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Background: Amyotrophic Lateral Sclerosis (ALS) leads to progressive functional decline and reduced survival. Identifying clinical predictors like ALSFRS-R and FVC is essential for prognosis and disease management. Understanding progression profiles based on diagnostic characteristics supports clinical trial design and assessment of treatment response. This study evaluates disease progression and survival predictors in ALS patients from the CNDR. Methods: 1565 ALS patients in the CNDR were analyzed to assess baseline ALSFRS-R, FVC, time from symptom onset to diagnosis, and their association with disease progression and survival. Results: At diagnosis, ALSFRS-R was 44.7 (SD = 5.46), with 72.3% scoring ≥44. Mean FVC was 84.2% (SD = 23.3), with 78.3% of patients having FVC ≥65%. ALSFRS-R declined at 1.06 points/month (SD = 1.33), with faster progression in patients diagnosed within 24 months (1.61 points/month). Patients with ALSFRS-R ≥44 had a median survival of 41.8 months, compared to 30.9 months for those <44 (p < 0.001). Similarly, FVC ≥65% was associated with longer survival (35.4 vs. 29.5 months, p = 0.002). Conclusions: ALSFRS-R and FVC at diagnosis predict survival and inform clinical decision-making. These findings highlight the importance of early diagnosis and targeted interventions to slow disease progression and improve patient outcomes.
Since the 1950s, the United Nations (UN) has designated days (e.g., World Wetland Day), years (e.g., Year of the Gorilla) and decades (e.g., Decade on Biodiversity) with a commonly stated goal to raise awareness and funding for conservation-oriented initiatives, and these Days, Years and Decades of ‘…’ (hereafter ‘DYDOs’) continue. However, the effectiveness of these initiatives to achieve their stated objectives and to contribute to positive conservation outcomes is unclear. Here we used a binary analysis change model to evaluate the effectiveness of UN conservation-oriented DYDOs observed between 1974 and 2020. We also examined four case studies to understand the different strategies employed to meet specified conservation goals. We found that DYDOs apparently contributed to positive conservation outcomes when they were tied to social media campaigns and/or when they were strategically situated in current events or global discourse. Although the outcomes of DYDOs were varied, those with longer timescales and those that engaged local communities were more likely to be successful. We suggest that DYDO organizers should identify all possible paths of action through the lens of the change model outlined in this paper to strengthen the value and effectiveness of these initiatives in the future. Using this approach could help ensure that resources are used efficiently and effectively, and that initiatives yield positive conservation outcomes that benefit people and nature.
The fossil record of dinosaurs in Scotland mostly comprises isolated highly fragmentary bones from the Great Estuarine Group in the Inner Hebrides (Bajocian–Bathonian). Here we report the first definite dinosaur body fossil ever found in Scotland (historically), having been discovered in 1973, but not collected until 45 years later. It is the first and most complete partial dinosaur skeleton currently known from Scotland. NMS G.2023.19.1 was recovered from a challenging foreshore location in the Isle of Skye, and transported to harbour in a semi-rigid inflatable boat towed by a motor boat. After manual preparation, micro-CT scanning was carried out, but this did not aid in identification. Among many unidentifiable elements, a neural arch, two ribs and part of the ilium are described herein, and their features indicate that this was a cerapodan or ornithopod dinosaur. Histological thin sections of one of the ribs support this identification, indicating an individual at least eight years of age, growing slowly at the time of death. If ornithopodan, as our data suggest, it could represent the world's oldest body fossil of this clade.
Racial and ethnic variations in antibiotic utilization are well-reported in outpatient settings but little is known about inpatient settings. Our objective was to describe national inpatient antibiotic utilization among children by race and ethnicity.
Methods:
This study included hospital visit data from the Pediatric Health Information System between 01/01/2022 and 12/31/2022 for patients <20 years. Primary outcomes were the percentage of hospitalization encounters that received an antibiotic and antibiotic days of therapy (DOT) per 1000 patient days. Mixed-effect regression models were used to determine the association of race-ethnicity with outcomes, adjusting for covariates.
