Rhode Island Research Articles

Pregnancy Outcomes from a Multidisciplinary Obstetric-Medicine/Rheumatology Clinic in the United States: A Five-Year Retrospective Analysis.

At Women & Infants Hospital in Providence, Rhode Island, the Specialty Care in Pregnancy clinic combines obstetric-medicine internists with rheumatologists to care for pregnant patients with rheumatologic conditions. These clinics are scarce, with only three known similar clinics in the United States. This study aims to characterize the population cared for in this clinic, identify interventions, and analyze pregnancy outcomes for the birthing parents and newborns. A five-year retrospective chart review was performed from January 1st, 2016, through December 31st, 2021. Of 81 patients, 62% had a clinically diagnosed rheumatic disorder. Of 87 patient visits, which included preconception, prenatal, and postpartum encounters, 54% of patients were taking conventional synthetic disease modifying antirheumatic drugs, and 17% were taking biologic disease modifying antirheumatic drugs. New medications were started in 52% of patients. A total of 52% of pregnancies resulted in live births, with 2% resulting in miscarriages. Prematurity occurred in 19% of newborns, and 9% had intrauterine growth restriction. Our study illustrates the benefits of multidisciplinary care in patients with rheumatologic disorders during their prenatal and perinatal periods. The expertise from both the obstetric-medicine internists and rheumatologists was critical in making complex decisions that weighed the benefits of therapy against potential risks for the fetus. Our multidisciplinary approach resulted in doubling of the number of patients initiating disease modifying therapy and increased prophylaxis with hydroxychloroquine and/or aspirin therapy, as recommended by current guidelines. Additional multidisciplinary clinics of this type would help coordinate care among physicians who frequently treat these high-risk, unique patients and open the door for more research of this understudied population.

Neurodevelopmental outcomes in children prenatally exposed to opioid maintenance treatment: A population-based study.

Opioid maintenance treatment (OMT), with methadone or buprenorphine, is a key approach for managing opioid use disorder (OUD) during pregnancy. Despite buprenorphine's superior short-term outcomes, its long-term effects remain understudied. This study aims to evaluate the effects of prenatal OMT exposure on the incidence of childhood neurodevelopmental disorders (NDDs) considering timing effect. A retrospective cohort study using Rhode Island Medicaid data linked to vital statistics from 2008 to 2018 was conducted. The study included pregnancies having live birth from 2008 to 2016 with continuous Medicaid insurance and OUD diagnosis within 3 months preceding conception until delivery. At least one buprenorphine dispensing or a claim of methadone was required for exposure definition. Exposure was evaluated during early (0-90 days) or late (>90 days) gestation, or at any pregnancy phase. NDDs, including autism, attention-deficit/hyperactivity disorder (ADHD), learning disabilities, speech/language disorders, developmental coordination disorder, intellectual disability, and behavioral disorders, were identified using validated algorithms. Applying Cox proportional-hazard models with propensity score overlap weighting, adjusted hazard ratios (aHR) were calculated, mitigating potential confounders. Children were followed up from birth until NDD diagnosis, disenrollment, or study end. Of 416 mother-child dyads with OUD, 40% used methadone and 20% had buprenorphine exposure during pregnancy. NDDs were observed in 36% of children with early methadone exposure compared to 17% in the early buprenorphine exposed group (aHR: 2.75; 95% confidence interval [CI]: 1.42-5.35). Further comparison to late buprenorphine exposure, late methadone exposure was associated with higher NDD risk (aHR: 2.05; 95% CI: 1.09-3.86). Compared to unexposed group, children exposed to methadone during early and late periods showed higher NDD incidences (aHR: 2.33; 95% CI: 1.51-3.60 and aHR: 2.42; 95% CI: 1.54-3.80, respectively). The study suggests that buprenorphine is a good treatment option for OUD during pregnancy due to minimal long-term neurodevelopmental impacts on children. However, further extensive research is necessary to rule-out potential confounding.

