the design of new antiviral drugs and monitoring of viral evolution. This study analyzed the NSP12 mutations detected in circulating SARS-CoV-2 during the years 2020 to 2022 in the population of the city of Manaus, Amazonas, Brazil. The most frequent mutations found were P323L and G671S. Reports in the literature indicate that these mutations are related to transmissibility efficiency, which may have contributed to the extremely high numbers of cases in this location. In addition, two mutations described here (E796D and R914K) are close and have RMSD that is similar to the mutations M794V and N911K, which have been described in the literature as influential on the performance of the NSP12 enzyme. These data demonstrate the need to monitor the emergence of new mutations in NSP12 in order to better understand their consequences for the treatments currently used and in the design of new drugs.

Level One Trauma Center Proliferation May Worsen Patient Outcomes.

BACKGROUND: From 2013 to 2020, Arizona state trauma system expanded from seven to thirteen level 1 trauma centers (L1TCs). This study utilized the state trauma registry to analyze the effect of L1TC proliferation on patient outcomes. METHODS: Adult patients age≥15 in the state trauma registry from 2007-2020 were queried for demographic, injury, and outcome variables. These variables were compared across the 2 time periods: 2007-2012 as pre-proliferation (PRE) and 2013-2020 as post-proliferation (POST). Multivariate logistic regression was performed to assess independent predictors of mortality. Subgroup analyses were done for Injury Severity Score (ISS)≥15, age≥65, and trauma mechanisms. RESULTS: A total of 482,896 trauma patients were included in this study. 40% were female, 29% were geriatric patients, and 8.6% sustained penetrating trauma. The median ISS was 4. Inpatient mortality overall was 2.7%. POST consisted of more female, geriatric, and blunt trauma patients (P < .001). Both periods had similar median ISS. POST had more interfacility transfers (14.5% vs 10.3%, P < .001). Inpatient, unadjusted mortality decreased by .5% in POST (P < .001). After adjusting for age, gender, ISS, and trauma mechanism, being in POST was predictive of death (OR: 1.4, CI:1.3-1.5, P < .001). This was consistent across all subgroups except for geriatric subgroup, which there was no significant correlation. DISCUSSION: Despite advances in trauma care and almost doubling of L1TCs, POST had minimal reduction of unadjusted mortality and was an independent predictor of death. Results suggest increasing number of L1TCs alone may not improve mortality. Alternative approaches should be sought with future regional trauma system design and implementation.

Progress towards a targeted biorefinery of Chromochloris zofingiensis: a review.

Biorefinery approaches offer the potential to improve the economics of the microalgae industry by producing multiple products from a single source of biomass. Chromochloris zofingiensis shows great promise for biorefinery due to high biomass productivity and a diverse range of products including secondary carotenoids, predominantly astaxanthin; lipids such as TAGs; carbohydrates including starch; and proteins and essential amino acids. Whilst this species has been demonstrated to accumulate multiple products, the development of an integrated downstream process to obtain these is lacking. The objective of this review paper is to assess the research that has taken place and to identify the steps that must be taken to establish a biorefinery approach for C. zofingiensis. In particular, the reasons why C. zofingiensis is a promising species to target for biorefinery are discussed in terms of cellular structure, potential products, and means to accumulate desirable components via the alteration of culture conditions. Future advances and the challenges that lie ahead for successful biorefinery of this species are also reviewed along with potential solutions to address them. Supplementary Information: The online version contains supplementary material available at 10.1007/s13399-022-02955-7.

Light, Copper, Action: Visible-Light Illumination Enhances Bactericidal Activity of Copper Particles.

Bacteria are an old concern to human health, as they are responsible for nosocomial infections, and the number of antibiotic-resistant microorganisms keeps growing. Copper is known for its intrinsic biocidal properties, and therefore, it is a promising material to combat infections when added to surfaces. However, its biocidal properties in the presence of light illumination have not been fully explored, especially regarding the use of microsized particles since nanoparticles have taken over all fields of research and subjugated microparticles despite them being abundant and less expensive. Thus, the present work studied the bactericidal properties of metallic copper particles, in microscale (CuMPs) and nanoscale (CuNPs), in the absence of light and under white LED light illumination. The minimum bactericidal concentration (MBC) of CuMPs against Staphylococcus aureus that achieved a 6-log reduction was 5.0 and 2.5 mg mL-1 for assays conducted in the absence of light and under light illumination, respectively. Similar behavior was observed against Escherichia coli. The bactericidal activity under illumination provided a percentage increase in log reduction values of 65.2% for S. aureus and 166.7% for E. coli when compared to the assays under dark. This assay reproduced the testing CuNPs, which showed superior bactericidal activity since the concentration of 2.5 mg mL-1 promoted a 6-log reduction of both bacteria even under dark. Its superior bactericidal activity, which overcame the effect of illumination, was expected once the nanoscale facilitated the interaction of copper within the surface of bacteria. The results from MBC were supported by fluorescence microscopy and atomic absorption spectroscopy. Therefore, CuMPs and CuNPs proved to have size- and dose-dependent biocidal activity. However, we have shown that CuMPs photoactivity is competitive compared to that of CuNPs, allowing their application as a self-cleaning material for disinfection processes assisted by conventional light sources without additives to contain the spread of pathogens.

