The Nearctic cynipid oak gall wasp genus Feron Kinsey, comb. rev., is re-established with 34 species: F. albicomus (Weld, 1952), comb. nov., F. amphorus (Weld, 1926), comb. nov., F. apiarium (Weld, 1944), comb. nov., F. atrimentum (Kinsey, 1922), comb. nov., F. bakkeri (Lyon, 1984), comb. nov., F. caepula (Weld, 1926), comb. nov., F. californicum (Beutenmueller, 1911), comb. nov., F. clarkei (Bassett, 1890), comb. nov., F. comatum (Weld, 1952), comb. nov., F. crystallinum (Bassett, 1900), comb. nov., F. cylindratum (Kinsey, 1937), comb. nov., F. discale (Weld, 1926), comb. nov., F. discularis (Weld, 1926), comb. nov., F. dumosae (Weld, 1957), comb. nov., F. gigas (Kinsey, 1922), comb. nov., F. izabellae Melika, Nicholls & Stone, sp. nov., F. kingi (Bassett, 1900), comb. nov., F. parmula (Bassett, 1900), comb. nov., F. pattersonae (Fullaway, 1911), comb. nov., F. roberti Melika, Nicholls & Stone, sp. nov., F. rucklei Melika, Nicholls & Stone, sp. nov., F. scutellum (Weld, 1930), comb. nov., F. serranoae Pujade-Villar & Cuesta-Porta, sp. nov., F. splendens (Weld, 1919), comb. nov., F. stellare (Weld, 1926), comb. nov., F. stellulum (Burnett, 1974), comb. nov., F. sulfureum (Weld, 1926), comb. nov., F. syndicorum Pujade-Villar & Cuesta-Porta, sp. nov., F. tecturnarum (Kinsey, 1920), comb. nov., F. tetyanae Melika, sp. nov., F. tibiale Kinsey, 1937, comb. rev., F. tubifaciens (Weld, 1926), comb. nov., F. verutum Kinsey, 1937, comb. rev., and F. vitreum Kinsey, 1937, comb. rev. Most species are known only from the asexual generation; F. clarkei, F. comatum, and F. dumosae are known only from the sexual generation, while both generations are recognised for F. atrimentum, F. crystallinum, F. gigas, F. kingi, and F. pattersonae. Matching of alternate sexual and asexual generations is established for the first time for F. kingi and F. pattersonae (= Andricus pedicellatus (Kinsey, 1922), syn. nov.) based on molecular data (both cytb and ITS2 sequences). Morphological descriptions, re-descriptions, diagnoses, and a key to species are given, as well as data on DNA sequences, biology, phenology, and distribution.

ABSTRACT Transit timing variations (TTVs) can be induced by a range of physical phenomena, including planet–planet interactions, planet–moon interactions, and stellar activity. Recent work has shown that roughly half of moons would induce fast TTVs with a short period in the range of 2–4 orbits of its host planet around the star. An investigation of the Kepler TTV data in this period range identified one primary target of interest, Kepler-1513 b. Kepler-1513 b is a $8.05^{+0.58}_{-0.40}$ R⊕ planet orbiting a late G-type dwarf at $0.53^{+0.04}_{-0.03}$ au. Using Kepler photometry, this initial analysis showed that Kepler-1513 b’s TTVs were consistent with a moon. Here, we report photometric observations of two additional transits nearly a decade after the last Kepler transit using both ground-based observations and space-based photometry with TESS. These new transit observations introduce a previously undetected long period TTV, in addition to the original short period TTV signal. Using the complete transit data set, we investigate whether a non-transiting planet, a moon, or stellar activity could induce the observed TTVs. We find that only a non-transiting perturbing planet can reproduce the observed TTVs. We additionally perform transit origami on the Kepler photometry, which independently applies pressure against a moon hypothesis. Specifically, we find that Kepler-1513 b’s TTVs are consistent with an exterior non-transiting ∼Saturn mass planet, Kepler-1513 c, on a wide orbit, $\sim 5~{{\ \rm per \, cent}}$ outside a 5:1 period ratio with Kepler-1513 b. This example introduces a previously unidentified cause for planetary interlopers in the exomoon corridor, namely an insufficient baseline of observations.

Importance: Excess aldosterone production contributes to hypertension in both classical hyperaldosteronism and obesity-associated hypertension. Objective: To compare the safety and efficacy of lorundrostat, an aldosterone synthase inhibitor, with placebo, and characterize dose-dependent safety and efficacy. Design, Setting, and Participants: Randomized, placebo-controlled, dose-ranging, double-blind clinical trial among adults with uncontrolled hypertension taking 2 or more antihypertensive medications. A first cohort of participants with suppressed plasma renin (plasma renin activity (PRA) of less than 1.0 ng/mL/h) and elevated plasma aldosterone (greater than 1.0 ng/dL) were enrolled (n=163), with subsequent enrollment of participants with PRA greater than 1.0 ng/mL/h (n=37). Interventions: Participants were randomized to placebo or one of five doses of lorundrostat (12.5, 50, or 100 mg once daily, or 12.5 or 25 mg twice daily.) Results: Following 8 weeks of treatment in participants with suppressed PRA, dose-dependent changes in office systolic BP were observed (figure). The primary endpoint, placebo-subtracted change in modeled systolic BP was -9.6 mmHg (90% confidence interval [CI], -15.8 to -3.4, p=0.01) for the 50 mg once daily dose and -7.8 mmHg (90% CI, -14.1 to -1.5, p=0.04) for 100 mg daily. Six participants had increases in serum potassium above 6.0 mmol/L that were reversed with dose reduction or drug discontinuation. Conclusions and Relevance: Among individuals with uncontrolled hypertension, use of lorundrostat was effective at lowering blood pressure compared with placebo.