Muskrat occurrence in Rhode Island shows little evidence of land use change driving declines

AbstractMuskrat (Ondatra zibethicus) populations have been in apparent decline across their native range in North America for decades. Several hypotheses exist for the causes of these declines, including loss of wetlands. We used time‐to‐detection data from 925 surveys from 276 sites across Rhode Island, USA, between 2021–2023 to fit an occupancy model that related the probability of muskrat occupancy at a site to land cover classification. We found that muskrat occupancy was higher in areas with more open water, urban land cover, or a second‐order or larger stream, and lower in areas with salt water. We estimated changes in wetland area throughout Rhode Island using the National Land Cover Database classifications from 2001 and 2019 and found a net loss in wetland cover of 219 ha. We calculated the distance between wetland patches in each of these periods and found that patches were closer together than the dispersal distance of muskrats, suggesting isolation is unlikely to be driving muskrat declines. Additionally, when we used our model to predict changes in muskrat occupancy between 2001 and 2019, both mean and median predicted occupancy changed by <0.005. These results indicate that muskrat declines are not driven by habitat loss, and suggest future research is needed that focuses on other hypothesized mechanisms of muskrat declines such as disease, declining habitat quality, predation, and competition.

An Ocean Memory Perspective: Disentangling Atmospheric Control of Decadal Variability in the North Atlantic Ocean

AbstractAn ocean memory framework is proposed to reveal the atmosphere's influence on ocean temperatures. Anomalous atmospheric forcing alters the ocean state through two mechanisms: short‐term, local effects involving airsea heat fluxes and Ekman circulation, and long‐term, far‐field effects involving changes from overturning and gyre circulations. The framework employs the Green function's method to incorporate both effects, enabling the quantification of ocean memory and the contribution of atmospheric forcing to ocean thermal variability. The framework is employed to examine the North Atlantic Oscillation's (NAO) influence on the North Atlantic Ocean variability, including the Atlantic Multidecadal Variability, with its memory estimated to be years. The NAO and variability in the North Atlantic jet speed explain up to 30% of ocean decadal variability, primarily driven by temporal changes in ocean heat transport. Therefore, decadal fluctuations in ocean temperatures cannot be accurately modeled solely as a passive response to stochastic atmospheric forcing.

Addressing barriers to implementing and scaling PrEP in carceral settings: Applying insights from implementation science.

Within the United States, individuals experiencing incarceration are at higher risk for HIV acquisition compared to the general population, yet may face additional difficulty engaging in HIV prevention clinical services. HIV pre-exposure prophylaxis (PrEP) is an effective approach to preventing HIV transmission, and the Centers for Disease Control (CDC) recommends that PrEP be offered in carceral settings, particularly during the vulnerable community re-entry period. However, there have been few efforts to scale PrEP in this setting. Based on our experience implementing PrEP in Rhode Island's state carceral system, we have identified potential approaches to overcoming barriers to PrEP use in this unique practice environment by utilizing the implementation research logic model (IRLM). We then evaluated specific implementation determinants and barriers as well as strategies used to overcome those barriers to effectively scale PrEP in this setting. We developed a "toolkit," or 14-step guide, for others in the field to use for implementing PrEP in carceral settings including the development and use of clinical protocols as well as community linkage strategies. Our experiences with barriers in the carceral setting, identifying and leveraging implementation strategies, allowed us to develop a "toolkit" to guide other PrEP implementation projects in carceral settings. We encourage others to scale-out our work to other carceral settings to better reach and engage a group of individuals both at elevated risk for HIV and currently underserved by HIV prevention strategies, including PrEP.

