Planamandibulus nevadensis n. gen n. sp. is a newly discovered exceptionally preserved Laurentian phosphatocopid crustacean described from the upper Windfall Formation (Furongian, Stage 10) in Nevada. Planamandibulus nevadensis has closest affinity with the Baltic and Avalonian taxon Cyclotron. Its occurrence in sedimentary facies associated with dysoxia on the Laurentian paleocontinent fills in a gap in the global distribution of phosphatocopid crustaceans, facilitating a paleoenvironmental synthesis of this Cambrian group. We assess 75 taxa from nine paleocontinental areas spanning Cambrian stages 3 to 10 (~521–486.9 Ma). Comparison of these data with paleoclimate model simulations suggests that phosphatocopid distribution is explained partly by biogeography and ocean temperature patterns. Dabashanella species (e.g., D. hemicyclica Huo et al., 1983) are found across the low paleolatitude (<35°) paleocontinents of East Gondwanan (Australia), South China, and the central Asian terranes, spanning marine shelf carbonates to deeper marine black shale lithofacies, but are absent from mid- and high-paleolatitude sites, suggesting a warmer water preference. A similar warm-water preference is inferred for endemic taxa (e.g., Ulopsis, Parashergoldopsis) of East Gondwana, and perhaps for the newly described Laurentian Planamandibulus. By contrast, the mid- to high-paleolatitude paleocontinents Baltica and Avalonia are characterized by Veldotron, Cyclotron, Bidimorpha, Waldoria, Vestrogothia, Falites, and Trapezilites species, which occur in deep-shelf, cooler-water settings, typically below storm wave base. Hesslandona species sensu lato occur in mid-depth (likely above storm-wave base) warm tropical marine waters but are more typically found in deeper shelf and cooler waters in mid to high paleolatitudes. Phosphatocopids are also associated with sedimentary deposits characteristic of low environmental oxygen concentrations; this is emphasized by a peak in occurrences in the Guzhangian (Miaolingian) and Paibian (Furongian) stages, around the interval of the Steptoean Positive Carbon Isotope Excursion (SPICE) and its associated expansion of anoxic water masses onto shallow marine shelves. Our data compilation and data–model comparison support the environmental preference of phosphatocopids for low-oxygen, but not anoxic, water masses, and the new occurrence of Planamandibulus is consistent with this pattern.

UUID: http://zoobank.org/f136f8bf-1ccf-46b0-8980-b88be8f9603d

Functional referral systems are critical to primary health care and universal health coverage. Referral and counter-referral are key relational mechanisms to link communities to the care they need and primary care to secondary and multi-sectoral services. Many referral systems are fragmented, leading to inefficiencies, coverage gaps, and compromised continuity and quality of care. In June 2024, we conducted a scoping review of PubMed, Global Index Medicus and WHO publication databases to identify referral coordination and process initiatives at national, subnational, and local levels.

We classified reports from 181 papers into non-exclusive categories based on referral system design, operational elements, service delivery platform, and/or user group. Initiatives targeting referral system design included modelling, organization and assessment methodologies. Initiatives focusing on operational elements included networks and linkages, pathways and algorithms, e-referral systems and platforms, digital processes and tools, and facility-level processes and tools.

When classified by service delivery platform, community-level initiatives emphasized improved recognition, screening, diagnosis, and communication by community health workers and use of SMS text messaging or mHealth apps. At initiating facilities, reports focused on standardizing referral criteria and protocols and optimizing communication with referral facilities, including for real-time clinical decision-making to improve timely referral and to reduce under- and over-referral. Structured algorithms and pathways were key to minimize the time between referral, diagnosis, and treatment for time-sensitive conditions. At receiving facilities, actions included supporting initiating facility clinical decision-making prior to referral, prioritizing urgent cases, and consistent counter-referral and/or onward referral.

Findings are informing WHO guidance on two-way referral systems.

