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The Tijuana River Valley along the US-Mexico border faces a severe environmental and public health crisis from contamination of the Tijuana River with untreated sewage, urban runoff, and industrial waste, leading to water and air exposure concerns. The County of San Diego Health and Human Services Agency (CoSD HHSA) and the Centers for Disease Control and Prevention (CDC) conducted 189 household-level surveys to assess experiences with the crisis and address concerns. Survey results revealed that ~96% of households were concerned about the crisis. Top needs included requests for action (64.3%) and air (38.2%) and water (27.1%) quality improvement. Subsequently, CoSD HHSA developed data-driven outreach programs and resources (e.g., provision of air filters), enhanced messaging (e.g., providing educational materials, promoting behavioral health hotlines) related to the crisis to address household concerns, and shared the results with other agencies (e.g., the water board) to promote further action and safety messaging.
A consensus has yet to be reached on whether the appraisal of risk is best represented quantitatively (e.g. probability estimates) or qualitatively (e.g. formulation). A more fundamental issue, though, is how to use the agreed representation to inform practice so as to reduce the likelihood of harm. The real-world implementation of risk representations in clinical practice is dependent on how these representations inform clinical decision-making. Clinical decision-making takes place in a complex system of interacting agents, entities, and processes. To date, risk-related research and practice guidance has not paid sufficient attention to studying this system.
Objectives
To develop a standardised model for representing those complex mental health systems in which appraisals of ‘risk of harm to others’ are used.
Methods
In order to identify a generally applicable representation of the system, practice experts in the field of risk of harm to others reflexively examined the systems within which they worked to firstly identify the actual individual agents, entities and processes in their systems. A thematic review of the elements was then undertaken so as the inform the development of more generally applicable characterisation of the system for wider use.
Results
The generalisable characterisation of the system (with illustrative local examples in parenthesis) is presented in Figure 1.Image 1:
Conclusions
Risk-related practice by mental health clinicians involves the development of quantitative and/or qualitative representations of risk which are used to guide decisions. In practice, the use of the risk representations to guide decisions is also heavily dependent on the complex system in which the decisions are made. This study has generated a model to characterise risk-related systems which can be used for service improvement and planning, and for future research into risk-related practice.
Objectives/Goals: This project evaluates the acceptability to patients of offering free tax preparation and joint charity-care enrollment in a clinical setting, leveraging an Internal Revenue Service-supported free income tax preparation program. The goal is to reduce administrative barriers and promote continuous access to care. Methods/Study Population: In September 2025, three members of our study team conducted in-person surveys with patients and visitors in outpatient waiting areas at Parkland Health, the county safety-net health system serving Dallas County in North Texas. The 16-item bilingual (English/Spanish) survey was developed in partnership with a large, Internal Revenue Service-supported, local VITA program, Dallas Community Tax Centers (DCTC). The survey collected sociodemographic information, household income, tax-filing practices, current charity care program enrollment status, and interest in combined VITA–charity care enrollment/renewal services. Data were entered into REDCap and analyzed descriptively in Excel. Results/Anticipated Results: Of 300 approached patients, 232 completed the survey, yielding a response rate of 77% (28% Spanish-preferring). Most respondents (86%) estimated that their household income was below $67,000, which would qualify them for VITA tax preparation, yet 82% of those eligible reported that they paid a tax preparer last year. More than half (54%) of respondents were enrolled in the charity care program for the county health system, and 87%of these adults indicated that integrated tax-and-charity care enrollment/renewal services would be helpful. Awareness and reported uptake of the Earned Income Tax Credit (EITC) was low: only 11% of respondents reported applying for EITC during the recent tax season. Interest in shifting to free on-site tax prep services was high, with 72% of respondents indicating a favorable response. Discussion/Significance of Impact: Embedding tax preparation and streamlining charity-care assistance applications in clinical environments was well received and highly acceptable. Future steps include piloting joint VITA–charity-care applications services to assess impact on operational workflows, uptake of both programs, continuity of care, and health outcomes.