Engagement in substance use disorder treatment after an emergency department visit among persons at high risk of opioid overdose: A prediction analysis

BackgroundCertified peer recovery specialists (CPRS) and licensed clinical social workers (LCSWs) can facilitate substance use disorder (SUD) treatment engagement for emergency department (ED) patients at risk for overdose. Predictors of treatment engagement after such behavioral services are unknown. MethodsThis secondary analysis included Rhode Island ED patients at high risk for opioid overdose participating in a randomized controlled trial comparing the effectiveness of CPRS and LCSWs services (2018–2021). SUD treatment engagement within 90 days post-discharge was identified using statewide administrative data. Potential predictors were obtained from baseline questionnaires. Classification and regression trees (CART) were used to identify predictors of treatment engagement. ResultsIn the ED, 323 and 325 participants received CPRS and LCSWs services, respectively, among whom 141 (43.7 %) and 137 (42.2 %) engaged in SUD treatment within 90 days post-discharge. For the CPRS group, predictors of treatment engagement included unhealthy alcohol use, prescription opioid or benzodiazepine use in past 6 months, and lifetime history of: unstable housing, barriers to treatment, bipolar disorder diagnosis, addiction treatment, and recovery services. In the LCSW group, predictors included health insurance, current pain, opioid overdose in past year, and lifetime history of anxiety disorder diagnosis and mental illness treatment. However, CART had low predictive accuracy (CPRS: 60.9 %, LCSW: 54.8 %). ConclusionsAmong ED patients at high risk of opioid overdose receiving behavioral services, 90-day SUD treatment engagement was high. Sociobehavioral and clinical patient characteristics did not accurately predict treatment engagement. Behavioral services should be offered to all ED patients at high risk of opioid overdose.

Uncovering the interannual predictability of the 2003 European summer heatwave linked to the Tibetan Plateau

Known as the Third Pole, the Tibetan Plateau (TP) significantly influences global weather and climate, but its potential for improving subseasonal-to-interannual predictions remains underexplored. Through coupled climate simulations and hindcast experiments, we uncovered interannual predictability of the 2003 European summer heatwave that persisted from June to August with devastating impacts. Hindcasts initialized from the atmosphere, land, and ocean states of a coupled simulation that assimilates soil moisture and soil temperature data over the TP show substantial skill in predicting this heatwave two years in advance. Hindcast sensitivity experiments isolated the indispensable role of the spring TP snow cover anomalies and their impact on the Atlantic and Pacific Oceans in exciting the Rossby waves that contributed to the anomalous European summer temperature. These findings highlight the dominant and remote influence of the TP and motivate research on its role in enhancing the predictability of extreme events worldwide.

Lethal grip for an endangered endemic frog: The freshwater crab Potamon karpathos (Decapoda, Potamidae) preys on Karpathos water frog Pelophylax cerigensis (Anura, Ranidae)

Invertebrate predation on amphibians is widespread, although unreported in Europe. Here, we present documented predation of the Karpathos water frog (Pelophylax cerigensis) by the crab Potamon karpathos. Pelophylax cerigensis is an endangered, endemic species exclusively found on the Rhodes and Karpathos Islands in the South Aegean Sea, Greece. The Karpathos population is at risk due to limited suitable habitats and a scarcity of freshwater bodies on the island. From April to October, when there is no rain on the island, frogs and crabs cohabitate, sharing the same shallow ditches. Incidents of frog predation by crabs are common, indicated by numerous individuals with amputated limbs and scars, representing an additional threat to the endangered frog. Further research on the interactions between the two species is urgently required, as it has direct conservation implications.

Evaluation of zinc oxide nanocomposites and L-ascorbic acid on meat quality during transport induced stress in birds of Sonali breed

The study assessed the efficacy of phytofabricated zinc oxide nanoparticles (CF-ZnONPs) and L-ascorbic acid in alleviating pre-slaughter transport induced stress in birds of Sonali breed (Cross bred of Rhode Island Red cocks and Fayoumi hens). A total of 120 birds were divided into four groups: negative control (T1) which were loaded in vehicle but not transported, Positive control (T2) birds were transported without any prior supplementation, T3 and T4 birds were transported with prior supplementation (a day before transportation) of CF-ZnONPs @100 µg/ml and L-ascorbic acid @82 µg/ml in drinking water. Results obtained observed significant reduction in live weight, meat colour and pH but increased drip loss percentage in T2 group. Significantly elevated H/L ratio was recorded in all transported groups. Increased cortisol and TSH levels and decreased thyroid hormones, Triiodothyronine and thyroxin (T3 and T4) levels were recorded in T2 group. However, supplementation with CF-ZnONPs and L-ascorbic acid notably reversed these adverse effects, restoring meat quality and other metabolic profiles. Notably, ascorbic acid exhibited greater efficacy, suggesting its superior role in mitigating transportation-induced stress. Overall, these findings highlight the importance of antioxidant supplementation in alleviating transport induced stress in birds.

