BACKGROUND:Although psychosocial support for siblings of youth with cancer is a standard of care, what sibling supportive services should entail remains unclear. Given limited resources for sibling care, establishing clinical and research priorities may guide resource allocation toward supports perceived as holding the greatest potential benefit. The current study used a two-round, value-weighting approach to identify priorities for sibling support services. PROCEDURE:Participants were recruited from a group of sibling experts (clinicians, researchers, community program leaders, and adults who had a sibling with childhood cancer) invited to attend an international sibling summit. In Round 1, 27 participants provided feedback on a list of potential priorities for sibling psychosocial support. In Round 2, 30 participants completed a web-based value-weighting questionnaire indicating how they would allocate 100 units of hypothetical funding among various priorities and qualitatively described the rationale for their decisions. RESULTS:Funding allocations generally averaged out across participants, highlighting the need for investments across all domains of sibling support. Participants allocated the greatest proportion of hypothetical funding to community-based sibling supports, which they perceived as more accessible to siblings than hospital-based supports. Participants allocated a particularly high level of funding to sibling supports in local schools. Within sibling subpopulations, bereaved siblings, siblings during active cancer treatment, and siblings with more adverse social determinants of health were allocated the largest proportion of funds. CONCLUSIONS:Sibling-focused researchers, clinicians, program leaders, and adult siblings endorse broad investments in sibling support. Investments in community-based supports particularly may improve access to sibling support services.

BACKGROUND:Ultraviolet (UV)-A therapy is a simple, inexpensive, and effective modality for wound healing, with tremendous potential to improve healing and reduce clinical infections in a number of clinical settings. To date, application of UV-A relies on bulky and hard-to-dose lamps that provide inconsistent therapy, thus making it difficult to apply therapy that is appropriate for the patient.METHODS:This study was designed to test the effectiveness of a novel wound therapy device that combines UV-A with traditional negative-pressure wound therapy (NPWT) to promote wound healing. Furthermore, we tested the ability of fiberoptic UV-A delivery to inhibit bacterial proliferation. Finally, we assayed the level of DNA damage that results from UV-A as compared to established UV-C therapies. Wound healing studies were performed in a porcine model using an articulated therapy arm that allows for continued therapy administration over an extended time course. Negative-pressure wound therapy was administered alone or with UV-A fiberoptic therapy for 2 weeks. Dressings were changed twice a week, at which time wound area was assessed.RESULTS:Data demonstrate that UV-A with NPWT treatment of wounds results in greater healing than NPWT alone. Using the same therapy device, we demonstrate that exposure of Staphylococcus aureus and Pseudomonas aeruginosa to fiberoptic UV-A results in decreased colony area and number of both bacterial strains. Finally, we show that UV-A induces minimal DNA damage in human fibroblasts and no more DNA damage in wound tissue as compare to intact skin.CONCLUSIONS:These data demonstrate that UV-A can decrease bacterial proliferation and promote wound healing when coupled with NPWT.

BACKGROUND:Evidence regarding the effects of infant feeding type (exclusive breastfeeding compared with exclusive formula feeding) on the gut microbiota and how it impacts infant growth status is limited. OBJECTIVES:The primary objective was to compare gut microbiota by feeding type and characterize the associations between gut microbiota and infant growth status. METHODS:Stool samples from healthy, full-term infants (4-5 mo-old) who were either exclusively breastfed (BF) or exclusively formula-fed (FF) in Denver, CO, United States were collected, and fecal 16S ribosomal ribonucleic acid gene-based profiling was conducted. Length and weight were measured at the time of stool collection. Length-for-age z-score, weight-for-age z-scores (WAZ), and weight-for-length z-scores were calculated based on the World Health Organization standards. Associations between gut microbial taxa and anthropometric z-scores were assessed by Spearman's rank correlation test. RESULTS:A total of 115 infants (BF n = 54; FF n = 61) were included in this study. Feeding type (BF compared with FF) was the most significant tested variable on gut microbiota composition (P < 1 × 10-⁶), followed by mode of delivery and race. Significant differences were observed in α-diversity, β-diversity, and relative abundances of individual taxa between BF and FF. BF infants had lower α-diversity than FF infants. Abundances of Bifidobacterium and Lactobacillus were greater in the breastfeeding group. FF infants had a higher relative abundance of unclassified Ruminococcaceae (P < 0.001), which was associated with a higher WAZ (P < 0.001) and length-for-age z-score (P < 0.01). Lactobacillus was inversely associated with WAZ (P < 0.05). CONCLUSIONS:Feeding type is the main driver of gut microbiota differences in young infants. The gut microbiota differences based on feeding type (exclusive breast- or formula feeding) were associated with observed differences in growth status. This trial was registered at clinicaltrials.gov as NCT02142647, NCT01693406, and NCT04137445.