Many environmental, energy and industrial processes involve the flow of viscoelastic polymer solutions in three-dimensional (3-D) porous media where fluid is confined to navigate through complex pore space geometries. As polymers are transported through the tortuous pore space, elastic stresses accumulate, leading to the onset of unsteady, time-dependent flow fluctuations above a threshold flow rate. How does pore space geometry influence the development and features of this elastic instability? Here, we address this question by directly imaging polymer solution flow in microfabricated 3-D ordered porous media with precisely controlled geometries consisting of simple-cubic (SC) or body-centred cuboid (BC) arrays of spherical grains. In both cases, we find that the flow instability is generated at stagnation points arising at the contacts between grains rather than at the polar upstream/downstream grain surfaces, as is the case for flow around a single grain. The characteristics of the flow instability are strongly dependent on the unit cell geometry: in SC packings, the instability manifests through the formation of time-dependent, fluctuating 3-D eddies; whereas in BC packings, it manifests as continual fluctuating ‘wobbles’ and crossing in the flow pathlines. Despite this difference, we find that characteristics of the transition from steady to unsteady flow with increasing flow rate have commonalities across geometries. Moreover, for both packing geometries, our data indicate that extensional flow-induced polymeric stresses generated by contact-associated stagnation points are the primary contributor to the macroscopic resistance to flow across the entire medium. Altogether, our work highlights the pivotal role of inter-grain contacts – which are typically idealised as discrete points and therefore overlooked, but are inherent in most natural and engineered media – in shaping elastic instabilities in porous media.
Extended radio sources present unique challenges for automated detection and classification in wide-field radio surveys. With current surveys such as the Evolutionary Map of the Universe (EMU), robust and scalable methods are essential to identify and catalogue these complex sources. We apply three automatic approaches to detect complex radio emission in EMU observations of the Galaxy And Mass Assembly (GAMA) 09 field (EMU-G09) in order to evaluate their relative strengths and limitations in preparation for large-scale application across future EMU data releases. These include DRAGNhunter, designed to detect likely DRAGNs (Double Radio sources associated with Active Galactic Nuclei) from a component catalogue; coarse-grained complexity, a metric designed to highlight regions of complex emission; and RG-CAT, a machine learning pipeline trained on radio sources identified in the EMU pilot survey. We find that together, the three methods recover nearly all extended sources in EMU-G09 but identify largely distinct, partially overlapping subsets, with only 375 sources identified by all finders. This demonstrates that a combination of complementary techniques will be required to achieve a complete census of extended radio sources in future large-scale surveys.
As the title of this chapter testifies, it takes a Lacanian approach to Herrmann’s work with Hitchcock. Drawing on Kristeva’s Lacanian pre-Symbolic notion of ‘the specular,’ Brown finds Herrmann’s music, not just his film work with Hitchcock, but also his concert and radio music, to demonstrate the full specular potential of the cinema. Drawing on Laura Mulvey’s theories, the chapter examines the way in which Herrmann’s deployment of the Hitchcock chord (as referenced above) in Vertigo and Psycho in particular, remove film’s Symbolic discursive attachments, in a manner similar to atonal or experimental music, and returns it to its specular potential.
Adolescent mental health has worsened, and prevention efforts have become increasingly important. The purpose of this study was to examine longitudinal symptom trajectories of depression and anxiety throughout adolescence, in a contemporary sample. The stress–diathesis model was used to inform potential vulnerability factors and stressors associated with these trajectories.
Methods
Symptoms of depression and generalized anxiety were assessed in a school-based population sample of N = 6102 adolescents (aged 13–14 at baseline). Growth mixture models across four time points were used to model longitudinal trajectories of symptoms. Multinomial regression was used to examine factors associated with each trajectory class.