8772 Impact of Stress Hyperglycemia on Individuals Hospitalized for COVID-19 with and without Diabetes

Abstract Disclosure: E. Burguera-Couce: None. V.O. Cheng: None. J.G. Monteiro: None. G. Gopalakrishnan: None. Background: Stress hyperglycemia (SH), the physiologic increase in blood glucose during severe illness, has been linked with poor outcomes in certain disease states1. Hyperglycemia in the setting of diabetes (DM) has been well established as a predictor of poor outcomes in Coronavirus disease 2019 (COVID-19) infection2-4. The impact of SH on health outcomes for individuals without DM (NoDM) hospitalized with COVID-19 infection is less clear with studies reporting variable outcomes in this population4-6. Objective: To evaluate the impact of SH on health outcomes among hospitalized individuals with COVID-19Methods: Data from 1001 individuals with SH (defined as ≥ 2 instances of BG above 180 mg/dL) admitted in Rhode Island with COVID-19 infection during the first-wave (March 1-June 30, 2020) and second-wave (July 1, 2020-February 28, 2021) was analyzed. Multivariate logistic regression was conducted to compare DM status for length of stay (LOS), ICU admission, mechanical ventilation (MV) and in-hospital mortality, and was adjusted for age, race/ethnicity, gender, insurance, and wave. Model investigating risk factors associated with poor outcomes (ICU admission, MV or in-hospital mortality) in hospitalized individuals with SH was additionally adjusted to include BMI, Chronic kidney disease (CKD), hypertension (HTN), pulmonary disease, and cardiovascular diseases. Results: 17.0% (170) of the cohort had NoDM. Average age (67.6±13.9), gender (57.1% male) and race/ethnicity (Caucasian/White 48.9%, Hispanic 28.0%, Black 13.2% and Other 10.0%) noted in the overall cohort. Individuals with NoDM were more likely to be Caucasian/White (57.7 vs 47.1%, p-value=0.0122), and more likely to require LOS ≥1-week (OR 2.32[1.57-3.44]), ICU admission (2.26[1.60-3.20]) and MV (3.39[2.35-4.89]). NoDM was also associated with higher in-hospital mortality (3.44[2.39-4.96]). The risk of poor outcomes was significantly higher in NoDM compared to DM (ICU admission 47.7 vs 28.6%, MV 45.3 vs 20.1%, Mortality 41.8 vs. 18.2%). In multivariate analysis, Caucasians/Whites (0.50[0.29-0.87]) were less likely to have poor outcomes than the other races. NoDM (3.55[2.40-5.25]), male gender (1.57[1.16-2.13]), CKD stage 5 (1.94[1.40-2.68]), and admission during the first-wave (2.64[1.89-3.70]) were identified as independent risk factors for poor outcomes in SH associated with COVID-19. Conclusion: Our study showed that individuals without a known diagnosis of diabetes hospitalized with COVID-19 who experienced SH during their hospital course had worse outcomes when compared to individuals with diabetes and hyperglycemia. NoDM, male gender, nonwhite race/ethnicity, CKD stage 5 and admission during the first wave were identified as independent risk factors for poor outcomes in COVID-19 hospitalizations with hyperglycemia. Presentation: 6/1/2024

Impact of High-Dose Supplemental Paprika Extract Feeding on Egg Storage and Biochemical Parameters in Laying Hens.