OBJECTIVE Psychosocial screening is recommended to connect siblings of youth with cancer to psychosocial services, but the lack of validated sibling-specific screening tools is a barrier to routine screening. The current study aimed to validate and establish a clinical cutoff for the recently developed Psychosocial Assessment Tool (PAT) Sibling Module follow-up version to address this barrier. METHODS Parents (N = 246) completed the PAT Sibling Module follow-up version for all siblings within their families ages 0-17 years (N = 458) at three time points between 6- and 24-month post-cancer diagnosis. For one target sibling within each family aged 8-17 years, parents also completed the Strengths and Difficulties Questionnaire, and the target sibling completed the Child PTSD Symptom Scale. Cross-sectional and longitudinal analyses examined internal consistency and convergent and predictive validity. Receiver operator characteristic analyses were used to establish a maximally sensitive and specific clinical cutoff. RESULTS Internal consistency was acceptable for all age versions (Kuder-Richardson 20s ≥ 0.79), except for the ages 0-2 version, which had low internal consistency at 18 months post-diagnosis (Kuder-Richardson 20 = 0.57). Convergent (r values >0.7, p values <.001) and predictive (r values >0.6, p values <.001) validity were strong at each time point. An optimal clinical cutoff of 0.32 was identified (range: 0.00-1.00). CONCLUSIONS The PAT Sibling Module follow-up version is a reliable and valid screener for sibling psychosocial risk following cancer diagnosis. Validation of a sibling-specific screener and establishment of a clinical cutoff are necessary first steps to addressing siblings' unmet psychosocial needs and improving trajectories of sibling functioning.

Marine protected areas (MPAs) have become a popular tool utilised across global oceans to achieve a variety of conservation goals. Because the reasons for MPA implementation can differ, it is imperative that resource managers design and execute management strategies that allow them to effectively assess MPA performance relative to the goals they set.We compared three MPA monitoring techniques commonly utilised to survey groundfish populations across different depth strata of temperate rocky reef habitat: underwater visual census (0-20 m), scientific hook and line fishing (10-50 m) and baited remote underwater video (30-100 m). We compared the strength and direction of standardised metrics, including response ratios, diversity indices and community structure, examining results through the lens of MPA performance.While each of our monitoring techniques detected similar MPA effects on groundfish biomass and density aggregated across species, MPA effects for individual species varied across methods.Each technique was shown to survey distinct groundfish community assemblages with varying levels of species diversity and richness.Synthesis and applications. While each technique was found to measure similar general trends in marine protected area (MPA) performance over time, we found compelling evidence that the utilization of multiple techniques allows managers to create the most comprehensive, effective and inclusive MPA monitoring regimes.