Results:
There were 846,530 hospitalizations. 45.2% of children were Non-Hispanic (NH) White, 27.1% were Hispanic, 19.2% were NH Black, 4.5% were NH Other, 3.5% were NH Asian, 0.3% were NH Native Hawaiian/Other Pacific Islander (NHPI) and 0.2% were NH American Indian. Adjusting for covariates, NH Black children had lower odds of receiving antibiotics compared to NH White children (aOR 0.96, 95%CI 0.94–0.97), while NH NHPI had higher odds of receiving antibiotics (aOR 1.16, 95%CI 1.05–1.29). Children who were Hispanic, NH Asian, NH American Indian, and children who were NH Other received antibiotic DOT compared to NH White children, while NH NHPI children received more antibiotic DOT.
Conclusions:
Antibiotic utilization in children’s hospitals differs by race and ethnicity. Hospitals should assess policies and practices that may contribute to disparities in treatment; antibiotic stewardship programs may play an important role in promoting inpatient pharmacoequity. Additional research is needed to examine individual diagnoses, clinical outcomes, and drivers of variation.
Motor neuron disease (MND) is a progressive, fatal, neurodegenerative condition that affects motor neurons in the brain and spinal cord, resulting in loss of the ability to move, speak, swallow and breathe. Acceptance and commitment therapy (ACT) is an acceptance-based behavioural therapy that may be particularly beneficial for people living with MND (plwMND). This qualitative study aimed to explore plwMND’s experiences of receiving adapted ACT, tailored to their specific needs, and therapists’ experiences of delivering it.
Method:
Semi-structured qualitative interviews were conducted with plwMND who had received up to eight 1:1 sessions of adapted ACT and therapists who had delivered it within an uncontrolled feasibility study. Interviews explored experiences of ACT and how it could be optimised for plwMND. Interviews were audio recorded, transcribed and analysed using framework analysis.
Results:
Participants were 14 plwMND and 11 therapists. Data were coded into four over-arching themes: (i) an appropriate tool to navigate the disease course; (ii) the value of therapy outweighing the challenges; (iii) relevance to the individual; and (iv) involving others. These themes highlighted that ACT was perceived to be acceptable by plwMND and therapists, and many participants reported or anticipated beneficial outcomes in the future, despite some therapeutic challenges. They also highlighted how individual factors can influence experiences of ACT, and the potential benefit of involving others in therapy.
Conclusions:
Qualitative data supported the acceptability of ACT for plwMND. Future research and clinical practice should address expectations and personal relevance of ACT to optimise its delivery to plwMND.
Key learning aims
(1) To understand the views of people living with motor neuron disease (plwMND) and therapists on acceptance and commitment therapy (ACT) for people living with this condition.
(2) To understand the facilitators of and barriers to ACT for plwMND.
(3) To learn whether ACT that has been tailored to meet the specific needs of plwMND needs to be further adapted to potentially increase its acceptability to this population.
Newly elevated to species rank, the Bahama Nuthatch Sitta insularis is or was a bark- and twig-gleaning insectivore only known in life from the pine forests of Grand Bahama in the Bahamas archipelago. It became increasingly difficult to find in the past 50 years, seemingly in part in response to multiple hurricanes in this century. In spring (June–April) 2018, when it was still known to be extant, we divided the island into seven sections and carried out point count transects with playback and measured habitat variables at 464 locations in pine forest across Grand Bahama. We made only six observations at six locations, all in the region of Lucayan North and each involving a single nuthatch (possibly all the same individual). Fourteen count points were within 500 m of the six locations, and tree size at these sites was greater in height and girth than at sites with no observations and indeed than at other sites within Lucayan North. Count points within 500 m of nuthatch records in 2004–2018 had larger trees and more snags than survey points over 500 m away from previous detections, while count points within 500 m of our 2018 nuthatch records tallied more snags than did those within 500 m of the 2004–2007 records. Declines in habitat quality, habitat extent, nesting substrate, and food availability (driven by logging, attritional island development, and the direct and indirect effects of hurricanes), plus speculated increases in populations of invasive predators/competitors and in major mortality events (hurricanes, increasing in force and frequency with climate change), are suspected to be the ultimate causes of the decline of the nuthatch, with Hurricanes Matthew and Dorian the proximate causes of its evident extinction in 2019.
