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The extent to which continental acidity during the Early Triassic varied with latitude remains insufficiently constrained, despite its relevance for understanding environmental stress and biotic recovery patterns across the Smithian–Spathian boundary (SSB). We examined the abundance, textures and compositions of strontium-rich hydrated aluminium phosphate–sulphate (APS) minerals in 179 continental samples spanning tropical to high paleolatitudes in both hemispheres. APS minerals display broadly comparable early-diagenetic features across sections, indicating formation shortly after deposition under acidic meteoric conditions. Their distribution suggests a latitudinal trend: APS contents commonly exceed 0.1 vol.% in equatorial western peri-Tethyan basins, where faunal and floral records are sparse during the SSB, whereas concentrations decrease towards higher latitudes and are rare beyond ∼40° in both hemispheres. This pattern does not appear to correlate with lithological or textural variability and may reflect spatial differences in the intensity or duration of acidification linked to Siberian Traps volcanism. Equatorial basins thus likely experienced more prolonged or recurrent acidic episodes, whereas higher-latitude areas may have been subject to comparatively attenuated effects, potentially contributing to earlier ecological recovery. These results provide a useful framework for evaluating continental acidification and its environmental implications during the interval following the end-Permian mass extinction (EPME).
This article reviews the general characteristics of the ‘crisis’ faced by the EU when confronted by the George W. Bush administration in the US, and considers it in relation to the EU's capacity for collective international action. On the basis of a range of examples, it appears that the EU's foreign policy ‘crisis’ was limited to one end of an extensive spectrum, and that in other areas there is considerable evidence of success in maintaining solidarity and proposing alternative policies. The article concludes by proposing an approach to EU collective international action that can account for and accommodate this unevenness, and which might be applied to EU–US relations more generally.
We investigate the convective stability of a thin, infinite fluid layer with a rectangular cross-section, subject to imposed heat fluxes at the top and bottom and fixed temperature along the vertical sides. The instability threshold depends on the Prandtl number as well as the normalized flux difference ($f$) and decreases with the aspect ratio ($\epsilon$), following a $\epsilon f^{-1}$ power law. Using a three-dimensional (3-D) initial value and two-dimensional eigenvalue calculations, we identify a dominant 3-D mode characterized by two transverse standing waves attached to the domain edges. We characterize the dominant mode’s frequency and transverse wavenumber as functions of the Rayleigh number and aspect ratio. An analytical asymptotic solution for the base state in the bulk is obtained, valid over most of the domain and increasingly accurate for lower aspect ratios. A local stability analysis, based on the analytical base state, reveals oscillatory transverse instabilities consistent with the global instability characteristics. The source term for this most unstable mode appears to be interactions between vertical shear and horizontal temperature gradients.
We aimed to quantify attention-deficit hyperactivity disorder (ADHD) and autism assessment requests, and explore correlations with public interest and COVID-19 restrictions. We collected data on referrals to adult ADHD or autism services, Google searches for ‘autism’ or ‘ADHD’, birth gender ratios, ADHD prescriptions in England and COVID-19 restriction measures in four countries.
Results
ADHD assessment demand tripled from July 2020 to January 2023, with Google searches for ADHD rising in parallel. Autism referrals and searches saw smaller, similarly timed rises. Female referrals outstripped males. ADHD prescriptions rose particularly in those aged 30–34 years. Google searches for ADHD unexpectedly rose from July 2020 in four countries, correlating with sustained intensity of national COVID-19 restrictions.
Clinical implications
Public interest may have driven demand for ADHD assessments, with COVID-19 restrictions encouraging social media use facilitated by easy electronic information access. The public has decided that ADHD is important, independent of professional views. It is now critical that a consensus is reached to determine who benefits most from an ADHD diagnosis and medication.