Background: Effective integration of antimicrobial resistant organism (ARO) admission screening into clinical information systems (CIS) can facilitate prompt identification of patients at risk of an ARO and interrupt transmission. However, ARO admission screening remains suboptimal in Alberta, Canada following implementation of the ARO admission screening tool in the provincial CIS. We sought to understand the determinants of adherence with the use of the ARO admission screening tool in the CIS. Methods: A mixed-methods study was conducted using a survey, human factors observations, and qualitative focus groups. Eligible participants included nursing staff and physicians from emergency departments and inpatient units in acute care and acute rehabilitation facilities where the ARO admission screening tool was utilized in the CIS in Alberta, Canada from September 6, 2023 to June 18, 2024 (n=100). A survey (REDCap) explored staff perceptions and experiences using the tool in the CIS. Observations and interviews of nursing staff completing the tool were guided by the Systems Engineering Initiative for Patient Safety model. Virtual (Zoom) semi-structured focus groups explored barriers and enablers of using the tool guided by the Theoretical Domains Framework. Descriptive analysis of survey responses was conducted using Microsoft Excel (Version 2409). Field notes and focus group transcripts were used for a rapid qualitative, thematic analysis. A weaving narrative by theme was used to integrate survey results with findings from the observations and focus groups. Results: There were 527 survey respondents representing all 5 health zones, 5 nurses observed and 20 interviews conducted by the human factors team, and 24 participants in 6 focus groups. Focus group participants represented different sized hospitals (12-1,099 beds) with varying ARO admission adherence rates (29-83%). Three emergent themes arose: context, the ARO admission screening tool, and the individual. Contextual factors included time constraints, increasing nursing workload, competing priorities, lack of patient cooperation, and a need to increase interactions with infection prevention and control programs. Attributes of the tool impacting completion included location of the tool within the CIS, lack of prompts, and multiple sources of information required to complete the tool. At an individual level, themes arose related to experience, perceptions of ARO screening, and lack of training that influenced completion of the tool. Conclusions: Among the emergent themes, multiple determinants were identified influencing the use of the ARO admission screening tool in the provincial CIS. These findings will help inform future strategies to improve ARO admission screening and reduce ARO transmission.

Background: Adherence with antimicrobial resistant organism (ARO) admission screening is suboptimal, despite clinical support tools in clinical information systems (CIS) to facilitate the process. Behaviour change techniques to improve adherence are needed. However, in a resource-constrained healthcare system, strategies that motivate healthcare workers (HCWs) to align their practices with infection prevention and control (IPC) policies need to be prioritized. Methods: An online survey (REDCap) and a virtual (Zoom) consensus meeting using a modified nominal group technique with online voting was conducted among HCWs, IPC, and the CIS staff in September and October 2024, respectively, to achieve consensus on a prioritized list of interventions to improve ARO admission screening at acute care and acute rehabilitation facilities (n=100) in Alberta, Canada. Interventions from the Behaviour Change Wheel were mapped to barriers/enablers influencing screening adherence. Each intervention was judged across the APEASE criteria (Acceptability, Practicality, Effectiveness, Affordability, Side Effects, Equity) using a 5-point Likert Scale. Consensus to include interventions required >4 criteria with >80% agreement, consensus to exclude required >4 criteria with 80%. Interventions that did not reach consensus were discussed to determine whether to include in the final candidate list. Attendees were asked to vote on their top three interventions from the final candidate list. Results: There were 15 barriers and one enabler to ARO admission screening, mapped to 43 unique interventions. Of these, 16 interventions addressed more than one barrier/enabler, while 27 interventions only addressed a single barrier. Fifty-nine respondents completed the survey. Most respondents (63%) were IPC staff, 20% were nurses, and 17% were other HCWs (including IPC physicians). Nine interventions met criteria to include in the candidate list, 26 were excluded, and 8 interventions did not reach consensus in the survey and were discussed. There were 32 attendees at the consensus meeting (53% IPC staff and physicians, 34% clinical staff, 13% other provincial teams). Three interventions were selected: 1) creating a nursing task to complete the tool in the CIS when an admission order is signed, 2) add a banner on the CIS Storyboard when the tool is not complete, and 3) develop a best practice guideline for frontline staff on ARO admission screening. Conclusions: The survey and consensus meeting were efficient methods to determine a prioritized list of interventions, which will be implemented and evaluated, to improve ARO admission screening in Alberta.

