Climate Change Curriculum in a Network of US Family Medicine Residency Programs.

Physicians require climate-related training, but not enough is known about actual or desired training at the graduate medical education level. To quantify the climate curriculum provided within a network of family medicine residency programs in the Northwestern United States, to assess barriers to adoption of climate curricula, and to identify preferred climate-related content, delivery methods, and program actions. In fall 2021, residents and faculty in a family medicine residency network responded to a 25-item, anonymous, online survey about climate-related training within their programs.

Routine stream monitoring data enables the unravelling of hydrological pathways and transfers of agricultural contaminants through catchments.

Catchment-scale understanding of water and contaminant fluxes through all pathways is essential to address land use and climate change impacts on freshwater. However, few options exist to obtain this understanding for the many catchments worldwide for which streamflow and low-frequency water chemistry, but little other data exists. We applied the Bayesian chemistry-assisted hydrograph separation and load partitioning model (BACH) to 47 catchments with widely differing characteristics.

Automated Motor Tic Detection: A Machine Learning Approach.

Background: Video-based tic detection and scoring is useful to independently and objectively assess tic frequency and severity in patients with Tourette syndrome. In trained raters, interrater reliability is good. However, video ratings are time-consuming and cumbersome, particularly in large-scale studies.

Improving accuracy of quantifying nitrate removal performance and enhancing understanding of processes in woodchip bioreactors using high-frequency data.

Woodchip bioreactors have gained popularity in many countries as a conservation practice for reducing nitrate load to freshwater. However, current methods for assessing their performance may be inadequate when nitrate removal rates (RR) are determined from low-frequency (e.g.

Reconstructing in-depth activity for chaotic 3D spatiotemporal excitable media models based on surface data.

Motivated by potential applications in cardiac research, we consider the task of reconstructing the dynamics within a spatiotemporal chaotic 3D excitable medium from partial observations at the surface. Three artificial neural network methods (a spatiotemporal convolutional long-short-term-memory, an autoencoder, and a diffusion model based on the U-Net architecture) are trained to predict the dynamics in deeper layers of a cube from observational data at the surface using data generated by the Barkley model on a 3D domain. The results show that despite the high-dimensional chaotic dynamics of this system, such cross-prediction is possible, but non-trivial and as expected, its quality decreases with increasing prediction depth.

Achieving unbiased predictions of national-scale groundwater redox conditions via data oversampling and statistical learning.

An important policy consideration for integrated land and water management is to understand the spatial distribution of nitrate attenuation in the groundwater system, for which redox condition is the key indicator. This paper proposes a methodology to accommodate the computational demands of large datasets, and presents national-scale predictions of groundwater redox class for New Zealand. Our approach applies statistical learning methods to relate the redox class determined on groundwater samples to spatially varying attributes.

Controlled Spacing between Nanopatterned Regions in Block Copolymer Films Obtained by Utilizing Substrate Topography for Local Film Thickness Differentiation.

Various types of devices require hierarchically nanopatterned substrates, where the spacing between patterned domains is controlled. Ultraconfined films exhibit extreme morphological sensitivity to slight variations in film thickness when the substrate is highly selective toward one of the blocks. Here, it is shown that using the substrate's topography as a thickness differentiating tool enables the creation of domains with different surface patterns in a fully controlled fashion from a single, unblended block copolymer.

Estimation of Random Coefficient Multilevel Models in the Context of Small Numbers of Level 2 Clusters.

Multilevel data are a reality for many disciplines. Currently, although multiple options exist for the treatment of multilevel data, most disciplines strictly adhere to one method for multilevel data regardless of the specific research design circumstances. The purpose of this Monte Carlo simulation study is to compare several methods for the treatment of multilevel data specifically when there is random coefficient variation in small samples.

The influence of unsaturated zone drainage status on denitrification and the redox succession in shallow groundwater.

Since nitrate is a major agricultural freshwater contaminant, denitrification is the environmentally most important step in the ecological succession of redox processes that can occur in groundwater. Understanding where and to what extent denitrification occurs would enable spatially differentiated land management and regulation. We investigated in a dairy farming catchment in the North Island of New Zealand the influence of the unsaturated zone's drainage status on the redox succession in shallow groundwater along a well transect spanning drainage conditions from well drained to very poorly drained.

Vertical stratification of redox conditions, denitrification and recharge in shallow groundwater on a volcanic hillslope containing relict organic matter.

Natural denitrification in groundwater systems has been recognised as an ecosystem service that reduces the impact of agriculturally-derived nitrate inputs to surface waters. Identification of this ecosystem service within the landscape would permit spatially differentiated land management and legislation. However, spatial variation in groundwater redox conditions poses a significant challenge to such a concept.

Aberrant Lck Signal via CD28 Costimulation Augments Antigen-Specific Functionality and Tumor Control by Redirected T Cells with PD-1 Blockade in Humanized Mice.