This study aimed to evaluate the effects of paprika extract supplementation on egg storage and blood biochemical parameters in 63-week-old Rhode Island Red (RIR) and Silky Fowl (SF) hens. The hens were divided into three groups: a control group with a basal diet and two groups receiving the basal diet with paprika extract. The trial lasted 28 days, with egg quality (yolk color and albumen pH) assessed after storing eggs at 25 °C for 21 days. A total of 144 eggs were used in 42 treatments (two breeds, three diets, and seven storage periods) with three eggs examined each (four eggs were used on day 0 and five eggs on day 21). Additionally, the yolk carotenoid content, yolk color, and pH of eggs stored at 4 °C and 25 °C were compared. Results showed that yolk color fan score (YCFS) decreased with storage, and SF had a higher albumen pH than RIR, with both breeds exhibiting an increase in pH over time. HDL cholesterol (HDL-C) levels and the HDL-C to total cholesterol ratio were significantly influenced by breed, diet, and their interaction. The HDL-C level in SF was affected linearly and quadratically by diet, while no such trend was observed in RIR. The study concluded that paprika extract affects egg quality and blood lipid profiles differently in different breeds, highlighting breed-specific responses to dietary supplementation.

Assessing student and patient perspectives on pharmacist-prescribed hormonal contraceptives

BackgroundIncreasing convenient, accessible, and cost effective contraceptive access is critically important. Two-thirds of U.S. states permit pharmacists to prescribe hormonal contraceptives. Community pharmacies are ideal settings for patients to be offered contraceptive therapeutic options, including hormonal contraceptives, emergency contraception (EC), and over-the-counter (OTC) oral contraception. ObjectiveThe objective of this study was to assess college student and community pharmacy patients’ perspectives on pharmacist-prescribed hormonal contraceptives, likelihood of accessing contraceptives from a pharmacist, and perspectves regarding EC and OTC oral contraception. MethodsThe researchers conducted an observational study distributed to college students and patients accessing care at community-based pharmacies from October 2022 to February 2023. The survey population included those who were 18 years or older, English speaking, and recruited both in person and online. Survey questions assessed barriers to contraception access, perspectives toward pharmacist-prescribed hormonal contraception, likelihood of receiving pharmacist-prescribed hormonal contraception, as well as EC and OTC oral contraception at the community pharmacy. Results from the pharmacist and clinician surveys were previously published, therefore this report will focus on the student and patient data. ResultsNinety-one percent of all respondents strongly agreed or agreed with pharmacist-prescribed hormonal contraception. Students and patients reported convenience, time-saving, and money saving as reasons for obtaining from their pharmacist. In regard to EC, 36% reported having ever purchased from a pharmacy and 58% were extremely or somewhat likely to purchase OTC oral contraception. ConclusionsThe majority of students and community pharmacy patients surveyed in Rhode Island support pharmacist-prescribed hormonal contraceptives. State-level policy advancements with reimbursement for services provide pharmacists an opportunity to provide contraceptive care for all people.

Babesiosis: Analysis of the Evidence for Infections in the United Kingdom.

Human babesiosis is caused when erythrocytes are invaded by Babesia. Infection can occur from the bite of an infected tick, blood transfusion or congenitally. Issues related to the infecting species, symptomology and testing technology are discussed and the implications of accurate incidence and prevalence of the disease discussed. Human babesiosis is considered to be relatively rare in the UK. With a considerable number of non-specific symptoms and diagnostic testing limitations, it is probable that true positives are being missed. Based on co-infection data for Borrelia and Babesia from Rhode Island and Connecticut, and on Borrelia seropositivity data from northeastern France, the prevalence of babesiosis in those aged under 35 years, 35 to 44 years, 45 to 54 years and 55 years and over would be expected to be 0.6%, 1.8%, 2.8% and 3.5%, respectively. Based on the prevalence of infections in ticks and canines and a disease model previously published, it is estimated that the UK incidence of human babesiosis is likely to be approximately 18,500 cases per year.