In the question put forward by Scott et al., implications about the role of immune activation in depressive or other mood disorders were suggested. Low-level inflammation, triggered by the release of inflammatory molecules such as cytokines, has been detected in individuals with major mood disorders. These markers can be present in very low concentrations, posing a significant analytical challenge and complicating their use as reliable biomarkers. In this Perspective, we discuss the potential promise in leveraging nanotechnology and trace-level analysis of biomarkers of immune activation to enhance our molecular understanding of the immune system’s functioning and its association with depressive and other mood disorders. This Perspective critically discusses the analytical challenges of trace biomarker detection, highlighting issues with variability in study methodologies and cohort heterogeneity and emphasising the need for diurnal and longitudinal sampling to study circadian disruption and immune activation. Profiling inflammatory markers in this manner could create individualised molecular fingerprints, revealing disruptions in immune synchronisation with circadian rhythms and detecting abnormalities linked to specific mood disorder subtypes, and particularly ‘circadian depression’. As the profiling of general inflammatory markers may not be sufficient to study any causative relationship between immune activation and major mood disorders, we propose the exploration of novel biomarkers such as extracellular vesicles to support these investigations. The use of nanotechnologies for trace profiling of diurnal variations of inflammatory molecules, in combination with novel biomarkers, offers a promising strategy to develop a molecular understanding of the role of immune activation in depressive and other mood disorders.
This editorial summarises the clinical relevance of ‘chronopsychiatry’, defined as the interface between circadian science and mental health science. Chronopsychiatry represents a move towards time-variable perspectives on neurobiology and symptoms, with a greater emphasis on chronotherapeutic interventions.
Until the early twentieth century, populations on many Pacific Islands had never experienced measles. As travel to the Pacific Islands by Europeans became more common, the arrival of measles and other pathogens had devastating consequences. In 1911, Rotuma in Fiji was hit by a measles epidemic, which killed 13% of the island population. Detailed records show two mortality peaks, with individuals reported as dying solely from measles in the first and from measles and diarrhoea in the second. Measles is known to disrupt immune system function. Here, we investigate whether the pattern of mortality on Rotuma in 1911 was a consequence of the immunosuppressive effects of measles. We use a compartmental model to simulate measles infection and immunosuppression. Whilst immunosuppressed, we assume that individuals are vulnerable to dysfunctional reactions triggered by either (i) a newly introduced infectious agent arriving at the same time as measles or (ii) microbes already present in the population in a pre-existing equilibrium state. We show that both forms of the immunosuppression model provide a plausible fit to the data and that the inclusion of immunosuppression in the model leads to more realistic estimates of measles epidemiological parameters than when immunosuppression is not included.