Results
Of the full sample, 49.5% were female, 45.9% were male, and 4.6% were gender diverse. Four discrete classes for both depression and anxiety trajectories were identified, which comprised consistently low symptoms (‘low’; 72.5% depression; 66.9% anxiety), consistently high symptoms (‘high’; 11.5% depression; 18.4% anxiety), elevated symptoms that reduced over time (‘decreasing’; 8.3% depression; 6.9% anxiety), and low-moderate symptoms that increased over time (‘increasing’; 7.7% depression; 7.8% anxiety). Factors associated with poorer trajectories were being female or gender diverse, lower socioeconomic status, higher levels of neuroticism and lower levels of conscientiousness, greater adverse childhood experiences, higher levels of peer problems, bullying victimization, and negative family interactions.
Conclusions
A range of background vulnerabilities and specific stressors were associated with poorer depression and anxiety trajectories over a 3-year period. Prevention approaches may require policy and practice changes that promote more supportive family, school, and societal environments from childhood to adolescence.
In Walman, a language in the Torricelli family spoken in Papua New Guinea, there are two words that have the function of conjoining noun phrases but that have the morphology of transitive verbs, exhibiting subject agreement with the first conjunct and object agreement with the second conjunct. We discuss two interrelated issues concerning these words: (i) Do these words behave syntactically like conjunctions in other languages, in combining with two noun phrases to form a single noun phrase, or are they really just verbs in a serial verb construction?, and (ii) Do these words have a meaning that is closer to a coordinative conjunction like and in English, or do they have a comitative meaning like English with? We show that the evidence on the first of these questions is somewhat contradictory, but that even in cases where the syntactic evidence argues that these verbs do not combine with two noun phrases to form a single noun phrase, they still have a meaning closer to that of and than of with
In 2013, the National Institute of Neurological Disorders and Stroke established National Institutes of Health (NIH) StrokeNet to support multi-site clinical trials focused on stroke prevention, treatment, and recovery. The University of Cincinnati (UC) serves as the National Coordinating Center for StrokeNet. As part of the initiative, the UC StrokeNet Central IRB (SN-CIRB) was established at UC to serve as a single IRB to oversee StrokeNet trials. Since the SN-CIRB approved the first StrokeNet study in 2014, it has reviewed and approved 16 additional studies. Over this period, the UC Human Research Protection Program refined its review processes based on insights from earlier reviews. These improvements have improved efficiency while still ensuring the protection of study participants. The successful implementation and ongoing conduct of the SN-CIRB at UC demonstrate that an academic-based IRB can effectively serve as a Central IRB for a large clinical trial network.
Preserving viable infective stages of chicken ascarids under laboratory conditions facilitates the maintenance of characterized nematode strains for research purposes. We investigated the survivability of Ascaridia galli eggs exposed to low temperatures and the cryoprotectant dimethyl sulfoxide (DMSO). Two egg developmental stages (unembryonated or fully embryonated) were stored at 4°C, –20°, or –80°C in sterile water or with 5% and 10% DMSO for 1, 2, 4, or 8 weeks. Egg survival was assessed by morphology following post-storage incubation in 0.1 N H2SO4 at 26°C for unembryonated eggs or with a viability dye exclusion test of hatched larvae for the embryonated eggs. The results revealed that neither DMSO nor the hardy chitinous eggshell protected eggs from freezing damage, and not a single egg survived even for 1 week of storage at –20° or –80°C. DMSO at 10% significantly reduced (P < 0.0001) overall egg survival and embryonation capacity with increasing storage time at 4°C compared to water alone. For both egg developmental stages, egg survival was maintained in 5% DMSO at a rate similar to that in water alone. Unembryonated A. galli eggs survived refrigeration better than embryonated eggs with larval viability declining linearly at almost a double rate in the latter (9.75%/week) compared to the former (5.64 %/week). We conclude that DMSO is unlikely to provide cryoprotection for A. galli eggs and also causes concentration-dependent toxicity with increasing exposure time. Furthermore, survival during refrigeration is better for unembryonated than embryonated eggs.