Quality of life and interpersonal support among adult patients with cancer undergoing chemotherapy at an academic cancer institute.

370 Background: The National Cancer Institute (NCI) defines quality of life (QOL) as “overall enjoyment of life.” Increasingly, cancer treatments like chemotherapy are focused on not only increasing survival time but on maintaining and/or improving QOL. Interpersonal support has been shown to have an impact on QOL. Assessment of both can help focus efforts to improve quality of care for cancer patients. Methods: This study enrolled patients from the Lifespan Cancer Institute at The Miriam Hospital (TMH) in Rhode Island who were adults 18+ and on chemotherapy infusion treatment with an active cancer diagnosis. Patients were randomly selected for an in-person interview during scheduled chemotherapy infusion appointments from February 9 to April 26, 2024. We collected patient demographics and study staff administered the 16-item Quality of Life Scale (QOLS) and 12-item Interpersonal Support Evaluation List (ISEL). Results: Of 432 total eligible cancer patients at TMH, 96 (22%) completed the prospective survey. The average (SD) age was 68.4 years old (10.3). The majority of patients were male (51%), Caucasian (80%), married (65%), on Medicare (62%), diagnosed in 2023 or 2024 (59%), and the most common cancers were gastrointestinal (30%), genitourinary (24%), and breast (17%). Overall, patients demonstrate mostly high satisfaction in certain QOL and interpersonal support domains with variation across others. Over 80% of patients are “delighted” or “pleased” with their material comforts, close family and friends, entertainment, and independence. However, approximately 50% of patients report a mixed or worse level of satisfaction with their health, participation in organizations/public affairs, and active recreation and varying levels of satisfaction with other QOL domains. Over 60% of patients report the highest level of perceived interpersonal support across all domains (appraisal, belonging, tangible) with indication of stronger appraisal support compared to belonging and tangible. Conclusions: Our results indicate a strong satisfaction among patients with their close interpersonal networks rather than external affairs or activities. Satisfaction with health and active recreation among chemotherapy patients is much more variable. These findings suggest possible benefits of wellness and health maintenance programs during treatment. Lowest areas of interpersonal support indicate a need to build more comprehensive support resources for tangible tasks like moving, assisting with chores, or other physical activities and building support groups to increase belonging. Opportunities to build community among chemotherapy patients or utilize clinical social workers will likely improve satisfaction in many of the more low and variable QOL and interpersonal support domains, particularly for patients navigating a new or first-ever cancer diagnosis.

Health information exchange and 42 CFR part two: Incorporating the voice of people with histories of substance use disorder

IntroductionWe set out to understand patient attitudes and concerns about sharing information about substance use disorder (SUD) history through a Health Information Exchange (HIE), in the context of 42 CFR Part 2. MethodsThe study conducted semi-structured qualitative interviews of people with SUD history, recruited through an association of recovery communities in Rhode Island. Interviews were recorded and transcribed. Two Research Assistants coded the interviews using Atlas.ti™ in consultation with the principal investigator. Each first coded a sample of interviews independently. The team then discussed the coding and agreed on broad coding categories. The team met regularly to discuss emerging constructs and agree on a detailed coding schema. We came to consensus on broad themes and selected illustrative quotations. Interpretation was pragmatic, focusing on the nature and consequences of participants' experiences, and their wishes and intentions with respect to information sharing. ResultsOf 27 respondents, all but three reported negative experiences with health care providers because of current or former SUD, ranging from judgmental to neglectful or inappropriate treatment, to disparagement and abuse. With few exceptions, they would not consider sharing their SUD history through an HIE without specific, revocable control over which individual providers could receive the information. ConclusionsRespondents' requirements are consistent with the legal requirements of 42 CFR Part 2. Implementing Part 2 compliant HIE will require overcoming substantial technical and procedural challenges.