Cereal rye (Secale cereale L.) as a cover crop can be an effective nonchemical tool for waterhemp [Amaranthus tuberculatus (Moq.) Sauer] suppression in crop production. Previous studies have evaluated A. tuberculatus suppression by cereal rye as part of weed management programs but have not investigated the underlying mechanism of suppression by the cover crop. This study aimed to investigate the effect of cereal rye biomass on A. tuberculatus emergence and development, and on soil environmental parameters (temperature, moisture, and light transmittance) that are key triggers of A. tuberculatus germination to elucidate the mechanism of suppression by the cover crop. A dose–response study was conducted under field conditions in Brooklyn and Janesville, WI, from 2021 to 2023. Cereal rye biomass from a fall-planted field was harvested at anthesis in the spring and dried to constant weight at 60 C to provide 0.0, 0.6, 1.2, 2.4, 4.8, 7.2, 9.6, and 12.0 Mg ha−1 of dry biomass that was evenly distributed over 1.9 m−2 plots. Increasing cereal rye biomass reduced A. tuberculatus height, biomass, and density. An average ED50 of 5.2 Mg ha−1 of biomass was needed to reduce A. tuberculatus density by 50%. Low levels of biomass (≤2.38 Mg ha−1) augmented A. tuberculatus density due to an increase in soil moisture underneath the mulch compared with bare soil. Cereal rye biomass decreased the amount of sunlight reaching the soil, which resulted in lower mean soil temperature and temperature amplitude throughout the day (9.3 and 2.7 C temperature amplitude at 0 and 12.0 Mg ha−1, respectively). Prevention of A. tuberculatus germination by this thermal effect is likely the main mechanism of A. tuberculatus suppression from the cereal rye cover crop. Our results support biomass from cereal rye cover crop effectively suppressing A. tuberculatus and contributing to the integrated management of A. tuberculatus.
For the Western Indian Ocean region, there is a significant knowledge gap regarding marine turtle nesting on the continental coast of East Africa. Here we present results from a long-term (2000–2020) community-based monitoring programme in and around Watamu Marine National Park, Kenya, covering 30 km of coastline (c. 6% of the national total). Conservation actions effectively protected nesting turtles and resulted in a near-total cessation of illegal egg harvesting in Watamu Marine National Park. Collected data indicate this is an important marine turtle nesting index site in Kenya and the wider region. Green turtle Chelonia mydas nests were most common (95%), followed by olive ridley turtles Lepidochelys olivacea (4%), with occasional nests of hawksbill Eretmochelys imbricata and leatherback turtles Dermochelys coriacea. Clutches per season increased significantly over the 20-year monitoring period for green turtles (50%) and showed a positive trend for olive ridley turtles. Watamu remains an area at risk from human pressures such as coastal development. Clutch distribution along the Watamu Marine National Park beach has shifted over time, probably because of coastal development and disturbance. Illegal take of adults and eggs continues in areas north and south of the Watamu Marine National Park, possibly slowing rates of recovery. Clutches deemed at risk were moved to a safe location within the National Park, and hatching success was high. Continued conservation efforts, including wider engagement with stakeholders to reduce human pressures, are needed to ensure the perpetuation of this nesting site.
Cereal rye cover crop (cereal rye) and preemergence (PRE) herbicides are becoming common practices for managing herbicide-resistant weeds in soybean production. Adopting these two practices in combination raises concerns regarding herbicide fate in soil, given that the cereal rye biomass can intercept the herbicide spray solution, preventing it from reaching the soil. Delaying cereal rye termination until soybean planting (planting green) optimizes biomass accumulation but might also increase PRE interception. To better understand the dynamics between cereal rye and PRE herbicides, a field experiment was conducted to evaluate two soil management practices (tillage and no-till) and two cereal rye termination practices in the planting-green system (glyphosate [1,260 g ae ha−1] and roller-crimper) on the spray deposition and fate of PRE herbicides and soybean yield. The spray deposition was assessed by placing water-sensitive paper cards on the soil surface before spraying the PRE herbicides (sulfentrazone [153 g ai ha−1] + S-metolachlor [1,379 g ai ha−1]). Herbicide concentration in soil (0 to 7.6 cm) was quantified 25 d after treatment (DAT). The presence of no-till stubble and cereal rye biomass reduced the spray coverage compared to tillage at PRE application, which reflected in a reduction in the concentration of both herbicides in soil 25 DAT. Soybean yield was reduced in all three years when the cereal rye was terminated with a roller-crimper but only reduced in one year when terminated with glyphosate. Our findings indicate that mainly cereal rye biomass reduced the concentration of PRE herbicides in the soil due to the interception of the spray solution during application. Although higher cereal rye biomass accumulation can provide better weed suppression according to the literature, farmers should be aware that the biomass can lower the concentration of PRE herbicides reaching the soil, thus intensifying field scouting to ensure that weed control is not being negatively affected.