Kelp forests are among the most productive ecosystems on Earth. In combination with their close proximity to the shore, the productivity and biodiversity of these ecosystems generate a wide range of ecosystem services including supporting (e.g., primary production, habitat), regulating (e.g., water flow, coastal erosion), provisioning (e.g., commercial and recreational fisheries), and cultural (e.g., recreational, artisanal) services. For these reasons, kelp forests have long been the target of ecological studies. However, with few exceptions, these studies have been localized and short term (<5 years). In 1999, recognizing the importance of large-scale, long-term studies for understanding the structure, functioning, and dynamics of coastal marine ecosystems, and for informing policy, the Partnership for Interdisciplinary Studies of Coastal Oceans (PISCO) designed and initiated a large-scale, long-term monitoring study of kelp forest ecosystems along 1400 km of coast stretching from southern California to southern Oregon, USA. The purpose of the study has been to characterize the spatial and temporal patterns of kelp forest ecosystem structure and evaluate the relative contributions of biological and environmental variables derived from external sources (e.g., sea otter density, Chl-a concentration, sea surface temperature, wave energy) in explaining observed spatial and temporal patterns. For this purpose, the ecological community (i.e., density, percent cover, or biomass of conspicuous fishes, invertebrates, and macroalgae) and geomorphological attributes (bottom depth, substratum type, and vertical relief) of kelp forest ecosystems have been surveyed annually using SCUBA divers trained in both scientific diving and data collection techniques and the identification of kelp forest species. The study region spans distinct ecological and biogeographic provinces, which enables investigations of how variation in environmental drivers and distinctive species compositions influence community structure, and its response to climate-related environmental change across a portion of the California Current Large Marine Ecosystem. These data have been used to inform fisheries management, design and evaluate California's state-wide network of marine protected areas (MPAs), and assess the ecological consequences of climate change (e.g., marine heatwaves). Over time, the spatial and temporal design of the monitoring program was adapted to fill its role in evaluating the ecological responses to the establishment of MPAs. There are no copyright restrictions; please cite this paper when data are used.

North American grassland birds colonized emerging habitat created by expanding agriculture in a pattern of eastward expansions from the mid-1800s to mid-1900s. These birds have been declining, since at least the mid-1900s, largely as result of anthropogenic landscape change. Only one bird that now breeds predominantly in southeastern pine savannas is thought to have experienced a concurrent range expansion into this region: Peucaea aestivalis (Bachman’s Sparrow). However, our understanding of the P. aestivalis expansion, and subsequent retraction to the southeastern United States, is largely based on a contemporaneous review of only a subset of historical records from beyond its modern, northern limit. We suggest an alternative explanation for these historical records is that P. aestivalis historically occurred more broadly than was recognized in contemporaneous literature. To evaluate these hypotheses, we reviewed field observations from literature, natural history collections, and eBird to show how P. aestivalis presence throughout eastern North America has shifted since the mid-1800s. To confirm that these findings were not the result of detection bias, we repeated our analysis on a common sparrow species (Spizella pusilla) with a largely overlapping breeding range, but no history of expansion and retraction. We confirm that P. aestivalis expanded its range, but add that prior to that expansion, its historical distribution was broader than commonly acknowledged today. As a result, we identify the northwestern historical limit of P. aestivalis, the Ouachita and Ozark highlands, as a potential source region for an eastward expansion that is consistent with those of other North American grassland birds of the era. We discuss the potential evolutionary and conservation implications of this range expansion on P. aestivalis given our more nuanced understanding of it. Anthropogenic landscape change initially provided additional habitat for P. aestivalis but has ultimately resulted in a reduction of the P. aestivalis distribution.