There is increasing interest in enhancing weed-suppression potential from cover crop surface residues by delaying termination until at or after cash crop planting, often referred to as “planting green.” The combination of increased cover crop biomass production and application of soil-residual herbicides into living cover crops in planting green systems may significantly affect herbicide deposition to the soil surface and wash-off from residues. We conducted field studies to describe the (1) relative effects of cover crop management tactics on herbicide deposition to the soil surface at the time of application; and (2) the influence of cover crop management tactics on herbicide wash-off potential from living cover crops (0 d after termination [DAT]) and aged early postemergence residues. Pyroxasulfone was used as the test herbicide. Our results indicate that in scenarios with standing cereal rye (Secale cereale L.) below 2 Mg ha−1, herbicide deposition is reduced by approximately 35% relative to bare ground regardless of application timing (0 DAT, early postemergence). At 5 Mg ha−1, herbicide deposition is reduced by 50% regardless of application timing, but due to greater wash-off potential, concentration in soil is greater at an early postemergence application timing (70%) than in a planting green scenario (0 DAT; 55%). When roll-crimping is employed before herbicide application, deposition is reduced by approximately 70% compared with bare ground regardless of application timing. After accounting for wash-off dynamics, total recovery was greater when pyroxasulfone was applied at an early postemergence timing (55%) compared with a planting green scenario (0 DAT; 45%). Inclusion of hairy vetch (Vicia villosa Roth) in mixture with cereal rye further decreased herbicide deposition (85%) into roll-crimped residues at a 5 Mg ha−1 biomass level, but comparatively greater wash-off of pyroxasulfone resulted in similar soil concentration compared with cereal rye monocultures. Our results quantify the relative effects of cover-cropping tactics on initial concentrations of herbicides in soil.
Agriculture is a major contributor to climate change, and there is an urgent need to reduce greenhouse gas (GHG) emissions from agriculture for mitigation purposes. Modern industrial agriculture has been recognized as a significant source of agricultural GHG emissions, whereas the adoption of regenerative organic agriculture has been proposed as a solution with the potential to reduce GHG emissions from agricultural production. However, there is a lack of on-the-ground studies reporting on the climate impacts of organic agriculture. To remedy this, a carbon footprint (CF) analysis was conducted comparing regionally representative organic and conventional arable cropping systems at Rodale Institute’s Farming Systems Trial in Pennsylvania, USA. Two separate modeling approaches were used to construct CFs for three agricultural systems (two organic and one conventional). The baseline CF analyses used an Intergovernmental Panel on Climate Change Tier 3 model (COMET-Farm) and Tier 2 model (Cool Farm Tool) for comparison purposes. Secondary analyses were conducted on the effects of CO2 emissions from composting manure on CFs. Emission metrics were generally higher (+27%) using the Tier 3 model compared with the Tier 2 model. In the baseline analysis, absolute area-scaled emissions were highest in the conventional system, ranging from 1.25 to 1.72 tons CO2-eq ha−1 yr−1. In comparison, emissions in the organic manure-based system were 25%–37% lower (0.94–1.09 tons CO2-eq ha−1 yr−1), while the organic legume-based system had the lowest emissions, which were 52%–74% lower (0.33–0.83 tons CO2-eq ha−1 yr−1). Yield-scaled emissions of maize in the baseline analyses were highest in the conventional system (0.19–0.26 kg CO2-eq kg−1), followed by the organic manure (0.13–0.16 kg CO2-eq kg−1) and organic legume (0.07–0.17 kg CO2-eq kg−1). Yield-scaled emissions on a feed digestible energy basis were highest in the conventional system (0.014–0.020 kg CO2-eq MJ−1) but were similar between organic manure (0.009–0.010 kg CO2-eq MJ−1) and organic legume (0.006–0.015 kg CO2-eq MJ−1). Including estimates of CO2 emissions due to composting increased emissions for the manure-based organic system substantially (+103%–122%). Our results imply that regenerative organic farming can help mitigate climate change. Future research should focus on more accurately measuring emissions from compost production and other sources of organic fertility, conducting a full life-cycle assessment of these systems, and verifying the results using in-situ field measurements.