This chapter provides an overview of the meteorology and climate of Australia, the Maritime Continent, New Zealand, and the South Pacific, including dominant regional circulation features and weather patterns, major modes of variability on timescales from intra-seasonal to interdecadal, long-term trends, and future projections. Over the past few decades, new research has provided insights into the role of synoptic and mesoscale systems, such as tropical and extratropical cyclones, East Coast Lows, atmospheric rivers, and the midlatitude stormtracks in the meteorology of the region. Our understanding of the nature and variability of the South Pacific Convergence Zone (SPCZ) has improved considerably. Additionally, there have been substantial advances in our understanding of how major regional climate drivers, such as the El Niño Southern Oscillation (ENSO), the Indian Ocean Dipole (IOD), the Southern Annular Mode (SAM), and the Madden–Julian Oscillation (MJO), influence regional climate and affect weather patterns. Sources of increased knowledge include new observational datasets and reanalyses with higher spatial and temporal resolution, as well as improved forecasting and climate models. The region has experienced warming since the beginning of the twentieth century, and this trend will continue as the globe warms. However, the patterns of precipitation change will depend on the future of ENSO, IOD, SAM, and SPCZ variability, all of which are uncertain at present.
Experts conducted a free statewide series on antibiotic stewardship for hospital, outpatient, and long-term care settings. In total, 366 participants from 244 sites represented 66% of counties in the state. Furthermore, 62% worked in nonmetropolitan counties, and 55% were from counties with medium-to-high social vulnerability, demonstrating reach into diverse sites.
Reproductive synchrony is common in populations that inhabit seasonal environments where reproductive timing is important to offspring survival. Weddell seals (Leptonychotes weddellii) reproduce in strongly seasonal Antarctic environments and are known to exhibit reproductive synchrony that varies by latitude, whereby more southerly populations give birth later. The Erebus Bay population of Weddell seals is the southernmost mammal population in the world, and birth-date synchrony has been demonstrated in this population. Various life history correlates including sex, maternal age and reproductive status have been identified as predictors of birth timing, but all prior work has been done on pups born to locally born mothers. Immigrant females originating from unknown sites in more northerly locations also produce pups in Erebus Bay and may have different birth timing due to the earlier average birth dates in their natal colonies. Using 22 years of capture-mark-recapture data for Weddell seals in Erebus Bay, we aimed to assess whether the timing of birth dates for pups born to immigrant mothers differs from that of pups born to locally born mothers. To our knowledge, this is the first time that such a comparison has been studied in a wild population. Birth dates were examined using Bayesian linear regression. We analysed birth dates from 7539 pups (4932 from locally born mothers, 2607 from immigrant mothers) born to 2210 mothers (1254 locally born, 956 immigrant) and found that there were no biologically impactful differences in the birth dates of pups born to locally born or immigrant mothers. Additionally, birth-date patterns for immigrant mothers were similar to those for locally born mothers with respect to various traits. Our results demonstrate that immigrant Weddell seal mothers can synchronize birth timing with locally born mothers. More research is required to understand the underlying mechanisms that allow for immigrant seals to achieve birth-date synchrony.
Distinguishing viral versus bacterial lower respiratory tract infection (LRTI) is challenging. We previously developed a rapid, host response-based test (Biomeme HR-B/V assay) using peripheral blood samples to identify viral versus bacterial infection. We assessed the performance of this assay when using nasopharyngeal (NP) samples.
Methods:
Patients with LRTI were enrolled, and a NP swab sample was run using the HR-B/V assay (assessing 24 gene targets) on the FranklinTM platform. The performance of the prior classifier at identifying viral versus bacterial infection was assessed. A novel predictive model was generated for NP samples using the same 24 targets. Results were validated using external datasets with nasal/NP RNA sequence data.
Results:
Nineteen patients (median age 62 years, 52.1% male) were included. When using the prior HR-B/V classifier on NP samples of 19 patients with LRTI (12 viral, 7 bacterial), the area under the receiver operator curve (AUC) for viral versus bacterial infection was 0.786 (0.524–1), with accuracy 0.79 (95% CI 0.57–0.91), positive percent agreement (PPA) 0.43 (95% CI 0.16–0.75), and negative percent agreement (NPA) 1.00 (95% CI 0.76–1). The novel model had AUC 0.881 (95% CI 0.726–1), accuracy 0.84 (95% CI 0.62–0.94), PPA 0.86 (95% CI 0.49–0.97), and NPA 0.83 (95% CI 0.55–0.95) for bacterial infection. Validation in two external datasets showed AUC of 0.932 (95% CI 0.90–0.96) and 0.915 (95% CI 0.88–0.95).