Combination therapy of adoptively transferred redirected T cells and checkpoint inhibitors aims for higher response rates in tumors poorly responsive to immunotherapy like malignant pleural mesothelioma (MPM). Only most recently the issue of an optimally active chimeric antigen receptor (CAR) and the combination with checkpoint inhibitors is starting to be addressed. Fibroblast activation protein (FAP)-specific CARs with different costimulatory domains, including CD28, Δ-CD28 (lacking lck binding moiety), or 4-1BB were established.

Bordetella pertussis proteins dominating the major histocompatibility complex class II-presented epitope repertoire in human monocyte-derived dendritic cells.

Knowledge of naturally processed Bordetella pertussis-specific T cell epitopes may help to increase our understanding of the basis of cell-mediated immune mechanisms to control this reemerging pathogen. Here, we elucidate for the first time the dominant major histocompatibility complex (MHC) class II-presented B. pertussis CD4(+) T cell epitopes, expressed on human monocyte-derived dendritic cells (MDDC) after the processing of whole bacterial cells by use of a platform of immunoproteomics technology.

Aligning provider incentives to improve primary healthcare delivery in the United States.

Background: The United States (US) is reforming primary care delivery systems, including the implementation of 'patient-centered medical homes.' Alignment of provider incentives with desired outcomes will likely be important to the success of these delivery system reforms.

Methods: This critical review uses a theoretical framework from game-theory models to discuss some of the dominant primary care provider payment models and how they create 'prisoner's dilemmas' that have stalled past reform efforts.

The impact of relict organic materials on the denitrification capacity in the unsaturated-saturated zone continuum of three volcanic profiles.

The denitrification capacity of wetlands, riparian zones, and aquifers in glacial outwash areas is well documented, but little or no information exists for volcanic profiles, particularly those containing relict organic matter contained in or on top of paleosols (old soils buried by volcanic deposits) below the groundwater table. Relict carbon contained in these layers could provide the necessary electrons to fuel heterotrophic denitrification. To the best of our knowledge, this is the first study investigating the denitrification capacity in both the unsaturated and saturated zone of volcanic profiles.

Ultrasound screening strategies for the diagnosis of congenital anomalies of the kidney and urinary tract.

Purpose: Congenital anomalies of the kidneys and urinary tract (CAKUT) are among the most common anomalies in newborn infants, and may cause chronic renal disease in newborns. We investigated the sensitivity and specificity of different ultrasound-based screening strategies for CAKUT.

Materials And Methods: Newborns (n = 4331) were analyzed for CAKUT in at least one ultrasound examination as a part of the Survey of Neonates in Pomerania (SNiP), a 7-year population-based study on neonates in Western Pomerania (Germany).

Defining the medical home: the Oregon experience.

Objective: The patient-centered medical home (PCMH) is emerging as a key strategy to improve health outcomes, reduce total costs, and strengthen primary care, but a myriad of operational measures of the PCMH have emerged. In 2009, the state of Oregon convened a public, legislatively mandated committee charged with developing PCMH measures. We report on the process of, outcomes of, and lessons learned by this committee.

Fast, antigen-saving multiplex immunoassay to determine levels and avidity of mouse serum antibodies to pertussis, diphtheria, and tetanus antigens.

To enhance preclinical evaluation of serological immune responses to the individual diphtheria, tetanus, and pertussis (DTP) components of DTP combination vaccines, a fast hexavalent bead-based method was developed. This multiplex immunoassay (MIA) can simultaneously determine levels of specific mouse serum IgG antibodies to P antigens P.69 pertactin (P.

Differential effect of TLR2 and TLR4 on the immune response after immunization with a vaccine against Neisseria meningitidis or Bordetella pertussis.

Neisseria meningitidis and Bordetella pertussis are Gram-negative bacterial pathogens that can cause serious diseases in humans. N. meningitidis outer membrane vesicle (OMV) vaccines and whole cell pertussis vaccines have been successfully used in humans to control infections with these pathogens.

Minimally-invasive implantation of living tissue engineered heart valves: a comprehensive approach from autologous vascular cells to stem cells.

Objectives: The aim of this study was to demonstrate the feasibility of combining the novel heart valve replacement technologies of: 1) tissue engineering; and 2) minimally-invasive implantation based on autologous cells and composite self-expandable biodegradable biomaterials.

Background: Minimally-invasive valve replacement procedures are rapidly evolving as alternative treatment option for patients with valvular heart disease. However, currently used valve substitutes are bioprosthetic and as such have limited durability.

Impaired long-term maintenance and function of Bordetella pertussis specific B cell memory.

Frequent occurrence of whooping cough in vaccinated populations suggests limited duration of vaccine-induced immunological memory. To investigate peculiarities in B cell memory specific for pertussis antigens P.69 pertactin (P.

Policy challenges in building the medical home: do we have a shared blueprint?

Background: The notion of a patient-centered medical home features prominently in policy reform initiatives across the country, with both state and federal legislation focusing on this new model. We sought to understand the views of key stakeholders and to examine the challenging landscape facing policymakers and practitioners as they attempt to translate the medical home concept into widespread practice change.

Methods: We reviewed legislative documents from state legislative sessions in the year 2007 to identify pieces of legislation that included the medical home concept.