Recently introduced parasites are predicted to cause more severe infections because of a lack of host-parasite co-evolution. When new parasites co-occur with similar parasites they may compete for resources within a host, with mixed species infections potentially resulting in antagonistic, synergistic or additive effects. We tested Ostrea chilensis flat oysters in New Zealand for infections by two species of haplosporidian oyster parasites. Bonamia exitiosa is an endemic parasite to New Zealand, whereas Bonamia ostreae is an introduced species first detected in New Zealand in 2015. We investigated the infection intensity of each parasite by estimating gene copy numbers using species-specific digital droplet PCR (ddPCR) across Bonamia spp. allopatric and sympatric ranges. Our results showed that B. ostreae had significantly higher gene copy numbers than B. exitiosa. However, concurrent infections of both Bonamia parasites had similar intensities (based on gene copy number) to single-species infections, with no detectable interactive effects. Collectively, the results indicate that B. ostreae remains a significant risk to O. chilensis, although coinfections may not exacerbate disease. This study demonstrates the value of ddPCR screening and the importance of considering evolutionary ecology in the management of commercially important marine diseases.
The effects of Reynolds number across ${\textit{Re}}=1000$, $2500$, $5000$ and $10\,000$ on separated flow over a two-dimensional NACA0012 airfoil at an angle of attack of $\alpha =14^\circ$ are investigated through biglobal resolvent analysis. We identify modal structures and energy amplifications over a range of frequencies, spanwise wavenumbers, and values of the discount parameter, providing insights across various time scales. Using temporal discounting, we find that the shear-layer dynamics dominates over short time horizons, while the wake dynamics becomes the primary amplification mechanism over long time horizons. Spanwise effects also appear over long time horizons, sustained by low frequencies. The low-frequency and high-wavenumber structures are found to be dominated by elliptic mechanisms within the recirculation region. At a fixed angle of attack and across the Reynolds numbers, the response modes shift from wake-dominated structures at low frequencies to shear-layer-dominated structures at higher frequencies. The frequency at which the dominant mechanism changes is independent of the Reynolds number. Comparisons at a different angle of attack ($\alpha =9^\circ$) show that the transition from wake to shear-layer dynamics with increasing frequency only occurs if the unsteady flow is three-dimensional. We also study the dominant frequencies associated with wake and shear-layer dynamics across the angles of attack and Reynolds numbers, and confirm characteristic scaling laws from the literature.
We surveyed physicians and patients to create a novel Desirability of outcome ranking (DOOR) for non-severe community-acquired pneumonia (CAP). Patients generally ranked uncomfortable but non-life-threatening symptoms as less desirable, while physicians focused on traditional medical outcomes. When developing DOORs, both patient and clinician perspectives should be considered.
Paleontology provides insights into the history of the planet, from the origins of life billions of years ago to the biotic changes of the Recent. The scope of paleontological research is as vast as it is varied, and the field is constantly evolving. In an effort to identify “Big Questions” in paleontology, experts from around the world came together to build a list of priority questions the field can address in the years ahead. The 89 questions presented herein (grouped within 11 themes) represent contributions from nearly 200 international scientists. These questions touch on common themes including biodiversity drivers and patterns, integrating data types across spatiotemporal scales, applying paleontological data to contemporary biodiversity and climate issues, and effectively utilizing innovative methods and technology for new paleontological insights. In addition to these theoretical questions, discussions touch upon structural concerns within the field, advocating for an increased valuation of specimen-based research, protection of natural heritage sites, and the importance of collections infrastructure, along with a stronger emphasis on human diversity, equity, and inclusion. These questions offer a starting point—an initial nucleus of consensus that paleontologists can expand on—for engaging in discussions, securing funding, advocating for museums, and fostering continued growth in shared research directions.
