While clinical research intends to improve health outcomes for all, access to research participation is often limited and inequitable. Geographic proximity is a recognized barrier, thus, systemic infrastructure solutions through federal programs including General Clinical Research Centers and Clinical and Translational Science Awards have sought to improve accessibility. Even with such support, academic medical centers often have limited clinical research-dedicated space apart from shared exam rooms in difficult-to-navigate hospitals or clinics. In 2019, the Duke University School of Medicine looked beyond its medical center campus to identify free-standing sites within Durham communities for participant study visits. Catalyzed by the COVID-19 pandemic, Duke Research at Pickett, a 22 000-square-foot building with a laboratory, 30 exam rooms, and on-site parking, opened in October 2020 to support vaccine and treatment trials. Upon the lifting of many COVID-19 restrictions, and in partnership with the Research Equity and Diversity Initiative (READI) Community Advisory Council, the building was transformed to encourage community gatherings, education, and training programs. To date, Duke Research at Pickett has hosted 2692 participants in 78 research trials and 14 community-engaged activities.

The functioning and richness of marine systems (and biological interactions such as parasitism) are continuously influenced by a changing environment. Using hierarchical modelling of species communities (HMSC), the presence and abundance of multiple parasite species of the black-spotted croaker, Protonibea diacanthus (Sciaenidae), was modelled against environmental measures reflecting seasonal change. Protonibea diacanthus were collected in three seasons across 2019–2021 from four locations within the waters of the Northern Territory, Australia. The length of P. diacanthus proved to have a strong positive effect on the abundance of parasite taxa and overall parasitic assemblage of the sciaenid host. This finding introduces potential implications for parasitism in the future as fish body size responds to fishing pressure and climate changes. Of the various environmental factors measured during the tropical seasons of northern Australia, water temperature and salinity changes were shown as potential causal factors for the variance in parasite presence and abundance, with changes most influential on external parasitic organisms. As environmental factors like ocean temperature and salinity directly affect parasite–host relationships, this study suggests that parasite assemblages and the ecological functions that they perform are likely to change considerably over the coming decades in response to climate change and its proceeding effects.

Few prospective studies have documented the seropositivity among those children infected with severe acute respiratory syndrome coronavirus 2. From 2 April 2021 to 24 June 2021, we prospectively enrolled children between the ages of 2 and 17 years at three North Carolina healthcare systems. Participants received at least four at-home serological tests detecting the presence of antibodies against, but not differentiating between, the nucleocapsid or spike antigen. A total of 1,058 participants were enrolled in the study, completing 2,709 tests between 1 May 2021 and 31 October 2021. Using multilevel regression with poststratification techniques and considering our assay sensitivity and sensitivity, we estimated that the seroprevalence of infection-induced antibodies among unvaccinated children and adolescents aged 2–17 years in North Carolina increased from 15.2% (95% credible interval, CrI 9.0–22.0) in May 2021 to 54.1% (95% CrI 46.7–61.1) by October 2021, indicating an average infection-to-reported-case ratio of 5. A rapid rise in seropositivity was most pronounced in those unvaccinated children aged 12–17 years, based on our estimates. This study underlines the utility of serial, serological testing to inform a broader understanding of the regional immune landscape and spread of infection.

Gatherings where people are eating and drinking can increase the risk of getting and spreading SARS-CoV-2 among people who are not fully vaccinated; prevention strategies like wearing masks and physical distancing continue to be important for some groups. We conducted an online survey to characterise fall/winter 2020–2021 holiday gatherings, decisions to attend and prevention strategies employed during and before gatherings. We determined associations between practicing prevention strategies, demographics and COVID-19 experience. Among 502 respondents, one-third attended in person holiday gatherings; 73% wore masks and 84% practiced physical distancing, but less did so always (29% and 23%, respectively). Younger adults were 44% more likely to attend gatherings than adults ≥35 years. Younger adults (adjusted prevalence ratio (aPR) 1.53, 95% CI 1.19–1.97), persons who did not experience COVID-19 themselves or have relatives/close friends experience severe COVID-19 (aPR 1.56, 95% CI 1.18–2.07), and non-Hispanic White persons (aPR 1.57, 95% CI 1.13–2.18) were more likely to not always wear masks in public during the 2 weeks before gatherings. Public health messaging emphasizing consistent application of COVID-19 prevention strategies is important to slow the spread of COVID-19.

We interviewed 1,208 healthcare workers with positive SARS-CoV-2 tests between October 2020 and June 2021 to determine likely exposure sources. Overall, 689 (57.0%) had community exposures (479 from household members), 76 (6.3%) had hospital exposures (64 from other employees including 49 despite masking), 11 (0.9%) had community and hospital exposures, and 432 (35.8%) had no identifiable source of exposure.

Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC.

The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.