Comprehensive Dynamic 3-Dimensional Analysis of the Tricuspid Valve in Functional Tricuspid Regurgitation: Implications for Prophylactic Tricuspid Valve Intervention

ObjectivesUnderstanding of changes in tricuspid annulus (TA) during secondary or functional tricuspid regurgitation (TR) is currently limited and its surgical management relies on limited 2-dimensional (2D) imaging. The aims of the study were to: 1) track and measure changes in TA using 3-dimensional (3D) echocardiography during complete cardiac cycle in patients with functional TR when compared to no TR, and 2) compare TAPSE derived from 2D and 3D coordinates as a measure of RV function when compared to standard method of fractional area change (FAC). DesignIntraoperative 3D echocardiography data was collected prospectively followed by post processing software analysis to track and reconstruct changes throughout the cardiac cycle. SettingData was collected from 108 patients undergoing left sided heart surgery at two large academic centers – Beth Israel Deaconess Medical Center in Boston, MA and Rhode Island Hospital, Providence, RI between from November 2018 to April 2020. ParticipantsFinal dataset (n=92) included two groups: no significant functional tricuspid regurgitation (NTR) group (n=74), defined as ≤ mild tricuspid regurgitation (TR) and TA < 35 mm, and a significant functional TR (FTR) group (n=18), defined as ≥ moderate TR. Interventions3D TEE datasets were analyzed, and the motion of TA coordinates was tracked during complete cardiac cycle in 2D and 3D planes using post-processing and software analysis. Computational modeling of TA motion was performed using computer-aided design. In further analysis, reconstructed and 3D printed models of TV were developed for the two groups. Measurements and Main ResultsPatients in FTR group had larger TA size during the cardiac cycle with less overall excursion and reduced annular dynamism. 3D motion of TA for lateral (L), anterolateral (AL) and posterolateral (PL) coordinates was lower in FTR group compared to NTR group [(18±6.8 vs 13.6±8.5, p=0.02), (15.2±5.5 vs 11.3±6.0, p=0.009) and (17.6±6.6 vs 12.3±5.2, p=0.002) respectively]. TAPSE derived from 3D planes was more accurate for RV function assessment (AUC 0.704, p = 0.011) than 2D TAPSE (AUC 0.625, p = 0.129). Finally, in the FTR group, the anteroseptal-posterolateral (AS-PL) diameter was consistently larger during all phases of cardiac cycle, in comparison with septo-lateral (S-L) diameter. Conclusion3D echocardiographic assessment of TA helps better understand its geometry and dynamism in functional TR, and is more accurate than 2D measurements for RV function assessment.

Implications of Positive Effects of Early Childhood Education for Education Policy

Emerging research on the benefits of early childhood education has sparked interest in making preschool education universal to improve children's readiness for school and their subsequent achievement of social, economic, and professional success. The implementation of early childhood education (ECE) programs, which aim to prepare 4-year-old children for school, has resulted in an increase in public funding. This increase can be attributed to the positive effects of the ECE program on children, as demonstrated by the academic skills of the children measured, which fall within the national average. These abilities include the ability to read and write, speak and understand mathematics, and recognize patterns in numbers. "Investing as early as possible, from birth through age five, in disadvantaged families yields the highest rate of return in early childhood development." Thus, the community and local government are required to actively involved in managing preschool structures, enhance the supervision and management of early childhood education. Common challenges encountered recorded nearly half of all teachers acknowledged to having significant levels of stress and burnout over the previous several years, mental health issues, low compensation, etc. Furthermore, NIEER research findings reveals only five states Hawaii, Michigan, Rhode Island, Alabama, and Mississippi meet all ten national program quality standards, which include putting child development guidelines into practice and offering professional development to teachers. Thus, this paper recommends that when formulating schools' improvement strategies, the Department of Education should take into account the enrollment rate in early learning and kindergarten institutions. All early childhood professional development programs aim to improve children's learning in the behavioral, social-emotional, communicative, and cognitive domains over the long run through indirect means.