Background: Dichotomous outcomes rarely capture the range of potential outcomes important to patients and clinicians. To address this limitation, the Desirability of Outcome Ranking (DOOR) score was created to rank potential outcomes from least to most desirable. Currently, there is no standardized method to develop a DOOR score and data are limited on whether patients and their clinicians rank outcomes similarly. We aimed: (a) to develop a novel DOOR score for adults hospitalized with community-acquired pneumonia (CAP) by surveying patients and clinicians on their preferred outcome ranking and (b) to compare their relative DOOR rankings. Methods: We created nine clinical scenarios describing the spectrum of potential outcomes of patients with CAP two weeks after initial emergency department visit. To ascertain clinician DOOR score, we used a snowball sampling method to recruit a target of 25 clinicians in specialties that regularly treat CAP. For the patient DOOR score, we recruited patients hospitalized with CAP by reviewing electronic patient lists for adults hospitalized with pneumonia. Respondents were asked to rank the 9 cases from most to least desirable in REDCap. To create the final DOOR score, we used Friedman rank sum tests to combine/collapse DOOR outcomes with scores that did not significantly differ. We used the Mann Whitney U test to compare DOOR rankings between physicians and patients. Final study results were presented to a national hospital medicine patient and family advisory committee (PFAC) for their impressions. Results: 22 patients (71% response rate) and 25 clinicians responded to our DOOR survey. Their ranked order of DOOR outcomes is shown in Table 1. Combining non-significantly different DOOR outcomes resulted in collapsing of 6 cases into 2 categories for 5 overall DOOR scores that significantly differed from each other (Table 1 for final ranking). Patients and clinicians had significantly different preferred ranking for 6 DOOR cases. Our PFAC had several hypotheses as to why rankings differed (Table 2). Conclusion: We present a novel DOOR score derived from patient and clinician reported preferences for outcomes of hospitalized adult patients with CAP. Clinicians and patients differed in their perception of certain outcomes with patients ranking symptoms that were uncomfortable but not potentially life-threatening as less desirable than physicians. Physicians tended to rank quality linked metrics such as readmission as worse than patients. When designing future trials using DOOR scores, researchers should consider including patients in DOOR score design as their perspectives may differ from clinicians.
Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of cancer treatment, significantly affecting patients’ quality of life. Current pharmacological treatments are often ineffective or poorly tolerated, necessitating alternative therapeutic approaches. Scrambler Therapy (ST), a non-invasive neuromodulation technique, has shown potential for reducing neuropathic pain, but optimal dosing regimens remain undefined.
Objective
This case study aims to evaluate the effectiveness of Scrambler Therapy in reducing pain levels and improving functional status in a patient with chemotherapy-induced peripheral neuropathy.
Methods
A single patient diagnosed with CIPN was treated with Scrambler Therapy over a series of sessions. Pain levels and functional status were measured using standardized assessment tools before, during, and after the therapy to evaluate the impact of ST on symptom relief and daily functioning.
Results
After completing the Scrambler Therapy sessions, the patient reported significant reductions in pain intensity and notable improvements in functional status. These improvements were sustained several weeks and months following the therapy, indicating the potential long-term benefits of ST for managing CIPN.
Conclusion
This case study demonstrates the potential of Scrambler Therapy as an effective treatment option for reducing pain and improving functional status in patients with chemotherapy-induced peripheral neuropathy. These findings suggest that ST may provide a promising non-invasive alternative to current treatments for managing neuropathic pain in cancer patients.
To estimate the cost-effectiveness of methicillin-resistant Staphylococcus aureus (MRSA) nares poymerase chain reaction (PCR) use in pediatric pneumonia and tracheitis.