The bright radio source, GLEAM J091734$-$001243 (hereafter GLEAM J0917$-$0012), was previously selected as a candidate ultra-high redshift ($z \gt 5$) radio galaxy due to its compact radio size and faint magnitude ($K(\mathrm{AB})=22.7$). Its redshift was not conclusively determined from follow-up millimetre and near-infrared spectroscopy. Here we present new HST WFC3 G141 grism observations which reveal several emission lines including [NeIII]$\lambda$3867, [NeV]$\lambda$3426 and an extended ($\approx 4.8\,$kpc), [OII]$\lambda$3727 line which confirm a redshift of $3.004\pm0.001$. The extended component of the [OII]$\lambda$3727 line is co-spatial with one of two components seen at 2.276 GHz in high resolution ($60\times 20\,$mas) Long Baseline Array data, reminiscent of the alignments seen in local compact radio galaxies. The BEAGLE stellar mass ($\approx 2\times 10^{11}\,\textit{M}_\odot$) and radio luminosity ($L_{\mathrm{500MHz}}\approx 10^{28}\,$W Hz$^{-1}$) put GLEAM J0917$-$0012 within the distribution of the brightest high-redshift radio galaxies at similar redshifts. However, it is more compact than all of them. Modelling of the radio jet demonstrates that this is a young, $\approx 50\,$kyr old, but powerful, $\approx 10^{39}\,$W, compact steep spectrum radio source. The weak constraint on the active galactic nucleus bolometric luminosity from the [NeV]$\lambda$3426 line combined with the modelled jet power tentatively implies a large black hole mass, $\ge 10^9\,\textit{M}_\odot$, and a low, advection-dominated accretion rate, i.e. an Eddington ratio $\le 0.03$. The [NeV]$\lambda$3426/[NeIII]$\lambda$3867 vs [OII]$\lambda$3727/[NeIII]$\lambda$3867 line ratios are most easily explained by radiative shock models with precursor photoionisation. Hence, we infer that the line emission is directly caused by the shocks from the jet and that this radio source is one of the youngest and most powerful known at cosmic noon. We speculate that the star-formation in GLEAM J0917$-$0012 could be on its way to becoming quenched by the jet.

The nature of interstratification in mixed-layer illite-montmorillonites has been investigated by comparison of diffraction patterns of ethylene glycol and ethylene glycol monoethyl ether treated samples with calculated one-dimensional diffraction profiles. The calculated profiles take into account the effects of particle size distribution, chemical composition, and convolution factors as well as proportions of layers and interstratification type. On the basis of detailed matching of diffraction patterns of monomineralic illite-montmorillonites of known chemical composition it is concluded that there are three types of interstratification: (1) random, (2) allevardite-like ordering, and (3) superlattice units consisting of three illite and one montmorillonite layers (IMII). By comparison of suites of calculated profiles with the diffraction patterns of many samples of illite-montmorillonites it is concluded that virtually all illite-montmorillonites with expandabilities from about 40 to 100 per cent are randomly interstratified (allevardite being exceptional); at >40 per cent montmorillonite layers they almost always have ordered interstratification. Allevardite-like ordering predominates in illitemontmorillonites which have ordered interstratification, with the IMII superlattice varieties confined to samples with about 10 per cent montmorillonite layers.

This study identified 26 late invasive primary surgical site infection (IP-SSI) within 4–12 months of transplantation among 2073 SOT recipients at Duke University Hospital over the period 2015–2019. Thoracic organ transplants accounted for 25 late IP-SSI. Surveillance for late IP-SSI should be maintained for at least one year following transplant.