BACKGROUND:Although providing sibling psychosocial services is a standard of care in pediatric oncology, initial survey research suggests that this standard is rarely achieved and siblings' support needs remain unmet. Which sibling psychosocial services are available and how centers provide such services is unknown. To identify targetable services gaps, this qualitative study characterizes current sibling psychosocial care practices at select pediatric cancer centers across the United States. PROCEDURE:Semi-structured interviews were conducted with a purposive sample of psychosocial care providers (N = 27) working across the United States in pediatric oncology centers of varied sizes. Interviews queried providers regarding sibling-focused parent psychoeducation, psychosocial screening, comprehensive assessment, and psychosocial support offerings. Interview data were analyzed using Applied Thematic Analysis. RESULTS:Across cancer centers, sibling care practices did not align with consensus-based recommendations. The nature and availability of sibling-focused psychoeducation, screening, assessment, and support were variable between and within centers. Siblings themselves were largely absent from sibling psychosocial care, and care was rarely sibling-specific. The flow of information about siblings was discontinuous and uncoordinated across the care continuum, resulting in psychosocial care provided reactively, typically in response to parental concerns. CONCLUSIONS:Sibling psychosocial care provision falls short of established care recommendations, leaving sibling psychosocial needs unmet. Findings highlight the need for tools and strategies to facilitate the implementation of sibling psychosocial care across the care continuum, to support siblings' psychosocial functioning across the life course.

Background: An urgent need exists for evidence-based dietary guidance early in life, particularly regarding protein intake. However, a significant knowledge gap exists in the effects of protein-rich foods on growth and development during early complementary feeding. Methods: This is a randomized controlled trial of infant growth and gut health (primary outcomes). We directly compare the effects of dietary patterns with common protein-rich foods (meat, dairy, plant) on infant growth trajectories and gut microbiota development (monthly assessments) during early complementary feeding in both breast- and formula-fed infants. Five-month-old infants (up to n = 300) are randomized to a meat-, dairy-, plant-based complementary diet or a reference group (standard of care) from 5 to 12 months of age, with a 24-month follow-up assessment. Infants are matched for sex, mode of delivery and mode of feeding using stratified randomization. Growth assessments include length, weight, head circumference and body composition. Gut microbiota assessments include both 16S rRNA profiling and metagenomics sequencing. The primary analyses will evaluate the longitudinal effects of the different diets on both anthropometric measures and gut microbiota. The secondary analysis will evaluate the potential associations between gut microbiota and infant growth. Discussion: Findings are expected to have significant scientific and health implications for identifying beneficial gut microbial changes and dietary patterns and for informing dietary interventions to prevent the risk of overweight and later obesity, and promote optimal health. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT05012930.

Objective: To compare one-year clinical outcomes in patients with different infection types: soft tissue-only, osteomyelitis with clean margin, and residual osteomyelitis (OM) after hospitalization for foot infection that required that surgery.Methods: Patients were prospectively enrolled in two randomized controlled trials. Two hundred-forty patients with diabetes underwent surgery at a single site. Sixty-three patients had soft tissue infection, 82 had OM resected with clean margin, and 95 had residual OM. Descriptive statistics were performed with chi square.Conclusion: There were no differences between infection groups for development of a new ulcer, number of soft tissue infections, number of osteomyelitis infections, number of additional surgeries, number of amputations, number of readmissions, or length of stay.View largeDownload slideView largeDownload slide DisclosureA. L. Killeen: None. K. Davis: None. J. La fontaine: None. O. K. Oz: n/a. P. Crisologo: None. L. A. Lavery: None.FundingAmerican Diabetes Association (1-15-TS-20 to L.A.L.)

Objective: To evaluate the incidence and severity of acute kidney injury (AKI) in patients with diabetes, hospitalized with foot infections.Methods: One hundred-fifty patients with moderate to severe foot infection as defined by the Infectious Diseases Society of America were prospectively enrolled. Fifty-three developed AKI within the 16 week trial and 89 did not. Eight were excluded due to dialysis at baseline. AKI was defined by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Descriptive statistics were performed.Conclusion: Patients with AKI had significantly higher glycated hemoglobin (p=0.001), WBC count (p=0.049), and CRP (p=0.02) at baseline.View largeDownload slideView largeDownload slideView largeDownload slideView largeDownload slideDisclosureL. A. Lavery: None. K. Davis: None. J. La fontaine: None. E. C. Ryan: None. P. Crisologo: None. A. L. Killeen: None.FundingAmerican Diabetes Association (1-15-TS-20 to L.A.L.)