Methods:
We built a cost-effectiveness model based on MRSA prevalence and probability of empiric treatment for MRSA pneumonia or tracheitis, with all parameters varied in sensitivity analyses. The hypothetical patient cohort was <18 years of age and hospitalized in the pediatric intensive care unit for community-acquired pneumonia (CAP) or tracheitis. Two strategies were compared: MRSA nares PCR-guided antibiotic therapy versus usual care. The primary measure was cost per incorrect treatment course avoided. Length of stay and hospital costs unrelated to antibiotic costs were assumed to be the same regardless of PCR use. Both literature data and expert estimates informed sensitivity analysis ranges.
Results:
When estimating the health care system willingness-to-pay threshold for PCR testing as $140 (varied in sensitivity analyses) per incorrect treatment course avoided, reflecting estimated additional costs of MRSA targeted antibiotics, and MRSA nares PCR true cost as $64, PCR testing was generally favored if empiric MRSA treatment likelihood was >52%. PCR was not favored in some scenarios when simultaneously varying MRSA infection prevalence and likelihood of MRSA empiric treatment. Screening becomes less favorable as MRSA PCR cost increased to the highest range value of the parameter ($88). Individual variation of MRSA colonization rates over wide ranges (0% – 30%) had lesser effects on results.
Conclusions:
MRSA nares PCR use in hospitalized pediatric patients with CAP or tracheitis was generally favored when empiric MRSA empiric treatment rates are moderate or high.
This study evaluated Medicaid claims (MC) data as a valid source for outpatient antimicrobial stewardship programs (ASPs) by comparing it to electronic medical record (EMR) data from a single academic center.
Methods:
This retrospective study compared pediatric patients’ MC data with EMR data from the Marshall Health Network (MHN). Claims were matched to EMR records based on patient Medicaid ID, service date, and provider NPI number. Demographics, antibiotic choice, diagnosis appropriateness, and guideline concordance were assessed across both data sources.
Setting:
The study was conducted within the MHN, involving multiple pediatric and family medicine outpatient practices in West Virginia, USA.
Patients:
Pediatric patients receiving care within MHN with Medicaid coverage.
Results:
MC and EMR data showed >90% agreement in antibiotic choice, gender, and date of service. Discrepancies were observed in diagnoses, especially for visits with multiple infectious diagnoses. MC data demonstrated similar accuracy to EMR data in identifying inappropriate prescriptions and assessing guideline concordance. Additionally, MC data provided timely information, enhancing the feasibility of impactful outpatient ASP interventions.
Conclusion:
MC data is a valid and timely resource for outpatient ASP interventions. Insurance providers should be leveraged as key partners to support large-scale outpatient stewardship efforts.
The Child Opportunity Index is an index of 29 indicators of social determinants of health linked to the United States of America Census. Disparities in the treatment of Wolff–Parkinson–White have not be reported. We hypothesise that lower Child Opportunity Index levels are associated with greater disease burden (antiarrhythmic use, ablation success, and Wolff–Parkinson–White recurrence) and ablation utilisation.
Methods:
A retrospective, single-centre study was performed with Wolff–Parkinson–White patients who received care from January 2021 to July 2023. Following exclusion for <5 years old and with haemodynamically significant CHD, 267 patients were included (45% high, 30% moderate, and 25% low Child Opportunity Index). Multi-level logistic and log-linear regression was performed to assess the relationship between Child Opportunity Index levels and outcomes.
Results:
Low patients were more likely to be Black (p < 0.0001) and to have public insurance (p = 0.0006), though, there were no significant differences in ablation utilisation (p = 0.44) or time from diagnosis to ablation (p = 0.37) between groups. There was an inverse relationship with emergency department use (p = 0.007). The low group had 2.8 times greater odds of having one or more emergency department visits compared to the high group (p = 0.004).
Conclusion:
The Child Opportunity Index was not related with ablation utilisation, while there was an inverse relationship in emergency department use. These findings suggest that while social determinants of health, as measured by Child Opportunity Index, may influence emergency department utilisation, they do not appear to impact the overall management and procedural timing for Wolff–Parkinson–White treatment.