The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.

The Repugnant Conclusion is an implication of some approaches to population ethics. It states, in Derek Parfit's original formulation,

Indigenous literature suggests Māori businesses are distinct within Aotearoa New Zealand, due to facing unique challenges and having different operating preferences. It could also be argued that Māori and non-Māori enterprises in the private, public and not-for-profit sectors are identical as a function of operating in similar markets. However, there is a paucity of empirical evidence, and the present article rectifies this with a study of 230 Aotearoa enterprises, including 24 Māori. We test differences and find Māori enterprises report higher cultural capital, which relates to employees' knowledge and skills towards working with and respecting cultural values. However, we find no differences across human capital, relational capital, entrepreneurial culture, and organisational performance. The findings suggest that apart from a culturally specific factor, Māori and non-Māori enterprises appear to be similarly enabled, which provides a useful benchmark for understanding Māori business. We discuss the implications for research.

In recent years, a variety of efforts have been made in political science to enable, encourage, or require scholars to be more open and explicit about the bases of their empirical claims and, in turn, make those claims more readily evaluable by others. While qualitative scholars have long taken an interest in making their research open, reflexive, and systematic, the recent push for overarching transparency norms and requirements has provoked serious concern within qualitative research communities and raised fundamental questions about the meaning, value, costs, and intellectual relevance of transparency for qualitative inquiry. In this Perspectives Reflection, we crystallize the central findings of a three-year deliberative process—the Qualitative Transparency Deliberations (QTD)—involving hundreds of political scientists in a broad discussion of these issues. Following an overview of the process and the key insights that emerged, we present summaries of the QTD Working Groups’ final reports. Drawing on a series of public, online conversations that unfolded at www.qualtd.net, the reports unpack transparency’s promise, practicalities, risks, and limitations in relation to different qualitative methodologies, forms of evidence, and research contexts. Taken as a whole, these reports—the full versions of which can be found in the Supplementary Materials—offer practical guidance to scholars designing and implementing qualitative research, and to editors, reviewers, and funders seeking to develop criteria of evaluation that are appropriate—as understood by relevant research communities—to the forms of inquiry being assessed. We dedicate this Reflection to the memory of our coauthor and QTD working group leader Kendra Koivu.1

Background: Certain nursing home (NH) resident care tasks have a higher risk for multidrug-resistant organisms (MDRO) transfer to healthcare personnel (HCP), which can result in transmission to residents if HCPs fail to perform recommended infection prevention practices. However, data on HCP-resident interactions are limited and do not account for intrafacility practice variation. Understanding differences in interactions, by HCP role and unit, is important for informing MDRO prevention strategies in NHs. Methods: In 2019, we conducted serial intercept interviews; each HCP was interviewed 6–7 times for the duration of a unit’s dayshift at 20 NHs in 7 states. The next day, staff on a second unit within the facility were interviewed during the dayshift. HCP on 38 units were interviewed to identify healthcare personnel (HCP)–resident care patterns. All unit staff were eligible for interviews, including certified nursing assistants (CNAs), nurses, physical or occupational therapists, physicians, midlevel practitioners, and respiratory therapists. HCP were asked to list which residents they had cared for (within resident rooms or common areas) since the prior interview. Respondents selected from 14 care tasks. We classified units into 1 of 4 types: long-term, mixed, short stay or rehabilitation, or ventilator or skilled nursing. Interactions were classified based on the risk of HCP contamination after task performance. We compared proportions of interactions associated with each HCP role and performed clustered linear regression to determine the effect of unit type and HCP role on the number of unique task types performed per interaction. Results: Intercept-interviews described 7,050 interactions and 13,843 care tasks. Except in ventilator or skilled nursing units, CNAs have the greatest proportion of care interactions (interfacility range, 50%–60%) (Fig. 1). In ventilator and skilled nursing units, interactions are evenly shared between CNAs and nurses (43% and 47%, respectively). On average, CNAs in ventilator and skilled nursing units perform the most unique task types (2.5 task types per interaction, Fig. 2) compared to other unit types (P < .05). Compared to CNAs, most other HCP types had significantly fewer task types (0.6–1.4 task types per interaction, P < .001). Across all facilities, 45.6% of interactions included tasks that were higher-risk for HCP contamination (eg, transferring, wound and device care, Fig. 3). Conclusions: Focusing infection prevention education efforts on CNAs may be most efficient for preventing MDRO transmission within NH because CNAs have the most HCP–resident interactions and complete more tasks per visit. Studies of HCP-resident interactions are critical to improving understanding of transmission mechanisms as well as target MDRO prevention interventions.

