adapted to steppe-desert climate extremes one million years ago.

Questions about when early members of the genus adapted to extreme environments like deserts and rainforests have traditionally focused on . Here, we present multidisciplinary evidence from Engaji Nanyori in Tanzania's Oldupai Gorge, revealing that thrived in hyperarid landscapes one million years ago. Using biogeochemical analyses, precise chronometric dating, palaeoclimate simulations, biome modeling, fire history reconstructions, palaeobotanical studies, faunal assemblages, and archeological evidence, we reconstruct an environment dominated by semidesert shrubland.

The mutation rate of SARS-CoV-2 is highly variable between sites and is influenced by sequence context, genomic region, and RNA structure.

RNA viruses like SARS-CoV-2 have a high mutation rate, which contributes to their rapid evolution. The rate of mutations depends on the mutation type (e.g.

Self-management behaviors do not affect remission but mediate between mental health and disease outcomes in a longitudinal study of rheumatoid arthritis.

Mental health has been shown to impact rheumatoid arthritis (RA) outcomes and is associated with self-management behaviors. The extent to which mental health impacts outcomes via different self-management behaviours has not been thoroughly investigated. Adult RA patients who were starting a new medication or dosage were recruited to a prospective cohort with follow-ups at 3 and 12-months covering clinical and patient-reported outcomes.

Characteristics of refractory disease and persistent symptoms in inflammatory arthritis: Qualitative framework analysis of interviews with patients and health care professionals.

Objectives: This study aims to explore patients' and clinicians' understanding and experiences of refractory disease (RD) and persistent physical and emotional symptoms (PPES) in patients with inflammatory arthritis (IA), namely rheumatoid arthritis or polyarticular juvenile idiopathic arthritis from their perspectives through interviews and/or focus groups.

Design: A qualitative study was conducted, following a pragmatic epistemology approach with framework analysis employed.

Methods: Semi-structured interviews or focus groups with IA patients (n = 25) and multi-disciplinary rheumatology HCPs (n = 32) were conducted at one time point to obtain participants respective understanding and experiences of managing RD/PPES, and its impact on the patient-professional relationship.

Novel electroretinography devices to detect hydroxychloroquine retinopathy: study protocol for a diagnostic accuracy and feasibility study.

Introduction: Annual screening for hydroxychloroquine (HCQ) retinopathy is recommended, and electroretinography (ERG) is considered a gold-standard test, but there are screening shortfalls and standard ERG is burdensome and has limited availability. Newer, portable ERG devices using skin-based electrodes may increase screening capacity but need validation. This study aims to determine initial device accuracies and feasibility of further research.

Association of patient- and hospital-level predictors with patterns of initial treatment in patients with Rheumatoid Arthritis: findings from a national cohort study.

Objectives: To update the first-line conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) prescribing pattern, describe change and variation across demographical and geographical factors in the Rheumatoid arthritis (RA) population, and identify individual and hospital factors associated with it.

Methods: This retrospective cohort study included newly diagnosed RA adult patients from 1 May 2018-1 April 2023 in the UK. We used adjusted multinomial logistic regression with random effect to explore associations with different first-line csDMRAD prescription and to account for hospital-level clustering.

STEM exam performance: Open- versus closed-book methods in the large language model era.

Background: The COVID-19 pandemic accelerated the shift to remote learning, heightening scrutiny of open-book examinations (OBEs) versus closed-book examinations (CBEs) within science, technology, engineering, arts and mathematics (STEM) education. This study evaluates the efficacy of OBEs compared to CBEs on student performance and perceptions within STEM subjects, considering the emerging influence of sophisticated large language models (LLMs) such as GPT-3.

Methods: Adhering to PRISMA guidelines, this systematic review analysed peer-reviewed articles published from 2013, focusing on the impact of OBEs and CBEs on university STEM students.

Impact of visualising healthcare quality performance: a systematic review.

Objective: Performance visualisation tools are increasingly being applied in healthcare to enhance decision-making and improve quality of care. However, there is a lack of comprehensive synthesis of their overall effectiveness and the contextual factors that influence their success in different clinical settings. This study aims to provide a broad synthesis of visualisation interventions not limited to a specific department.

Temporal and regional variation in the use of biologic and targeted synthetic DMARDs for rheumatoid arthritis: a nationwide cohort study.

Objective: To evaluate temporal and regional variation in biologic and targeted synthetic DMARD (b/tsDMARD) initiation for rheumatoid arthritis (RA) in England and Wales.

Methods: An observational cohort study was conducted for people with RA enrolled in the National Early Inflammatory Arthritis Audit (NEIAA) between May 2018 and April 2022 who had 12-month follow-up data. Temporal trends in escalation to b/tsDMARDs within 12 months of initial rheumatology assessment were explored, including comparisons before and after publication (July 2021) of national guidelines that lowered the threshold for b/tsDMARD initiation to include moderate-severity RA.