Addressing a Pre-Clinical Pipeline Gap: Development of the Pediatric Acute Myeloid Leukemia Patient-Derived Xenograft Program at Texas Children's Hospital at Baylor College of Medicine.

The survival rate of pediatric acute myeloid leukemia (pAML) is currently around 60%. While survival has slowly increased over the past few decades, the development of novel agents likely to further improve survival for this heterogeneous patient population has been limited by gaps in the pAML pre-clinical pipeline. One of the major hurdles in evaluating new agents for pAML is the lack of pAML patient-derived xenograft (PDX) models. Unlike solid tumors and other types of leukemias, AML is notoriously hard to establish in mouse models, likely due in part to the need for specific human microenvironment elements. Our laboratory at TCH/BCM addressed this gap by establishing a systematic PDX workflow, leveraging advanced immunodeficient hosts and capitalizing on our high volume of pAML patients and close coordination between labs and clinical sections. Patients treated at TCH are offered the chance to participate in specimen banking protocols that allow blood and bone marrow collection as well as the collection of relevant clinical data. All patients who consent and have samples available are trialed for PDX development. In addition, samples from the Children's Oncology Group (COG) are also trialed for PDX generation. Serially transplanting PDX models are validated using short tandem repeat (STR) and characterized using both targeted DNA/RNA next generation sequencing and RNAseq. As of March 2023, this systematic approach has resulted in 26 serially transplanting models. Models have been shared with requesting labs to facilitate external pAML pre-clinical studies. Available PDX models can be located through the BCM PDX Portal. We expect our growing PDX resource to make a significant contribution to expediting the testing of promising novel therapeutics for pAML.

Remission, Recovery, Relapse, and Recurrence Rates for Suicide Attempts and Nonsuicidal Self-Injury for Suicidal Youth Treated With Dialectical Behavior Therapy or Supportive Therapy.

OBJECTIVE: To evaluate rates of remission, recovery, relapse, and recurrence in suicidal youth who participated in a clinical trial comparing Dialectical Behavior Therapy (DBT) and Individual and Group Supportive Therapy (IGST). METHOD: Participants were 173 youth, aged 12 to 18 years, with repetitive self-harm (including at least 1 prior suicide attempt [SA]) and elevated suicidal ideation (SI). Participants received 6 months of DBT or IGST and were followed for 6 months post-treatment. The sample was 95% female, 56.4% White, and 27.49% Latina. Remission was defined as absence of SA or nonsuicidal self-injury (NSSI) across one 3-month interval; recovery was defined across 2 or more consecutive intervals. Relapse and recurrence were defined as SA or NSSI following remission or recovery. Cross-tabulation with χ2 was used for between-group contrasts. RESULTS: Over 70% of the sample reported remission of SA at each treatment and follow-up interval. There were significantly higher rates of remission and recovery and lower rates of relapse and recurrence for SA in DBT than for IGST. Across treatments and time points, SA had higher remission and recovery rates and lower relapse and recurrence rates than NSSI. There were no significant differences in NSSI remission between conditions; however, participants receiving DBT had significantly higher NSSI recovery rates than those receiving IGST for the 3- to 9-month, 3- to 12-month, and 6- to 12-month intervals. CONCLUSION: Results showed higher percentages of SA remission and recovery for DBT as compared to IGST. NSSI was less likely to remit than SA. DIVERSITY & INCLUSION STATEMENT: We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. CLINICAL TRIAL REGISTRATION INFORMATION: Collaborative Adolescent Research on Emotions and Suicide (CARES); https://www. CLINICALTRIALS: gov/; NCT01528020.

Biomimetic proteoglycans as a tool to engineer the structure and mechanics of porcine bioprosthetic heart valves.

The utility of bioprosthetic heart valves (BHVs) is limited to certain patient populations because of their poor durability compared to mechanical prosthetic valves. Histological analysis of failed porcine BHVs suggests that degeneration of the tissue extracellular matrix (ECM), specifically the loss of proteoglycans and their glycosaminoglycans (GAGs), may lead to impaired mechanical performance, resulting in nucleation and propagation of tears and ultimately failure of the prosthetic. Several strategies have been proposed to address this deterioration, including novel chemical fixatives to stabilize ECM constituents and incorporation of small molecule inhibitors of catabolic enzymes implicated in the degeneration of the BHV ECM. Here, biomimetic proteoglycans (BPGs) were introduced into porcine aortic valves ex vivo and were shown to distribute throughout the valve leaflets. Incorporation of BPGs into the heart valve leaflet increased tissue overall GAG content. The presence of BPGs also significantly increased the micromodulus of the spongiosa layer within the BHV without compromising the chemical fixation process used to sterilize and strengthen the tissue prior to implantation. These findings suggest that a targeted approach for molecularly engineering valve leaflet ECM through the use of BPGs may be a viable way to improve the mechanical behavior and potential durability of BHVs.