Funding: Centers for Disease Control and Prevention (grant no. U01CK000555-01-00)

Disclosures: Scott Fridkin, consulting fee, vaccine industry (spouse)

Here we report on the infection of captive crested geckos Correlophus ciliatus Guichenot (Reptilia: Diplodactylidae), with adults of the ascaridoid nematode, Hexametra angusticaecoides Chabaud & Brygoo, 1960 (Ascarididae). A population of captive crested geckoes became ill and died within a short period of time. Nematodes were recovered from the crested geckoes examined from within the coelomic cavity, penetrating various organs and migrating through subcutaneous tissues, as well as emerging through the geckos' skin. One gecko was treated with levamisole following surgical excision of nematodes from under the skin; this gecko survived. The potential source of the nematode infection in the captive geckoes is discussed. It is most likely that wild-caught Madagascan mossy geckoes, Uroplatus sikorae Boettger (Reptilia: Gekkonidae), introduced the infection to the colony. Molecular sequences of the nematodes are the first produced for the members of this genus. A redescription of the species and its genetic characterization based on the internal transcribed spacer sequence data is provided, suggesting some of the morphological criteria that have been used in the past to distinguish between Hexametra spp. may have been intraspecific morphological variations.

In contrast to the view that survey key driver analysis (SKDA) is a misused and blind empirical process, we suggest it is a reasonable, hypothesis-driven approach that builds on cumulative knowledge drawn from both the literature and practice, and requires reasoned judgment about the relationships of individual items to the constructs they represent and the criteria of interest. The logic of key driver analysis in applied settings is no different than the logic of its application in fundamental research regarding employee attitudes (e.g., Dalal, Baysinger, Brummel, & LeBreton, 2012). However, there are important survey design and analysis issues with respect to how key driver analyses are best conducted. Just some of these are discussed below.

Voluminous and widespread tephras were produced frequently during the last 36,000 yr of volcanic activity at Mount St. Helens. Numerous tephra sets have been defined by D. R. Mullineaux, J. H. Hyde, and M. Rubin (1975, U.S. Geological Survey Journal of Research, 3, 329–335) on the basis of field relations, Fe–Mg phenocryst assemblage, and 14C chronology and are valuable marker beds for regional stratigraphic studies. In this study modal abundances and mineral compositions were determined (via petrographic and electron microprobe techniques) for numerous samples of individual layers within tephra sets W and Y to evaluate the degree of compositional variability within and between tephra layers and criteria by which to distinguish among Mount St. Helens and other Pacific Northwest tephras. Although individual layers within a set (e.g., We, Wn) cannot be distinguished from each other on the basis of mineralogic characteristics examined, mineral compositions allow distinction among layers W and Y and other Pacific Northwest tephras (e.g., Mazama, Glacier Peak). Fe–Ti oxide compositions and T–fO2 estimates derived using coexisting magnetite—ilmenite are especially useful due to the compositional homogeneity of these minerals both within and between samples of a given unit over a wide geographic area. The silicates show more compositional variability than the oxides, but SiO2/Al2O3 contents in hornblende and Fe/Mg ratios in hypersthene aid in distinguishing among Pacific Northwest tephras.

Three new species of trilobites, Erixanium lacunatum, Cernuolimbus monilis, and Anechocephalus aphelodermus, have been recovered from two new fossiliferous localities in the normally unfossiliferous Collier Shale in the Ouachita Mountains of west-central Arkansas. These new taxa occur with other trilobites previously reported from the Elvinia Zone in the Collier and elsewhere. Like the other trilobites reported from the Collier, these new taxa were originally deposited on the outer shelf, and were later eroded and redeposited in the adjacent, deep-water basin. Other species assigned to these genera have also been reported from outer shelf or continental slope sites. Species of Erixanium were widely distributed in equatorial and subtropical paleolatitudes in the Late Cambrian.

Hearts in which the arterial trunks arise from the morphologically appropriate ventricles, but in a parallel manner, rather than the usual spiralling arrangement, have long fascinated anatomists. These rare entities, for quite some time, were considered embryological impossibilities, but ongoing experience has shown that they can be found in various segmental combinations. Problems still exist about how best to describe them, as the different variants are often described with esoteric terms, such as anatomically corrected malposition or isolated ventricular inversion. In this review, based on our combined clinical and morphological experience, we demonstrate that the essential feature of all hearts described in this manner is a parallel arrangement of the arterial trunks as they exit from the ventricular mass. We show that the relationship of the arterial roots needs to be described in terms of the underlying ventricular topology, rather than according to the arrangement of the atrial chambers. We then discuss the importance of determining atrial arrangement on the basis of the morphology of the appendages, following the precepts as set out in the so-called “morphological method” and distinguished according to the extent of the pectinate muscles relative to the atrioventricular junctions as opposed to basing diagnosis on the venoatrial connections. We show that, when approached in this manner, the various combinations can be readily diagnosed in the clinical setting and described in straightforward way.