Fisher activity patterns show potential for behavioral adaptations to human modified landscapes

Animals alter their diel activity in response to physiological constraints and ecological conditions. Fisher (Pekania pennanti) activity is known to vary through the diel cycle and change in response to cold stress and generally through both the climatic and biological seasons. However, less is known whether thermoregulatory effects impact fisher activity in milder climates and in areas of high human disturbance. We focused on two distinct research objectives to understand the 1) physiological constraints, and 2) ecological components of fisher activity in a highly disturbed landscape with a relatively mild climate. We used accelerometer data from 34 individual live-captured fisher in Rhode Island, USA from 2021 to 2023. We found that fisher activity patterns were primarily driven by diel cycle with higher activity levels at night than during the day. We did not observe any physiological influence of ambient temperature on fisher activity; daily minimum temperatures did not constrain fisher activity in the colder months, nor did daily maximum temperatures in warmer months. We did find that female activity levels differed by breeding status with non-pregnant females having higher activity levels than pregnant females. Considering ecological components, we found fisher decreased activity levels in higher road density areas during warmer months that coincide with higher traffic volumes. For fisher living in areas with lower road densities, we saw higher activity in the breeding season and summer than in winter. In contrast, fisher living in areas with high road densities had lower activity in the breeding season and summer than in winter. We conclude that fisher largely do not shift their activity to mitigate thermoregulatory costs in areas where temperatures do not reach extremes for extended periods of time. However, our findings suggest that behavioral shifts in activity are impacted by human disturbance and fisher minimize activity in risky areas.

The state of the ocean in the northeastern Atlantic and adjacent seas

Abstract. In this paper, the Copernicus Ocean State Report offers detailed scientific analysis of the ocean under climate change, ocean variability, and ocean extremes in the northeastern Atlantic and adjacent seas. Major results show that the northeastern Atlantic Ocean and adjacent seas have experienced consistent warming, with sea surface temperatures increasing at a rate of 0.25 ± 0.03 °C per decade since 1982, doubling the global average trend. This warming is most pronounced in the Black Sea, Mediterranean Sea, and Baltic Sea. Sea levels have risen significantly over the past 30 years, particularly in the Baltic and Mediterranean seas. Ocean acidification has also increased, with pH decreasing at a rate of −0.017 ± 0.001 units per decade. Marine heatwaves have intensified and expanded, affecting over 60 % of the region in 2022 and 2023. Over the past 16 years, most extreme wind speeds exceeding 22 m s−1 prevailed in the central and subpolar North Atlantic and northern Mediterranean Sea. The region has also seen significant variability in ocean climate indicators and circulation patterns, including increased Atlantic Water transport to the Arctic Ocean through the Fram Strait and notable variations in the Mediterranean Sea's meridional overturning circulation. No major Baltic inflow occurred in winter 2022/23.

Advancing readiness for change in substance use for people with substance use disorders using the Kawa model based intervention program: A quasi-experimental study.

Substance use disorders (SUDs) may cause severe social and health problems. Therefore, providing adequate treatments for people with SUDs to change their drug use behaviors is important. This study examined the effectiveness of Kawa Model based therapy among people with SUDs in Taiwan. Participants were recruited from people with SUDs who violated the Controlled Drugs Act in Taiwan were mandated to abstinence services by law from January 2016 through October 2021 in Southern Taiwan. Each participant selected a 2-hour for 4 times or 8-hour for one day compulsory treatments and received either the Kawa model based treatment (n = 55; 9 women; mean ± SD age = 36.73 ± 10.42years) or psychoeducation courses (n = 42; 8 women; mean ± SD age = 27.57 ± 5.78years), respectively. Stages of change was assessed using the University of Rhode Island Change Assessment before and after treatments. There were no significant differences in the stages of change scores at baselines between the 2 groups (p = .06-0.20). After treatments, participants who received the Kawa Model based treatment had higher scores in specific stages of change than did those who received the psychoeducation course in the domains of 'contemplation' (p = .001), 'action' (p = .001), and 'readiness' (p = .002). The present study demonstrated initial and preliminary findings that the Kawa Model based therapy may improve readiness for changing drug use behaviors in people with SUDs.