We present the Evolutionary Map of the Universe (EMU) survey conducted with the Australian Square Kilometre Array Pathfinder (ASKAP). EMU aims to deliver the touchstone radio atlas of the southern hemisphere. We introduce EMU and review its science drivers and key science goals, updated and tailored to the current ASKAP five-year survey plan. The development of the survey strategy and planned sky coverage is presented, along with the operational aspects of the survey and associated data analysis, together with a selection of diagnostics demonstrating the imaging quality and data characteristics. We give a general description of the value-added data pipeline and data products before concluding with a discussion of links to other surveys and projects and an outline of EMU’s legacy value.
In this paper, we demonstrate that the federal enforcement of the 15th Amendment is necessary for Black representation in the U.S. South. Using novel data on Black officeholders in the South from 1866 to 1912 and from 1969 to 1993, we examine Black representation during Reconstruction and after the passage of the 1965 Voting Rights Act. In both political periods, we find that policies aimed to enforce the 15th Amendment and active Black political participation are necessary preconditions for Black officeholding. This paper helps contextualize scholarship on descriptive representation by identifying this critical link between democracy and representation in the American South. By analyzing broad periods of history, we demonstrate the enduring necessity of active policymaking to ensure fair elections as a precondition of democracy in the American South. Our findings carry significant consequences for understanding the health of American democracy in the twenty-first century.
An important component of post-release monitoring of biological control of invasive plants is the tracking of species interactions. During post-release monitoring following the initial releases of the weevil Ceutorhynchus scrobicollis Nerenscheimer and Wagner (Coleoptera: Curculionidae) on garlic mustard, Alliaria petiolata (Marschall von Bieberstein) Cavara and Grande (Brassicaceae), in Ontario, Canada, we identified the presence of larvae of the tumbling flower beetle, Mordellina ancilla Leconte (Coleoptera: Mordellidae), in garlic mustard stems. This study documents the life history of M. ancilla on garlic mustard to assess for potential interactions between M. ancilla and C. scrobicollis as a biological control agent. Garlic mustard stems were sampled at eight sites across southern Ontario and throughout the course of one year to record the prevalence of this association and to observe its life cycle on the plant. We found M. ancilla to be a widespread stem-borer of late second–year and dead garlic mustard plants across sampling locations. This is the first host record for M. ancilla on garlic mustard. The observed life cycle of M. ancilla indicates that it is unlikely to negatively impact the growth and reproduction of garlic mustard and that it is unlikely to affect the use of C. scrobicollis as a biological control agent.
Objectives/Goals: Cervical cancer is preventable through HPV vaccination and the detection/removal of precancerous lesions. Incidence and mortality rates have only decreased by 3–4% in the past decade. Despite having the tools to prevent all cervical cancers, they are not being fully utilized. Our goal is to identify barriers and design strategies to overcome them. Methods/Study Population: Women in urban (750) and rural (750) settings will be screened for the presence of high-oncogenic risk HPV (hrHPV) by self-vaginal swab, complete the Monitoring Blunting Style Scale, a validation scale to determine attentional style, and a structural barrier to care survey. A subset (Results/Anticipated Results: The study, launched in September 2024 at the Medicine Primary Care Clinic at UMC in New Orleans, has enrolled 16 women. Sample adequacy was high (82%), with 5 women having hrHPV present. Participants expressed high satisfaction and acceptance of the self-administered vaginal swab, with most samples demonstrating high quality. Surveys have been collected, and hrHPV-positive women have been referred for gynecological follow-up. Shreveport site will recruit women across over 20 rural clinical sites using a Mobile Health Unit to increase access in rural and underserved communities. Discussion/Significance of Impact: The baseline study will take 12–18 months. We will identify and address key barriers to follow-up gynecological care, including logistical issues (improving access and navigation), educational needs (developing culturally sensitive materials), and emotional support. We will create a care delivery model to eliminate cervical cancer in Louisiana.