AID systems aim to reduce mental burden experienced by people with diabetes by automatically adjusting insulin delivery in response to real-time glucose levels; however, systems still require pre-meal boluses for optimal outcomes. A system providing an automatic bolus response (‘AutoBolus’) to rising glucose levels (e.g., after meals) lessens user burden and reduces hyperglycemic events by compensating for missed or under-estimated pre-meal boluses. We propose a novel method to deliver an AutoBolus based on rising glucose levels via a machine learning based meal detection algorithm. AutoBolus meal detection is paired with a two-part novel insulin delivery scheme with an immediate safe upfront delivery, followed by temporarily tuning AID algorithm parameters to progressively respond to the post-prandial glucose response by delivering additional insulin. If a decreasing glucose condition is detected, the AID algorithm parameters revert to baseline. In-silico simulation demonstrates AutoBolus increases time in euglycemia by as much as 11% in adolescents, 8% in adults, and 6% in children for missed boluses for three meals in a 24-hour period. Our results show that the proposed AutoBolus insulin delivery partially compensates for missed pre-meal boluses increasing time in euglycemia, reducing user burden. Figure. Illustrative diagram showing the two-part novel insulin delivery scheme upon meal detection. Disclosure R.Narayanaswami: None. Y.Zheng: Employee; Insulet Corporation. W.J.Whiteley: Employee; Insulet Corporation. M.Sevil: None. S.Salavati: Employee; Insulet Corporation.

A new species, Holocynips illinoiensis Melika & Nicholls, sp. nov. is described from the Nearctic (America north of Mexico). Description, diagnoses, information on biology and host association is given for the new species, as well as preliminary discussion on the coherence of the genus Holocynips.

We report the confirmation of three exoplanets transiting TOI-4010 (TIC-352682207), a metal-rich K dwarf observed by the Transiting Exoplanet Survey Satellite in Sectors 24, 25, 52, and 58. We confirm these planets with the High Accuracy Radial velocity Planet Searcher for the Northern Hemisphere radial velocity observations and measure their masses with 8−12% precision. TOI-4010 b is a sub-Neptune (P = 1.3 days, , ) in the hot-Neptune desert, and is one of the few such planets with known companions. Meanwhile, TOI-4010 c (P = 5.4 days, , ) and TOI-4010 d (P = 14.7 days, , ) are similarly sized sub-Saturns on short-period orbits. Radial velocity observations also reveal a super-Jupiter-mass companion called TOI-4010 e in a long-period, eccentric orbit (P ∼ 762 days and e ∼ 0.26 based on available observations). TOI-4010 is one of the few systems with multiple short-period sub-Saturns to be discovered so far.

Abstract Background: Characterization of the aggressive biology of triple-negative breast cancer (TNBC), defined by its lack of estrogen receptor, progesterone receptor, and human epidermal growth factor 2 (HER2) expression, has led to the development of more effective treatments for patients, but research indicates that clinicians face challenges in maintaining a working knowledge of evolving data. This study was conducted to determine what learning gaps exist in the area of therapeutic advances in TNBC and to investigate whether an online, case-based continuing medical education (CME)/nursing continuing professional development (NCPD)–approved activity could address gaps in clinicians’ knowledge regarding the personalized care of patients with metastatic TNBC. Methods: The CME/NCPD-approved live webinar series titled Metastatic Triple-Negative Breast Cancer: Applying Treatment Advances to Personalized Care was presented by Sara A. Hurvitz, MD, FACP, on July 13 and July 15, 2021, and was made accessible as a CME/NCPD-approved enduring webinar archive starting on July 23, 2021. Learners participated in a 1-hour activity that highlighted emerging therapeutic targets in TNBC, with an emphasis on current challenges and new opportunities in the management of metastatic disease. Learners completed a repeated-pairs pre- and post-activity assessment consisting of case-based questions that gauged their ability to apply emerging data to clinical decision making. Baseline knowledge gaps and subsequent learning gains were calculated based on percentages of learners obtaining correct responses on the pre- and post-activity assessments. Significance was assessed using a chi-squared test. In addition, learners reported self-perceived gains in confidence and competence using 5-point Likert scale questions. Results: As of June 28, 2022, 811 clinicians had completed the activity for credit; 62 learners participated in the live webinar, while 749 participated in the online enduring activity. Baseline assessment data revealed gaps in knowledge regarding emerging actionable targets and management of treatment-related adverse events (Table 1). Learners participating in the enduring activity scored an average of 43% on pretest topics; after completing the activity, the posttest average rose to 92%. The activity resulted in significant gains in knowledge and competence related to these topics, with P < 0.0001 for all learning gains. Upon completion of the activity, 86% of learners self-reported that knowledge acquired from this activity would be utilized to improve the outcomes of their patients, and 86% of learners self-reported that based on the information learned during the activity, they felt more confident in treating patients with metastatic TNBC. Conclusions: These data indicate that a substantial knowledge gap exists regarding the latest developments in the treatment of metastatic TNBC. They also demonstrate that online, case-based CME/NCPD-approved activities can result in statistically significant improvements in clinicians’ knowledge of therapeutic advances and management of treatment-related adverse events for patients with metastatic TNBC. Acknowledgements: This activity was supported by an independent educational grant from Merck. Table 1. Baseline Knowledge Gaps and Post-Activity Learning Gains. Citation Format: Elizabeth J. Heller, Keira Smith, Sarah L. Williams. Therapeutic Advances in Metastatic Triple-Negative Breast Cancer: Identifying and Reducing Clinician Knowledge Gaps [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-08-04.