The Cambrian (Miaolingian; Wuliuan) Spence Shale Lagerstätte of northern Utah and southern Idaho is one of the most diverse Burgess Shale-type deposits of Laurentia. It yields a diverse fauna consisting of abundant biomineralized and locally abundant soft-bodied fossils, along a range of environments from shallow-water carbonates to deep-shelf dark shales. Panarthropods are the dominant component throughout the deposit, both in time and space, but whereas the trilobites and agnostoids are abundant, most of the soft-bodied taxa are only known from very few specimens. Additionally, the knowledge of soft-bodied panarthropods is currently largely limited to locations in the Wellsville Mountains of northeastern Utah. This contribution describes 21 new soft-bodied panarthropods from six locations, including the first occurrences of soft-bodied panarthropods in the High-Creek, Smithfield Creek, Spence Gulch, and Two-Mile Canyon localities. Additionally, we report the presence of bradoriids— i.e., Branchiocaris pretiosa Resser, 1929, Perspicaris? dilatus Robison and Richards, 1981, Naraoia? sp. indet., Thelxiope cf. T. palaeothalassia Simonetta and Delle Cave, 1975, and Tuzoia guntheri Robison and Richards, 1981—for the first time from the Spence Shale Lagerstätte; the first reported occurrence outside of the Burgess Shale for Thelxiope cf. T. palaeothalassia; and the first Wuliuan occurrence of Tuzoia guntheri. We also report on a new hurdiid carapace element and additional specimens of Buccaspinea cooperi? Pates et al., 2021, Dioxycaris argenta Walcott, 1886, Hurdia sp. indet., and Tuzoia retifera Walcott, 1912. This new material improves our understanding of the panarthropod fauna of the Spence Shale Lagerstätte and substantially increases our understanding of the distribution of the described taxa in time and space.
We present a new neoclassical transport model for large aspect ratio tokamaks where the gradient scale lengths are of the size of the ion poloidal gyroradius. Previous work on neoclassical transport across transport barriers assumed large density and potential gradients but a small temperature gradient, or neglected the gradient of the mean parallel flow. Using large aspect ratio and low collisionality expansions, we relax these restrictive assumptions. We define a new set of variables based on conserved quantities, which simplifies the drift kinetic equation whilst keeping strong gradients, and derive equations describing the transport of particles, parallel momentum and energy by ions in the banana regime. The poloidally varying parts of density and electric potential are included. Studying contributions from both passing and trapped particles, we show that the resulting transport is dominated by trapped particles. We find that a non-zero neoclassical particle flux requires parallel momentum input which could be provided through interaction with turbulence or impurities. We derive upper and lower bounds for the energy flux across a transport barrier in both temperature and density and present example profiles and fluxes.
Unsustainable hunting, both illegal and legal, has led to the extirpation of many species. In the last 35 years giraffe Giraffa spp. populations have declined precipitously, with extinctions documented in seven African countries. Amongst the various reasons for these population declines, poaching is believed to play an important role in some areas. Giraffes are primarily hunted for consumption and for the use of their body parts as trophies and in traditional medicine. However, the socio-economic factors that correlate with the use of giraffe body parts are not well understood. We conducted our study in Tsavo Conservation Area, Kenya, which experiences high levels of poaching. We used semi-structured surveys amongst 331 households to document how giraffe body parts are typically acquired and their intended use (i.e. trophy, medicinal or consumptive). We then used logistic regression models to assess the correlations between nine socio-economic factors and the use of giraffe body parts. We found that giraffe body parts had mostly consumptive and trophy uses. One-time suppliers, opportunistic access and widely known markets were the most common means of acquiring giraffe body parts. Results from our models showed that three variables (gender: men, occupation: tourism worker, and land ownership) were correlated significantly and positively with the use of giraffe body parts. We describe the complex links between socio-economic factors and the use of giraffe body parts and highlight the importance of implementing mitigation measures adapted to local contexts to combat a challenge that many species of conservation concern are facing.