Conclusions:
We show that host response in the nasopharynx can distinguish viral versus bacterial LRTI. These findings need to be replicated in larger cohorts with diverse LRTI etiologies.
Lobesiodes euphorbiana (Freyer) (Lepidoptera: Tortricidae), commonly known as the spurge leaf tying moth, was intentionally introduced into Canada in the 1980s as a biocontrol agent for leafy spurge, Euphorbia virgata Waldstein and Kitaibel (Euphorbiaceae). The moth has never been reported in the United States of America, where it was not approved for release as a biocontrol agent. Here, we report the first records of L. euphorbiana in Montana and North Dakota, United States of America.
Everyday functional capacity in older adults is influenced by several factors, with prior studies finding that cognition mediates the relationship between depression and everyday functioning. However, these studies utilized samples with low depression severity and used only one type of functional assessment. We aimed to examine whether cognition mediates the relationship between depression and functioning in older adults with a history of treatment-resistant depression.
Method:
Data from 383 participants enrolled in the OPTIMUM Neuro study were analyzed. Participants completed a neuropsychological assessment battery, depression severity interview, self-/informant-rated functioning measures and a performance-based functioning measure. Linear regression was used to determine whether depression scores predicted cognitive domain and everyday functioning scores. Cognitive domain scores predicted by depression were then tested as mediators between depression and functioning.
Results:
Higher depression symptoms predicted poorer performance on all measures of functioning as well as the cognitive domains of attention, executive functioning, and immediate memory. Immediate memory partially mediated the relationship between depression and a performance-based measure of functioning, while attention and executive functioning partially mediated the relationship between a self-report measure of functioning and depression.
Conclusions:
The relationship between depression severity and poorer functional performance was partially mediated by attention, executive functioning, and immediate memory, with results differing based on the measure of functioning used. Our findings suggest that there may be additional non-cognitive factors influencing this relationship and highlight the importance of using multiple methods to assess functional performance.
Foodservice provision is a key contributor to both dietary intake and food waste production(1). The development of ‘root-to-tip’ recipes in foodservice that incorporate more of the plant (i.e. peels and stalks) is being explored to reduce the climate impact of food waste(1) and improve suboptimal population intakes of fruits and vegetables, which provide useful sources of dietary fibre associated with lower risk of all-cause mortality(2). However, given low peels and stalks consumption in the UK(3), the extent to which ‘root-to-tip’ dishes may just shift food waste along the supply chain by increasing plate waste is unknown. The aim of this study is to understand the acceptability of ‘root-to-tip’ dining by exploring consumer attitudes towards food waste and perceived barriers and enablers to eating peels and stalks.
In-person focus groups were conducted at a UK university with current students and employees. Convenience sampling was used to recruit between five to eight participants across six focus groups. A semi-structured topic guide with open-ended questions was developed to facilitate discussion. Discussions were audio recorded, transcribed verbatim and an inductive thematic analysis undertaken. The research protocol was approved by the King’s College London Research Ethics Committee (Ref: MRA-24/25-46016; LRS/DP- 24/25-46017)
Six focus group discussions were conducted with forty participants (November 2024 to January 2025), primarily aged 18-25 years (53%) and female (75%). Six preliminary themes were identified: 1) food waste as a structural issue; 2) personal food waste awareness and the intention-behaviour gap; 3) the role of social modelling in ‘root-to-tip’ behaviours; 4) safety and edibility concerns around peels and stalks; 5) knowledge as a facilitator for ‘root-to-tip’ adoption; and 6) the importance of sensory appeal. These themes illustrate consumers’ perception of food waste as primarily occurring up the supply chain prior to the preparation stage, with structural barriers to its reduction. Participants perceive a growing societal and personal consciousness of food waste and desire to reduce its associated negative consequences. However, results highlight social and personal barriers, such as cost and convenience, which may contribute to an intention-behaviour gap. These barriers were referenced regarding the use of peels and stalks specifically, with upbringing, social modelling and food habits described as factors influencing consumption. Improving awareness of the safety and edibility of peels and stalks and practical knowledge related to their use may facilitate adoption of ‘root-to-tip’ behaviours. Anticipation of an unappealing sensory experience was described as a deterrent for consuming ‘root-to-tip’ dishes. Therefore, ensuring ‘root-to-tip’ dishes have sensory appeal is important to increase acceptability and prevent plate waste.