Thematic assessment report on invasive alien species in Brazil: summary for policymakers / Relatório temático sobre espécies exóticas invasoras no Brasil: sumário para tomadores de decisão

Abstract Biological invasions are one of the major threats to biodiversity and good quality of life, resulting from the translocation of species by human action. There are more than 500 alien species currently invading ecosystems in Brazil, particularly plants and fishes, while little is known about invasive microorganisms. Although invasive alien species are present in all ecosystems in the country, most have been recorded in habitats with greater human interference, such as urban and peri-urban areas, farmland, dams, reservoirs, ports, and canals. Historically, the southern and southeastern regions of Brazil have had more invasive alien species, but there has been an increase in the number of invasive alien species in the central-western and northern regions in recent decades. The ornamental trade of plants and fishes as well as the illegal pet trade of wild mammals and reptiles are some of the main pathways for invasive species introduction and spread in Brazil. Breeding and cultivation systems that allow escape to natural areas are a relevant route of species introductions in freshwater ecosystems, while unintentional introductions from shipping and infrastructure are of extreme concern in marine ecosystems. The negative impacts of invasive alien species on the biota mainly include changes in community structure and local decrease in native species richness, mediated by predation, competition, and ecosystem changes. Most negative impacts are recorded for intentionally introduced species, such as fishes and plants, but unintentional introductions have led to impacts on good quality of life, with associated costs and impacts on human health. The management of biological invasions faces challenges that need to be overcome, such as the lack of public knowledge about the impact of invasive alien species, the popular appeal of charismatic invasive species or those used by humans, and the use of controversial control techniques. However, successful experiences of eradication and control in terrestrial and marine ecosystems have been recorded, some of them involving public engagement in management actions. Recognizing the issue as a cross-cutting public policy and developing ongoing governance experiences are fundamental goals for the management of invasive alien species in Brazil.

Resumo Invasões biológicas são uma das maiores ameaças à biodiversidade e à boa qualidade de vida, ocorrendo a partir da translocação de espécies por ação humana. Existem mais de 500 espécies exóticas invadindo ecossistemas atualmente no Brasil, com destaque para plantas e peixes. Pouco se sabe sobre microrganismos invasores. Apesar de existirem espécies exóticas invasoras em todos os ecossistemas no país, a maior parte dos registros foi feita em hábitats com maior interferência humana, como áreas urbanas, periurbanas, terras cultivadas, represas, reservatórios, portos e canais. Historicamente, as regiões sul e sudeste do Brasil apresentam mais espécies exóticas invasoras, mas nas últimas décadas se tem observado um aumento no número de espécies exóticas invasoras nas regiões centro-oeste e norte. O comércio de plantas e peixes ornamentais, assim como o comércio ilegal de mamíferos e répteis silvestres como animais de estimação são algumas das principais vias de introdução e disseminação de espécies exóticas invasoras no Brasil. Sistemas de criação e cultivo que possibilitam o escape para áreas naturais são uma relevante via de introdução em ecossistemas de águas continentais, enquanto introduções não intencionais a partir de navegação e de infraestrutura são de extrema preocupação em ecossistemas marinhos. Os impactos negativos de espécies exóticas invasoras sobre a biota incluem principalmente alterações na estrutura de comunidades e diminuição local da riqueza de espécies nativas, mediados por predação, competição e modificações ecossistêmicas. A maior parte dos impactos negativos registrados ocorreram para espécies introduzidas intencionalmente, como peixes e plantas, mas introduções não intencionais têm levado a impactos na boa qualidade de vida, com custos associados e impactos sobre a saúde humana. A gestão de invasões biológicas esbarra em desafios a serem superados, tais como a falta de conhecimento do público sobre o impacto de espécies exóticas invasoras, o apelo popular de espécies invasoras carismáticas ou utilizadas por humanos e o emprego de técnicas controversas de controle. Entretanto, experiências bem-sucedidas de erradicação e controle em ecossistemas terrestres e marinhos têm sido registrados, alguns deles envolvendo engajamento público nas ações de manejo. Reconhecer o tema como uma política pública transversal e desenvolver experiências continuadas de governança são metas fundamentais para a gestão e o manejo de espécies exóticas invasoras no Brasil.

Assessing the Effect of Augmented Reality on Procedural Outcomes During Ultrasound-Guided Vascular Access.