OBJECTIVES/GOALS: Prematurity and perinatal brain injury are known risk factors for strabismus. In this study, we sought to understand the link between neonatal neuroimaging measures in very preterm infants and the emergence of strabismus later in life. Study findings may inform if neonatal brain MRI could serve as a prognostic tool for this visual disorder. METHODS/STUDY POPULATION: This study draws from a longitudinal cohort of very preterm infants (VPT, < 30 weeks gestation, range 23 – 29 weeks) who underwent an MRI scan at 36 to 43 weeks postmenstrual age (PMA). Anatomic and diffusion MRI data were collected for each child . A subset of thirty-three patients in this cohort had records of an eye exam, which were reviewed for a history of strabismus. Patients with MRI scans demonstrating cystic periventricular leukomalacia or grade III/IV intraventricular hemorrhage were classified as having brain injury. Clinical variables with a known association to strabismus or diffusion metrics were included in a multivariable logistic regression model. Diffusion tractography metrics were screened for association with strabismus on univariable analysis prior to inclusion in the regression model. RESULTS/ANTICIPATED RESULTS: A total of 17/33 (51.5%) patients developed strabismus. A logistic regression model including gestational age, PMA at MRI, retinopathy of prematurity (ROP) stage, brain injury, and fractional anisotropy of the right optic radiation was significant at the .001 level according to the chi-square statistic. The model predicted 88% of responses correctly. Each decrease of 0.01 in the fractional anisotropy of the right optic radiation increased the odds of strabismus by a factor of 1.5 (95% CI 1.03 – 2.06; p = .03). Patients with brain injury had 15.8 times higher odds of strabismus (95% CI 1.1 – 216.5; p = .04). Gestational age (OR 1.7; 95% CI 0.9 – 3.3; p = .1) and stage of ROP (OR 0.6; 95% CI 0.2 – 2.0; p = .4) were not significant predictors of strabismus in the multivariable model. DISCUSSION/SIGNIFICANCE: Our findings suggest that strabismus in VPT patients may be related to specific changes in brain structure in the neonatal period. The identified association between neonatal optic radiation microstructure and strabismus supports the possibility of using brain MRI in very preterm infants to prognosticate visual and ocular morbidity.

The International VLBI Service for Geodesy and Astrometry (IVS) regularly provides high-quality data to produce Earth Orientation Parameters (EOP), and for the maintenance and realisation of the International Terrestrial and Celestial Reference Frames, ITRF and ICRF. The first iteration of the celestial reference frame (CRF) at radio wavelengths, the ICRF1, was adopted by the International Astronomical Union (IAU) in 1997 to replace the FK5 optical frame. Soon after, the IVS began official operations and in 2009 there was a significant increase in data sufficient to warrant a second iteration of the CRF, ICRF2. The most recent ICRF3, was adopted by the IAU in 2018. However, due to the geographic distribution of observing stations being concentrated in the Northern hemisphere, CRFs are generally weaker in the South due to there being fewer Southern Hemisphere observations. To increase the Southern Hemisphere observations, and the density, precision of the sources, a series of deep South observing sessions was initiated in 1995. This initiative in 2004 became the IVS Celestial Reference Frame Deep South (IVS-CRDS) observing programme. This paper covers the evolution of the CRDS observing programme for the period 1995–2021, details the data products and results, and concludes with a summary of upcoming improvements to this ongoing project.

In 1922, the League of Nations inscribed the goal of establishing a settler colony in Palestine for the Jewish people—in denial of the national self-determination of the Indigenous Arab population—in public international law. The Palestine Mandate juridically erased the national status of the Palestinian people by: (1) framing the Arabs as incapable of self-rule; (2) heightening the significance of establishing a Jewish national home; and (3) distinguishing Palestine from the other Class A mandates for possessing religious significance that exceeded the interests of any single national group. A century later, the still-unresolved “question” of Palestine remains central to struggles for anti-racism and anti-colonialism in international law. This essay revisits two flashpoints in the tangled history of Palestine and international law, where questions of race and racism have been central: first, ongoing debates over the regime and crime of apartheid; and second, the now-repudiated UN General Assembly Resolution 3379, recognizing Zionism as a form of racism and racial discrimination. Both stories demonstrate the importance of understanding race and colonialism as conjoined concepts, neither of which can be properly understood in isolation from the other.

Partial agonists of dopamine receptors are used in combination with full antagonists in treating psychosis, either to mitigate side-effects or in the hope of increasing effectiveness. We examine how combinations may affect the occupancy of D2/D3 dopamine receptors and explore how these can explain the outcomes in the light of the dopamine hypothesis of psychosis. The combinations considered here are from published studies combining aripiprazole with amisulpride, with risperidone in people with hyperprolactinaemia and with olanzapine to mitigate weight gain. We discuss possible worsening of symptoms by the addition of a partial agonist or switching. We also examine the potentially adverse interaction with a full antagonist such as haloperidol given during a subsequent relapse to control severe agitation.