Our findings contribute to the understanding of attitudes towards food waste reduction practices at the preparation stage, in particular the use of peels and stalks, and highlight a need for increased knowledge to facilitate behaviour adoption.
This study aimed to evaluate the role of oral antibiotic stepdown therapy in patients with uncomplicated streptococcal bacteremia. Streptococcus species are known pathogens in bloodstream infections (BSIs). Traditionally, BSIs were managed with intravenous (IV) antibiotics; however, growing literature supports oral antibiotics in invasive infections including BSIs.
Design:
This was a retrospective cohort study evaluating patients with streptococcal bacteremia between September 2019 and September 2021 at an academic safety-net hospital. Clinical outcomes were compared between patients completing treatment with IV antibiotics versus an oral stepdown regimen. The primary outcome, clinical failure, was a composite of BSI recurrence and infection-related readmission.
Patients:
Adult patients with at least one positive blood culture for any Streptococcus species were included. Patients with polymicrobial BSIs or complicated bacteremia were excluded.
Results:
155 patients were included, 77 (49.7%) received a course of IV antibiotics and 78 (50.3%) received an oral antibiotic stepdown regimen. Clinical failure was not different between the IV and oral groups (15.6% vs. 15.4%, respectively; OR .99 [95% CI, .41 to 2.35]). No differences were observed in 30-day all-cause mortality. Patients that received oral antibiotics had a significantly shorter hospital length of stay by 6 days (6 vs 12 d, p < .01).
Conclusions:
Our results suggest that an oral stepdown regimen for uncomplicated streptococcal BSIs is associated with similar outcomes compared to IV antibiotics. Furthermore, oral antibiotics may offer reduced length of stay and avoidance of outpatient central line placement in patients with uncomplicated streptococcal BSIs.
Species of the Burkholderia (B.) cepacia complex (Bcc) have been implicated in multiple nosocomial outbreaks linked to contaminated water-based products, including liquid soaps, mouthwash, and other non-alcoholic aqueous solutions.
Objective:
We describe two substantial healthcare-associated outbreaks of Bcc (B. cepacia and B. contaminans) in the United Kingdom and Ireland associated with contaminated products. We highlight the challenges during investigation and mitigation, and provide recommendations.
Methods:
A multidisciplinary, multi-stakeholder investigation across both outbreaks was adopted, involving interviews, trawling questionnaires, and targeted product sampling.
Results:
There were 153 and 66 confirmed cases in the B. cepacia and B. contaminans outbreaks, respectively. Cases predominantly comprised hospitalized individuals, and 70% of isolates were recovered from an invasive site. The outbreak strain of B. cepacia was isolated from non-sterile ultrasound gel. An analytical study suggested the B. contaminans cluster was also linked to ultrasound gel; however, a disinfectant wipe product was subsequently identified as the source (0–3 single nucleotide polymorphism differences between case and wipe isolates).
Outbreak control measures:
The affected disinfectant wipes were withdrawn. The ultrasound gel was not recalled but health system procurement was suspended, rapid clinical guidance was produced and a National Patient Safety Alert was issued. Inter-organizational partnership was required to mitigate risks.
Conclusion:
Identifying the source of outbreaks associated with contaminated products can be challenging, requiring complex multi-stakeholder interventions. We recommend a low threshold for investigation of Bcc clusters, adopting a multidisciplinary approach to investigation and mitigation, implementing interventions focusing on practice, and prompt product removal to protect patients.