The relationship between Zoster serology, vaccination uptake and infection rates: a single-centre cross-sectional study.

Objective: This study aimed to assess the prevalence of Varicella-Zoster Virus (VZV) immunity, vaccination uptake and incidence of VZV-related events in inflammatory arthritis (IA) patients initiating biologic or targeted synthetic disease-modifying antirheumatic drugs.

Methods: An observational study was conducted in a single hospital between March 2019 and December 2020. Ninety-three IA patients were included.

Factors influencing seasonal chemistry patterns in Virginia mountain streams.

Unlabelled: The relative influence of seasonal patterns in hydrological flow and seasonal differences in biological and geochemical activity on stream chemistry patterns is difficult to discern because they covary; temperate systems are characterized by lower mean flow in the summer (i.e. corresponding to deeper flow paths, elevated temperature, and biological activity), and higher mean flow in the winter (i.

A latent Axin2/Scx progenitor pool is the central organizer of tendon healing.

A tendon's ordered extracellular matrix (ECM) is essential for transmitting force but is also highly prone to injury. How tendon cells embedded within and surrounding this dense ECM orchestrate healing is not well understood. Here, we identify a specialized quiescent Scx/Axin2 population in mouse and human tendons that initiates healing and is a major functional contributor to repair.

Safety, tolerability, and efficacy outcomes of the Investigation of Levetiracetam in Alzheimer's disease (ILiAD) study: a pilot, double-blind placebo-controlled crossover trial.

Objective: To assess whether the antiseizure medication levetiracetam may improve cognition in individuals with Alzheimer's disease who have not previously experienced a seizure.

Methods: We performed a randomized, double-blind, placebo-controlled crossover pilot study in individuals with mild-to-moderate Alzheimer's disease. Electroencephalography was performed at baseline and those with active epileptiform discharges were excluded.

A 33.5 cm Mucinous Ovarian Carcinoma and Associated Comorbidities in an 89-Year-Old Female.

Ovarian cancer is known to cause the highest mortality of gynecologic cancers. We present the case of an 89-year-old Caucasian female who presented to her surgeon with a large 33.5 cm abdominopelvic mass.

Weight changes following Achilles debridement with flexor hallucis longus transfer: A retrospective analysis.

Obesity poses a growing concern, with global predictions estimating over half the population to be overweight or obese by 2030 (1). While prior research has extensively explored the impact of obesity on hip and knee surgeries, a notable gap persists in understanding weight changes following foot and ankle procedures. This retrospective study focuses on the relationship between Body Mass Index (BMI) and Achilles debridement with flexor hallucis longus (FHL) transfer.

Association between interleukin-12 p40 subunit and risk of primary Sjögren's syndrome: a Mendelian randomization study.

Objectives: Interleukin-12 (IL-12) signalling was proposed in the immunopathogenesis of primary Sjögren's disease. The efficacy of therapies targeting this pathway is currently unclear. Herein, we investigated the associations between circulating proteins involved in the IL-12 and IL-23 signalling pathways on primary Sjögren's disease using mendelian randomization.

Serial transverse enteroplasty in adults with parenteral nutrition dependence: A case series.

Background: Serial transverse enteroplasty is used to treat patients with chronic intestinal failure owing to short bowel syndrome. Current literature lacks discussion of its role for other etiologies of intestinal failure and its impact on adult patients' nutrition support needs and quality of life.

Methods: We performed a case series on adults with parenteral nutrition (PN) dependence who underwent serial transverse enteroplasty at Emory University Hospital, a quaternary referral center between 2011 and 2022.

A conserved transcription factor regulatory program promotes tendon fate.

Tendons, which transmit force from muscles to bones, are highly prone to injury. Understanding the mechanisms driving tendon fate would impact efforts to improve tendon healing, yet this knowledge is limited. To find direct regulators of tendon progenitor emergence, we performed a zebrafish high-throughput chemical screen.

Simple Modification of a DSAEK Carrier Enables Graft Insertion by Injection Without Compromising Endothelial Cell Viability.

Purpose: We evaluate the quality and feasibility of preloading Descemet stripping automated endothelial keratoplasty (DSAEK) grafts into a modified EndoGlide Ultrathin system for graft injection.

Methods: DSAEK grafts were prepared by experienced processing technicians at 2 separate locations, loaded into a modified EndoGlide Ultrathin, and placed in storage media. Grafts processed at one location were shipped cross-country overnight to the other location and were examined on arrival for positioning within the modified EndoGlide Ultrathin.

Harnessing Mobility: A Medically Complex Child's Home Program Utilizing an In-Home Body Weight Support System.

Purpose: To describe a home program for a child with medical complexity using an over-ground body weight support (BWS) system.

Summary Of Key Points: Children with medical complexity often use home programs due to challenges with regular therapy attendance. In this case, effective home program components including child centered design, family leadership, and best practice principles were prioritized around the PUMA (portable mobility aid for children).