The causal impacts of recreational cannabis legalization are not well understood due to the number of potential confounds. We sought to quantify possible causal effects of recreational cannabis legalization on substance use, substance use disorder, and psychosocial functioning, and whether vulnerable individuals are more susceptible to the effects of cannabis legalization than others.
Methods
We used a longitudinal, co-twin control design in 4043 twins (N = 240 pairs discordant on residence), first assessed in adolescence and now age 24–49, currently residing in states with different cannabis policies (40% resided in a recreationally legal state). We tested the effect of legalization on outcomes of interest and whether legalization interacts with established vulnerability factors (age, sex, or externalizing psychopathology).
Results
In the co-twin control design accounting for earlier cannabis frequency and alcohol use disorder (AUD) symptoms respectively, the twin living in a recreational state used cannabis on average more often (βw = 0.11, p = 1.3 × 10−3), and had fewer AUD symptoms (βw = −0.11, p = 6.7 × 10−3) than their co-twin living in an non-recreational state. Cannabis legalization was associated with no other adverse outcome in the co-twin design, including cannabis use disorder. No risk factor significantly interacted with legalization status to predict any outcome.
Conclusions
Recreational legalization was associated with increased cannabis use and decreased AUD symptoms but was not associated with other maladaptations. These effects were maintained within twin pairs discordant for residence. Moreover, vulnerabilities to cannabis use were not exacerbated by the legal cannabis environment. Future research may investigate causal links between cannabis consumption and outcomes.
The updated vancomycin guideline for treatment of serious methicillin-resistant Staphylococcus aureus infections prompted institutions to convert from trough to area-under-the-curve monitoring. The physician perception of the transition, coupled with that of pharmacists, was measured by pre- and postimplementation surveys. Both groups believed safety would be increased without efficacy changes.
Global climate change (global warming) has been identified as the primary factor responsible for the observed increase in frequency and severity of wildfires (also known as bushfires in some countries) throughout the majority of the world’s vegetated environments. This trend is predicted to continue, causing significant adverse health effects to nearby residential populations and placing a potential strain on local emergency departments (EDs).
Study Objective:
The aim of this literature review was to identify papers relating to wildfires and their impact on EDs, specifically patient presentation characteristics, resource utilization, and patient outcomes.
Method:
This integrative literature review was guided by the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines for data collection, and Whittemore and Knafl’s framework for data analysis. Data were collected from OvidSP, MEDLINE, DARE, CINAHL, PubMed, and Scopus databases. Various Medical Subject Headings (MeSH) and keywords identified papers relevant to wildfires/bushfires and EDs.
Results:
Literature regarding the relationship between ED presentations and wildfire events, however, is primarily limited to studies from the United States and Australia and indicates particulate matter (PM) is principally linked to adverse respiratory and cardiovascular outcomes. Observable trends in the literature principally included a significant increase in respiratory presentations, primarily with a lag of one to two days from the initial event. Respiratory and cardiovascular studies that stratified results by age indicated individuals under five, over 65, or those with pre-existing conditions formed the majority of ED presentations.
Conclusion:
Key learnings from this review included the need for effective and targeted community advisory programs/procedures, prior to and during wildfire events, as well as pre-event planning, development, and robust resilience strategies for EDs.
The Makapansgat Valley is located in Limpopo Province, South Africa (Figure 7.1), and is the northernmost of the South African australopithecine fossil sites. Hominin fossils were first recovered there in 1947, but the history and significance of the valley dates to the nineteenth century. The name of the site and valley derives from the Historic, or Gwasa, Cave at the head of the valley, which was the location of a siege in 1854 (Naidoo, 1987; Esterhuysen et al., 2008) on local Ndebele tribespeople by a Boer Commando in retaliation for two massacres – themselves retaliation for raids for ivory and slave labor by the Boer on Ndebele villages. The chief was Mokopane, and the cave became known as “Makapan’s Cave” or -gat in Afrikaans.