OBJECTIVE: Augmented reality devices are increasingly accepted in health care, though most applications involve education and pre-operative planning. A novel augmented reality ultrasound application, HoloUS, was developed for the Microsoft HoloLens 2 to project real-time ultrasound images directly into the user's field of view. In this work, we assessed the effect of using HoloUS on vascular access procedural outcomes. METHODS: A single-center user study was completed with participants with (N = 22) and without (N = 12) experience performing ultrasound-guided vascular access. Users completed a venipuncture and aspiration task a total of four times: three times on study day 1, and once on study day 2 between 2 and 4 weeks later. Users were randomized to use conventional ultrasound during either their first or second task and the HoloUS application at all other times. Task completion time, numbers of needle re-directions, head adjustments and needle visualization rates were recorded. RESULTS: For expert users, task completion time was significantly faster using HoloUS (11.5 s, interquartile range [IQR] = 6.5-23.5 s vs. 18.5 s, IQR = 11.0-36.5 s; p = 0.04). The number of head adjustments was significantly lower using the HoloUS app (1.0, IQR = 0.0-1.0 vs. 3.0, IQR = 1.0-5.0; p < 0.0001). No significant differences were identified in other measured outcomes. CONCLUSION: This is the first investigation of augmented reality-based ultrasound-guided vascular access using the second-generation HoloLens. It demonstrates equivalent procedural efficiency and accuracy, with favorable usability, ergonomics and user independence when compared with traditional ultrasound techniques.

Effective inclusion practices for neurodiverse children and adolescents in informal STEM learning: a systematic review protocol.

BACKGROUND: Informal learning experiences in science, technology, engineering, and math (STEM) can enhance STEM learning that occurs in formal educational settings and curricula as well as generate enthusiasm for considering STEM careers. The aim of this systematic review is to focus on the experiences of neurodiverse students in informal STEM learning. Neurodiversity is a subgroup of neurodevelopmental conditions, such as autism, attention deficit disorder, dyslexia, dyspraxia, and other neurological conditions. The neurodiversity movement regards these conditions as natural forms of human variation, as opposed to dysfunction, and recognizes that neurodiverse individuals possess many strengths relevant to STEM fields. METHODS: The authors will systematically search electronic databases for relevant research and evaluation articles addressing informal STEM learning for K-12 children and youth with neurodiverse conditions. Seven databases and content-relevant websites (e.g., informalscience.org) will be searched using a predetermined search strategy and retrieved articles will be screened by two members of the research team. Data synthesis will include meta-synthesis techniques, depending on the designs of the studies. DISCUSSION: The synthesis of the findings resulting from various research and evaluation designs, across the K-12 age span, and across various informal STEM learning contexts, will lead to depth and breadth of understanding of ways to improve informal STEM learning programs for neurodiverse children and youth. The identification of informal STEM learning program components and contexts shown to yield positive results will provide specific recommendations for improving inclusiveness, accessibility, and STEM learning for neurodiverse children and youth. TRIAL REGISTRATION: The current study has been registered in PROSPERO. REGISTRATION NUMBER: CRD42021278618.

ALK Fusion in an Adolescent with Acute Myeloid Leukemia: A Case Report and Review of the Literature.

Activating mutations and fusions of the ALK oncogene have been identified as drivers in a number of malignancies. Crizotinib and subsequent ALK tyrosine kinase inhibitors have improved treatment outcomes for these patients. In this paper, we discuss the case of an adolescent patient with acute myeloid leukemia, who was identified to have an activating ALK fusion, which is a rare finding and has never been reported in cases of AML without monosomy 7. Crizotinib was added to this patient's frontline therapy and was well tolerated. In cases of more common gene alterations, existing data supports the use of targeted agents as post-HSCT maintenance therapy; however, crizotinib was not able to be used post-HSCT for this patient due to the inability to obtain insurance coverage.

Consistent spatial scaling of high-severity wildfire can inform expected future patterns of burn severity.

Increasing wildfire activity in forests worldwide has driven urgency in understanding current and future fire regimes. Spatial patterns of area burned at high severity strongly shape forest resilience and constitute a key dimension of fire regimes, yet remain difficult to predict. To characterize the range of burn severity patterns expected within contemporary fire regimes, we quantified scaling relationships relating fire size to patterns of burn severity. Using 1615 fires occurring across the Northwest United States between 1985 and 2020, we evaluated scaling relationships within fire regimes and tested whether relationships vary across space and time. Patterns of high-severity fire demonstrate consistent scaling behaviour; as fire size increases, high-severity patches consistently increase in size and homogeneity. Scaling relationships did not differ substantially across space or time at the scales considered here, suggesting that as fire-size distributions potentially shift, stationarity in patch-size scaling can be used to infer future patterns of burn severity.